bluuebunny/crossref_metadata_2025 huggingface dataset:
Antimicrobial susceptibility profiles, presence of integrons and associated cassette genes among Acinetobacter baumannii isolates from Southern part of Iran, Shiraz
Authors: Khoramrooz SeyedSajjad , Eslami Saba , Motamedifar Mohammad , Bazargani Abdollah , Zomorodian Kamiar
Published: January 2021

Background

Acinetobacter baumannii is a global concern to cause the health-care-associated infections, due to multidrug resistance against available commercially antimicrobial agents. Regarding this, the present study was conducted to determine the antimicrobial susceptibility of A.baumannii isolates from clinical specimens in Shiraz, and explore the possible relationship of susceptibility patterns with the presence of integrons and related gene cassettes.
Methods

A.baumannii isolates were collected, and their susceptibility to various antibiotics was tested using Kirby-Bauer disk diffusion method. Also, molecular analyses were performed to detect the presence of OXA-51 like gene, class I, II and III integrons, and associated gene cassettes.
Results

Majority of isolates demonstrated resistance to imipenem(99.4%),piperacilin(98.2%),gentamycin (98.2%) meropenem (97.7%)ceftazidime(95.4%)amikacin(95.4%) and trimethoprim-sulfamethoxazole (90.8%). All strains showed multidrug-resistance to most of the tested antibiotics. The distribution analysis of integrons genes showed that 90.2%, 72.4% and 12.1% of isolates carried the intI 1, intI2 and intI3 genes, respectively. Moreover, two types of prevalent gene cassettes including aad and dfr were detected in Class 1 integron-carrying strains.
Conclusions

The current study showed the high prevalence of A.baumannii isolates harboring integrons in our investigated medical center, which may propel distribution of multidrug resistance event. The different types of gene cassette arrays in the present study spotlight the remarkable role of geographical issues in MDR isolates dissemination. This subject could attribute to choose appropriate therapeutic interventions in different areas. Obtained data highlighted the necessity for continuous surveillance to prevent distribution of multidrug resistance among A.baumannii strains in Iran.
Sustainment of Proactive Physical Therapy for Individuals With Early-Stage Parkinson’s Disease: A Quality Improvement Study Over 4 Years
Authors: MacDonald Jillian , Doyle Laura , Moore Jennifer L , Rafferty Miriam R
Published: January 2021

Background: Implementation science frameworks aided the development of a new, evidence-based clinical physical therapy program. The purpose of this report is to describe the process of sustaining a clinical program in practice for over four years. We present a framework for integrating tools for sustainability with the Knowledge-to-Action model in the context of a proactive physical therapy program (PAPT) for individuals with early stage Parkinson’s disease.Methods: Sustainability of implementation strategies was addressed using the Dynamic Sustainability Framework and sustainability assessment tools. Repeated retrospective medical record reviews and semi-structured interviews were used to evaluate the reach and adoption of the PAPT over four years. Characteristics of those who engaged with PAPT, implementation fidelity, and clinical effectiveness were assessed for Year 1 and Year 3. Sustainability was measured using RE-AIM, NHS Sustainability Model, and Clinical Sustainability Assessment Tool.Results: Reach increased from 28 to 110 total patients per year and spread occurred from one to three sites. PAPT user age, sex, Hoehn & Yahr rating, time since diagnosis and type of insurance were similar in Year 1 and Year 3 (p>0.05). The program sustained its effect to help participants increase or maintain self-reported exercise (Y1: 95%, Y3: 100%). However, upon evaluation PAPT users in Year 3 had longer time since symptom onset and worse UPDRS motor scores compared to the PAPT users in Year 1 (p<0.05). All sites sustained the core intervention components, with sustainability scores of 71/100 (± 9.9) on the NHS Sustainability Model and 6.1/7 (± 0.9) on the Clinical Sustainability Assessment Tool.Conclusions: Integrating multiple sustainability models and assessments supported continued effectiveness, spread, and sustainment of PAPT for four years. Effective planning, anticipating common healthcare changes, and addressing sustainability determinants early in program implementation were essential aspects of long-term success.
Genetic Characterization of Multidrug-Resistant Salmonella Typhimurium Carrying Mcr-1 in China
Authors: Haoran Zhang , Yong Huang , Beibei Liang , Jing Xie , Ying Xiang , Xinying Du , Chaojie Yang , Hongbo Liu , HONGBo Liu , Hui Wang , Mingjuan Yang , Ligui Wang , Xiaofeng Hu , Lianqun Jin , Zhengquan Yuan , Shaofu Qiu , Hongbin Song
Published: January 2021

