bluuebunny/crossref_metadata_2025 huggingface dataset:
Beyond Viral Suppression: Quality of Life among stable ART Clients in a Differentiated Service Delivery Intervention in Tanzania
Authors: Okere Nwanneka Ebelechukwu , Censi Veronica , Machibya Clementina , Costigan Kathleen , Katambi Patrobas , Martelli Guilia , de Klerk Josien , Hermans Sabine , Gomez Gabriela , Pozniak Anton , de Wit Tobias Rinke , Naniche Denise
Published: October 2020

Background: More people living with HIV (PLHIV) in resource-limited settings are virally suppressed and living longer, mainly due to an increased access to effective antiretroviral therapy (ART). With the expansion of ART programmes, the World Health Organisation recommended differentiated service delivery (DSD) as an alternative less resource-demanding way of accessing HIV services. While maintaining quality of care and continued adherence among patients are health system’s priorities, monitoring patient’s quality of life is key to ensure sustainability and uptake of services. However, health-related quality of life (HRQoL) is understudied in sub-Saharan Africa (SSA). We aimed to assess HRQoL among stable ART clients accessing ART care in adherence clubs implemented in Tanzania. Methods: We conducted a cross-sectional survey from May to August 2019 among stable ART clients randomly sampled among those accessing clinics and clubs daily in two sites, a rural and peri-urban setting in the Shinyanga region. HRQoL data was collected, after obtaining informed consent, using the interviewer-administered Functional Assessment of HIV infection (FAHI), a validated HIV-specific HRQoL instrument. We also collected on socio-demographic, HIV care and service accessibility factors. Descriptive analysis, modified Poisson regression with robust variance and a stepwise multiple linear regression were performed to analyse HRQoL and its determinants.Results: A total of 629 participants were enrolled, of which 40% were DSD patients. DSD and clinic participants showed similar HRQoL scores [mean (SD), p value]; FAHI total [152.2 (22.2) vs 153.8 (20.6), p 0.687]. Accessibility factors, e.g. less time spent during and less frequent DSD meetings, contributed to emotional wellbeing among DSD participants compared to those in clinic (53.4% vs 18.5%,p=<0.001). Satisfactory (>80% of achievable) HRQoL scoring was independently associated with (relative risk [95% confidence interval], p value) being male (1.18[1.06-1.31], p 0.002); being married (1.22 [1.01-1.45, p 0.043); and living in an urban setting (1.28 [1.09-1.49], p 0.001). Conclusions: DSD does not appear to compromise HRQoL and, encouragingly, it could contribute to an improvement in emotional wellbeing among patients. While DSD shows promise in improving acceptability among patients and, therefore, sustainability of such services, our research highlights future research avenues to identify supporting interventions to improve other HRQoL domains among PLHIV.
Disparate Volumetric Fluid Shifts Across Cerebral Tissue Compartments with Two Different Anesthetics
Authors: Ozturk Burhan O. , Monte Brittany , Koundal Sunil , Dai Feng , Benveniste Helene , Lee Hedok
Published: October 2020

Background: Large differences in glymphatic system transport - similar in magnitude to those of the sleep/wake cycle - have been observed during anesthesia with dexmedetomidine supplemented with low dose isoflurane (DEXM-I) in comparison to isoflurane (ISO). However, the biophysical and bioenergetic tissue status underlying glymphatic transport differences between anesthetics remains undefined. To further understand biophysical characteristics underlying these differences we investigated volume status across cerebral tissue compartments, water diffusivity, and T2* values in rats anesthetized with DEXM-I in comparison to ISO. Methods: Using a crossover study design, a group of 12 Sprague Dawley female rats underwent repetitive magnetic resonance imaging (MRI) under ISO and DEXM-I. Physiological parameters were continuously measured. MRI included a proton density weighted (PDW) scan to investigate cerebrospinal fluid (CSF) and parenchymal volumetric changes, a multigradient echo scan (MGE) to calculate T2* maps as a measure of ‘bioenergetics’, and a diffusion scan to quantify the apparent diffusion coefficient (ADC). Results: The heart rate was lower with DEXM-I in comparison to ISO, but all other physiological variables were similar across scans and groups. The PDW images revealed a 1% parenchymal volume increase with ISO compared to DEXM-I comprising multiple focal tissue areas scattered across the forebrain. In contrast, with DEXM-I the CSF compartment was enlarged by ~6% in comparison to ISO at the level of the basal cisterns and peri-arterial conduits which are main CSF influx routes for glymphatic transport. The T2* maps showed brain-wide increases in T2* in ISO compared to DEXM-I rats. Diffusion-weighted images yielded no significant differences in ADCs across the two anesthesia groups. Conclusions: We demonstrated CSF volume expansion with DEXM-I (in comparison to ISO) and parenchymal (GM) expansion with ISO (in comparison to DEXM-I), which may explain the differences in glymphatic transport. We propose that tissue enlargements observed with ISO represent clusters of cellular ‘swelling’ imposing hydraulic resistance for solute and fluid transport, thereby explaining the reduced glymphatic transport with ISO compared to DEXM-I. The T2* changes in ISO are suggestive of an increased bioenergetic state associated with excess cellular firing/bursting when compared to DEXM-I.
A haemagglutination test for rapid detection of antibodies to SARS-CoV-2
Authors: Townsend Alain , Rijal Pramila , Xiao Julie , Tan Tiong Kit , Huang Kuan-Ying , Schimanski Lisa , Huo Jiandong , Gupta Nimesh , Rahikainen Rolle , Matthews Philippa , Crook Derrick , Hoosdally Sarah , Street Teresa , Rudkin Justine , Stoesser Nicole , Karpe Fredrik , Neville Matthew , Ploeg Rutger , Oliveira Marta , Roberts David , Lamikanra Abigail , Tsang Hoi , Bown Abbie , Vipond Richard , Mentzer Alexander , Knight Julian , Kwok Andrew , Screaton Gavin , Mongkolsapaya Juthathip , Dejnirattisai Wanwisa , Supasa Piyasa , Klenerman Paul , Dold Christina , Baillie J , Moore Shona , Openshaw Peter , Semple Malcolm , Turtle Lance , Ainsworth Mark , Allcock Alice , Beer Sally , Bibi Sagida , Clutterbuck Elizabeth , Espinosa Alexis , Mendoza Maria , Georgiou Dominique , Lockett Teresa , Martinez Jose , Perez Elena , Sanchez Veronica , Scozzafava Giuseppe , Sobrinodiaz Alberto , Thraves Hannah , Joly Etienne
Published: October 2020

