bluuebunny/crossref_metadata_2025 huggingface dataset:
Outcomes of Induction Versus Spontaneous Onset of Labour at 40 and 41 Gw: Findings From A Prospective Database, Sri Lanka
Authors: Senanayake Hemantha , Mariani Ilaria , Valente Emanuelle Pessa , Piccoli Monica , Armocida Benedetta , Businelli Caterina , Rishard Mohamed , Covi Benedetta , Lazzerini Marzia
Published: June 2021

Objectives

The World Health Organization recommends induction of labour (IOL) for low risk pregnancy from 41 + 0 gestational weeks (GW). Nevertheless, in Sri Lanka IOL at 40 GW is common practice. This study compares maternal/newborn outcomes after IOL versus spontaneous onset of labour (SOL) at 40 GW (IOL40) and 41 GW (IOL41).
Methods

Data were extracted from the routine prospective individual patient database of the Soysa Teaching Hospital for Women, Colombo. IOL and SOL groups were compared using logistic regression.
Results

Of 13670 deliveries, 2359 (17.4%) were singleton and low risk at 40 or 41 GW. Of these, 456 (19.3%) women underwent IOL40, 318 (13.5%) IOL41, and 1585 (67.2%) SOL. Both IOL40 and IOL41 were associated with an increased risk of any maternal/newborn negative outcomes (OR = 2.21, 95%CI = 1.75–2.77, p < 0.001 and OR = 1.91, 95%CI = 1.47–2.48, p < 0.001 respectively), maternal complications (OR = 2.18, 95%CI = 1.71–2.77, p < 0.001 and OR = 2.34, 95%CI = 1.78–3.07, p < 0.001 respectively) and CS (OR = 2.75, 95%CI = 2.07–3.65, p < 0.001 and OR = 3.01, 95%CI = 2.21–4.12, p < 0.001 respectively). Results did not change in secondary and sensitivity analyses.
Conclusions

Both IOL groups were associated with higher risk of negative outcomes compared to SOL. Findings, potentially explained by selection bias, local IOL protocols and CS practices, are valuable for Sri Lanka, particularly given contradictory findings from other settings.
Bendamustine Plus Rituximab Versus R-Minichop as First-Line Treatment in Unfit Patients with Diffuse Large B-Cell Lymphoma
Authors: Zhang Dongdong , Liu Tao , Kaweme Natasha , Dong Youhong , Zhang Liling
Published: June 2021

Objective: To evaluate the efficacy and safety of bendamustine plus rituximab (BR) and low-does CHOP chemotherapy regimen-rituximab combination (R-miniCHOP) in elderly patients with diffuse large-B cell lymphoma, unfit for full dose immunochemotherapy.Method: Patients over 70 years with diffuse larger B-cell lymphoma or follicular lymphoma grade 3B, defined as unfit according to Comprehensive Geriatric Assessment (CGA), were included in our study. BR or R-miniCHOP was individualized according to the patients’ performance status and the presence of comorbidities. All the patients were received 4-6 cycles of immunochemotherapy at three-week intervals. Objective remission rate and adverse reaction were evaluated between the two groups.Result: This study included thirty-two patients enrolled between January 2020 and November 2020. The median age was 74 years (range 70-82). Twelve patients received BR, whereas twenty patients were treated with R-miniCHOP. The objective remission rate in the BR group was a slightly higher than the R-miniCHOP group (83.3% vs 75%), but with no statistical significance (P = 0.581). Furthermore, the objective remission rate was influenced by a serum beta 2 microglobulin concentration of 3 mg/L or less. The BR group showed a lower incidence of leukopenia than the R-miniCHOP group (P = 0.029), but had a higher incidence of fever (P = 0.036). Conclusion: BR showed equivalent efficacy but more improved safety in unfit patients with diffuse large-B cell lymphoma compared to R-miniCHOP. BR should be considered as an alternative treatment in this subgroup of patients.
Feeding a Low-protein Maternal Diet Affects Qinghai Bamei Piglet Jejunal Microbiome-metabolome Response
Authors: Jin Jipeng , Zhang Liping , Chen Qian , Ma Cunming , Jia Jianlei , Casper David. P.
Published: June 2021

This experiment investigated the impacts of feeding a maternal low-CP concentration diet having iso-essential amino acids on new born suckling piglets intestinal microbial composition and metabolic profiles. The Bamei swine breed was selected due to high meat quality and flavor, but demonstrates slower growth rates which may be related to jejunal nutrient supply. Forty randomly selected purebred Bamei sows were divided into two groups and fed a low dietary CP (12%, LP) or a normal CP (14%, CON) diet, respectively, but formulated to contain similar (iso-) essential amino acid concentrations per current recommendations. At 21 days, 12 piglets were randomly selected from each treatment and euthanized with jejunum content samples collected. The 16S rRNA gene sequencing and mass spectrometry-based metabolomics profiling were combined as an integrated approach for evaluating the functional impact of maternal CP concentrations on piglet intestinal microbiome. Even though piglets demonstrated similar 0 to 21 d ADG among treatments, the jejunum relative weight, villus width, crypt depth and muscular thickness were increased (P < 0.05), while villus height, and villus height:crypt depth were reduced (P < 0.05) for the material LP compared to the maternal fed CON diet. Maternal CP concentrations can modify the intestinal microbial composition of Bamei suckling piglets. The relative abundances of the bacterial species Escherichia-Shigella, Actinobacillus, Clostridium_sensu_stricto_1, Veillonella, and Turicibacter were increased (P < 0.05) in the maternal LP fed diet compared with the maternal fed CON diet. Jejunal digesta metabolomics analysis indicated that several amino acids were metabolized (i.e. cys, met, tyr phe and trp), biosynthesized (arg phe, tyr, and trp), or degraded (lys) were enriched (P < 0.05) for the maternal fed LP compared with the maternal fed CON. Correlation analysis demonstrated that certain intestinal bacterial genera were highly related to the histomorphology and altered intestinal microbiota metabolites. In conclusion, maternal dietary CP concentrations in excess of protein and amino acid requirements not only altered suckling Bamei piglets histomorphology, microbial composition and function, but also modulated jejunum microbial metabolic profiles, which aids in understanding the beneficial effects when feeding a maternal LP diet on piglet intestinal health.
Recycling and Biomass Influence on the Production-Based CO2 Intensity Based on Circular Economy Concept
Authors: Petkovic Biljana , Nikolic Ivica , Denic Nebojša , Petković Dalibor
Published: June 2021

