bluuebunny/crossref_metadata_2025 huggingface dataset:
Diagnostic Accuracy of a Liquid Chromatography-Tandem Mass Spectrometry Assay for Rifampin-resistant Tuberculosis Drug Concentrations in a Routine Care Setting
Authors: Metcalfe John , Bacchetti Peter , Esmail Ali , Reckers Andrew , Aguilar David , Wen Anita , Huo Shu , Muyindike Winnie R. , Hahn Judith A. , Dheda Keertan , Gandhi Monica , Gerona Roy
Published: October 2020

BackgroundTreatment monitoring of drug-resistant tuberculosis (DR-TB) in resource-limited settings is challenging. We developed a multi-analyte assay for eleven anti-TB drugs in small hair samples as an objective metric of drug exposure.MethodsSmall hair samples were collected from participants at various timepoints during directly observed RR-TB treatment at an inpatient tertiary referral facility in South Africa (DR-TB cohort). We assessed qualitative determination (i.e., detection above limit of detection) of bedaquiline, linezolid, clofazimine, pretomanid, levofloxacin, moxifloxacin, pyrazinamide, isoniazid, ethambutol, ethionamide, and prothionamide in an LC-MS/MS index panel assay against a reference standard of inpatient treatment records. Because treatment regimens prior to hospitalization were not available, we also analyzed specificity (for all drugs except isoniazid) using an external cohort of HIV-positive patients treated for latent TB infection with daily isoniazid (HIV/LTBI cohort) in Uganda.ResultsAmong the 57 DR-TB patients (58% with pre-XDR/XDR-TB; 70% HIV-positive) contributing analyzable hair samples, the sensitivity of the investigational assay was 94% or higher for all drugs except ethionamide (58.5%, 95% confidence interval [CI], 40.7-99.9). Assay specificity was low across all tested analytes within the DR-TB cohort; conversely, assay specificity was 100% for all drugs in the HIV/LTBI cohort.ConclusionsHair drug concentrations reflect long-term exposure, and multiple successive regimens commonly employed in DR-TB treatment may result in apparent false-positive qualitative and falsely elevated quantitative hair drug levels when prior treatment histories within the hair growth window are not known.
Evaluation of TaqMan Array Card (TAC) for the Detection of 28 Respiratory Pathogens
Authors: Liu Keke , Jing Hongbo , Chen Ying , Zheng Xin , Jiang Hua , Kong Decong , Zheng Yvling , Chen Shuiping , Liu Peng , Jiang Yongqiang
Published: October 2020

Background: Respiratory infections are a serious threat to human health. So, rapid detection of all respiratory pathogens can facilitate prompt treatment and prevent the deterioration of respiratory disease. Previously published primers and probes of the TaqMan array card (TAC) for respiratory pathogens are not sensitive to Chinese clinical specimens. This study aimed to develop and improve the TAC assay to detect 28 respiratory viral and bacterial pathogens in a Chinese population. Methods: To improve the sensitivity, we redesigned the primers and probes, and labeled the probes with minor groove binders. The amplification efficiency, sensitivity, and specificity of the primers and probes were determined using target-gene containing standard plasmids. The detection performance of the TAC was evaluated on 754 clinical specimens and the results were compared with those from conventional methods.Results: The performance of the TAC assay was evaluated using 754 clinical throat swab samples and the results were compared with those from gold-standard methods. The sensitivity and specificity were 95.4% and 96.6%, respectively. The lowest detection limit of the TAC was 10 to 100 copies/μL. Conclusions: TAC is an efficient, accurate, and high-throughput approach to detecting multiple respiratory pathogens simultaneously and is a promising tool for the identification of pathogen outbreaks.
Generation of small interfering RNA (siRNA) database from SARS-CoV-2 genome sequences
Authors: Medeiros Inácio Gomes , Khayat André Salim , Stransky Beatriz , Santos Sidney Emanuel Batista dos , Assumpção Paulo Pimentel de , Souza Jorge Estefano Santana de
Published: October 2020

This protocol aims to describe the building of a database of SARS-CoV-2 targets for siRNA approaches. Starting from the virus reference genome, we will derive sequences from 18 to 21nt-long and verify their similarity against the human genome and coding and non-coding transcriptome, as well as genomes from related viruses. We will also calculate a set of thermodynamic features for those sequences and will infer their efficiencies using three different predictors. The protocol has two main phases: at first, we align sequences against reference genomes. In the second one, we extract the features. The first phase varies in terms of duration, depending on computational power from the running machine and the number of reference genomes. Despite that, the second phase lasts about thirty minutes of execution, also depending on the number of cores of running machine. The constructed database aims to speed the design process by providing a broad set of possible SARS-CoV-2 sequences targets and siRNA sequences.
Knowledge, attitudes, beliefs, and stigma related to latent tuberculosis infection: a qualitative study among Eritreans in the Netherlands
Authors: Spruijt Ineke , Haile Dawit Tesfay , Hof Susan van den , Fiekert Kathy , Jansen Niesje , Jerene Degu , Klinkenberg Eveline , Leimane Ieva , Suurmond Jeanine
Published: October 2020