Serological detection of antibodies to SARS-CoV-2 is essential for establishing rates of seroconversion in populations, detection of seroconversion after vaccination, and for seeking evidence for a level of antibody that may be protective against COVID-19 disease. Several high-performance commercial tests have been described, but these require centralised laboratory facilities that are comparatively expensive, and therefore not available universally. Red cell agglutination tests have a long history in blood typing, and general serology through linkage of reporter molecules to the red cell surface. They do not require special equipment, are read by eye, have short development times, low cost and can be applied as a Point of Care Test (POCT). We describe a red cell agglutination test for the detection of antibodies to the SARS-CoV-2 receptor binding domain (RBD). We show that the Haemagglutination Test (HAT) has a sensitivity of 90% and specificity of 99% for detection of antibodies after a PCR diagnosed infection. The HAT can be titrated, detects rising titres in the first five days of hospital admission, correlates well with a commercial test that detects antibodies to the RBD, and can be applied as a point of care test. The developing reagent is composed of a previously described nanobody to a conserved glycophorin A epitope on red cells, linked to the RBD from SARS-CoV-2. It can be lyophilised for ease of shipping. We have scaled up production of this reagent to one gram, which is sufficient for ten million tests, at a cost of ~0.27 UK pence per test well. Aliquots of this reagent are ready to be supplied to qualified groups anywhere in the world that need to detect antibodies to SARS-CoV-2, but do not have the facilities for high throughput commercial tests.
Distinct Cognitive and Neuroimaging Profiles in Later-Life Attention Deficit/Hyperactivity Disorder and Mild Cognitive Impairment
Authors: Callahan Brandy L. , Ramakrishnan Nayani , Shammi Prathiba , Bierstone Daniel , Taylor Rebecca , Ozzoude Miracle , Goubran Maged , Stuss Donalt T. , Black Sandra E.
Published: October 2020

Background: Attention deficit/hyperactivity disorder (ADHD) is increasingly being recognized in adults and older adults. Some of its behavioral features (e.g., distractibility, forgetfulness, impulsivity) may resemble those of mild cognitive impairment (MCI), which contributes to diagnostic uncertainty in later life. The present study aimed to systematically compare ADHD and MCI on measures of cognition and structural neuroimaging to clarify the extent of their overlap (i.e., cognitive features of ADHD that are most likely to be taken for signs of MCI) and identify potential features unique to each disorder (i.e., that may be used to guide diagnostic impressions). Methods: One hundred and six adults aged 50 years or above were recruited from a Cognitive Neurology clinic (40 ADHD, 29 MCI and 37 controls) completed a comprehensive neuropsychological battery. A subsample (n=80) underwent structural neuroimaging.Results: Memory was impaired in both patient groups, but reflected a storage deficit in MCI (supported by imaging findings of reduced hippocampal volumes) and an encoding deficit in ADHD (supported by frontal-lobe cortical thinning). Both groups performed normally on executive measures. Semantic retrieval was uniquely impaired in MCI.Conclusions: Behavioral and structural imaging features strongly suggest that ADHD and MCI are similar manifestations of separate pathophysiological processes. Although ADHD has been proposed as a risk factor or prodromal stage of neurodegeneration, we propose it is rather acting as a phenotypic mimic of MCI via overlap in memory and executive performance.
Analysis of Immune Infiltration Pattern in Osteosarcoma and Its Clinical Significance
Authors: Yuan Wenhua , Deng Yajun , Ren Enhui , Zhang Guangzhi , Wu Zuolong , Xie Qiqi
Published: October 2020

