bluuebunny/crossref_metadata_2025 huggingface dataset:
Determinants for Choice of Home Birth over Health Facility Birth among Women of Reproductive Age in Tanzania: An Analysis of Data from the 2015-16 Tanzania Demographic and Health Survey and Malaria Indicator Survey
Authors: Moshi Fabiola Vincent , Mbotwa Christopher H.
Published: July 2020

Background While evidence has shown an association between place of childbirth and birth outcomes, still factors contributing to the choice of home childbirth have not been adequately investigated. Childbirth assisted by unskilled birth attendants has been cited as a contributing factor for the high maternal and neonatal mortalities in low resources countries. This study aimed at determining determinants of preference for home childbirth assisted by unskilled attendants in Tanzania Method The study used the 2015-16 Tanzania Demographic and Health Survey and Malaria Indicator Survey (2015-16 TDHS-MIS) dataset. A total of 2286 women of reproductive age (15-49 years) who had childbirth within one year preceding the survey were included in the analysis. Both univariate and multivariable regression analysis was used to determine predictors for home-based childbirth. Results A total of 805(35.2%) of women had home childbirth assisted by unskilled providers. After adjusting for confounders, the determinants of preference for home childbirth were the level of education (primary education, AOR=0.666; p=0.001; secondary and higher education, AOR=0.417; p<0.001); not owning mobile phone, AOR= 1.312; p=0.018; parity (parity 2-4, AOR=1.594; p=0.004; Parity 5 and above, AOR=2.158; p<0.001); inadequate antenatal visits, AOR=1.406; p=0.001; wealth index (poorest, AOR=9.395; p<0.001; poorer, AOR=7.701; p<0.001; middle, AOR=5.961; p<0.001; richer, AOR=2.557; p<0.001) and Zones (Southern Highlands, AOR=0.189; p<0.001; Southern, AOR=0.225; p<0.001; Zanzibar, AOR=2.55; p<0.001). Conclusion There are large proportions of women who use home childbirth assisted by unskilled birth attendant’s mainly traditional birth attendants (TBA). Predictors for home-based childbirth were being illiterate women, poor access to communication, inadequate antenatal visits, low socio-economic status and those from Zanzibar. Innovative strategies targeting these groups are highly needed to increase the use of health facilities for childbirth and hence reduce maternal and neonatal mortalities in Tanzania.
A novel variant in PAX6 as the cause of aniridia in a Chinese family
Authors: Jin Xin , Liu Wei , Huang HouBin
Published: July 2020

Background: Aniridia is a kind of congenital human panocular anomaly, which is related to PAX6 commonly.Methods: The ophthalmic examinations including visual acuity, slit lamp and fundoscopy examination were preformed in a Chinese aniridia pedigree. The targeted next-generation sequencing of Aniridia genes was used to identify the causative mutation.Results: A novel heterozygous PAX6 nonsense mutation c.619A>T (p.K207*) was identified in the Chinese autosomal dominant family with aniridia. Phenotypes related to the novel mutation include nystagmus, iris defect, cataract and absence of macular fovea.Conclusion: The novel nonsense variation in PAX6 was the cause of aniridia in this family, which expands the spectrum of the PAX6 mutation and its associated phenotype.
Alantolactone inhibits cell autophagy and promotes apoptosis through targeting AP2M1 in acute lymphotic leukemia
Authors: Shi Ce , Wang Zhenkun , Yang Dongguang , Wei Jia , Liu Zhiyu , Teng Yueqiu , Lan Wenjia , Gu Mengmeng , Yuan Tian , Cao Fenglin , Zhou Jin , Li Yang
Published: July 2020

Background: Acute lymphoblastic leukemia (ALL) is an aggressive hematopoietic malignancy that is most common in children. Alantolactone (ALT) has been reported to have antitumor activity in different types of cancers. This study aimed to investigate the antitumor activity and molecular mechanism of ALT in ALL. Methods: The ALL cell lines were treated with 1, 5 and 10μM of ALT, and then subjected to MTT assay and RNA sequencing. Flow cytometry, JC-1 staining and immunofluorescence staining assays were employed to measure cell apoptosis and autophagy. Meanwhile, Western blot analysis was used to detect apoptosis and autophagy related proteins. Finally, the effect of ALT on tumor growth was measured in BV173 xenograft nude mouse model. Results: In this study, we demonstrated that ALT inhibited the proliferation of ALL cells in does-dependent manner. A series of experiments demonstrated that ALT inhibited cell proliferation, colony formation, autophagy, induced apoptosis and restained tumor growth in vivo through upregulating adaptor related protein complex 2 subunit mu 1 (AP2M1). Moreover, autophagy activator rapamycin attenuated the pro-apoptotic effect of ALT on BV173 and NALM6 cell lines. Further, overexpressed AP2M1 decreased the expression of Beclin1, LC3-II/LC3-1 ratio and increased p62 expression. Fianally, knockdown of Beclin1 increased the levels of bax, cleaved caspase 3 and cytochrome C and decreased bcl-2 expression. Conclusions: This study demonstrated that ALT exerts antitumor activity through inducing apoptosis and inhibiting autophagy by upregulating AP2M1 in ALL, indicating a potential therapeutic strategy for ALL treatment.
Predictors of School Students’ Leisure-Time Physical Activity: An Extended Trans-Contextual Model Using Bayesian Path Analysis
Authors: Polet Juho J. , Schneider Jekaterina , Hassandra Mary , Lintunen Taru , Laukkanen Arto , Hankonen Nelli , Hirvensalo Mirja , Tammelin Tuija H. , Hamilton Kyra , Hagger Martin S.
Published: July 2020