Background: Tailored and culturally appropriate latent tuberculosis (TB) infection screening and treatment programs, including interventions against TB stigma, are needed to reduce TB incidence in low TB incidence countries. However, we lack insights in stigma related to latent TB infection (LTBI) among target groups, such as asylum seekers and refugees. We therefore studied knowledge, attitudes, beliefs, and stigma associated with LTBI among Eritrean asylum seekers and refugees in the Netherlands.Methods: We used convenience sampling to interview adult Eritrean asylum seekers and refugees: 26 semi-structured group interviews following TB and LTBI related health education and LTBI screening, and 31 semi-structured individual interviews with Eritreans during or after completion of LTBI treatment (November 2016-May 2018). We used a thematic analysis to identify, analyse and report patterns in the data.Results: Despite TB/LTBI education, misconceptions embedded in cultural beliefs about TB transmission and prevention persisted. Fear of getting infected with TB was the cause of reported enacted (isolation and gossip) and anticipated (concealment of treatment and self-isolation) stigma by participants on LTBI treatment.Conclusion: The inability to differentiate LTBI from TB disease and consequent fear of getting infected by persons with LTBI led to enacted and anticipated stigma comparable to stigma related to TB disease among Eritreans. Additional to continuous culturally sensitive education activities, TB prevention programs should implement evidence-based interventions reducing stigma at all phases in the LTBI screening and treatment cascade.
Cost of investigations during the acute hospital stay following total hip or knee arthroplasty, by complication status
Authors: Cheng Emma Tsz Lou , Lewin Adriane , Churches Tim , Harris Ian A , Naylor Justine
Published: October 2020

Background: Total hip and total knee arthroplasties are among the most common types of surgery performed in Australia today and are effective treatments for severe osteoarthritis. However, the increasing financial burden on the health system owing to the increasing rates of surgery has led to a growing interest in improving the cost-effectiveness and safety of arthroplasty care. This study was designed to quantify the association between post-operative complications, a major cost driver, and the cost of investigations following total hip or knee arthroplasty.Methods: This is a prospective cohort study of consecutive patients undergoing primary total hip or knee arthroplasty at an Australian public hospital. We measured the number and cost of imaging and pathology tests performed during the acute hospital stay and used linear regression to quantify the association between complication status and investigation costs.Results: Five hundred patients were included in the analysis. On average, those with complications received more tests, and more expensive tests. The mean combined cost of imaging and pathology tests in patients with no complications was AU$ 187 (SD: 12.0). In comparison, patients with minor complications had a mean additional cost of AU$ 270 (SD: 31.0), and those with major complications had a mean additional cost of AU$ 493 (SD: 54.2) (p<0.001).Conclusions: In patients undergoing hip or knee arthroplasty, investigation costs are substantially greater in the presence of either minor or major complications. With growing volumes of total hip and total knee arthroplasties, a potential focus of future research could include optimising investigation practices for patients with and without complications.
Clinically oriented contour evaluation using geometric and dosimetric indices based on simple geometric transformations
Authors: Xian Lixun , Li Guangjun , Xiao Qing , Li Zhibin , Zhang Xiangbin , Chen Li , Hu Zhenyao , Bai Sen
Published: October 2020

Background: In radiotherapy, geometric indices are often used to evaluate the accuracy of contouring; however, the ability of geometric indices to identify the error of contouring results is limited, mainly because it does not consider any clinical background. To study the relationship between geometric indices and dosimetric indices, four different types of targets were selected to introduce the systematic and random geometric errors in the delineation process. Materials and Methods: The C-shaped target outlined in the American Association of Physicists in Medicine (AAPM) TG-119 report (The report of Task Group 119 of the AAPM) and the targets of three actual cases of oropharyngeal cancer, metastatic spine cancer, and prostate cancer were selected as the test contours that needed to be modified. Python software was used to perform translation, scaling, rotating and sine function transformation to introduce systematic and random errors into the above contours. These geometrically transformed contours were regarded as reference contours corrected by systematic and random errors. The corresponding dosimetric indices were obtained from the original dose distribution of the radiotherapy plan, and correlations (R²) between geometric and dosimetric indices were quantified through linear regression. The Wilcoxon signed rank test was used to compare the ability of spatial-direction discrimination between the geometric indices of different directions of transformations. Results: The correlations between the geometric and dosimetric indices were inconsistent for the targets. For systematic errors, except for the sine function transformation (R²: 0.023–0.04, p＞0.05), the geometric transformations of the C-shaped target’s planning target volume (C-PTV) had correlations with the dosimetric indices D98% and Dmean (R²: 0.689–0.988), 80% of which were strongly correlated (R² > 0.8). For the random errors, the correlation coefficients of the actual cases were also high, R2 > 0.384, p < 0.05. The results of Wilcoxon signed rank test showed that only the p-values of volumetric geometric indices of C-PTV were less than 0.05. Conclusions: Clinically, an assessment of the contour accuracy of the region of interest is not feasible based on geometric indices alone, and should be combined with dosimetric indices. Keywords: Contour evaluation, Geometric indices, Dosimetric indices, Geometric transformation
A Human Factors Intervention in a Hospital - Evaluating the Outcome of a TeamSTEPPS Program in a Surgical Ward
Authors: Aaberg Oddveig Reiersdal , Hall-Lord Marie Louise , Husebø Sissel Iren Eikeland , Ballangrud Randi
Published: October 2020

