bluuebunny/crossref_metadata_2025 huggingface dataset:
What Kinds of Advantages and Disadvantages Is May Merging Health Insurance Funds Bring About? A Qualitative Policy Analysis from Iran
Authors: Bazyar Mohammad , Yazdi-Feyzabadi Vahid , Rahimi Nouroddin , Rashidian Arash
Published: June 2020

Background: Fragmentation in health insurance system is a major concern in health financing. One possible solution to overcome problems resulting from fragmentation is combining risk pools together. This study aims to realize the potential advantages and disadvantages of merging health insurance funds. Methods: In this qualitative study, a purposeful sampling with maximum variation was used to obtain representativeness and rich data. Sixty face-to-face interviews were conducted. The documentary review was used as a supplementary source of data collection. Content analysis using the 'framework method' was used to analyze the qualitative data. Results: The results of this study indicated that there are diverse positive and negative consequences for merging health insurance funds in Iran. These are categorized into seven categories, including governance/stewardship, financing, population, basic benefit package, structure, operational procedures, and interaction with providers. Control of total health care expenditures; improving strategic purchasing; removing duplication in population coverage; centralizing the profile of providers in a single database and reducing fraud and controlling the volume of health care services provided by the providers; interaction of hospitals with single insurance with a single set of instructions for contracting, claiming review and reimbursement; reducing administrative and overhead costs were among the main benefits of merging mentioned by interviewees. The following drawbacks were raised as well: the unwillingness of the social security organization to collect insurance premiums from private workers actively as before; increasing dissatisfaction among population groups enjoying generous basic benefits package at the current situation; risk of financial fraud and corruption due to gathering all premiums in a single bank; and risk of putting more financial pressure on the providers in case of delay in reimbursement by the single-payer. Conclusions: Implementation of merging health insurance schemes in Iran would be influenced by a wide range of potential merits and drawbacks. Thus, to facilitate the process and lessen the opposition of opponents, policy makers should act as brokers taking into account the contextual factors and adopting tailored policies to maximize the benefits and minimize the potential drawbacks of consolidation in Iran.
Predicting developmental dysplasia of the hip in at-risk newborns
Authors: Roposch Andreas , Protopapa Evangelia , Malaga-Shaw Olivia , Gelfer Yael , Humphries Paul , Ridout Deborah , Wedge John H.
Published: June 2020

Background: The development of developmental dysplasia of the hip can be attributed to several risk factors and often in combination with each other. When predicting the likelihood of developing this condition, clinicians tend to over and underestimate its likelihood of occurring.Therefore, the study aim is to determine among at-risk newborns how to best predict developmental dysplasia of the hip (DDH) within 8 weeks post-partum.Methods: Prospective cohort study in secondary care. Patient population included newborns at-risk for DDH – we assessed 13,276 consecutive newborns for the presence of DDH risk factors. Only newborns with at least one of the predefined risk factors and those showing an abnormal examination of the hip were enrolled (n=2,191). For the development of a risk prediction model we considered 9 candidate predictors and other variables readily available at childbirth. The main outcome measure was ultrasonography at a median age of 8 weeks using consensus diagnostic criteria; outcome assessors were blinded. Results: The risk model includes four predictors: female sex (OR=5.6; 95% CI: 2.9-10.9; P<0.001); first degree family history of DDH (OR=4.5; 95% CI: 2.3-9.0; P<0.001), birthweight >4000g (OR=1.6; 95% CI: 0.6-4.2; P=0.34), and abnormal examination of hip (OR=58.8; 95% CI: 31.9, 108.5; P<0.001). This model demonstrated excellent discrimination (C statistic=0.9) and calibration of observed and predicted risk (P=0.35). A model without the variable ‘hip examination’ demonstrated similar performance.Conclusion: The risk model quantifies absolute risk of DDH within 8 weeks postpartum in at-risk newborns. Based on clinical variables readily available at the point of childbirth, the model will enhance parental counselling and could serve as the basis for real time decisions prior to discharge from maternity wards.
A prospective feasibility study of one-year administration of adjuvant S-1 therapy for resected biliary tract cancer in a multi-institutional trial (Tokyo Study Group for Biliary Cancer: TOSBIC01)
Authors: Itano Osamu , Takemura Yusuke , Kishida Norihiro , Tamagawa Eiji , Shinozaki Hiroharu , Ikeda Ken , Urakami Hidejiro , Ei Shigenori , Hayatsu Shigeo , Suzuki Keiichi , Sakuragawa Tadayuki , Ishii Masatsugu , Shito Masaya , Aiura Koichi , Fujisaki Hiroto , Takano Kiminori , Matsui Junichi , Minagawa Takuya , Shinoda Masahiro , Kitago Minoru , Abe Yuta , Yagi Hiroshi , Oshima Go , Hori Shutaro , Kitagawa Yuko
Published: June 2020