ObjectiveOsteosarcoma (OS), the most common malignant bone tumor, is prone to early metastasis and recurrence, resulting in poor prognosis. The purpose of this study was to investigate gene expression in OS samples, and to study the relationship between tumor infiltrating immune cells (TIICS) in the tumor microenvironment and the occurrence, development, and prognosis of OS. MethodsIntegrated analysis was performed on the gene expression profile of OS samples in the Therapeutically Applicable Research to Generate Effective Treatments (TARGET) database, and normal muscle tissue samples in the Genotype-Tissue Expression (GTEx) database. Screening of differentially expressed genes in OS samples and healthy muscle tissue samples was performed using R software. Functional annotation and pathway enrichment analyses were performed, a protein-protein interaction network was constructed, and the Hub genes were screened. The infiltration differences of 22 TIICs in OS samples and normal muscle tissue samples were analyzed using CIBERSORT. ROC curve, and OS survival analyses were performed on the Hub genes and 22 TIICs. The correlation between Hub genes with prognostic value and the 22 TIICs was discussed. ResultsTen Hub genes were screened. OS and normal muscle tissue samples were compared. Significant differences were observed in the infiltration of follicular helper T cells, resting NK cells, plasma cells, activated CD4 memory T cells, gamma delta T cells, monocytes, M0 macrophages and resting dendritic cells (P<0.05). ROC curve analysis showed that the area under the curve (AUC) for the 10 hub genes was 0.9 ~ 1.0, and for naive B cells (AUC=0.942), plasma cells (AUC=0.999), follicular T helper cells (AUC=0.814), resting NK cells (AUC=0.864), monocytes (AUC=0.987), and M0 macrophages (AUC=0.995). Kaplan-Meier curves revealed positive correlation between the expression levels of TNNI2, TTN, ACTN3, TNNC2, MYL3, and survival of OS patients. Correlation analysis revealed close association between ACTN3, TNNI2, TNNC2, MYL3, TTN, and the infiltration of M0 macrophages and plasma cells. ConclusionOur findings provide a theoretical basis for further study of the molecular mechanisms underlying OS development and occurrence. It serves as a reference for the development of new diagnostics, identification of prognostic biomarkers, and targeted drug therapy for OS.
PolG Inhibits Glycolysis by Suppressing PKM2 Phosphorylation Resulting Reduced Gastric Cancer Proliferation
Authors: Lv Mengzhu , Zhang Simeng , Dong Yuqing , Cao Liu , Guo Shu
Published: October 2020

Background: Gastric cancer (GC) is the fifth most frequently diagnosed cancer and the third leading cause of cancer death. There is a critical need for the development of novel therapies in GC. DNA polymerase gamma (PolG) has been implicated in mitochondrial homeostasis and affects the development of a numerous of cancer types. However, its effects in GC and molecular mechanisms remain to be fully determined. Methods: GSE62254 dataset was used to predict the impact of PolG on prognostic valule in GC patients. Lentivirus-mediated transduction was used to silence PolG expression. Western blot analysis the knockdown effect. Co-immunoprecipitation analysis was performed to explore the potential molecular mechanism. Analysis of the glycolysis process in GC cells was also performed. Cell proliferation was determined using a CCK-8 (Cell Counting Kit-8) proliferation assay. Cell migration was detected using transwell method. Animal experiment was used to measure the In vivo xenograft tumor growth.Results: GC patients with low PolG expression have worse OS and pFS . PolG binds to PKM2 and affects the activation of the Tyr105 site phosphorylation, then interfering with the glycolysis of Gastric cancer cells. In vitro tumor formation experiments in mice also confirmed that PolG knockdown GC has stronger proliferation ability. PolG can suppress GC cells growth in both vivo and vitro.Conclusion: Our study reveals a potential molecular mechanism between PolG and the energy metabolic process of GC tumor cells, suggesting PolG as an independent novel potential therapeutic target for tumor therapy.
Cancer Exosome-derived Integrin α6 and Integrin β4 Promote Lung Metastasis of Colorectal Cancer
Authors: Luo Tao , Huang Jiahao , Wu Changtao , Huang Qinghua , Zhong Huage , Qiu Guanhua , Liu Yan , Liu Junjie , Tang Weizhong
Published: October 2020

Background: Colorectal cancer (CRC) metastasis remains the major cause of the CRC mortality, while the underlying mechanisms remain to be fully understood. In this study we investigated the role of cancer exosomes in CRC lung metastasis in vivo and in vitro. Methods: Expressions of Integrinα6 and Integrin β4 were examined in CRC cells as well as released exosomes. Co-culture assay with vascular endothelial cells was also analyzed.Results: We found that Integrin α6 and Integrin β4 are overexpressed in highly tumorigenic and metastatic CRC cell lines HCT116 and SW620 and their secreted exosomes, compared to the low tumorigenic and non-metastatic CRC cell lines. Disruption of ITGA6 and ITGB4 expression in CRC decreased the proliferation and tubulogenic capacities of vascular endothelial cells significantly, while ectopic expression of ITGA6 and ITGB4 gave rise to opposite effects. Further more, we demonstrated that exosomal ITGA6 and ITGB4 promoted the lung metastasis of CRCs in vivo.Conclusions: Our study provides new insight into the molecular mechanism of CRC metastasis by which CRC-derived exosomal ITGA6 and ITGB4 induce organotropism to the lung, leading to increased tubulogenic capacity and metastasis. It also reveals a biomarker-based prediction for CRC metastasis and a novel potential therapeutic targets for CRC.
A Rare Case of Coexistence of Pituitary Stalk Interruption Syndrome and Mayer-Rokitansky-Küster-Hauser Syndrome
Authors: Ma Wanlu , Wang Xi , mao jiangfeng , Nie Min , Wu Xueyan
Published: October 2020