Background: Patient safety in hospitals is being jeopardized, since too many patients experience adverse events. Most of these adverse events arise from human factors, such as inefficient teamwork and communication failures, and the incidence of adverse events is greatest in the surgical area. Previous research has shown the effect of team training on patient safety culture and on different areas of teamwork. Limited research has investigated teamwork in surgical wards. The aim of this study was to evaluate the professional and organizational outcomes of a team training intervention among healthcare professionals in a surgical ward after 6 and 12 months. Systems Engineering Initiative for Patient Safety 2.0 was used as a conceptual framework for the study.Methods: This study had a pre-post design with measurements at baseline and after 6 months and 12 months of intervention. The intervention was conducted in a urology and gastrointestinal surgery ward in Norway, and the study site was selected based on convenience and the leaders’ willingness to participate in the project. Survey data from healthcare professionals were used to evaluate the intervention. The organizational outcomes were measured by the unit-based sections of the Hospital Survey of Patient Safety Culture Questionnaire, and professional outcomes were measured by the TeamSTEPPS Teamwork Perceptions Questionnaire and the Collaboration and Satisfaction about Care Decisions in Teams Questionnaire. A paired t-test, a Wilcoxon signed-rank test, a generalized linear mixed model and linear regression analysis were used to analyze the data.Results: After six months, improvements were found in organizational outcomes in two patient safety dimensions. After 12 months, improvements were found in both organizational and professional outcomes, and these improvements occurred in three patient safety culture dimensions and in three teamwork dimensions. Furthermore, the results showed that one of the significant improved teamwork dimensions “Mutual Support” was associated with the Patient Safety Grade, after 12 months of intervention.Conclusion: These results demonstrate that the team training program had effect after 12 months of intervention. Future studies with larger sample sizes and stronger study designs are necessary to examine the causal effect of a team training intervention in this context.Trial registration number: ISRCTN13997367 (retrospectively registered)
Local Use of Dexamethasone in the Treatment of Ocular Myasthenia Gravis
Authors: Shi Minghua , Ye Yingjia , Zhou Junping , Qin Aijiao , Cheng Jing , Ren Hongxing
Published: October 2020

Background: At present, patients with ocular myasthenia gravis (OMG) are typically treated with systemic drugs. We investigated the use of dexamethasone injected in the peribulbar region or extraocular muscle to treat patients with OMG.Methods: Patients with OMG were given dexamethasone via peribulbar injection or direct injection into the main paralyzed extraocular muscles, once a week, for 4-6 weeks. The severity of diplopia, blepharoptosis, eye position, and eye movement were evaluated before and after treatment. The duration of follow-up time was ≥6 months.Results: Among the 14 patients with OMG who received this treatment, mean age was 38.7 ± 29.7 years. After treatment, symptoms were relieved in 12 patients (85.7%), 1 patient (7.1%) had partial response to treatment, and 1 patient (7.1%) had no response. Two patients (14.2%) experienced symptom recurrence during the follow-up period.Conclusions: Dexamethasone peribulbar or extraocular muscle injection is effective in the treatment of patients with OMG and may replace systemic drug therapy.Trial registration: Chinese Clinical Trial Registry, ChiCTR2000038863, October 7, 2020.Retrospectively registered.
Comparing breastfeeding experiences between mothers spending the traditional Chinese confinement period in a confinement centre and those staying at home: a cohort study
Authors: Foong Siew Cheng , Tan May Loong , Foong Wai Cheng , Ho Jacqueline J , Rahim Fairuz Fadzilah
Published: October 2020

Background Ethnic Chinese mothers in Malaysia adhere to 30 days of traditional post-partum practices (the “confinement period”) aimed at recuperation after delivery. Recently there has been an emergence of confinement centres (CCs) where mothers stay and receive traditional confinement care. Ethnic Chinese mothers have low breastfeeding rates. There are concerns that practices in CCs could contribute to this but no data exists. We described mother’s breastfeeding experience at CCs and identify areas for potential improvement in breastfeeding support.Methods Ethnic Chinese mothers intending to breastfeed their healthy infants were recruited post-delivery between August and October 2017 then, at 1 and 6 months, were telephone interviewed about their experience. For every participant going to a CC, another mother going home was recruited. Chi-square test was used to compare groups and multiple logistic regression was used to assess the effect of confinement place on exclusive breastfeeding. Results Of 187 mothers, 88(47%) went to CCs. Significantly more were primipara and fewer had previous breastfeeding experience. Response rates for the 1- and 6- month interviews were 88%(CC) versus 97%(home); and 77%(CC) versus 87%(home).Exclusive breastfeeding rates were similar between the groups: 62%(CC) versus 56%(home) at 1 month (p=0.4); and 37%(CC) versus 42%(home) at 6 months (p=0.5). Multiple logistic regression did not show that CCs were a factor affecting exclusive breastfeeding rates at 1 month, (adjusted odds ratio(aOR) 1.7, 95% confidence interval(CI) 0.9, 3.3), or 6 months (aOR 0.9, 95% CI 0.4, 1.7). However, significantly more CC participants only fed expressed breast milk. Despite 66% of CC participants reporting that their centre supported breastfeeding, only 6(8%) CC participants compared to 66(69%) of home participants slept with their baby (p<0.001). The proportion encountering breastfeeding difficulties were similar between groups. CC participants sought help for breastfeeding problems mainly from CC staff and support groups while home participants obtained help from friends and healthcare professionals. Conclusion Breastfeeding rates appeared to be similar at CCs and home but there were gaps in how CCs supported breastfeeding. Targeted training to CC staff to support breastfeeding may result in better outcomes for mothers staying in CCs. Trial registration National Medical Research Register NMRR-17-1174-36384S1
Demographic Features of Identified PLWHA Infected through Commercial and Nonmarital Noncommercial Heterosexual Contact in China from 2015–2018: A Retrospective Cross-Sectional Study
Authors: Dong Zhilong , Ma Liying , Cai Chang , Gao George Fu , Lyu Fan
Published: October 2020