Background: The trans-contextual model has been applied to identify the determinants of leisure-time physical activity participation in secondary school students. In the current study, the trans-contextual model was extended to include additional constructs that represent non-conscious, implicit processes that lead to leisure-time physical activity participation alongside the motivational and social cognition constructs from the model. The current study used baseline and follow-up data from an intervention study to test the extended model.Methods:The current study adopted a two-wave prospective design. Secondary-school students (N = 502) completed measures of perceived autonomy support from physical education (PE) teachers, autonomous motivation in PE and leisure-time contexts, social cognition constructs (attitudes, subjective norms, perceived behavioral control), intentions, trait self-control, habits, and past behavior all in a leisure-time physical activity context. Five weeks later, students (N = 298) completed a follow-up self-report measure of their leisure-time physical activity.Results: Bayesian path analyses supported two key premises of the model: perceived autonomous support predicted autonomous motivation in PE, and autonomous motivation in PE predicted autonomous motivation in leisure time. However, while both forms of autonomous motivation predicted social cognition constructs and intentions, they did not predict leisure-time physical activity participation. Trait self-control, attitudes, and past behavior were direct predictors of intentions and leisure-time physical activity participation. Specifying informative priors for key model relations using Bayesian analysis yielded greater precision for some of the estimates.Conclusions: Findings raise some questions on the efficacy of the original trans-contextual model, but highlight the value of extending the model to incorporate additional constructs representing non-conscious processes.
How should community health workers in fragile contexts be supported: Qualitative evidence from Sierra Leone, Liberia and Democratic Republic of Congo
Authors: Raven Joanna , Wurie Haja , Idriss Ayesha , Bah Abdulai Jawo , Baba Amuda , Nallo Gartee , Kollie Karsor K. , Dean Laura , Steege Rosie , Martineau Tim , Theobald Sally
Published: July 2020

Background: Community Health Workers (CHWs) are critical players in fragile settings, where staff shortages are particularly acute, health indicators are poor and progress towards Universal Health Coverage is slow. Like other health workers, CHWs need support to contribute effectively to health programmes and promote health equity. Yet the evidence base of what kind of support works best is weak. We present evidence from three fragile settings - Sierra Leone, Liberia and Democratic Republic of Congo on managing CHWs, and synthesise recommendations for best approaches to support this critical cadre.Methods: We used a qualitative study design to explore how CHWs are managed, the challenges they face and potential solutions. We conducted interviews with decision makers and managers (n=37), life history interviews with CHWs (n=15) and reviewed policy documents. Results: Fragility disrupts education of community members so that they may not have the literacy levels required for the CHW role. This has implications for the selection, role, training and performance of CHWs. Policy preferences about selection need discussion at the community level, so that they reflect community realities. CHWs scope of work is varied and may change over time, requiring ongoing training. The modular, local, and mix of practical and classroom training approach worked well, helping to address gender and literacy challenges and developing a supportive cohort of CHWs. A package of supervision, community support, regular provision of supplies, performance rewards and regular remuneration is vital to retention and performance of CHWs. But there are challenges with supervision, scarcity of supplies, inadequate community recognition and unfulfilled promises about allowances. Clear communication about incentives with facility staff and communities is required as is their timely delivery.Conclusions: This is the first study that has explored the management of CHWs in fragile settings. CHWs interface role between communities and health systems is critical because of their embedded positionality and the trusting relationships they (often) have. Their challenges are aligned to those generally faced by CHWs but chronic fragility exacerbates them and requires innovative problem solving to ensure that countries and communities are not left behind in reforming the way that CHWs are supported.
An Improved WENO-Z Scheme with Symmetry-Preserving Mapping
Authors: Hong Zheng , Ye Zhengyin , Ye Kun
Published: July 2020

Since the classical weighted essentially non-oscillatory (WENO) scheme is proposed, various improved versions have been developed, and typical one is the WENO-Z scheme. Although better resolution is achieved, it is shown in this article that, the result of WENO-Z scheme suffers evident distortion in the long-time simulation of the linear advection equation. In order to fix the problem of WENO-Z, a symmetry-preserving mapping method is proposed in this article. In the original mapping method, the weight of each sub-stencil is used to map, which is demonstrated to cause asymmetric improvement about a discontinuity. This asymmetric improvement will lead to a distorted solution, more severe with longer output time. In the symmetry-preserving mapping method, a new variable related to the smoothness indicator is selected to map, which has the same ideal value for each sub-stencil. Using the new mapping method can not only fix the distortion problem of WENO-Z, but also improve the numerical resolution. Several benchmark problems are conducted to show the improved performance of the resultant scheme.
Reference values of the central corneal thickness with different refractive errors for the adult Egyptian population
Authors: Gab-Alla Amr A.
Published: July 2020