In a closed loop structure, the circular economy reflects a concept for converting material and energy wastes into capital for other purposes. The circular economy's key goal is to reduce energy and material waste. The best-case scenario will be to eliminate wastes and repurpose them, which is one of the key goals of the circular economy. The circular economy and sustainable development are inextricably linked. The framework reflects resource reuse and recycling in order to reduce waste and the use of biodegradable items that can be returned to the ecosystem after rejection. Many programs are being developed to incorporate the circular economy in order to apply the system's best practices. Recycling and reusing goods for the same or new items are the best practices for reducing waste and energy consumption. The main goal of the study was to analyze the effect of waste generation and recycling on production-based CO2 intensity based on circular economy concept. For such a purpose adaptive neuro fuzzy inference system (ANFIS) was implemented since the methodology is suitable for statistical investigation of strongly nonlinear data sample due to features of fuzzy logic system. Generated and recycled waste including biomass is the most influential factors for the production-based CO2 intensity based on circular economy concept. The obtained results could represent the best practices for implementation of circular economy concept.
Simultaneous Damage to the Hepatic Artery and Common Bile Duct in a Blunt Abdominal Trauma: A Case Report
Authors: Mansoorian Mohsenreza Mansoorian , Babaei Mohammad reza , Nikkhah Mehdi , Majd Behrooz Seyedi , Alibeik Nazanin , Rahimian Neda , Bozorgmehr Ramin
Published: June 2021

Background: Diagnosis and management of extrahepatic duct injuries in blunt abdominal trauma is very difficult and challenging. First because these injuries are very rare. Also, in the management of abdominal blunt trauma, many patients are currently managed with non-surgical and conservative methods. Case presentation: A 23-year-old man who referred to General Hospital in down town of Tehran due to severe trauma in rollover motorcycle accident. There was no evidence of hemodynamic instability in emergency department. There was a drop in hemoglobin in the first week of hospitalization, which could be due by hepatic artery injury. We decided to manage hepatic artery pseudo aneurysm with interventional radiology approach. On angiography, a picture of a thrombotic pseudoaneurysm was seen, which was embolized by passing a catheter and endovascular coiling. Four days later, he presented with severe abdominal distension. In the study, the abdomen was full of fluid, which was emptied, and about 5 liters of bile were expelled. Twenty-four days after the accident, the patient underwent ERCP and a clear leak of proximal part CBD was evident. CBD stent was inserted under the guide of fluoroscopy. The patient underwent complete intravenous nutrition and the volume of discharge did not decrease during treatment. One week after starting intravenous feeding, the patient developed fever, tachycardia, and abdominal tenderness, so he underwent surgery. Severe adhesions and multiple collections were evident in the abdomen. Abdominal lavage was performed and two right and left sub-diaphragmatic drains were inserted and the abdomen was closed. Enteral feeding began 5 days after the surgery and the patient was discharged in good general condition. Conclusions: This is a rare case of simultaneous hepatic artery and common bile duct injury at the same time which manage with interventional embolization for hepatic artery pseudoaneurysm and ERCP and stenting also total parenteral nutrition for common bile duct injury at first step. At last surgery was done due to control the sepsis and abdominal collections drainage.
A Descriptive Cross-Sectional Analysis Of Potential Factors, Motivations, And Barriers Influencing Research Participation And Retention Among People Who Use Drugs In The Rural United States
Authors: Hetrick Angela T , Young April M. , Elman Miriam R. , Bielavtiz Sarann , Alexander Rhonda L. , Brown Morgan , Waddell Elizabeth Needham , Korthuis P. Todd , Lancaster Kathryn E.
Published: June 2021

Background: Despite high morbidity and mortality among people who use drugs (PWUD) in rural America, most research is conducted within urban areas. We describe influencing factors, motivations, and barriers to research participation and retention among rural PWUD. Methods: We recruited 255 eligible participants from community outreach and community-based, epidemiologic research cohorts from April-July 2019 to participate in a descriptive cross-sectional study. Eligible participants reported opioid or injection drug use to get high within 30 days and resided in high-needs rural counties in Oregon, Kentucky, and Ohio. We aggregated response rankings to identify salient influences, motivations, and barriers. We estimated prevalence ratios to assess for gender, preferred drug use, and geographic differences using log-binomial models.Results: Most participants were male (55%) and recently injected methamphetamine (61%) and/or heroin (57%). The primary influential factors for research participation are confidentiality, amount of financial compensation, and time required. Primary motivations for participation include financial compensation, free HIV/HCV testing, and linkage with resources. Changed or false participant contact information and transportation are principal barriers to retention. Respondents who prefer methamphetamines over heroin are more influenced by why their information is collected and how it is used (PR=1.12; 95%CI:1.00, 1.26). Knowing and wanting to help the research team are motivations for participation among Oregon participants (PR=2.12; 95%CI:1.51, 2.99) and females (PR=1.57; 95%CI:1.09, 2.26).Conclusions: Beyond financial compensation, researchers should emphasize confidentiality, offer testing and linkage with care, use several contact methods, aid transportation, and accommodate demographic differences to improve research participation and retention among rural PWUD.
Virtual Reality Alleviates Post-Stroke Depression by Regulating FGF21
Authors: Zhang Yihui , Xing Zekun , Xie Zhanxiang , Zhou Yuzheng , Wan Shengjie , Luo Yi , Zhou Kecheng , Jiang Songhe
Published: June 2021