Background:Understanding the demographic characteristics of people living with HIV/AIDS (PLWHA) infected through commercial heterosexual contact (CHC) or nonmarital noncommercial heterosexual contact (NMNCHC) is important for HIV/AIDS prevention and control.Methods:Cases reported through the Chinese HIV/AIDS Case Reporting System (CRS) from 2015 to 2018 were analyzed. A descriptive and preliminary inferential analysis were performed for those demographic characteristics deemed of interest.Results:Overall, 523,121 identified PLWHA between 2015 and 2018 in the CRS were analyzed. The constituent ratio of heterosexual transmission increased from 66.25% in 2015 to 71.48% in 2018. The proportion of CHC heterosexual transmission decreased from 40.18% in 2015 to 37.99% in 2018, while that of NMNCHC increased from 46.33% in 2015 to 49.02% in 2018. Those who were infected through NMNCHC were significantly younger than people infected through CHC (Student’s t test, P<0.0001), with an average age gap ranging from 5.63 (2015) to 7.46 (2018) years. The frequency of newly identified PLWHA who were infected through CHC had a remarkable increase among the ages of 65 and above. During the study years, the average age of the two groups increased annually. Gender distribution was significantly different between CHC and NMNCHC (χ2 test, P<0.0001), and the ratio of men to women in the NMCHC group was 1.50:1 (2015), 1.51:1 (2016), 1.54:1 (2017), and 1.52:1 (2018), while in the commercial heterosexual contact (CHC) group, these ratios were 11.45:1 (2015), 12.08:1 (2016), 12.53:1 (2017), and 13.28:1 (2018). Marital status was significantly different between CHC and NMNCHC (χ2 test, P<0.0001), and the married proportion of NMNCHC increased from 49.1% (2015) to 51.02% (2018). As the educational level improved, the proportion of NMNCHC also increased (Cochran - Armitage test, P<0.0001).Conclusions:We found that heterosexual transmission was the primary mode of HIV transmission in China from 2015 to 2018. PLWHA infected through CHC and NMNCHC had different characteristics in age, gender, marital status, and educational level. The frequency of PLWHA infected through CHC increased substantially in the age group of 65 and above. This study provides useful baseline data for future studies on the heterosexual transmission of HIV in China.
Atraumatic Restorative Treatment compared to the Hall Technique for occluso-proximal carious lesions in primary molars; 36-month follow-up of a randomised control trial in a school setting
Authors: Araujo Mariana Pinheiro , Innes Nicola Patricia , Bonifácio Clarissa Calil , Hesse Daniela , Olegário Isabel Cristina , Mendes Fausto Medeiros , Raggio Daniela Prócida
Published: October 2020

Background:Atraumatic Restorative Treatment (ART) and the Hall Technique (HT) are both minimally invasive, non-aerosol generating procedures (non-AGPs). They seem to have never been directly compared, nor has the HT been studied in a non-clinical setting. This study compared the HT and ART restorations placed in a school setting after 36 months.Methods:Children (5-10 yo) who had a primary molar with an occluso-proximal carious lesion were allocated to the ART or HT arms. Primary outcome: restoration survival over 36-months (using Kaplan-Meier survival analysis, log rank test, and Cox regression). Secondary outcomes: 1) occlusal vertical dimension (OVD) (1, 2, 3, 4 weeks) and 2) child self-reported discomfort; 3) treatment acceptability (immediately following interventions); 4) Child Oral Health Related Quality of Life (OHRQoL), before treatment and after 6 months and 5) a post-hoc analysis of time to tooth exfoliation (1, 6, 12, 18, 24, 30, 36 months).Results:One-hundred and thirty-one children (ART=65; HT=66) were included (mean age=8.1±1.2). At 36 months, 112 (85.5%) children were followed-up. Primary outcome: restoration survival rates ART=32.7% (SE=0.08; 95%CI=0.17-0.47); HT=93.4% (0.05; 0.72-0.99), p<0.001; Secondary outcomes: 1) OVD returned to pre-treatment state within 4 weeks; 2) treatment discomfort was higher for the HT (p=0.018); 3) over 70% of children and parents showed a high acceptability for treatments, with crown aesthetics being a concern for around 23% of parents; 4) Child OHRQoL improved after six months; and 5) teeth treated with the HT exfoliated earlier than those in the ART group (p=0.007).Conclusions:Both ART and the HT were acceptable to child participants and their parents and all parents thought both restorations protected their child’s tooth. However, the crown appearance concerned almost a quarter of parents in the HT arm. Children experienced less discomfort in the ART group. Although both treatments can be performed in a non-clinical setting and have the advantage of being non-aerosol generating procedures (non-AGPs), the HT had almost three times higher survival rates (93.4%) for restoring primary molar occluso-proximal cavities compared to ART (32.7%).Trial registration: This trial was registered in ClinicalTrials.gov (NCT02569047), 5th October 2015. https://clinicaltrials.gov/ct2/show/study/NCT02569047?cond=Hall+Technique+Atraumatic+Restorative+Treatment&draw=2&rank=2 Protocol: Hesse D, de Araujo MP, Olegário IC, Innes N, Bonifácio CC, Raggio DP. Atraumatic Restorative Treatment compared to the Hall Technique for occluso-proximal cavities in primary molars: study protocol for a randomized controlled trial. Trials 2016 Mar 31;17:169.
What Factors Contribute to High Mechanical Strength of Tabia? Case Study of the Tabia from Coastal Forts Sites at Zhejiang, China
Authors: Zhang Cuisong , Zhang Bingjian , Cui Biao , Lin Guocong
Published: October 2020