Background: Although surgery is the definitive curative treatment for biliary tract cancer (BTC), outcomes after surgery alone have not been satisfactory. Adjuvant therapy with S-1 may improve survival in patients with BTC. This study examined the safety and efficacy of 1 year adjuvant S-1 therapy for BTC in a multi-institutional trial. Methods: The inclusion criteria were as follows: histologically proven BTC, Eastern Cooperative Oncology Group (ECOG) performance status 0 or 1, R0 or R1 surgery performed, cancer classified as Stage IB to III. Within 10 weeks post-surgery, a 42-day cycle of treatment with S-1 (80 mg/m2/day orally twice daily on days 1–28 of each cycle) was initiated and continued up to 1 year post surgery. The primary endpoint was adjuvant therapy completion rate. The secondary endpoints were toxicities, disease-free survival (DFS), and overall survival (OS).Results: Forty-six patients met the inclusion criteria of whom 19 had extrahepatic cholangiocarcinoma, 10 had gallbladder carcinoma, 9 had ampullary carcinoma, and 8 had intrahepatic cholangiocarcinoma. Overall, 25 patients completed adjuvant chemotherapy, with a 54.3% completion rate while the completion rate without recurrence during the 1 year administration was 62.5%. Seven patients (15%) experienced adverse events (grade 3/4). The median number of courses administered was 7.5. Thirteen patients needed dose reduction or temporary therapy withdrawal. OS and DFS rates at 1/2 years were 91.2/80.0% and 84.3/77.2%, respectively. Among patients who were administered more than 3 courses of S-1, only one patient discontinued because of adverse events.Conclusions: One-year administration of adjuvant S-1 therapy for resected BTC was feasible and may be a promising treatment for those with resected BTC. Now, a randomized trial to determine the optimal duration of S-1 is ongoing.Trial registration: UMIN-CTR, UMIN000009029. Registered 5 October 2012-Retrospectively registered, https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000009347)
Clouds over IEMs? Perspectives for inherited metabolic diseases in adults from a retrospective cohort study in two Swiss adult metabolic clinics
Authors: Gariani Karim , Nascimento Marina , Superti-Furga Andrea , Tran Christel
Published: June 2020

Background: Inherited metabolic diseases (IMD) are complex medical conditions. Thanks to improvements in diagnosis and treatment, a growing number of pediatric IMD patients reach adulthood. Thus, clinical care of adults with IMD has emerged as a new and challenging reality. This purpose of this study of adults with IMD in an adult metabolic clinic at two academic hospitals (Lausanne and Geneva) was to help inform decisions on the future organization of health care for this group of patients. Methods: All adult patients with a biochemical and/or genetic diagnosis of IMD followed at the clinic were included in the study. Electronic patient records were reviewed for clinical features, diagnostic studies, treatment and long-term outcome. Data of undiagnosed patients referred for suspected IMD were analyzed separately. Results: 126 patients were included in the study. The most prevalent group of diseases was small molecules disorders with 82 (65%) patients, followed by energy defects disorders with 29 (23%) patients and complex molecules disorders with 15 (12%) patients. Overall, 64% of patients were diagnosed before, and 36 % after the age 16 years. Among the 126 cases, 51% suffered from medical complications. 79% of the patients were receiving a specific treatment for their disease. Among the 138 undiagnosed patients referred for suspicion of IMD, investigations lead to a genetic diagnosis in 24 (17%) patients. 19 had confirmation of an IMD, 5 were found to have another genetic condition. Conclusions: This retrospective study reveals significant features of adult IMD cohort. The disorders are heterogeneous, and there is no one-size-fits-all approach – treatment must be tailored to fit each specific disorder in each individual patient. Even patients who are followed at the dedicated clinic are not protected from metabolic decompensations and/or chronic organ-specific complications. While it is commonly assumed that patients with IMD are more stable once they become adults, our data show that the diseases continue to exact a lifelong toll. A coordinated monitoring of target organs by a multidisciplinary team is needed. To ensure that the success in diagnosis and treatment of individuals with IMD is sustained, there is a clear requirement for adequately staffed adult IMD clinics.
Somatic mutation detection efficiency in EGFR: a comparison between High Resolution Melting Analysis and Sanger Sequencing
Authors: Joy Reenu Anne , Thelakkattusserry Sukrishna Kamalasanan , Vikkath Narendranath , Bhaskaran Renjitha , Vasudevan Damodaran , Krishnan Sajitha , Ariyannur Prasanth S.
Published: June 2020

Background: The current study focuses on comparing the mutation detection efficiency of High-Resolution Melt Analysis (HRM) with Sanger Sequencing in EGFR gene.Methods: The minor allele frequency of somatic mutations was titrated against total DNA concentration using Sanger sequencing and HRM. Somatic mutation detection efficiency, for exons 19 & 21 of the EGFR gene, was compared in 116 formalin fixed paraffin embedded tumor tissues, after screening 275 tumor tissues by Sanger sequencing.Results: The limit of detection of minor allele fraction of exon 19 mutation was 1% with Sequencing, and 0.25% with HRM, whereas for exon 21 mutation, 0.25% MAF was detected using both methods. All mutation positive samples detected by Sanger sequencing, were also detected by HRM. About 28% cases in exon 19 and 40% in exon 21, detected as mutated in HRM, were not detected by sequencing. Overall, sensitivity and specificity of HRM were found to be 100% and 67% respectively, and the negative predictive value was 100%, while positive predictive value was 80%.Conclusion: The comparative series study suggests that HRM is a modest initial screening test for somatic mutation detection of EGFR, which must further be confirmed by Sanger sequencing.
Survival benefit of surgical resection after first-line triplet chemotherapy and bevacizumab in patients with initially unresectable metastatic colorectal cancer
Authors: Elshenawy Mahmoud A. , Badran Ahmed , Aljubran Ali , Alzahrani Ahmed , Rauf M. Shahzad , Eldali Abdelmonem , Bazarbashi Shouki
Published: June 2020