Background: Post-stroke depression(PSD) lacks timely and effective treatment and virtual reality (VR) technology can create a lifelike experience and simulate users' physical presence in an immersive environment. It has been confirmed to have a positive effect on stroke and depression. Data about the efficacy VR on PSD are limited. The intensification of fibroblast growth factor 21(FGF21) can improve depression and other emotional symptoms, but there is no study on its role in PSD.Methods: We enlisted 76 PSD patients (6 lost) and divided into the experimental group and control group randomly. The patient underwent psychological rehabilitation once a week for 50 minutes each time for a total of 12 weeks. The patients in the experimental group received psychological counseling and VR rehabilitation while patients in the control group also took the same pattern but without VR rehabilitation. The Hamilton Depression Scale (HAMD) and Hamilton Anxiety Scale (HAMA) were evaluated before rehabilitation, in the 4th week and at the end of rehabilitation respectively in two groups for the sake of observing changes in the patients' depression. Then 8 people in each group did functional near-infrared spectroscopy (fNIRS), and blood samples were taken for detection with brain-derived neurotrophic factor (BDNF), IL-6, TNF-α and FGF21 by ELISA.Results: The result of fNIRS showed the hemodynamic activation in the prefrontal region of the experimental group was significantly increased. Both groups of FGF21 increased and compared with the control group, the experimental group has a greater upsurge and a faster increase rate.Conclusions: VR alleviates PSD. FGF21 is closely related to PSD，and it is likely to be a potential pathological mechanism of PSD. It suggests that VR is possible to improve PSD by increasing FGF21.Trial registration: We registered in Chinese Clinical Trial Registry which is the first level registration organization of WHO international clinical trial registration platform. The registration number is ChiCTR1900027987, the date of registration December 7, 2019.
Study of Analog/Rf and Stability Investigation of Surrounded Gate Junctionless Graded Channel MOSFET(SJLGC MOSFET)
Authors: Misra Sarita , Biswal Sudhansu Mohan , Baral Biswajit , Swain Sanjit Kumar , Pati Sudhansu Kumar
Published: June 2021

This paper explores the potential advantage of surrounded gate junctionless graded channel (SJLGC) MOSFET in the view of its Analog, RF performances using ATLAS TCAD device simulator. The impact of graded channel in the lateral direction on the potential, electric field, and velocity of carriers, energy band along the channel is investigated systematically. The present work mainly emphasises on the superior performance of SJLGC MOSFET by showing higher drain current (ID) , transconductance (gm) ,cut off frequency (fT) , maximum frequency of oscillation (fmax) , critical frequency (fK) .The drain current is improved by 10.03 % in SJLGC MOSFET due to the impact of grading the channel. There is an improvement in fT, fmax, fK by 45%, 29% and 18% respectively in SJLGC MOSFET showing better RF Performance. The dominance of the SJLGC MOSFET over SJL MOSFET is further elucidated by showing 74% improvement in intrinsic voltage gain (gm / gds) indicating its better applications in sub threshold region. But the transconductance generation factor of SJLGC MOSFET is less than SJL MOSFET in the subthreshold region. The intrinsic gate delay (ζD) of SJLGC MOSFET is less in comparison to SJL MOSFET due to the impact of lower gate to gate capacitance (CGG) suggesting better digital switching applications. The simulation results reveal that SJLGC MOSFET can be a competitive contender for the coming generation of RF circuits covering a broad range of operating frequencies in RF spectrum.
A Prediction Model for Intermediate- and High-risk Pulmonary Hypertension During the Acute Exacerbation of Chronic Obstructive Pulmonary Disease
Authors: Feng Xilian , Liang Jiahua , Chen Jiamin , Chen Weiyan , Li Hui , Zhang Wei , Yang Liuliu
Published: June 2021

Background: Pulmonary hypertension (PH) is a serious complication of COPD and is associated with poor prognosis. There are currently no established predictive models for PH during the acute exacerbation of chronic obstructive pulmonary disease (AECOPD).Objective: To establish a prediction model for intermediate- and high-risk PH in AECOPD patients.Methods: This study collected data from 203 AECOPD patients and divided the patients into a model group and an external validation group. The influence of each parameter on PH was analysed through univariate and multivariate analyses, and these data were used to build a prediction model. Finally, the discriminative ability, calibration ability and clinical efficacy of the model were tested.Result: Age, RDW-CV and RDW-SD were related to PH, so these variables were used to establish a prediction model. In addition, the discriminative ability, calibration ability and clinical efficacy of the model were affirmed.Conclusion: This study established a clinical prediction model for AECOPD patients with PH, and the prediction model has certain clinical value for assisting in the screening of intermediate- and high-risk patients with PH.
A Core Outcome Set for Clinical Trials of First- and Second-Segree Perineal Tears Prevention and Treatment: A Study Protocol for a Systematic Review and a Delphi Survey
Authors: Xiao Lin , Shi Lei , Liu Suting , Luo yuan yuan , Tian Jin hui , Zhang Lili
Published: June 2021