Tabia is one of the most widely used construction materials in ancient China. In this work, the tabia samples from three coastal defense fort sites at Zhejiang Province, China, we analyzed to determine their component composition and physiochemical properties. The results show that these tabia samples exhibited high compressive strength, which could be as high as 4-9 MPa. Furthermore, the systematic analysis demonstrated that the high compressive strength was related to the following factors: 1) a suitable mass ratio of sand, lime, and clay; 2) an appropriate sand particle size ratio; and 3) the formation of hydrated calcium silicate (C-S-H). Moreover, sticky rice was also detected in the tabia samples. These findings are fundamentally important, which could be beneficial to further study of the craftsmanship of the coastal defense forts and could further provide essential guidance for the protection and restoration of the tabia relics.
Association between post-traumatic stress disorder symptoms and bone fractures after the Great East Japan Earthquake in older adults: a prospective cohort study from the Fukushima Health Management Survey
Authors: Hayashi Fumikazu , Ohira Tetsuya , Nakano Hironori , Nagao Masanori , Okazaki Kanako , Harigane Mayumi , Yasumura Seiji , Maeda Masaharu , Takahashi Atsushi , Yabe Hirooki , Suzuki Yuriko , Kamiya Kenji
Published: October 2020

Background Psychological stress has been known to affect bone metabolism and increase fracture risk. However, the association between post-traumatic stress disorder (PTSD) and bone fractures remains unclear. The current study aimed to clarify the effects of disaster-induced PTSD symptoms on fracture risk in older adults.Methods This study analyzed responses from 17,474 individuals aged ≥65 without a history of fractures at the time of the Great East Japan Earthquake who answered the Mental Health and Lifestyle Survey component of the Fukushima Health Management Survey conducted in 2011. Obtained data were able to determine the presence or absence of fractures until 2016. Age, sex, physical factors, social factors, psychological factors, and lifestyle factors were subsequently analyzed. Survival analysis was then performed to determine the relationship between each factor and fractures. Thereafter, univariate and multivariate Cox proportional hazard models were constructed to identify fracture risk factors.Results A total of 2,097 (12.0%) fractures occurred during the follow-up period. Accordingly, univariate and multivariate Cox proportional hazard models showed that PTSD symptoms (total PTSD checklists scoring ≥ 44) [hazard ratio (HR): 1.26; 95% confidence interval (CI): 1.10–1.44; P = 0.001], history of cancer (HR: 1.49; 95% CI: 1.24–1.79; P < 0.001), history of stroke (HR: 1.25; 95% CI: 1.03–1.52; P = 0.023), history of heart disease (HR: 1.30; 95% CI: 1.13–1.50; P < 0.001), history of diabetes (HR: 1.23; 95% CI: 1.09–1.39; P < 0.001), current smoking (HR: 1.29; 95% CI: 1.02–1.63; P = 0.036), and high dissatisfaction with sleep or no sleep at all (HR: 1.33; 95% CI: 1.02–1.74; P = 0.035) promoted a significant increase in fracture risk independent of age and sex.Conclusions The present study indicates that disaster-induced PTSD symptoms and insomnia contribute to increased fracture risk among older adults residing in evacuation areas within Fukushima Prefecture.
The potential role of serum angiotensin-converting enzyme in coronavirus disease 2019
Authors: Zhu Zhe , Cai Ting , Fan Lingyan , Lou Kehong , Hua Xin , Huang Zuoan , Gao Guosheng
Published: October 2020

Objective To explore the clinical significance of serum angiotensin-converting enzyme (ACE) activity in coronavirus disease 2019 (COVID-19).Methods In this retrospective study, a total of 136 consecutive patients with confirmed COVID-19 were recruited. Demographic and clinical data were recorded. The serum ACE activity was measured at baseline and during the recovery phase, and its relationship with clinical condition was analyzed.Results Of the 136 patients with confirmed COVID-19, the 16 severe patients were older and had a higher body mass index (BMI) and proportion of hypertension than the 120 nonsevere patients. In comparison to those of normal controls, the baseline serum ACE activities of subjects in the severe group and nonsevere group were decreased, with the lowest level in the severe group. However, the serum ACE activity increased in the recovery phase, and there were no significant differences among the severe group, nonsevere group and normal control group.Conclusion Serum ACE activity could be used as a marker to reflect the clinical condition of COVID-19 since low activity was associated with the severity of COVID-19 at baseline, and the activity increased with the remission of the disease.
Surgical treatment of 125 cases of congenital diaphragmatic eventration in a single institution
Authors: Zhao Shengliang , Pan Zhengxia , Li Yonggang , An Yong , Zhao Lu , Jin Xin , Fu Jian , Wu Chun
Published: October 2020