Background: Surgical resection of metastatic disease in patients with initially non-resectable colorectal cancer (CRC) has improved overall survival. Intensified chemotherapy regimens have increased the probability of converting unresectable metastasis to resectable. Here we report the result of combining intensive chemotherapy (triplet) and surgical resection of metastatic lesions in patients with metastatic CRC. Patients and methods: Patients with unresectable metastatic CRC were enrolled in phase I/II trial of triplet chemotherapy consisting of Capecitabine, oxaliplatin, Irinotecan, and Bevacizumab. Patients were given 5-8 cycles induction chemotherapy of the above regimen followed by maintenance capecitabine and bevacizumab until disease progression, unacceptable toxicity or patient request. All patients were assessed at a multidisciplinary conference for possible surgical resection of their metastatic disease at the time of inclusion in the trial and two-monthly intervals thereafter. Patients who underwent R0 resection of their metastatic disease received adjuvant oxaliplatin and capecitabine to complete a total of 6 months of chemotherapy. Results: Fifty-three patients were enrolled. The median age was 52 years (range 23-74), 29(55%) were males, ECOG PS 0-1 was 13(66%), 11 (42%) had a right-sided tumor, 29 (55%) had resection of their primary tumor, 22(42%) had a single metastatic site and 8 (15.1%) had a liver-limited disease. Thirteen patients (24.5%) underwent surgical resection of residual metastatic disease +/- the primary tumor with 10 (18.9%) of them were R0. The surgical group had higher incidence of males compared to non-surgical group ( 69.3% vs 47.2%,p = 0.2), equal performance status, lower median number of metastatic sites (1 vs 2, p=0.09), higher mutant Kras (53.8 % vs 34.2%, p=0.3) and higher response rate ( 84.6% vs 56.2%, p=0.3). With a median follow up duration of 89 months, the median PFS for the whole group was 16.1 months [95% confidence interval (CI); 9.1-20] and the median OS was 28.2 months (95% CI; 22.5-53.3). The median PFS for the surgery group was 18.9 months (95% CI; 12.6-not reached) compared to 9.6 months (95% CI; 7.0-18.3) for the non-surgical group, Log-rank p =0.0165. The median OS for both groups was not reached (95% CI; 53.3-not reached) and 23.2 months (95% CI; 17.0-28.4) respectively, Log-rank p=0.0006). Five-year PFS and OS for the surgery group were 46.2% and 67.6% respectively. Conclusions: Patients with unresectable metastatic CRC and fit for triplet chemotherapy should have the benefit of combining this intensified regimen and surgical resection of their metastatic disease if possible. Trial registration: Clinicaltrials.gov, NCT01311050, registered March,06,2011, retrospectively registered. https://ClinicalTrials.gov/show/NCT01311050.
Prevalence and risk factors for mental health problems and suicidal expressions among young male prisoners in Cambodia: A cross-sectional study
Authors: PAT Puthy , Richter-Sundberg Linda , Jegannathan Bhoomikumar , Edin Kerstin , Sebastian Miguel San
Published: June 2020

Background: incarceration and mental health problems are empirically known to have a strong association. Many studies have confirmed the high prevalence of mental health problems among young prisoners in particular, yet none have been conducted in Cambodia. Objectives: this study aimed first to assess the prevalence of mental health problems and suicidal expressions among young prisoners, and second, to determine the risk factors associated with these two outcomes in Cambodia. Method: a cross-sectional study among 572 young male prisoners between the ages of 15 and 24 from three prisons was conducted. Sociodemographic data and detailed information on participants’ profiles were gathered, and the Youth Self-Report (YSR) and the Attitude towards Suicide (ATTS) questionnaires were applied. Results: anxiety-depression affected 52.10% of the respondents with a similar prevalence of withdrawal depression, somatic complaints, social problems, and aggressive behaviours (around 46%). Mental health problems were strongly associated with younger age, lower educational background, and less time spent in prison. Around half (51.05%) considered life to be meaningful while 16.26% had thoughts about their own death, and 12.06% expressed wishes to die. Suicide ideation, planning, and attempts were reported by almost 6.82%, 1.75% and 2.80% of participants respectively. Prisoners who used drugs prior to imprisonment thought about death significantly more than their counterparts while suicide ideation was reported to be significantly lower among prisoners with higher education. Conclusion: the prevalence of mental health problems among young male prisoners was considerably high, while suicide expressions were reported to be lower compared to studies from other countries. This study highlights the need for implementing preventive interventions integrated into the prison health care system to im­prove the mental health of young prisoners.
Double QSSE innovative hospital management model based on JCI standard and its application in private hospital in China
Authors: Yali Zong , Zheng Dawei
Published: June 2020

BackgroundThe Joint Commission on International Accreditation of Health Care Organizations (JCI) standard is a hospital accreditation standard recognized by the medical industry worldwide. However, the previous Chinese hospital management model cannot be fully integrated with the JCI standard. The purpose of this study is to explore a new Chinese hospital management mode that adapts to JCI standard.MethodsThis article retrospectively analyzed the initial results of the operation of the double QSSE management mode at Xuzhou Renci Hospital, a Chinese private hospital from 2016 to 2018. The innovation mode combines the four elements of patients' needs "Quaesitum, Solicitude, Surroundings, and Expenditure" with the four core contents of hospital management "Quality, Service, Staff and Economic operation".ResultsAfter two years implementation of the model, Xuzhou Renci hospital has reached a series of achievements, including being elected as the honest private hospitals and ranking first, achieved the highest grade of "special satisfaction" in the third-party hospital satisfaction survey organized by the government; being rated as "the most beautiful hospital in China" and awarded the title of "the most beautiful hospital in China—the light of the city"; promoted to the third-grade orthopedic hospital in 2019; ranked in the forefront of original non-public hospitals in northern Jiangsu Province in the Chinese hospital competitiveness conference hosted by Asclepius Health in Hong Kong 2019; recognized as the "safe demonstration hospital" in Jiangsu Province 2019.ConclusionThe double QSSE refined management mode has the characteristics of standardization, quantification, comparison, easy assessment and easy replication, which improves not only the patient-centered medical experience, but also the hospital-department quality management system. It is an innovative hospital management mode that conforms to JCI standard and adapts to China's national conditions.
The significance of blood cell biomarkers in the prognosis of gastric cancer
Authors: Huang Pu , Zhang Yiran , Wang Anqiang , Bu Zhao-de
Published: June 2020