Background

Perineal tear is a common consequence of vaginal births affecting females globally. Even mild perineal tears could cause short- and long-term complications for females. Though many studies of interventions to prevent or treat perineal tears to minimize the consequences have been conducted, however, there is significant heterogeneity in the outcomes measured and reported in existing studies, which makes meaningful comparison difficult and makes the generalizability to clinical practice challenging. Developing a core outcome set (COS) could solve these methodological concerns. In this paper, we report a protocol to develop a COS for clinical trials of mild perineal tears, which shall assist in establishing the evidence base and implementation of effective measures to reduce the incidence and minimize the consequences of mild perineal tears.
Methods /Design:

The development of this COS will be guided by a study advisory group composed of obstetricians, midwives, nursing managers, service users and methodologists. This study will include four stages: (1) a systematic review of the literature to identify outcomes reported in prior studies; (2) a semi-structured interview with key stakeholders to collect their opinions on important outcomes; (3) a panel of experts will be invited to conduct a three-round Delphi survey to prioritize these outcomes; (4) a consensus meeting with key stakeholders to determine the list of outcomes included in the final COS.
Discussion

The development of this COS will provide an international standards for the outcomes to be collected and reported in all clinical trials and audits of practice, that involve prevention and treatment of first- and second-degree perineal tears for women with vaginal delivery. This will facilitate comparing and contrasting of studies and allow for combining of appropriate studies with the ultimate goal of improved perineal care for women choosing vaginal delivery.
A Human Resource Development Strategy for Primary Health Care: an Exploratory Study of Mixed Methods
Authors: Jia Huanhuan , Jiang Hairui , Yu Jianxing , Zhang Jingru , Zheng Zhou , Gao Shang , Shang Panpan , Cao Peng , Qiang bayuzhen , Yu Xihe
Published: June 2021

Background: The serious shortage of primary health care (PHC) providers is a common issue in the health reforms worldwide, including in China. The government of China have proposed that encouraging and guiding qualified medical personnel to work in primary medical and health care institutions (PMHCIs) is an effective way to improve the overall quality and efficiency of PHC, but it has not produced good results. The problem of insufficient human resources of PHC has not been substantially ameliorated.Methods: Based on implicit theory and lexical approach, pre-investigation was conducted to collect the items that influence the medical personnel to seek employment at PMHCIs from the perspective of guided objects. Through a three-phase investigation of 1,160 doctors in 29 public hospitals in 9 cities, the items were categorized, and a structural equation model was established and verified to explore the interrelationship of influencing factors.Results: A total of 5 factors were rotated, including Sense of Gain (SG), Internal Organization Development (IOD), Remuneration and Development (RD), Condition of the City Where the PMHCI Is Located (CCPL), Job Responsibilities (JR) and Family Support (FS). The results of the model showed that IOD, RD, JR and FS had a significantly positive effect on the SG, whereas CCPL had no significant direct effect. In addition, the FS, RD and JR significantly mediated the relationship between the internal and external environment of the institution and the willing of medical personnel to seek employment at PMHCIs. The values of fit index indicated an acceptable-fitting model.Conclusion: Family, remuneration, individual development, and job responsibility are closely related with the willingness of medical personnel to seek employment at PMHCIs, and the internal and external environment of PMHCIs is also an important factor. Based on this, targeted measures can be proposed to promote the development of PHC providers.
Long-term Quality of Life After Decompressive Craniectomy in Severe Traumatic Brain Injury and Stroke
Authors: Vicino Alex , Vuadens Philippe , Léger Bertrand , Benaim Charles
Published: June 2021

PurposeDecompressive craniectomy (DC) can rapidly reduce intracranial pressure and save lives in the acute phase of severe traumatic brain injury (TBI) or stroke, but little is known about the long-term outcome after DC. We evaluated quality of life (QoL) a few years after DC for severe TBI/stroke.MethodsThe following data were collected for stroke/TBI patients hospitalized for neurorehabilitation after DC: 1) at discharge, motor and cognitive sub-scores of the Functional Independence Measure (motor-FIM [score 13-91] and cognitive-FIM [score 5-35]) and 2) more than 4 years after discharge, the QOLIBRI health-related QoL (HR-QoL) score (0-100; <60 representing low or impaired QoL) and the return to work (RTW: 0%, partial, 100%)ResultsWe included 88 patients (66 males, median age 38 [interquartile range 26.3-51.0], 65 with TBI/23 stroke); 46 responded to the HR-QoL questionnaire. Responders and non-responders had similar characteristics (age, sex, functional levels upon discharge). Median motor-FIM and cognitive-FIM scores were 85/91 and 27/35, with no significant difference between TBI and stroke patients. Long-term QoL was borderline low for TBI patients and within normal values for stroke patients (score 58.0[42.0-69.0] vs. 67.0[54.0-81.5], p=0.052). RTW was comparable between the groups (62% full time).ConclusionWe already knew that DC can save the lives of TBI or stroke patients in the acute phase and this study suggests that their long-term quality of life is generally quite acceptable.
Chromatin Landscape Dynamics in Development of the Plant Parasitic Nematode Meloidogyne Incognita
Authors: Hassanaly-Goulamhoussen Rahim , Augusto Ronaldo De Carvalho , Marteu-Garello Nathalie , Péré Arthur , Favery Bruno , Rocha Martine Da , Danchin Etienne G.J. , Abad Pierre , Grunau Christoph , Zurletto Laetitia Perfus-Barbeoch
Published: June 2021