Background Pituitary stalk interruption syndrome (PSIS) is a rare congenital pituitary anatomical disorder. Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome is characterized by congenital absence of the uterus, cervix, and part of the vagina in phenotypically normal 46, XX females. Case presentation A young woman was initially diagnosed as MRKH syndrome based on primary amenorrhea, 46, XX karyotype, and absence of uterus or vagina. Further investigation revealed breech delivery, short stature, hypogonadotropic hypogonadism, interrupted pituitary stalk on pituitary MRI, which led to the diagnosis of PSIS. After a 12-month treatment with estradiol, no signs of uterus or vagina were found on pelvic computed tomography.Conclusions We highlight the importance of considering PSIS in the differential diagnosis of suspected MRKH syndrome in prepubertal girls or girls with delayed or absent puberty, when no uterus is visualized on imaging.
Intraoperative Ultrasound-assisted Treatment of Idiopathic Spontaneous Intramedullary Hemorrhage: A Case Report and Literature Review
Authors: Liu Chunyang , Zhu Huiqin , Yu Mingxin , Yang Bo , Zhang Xianfeng , Wang Yubo
Published: October 2020

Background: Idiopathic spontaneous intramedullary hemorrhage is a rare clinical disease. No cases of intraoperative ultrasound-assisted treatment of the disease have been reported in the literature. To present a case of idiopathic spontaneous intramedullary hemorrhage treated with intraoperative ultrasound and review the diagnosis and treatment of the disease.Case presentation: An 11-year-old child was admitted to our department because of a sudden severe pain on the left side of her back. Magnetic resonance images of the thoracic vertebrae showed abnormal signals in T2-T3 and spontaneous intramedullary hemorrhage was suspected. Intraoperative ultrasound-assisted evacuation of the intramedullary hematoma was performed and no abnormal blood vessels or malformations were found during intraoperative exploration.Conclusion: We report a rare case of idiopathic spontaneous intramedullary hemorrhage with intraoperative ultrasound-assisted hematoma clearance and a good prognosis.
Feasibility Assessment of an 8-week Attention-based Training Programme in the Management of Chronic Spontaneous Urticaria 
Authors: Ridge Katie Elizabeth , Conlon Niall , Hennessy Martina , Dunne Pádraic J
Published: October 2020

Background: Chronic spontaneous urticaria is a common disorder that is poorly understood and frequently misdiagnosed. Psychological difficulties are a significant factor in dermatological diseases and may also aggravate symptom burden. Mind-body interventions are used as a complementary approach to alleviate symptoms in chronic diseases and may represent a valuable non-pharmacological approach in CSU.Methods: We sought to develop and evaluate the feasibility of an 8-week Attention-based Training (ABT) programme, coupled to biofeedback technology for CSU. Through convergent interviews, we gathered information from individuals with urticaria about possible links between stress, mood and skin symptoms. Using these data, we recruited 12 participants to engage in an amended ABT programme for patients with CSU, comprising eight ninety minute sessions held weekly. Participants completed psychometric measures and measures of urticaria symptomatology prior to and after the intervention. Adherence to ABT practice was measured using individual Inner Balance devices which tracked heart rate variability. We completed qualitative interviews after the intervention to obtain feedback on participant experience of the programme. Results: Participants with CSU described how their psychological wellbeing can be linked to skin symptoms, poor sleep and difficulty concentrating. An amended ABT programme was found to be an acceptable component of care in the management of CSU. Retention of participants in the programme was challenging with 33% participants dropping out of the programme. For those who did complete the programme, adherence to ABT practice was impressive with 25% of participants exceeding weekly practice at week 8. A statistically significant fall in severity of urticaria symptomatology was observed upon completion of the intervention (x = 12.3 SD 3.3, p < 0.03). The most commonly cited barrier to implementation of the programme was the time commitment required.Conclusions: An ABT programme can be integrated into clinical care for CSU patients and is valued by individuals who take part. Further formal evaluation of ABT for CSU including the analysis of biochemical parameters is required to determine its role in the management of this distressing condition.
A Retrospective Study of CT-Guided Percutaneous Irreversible Electroporation (IRE) Ablation: Clinical Efficacy and Safety
Authors: Wang Ziyin , Lu Jian , Wei Huang , Wu Zhiyuan , Gong Ju , Wang Qingbing , Liu Qin , Wang Cangyi , Zhu Yu , Ding Xiaoyi , WANG Zhong-min
Published: October 2020

BackgroundTo evaluate the clinical efficacy and safety of ablating renal cell carcinoma (RCC) by irreversible electroporation (IRE). MethodsFifteen patients (19 lesions) with RCC who underwent IRE were retrospectively reviewed. Seven patients had solitary kidneys. Two lesions were located in the renal hilus. One patient had chronic renal insufficiency. Percutaneous biopsy for histopathology was performed. The best puncture path plan was evaluated before CT-guided IRE. The estimated glomerular filtration rate (eGFR) was compared vs baseline at 1-2 months after the ablation. Contrast-enhanced computed tomography imaging changes were evaluated immediately after IRE. Contrast-enhanced computed tomography/magnetic resonance was performed 1 month, 3 months, 6 months, 12 months and every year thereafter. The complications after treatment were also reviewed. ResultsThe success rate of the procedure was 100%. The mean tumor size was 2.3 cm±1.1 cm (range: 1.1-4.5 cm), with an average score of 6.5 (range 4-9) per R.E.N.A.L. criteria (radius, exophytic/endophytic, nearness to collecting system or sinus, anterior/posterior, and location relative to polar lines). Two cases (3 lesions) were punctured through the liver. In other cases, puncture was performed through the perirenal space. There were no severe complications in interventional therapy. Transient gross hematuria occurred in 2 patients (centrally located). Self-limiting perinephric hematomas occurred in 1 patient. Needle puncture path metastasis was found in 1 patient 2.5 years after IRE. The subcutaneous metastasis was surgically removed, and there was no evidence of recurrence. There was no significant change in eGFR levels in terms of short- term clinical outcomes (t=0.348, P=0.733). At 6 months, all 15 patients with imaging studies available had no evidence of recurrence. At 1 year, 1 patient (1 of 15) was noted to have experienced needle tract metastasis and accepted salvage radiofrequency ablation (RFA) therapy. ConclusionsIRE appears to be a safe and effective treatment for RCC that may offer a tissue-sparing method and complete ablation as an alternative therapy for RCC.
Exclusive Breastfeeding Continuation and Associated Factors Among Employed Women in North Ethiopia: A Cross-sectional Study
Authors: Gebrekidan Kahsu , Hall Helen , Plummer Virginia , Fooladi Ensieh
Published: October 2020