Background Studies have shown that inflammation-associated blood cell markers are associated with prognoses in a variety of tumors. However, the prognostic significance of these markers for gastric cancer (GC) is still not very clear. This article aims to explore its value of GC prognostic assessment.Methods From July 2011 to July 2016, 353 GC patients with surgical treatment were enrolled in this retrospective study. Patients’ demographics were analyzed along with clinical and pathologic data. The chi-square test was used to evaluate relationships between the markers and other clinicopathological variables; The Kaplan–Meier method and Cox regression proportional hazard model were performed to evaluate prognostic factors.Results Univariate analysis indicated T stage, N stage, vascular tumor thrombus, tumor long diameter, Bormann Classification, preoperative MWR (monocyte/leukocyte ratio), preoperative serum CEA levels are prognostic factors for GC. Multivariate analysis showed that preoperative MWR, tumor differentiation, and tumor length were independent prognostic factors in patients with GC. The boundary value of MWR is 0.8.Conclusion Preoperative MWR was convenient, simple marker of gastric cancer, might be useful for the evaluation of prognosis of patients with GC. Comparing with TNM stage, tumor differentiation was a more reliable pathological factor evaluating recurrence.
Upper and lower bounds of the ﬁrst exit time of Brownian motion from The Minimum and Maximun Parabolic Domains with variable dimension to research the variation of biological species
Authors: Liu Chao , Che Wenbin , Zhang Jingjun
Published: June 2020

Consider a Brownian motion with variable dimension starting at an interior point of the minimum or maximum parabolic domains Dmax t and Dmin t in Rd(t)+2, d(t) ≥ 1 is an increasing integral function as t →∞,d(t) →∞, and let τDmax t and τDmin t denote the ﬁrst time the Brownian motion exits from Dmax t and Dmin t , respectively. Upper and lower bounds with exact constants for the asymptotics of logP(τDmax t > t) and logP(τDmin t > t) are given as t → ∞, depending on the shape of the domain Dmax t and Dmin t . The methods of proof are based on Gordon’s inequality and early works of Li, Lifshits and Shi in the single general parabolic domain case.
The Association Between Hepatitis C Virus Infection and Renal Cell Cancer, Prostate Cancer, and Bladder Cancer: A Systematic Review and Meta-Analysis
Authors: Jian Zhongyu , Ma Yucheng , Li Hong , Wang Kunjie
Published: June 2020

Background: To update the current evidence on whether hepatitis C virus (HCV) infection represents a possible risk factor for renal cell cancer (RCC), prostate cancer (PCa) and bladder cancer (BC). Methods: We searched literatures on Pubmed, Web of Science and Embases before February 2020. A systematic review and meta-analysis were performed. Results: Finally, we extracted 12 studies based on the eligible criteria. Across 11 studies for HCV and RCC, the incorporated RR was 1.28 (95% CI 1.05-1.55), which meant that participants with HCV infection were associated with a higher risk of RCC. The pooled RR in hazard ratio (HR) subgroup (HR 1.59, 95% CI 1.22-2.08), cohort studies (CS) subgroup (RR 1.47, 95% CI 1.18-1.82), and North America subgroup (RR 1.71, 95% CI 1.40-2.09) detected a stronger association between HCV and RCC risk. Although an inverse association was seen for PCa (RR 0.75, 95% CI 0.54-1.03) across 7 studies, it was not statistically significant (P = 0.075). There was no significant association between HCV and BC with an incorporated RR of 0.92 (95% CI, 0.82-1.03) across 5 studies.Conclusions: Our study demonstrated that HCV infection was significantly associated with increased RCC risk. There appeared to be an inverse association for HCV in PCa risk but no statistically significant. No significant association was found between HCV and BC risk. Prospective, large-scale and well-designed cohort studies are required to validate the association between HCV and RCC, and to investigate the role of HCV on PCa.
Multi-omics analysis provides insights into lignocellulosic biomass degradation by Laetiporus sulphureus ATCC 52600
Authors: de Oliveira Ana Carolina Piva , de Figueiredo Fernanda Lopes , Gonçalves Thiago A , Terrasan Cesar RF , Tomazetto Geizecler , Persinoti Gabriela F , Rubio Marcelo V , Gerhardt Jaqueline A , Silvello Maria AC , Franco Telma T , Goldbeck Rosana , Squina Fabio , Damasio André
Published: June 2020