Background: With the rapid emergence of plasmid mediated polymyxin resistance gene mcr-1, multidrug-resistant Salmonella caused great troubles in clinical treatment and attracted extensive attention. Here we report multidrug-resistant Salmonella strains harboring mcr-1 in China, which are resistant to both polymyxin, traditional antibiotics and even clinically wide-used antibiotics. Methods: We screened 1454 strains of Salmonella collected in our laboratory from 2006 to 2018 from 3 provinces or regions for mcr-1 by PCR. Antimicrobial susceptibility testing was determined. Plasmid conjugation assays were carried out to analysis the transferability of polymyxin resistance. Genetic polymorphism analysis of Salmonella was performed using the PFGE, and the plasmid profiles were characterized by S1-PFGE and southern blotting. The plasmids harboring mcr-1 were sequenced and compared. Results: Eleven S. Typhimurium isolates harboring mcr-1 with polymyxin resistance (MICs 4μg/ml) were identified from intestinal infections and foods in China. All S. Typhimurium isolates were multidrug-resistant to traditional antibiotics and even clinically wide-used antibiotics. Three types of plasmids harboring mcr-1 were recovered (IncHI2, IncX4 and IncI2). Compared with the reference plasmid, IncX4 and IncI2 plasmids had extremely similar typical backbone, and contain only mcr-1 resistance gene. However, IncHI2 were the most diverse type of plasmid due to containing a large MDR region, including blaCTX-M, oqxB, sul, aph, aadA and blaTEM. IncHI2 plasmids were observed to contain only one or no insertion sequence ISApl1 around mcr-1, without forming a circular intermediate. Conclusion: With the horizontal transfer of different types of plasmids, mcr-1 is widely spread worldwide. These prevalent plasmids are responsible for resistance to polymyxin, traditional antibiotics and even clinically wide-used antibiotics resulting from transmission of mcr-1 and other resistance genes. Our studying emphasizes the necessity to jointly monitor its international epidemic and preemptive further upgrade.
Hypothalamus-pituitary Dysfunction as an Independent Risk Factor for Postoperative Central Nervous System Infections in Patients with Sellar Region Tumors
Authors: Wen Junxian , Yin Rui , Chen Yihao , Chang Jianbo , Ma Baitao , Zuo Wei , Zhang Xiao , Ma Xiaojun , Feng Ming , Wang Renzhi , Ma Wenbin , Wei Junji
Published: January 2021

Objective: The purpose of this study was to verify that hypothalamus-pituitary dysfunction is one of the risk factors for postoperative central nervous system infections (PCNSIs).Method: We performed a retrospective analysis of all patients with sellar region lesions who underwent surgery between January 2016 and November 2019 at Peking Union Medical College Hospital. In total, 44 age‑ and sex-matched controls were enrolled. Univariate and multivariate analyses were performed to identify risk factors for PCNSIs.Result: We enrolled 88 patients, 44 of whom had PCNSIs. Surgical approach (TCS) (P<0.001), previous surgery on the same site (P=0.001), intraoperative cerebral spinal fluid (CSF) leakage (P<0.001), postoperative adrenal insufficiency (P=0.017), and postoperative DI (P=0.004) correlated significantly with PCNSIs. Multivariate analysis showed that intraoperative CSF leakage (OR:13.754; 95%CI: 3.482-54.328; P<0.001), postoperative diabetes insipidus (DI) (OR: 6.261; 95%CI: 1.114-35.189; P=0.037) and postoperative adrenal insufficiency (OR: 7.153; 95%CI: 1.071-47.764; P=0.042) were independent influencing factors for PCNSIs.Conclusion: Intraoperative CSF leakage, postoperative DI and postoperative adrenal insufficiency are risk factors for PCNSIs in patients with sellar region tumors.
Efficacy and Safety of Tocilizumab in Patients with COVID-19: A Systematic Review and Meta-Analysis.
Authors: Li Zhenlu , Che Qianqiu , Li Mao , Liu Jianping , Du Rao , Yue Chao , Zhang Ling , Li Hongwei , Zhao Liming , Hu Weiming , Lu huimin , Xiong Junjie
Published: January 2021

Background Tocilizumab (TCZ) is an anti-interleukin-6 antibody that has been used to treat patients with 2019 coronavirus disease (COVID-19). Numerous retrospective studies have shown beneficial treatment efficacy. Several recent randomized clinical trials have questioned the efficacy of TCZ in patients with COVID-19. Therefore, we performed an updated systematic review and meta-analysis to explore the effectiveness and safety of tocilizumab recently used for treating patients with COVID-19. Methods Randomized clinical trials (RCTs) and comparative studies that compared the outcomes between TCZ and standard of care (SOC) were analysed. PubMed, EMBASE, and the Cochrane Library (inception to November 20, 2020) were systematically searched. Primary outcomes included mortality and the rate of requirement for mechanical ventilation (MV). In addition, several subgroup analyses stratified by disease severity, publication type and TCZ administration were performed. Results Three RCTs, twenty-one cohort studies and nine case-control studies including 11,206 patients were finally included. The TCZ group included 2,794 patients (24.93%) and the SOC group included 8,412 patients (75.07%). The mortality rate (>14 days) of the TCZ group, 29.63% (590/1,991), was lower than the SOC group, 41.51% (2,380/5,734) (OR 0.64, 0.57 to 0.73; p <0.00001). However, no significant difference in-14-day mortality rates was observed between the two groups (13.53% vs 22.92%, p = 0.21). Meanwhile, the rate of MV was significantly decreased in the TCZ group compared with the SOC group (OR 0.42, 0.22 to 0.83; p = 0.01). According to the results of the subgroup analysis stratified by disease severity, TCZ only reduced the mortality rate for critical patients with COVID-19 compared with SOC (OR 0.60, 0.52 to 0.71; P < 0.00001), particularly for patients in the intensive care unit (ICU) or patients requiring MV. No statistically significant increase was recognized in the rates of secondary infections or thrombosis between the two groups. Conclusions This systematic review and meta-analysis found that the addition of tocilizumab to the SOC might reduce mortality after 14 days in patients with COVID-19, particularly critical patients requiring MV. More extensive RCTs with longer follow-up periods are needed to validate these findings.
The prevalence and risk factors for anxiety in frontline nurses under COVID-19 pandemic based on a large cross-sectional study using the propensity score-matched method
Authors: Zhao Qingyun , Yao Zichuan , Zhu Xianqing , Jiang Yunzhong , Pan Chunyu
Published: January 2021