Background:In model organisms, epigenome dynamics underlies a plethora of biological processes. The role of epigenetic modifications in development and parasitism in nematode pests remains unknown. The root-knot nematode Meloidogyne incognita adapts rapidly to unfavorable conditions, despite its asexual reproduction. However, the mechanisms underlying this remarkable plasticity and their potential impact on gene expression remain unknown. Results:This study provides the first insight into contribution of epigenetic mechanisms to this plasticity, by studying histone modifications in M. incognita. The distribution of five histone modifications revealed the existence of strong epigenetic signatures, similar to those found in the model nematode Caenorhabditis elegans. We investigated their impact on chromatin structure and their distribution relative to transposable elements (TE) loci. We assessed the influence of the chromatin landscape on gene expression at two developmental stages: eggs, and pre-parasitic juveniles. H3K4me3 histone modification was strongly correlated with high levels of expression for protein-coding genes implicated in stage-specific processes during M. incognita development. Conclusions:We provided new insights in the dynamic regulation of parasitism genes kept under histone modifications silencing. In this pioneering study, we establish a comprehensive framework for the importance of epigenetic mechanisms in the regulation of the genome expression and its stability in plant-parasitic nematodes.
Oncotype DX RS Correlation with Clinicopathologic Risk Factors and Chemotherapy: Follow up Based on TAILORx Study
Authors: Ali Faroug , Omar Nabil , Calaud Francois , Elmistiri Mufid , Ghazouani Hafedh , ALBADR Salha , Rasul Kakil
Published: June 2021

Background: Oncotype DX risk score is a clinically validated prognostic and predictive molecular test. It estimates the recurrence and predicts the likelihood of benefit from adjuvant chemotherapy in early ER\PR positive, node-negative breast cancer. Patients are categorized into one of three tiers based on a calculated recurrence score (RS); low (<18), intermediate (18-30), and high (≥31-100) reflecting 10 years distant recurrence likelihood. 2008 NCCN guidelines recommended adjuvant endocrine therapy for low RS and adjuvant chemoendocrine therapy for high RS, but there was no clear recommendation of chemotherapy for intermediate RS (18-30). In 2018 the TAILORx re-established RS categories; a score of less than 11 is low, 11-25 is intermediate and 26-100 is high, and provided evidence to treat patients in intermediate RS category. Reviewing of Oncotype DX RS previous data in reference to TAILORx might support the optimal utility of this test which was suggested by the study. The Aim of the Study: Look for Oncotype Dx RS correlation, with clinical and pathological risk factors (age, tumor size, tumor grade, ER/PR status, tumor proliferation index) and chemotherapy based on TAILORx RS tier. Study the characteristics of patients who had cancer recurrence. Method: Retrospective data review of 54 patients who had Oncotype DX test during 2012-2017 at National Cancer Center-Qatar. Result: Of 54 patients studied 16(29.63%) had low RS, 32(59.26%) had intermediate RS, and 6(11.1%) had high RS. Univariate analysis showed that age (p<0.014), tumor grade (p<0.034), and Ki67% (cut-off 20%; p<0.013) were significantly different among Oncotype DX RS categories. There was no significant difference among Oncotype DX RS categories for tumor size (p<0.288) or PR status (cut-off 1%, p<0.3). Multivariate analysis showed that none of the clinical/pathological factors significantly predict the Oncotype DX RS. Chemotherapy was given to 1/16 (6.25%) patients with low, 7/32(21.9%) patients with intermediate, and 4/6 (66.7%) patients with high Oncotype DX RS (univariate analysis p<0.01). Although Oncotype DX RS had significant association with chemotherapy in univariate analysis, tumor size was the only predictor of adjuvant chemotherapy treatment from all factors including Oncotype DX RS (OR 2.33 CI 0.33 - 3.86, p<0.020). The majority (75%) of patients who had disease recurrence belonged to the high intermediate (16-25) Oncotype DX tier, and all were less than 50 years old in age. Conclusion: Oncotype RS correlates significantly with individual clinical risk factors including age, tumor grade, Ki67%, chemotherapy treatment. Tumor size significantly predicts adjuvant chemotherapy. Breast cancer recurrence was noticed in younger patients with high intermediate RS (16-25), and adjuvant chemotherapy may be a reasonable option for these patients.
Short Isoform Thymic Stromal Lymphopoietin Reduces Inflammation and Aerobic Glycolysis of Asthmatic Airway Epithelium by Antagonizing Long Isoform Thymic Stromal Lymphopoietin
Authors: Yu Changhui , Huang Wufeng , Zhou Zicong , Liang Shixiu , Zhou Zili , Liu Jieyi , Zhao Haijing , Liu Laiyu , Dong Hangming , Zou Fei , xi Cai Shao
Published: June 2021