Background: Wood-decay basidiomycetes are effective for the degradation of highly lignified and recalcitrant substrates. Brown-rot strains produce carbohydrate-active enzymes involved in the degradation of lignocellulosic materials, along with a non-enzymatic mechanism via Fenton reaction. Differences in the lignocellulose metabolism among closely related brown rots are not completely understood. Here, a multi-omics approach provided a global understanding of the strategies employed by L. sulphureus ATCC 52600 in the degradation of lignocellulosic by-products derived from sugarcane and Eucalyptus. Results: To evidence the oxidative-hydrolytic mechanism, the Laetiporus sulphureus ATCC 52600 genome was sequenced and the response to lignocellulosic substrates was analyzed by transcriptomics and proteomics. The transcriptomic profile in response to a short cultivation period on in natura sugarcane bagasse revealed 128 out of 12,802 upregulated transcripts. The high upregulated transcripts included a set of redox enzymes along with hemicellulases. The exoproteome produced in response to extended time cultivation on Avicel, and steam-exploded sugarcane bagasse, sugarcane straw, and Eucalyptus (from Eucalyptus grandis) revealed 121 proteins. Contrasting with the mainly oxidative profile observed in the transcriptome, the secretomes showed a diverse hydrolytic repertoire including constitutive cellulases and hemicellulases, in addition to 19 upregulated proteins relative to glucose. The secretome produced on sugarcane bagasse was evaluated in the saccharification of pretreated sugarcane straw by supplementing a commercial cocktail. Additionally, growth analysis revealed that L. sulphureus ATCC 52600 has higher efficiency to assimilate glucose than other mono- and disaccharides.Conclusion: This study shows the singularity of L. sulphureus ATCC 52600 compared to other Polyporales brown rots, regarding the presence of cellobiohydrolase and peroxidase class II. The multi-omics analysis reinforces the oxidative-hydrolytic metabolism involved in lignocellulose deconstruction, providing insights into the overall mechanisms as well as specific proteins of each step.
The potential role of serum angiotensin-converting enzyme in the coronavirus disease 2019
Authors: Zhu Zhe , Cai Ting , Fan Lingyan , Lou Kehong , Hua Xin , Huang Zuoan , Gao Guosheng
Published: June 2020

Objective To explore the clinical significance of serum angiotensin-converting enzyme (ACE) in the coronavirus disease 2019 (COVID-19).Methods In this retrospective study, a cohort of 136 consecutive patients with confirmed COVID-19 was recruited. Demographics and clinical data were recorded. The serum ACE activity were measured at baseline and recovery phase, and its relationship with clinical condition was analyzed.Results Of the 136 patients with confirmed COVID-19, 16 severe cases were older, had higher body mass index (BMI) and proportion of hypertension when compared with 120 non-severe cases. In comparison to normal controls, the baseline serum ACE activity in the severe group and non-severe group were both decreased, with the lowest level in the severe group. However, the serum ACE activity raised in the recovery phase, and there were no significant differences among severe group, non-severe group and normal controls.Conclusion Serum ACE could be used as a marker to reflect the clinical condition of COVID-19, since its low level was associated with the severity of COVID-19 at baseline, and it increased with the remission of the disease.
No detection of SARS-CoV-2 RNA on urethral swab in patients with positive naso-pharyngeal swab
Authors: Spirito Lorenzo , Pinchera Biagio , Patrì Angela , Delfino Mario , Imbimbo Ciro , Salvatore Paola , Gentile Ivan , Fabbrocini Gabriella
Published: June 2020

Background The recent SARS-CoV-2 infection is the cause of one of the most important pandemics that history has ever experienced. SARS-CoV-2 can lead to a MOF (Multiple Organ Failure) that is critical for life of patients. Viral RNA is found in human tissues as lung, intestine, testicle, kidney, etc. and it is the reason to theorize different ways of transmission of the virus in addition to respiratory droplets. The aim of our study was to evaluate the presence of SARS-CoV-2 in urethral swabs.Methods We enrolled 10 patients with SARS-CoV-2 infection who attended the Infectious Diseases Unit of the A.O.U. Federico II of Naples, from March 2020 to April 2020. For each patient, one urethral swab was collected at the time of SARS-CoV-2 infection.Results All ten patients had a negative urethral swab for SARS-CoV-2 RNA when the rhino-oropharyngeal swab was found to be positive for SARS-CoV-2 RNA. Our data show for the first time that the virus would not affect the urinary tract and therefore would not be found in the urine and even less would it be transmissible through the urine. This result was independent of the stage of the disease, in fact, regardless of the severity of the clinical conditions, all patients had a negative urethral swab for SARS-CoV-2 RNA.Conclusion This observation, which needs to be further investigated with further studies and a larger sample, could be the cornerstone for understanding the role of SARS-CoV-2 in relation to the genitourinary system.
CCL18 Induces EMT via CEP192 Down-Regulation in Breast Cancer
Authors: Wu Zichao , Ke Xinrong , Liu Yanli , Dong Yihong , Chen Jingqi
Published: June 2020