BackgroundExclusive Breastfeeding (EBF) can prevent up to 13% of under-five mortality in developing countries. In Sub-Saharan Africa the rate of EBF at six months remains very low at 36%. Different types of factors such as maternal, family-related and work-related factors are responsible for the low rate of EBF among employed women. This study aimed to assess the prevalence of EBF continuation and associated factors among employed women in North Ethiopia. MethodsA community-based, cross-sectional study was conducted in two towns of Tigray region, North Ethiopia. Employed women who had children between 6 months and 2 years were surveyed using multistage, convenient sampling. Women filled a paper-based validated questionnaire adopted from Breastfeeding and Employment Study toolkit. The questions were grouped into four parts of sociodemographic characteristics, maternal characteristics, family support and work-related factors. Factors associated with EBF continuation as a binary outcome (yes/no) were determined using multivariate logistic regression. ResultsFour-hundred and forty-nine women participated in this study with a mean (SD) age 30.4 (4.2) years. Two hundred and fifty-four (56.4%) participants exclusively breastfed their children for six months or more. The main reason for discontinuation of EBF was the requirement of women to return to paid employment (31.5%). Four-hundred and forty (98.2%) participants believed that breastfeeding has benefits either to the infant or to the mother. Three hundred and seventy-one (82.8%) of the participants received support from their family at home to assist with EBF most commonly from their husbands and mothers. Having family support (adjusted odds ratio [AOR]= 2.1, 95%, CI 1.2-3.6; P = 0.005), having frequent breaks at work (AOR= 2.6, 95% CI, 1.4-4.8; P = 0.002) and the possibility of buying or borrowing required equipment for expressing breast milk (AOR= 1.7, 95% CI, 1.0-3.0; P = 0.033) were statistically associated with increasing chance of EBF. ConclusionAlthough returning to work was reported by the study participants as the main reason for discontinuation of EBF, families and managers’ support have significant roles in EBF continuation which in the absence of six-month maternal leave for employed women in Ethiopia would be of benefit to mothers and their child.
Serum Neurofilament Measurement Improves Clinical Risk Score for Outcome Prediction After Cardiac Arrest: Results of A Prospective Study
Authors: Hunziker Sabina , Quinto Adrian , Ramin-Wright Maja , Becker Christoph , Beck Katharina , Vincent Alessia , Tisljar Kai , Disanto Giulio , Benkert Pascal , Leppert David , Pargger Hans , Marsch Stephan , Sutter Raoul , Peters Nils , Kuhle Jens
Published: October 2020

Background: A recent study found serum neurofilament light chain (NfL) levels to be strongly associated with poor neurological outcome in patients after cardiac arrest. Our aim was to confirm these findings in an independent validation study and to investigate whether NfL improves the prognostic value of two cardiac arrest risk scores.Methods: This prospective, single-center study included 164 consecutive adult cardiac arrest patients upon intensive care unit admission. We calculated two clinical risk scores (OHCA, CAHP) and measured NfL on admission using the single molecule array NF-light® assay. The primary endpoint was neurological outcome at hospital discharge assessed with the cerebral performance category (CPC) score.Results: Poor neurological outcome (CPC≥3) was found in 60% (98/164) of patients, and 55% (91/164) died. Compared to patients with favorable outcome, NfL was 14-times higher in patients with poor neurological outcome (685±1787 vs. 49±111pg/mL), with an adjusted odds ratio of 3.4 (95%CI 2.1 to 5.6, p<0.001) and an area under the curve (AUC) of 0.82. Adding NfL to the clinical risk scores significantly improved discrimination of both the OHCA score (from AUC 0.82 to 0.89, p<0.001) and CAHP score (from AUC 0.89 to 0.92, p<0.05). Admission NfL showed better outcome prediction compared to neuron-specific enolase (NSE) (AUC 0.84 vs.0.69, p=0.01).Conclusions: This study confirms the high performance of admission NfL alone and in combination with two clinical risk scores to prognosticate clinical outcome in patients after cardiac arrest. NfL should be considered as a standard laboratory measures in the evaluation of cardiac arrest patients.
Impact of Extended Duration of Polymyxin B-immobilized Fiber Column Direct Hemoperfusion on Hemodynamics, Vasoactive Substance Requirement, and Pulmonary Oxygenation in Patients With Sepsis: An Observational Study
Authors: Mitaka Chieko , Kusaoi Makio , Kawagoe Izumi , Satoh Daizoh , Iba Toshiaki , Ronco Claudio
Published: October 2020