Introduction: We determined the prevalence of anxiety and the associated risk factors in in frontline nurses under COVID-19 pandemic. Methods: This cross-sectional study was conducted from February 20, 2020 to March 20, 2020 and involved 562 frontline nurses. The effective response rate was 87.68%. After propensity score matched, there were 532 participants left. Extensive characteristics, including demographics, dietary habits, life-related factors, work-related factors, and psychological factors were collected based on a self-reported questionnaire. Specific scales measured the levels of sleep quality, physical activity, anxiety, perceived organization support and psychological capital. Adjusted odds ratios and 95% confidence intervals were determined by binary paired logistic regression.Results: Of the nurses enrolled in the study, 33.60% had anxiety. Five independent risk factors were identified for anxiety: poor sleep quality (OR=1.235), experienced major events (OR=1.653), lower resilience and optimism of psychological capital (OR=0.906, and OR=0.909) and no visiting friend constantly (OR=0.629). Conclusions: This study revealed a considerable high prevalence of anxiety in frontline nurses during the COVID-19 outbreak, and identified five risk factors, which were poor sleep quality, experienced major events, lower resilience and optimism of psychological capital, and no visiting friend rarely. Protecting mental health of nurses is important for COVID-19 pandemic control and their wellbeing. These findings enrich the existing theoretical model of anxiety and demonstrated a critical need for additional strategies that could address the mental health in frontline nurses for policymakers.
Alexithymia, Suicidal Ideation and Behaviour in Moroccan Psychoactive Substance Users
Authors: Karjouh Khadija , Azzaoui Fatima-Zahra , Ouerchefani Riadh , semlali Wafae idrissi , Mammad Khaoula , Chtabou Ghizlane , Ahami Ahmed
Published: January 2021

Alexithymia is an emotion regulation problem that may be related to suicidality, especially in patients with SUD.The study aimed at estimating the prevalence of alexithymia in Moroccan psychoactive substances users, and to establish the links between alexithymia and suicidal ideation and behaviors, anxiety and depression in drug-dependent patients.We also aimed to elucidate if alexithymia predicts suicidal thoughts and behaviors in these consumers. The study included 451 consecutively admitted patients with substance use. Consumers were examined with the Toronto alexithymia scale (TAS-20), State and Trait Anxiety Inventory (STAI-Y), Beck Depression Inventory (BDI) and The Columbia-Suicide Severity Rating Scale (C-SSRS)Among substance-dependent individuals, 72.7% was identified as a group with alexithymia. Current age and age at first substance use were lower in the alexithymic group (p<0.01).The mean STAI-Y state and C-SSRS scores were higher in the group with alexithymia (p<0.01). There was a statistically significant difference between the groups in terms of mean scores for anxiety traits (p<0.05) and no significant difference in terms of mean scores for depression. All of the scores correlated significantly with.Addicted patients with alexithymia could be targeted at preventing the onset of suicidal thoughts and behaviorThe present study also evokes that whenever an emotional regulation disorder is observed, the possibility of anxio-depressive symptomatology and suicidality (ideation and behavior) needs to be assessed.
Anther Dehiscence Is Regulated By Gibberellic Acid In Yellow Lupine (Lupinus Luteus L.)
Authors: Marciniak Katarzyna , Przedniczek Krzysztof
Published: January 2021

Background:Anther dehiscence resulting in the release of pollen grains is tightly regulated in spatio-temporal manner by various factors. In yellow lupine (Lupinus luteus L.), the species which shows cleistogamy, the anthers split before the flowers open but the course and regulation of this process is unknown. Specific control of the anther development takes place with the participation of hormonal pathways, the wide action of which ensures reproductive success. In our previous research we have shown that the lowest transcript level of LlDELLA1, a main repressor of gibberellin (GA) signaling, in flower and early pod development occurs about the time of anther opening; therefore the main purpose of this study was to precisely investigate the gibberellic acid (GA3)-dependent regulation of anther dehiscence program in yellow lupine.Results:In this paper we showed the specific changes in the yellow lupine anther structure during the dehiscence and identified several genes widely-associated with this process, including deposition of lignocellulosic secondary thickening in the endothecium, enzymatic breakdown of cell walls at the septum/stomium and cell degeneration via programmed cell death (PCD). The expression profile of genes varied over time with the most intense mRNA accumulation in the phases prior to or about time of anther opening. The transcriptional activity revealed also that these genes are highly co-expressed and regulated in a GA-dependent manner. The cellular and tissue localization of GA3 exhibited that these molecules are present right before anther opening, mainly in septum cells, near the vascular bundle and in the endothecium, and later they were completely undetectable. The GA3 localization strongly correlates with the transcriptional activity of genes related with GA biosynthesis and deactivation. The obtained results also suggest that GA3 controls LlGAMYB expression via LlMIR159-dependent pathway.Conclusions:The presented results show a clear contribution of GA3 in the control of the extensive anther dehiscence program in yellow lupine. Understanding the processes underlying pollen release at hormonal and molecular level is a significant aspect in controlling fertility in economically important legume crop species and increased attention of breeders.
There is no special condition where a velocity of a light wave is invariance in all inertial frames.
Authors: Gupta Mahesh , Acharya Prafful , Yadav Rampravesh
Published: January 2021