Background: Chemokine (C-C motif) ligand 18 (CCL18) secreted by TAMs induces epithelial-mesenchymal transformation (EMT) in breast cancer cells. Centrosome scaffold protein KDA192 (CEP192) ,as the important pericentriolar material (PCM), plays a critical role in microtubule nucleation and centrosome replication. Decreased expression of CEP192 will cause tumor cell polarization and elevated motility. Whether CEP192 is involved in the process of breast cancer EMT induced by CCL18 has not been reported.Methods: CEP192 mRNA level in Lymph node metastasis and non-lymph node metastasis breast cancer was evaluated by bioinformatics analysis. CCL18 and CEP192 expressions in breast tissues were examined using immunochemistry, CEP192 expression in breast cancer cells was examined using qPCR and Western blot. CEP192 was silenced using siRNA. EMT phenotype proteins were examined using Western blot. Statistical analysis was performed using GraphPad Prism 8.0 (GraphPad Software Inc).Results: CEP192 expression was decreased in lymph node metastasis breast cancer tissues compared with non-lymph node metastasis. CEP192 expression was down-regulated by CCL18 in breast cancer cells and silencing CEP192 promoted the migration and invasion of cancer cells. Based on the promotion of breast cancer EMT by CCL18, silencing CEP192 in breast cancer further increased E-cadherin and decreased KRT-8which are both EMT phenotype proteins in vitro.Conclusions: Our study elucidates that CCL18 promotes breast cancer EMT by down-regulating CEP192 expression. Down-regulated CEP192 plays a key role in invasion and migration of breast cancer cells. CEP192 is a potential new marker for tumor metastasis induced by CCL18.
Which is the most appropriate strategy for nasal screening and Staphylococcus aureus decolonization in total hip arthroplasty patients?
Authors: Tonotsuka Hisahiro , Sugiyama Hajime , Amagami Ayano , Yonemoto Keigo , Sato Ryuichi , Saito Mitsuru
Published: June 2020

Background: To reduce periprosthetic joint infection after total hip arthroplasty (THA), several nasal screening and decolonization strategies for methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-sensitive Staphylococcus aureus (MSSA) have been performed. These include universal decolonization (UD; i.e., no screening and decolonization for all patients), universal screening and target decolonization (US; i.e., screening for all patients and decolonization for bacterial positive patients), and target screening and decolonization (TS; i.e., screening and decolonization for high-risk populations only). Although TS is the most cost-effective strategy, useful risk factors must be identified. The purpose of this study was to evaluate the presence of predictive factors that enable the TS strategy to be successfully implemented and to compare the costs of each strategy.Methods: A total of 1654 patients scheduled for primary or revision THA (1464 women, 190 men; mean age 64 years) were screened prior to surgery for bacterial colonization of the nasal mucosa. Risk factors for positive MRSA and MRSA/MSSA tests were analyzed according to the following parameters: sex, age ≥80 years, body mass index ≥30 kg/m2, antibiotic use within 3 years, corticosteroid use, serum albumin <3.5 g/dL, glomerular filtration rate <50 mL/min, presence of brain, thyroid, cardiac or pulmonary disease, diabetes, asthma, and smoking habit. The average cost of each strategy was calculated.Results: In total, 29 patients (1.8%) tested positive for MRSA and 445 (26.9%) tested positive for MRSA/MSSA. No parameters were identified as independent risk factors for MRSA and only female sex was identified as a risk factor for MRSA/MSSA (p=0.003; odds ratio: 1.790; 95% confidence interval: 1.210-2.640). The average cost of each strategy for eradicating MRSA was 1641.3 yen for UD, 285.8 yen for US, and 252.3 yen for TS.Conclusions: No useful predictive parameters for implementing the TS strategy were identified. Based on cost implications, US is the most cost-effective strategy for THA patients.
Arthroscopic Bankart Repair vs. Open Latarjet Procedure: A Comparative Study of Clinical and Functional Results.
Authors: Sherchan Binod , Rai Saroj , Tamang Nira , Dhungana Siddhartha , Sharma Laxmi Kanta , Marasini Rudra Prasad , Singh Janith Lal , Khanal Kiran
Published: June 2020

Background The primary aim of this study was to compare the clinical outcomes of patients undergoing arthroscopic Bankart repair and open Latarjet procedure for recurrent dislocation of the shoulder. Secondary aims were to assess and compare the cost-effectiveness, satisfaction and complications, including recurrence and infection. Methods We retrospectively evaluated the patients who underwent either arthroscopic Bankart repair with or without Remplissage procedure or open Latarjet procedure between May 2015 and May 2018. The preoperative data were collected from the hospital records, and the postoperative data were collected during the follow-up visit. At the final follow-up, 41(male=32, female=9) patients in the Bankart group and 40(male=34 and female=6) patients in the Latarjet group were included in the study. Clinical outcomes were assessed using the ASES score, Rowe score, and Quick DASH score. A self-constructed scale that consisted of satisfied and dissatisfied was used to measure the level of satisfaction. Any complications were recorded in every follow-up visit. Collected data were analyzed using SPSS version 25. Results There was no statistically significant difference regarding the age (p=0.401), gender (p=0.569), site of involvement (p=0.158), number of preoperative dislocations (p=0.085), follow-up (p=0.061), between the two groups. Similarly, no statistically significant difference existed regarding the ASES score (p=0.388), Rowe score (p=0.211), and Quick DASH score (p=0.713). The average external rotation was 83 degrees in the Bankart group and 85 degrees in the Latarjet group (p=0.140). Functional satisfaction was higher in the Laterjet group compared to the Bankart group (p=0.482). Hundred percent of the patients were cosmetically satisfied in the Bankart group, whereas only 32(80%) patients were cosmetically satisfied in the Latarjet group (p=0.002). There was a significantly higher operating cost for arthroscopic Bankart repair compared to open Latarjet procedure (p<0.001). Three patients had a recurrence in the Bankart group, whereas no recurrence occurred in the Latarjet group. And, 2 superficial infections occurred in the Latarjet group. Conclusion These results provide the fact that arthroscopic Bankart repair might be a fancy and minimally invasive procedure, Latarjet procedure should still be a priority in a developing country like Nepal, where financial cost is a huge burden.
Elective tracheostomy during COVID-19 outbreak: to whom, when, how? Early experience from Venice, Italy
Authors: Volo T. , Stritoni P. , Zennaro B. , Battel I. , Lazzari F. , Bellin M. , Michieletto L. , G.Spinato  , Busatto C. , Spinato R. , Politi D.
Published: June 2020