BackgroundPolymyxin B-immobilized fiber column direct hemoperfusion (PMX-DHP) is used for patients with septic shock, and the recommended hemoperfusion period is 2 h. However, it remains unclear whether the optimal duration is 2 h or longer. The purpose of this study was to compare the effects of PMX-DHP between conventional and longer duration of PMX-DHP.MethodsWe retrospectively investigated 103 patients with sepsis who underwent PMX-DHP between April 2015 and March 2020. The demographic data, routine biochemistry, microbiological data, primary infection site were reviewed in the medical chart. The acute physiology and chronic health evaluation (APACHE) II score, sequential organ failure assessment (SOFA) score, heart rate, mean arterial pressure (MAP), vasoactive-inotropic score (VIS), respiratory rate, PaO2/FIO2, at baseline and day 3 were compared between the standard group (patients received 2 h of PMX-DHP) and extended group (patients received more than 2 h of PMX-DHP). Ventilator-free days, incidence of continuous renal replacement therapy, and 28-day mortality were also compared between the groups. ResultsMedian MAP was significantly lower and median VIS was significantly higher in the extended group at baseline (p < 0.05, 0.01, respectively) There were no significant differences in APACHE II score, SOFA score, and PaO2/FIO2 at baseline between the two groups. The increase of MAP and the decrease in VIS from baseline to day 3 were significantly greater in the extended group (p < 0.01, respectively). In the extended group, increase in PaO2/FIO2 was significantly larger in the patients who underwent ≥ 8 h duration than that in patients who underwent < 8 h duration (p < 0.01). The ventilator-free days, the incidence of continuous renal replacement therapy, and the 28-day mortality were not different between the groups.ConclusionsLonger duration of PMX-DHP effectively improved MAP and decreased the volume of vasoactive-inotropic agents compared with the conventional duration. Eight and longer hours duration of PMX-DHP improved the pulmonary oxygenation. Further studies are needed to confirm the efficacy of longer duration of PMX-DHP in patients with septic shock. (329/350 limits)
Novel Few-shots Learning Neural Network for Predicting Carbohydrate-active Enzyme (CAZyme) Affinity Towards Fructo-oligosaccharides
Authors: Liu Shaoxun , Kou Yi , Chen Lin
Published: October 2020

Background: The enzymatic activity of the microbiome toward carbohydrates in the human digestive system is of enormous health significance (Zou, Y., et al., 2019; Pinard, D., et al., 2015). Predicting how carbohydrates through food intake may affect the distribution and balance of gut microbiota remains a major challenge. Understanding the enzyme-substrate specificity relationship of the carbohydrate-active enzyme (CAZyme) encoded by the vast gut microbiome will be an important step to address this question. In this study, we seek to establish an in-silico approach to studying the enzyme-substrate binding interaction. Results: We focused on the key carbohydrate-active enzyme (CAZyme) and established a novel Poisson noise-based few-shots learning neural network (pFSLNN) for predicting the binding affinity of indigestible carbohydrates. This approach achieved higher accuracy than other classic FSLNNs, and we have also formulated new algorithms for feature generation using only a few amino acid sequences. Sliding bin regression is integrated with mRMR for feature selection. Conclusion: The resulting pFSLNN is an efficient model to predict the binding affinity between CAZyme and common oligosaccharides. This model can be potentially applied to binding affinity prediction of other protein-ligand interactions based on limited amino acid sequences.
Affinity maturation of cross-reactive CR3022 antibody against the receptor binding domain of SARS-CoV-2 via in silico site-directed mutagenesis
Authors: Pradhan Amartya , Saini Samvedna , Agarwal Manusmriti , Kumar Yatender
Published: October 2020

Background: The coronavirus disease 2019 (COVID-19) has unequivocally affected the lives of people across the planet and has imposed an unprecedented burden on our healthcare systems. With no potent regimen for treatment, there is a dire need for finding promising candidates. Receptor binding domain (RBD) of the spike protein of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of COVID-19, has proven to be a promising target owing to its role in viral invasion. Methods: Our study aimed at generating antibody candidates from the human antibody CR3022 (derived from convalescent SARS patient) against the RBD of SARS-CoV-2 via in silico affinity maturation. We optimized the paratope of the CR3022 antibody towards the RBD of SARS-CoV-2 for better binding affinity and stability, employing molecular modeling, docking, and dynamics simulations. Results: Out of seven antibody leads generated post in silico site-directed mutagenesis followed by preliminary screening, antibody named SAM3 was predicted to have the highest binding affinity towards RBD. However, molecular dynamics simulation of fifty nanoseconds set the seal on SAM1 and SAM2. Both demonstrated a higher binding affinity and stability compared to other counterparts and CR3022. Conclusion: We hypothesize that SAM1, SAM2, and SAM3 antibody candidates can bind to the RBD and potentially disrupt the viral invasion. All three antibody candidates to bind residues on the human ACE-2 binding site of SARS-CoV-2 which were not conserved from SARS-CoV. Our study calls for further in vitro and in vivo testing of SAM1, SAM2, and SAM3 candidates for COVID-19 treatment.
Estimating the proportion of asymptomatic COVID-19 cases during the first pandemic wave in Apulia region, Italy
Authors: Martinelli Domenico , Fortunato Francesca , Mazzilli Sara , Bisceglia Lucia , Lopalco Pier Luigi , Prato Rosa
Published: October 2020