This study of the literature reveals that the concept such as the velocity of a light wave is invariance in all inertial frames is wrong. A velocity of any motion always depends upon its reference frame. There is no special condition present in nature where the velocity is invariance in all inertial frames. Galileo Galilei defined speed is the distance covered per unit of time. Sir Isaac Newton defined velocity is the speed with direction. In the same period, physicists introduced the concept such as wavelength and frequency for measuring the speed a wave. The wave motion in which cycles are repeating after the same interval of time with the same distance between them. In 1887, Albert A. Michelson and Edward W. Morley performed an experiment to detect ether medium. But they failed to prove the existence of the ether medium and published Null Result. This Null Result has led to the creation of various new hypothetical theories. This study tries to reveal the relation between mathematics and physics and also comprehensive literature of light is a particle-wave duality in nature.
Potential of Preoperative Voiding Efficiency in Predicting Postoperative Α-1 Adrenergic Antagonist Usage After Transurethral Resection of the Prostate
Authors: Cheng Wei-Ming , Chiu Yi-Chun , Fan Yu-Hua , Hsu Che-Wei , Chang Chan-Chi , Weng Shih-Han , Chang Te-Wei
Published: January 2021

Background: Transurethral resection of the prostate (TURP) is the treatment of choice for patients with benign prostatic obstruction (BPO) who are refractory to medical treatment. Nevertheless, some patients still need α-1 adrenergic antagonists to control their post-TURP lower urinary tract symptoms (LUTS).Methods: In the present study, we developed a preoperative predictor of the continuous usage of α-1 adrenergic antagonists for post-TURP LUTS. We consecutively enrolled patients who underwent TURP at our hospital and divided them based on their use of α-1 adrenergic antagonists for more than 3 months postoperatively. Preoperative demographic data, including urodynamic parameters, were compared between the two groups. Forty-one patients were included in the study, with 17 patients (41%) receiving long-term α-1 adrenergic antagonists for their post-TURP LUTS.Results: Only lower pre-TURP voiding efficiency was significantly associated with long-term post-TURP α-1 adrenergic antagonist usage (63.3% vs. 75.1%, p = 0.03). A pre-TURP voiding efficiency of less than 75.48% had the greatest predictive ability, with a sensitivity of 88% and specificity of 50%.Conclusions: A preoperative voiding efficiency of less than 75.48% is a simple and noninvasive predictive factor for LUTS and would be helpful in preoperative evaluation and patient counseling.
Inflammatory Pseudo Tumor-Like Follicular Dendritic Cell Sarcoma of the Liver with Hepatic Lymphoma History: A Case Report and Literature Review
Authors: Li Jian , Wang Wenqiang , Chen Dong , Akilu Wajeehullahi , Huang Zhiyong , Zhang Erlei
Published: January 2021

Background: Inflammatory Pseudo Tumor (IPT)-like Follicular Dendritic Cell (FDC) Sarcoma of the liver is a very rare disease and occurs mostly in the lymph nodes. Till now, only 19 cases were reported in the English literature. However, the coexistence of IPT-like Sarcoma and Non-Hodgkin’s Lymphoma(NHL) in the same patient has never been reported.Case presentation: We reported a case of a 47-year-old male patient who had a history of Hepatitis B virus (HBV) infection and presented with right upper abdominal discomfort. Nineteen years ago, he underwent liver resection of segment VII for Hepatic Non-Hodgkin Lymphoma (B-cell lymphoma). Serum alpha fetoprotein (AFP) level was normal. However, Imaging studies revealed a well-circumscribed, solid mass in the right hepatic lobe and was diagnosed as (Hepatocellular Carcinoma) HCC or Hepatic Lymphoma preoperatively. Right hemi-hepatectomy was performed on this patient. Histological report showed features of a mixture of chronic inﬂammatory cells and variable amounts of spindle cells. Also, Immuno-Histo-Chemical (IHC) studies demonstrated that all the tumor cells showed strong nuclear in situ labeling for EBV-encoded small RNAs (EBER) and strongly positive stainings with CD21 and CD35. The patient is still disease free after a follow-up of 40 months. Conclusions: To our knowledge, this is the first report demonstrating Hepatic IPT-like FDC Sarcoma in a patient with Primary Hepatic Non-Hodgkin Lymphoma history. In regards to treatment, complete surgical resection should be performed and would acquire excellent long-term outcomes.
Quantitative Evaluation of Upright Posture by X-Ray and 3D Stereophotogrammetry With an Original Marker Placement Protocol in Late Onset Pompe Disease.
Authors: Blasiis Paolo De , Fullin Allegra , Sansone Mario , Viscovo Luca Del , Napolitano Filomena , Terracciano Chiara , Lus Giacomo , Melone Mariarosa Anna Beatrice , Sampaolo Simone
Published: January 2021