PurposeThe need for prolonged invasive mechanical ventilation in COVID-19 patients is placing the Otorhinolaryngologist in front of an increasing request for tracheostomy. Nowadays, there is uncertainty regarding the timing of tracheostomy, the prognosis of these patients and safety of healthcare workers. The aim of this study is to evaluate the efficacy and safety of tracheostomy placement in patients with COVID-19. MethodsIt wasconducted a retrospective cohort study on 23 COVID 19 patients, in order to analyse the timing of tracheostomy, the risk factors associated with in-hospital death and theinfection of the involved health care workers. Early tracheostomy was defined as ≤ 10 days and late ones > 10 days.ResultsThe mortality rate of COVID-19 patients admitted to ICU that underwent tracheostomy was 18%. The overall mortality of patients admitted to ICU was 53%. The univariate analysis revealed that early tracheostomy, SOFA score > 6, D-Dimer level > 4 were significantly associated with a greater risk of death. At the multivariate analysis SOFA score > 6 and D-Dimer level > 4 resulted as significant factors for a higher risk of death. No health care workers associated with tracheostomy are confirmed to be infected by SARS- CoV2.ConclusionWe suggest to wait at least 14 days to perform tracheostomy. In patients with SOFA score > 6, and D dimer > 4 tracheostomy should not be performed or should be postponed. Optimized procedures and enhanced personal protective equipment can make the tracheostomy safe and beneficial in COVID-19 patients.
FDA-approved Pralatrexate and Azithromycin identified by virtual drug screening inhibit SARS-CoV-2 replication in vitro
Authors: Zhang Haiping , Yang Yang , Li Junxin , Wang Min , Saravanan Konda Mani , Wei Jinli , Ng Justin Tze-Yang , Hossain Md. Tofazzal , Liu Maoxuan , Zhang Huiling , Ren Xiaohu , Pan Yi , Peng Yin , Shi Yi , Wan Xiaochun , Liu Yingxia , Wei Yanjie
Published: June 2020

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic poses serious threats to the global public health and leads to an unprecedented worldwide crisis. Unfortunately, no effective drugs or vaccines are available till now. Since the RNA-dependent RNA polymerase (RdRp) of SARS-CoV-2 is a promising therapeutic target, a deep learning and molecular simulation based hybrid drug screening procedure was proposed and applied to identify potential drug candidates targeting RdRp from 1906 approved drugs. Among the four selected FDA-approved drug candidates, Pralatrexate and Azithromycin were confirmed to effectively inhibit SARS-CoV-2 replication in vitro with EC50 values of 0.008µM and 9.453 µM, respectively. For the first time, our study discovered that Pralatrexate is able to potently inhibit SARS-CoV-2 replication with a stronger inhibitory activity than Remdesivir within the same experimental conditions. The paper demonstrates the feasibility of accurate virtual drug screening for inhibitors of SARS-CoV-2 and provides potential therapeutic agents against COVID-19.
Lumbar Vertebrae and Epidural Space Metastases of Choriocarcinoma: A Case Report
Authors: Liu Lin , Zhang Yini , Zhang Wei , Zhao Zhi , Li Zhengwei
Published: June 2020

Background: Choriocarcinoma is a rare and highly malignant tumor. It is characterized by the production of large amounts of human chorionic gonadotropin (HCG). The lumbar vertebrae and epidural space metastases of choriocarcinoma are extremely rare. This is a rare case report of a middle-aged woman with metastatic choriocarcinoma in the lumbar vertebrae, epidural space.Case presentation: The present case report describes a 42-year-old Chinese female patient who was admitted to the spine surgery department of The Second Afflicted Hospital of Dalian Medical University with signs of low back pain for ten days, weakness in both lower limbs and dysuria for four days in 2019. Magnetic resonance imaging revealed an inhomogeneous nodular lesion in the anterior epidural space from L3 to L4 and an abnormal signal in the L4 vertebral body. The patient underwent emergency surgery on the first day of admission for quick onset of paraplegia and dysuria. But the operation was stopped because of heavy bleeding. Five days later, she underwent endovascular embolization of the left and the right L4 lumbar segmental arteries, and after that, the hypervascular mass was subtotally removed. The histopathological diagnosis was choriocarcinoma. Then the patient received chemotherapy. But there was no apparent improvement in the neurological statement after chemotherapy. The patient’s outcome is death.Conclusions: This case suggests that choriocarcinoma should be borne in mind when observing a spinal extraosseous extension lesion with elevated β-HCG in a woman of child-bearing age.
Khat (Catha edulis) Plant Abuse in Saudi Arabia
Authors: AlAhmadi Tareq
Published: June 2020

BackgroundThe khat (Catha edulis) shrub is cultivated in both the Arabian Peninsula and North Africa. The citizens of this region have carried the tradition of chewing khat leaves since the 15th century. This plant is a natural stimulant which contains two main substances, cathine and cathinone, which cause excitement, euphoria, and loss of appetite. Moreover, the khat trade is considered a source of income within countries of these regions. However, khat holds both benefits and negative aspects for mankind, society, and the environment. This article focuses on the issue of khat smuggling to Saudi Arabia, which has increased over between 2010 and 2016 according to the recent statistics.MethodResearch on the problem of khat smuggling to Saudi Arabia was performed through the analysis of seven years of data (2010–2016) obtained by Saudi Customs and other governmental entities responsible for monitoring the smuggling of drugs, which includes data reflecting the amount of khat seized and smuggled to Saudi Arabia.ResultsKhat smuggling has increased in Saudi Arabia over seven (2010–2016) years. The analysis of data on both the promotion and smuggling of khat were considered, and placed khat in third place among other drugs since the year 1999.ConclusionStatistically, Jazan is the most vulnerable to the smuggling of khat. As such, the to design of intervention programs is recommended to address the problem of khat smuggling in the Jazan region. Additionally, awareness should be increased among the youth through cooperation between public education and higher education, which should include further research on this problem.
The impact of online group counselling programs on substance use, mental health, and physical health among adults: A systematic review protocol
Authors: Currie Cheryl L , Larouche Richard , Voss M. L. , Higa Erin K. , Spiwak Rae , Scott David , Tallow Treena
Published: June 2020