Background:Up-regulation of aerobic glycolysis has been reported as a characterization of asthma and facilitates airway inflammation. We has been previously reported that short isoform thymic stromal lymphopoietin (sTSLP) could reduce inflammation in asthmatic airway epithelial. Here we wanted to investigate whether the inhibition of sTSLP on asthma is related to aerobic glycolysis. Methods:Asthmatic model was established in challenging Male BALB/c mice and 16-HBE (human bronchial epithelial) cell line with house dust mite (HDM). Indicators of glycolysis were assessed to measure whether involve in sTSLP regulating airway epithelial inflammation in asthmatic model in vivo and in vitro.Results:sTSLP decreased inflammation of asthmatic airway and aerobic glycolysis in mice. HDM or long isoform thymic stromal lymphopoietin (lTSLP) promoted HIF-1α expression and aerobic glycolysis by miR-223 to target and inhibit VHL (von Hippel-Lindau）expression 16-HBE. Inhibition of aerobic glycolysis restrained HDM- and lTSLP-induced inflammatory cytokines production. sTSLP along had almost no potential to alter aerobic glycolysis of 16-HBE. But sTSLP decreased LDHA (lactate dehydrogenase A) and LD (Lactic acid) levels in BALF, and HIF-1α and LDHA protein levels in airway epithelial of asthma mice model. lTSLP and sTSLP both induced formation of TSLPR and IL-7R receptor complex, and lTSLP obviously facilitated phosphorylation of JAK1, JAK2 and STAT5, while sTSLP induced a little phosphorylation of JAK1 and STAT5. Conclusion: We identified a novel mechanism that lTSLP could promote inflammatory cytokines production by miR-223/VHL/HIF-1α pathway to upregulate aerobic glycolysis in airway epithelial in asthma. This pathway is suppressed by sTSLP through occupying binding site of lTSLP in TSLPR and IL-7R receptor complex.
Kawasaki Disease with Dilatation of the Common Bile Duct: A Case Report and Review of Literature
Authors: Morita Atsushi , Imagawa Kazuo , Ishiodori Takumi , Tagawa Manabu , Takada Hidetoshi
Published: June 2021

Background

Kawasaki disease (KD), which was first described by Tomisaku Kawasaki in 1967, is a syndrome that results in acute systemic vasculitis, affecting mainly infants and children, and is a major cause of acquired heart disease in developed countries. KD is diagnosed based on certain characteristic symptoms and echocardiogram results. It has been reported that neck and abdominal ultrasound is also reliable diagnostic method. Nevertheless, abdominal ultrasound is not a routine procedure in KD. Moreover, dilatation of the common bile duct (CBD) has been rarely reported in previous cases.
Case presentation:

A 4-year-old boy presented with fever and markedly high transaminase level (AST, 5,323 U/L, ALT, 1,554 U/L). The patient was diagnosed as having KD based on characteristic symptoms and echocardiogram findings. Neck and abdominal ultrasound revealed dilatation of the CBD as well as cervical lymphadenopathy resembling a cluster of grapes, thickening of the gallbladder wall, and increased periportal echogenicity throughout the liver parenchyma. The patient received initial treatment with intravenous immunoglobulin (IVIG) at day 4 of fever, following which, transaminase level decreased. The patient received second-line treatment with IVIG and prednisolone because of recurrent fever on day 6. Dilatation of the CBD was improved from 6.6 mm on day 4 to 3.1 mm on day 8. Although re-dilatation was observed, it gradually diminished and normalized (4.3 mm on day 28, 4.0 mm on day 63, 3.3 mm on day 105, and 2.8 mm on day 182).
Conclusion

This case highlights the usefulness of abdominal ultrasound and the importance of considering dilatation of the CBD as one of the complications of KD. Because abdominal ultrasound is not a routine procedure in KD, it is possible that dilatation of the CBD in KD is quite latent if not investigated thoroughly. Further prospective studies to support these findings are warranted.
A Self-Assembling Blockchain-Based Database in Global Data Sharing of SARS-CoV-2
Authors: Sajedi Hedieh , Mohammadipanah Fatemeh , Davoodzadeh Melika
Published: June 2021

Background

The year 2020 has been through the occurrence of a pandemic caused by a virus known as SARS-CoV-2. The uncontrolled worldwide spread of COVID-19 and the rapid transmission of this virus lead to more and more cases, which results in a massive data stream. Each day a new set of data points are being reported regarding the number of positive test results, patients hospitalized, deaths, ventilator shortages, etc. This paper reviews Blockchain technology principles that suit it for data sharing of the pandemic and highlights the potential applications and opportunities in allying this form of data deposition and sharing for combating the COVID-19 pandemic.
Results

Blockchain has potential application in rapid data sharing of COVID-19 associated data. Data sharing using Blockchain is among the most influencing and practical approaches that healthcare data management can utilize to be more efficacious. Despite Blockchain robustness, it still has limitations that need to be considered in this paper.
Conclusions

The key concept of Blockchain technology is decentralization, which provides high performance and security for records stored on the net. Moreover, Blockchain is accessible to every participating block in the network. As a result, Blockchain can play an important role in storing and sharing medical records by giving global secure access to trusted data.
Perfusion Abnormalities Shown On Subtraction CT Angiography In Apparently Normal Lungs And Their Impact On Patient Outcome. A Prospective Cohort Study: What Could We Be Missing?
Authors: Santamarina Mario G. , Lomakin Felipe Martinez , Beddings Ignacio , Riscal Dominique Boisier , Villacís Jose Chang , Aguilera Roberto Contreras , Marambio Jaime Vidal , Mellado Eduardo Labarca , Volpacchio Mariano
Published: June 2021