Background: Late Onset Pompe Disease (LOPD) is an autosomal recessive muscular disorder characterized by prevailing weakness of trunk and pelvic girdle muscles that causes ventilatory insufficiency and postural abnormalities. The most common myopathy phenotype described clinically in LOPD is the Limb Girdle and Diaphragmatic Pattern; spinal deformities, as hyperlordosis, hyperkyphosis and scoliosis diagnosed by x-Ray exam, have been reported in about a third of LOPD patients. The non-specific clinic onset, the similarity of the LOPD phenotypes with other myopathies, inter-individual heterogeneity and the lack of any disease hallmark, make early diagnosis challenging and, if enzyme replacement therapy does not begin timely, about 60% of patients develops severe motor and ventilatory disabilities.Aim of our study was to quantitatively assess the upright posture in a sibship of LOPD adults by x-Ray(xR) and 3D Stereophotogrammetry (St), considered the gold standard to measure spinal angles and whole-body posture respectively, in order to better identify specific alterations more likely to be present in a homogeneous group.Results: Statistical analysis of St parameters showed a larger ankle, knee, elbow, dorsal, S2-C7, heel-S2-C7, heel-S2-nasion angles and a lower sagittal vertical axis (SVA) than healthy controls. Moreover, xR analysis highlighted a lower occipito-cervical, C2-C7 cervical and Cobb dorsal angles, and a trend to lower lumbar lordosis and SVA compared to normal values. Pearson’s coefficient analysis was carried on in order to evaluate the correlation between xR and St sagittal spino-pelvic parameters and significant correlation was found in dorsal and lumbar angles calculated using xR markers placed on spiny apophysis, xR centre of vertebral bodies, Cobb method and St markers. Conclusions: This is the first study that quantitatively assesses standing whole-body alignment and postural abnormalities in LOPD. These postural alterations are not easily detectable during clinical examination and might be useful to early identify LOPD patients and to facilitate differential diagnosis with other proximal myopathies. Moreover, our St-mks placement protocol showed high reliability to assess any sagittal angles and, being non-invasive as compared to xR, is advisable to investigate and monitor the course of the disease and the response to treatment.
Association Between Plasma Glycocalyx Component Levels and Poor Prognosis in Influenza Type A (H1N1)
Authors: Huang Xiao , Lu Feng , Tian Huanhuuan , Hu Haoran , Ning Fangyu , Shang Quanmei , Hao Dong , Zhu Weiwei , Kong Guiqing , Ma Xiaohong , Feng Jiali , Wang Tao , Wang Xiaozhi
Published: January 2021

Background: Influenza A virus infection causes a series of diseases, but the factors associated with disease severity are not fully understood. Disruption of the endothelial glycocalyx contributes to acute lung injury in sepsis, but has not been well studied in H1N1 influenza. We aim to determine whether the plasma glycocalyx components levels are predictive of disease severity in H1N1 influenza.Methods: This prospective observational study included 53 patients with influenza A (H1N1), who were admitted to the Pulmonary and Critical Care Medicine and Intensive Care Unit, and 30 healthy controls between November 2017 and March 2019 in our hospital. Patients were grouped by severity and survival. We collected clinical data and blood samples at admission. Inflammatory factors (tumor necrosis factor-α, interleukin-6, interleukin-10) and endothelial glycocalyx components (syndecan-1, hyaluronan, heparan sulfate) were measured.Results: The plasma levels of syndecan-1, hyaluronan, and heparan sulfate were significantly higher in patients with severe influenza A (H1N1) than in mild cases. At a cutoff point >81.0 ng/mL, syndecan-1 had a 92.1% sensitivity and 86.7% specificity for diagnosing severe H1N1. Syndecan-1 and hyaluronan were positively correlated with disease severity, which was indicated by the APACHE II and SOFA scores and lactate levels, and negatively correlated with albumin levels. Non-survivors had higher syndecan-1 levels than did survivors, and syndecan-1 was strongly predictive of 28-day mortality (area under the curve, 0.855).Conclusions: An increased plasma syndecan-1 level was an independent risk factor for mortality and may be indicative of disease severity in patients with influenza A (H1N1).Trial registration: CHINA, ChiCTR2000040921. Retrospectively registered
Cutaneous Iontophoresis of Vasoactive Medications in Patients with Scleroderma- Associated Pulmonary Arterial Hypertension
Authors: Ampnti Sami Al , Almoushref Allaa , Naal Tawfeq , Melillo Celia , Aulak Kulwant S. , Ahmed Mostafa K. , Chatterjee Soumya , Highland Kristin , Dweik Raed A. , Tonelli Adriano
Published: January 2021

Background:It remains unknown whether the cutaneous microvascular responses are different between patients with scleroderma-associated pulmonary arterial hypertension (SSc-PAH) and SSc without pulmonary hypertension (PH).Methods:We included 59 patients with SSc between March 2013 and September 2019. We divided patients into 4 groups: a) no PH by right heart catheterization (RHC) (n=8), b) no PH by noninvasive screening tests (n=16), c) treatment naïve PAH (n=16) and d) PAH under treatment (n=19). Microvascular studies using laser Doppler flowmetry (LDF) were done immediately after RHC or at the time of an outpatient clinic visit (group b). Results:The median (IQR) age was 59 (54-68) years, and 90% were females. The responses to thermal and post occlusive reactive hyperemia, acetylcholine, and sodium nitroprusside iontophoresis were similar among groups. The microvascular response to treprostinil was more pronounced in SSc patients without PH by screening tests (% change: 340 (214-781)) compared with SSc-PAH (naïve + treatment) (Perfusion Units (PU) % change: 153 (94-255) % [p=0.01]). The response to A-350619 (a sGC activator) was significantly higher in patients with SSc without PH by screening tests (PU % change: 168 (46-1,296)) than those with SSc-PAH (PU % change: 22 (15-57) % [p=0.006]). The % change in PU with A350619 was directly associated with cardiac index and stroke volume index (R: 0.36, p=0.03 and 0.39, p=0.02, respectively). Conclusions:Patients with SSc-PAH have a lower cutaneous microvascular response to a prostacyclin analog treprostinil and the sGC activator A-350619 when compared with patients with SSc and no evidence of PH on screening tests.
Cytoplasmic String Between ICM and mTE Is a Positive Predictor of Clinical Pregnancy and Live Birth Outcomes in Elective Frozen-thawed Single Blastocyst Transfer Cycles: A Time-lapse Study
Authors: Ma Bingxin , Jin Lei , Huang Bo
Published: January 2021