Background: COVID-19 has resulted in an increased demand for online mental health services globally. There is emerging evidence for the efficacy for group online interventions that support population-based mental health, but a systematic review is lacking. The primary objective of this rapid systematic review is to summarize the evidence for online group counselling programs for adults. A second objective is to assess, within studies selected for our primary objective, the impact of online group counselling programs that encourage PA on outcomes compared to those that do not.Methods and Design: Randomized controlled trials that assess the impact of online group counselling programs on substance use, mental health, or physical health among community dwelling adults will be searched in MEDLINE, PsycInfo, CINHAL, and the Central Register of Controlled Trials. The review will be structured using PRISMA guidelines. Studies will be synthesized using the Cochrane Handbook and Synthesis Without Meta-Analysis (SWiM) reporting guideline. Quality will be evaluated using GRADE. Risk of bias will be assessed using the Cochrane Risk of Bias tool; with higher quality studies prioritized when drawing conclusions. The role of sex and gender will be considered as well as possible gender biases at all stages of the review.Discussion: This review will examine the effectiveness of online counselling programs that can be delivered to populations in a group format, and thus in a potentially cost-effective way. Findings will inform the decisions of governments, communities, and health care organizations responding to the COVID-19 pandemic in Canada. Systematic review registration: The protocol has been registered at the International Prospective Register of Systematic Reviews (PROSPERO: CRD42020187551).
Has the Indian lockdown averted deaths?
Authors: Raju Suvrat
Published: June 2020

Within the context of SEIR models, we consider a lockdown that is both imposed and lifted at an early stage of an epidemic. We show that, in these models, although such a lockdown may delay deaths, it eventually does not avert a significant number of fatalities. Therefore, in these models, the efficacy of a lockdown cannot be gauged by simply comparing figures for the deaths at the end of the lockdown with the projected figure for deaths by the same date without the lockdown. We provide a simple but robust heuristic argument to explain why this conclusion should generalize to more elaborate compartmental models. We qualitatively discuss some conditions, beyond the scope of simple models, under which a lockdown might increase or decrease the epidemic's final toll in the real world. We conclude that SEIR models and their generalizations provide no reliable quantitative evidence that the Indian lockdown has averted any deaths from the COVID-19 pandemic.
Clinical and Radiographic Comparisons of Distal Tibia Shaft Fractures Stabilized with an Intramedullary Nail: Blocking Pin Versus Blocking Screw
Authors: Wu Haotian , Bai Xiaodong , Song Zhaohui , Yao Shuangquan , Liu Song , Ma Lijie , Ren Pengcheng , Wang Pengcheng
Published: June 2020

Background: Distal tibia shaft fractures have a high risk of mal-alignment when treated with intramedullary nailing (IMN). Permanent blocking screws (BSs) and temporary blocking pins (BPs) are often used as supplements to help IMN get good alignment. The purpose of this study was to compare the clinical and radiographic outcomes of temporary BPs and permanent BSs for distal tibia shaft fractures.Methods: From March 2014 to May 2019, a total of 89 patients with distal tibia shaft fractures were included in this retrospective study and divided into two groups. All fractures were located below the isthmus but 4 cm above the tibial plafond. The differences in operating time, intraoperative bleeding, fibula plate fixation, number of BP/BS, initial and final alignment, loss of reduction, fracture healing time, and postoperative complications were analyzed. Functional outcomes of the ankle were assessed with the American Orthopedic Foot and Ankle Society (AOFAS) score.Results: All patients underwent a minimum follow-up of 13 months. The operating time was (73.9±6.1) min and (80.2±8.6) min in the BP group and BS group, respectively (P < 0.05); intraoperative bleeding was (88.2±18.0) mL and (92.9±26.6) mL, respectively (P > 0.05); initial reduction deformity in coronal plane was (0.5±2.3) degrees and (0.9±2.3) degrees, respectively (P > 0.05); final alignment deformity in coronal plane was (1.2±2.7) degrees and (1.3±2.4) degrees, respectively (P > 0.05); initial reduction deformity in sagittal plane was (0.6±2.2) degrees and (0.6±2.4) degrees, respectively (P > 0.05); final alignment deformity in sagittal plane was (0.9±2.3) degrees and (1.0±2.2) degrees, respectively (P > 0.05); As for the loss of reduction, there was no significant difference in sagittal plane between the two groups(P > 0.05). Although the loss of reduction in the coronal plane of the BP group (0.8±0.7 degrees) is statistically higher than that of the BS group (0.5±0.5 degrees), the small difference was not clinically important (P < 0.05). No significant differences were found between the two groups in fracture healing time, AOFAS score and complications (P > 0.05).Conclusion: Both temporary BP and permanent BS can help achieve equivalent overall alignment. However, BP technique is simpler and takes less time.