Backgrounds: This study sought to investigate the clinical characteristics of congenital diaphragmatic eventration (CDE) and to compare the efficacies of thoracoscopy and traditional open surgery in infants with CDE. Methods: This study sought to investigate the clinical characteristics of congenital diaphragmatic eventration (CDE) and to compare the efficacies of thoracoscopy and traditional open surgery in infants with CDE. Results: A total of 108 children in this group underwent surgery, of whom 67 underwent open surgery and 41 underwent thoracoscopic diaphragmatic plication. A total of 107 patients recovered well postoperatively, except for 1 patient who died due to respiratory distress after surgery. After 1-9.5 years of follow-up, 107 patients had significantly improved preoperative symptoms. During follow-up, the location of the diaphragm was normal, and no paradoxical movement was observed. Eleven of the 17 children who did not undergo surgical treatment did not have a decrease in diaphragm position after 1-6 years of follow-up. The index data on the operation time, intraoperative blood loss, chest drainage time, postoperative mechanical ventilation time, postoperative hospital stay and postoperative CCU admission time were better in the thoracoscopy group than in the open group. The difference between the two groups was statistically significant (P<0.05). Conclusions: The clinical symptoms of congenital diaphragmatic eventration vary in severity. Patients with severe symptoms should undergo surgery. Both thoracoscopic diaphragmatic plication and traditional open surgery can effectively treat congenital diaphragmatic eventration, but compared with open surgery, thoracoscopic diaphragmatic plication has the advantages of a short operation time, less trauma, and a rapid recovery.　Thus, thoracoscopic diaphragmatic plication should be the first choice for children with congenital diaphragmatic eventration.
Association of shared decision making with inpatient satisfaction: A cross-sectional study
Authors: Luo Huiwen , Liu Guohua , Lu Jing , Xue Di
Published: October 2020

Background: We assessed inpatient perceived shared decision making (SDM) and tested the association of SDM with inpatient satisfaction in public tertiary hospitals in Shanghai, China.Methods: A cross-sectional survey was of 2585 inpatients in 47 public tertiary hospitals in Shanghai in July and August 2018 was conducted. We assessed overall SDM and 4 aspects of SDM and tested the factors influencing SDM and the association of SDM with patient satisfaction (patient satisfaction with physician services, medical expenses, outcomes and overall inpatient care), by adopting linear or two-level regression models.Results: The positive response rate (PRR) and high positive response rate (HPRR) to overall SDM among the inpatients of public tertiary hospitals in Shanghai were relatively high (95.30% and 87.86%, respectively), while the HPRR to “My physician informed me of different treatment alternatives” was relatively low (80.09%). In addition, the inpatients who underwent surgery during admission had higher HPRRs and adjusted HPRRs to overall SDM than those who did not undergo surgery. The study showed that the adjusted high satisfaction rates (HSRs) with physician services, medical expenses, outcomes and overall inpatient care among the inpatients with high level of overall SDM were higher (96.50%, 68.44%, 89.50% and 92.60%) than those among the inpatients without a high level of overall SDM (71.77%, 35.19%, 57.30% and 67.49%). The greatest differences in the adjusted HSRs between the inpatients with and without a high level of SDM were found in inpatient satisfaction with medical expenses and informed consent in SDM. Moreover, 46.22% of the variances in the HSRs with overall inpatient care across the hospitals were attributed to the hospital type (general hospitals vs. specialty hospitals).Conclusions: Inpatient PRRs and HPRRs to SDM in public tertiary hospitals in Shanghai are relatively high overall but lower to information regarding alternatives. SDM can be affected by the SDM preference of both the patients and physicians and medical condition. Patient satisfaction can be improved through better SDM and should be committed at the hospital level.
Are lifestyle factors significantly associated with self-rated health among Japanese female healthcare students?
Authors: Ohtsuki Makoto , Wakasugi Yusuke , Narukawa Takuhiro , Uehara Shunsuke , Ohkubo Takeshi
Published: October 2020

Background: Self-rated health (SRH), a subjective perception of an individual’s overall health, is widely used in public health assessment. The transition from adolescence to young adulthood is a critical period involving substantial changes in lifestyle and dietary habits. Therefore, it is important to understand SRH among young Japanese females. The present study aimed to investigate the relationships between SRH among female healthcare students and their lifestyle factors, such as living status (living with others or living alone), smoking habit, alcohol consumption, frequency of breakfast consumption (FBC), physical activity, insomnia, and physique recognition.Methods: A cross-sectional survey was conducted among a total of 1101 female healthcare students in Japan. Body mass index was calculated from body height and weight using data from periodic health examinations. Lifestyle habits, physical activity, and SRH were self-reported using several previously validated scales. Participants were classified as having either good SRH (excellent, very good, or good) or impaired SRH (fair or poor). Multivariate logistic regression analysis was performed to investigate independent relationships between SRH and lifestyle factors after adjusting for grade level.Results: We observed that 11.4% of the participants demonstrated impaired SRH. Participants with grade ≥3 showed a significantly higher percentage (13.9%) of impaired SRH compared with those with grades 1-2 (p < 0.05). Logistic regression analysis revealed that grade level, smoking habit, FBC, University of California Los Angeles activity score, Athens Insomnia Scale, and physique recognition were associated with SRH.Conclusions: Our results suggest that young Japanese females believe that skipping breakfast, smoking, lack of exercise, and insomnia are unhealthy, whereas a slender physique is healthy.
Application of Ex Vivo Liver Resection Followed by the Autotransplantation Technique in Radical Resection of Gastric Cancer Liver Metastases: A Case Report
Authors: Wang Hong , Zhang Chengcheng , Ou Yanjiao , Zhang Leida
Published: October 2020