Background: In this study, we aim to investigate whether cytoplasmic string between inner cell mass (ICM) and mural trophectoderm (mTE) is a positive predictor of clinical pregnancy and live birth outcomes.Methods: 1,267 elective frozen-thawed single blastocyst transfer (eSBT) cycles cultured in time-lapse incubation system from January 2018 to May 2019 were involved in the study. Blastocysts were grouped according to the appearance of cytoplasmic strings between ICM and mTE cells, and identified as “Present” and “Absent” groups. In Present group, they were further categorized according to the quantity of cytoplasmic strings between ICM and mTE cells. Clinical pregnancy and live birth outcomes of blastocysts were used to evaluate the effect of cytoplasmic strings between ICM and mTE.Results: The baseline demographic and laboratory features were similar between the Present and Absent groups of cytoplasmic strings between ICM and mTE (P>0.05). According to the time-lapse analysis, cytoplasmic strings between ICM and mTE were more visible among good quality blastocysts. Furthermore, blastocysts with cytoplasmic strings showed a higher clinical pregnancy and live birth rates (P<0.05), and no significant differences were observed in abortion rate and birth weight (P>0.05).Conclusions: Although the previous conclusions of cytoplasmic strings were controversial, the present time-lapse analysis provides the evidence for the first time that cytoplasmic strings between ICM and mTE cells would be a positive predictor of clinical pregnancy and live birth outcomes in elective frozen-thawed single blastocyst transfer cycles.
The Skill Training of Resident Anesthesiologists During the Outbreak Of COVID-19
Authors: Xie Min , Zhou Qin , Kang Yuanyuan , Qing Ping , Guo Yang , Wei Xinchuan , Cai Bing , Zeng Jie , Huang Jianxin
Published: January 2021

Background: With the spread of the coronavirus disease 19 (COVID-19), Sichuan provincial people's hospital, at the frontline fighting this public health crisis, took a lead in the reception, diagnosis and treatment of patients with COVID – 19 in the greater Sichuan area. As an effort to prevent nosocomial infections among the medical staff, we switched from the traditional face-to-face instruction to a web-based multimodal teaching model in our resident training program. Specifically, we explored ways to provide remote training in the proper procedure of donning and doffing of personal protective equipment (PPE). The purpose of the study was to evaluate the effectiveness of various teaching methods in teaching clinical skills of our residents during the epidemic period.Methods: 72 resident anesthesiologists (1st to 3rd year) were recruited to receive remote skill training on donning and doffing of PPE. In this study, all participants received instructional videos/text for the proper protocol, in addition to watching a live-stream instructional video that simulated the procedure of donning and doffing of PPE. We matched the residents by year and divided them into two groups through a WeChat Draw Program. The video feedback (VF) group recorded and submitted videos of simulated donning and removing PPE followed by a debriefing session through a collaborative WeChat learning group. The independent learning (IL) group did not record videos, but were encouraged to consult with their instructors by WeChat or phone if they had any questions. Then the two groups completed questionnaire as well as theory tests and skill assessment. Results: The VF group responded positively to the additional video-recording/debriefing approach. We did not observe any significant difference between the two groups in theoretical test scores. However, the VF group had significantly higher performance than the IL group in skill assessment. Conclusion: The web-based teaching, simulation teaching and video feedback model is an effective alternative to the conventional face-to-face instruction as part of an adapted resident training curriculum involving donning and doffing of protective equipment during an epidemic outbreak.
Nurses’ Encountered Challenges with Patient-centered Care in Rural Primary Health Care Centers: A Case Study of Nigeria
Authors: Lateef Adepeju , Mhlongo Euphemia Mbali
Published: January 2021

BackgroundGlobally, patient-centered care has become the focus of the healthcare system. Therefore, it is imperative to note that patient-centered care seeks to empower partnering approaches to primary health care and has recently gained prominence in nursing practice and applied nursing research. However, nurses are faced with numerous challenges in achieving the desired results and objectives related to Patient-centered care in the Primary Health Care system. Thus, the study explores the negative factors influencing the implementation of Patient-centered care in rural Primary Health Care facilities in Nigeria.MethodA qualitative participatory action research design was used. Data collection was conducted with the nurses from Primary Health Care facilities through individual interviews and focus group discussions. Data saturation was achieved with 35 participants from 30 Primary Health Care facilities in Osun State, Southwest Nigeria, using a purposive sampling technique. All interviews were audio-recorded, which were later transcribed verbatim and analyzed using a thematic content analysis approach. NVivo 12 software was used for data management.ResultsThe results from this study was categorized into two: organizational factors and individual factors. Five themes that emerged from the study include: inadequate management support, insufficient operational skills and knowledge /equipped learning, increased workload and time constraints, health personnel readiness, dearth enthusiasm for change and accountability of the staff.ConclusionThe results of this study show that nurses encountered diverse challenges in the implementation of patient-centered care. To improve healthcare delivery quality in the Primary Health Care facilities, there is a need to reinforce adequate management support, education, training, and the nurses’ internal motivation to achieve a transformative healthcare outcome.
A Precision Medicine Framework for Personalized Simulation of Hemodynamics in Cerebrovascular Disease
Authors: Frey Dietmar , Livne Michelle , Leppin Heiko , Akay Ela Marie , Aydin Orhun , Behland Jonas , Sobesky Jan , Vajkoczy Peter , Madai Vince Istvan
Published: January 2021