Background: COVID-19 pneumonia seems to affect the regulation of pulmonary perfusion. In this study, through iodine distribution maps obtained with subtraction CT angiography, we quantified and analyzed perfusion abnormalities in patients with COVID-19 pneumonia and correlated them with clinical outcomes.Methods: 205 patients were included in this cohort, from two different tertiary-care hospitals in Chile. All patients had RT-PCR confirmed SARS-CoV-2 infection. CT scans were performed within 24 h of admission, in supine position. Airspace compromise was assessed with CT severity score, and the extension of hypoperfusion in apparently healthy lung parenchyma with perfusion score. CT severity and perfusion scores were then correlated with clinical outcomes. Multivariable analyses using Cox Proportional Hazards regression were used to control for clinical confounders.Results: Fourteen patients were excluded due to uninterpretable images. This left 191 patients, 112 males and 79 females. The mean age was 60.8±16.0 years. The median SOFA score on admission was 2 and average PaFi ratio was 250±118. Patients with severe perfusion abnormalities showed significantly higher SOFA scores and lower Pa/Fi ratios when compared to individuals with mild or moderate anomalies. Severe perfusion abnormalities were associated with an increased risk of intensive care unit (ICU) admission and the requirement of invasive mechanical ventilation (IMV).Conclusion: Patients with severe perfusion anomalies have a higher risk of admission to the ICU and IMV. Perfusion alterations could be considered as an independent risk factor in patients with COVID-19 pneumonia.Summary Statement: Lung perfusion abnormalities in patients with COVID-19 pneumonia were associated with admission to Intensive Care Unit and requirement of invasive mechanical ventilation. Perfusion abnormalities could be considered as an independent risk factor in patients with COVID-19 pneumonia.
Bioinformatics Analysis of Genes Upregulating Poor Prognosis In Colorectal Cancer And Gastric Cancer
Authors: Dong Ruizhi , Li Shaodong , Liang Bin , Kang Zhenhua
Published: June 2021

Purpose : To analyze the up-regulated genes of poor prognosis in colorectal cancer and gastric cancer by bioinformatics. Methods: We searched the gene expression profiles GSE156355 and GSE64916 in colorectal cancer and gastric cancer tissues in NCBI-GEO. With P value < 0.05 and log2>1 as the standard, Venn diagram software was used to identify the common DEGs in the two data sets. Kaplan Meier plotter was used to analyze the survival rate data of common differentially expressed genes, draw and select survival curves, and analyze their expression levels. Results: A total of 97 genes were detected to be up-regulated in the two gene expression profiles. There were 19 genes in the prognosis of gastric cancer and 15 genes in the prognosis of colorectal cancer that had significant differences in the survival rate. Among them, KCNQ1, TRIM29, GART, MSX1, SNAI1, SUV39H2, LOXL2 and KCTD14 significantly decreased the survival rate of gastric cancer and colorectal cancer. The expression of MSX1 was the highest in gastric cancer. The expression level of KCTD14 was the highest in colorectal cancer, and there was no significant difference in the expression levels of other genes. Conclusion: There are 19 and 15 genes with significantly different prognostic viability in gastric cancer and colorectal cancer, respectively. The survival rates of KCNQ1, TRIM29, GART, Msx1, SNAI1, SUV39H2, LOXL2 and KCTD14 were significantly decreased in gastric cancer and colorectal cancer. The expression of MSX1 was the highest in gastric cancer. The expression of KCTD14 was the highest in colorectal cancer.
OsWRKY62 and OsWRKY76 interact with Importin α1s for Negative Regulation of Defensive Responses in Nucleus
Authors: Xu Xiaohui , Wang Han , Liu Jiqin , Han Shuying , Lin Miaomiao , Guo Zejian , Chen Xujun
Published: June 2021

Background: OsWRKY62 and OsWRKY76, two close members of WRKY transcription factors, function together as transcriptional repressors. OsWRKY62 is predominantly localized in the cytosol. What are the regulatory factors for OsWRKY62 nuclear translocation?Results: In this study, we characterized they interacted with rice importin, OsIMα1a and OsIMα1b, for nuclear translocation. Chimeric OsWRKY62.1-GFP, which is predominantly localized in the cytoplasm, was translocated to the nucleus of Nicotiana benthamiana leaf cells in the presence of OsIMα1a or OsIMαDIBB1a lacking the auto-inhibitory importin β-binding domain. OsIMαDIBB1a interacted with the WRKY domain of OsWRKY62.1, which has specific bipartite positively charged concatenated amino acids functioning as a nuclear localization signal. Similarly, we found that OsIMαDIBB1a interacted with the AvrPib effector of rice blast fungus Magnaporthe oryzae, which contains a scattered distribution of positively charged amino acids. Furthermore, we identified a nuclear export signal in OsWRKY62.1 that inhibited nuclear transportation. Overexpression of OsIMα1a or OsIMα1b enhanced resistance to M. oryzae, whereas knockout mutants decreased resistance to the pathogen. However, overexpressing both OsIMα1a and OsWRKY62.1 were slightly more susceptible to M. oryzae than OsWRKY62.1 alone. Ectopic overexpression of OsWRKY62.1 with an extra nuclear export signal compromised the enhanced susceptibility of OsWRKY62.1 to M. oryzae.Conclusion: These results indicated that OsWRKY62 localization is a consequence of competition binding between rice importins and exportins. OsWRKY62, OsWRKY76, and AvrPib effector translocate to nucleus in association with importin α1s through new types of nuclear localization signals for negatively regulating defense responses.
Sexual Autonomy and Self-reported Sexually Transmitted Infections Among Sub-saharan African Women in Sexual Unions
Authors: Adu Collins , Mohammed Aliu , Budu Eugene , Frimpong James Boadu , Tetteh Justice Kannor , Ahinkorah Bright Opoku , Seidu Abdul-Aziz
Published: June 2021