In the current epidemiological situation of COVID-19 in countries such as Italy, quantifying the contribution of asymptomatic infections to SARS-CoV-2 transmission is of crucial importance for pandemic control. We conducted a retrospective epidemiological study to characterize asymptomatic COVID-19 cases occurred in the Apulia region, Italy, during the first epidemic wave of COVID-19 outbreak.We analyzed data collected in a regional surveillance platform developed to manage the emergency through investigation and follow-up of cases and contacts, contact tracing, laboratory and clinical data collection. We included asymptomatic laboratory-confirmed cases defined as persons infected with SARS-CoV-2 who did not develop symptoms/clinical signs of the disease.Between February 29 and July 7, 2020, a total of 4,536 cases were diagnosed with COVID-19 among 193.757 tests performed. The group of persons with asymptomatic SARS-CoV-2 infection consisted of 903 cases; the asymptomatic proportion was 19.9% (95%CI: 18.8-21.1%); this decreased with increasing age (OR: 0.89, 95%CI: 0.83-0.96; p=0.001), in individuals with underlying comorbidities (OR: 0.55, 95%CI: 0.41-0.73; p<0.001), and males (OR: 0.69, 95%CI: 0.54-0.87; p=0.002). The median asymptomatic infectious period was 19 days (IQR: 14-31) and the cumulative proportion of persons with resolution of infection 14 days after the first positive PCR test was 74%.In Europe and globally, there is again an increase in the number of new cases, mainly asymptomatic. As the public health community debates the question of whether asymptomatic and late spreaders could sustain virus transmission in the communities, such cases present unique opportunities to gain insight into SARS-CoV-2 adaptation to human host.
Estimating the critical points of an epidemic: An application of non-epidemiological logistic growth model for COVID-19
Authors: Allaman Ivan Bezerra , Jelihovschi Enio Galinkin
Published: October 2020

Epidemiological models have become a very important tool in understanding an epidemic development, mainly because they help researchers in finding good and new strategies in their fight against its spread. Several models have been proposed up to now, some are mathematical others apply models from other areas. The SIR and SEIR among others, mainly focus on the variable response and on epidemiological parameters as the basic reproduction number (R0) and infection rate per unit of time, nevertheless they do not focus on the variable ‘time’. We propose the use of the variable time using the logistic model as it is generally used to describe the growth of animals. This model is important because it allows the estimation of the points of acceleration and deceleration, the point of maximum growth and the asymptotic point of the epidemic. This is only possible when the epidemic curve is stable and has an ‘S’ shape. In this work we use the variable ‘accumulated cases’ of China and Italy and point out the main socioeconomic facts that occurred in each period of the estimated critical points from the logistic growth model.
Conflict-Related Population Health Research in Syria, 2011-2019: An Assessment of Information Gaps, Research Needs and Challenges, for The Lancet - AUB Commission on Syria
Authors: Abouzeid Marian , Elzalabany Manal , Nuwayhid Iman , Jabbour Samer
Published: October 2020

Backgorund. While there has been a growth of research on health and the Syrian conflict, most such research covers Syrian refugees. There is limited information about the scope and focus of research on health and population inside Syria. While there are several systemtic and scoping literarure reviews of health of Syrian refugees, there has not been a sccoping review of research literature on health issues inside Syria. Methods. As part of a broader scoping review covering January 2011 to December 2019, we examined English-language conflict-related research papers that studied health issues inside Syria and focused on Syrians or those permanently resident in Syria. We classified research articles based on the major thematic areas studied. We abstracted bibliometric information, study characteristics, funding statements and reported key limitations and challenges of conducting research. To gain additional insights or data, we examined separately publications reporting field and operational activities as well as personal reflections and narrative accounts of first-hand experiences inside Syria. Results. Of 2,088 papers identified in the scoping review, 708 (34%) exclusively focus on health issues of Syrians inside Syria, of which 350 (49%) are conflict-related with. Of conflict-related publications, 89 (25%) are research papers. Annual volume of research increased over time, from one publication in 2013 to 27 publications in each of 2018 and 2019. Damascus is the most frequently studied governorate (n=33), followed by Aleppo (n=25). Papers used a wide range of research methodologies, primarily quantitative (n=68). The country of institutional affiliation(s) of first and last authors are Syria (n=30, 20 respectively), the United States (n=25, 19 respectively) or the United Kingdom (n=12, 10 respectively). Themes most covered were health status, health system and humanitarian assistance, response or needs (n=38, 32, 26 respectively). Thirty one publications presented field and operational activities and eight publications were reflections or first-hand personal accounts of experiences inside Syria. Authors encountered contextual, methodological and administrative challenges in doing research on health inside Syria. Conclusions. Although it is commonly stated that Syria is among the most documented of recent wars, our analysis shows that a relatively limited number of research studies focused on health or populations inside Syria have been published over the nine years of the conflict. Beyond the need to increase the volume of research, it is important to address the knowledge gaps identified in this review.
Jet Fans in the Underground Car Parks and Virus Transmission 
Authors: Nazari Ata , Jafari Moharram , Rezaei Naser , Taghizadeh-Hesary Farzad
Published: October 2020