Cerebrovascular disease, in particular stroke, is a major public health challenge. An important biomarker is cerebral hemodynamics. To measure and quantify cerebral hemodynamics, however, only invasive, potentially harmful or time-to-treatment prolonging methods are available. We present a simulation-based approach which allows calculation of cerebral hemodynamics based on the patient-individual vessel configuration derived from structural vessel imaging. For this, we implemented a framework allowing segmentation and annotation of brain vessels from structural imaging followed by 0-dimensional lumped simulation modelling of cerebral hemodynamics. For annotation, a 3D-graphical user interface was implemented. For 0D-simulation, we used a modified nodal analysis, which was adapted for easy implementation by code. The simulation enables identification of areas vulnerable to stroke and simulation of changes due to different systemic blood pressures. Moreover, sensitivity analysis was implemented allowing the live simulation of changes to simulate procedures and disease progression. Beyond presentation of the framework, we demonstrated in an exploratory analysis in 67 patients that the simulation has a high specificity and low to moderate sensitivity to detect perfusion changes in classic perfusion imaging. The presented precision medicine approach using novel biomarkers has the potential to make the application of harmful and complex perfusion methods obsolete.
Adolescent-Onset Anti-MDA5 Antibody-Positive Juvenile Dermatomyositis with Rapidly Progressive Interstitial Lung Disease and Spontaneous Pneumomediastinum: A Case Report and Literature Review
Authors: Yeung Tsz Wing , Cheong Kai Ning , Lau Yu Lung , Tse Kei Chiu Niko
Published: January 2021

Background:Dermatomyositis with positive anti-melanoma differentiation-associated gene 5 (anti-MDA5) antibody has a distinct phenotype associated with small hand joint arthritis, mucocutaneous ulceration, and less muscle involvement. It is reported to be associated with rapidly progressive interstitial lung disease (RP-ILD) and have a high mortality rate in adult studies. There is evidence that cases complicated with spontaneous pneumomediastinum (PNM) have an increase in mortality. Most of the evidence of this rare disease is derived from adult studies. We report a case in adolescent age complicated with both RP-ILD and PNM with a good disease outcome after aggressive immunosuppressive therapy. We illustrate the diagnostic challenge and the importance of test for the myositis-associated antibodies (MSA).Case presentation:A 16-year-old Chinese female presented with fever and cough for one day, and finger swelling for three weeks. Physical examination revealed arthritis of fingers and wrists, ulcers and palmar papules over fingers, hyperpigmentation of interphalangeal joints, rash over the neck and calcinosis over external ears. The diagnosis of dermatomyositis was made one month later until the onset of malar rash, Gottron’s papules and myalgia. The diagnosis was supported by the presence of anti-MDA5 antibody and evidence of inflammatory myopathy on magnetic resonance imaging without performing muscle biopsy or electromyography. In retrospect, she already had interstitial lung disease at first presentation manifested as cough and opacity on chest radiograph, which was later confirmed with chest computed tomography and pulmonary function test. She was treated according to adult guidelines with calcineurin inhibitor and steroid. Her disease was steroid-resistant, which was complicated with RP-ILD and spontaneous PNM. Intensive immunosuppressive therapy including cyclophosphamide and rituximab were required to induce remission.Conclusions:Recognition of distinct clinical features including mucocutaneous ulceration and test for MSA are important for prompt diagnosis of anti-MDA5 antibody-positive dermatomyositis, as early aggressive treatment and anticipation of complications could make a difference in the outcome of this disease with high mortality.
First Record of A New Microsporidium Pathogenic to the Eucalyptus Snout Beetle in Brazil
Authors: Jordan Carolina , Carvalho Vanessa , Mascarin Gabriel , Oliveira Leiliane , Dunlap Christopher , Wilcken Carlos
Published: January 2021

Microsporidia are naturally occurring fungal-related parasites that can infect nearly all animal hosts, but their biocontrol potential of insect pests is routinely overlooked in agriculture and forestry. This research brings the first report describing the natural occurrence of a microsporidium causing disease in field-collected populations of the invasive eucalyptus snout beetle, Gonipterus platensis (Coleoptera: Curculionidae), a major destructive pest of eucalyptus plantations in Brazil. Adult beetles were collected during field surveys in commercial eucalyptus plantations in southern Brazil to be examined and dissected with typical symptoms to verify presence of microsporidian spores in haemolymph. From 14 plantations in different sites, the natural infection occurrence in these populations ranged from 0 to 65%, while a lab colony exhibited an infection incidence of 70%. Spore density in haemolymph of symptomatic insects averaged 2.1(±0.4) × 107 spores/mL. Symptoms in infected adults were identified by abnormal abdomen with malformation of the second pair of wings, impairing their flight activity. Electron transmission microscopy of the pathogen showed morphological features similar to species belonging to the genus Nosema or Vairimorpha. Phylogenetic analysis of the full-length small subunit ribosomal RNA gene suggests this pathogen’s placement in the genus Vairimorpha, but with a sequence identity of ~94% with the nearest neighbours. The low level of sequence identity suggests this pathogen may represent a novel taxon in the genus and further requires whole genome sequencing for definitive taxonomic resolution. These findings provide insights on the natural occurrence of this novel pathogen for potential use in biocontrol of this invasive pest in Eucalyptus plantations in Brazil, and prompts the design of conservative or augmentative strategies for the establishment of this microsporidium in field populations for sustainable management of eucalyptus snout beetles.
Characteristics of Colon Crypt Stem Cells in Preserved Epithelial Cell Clumps in Dextran Sulfate Sodium-induced Mouse Model of Ulcerative Colitis
Authors: Kobayashi Mio , Yamashita Risako , Ichikawa Ryo , Shibutani Makoto , Yoshida Toshinori
Published: January 2021