Background: Radical resection of gastric cancer liver metastases can increase the 5-year survival rate of GCLM patients. However, patients may lose the theoretical feasibility of surgery due to the critical location of liver metastasis in some cases.Case presentation: A 29-year-old female had a chief complaint of chronic abdominal pain for one year. Abdominal CT and MRI examinations suggested a mass of unknown pathological nature located between the first and second hila and the margin of the lower segment of the right lobe of the liver. The anterior wall of the gastric antrum was unevenly thickened. The diagnosis of (gastric antrum) intramucosal well-differentiated adenocarcinoma was histopathologically confirmed by puncture biopsy with gastroscopy guidance. She underwent radical resection（excision of both gastric tumors and ELRA simultaneously）followed by XELOX adjuvant chemotherapy. Without serious postoperative complications, the patient was successfully discharged on the 20th day after the operation. Pathological examination of the excised specimen indicated that gastrectomy with D2 lymph node dissection for primary gastric tumors and R0 resection for liver metastases were achieved. The resected mass was confirmed to be poorly differentiated gastric carcinoma (hepatoid adenocarcinoma with neuroendocrine differentiation) with liver metastases in segments VIII. No recurrence or metastasis within the liver was found during a 7.5-year follow-up review that began one month after surgery.Conclusions: Application of ELRA in radical resection for GCLM can help selected patients with intrahepatic metastases located in complex sites obtain a favorable clinical outcome.
Changes in plastid biogenesis leading to the formation of albino regenerants in barley microspore culture 
Authors: Gajecka Monika , Marzec Marek , Chmielewska Beata , Jelonek Janusz , Zbieszczyk Justyna , Szarejko Iwona
Published: October 2020

Background: Microspore embryogenesis is potentially the most effective method of obtaining doubled haploids (DH) which are utilized in breeding programs to accelerate production of new cultivars. However, the regeneration of albino plants significantly limits the exploitation of androgenesis for DH production in cereals. Despite many efforts, the precise mechanisms leading to development of albino regenerants have not yet been elucidated. The objective of this study was to reveal the genotype-dependent molecular differences in chloroplast differentiation that lead to the formation of green and albino regenerants in microspore culture of barley.Results: We performed a detailed analysis of plastid differentiation at successive stages of androgenesis in two barley cultivars, ‘Jersey’ and ‘Mercada’ that differed in their ability to produce green regenerants. We demonstrated the lack of transition from the NEP-dependent to PEP-dependent transcription in plastids of cv. ‘Mercada’ that produced mostly albino regenerants in microspore culture. The failed NEP-to-PEP transition was associated with the lack of activity of Sig2 gene encoding a sigma factor necessary for transcription of plastid rRNA genes. A very low level of 16S and 23S rRNA transcripts and impaired plastid translation machinery resulted in the inhibition of photomorphogenesis in regenerating embryos and albino regenerants. Furthermore, the plastids present in differentiating ‘Mercada’ embryos contained a low number of plastome copies whose replication was not always completed. Contrary to ‘Mercada’, cv. ‘Jersey’ that produced 90% green regenerants, showed the high activity of PEP polymerase, the highly increased expression of Sig2, plastid rRNAs and tRNAGlu, which indicated the NEP inhibition. The increased expression of GLKs genes encoding transcription factors required for induction of photomorphogenesis was also observed in ‘Jersey’ regenerants. Conclusions: Proplastids present in microspore-derived embryos of albino-producing genotypes did not pass the early checkpoint of their development that are required for induction of further light-dependent differentiation of chloroplasts. The failed activation of plastid-encoded RNA polymerase during differentiation of embryos was associated with the genotype-dependent inability to regenerate green plants in barley microspore culture. The better understanding of molecular mechanism underlying formation of albino regenerants may be helpful in overcoming the problem of albinism in cereal androgenesis.
Age Differences in the Relationships between Risk Factors and Loss of Kidney Function: A General Population Cohort Study
Authors: Toyama Tadashi , Kitagawa Kiyoki , Oshima Megumi , Kitajima Shinji , Hara Akinori , Iwata Yasunori , Sakai Norihiko , Miho Shimizu , Hashiba Atsushi , Furuichi Kengo , Wada Takashi
Published: October 2020

Background: Annual decline in kidney function is a widely applied surrogate outcome of renal failure. It is important to understand the relationships between known risk factors and the annual decline in estimated glomerular filtration rate (eGFR) according to baseline age; however, these remain unclear.Methods: A community-based retrospective cohort study of adults who underwent annual medical examinations between 1999 and 2013 was conducted. The participants were stratified into different age groups (40–49, 50–59, 60–69, 70–79, and ≥80 years) to assess the risk for loss of kidney function. A mixed-effects model was used to estimate the association between risk factors and annual changes in eGFR.Results: In total, 51,938 participants were included in the analysis. The age group of ≥80 years included 8,127 individuals. The mean annual change in eGFR was -0.39 (95% confidence interval: -0.41 to -0.37) mL/min/1.73 m2 per year. Older age was related to faster loss of kidney function. In the older age group, higher systolic blood pressure, proteinuria, and current smoking were related to faster loss of kidney function (p trend <0.01, 0.03, and <0.01, respectively). Conversely, each age group showed similar annual loss of kidney function related to lower hemoglobin levels and diabetes mellitus (p trend 0.47 and 0.17, respectively).Conclusions: Higher systolic blood pressure, proteinuria, and smoking were related to faster loss of kidney function, and a greater effect size was observed in the older participants. More risk assessments for older people are required for personalized care.
Factors Influencing the Result of Superior Oblique Weakening Procedures in Patients with Superior Oblique Overaction in Horizontal Strabismus
Authors: Chun Junwoo , Kim Seong-Joon
Published: October 2020

Background

Few studies have evaluated the surgical outcome of superior oblique weakening procedures in patients with superior oblique overaction associated with exotropia or esotropia. This study aimed to evaluate the outcome of superior oblique muscle weakening and the influencing factors in patients with superior oblique overaction.