Background Sexually transmitted infections (STIs) remain a major public health challenge worldwide. Despite the importance of sexual autonomy in the prevention and control of sexual and reproductive health disorders such as STIs, there are limited studies on the possible relationship between women’s sexual autonomy and self-reported STIs, especially in sub-Saharan Africa (SSA). This study, therefore, examined the association between sexual autonomy and self-reported STIs among women in sexual unions in SSA.Methods Data from the Demographic and Health Survey (DHS) of 31 countries in SSA conducted between 2010 and 2019 were analysed. A total of 234,310 women in sexual unions were included in the study. Data were analysed using binary logistic regression models and the results were presented as crude odds ratios (cORs) and adjusted odds ratios (aORs) at 95% confidence interval (CI). Results The prevalence of self-reported STIs among women in sexual unions in SSA was 5.8%. Approximately 83.0% of the women surveyed had sexual autonomy. Women who had no sexual autonomy were less likely to have self-reported STIs (cOR=0.52, CI: 0.46-0.54), compared to those who had sexual autonomy. Additionally, higher odds of self-reported STIs were found among women aged 25-29, compared to those aged 15-19 (aOR= 1.21, CI: 1.09-1.35); those who reside in urban areas, compared to those who reside in rural areas (aOR= 1.51, CI: 1.37-1.66) and those who were cohabiting, compared to those who were married (aOR= 1.65, CI: 1.52-1.79). On the other hand, lower odds of self-reported STIs were found among women who were exposed to newspapers (aOR= 0.89, CI: 0.82-0.95), those whose partners had primary education (aOR= 0.84, CI: 0.78-0.91), those who were not exposed to radio (aOR= 0.84, CI: 0.79-0.89), and working women (aOR= 0.86, CI: 0.80-0.93). Conclusion Findings from this study suggest that sexual autonomy is a significant predictor of self-reported STIs among women in sexual unions in SSA. Thus, instituting policies and programs that empower women and improve their levels of sexual autonomy may result in increased self-reporting of symptoms associated with STIs which subsequently help in minimising STI-related complications. Also, policies aimed at enhancing women’s sexual autonomy may reduce the burden of STIs in SSA, especially among women in sexual unions.
The Predictive Value of the Oxford Acute Disease Severity Score for Clinical Outcomes in Patients with Acute Kidney Injury: A Secondary Analysis of a Large Prospective Observational Study
Authors: Wang Na , Wang Mei-Ping , Jiang Li , Du Bin , Zhu Bo , Xi Xiuming
Published: June 2021

Background: To compare the performance of the Oxford Acute Severity of Illness Score (OASIS), the Acute Physiology and Chronic Health Evaluation II (APACHE II) score, the Simplified Acute Physiology Score II (SAPS II) and the Sequential Organ Failure Assessment (SOFA) score in predicting 28-day mortality in acute kidney injury (AKI) patients.Methods: Data were extracted from the Beijing Acute Kidney Injury Trial (BAKIT). 2,954 patients with complete clinical data were included in this study. We calculated the OASIS, APACHE II, SAPS II and SOFA within the first day of ICU admission. Receiver operating characteristic (ROC) curves were used to analyse and evaluate the predictive effects of the four scoring systems on the 28-day mortality risk of AKI patients and each subgroup. The best cut-off value was identified by the highest combined sensitivity and specificity using Youden’s index. The significance level was set at 5%.Results: Among the 2,954 patients, the 28-day mortality rate was 17.0% (501 patients died). The OASIS, APACHE II, SAPS II and SOFA of nonsurviving patients were higher than those of surviving patients with AKI. The 28-day mortality of AKI patients increased accordingly with the increase in OASIS. Among the four scoring systems, the area under the curve (AUC) of OASIS was the highest. The comparison of AUC values of different scoring systems showed that there were no significant differences among OASIS, APACHE II and SAPS II, which were better than SOFA. Moreover, logistic analysis revealed that OASIS was an independent risk factor for 28-day mortality in AKI patients, whether as a continuous variable or a categorical variable. OASIS also had good performance in predicting ICU mortality and in-hospital mortality in AKI patients and had good predictive ability for the 28-day mortality of each subgroup of AKI patients.Conclusion: OASIS, APACHE II and SAPS II all presented good discrimination and calibration in predicting the 28-day mortality risk of AKI patients. OASIS, APACHE II and SAPS II had better predictive accuracy than SOFA, but due to the complexity of APACHE II and SAPS II calculations, OASIS is a good substitute.Trial RegistrationThis study was registered at www.chictr.org.cn (registration number Chi CTR-ONC-11001875). Registered on 14 December 2011.
Costs Related to Immunopreventable Diseases: Brazil and Its Geographic Areas (Immunopreventable Diseases’ Costs in Brazil)
Authors: Costa Elide Sbardellotto Mariano da , Hyeda Adriano , Maluf Eliane M Cesario Periera
Published: June 2021

Introduction: the occurrence of the immunopreventable diseases in a population global reality. Objective: to discriminate the direct costs of the hospitalizations from the immunopreventable diseases in the Unified Health System (SUS), in Brazil and their areas, between 2008 and 2018. Methods: A population, observational, descriptive and retrospective study, with data from the information supplied by the DATASUS website, these data were collected during the 2019. Results: It was identified 457,479 hospitalizations in the period; with a total of 2,450,870 days of hospital stay, with total costs of R$389,243,264.85. Only the disease mumps presented a growing tendency in whole areas; the chickenpox was decreasing; the illness whooping cough, yellow fever and tetanus were stationary in this period. Conclusions: The costs related to immunopreventable diseases were relevant in all the Brazil areas, with tendencies different between the geographic areas and between the several illnesses analyZed.
KEY WORDS: Hospital Costs; Communicable diseases; Vaccines; Unified Health System