Crypt stem cells rescue the colorectum from refractory ulcers in ulcerative colitis (UC). We previously reported that clumps of a few epithelial cells were scattered in ulcer regions in a dextran sulfate sodium (DSS)-induced mouse model of UC; however, the origin of the clumps is unknown. We determined the immunohistochemical expression of stem-cell markers in the epithelial clumps in female Balb/c mice administered DSS in drinking water for 6 days, followed by withdrawal of DSS for 6 days. Similar to the characteristics of UC, the ulcers were more severe in the distal region close to the anus than in the proximal region of the colorectum. Quantitative analyses revealed that the epithelial clumps appeared in relation to the severity of ulcer, and they expressed the cell adhesion molecules E-cadherin and β-catenin. Among stem cell markers, the epithelial clumps primarily expressed + 5 cell marker Dll1, followed by + 4 cell marker Bmi1 and crypt stem cell marker Lgr5 in that order. Nuclear expression of Sox9, but not Ki-67 and β-catenin was identified in the clumps. The present results suggest that the epithelial clumps comprised crypt-derived stem cells with the potential to regenerate crypts, which could serve as a potential treatment strategy for UC.
Trajectory Planning in UAV Emergency Networks with Potential Underlaying D2D Communication Based on K-means
Authors: Zhang Shuo , Shi Shuo , Feng Tianming , Gu Xuemai
Published: January 2021

Unmanned aerial vehicles (UAVs) have been widely used in communication systems due to excellent maneuverability and mobility. The ultra-high speed, ultra-low latency, and ultra-high reliability of 5th generation wireless systems (5G) have further promoted vigorous development of UAVs. Compared with traditional means of communication, UAV can provide services for ground terminal without time and space constraints, so it is often used as air base station (BS). Especially in emergency communications and rescue, it provides temporary communication signal coverage service for disaster areas. In the face of large-scale and scattered user coverage tasks, UAV's trajectory is an important factor affecting its energy consumption and communication performance. In this paper, we consider a UAV emergency communication network where UAV aims to achieve complete coverage of potential underlying D2D users (DUs). The trajectory planning problem is transformed into the deployment and connection problem of stop points (SPs). Aiming at trajectory length and sum throughput, two trajectory planning algorithms based on K-means are proposed. Due to the non-convexity of sum throughput optimization, we present a sub-optimal solution by using the successive convex approximation (SCA) method. In order to balance the relationship between trajectory length and sum throughput, we propose a joint evaluation index which is used as an objective function to further optimize trajectory. Simulation results show the validity of the proposed algorithms which have advantages over the well-known benchmark scheme in terms of trajectory length and sum throughput.
The Factors Influencing the Implementation of Clinical Guidelines in the World; a Systematic Review Protocol
Authors: Babaei Javad , Hajebrahimi Sakineh , Jannati Ali , Azizzadeh Mina
Published: January 2021

Background: Clinical guidelines are a systematic collection of the latest and most authoritative scientific evidence that describes thediagnostic steps and methods of clinical treatment of a patient in a categorized manner, taking into account priorities, effectiveness, and cost-effectiveness. It is necessary to explore and categorize influencing factors in the implementation of clinical guidelines worldwide to pave the way for their implementation in medical centers.Methods: In this systematic review we will search Scopus, PubMed, Web of sciences, clinical key, Google Scholar (Search Engine as well as Iranian data bases including: Magiran, SID, Irandoc, Iranmedex. We will include all related original studies that generally cover all relevant outcomes to determine the factors influencing the success of the implementation of clinical guidelines and to identify barriers and facilitators as well.The quality of the included studies will be assessed by appropriate Joanna Briggs Institute (JBI) Checklists according to the type of studies. The selection and appraisal process will be performed by two members of the research team; and in case of disagreement between the two researchers, the third person will review the articles.Discussion: Identifying the facilitators and factors affecting the implementation of clinical guidelines as well as the related obstacles is expected to pave the way for helping managers, policymakers and health planners in implementing them correctly.Systematic review registration: CRD42020201350
A Pivotal Restructuring of Modeling the Control of COVID-19 During and After Massive Vaccinations for the Next Few Years
Authors: Cruz Jose B , Ronquillo Tirso A , Sangalang Ralph G B , Amante Albertson D , Ronquillo Divina G D , Peralta Janice F , Chua Antonette V , Inojosa Raynell A , Jose Oliver L J A
Published: January 2021

This paper presents a pivotal restructuring of modeling the control of COVID-19 even when massive vaccination is in progress. A new closed loop mathematical model to demonstrate how direct observations of the epidemiological compartments of population could be mapped to inputs, such that the social spread of the disease is asymptotically subdued. Mathematical details of the stabilization and robustness are included. A new engineered closed loop model is designed to control the spread of COVID-19 or its variants—that is, one input directly increases the time-rate of the compartment of population free of virus, and the other input directly changes the time-rate of the susceptible compartment of population. Both inputs have collateral opposite influences on the time-rate of the infected compartment of population. The loop is closed around the new input-output model and designed so that the outputs reach the desired asymptotes. New surges of disease spread are not possible in appropriately designed stable closed loop models. However, extensive testing, contact tracing, and medical treatment of those found infected, must be maintained.