Methods

The medical charts of 37 patients (55 eyes) with superior oblique overaction associated with esotropia or exotropia who were treated with a superior oblique weakening procedure at the Seoul National University Hospital from January 2010 to June 2017 were retrospectively reviewed. Superior oblique overaction was graded using, a 6-point scale ranging from +0.5 to +3, and pre- and postoperative grades were recorded for all patients.

Results

The mean age of the patients was 91.81 ± 59.37 months. Superior oblique muscle suture spacer and superior oblique posterior tenectomy were performed for 17 (23 eyes) and 20 (32 eyes) patients, respectively. Surgical success was achieved in 15 (65.2%) eyes in the suture spacer group and 23 (71.9%) eyes in the posterior tenectomy group. Surgical success was achieved for 69.1% (38/55 eyes) of patients. Dissociated vertical deviation exhibited a significant negative association with the surgical success rate (p<0.001).

Conclusion

There was no significant difference in surgical success rate between the superior oblique posterior tenectomy and superior oblique suture spacer groups in superior oblique overaction associated with horizontal strabismus. Associated dissociated vertical deviation can affect the surgical success of the superior oblique weakening procedure.
Fine mapping of the QTL cqSPDA2 for chlorophyll content in Brassica napus L.
Authors: Ye Jingxiu , Liu Haidong , Zhao Zhi , Xu Liang , Li Kaixiang , Du Dezhi
Published: October 2020

Background

Chlorophyll is the most important factor enabling plants to absorb, transfer and transform light energy and plays an important role in yield formation. Brassica napus is one of the most important oil crops. Breeding Brassica napus for high light efficiency by improving photosynthetic efficiency has considerable social and economic value. In Brassica napus , there have been studies of the initial location of chlorophyll in seed embryos and pericarps, but there are few reports on the fine mapping of chlorophyll QTLs. We constructed near-isogenic lines (NIL), fine-mapped a chlorophyll locus, and evaluated the effect of this dominant locus on agronomic traits.

Results

The cqSPDA2 locus was mapped to an interval of 21.87-22. 91 Mb on the chromosome A02 of Brassica napus using doubled haploid (DH) lines. To fine-map cqSPDA2 , we built NIL and designed Indel primers covering the mapping interval. The 469 individuals in the BC 3 F 2 population were analyzed using these indel primers. Among the indel primers, 15 could narrow the mapping interval to 188 kb between Indel3 and Indel15. Next, 16 indel primers and 19 SSR primers were designed within the new narrower mapping interval , and 5 of the primer-amplified fragments were found to be polymorphic and tightly linked to the cqSPDA2 locus in the BC 4 F 2 population. The mapping interval was narrowed to 152 kb on A02 between SSR2 and Indel15. By gene expression analysis, we found three annotated genes in the mapping interval, including BnaA02g30260D , BnaA02g30290D and BnaA02g30310D , which may be responsible for chlorophyll synthesis.

Conclusions

The locus cqSPDA2 , a dominant QTL for chlorophyll content in Brassica napus , was fine-mapped to a 21.89-22.04 Mb interval on A02 . Three annotated genes ( BnaA02g30260D , BnaA02g30290D and BnaA02g30310D ) that may be responsible for chlorophyll synthesis were found.
Clinical Characteristics of Dry Eye with Ocular Neuropathic Pain Features: Comparison According to the Types of Sensitization Based on the Ocular Pain Assessment Survey
Authors: Kim Jonghwa , Yoon Hyeon Jeong , You In Cheon , Ko Byung Yi , Yoon Kyung Chul
Published: October 2020

Background: To compare the clinical characteristics of dry eye patients with ocular neuropathic pain features according to the types of sensitization based on the Ocular Pain Assessment Survey (OPAS).Methods: Cross-sectional study of 33 patients with dry eye and ocular neuropathic pain features. All patients had a comprehensive ophthalmic assessment including detailed history, the intensity and duration of ocular pain, the tear film, ocular surface, and Meibomian gland examination, and OPAS. Patients with <50% improvement in pain intensity after proparacaine challenge test were assigned to the central-dominant sensitization group (central group) and those with ≥50% improvement were assigned to the peripheral-dominant sensitization group (peripheral group). All variables were compared between the two groups.Results: No significant differences were observed in age, sex, underlying diseases, history of ocular surgery, duration of ocular pain, tear film, ocular surface and Meibomian gland parameters (all p>0.05). Ocular pain and non-ocular pain severity and the percentage of time spent thinking about non-ocular pain were significantly higher in the central group than in the peripheral group (all p<0.05). Central group complained more commonly of a burning sensation than did the peripheral group (p=0.01).Conclusions: Patients with central-dominant sensitization may experience more intense ocular and non-ocular pain than the others and burning sensation may be a key symptom in those patients.