Jet fans are increasingly preferred over traditional ducted systems as a means of ventilating pollutants from large spaces such as underground car parks. The spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) -which causes novel coronavirus disease (COVID-19)- through the jet fans in the underground car parks has been considered a matter of key concern. A quantitative understanding of the propagation of respiratory droplets/particles/aerosols containing the virus is important. However, to date, studies are yet to demonstrate the viral (e.g. SARS-CoV-2) transmission in the underground car parks equipped with jet fans. In this paper, the numerical simulation has been performed to assess the eﬀects of jet fans on the spreading of viruses inside the underground car parks.
Inflammatory (Reactive) Hyperplastic conditions in puberty
Authors: Thapa Vinita , Dhawan Preeti , Khanduri Nitin , Gupta Brijesh
Published: October 2020

The gingiva is often the site of localize growth that are considered to be reactive rather than neoplastic in nature.Many of these lesions are difficult to be identified clinically and can only be identified by histological examination.Many types of localized reactive lesions occurring on the gingiva includes focal ﬁbrous hyperplasia, pyogenic granuloma, peripheral giant cell granuloma and peripheral ossifying ﬁbroma . Clinical reports of  12 and 13 year old girls with Pyogenic Granuloma and Peripheral ossifying fibroma are presented.
Willet’s distal shoe appliance for early loss of second deciduous molar: A case report with 2 year follow up
Authors: Singhal Monisha , Vashishta Vaibhav , Chauhan Ashish , Kumar Swarnkar Sandeep
Published: October 2020

Abstract

The possibilities for space loss are even higher when second primary molars are lost early because they serve as a buttress for the eruption of first permanent molar. Distal shoe space maintainer is indicated in such type of cases. It is otherwise known as intra-alveolar appliance. In this article, we report the successful use of the distal shoe space maintainer in a 4yr old child.
Effectiveness of Oral Health Education on knowledge and practice among 15 year old children of Government High Schools in Lucknow city (Uttar Pradesh).
Authors: Malhotra Shitanshu , Singh Pallavi , Dubey Himangi
Published: October 2020

Background: Oral health education, as a part of oral health promotion, has been considered as essential and basic part of dental health services.School provides a perfect setting for health education programmes aiming to control the growing burden of oral diseases and to promote oral health. Aim: To determine the impact of oral health education on oral health knowledge and practice among 15 year old school going children of government high schools in Lucknow city. Design: The schools were selected by simple random sampling method following the lottery method of selection. These classes have children of 15 years of age. Each class has two to three sections, and these sections were chosen for the purpose of data collection. Children were selected by simple random sampling technique. Results: The oral health knowledge and awareness of all children improved significantly after the education. Statistically significant increase in the proportion of correct responses was noted following the programme especially in relation to Q2, Q6, Q7, Q9 and Q10. Conclusion: The information, which children receive and the awareness that is created during the programme in school, contributes to the first tentative steps to forming their attitudes and beliefs, which may later lead to healthier choices.
Angelman Syndrome: A Rare Case Report
Authors: Gaur Balkrishn , R. Nair Gopa Kumar , Mohan Vinay , Kumar Gupta Suneel
Published: October 2020

Angelman syndrome (AS) is a rare neurodevelopmental disorder characterized by severe intellectual disability, speech delay, dysmorphic features, cognitive impairment, seizures as well as a unique behaviour with an inappropriate happy demeanor. This article discuss the case of an eight year old male patient with the chief complain of dental pain but presented with the signs of AS. He appeared hyperactive and easily excitable with an unusual laughing facial expression. His speech was impaired and showed unusual fascination towards water. Metabolic screening tests and brain Magnetic Resonance Imaging (MRI) revealed no abnormality. Genetic analysis is pathognomonic for Angelman Syndrome.
A bench-scale assessment of the effect of soil temperature on bare soil evaporation in winter
Authors: Liu Peigui , Xia Yan , Shang Manting
Published: October 2020

To quantitatively evaluate in the laboratory the effect of soil temperature on bare soil evaporation, this study uses two indoor soil columns and homogenized sand as an example to carry out the experimental study of soil temperature on bare soil evaporation in winter. The results show that the soil temperature directly affects the change in bare soil evaporation and that the effect decreases as the soil temperature decreases. Because of the influence of soil temperature, the soil water movement accelerates, and the soil water content increases. At a depth of 50 cm, the average difference in soil water content between groups A and B was 7.61%. The soil evaporation when considering the soil temperature was obviously greater than that without considering the soil temperature. This shows that in a laboratory environment where the soil temperature is higher than the room temperature in winter, the effect of the soil temperature on bare soil evaporation is significant. Soil temperature directly affects soil water movement and distribution, which is one of the important influencing factors affecting bare soil evaporation.
Probabilistic assessment of hydrologic retention performance of green roof considering aleatory and epistemic uncertainties
Authors: You Lingwan , Tung Yeou-Koung , Yoo Chulsang
Published: October 2020

Green roofs (GRs) are well known for source control of runoff quantity in sustainable urban stormwater management. By considering the inherent randomness of rainfall characteristics, this study derives the probability distribution of rainfall retention ratio and its statistical moments. The distribution function of can be used to establish a unique relationship between target retention ratio , achievable reliability AR, and substrate depth h for the aleatory-based probabilistic (AP) GR design. However, uncertainties of epistemic nature also exist in the AP GR model that makes AR uncertain. In the paper, the treatment of epistemic uncertainty in the AP GR model is presented and implemented for the uncertainty quantification of AR. It is shown that design without considering epistemic uncertainties by the AP GR model yields about 50% confidence of meeting . A procedure is presented to determine the design substrate depth having the stipulated confidence to satisfy and target achievable reliability .