The authors have withdrawn this preprint due to author disagreement.
Development and internal validation of risk prediction model of metabolic syndrome in oil workers
Authors: Wang Jie , Li Chao , Li Jing , Qin Sheng , Liu Chunlei , Wang Jiaojiao , Chen Zhe , Wu Jianhui , Wang Guoli
Published: July 2020

Background.The prevalence of metabolic syndrome continues to rise sharply worldwide, seriously threatening people's health. The optimal model can be used to identify people at high risk of metabolic syndrome as early as possible, to predict their risk, and to persuade them to change their adverse lifestyle so as to slow down and reduce the incidence of metabolic syndrome.Objective.To develop and internally verify three risk prediction models for the metabolic syndrome of petroleum workers, compare the prediction performance of the three models, and find the optimal model.Methods. Design existing circumstances research. A total of 1,468 workers from an oil company who participated in occupational health physical examination from April 2017 to October 2018 were included in this study. We established the Logistic regression model, the random forest model and the convolutional neural network model, and compared the prediction performance of the models according to the F1 score, sensitivity, accuracy and other indicators of the three models.Results.The results showed that the accuracy of the three models in the training set was 83.45%, 94.21% and 86.34%, the sensitivity was 78.47%, 94.62% and 81.30%, the F1 score was 0.79, 0.93 and 0.83, the area under the ROC curve was 0.894, 0.987 and 0.935, and the Integrated Calibration Index was 0.074, 0.071 and 0.078, respectively. In the test set, the accuracy was 76.72%, 80.66% and 78.69%, the sensitivity was 70.00%, 77.50% and 68.33%, the F1 score was 0.70, 0.76 and 0.71, the area under the ROC curve was 0.797, 0.861 and 0.855, and the Integrated Calibration Index was 0.064, 0.051 and 0.096, respectively.Conclusions.The study showed that the prediction performance of random forest model is better than other models, and the model has higher application value, which can better predict the risk of metabolic syndrome in oil workers, and provide corresponding theoretical basis for the health management of oil workers.
Differentiating novel coronavirus pneumonia from general pneumonia based on machine learning
Authors: Liu Chenglong , Wang Xiaoyang , Liu Chenbin , Sun Qingfeng , Peng Wenxian
Published: July 2020

Background: Chest CT screening as supplementary means is crucial in diagnosing novel coronavirus pneumonia (COVID-19) with high sensitivity and popularity. Machine learning was adept in discovering intricate structures from CT images and achieved expert-level performance in medical image analysis. Methods: An integrated machine learning framework on chest CT images for differentiating COVID-19 from general pneumonia (GP) was developed and validated. Seventy-three confirmed COVID-19 cases were consecutively enrolled together with twenty-seven confirmed general pneumonia patients from Ruian People’s Hospital, from January 2020 to March 2020. To accurately classify COVID-19, region of interest (ROI) delineation was implemented base on ground glass opacities (GGOs) before feature extraction. Then, 34 statistical texture features of COVID-19 and GP ROI images were extracted, including 13 gray level co-occurrence matrix (GLCM) features, 15 gray level-gradient co-occurrence matrix (GLGCM) features and 6 histogram features. High dimensional features impact the classification performance. Thus, ReliefF algorithm was leveraged to select features. The relevance of each features was the average weights calculated by ReliefF in n times. Features with relevance lager than the empirically set threshold T were selected. After feature selection, the optimal feature set along with 4 other selected feature combinations for comparison were applied to the ensemble of bagged tree (EBT) and four other machine learning classifiers including support vector machine (SVM), logistic regression (LR), decision tree (DT), and K-nearest neighbor with Minkowski distance equal weight (KNN) using 10-fold cross-validation. Results and Conclusions: The classification accuracy (ACC), sensitivity (SEN), specificity (SPE) of our proposed method yield 94.16%, 88.62% and 100.00%, respectively. The area under the receiver operating characteristic curve (AUC) was 0.99. The experimental results indicate that the EBT algorithm with statistical textural features based on GGOs for differentiating COVID-19 from general pneumonia achieved high transferability, efficiency, specificity, sensitivity, and impressive accuracy, which is beneficial for inexperienced doctors to more accurately diagnose COVID-19 and essential for controlling the spread of the disease.
Maintaining proper health records improves machine learning predictions for novel 2019-nCoV
Authors: KHAN KOFFKA , Ramsahai Emilie
Published: July 2020

Background: An ongoing outbreak of a novel coronavirus (2019-nCoV) pneumonia continues to affect the whole world including major cities such as China, USA, Italy, France and the United Kingdom. We present outcome ('recovered', 'isolated' or 'death') risk estimates of the 2019-nCoV over 'early' datasets. A major consideration is how likely are people to die from 2019-nCoV? Method: Accounting for the impact of the variations in the reporting rate of 2019-nCoV, we modelled machine learning techniques (AdaBoost, Bagging, Extra-Trees, Decision-Trees and k-Nearest Neighbours Classifiers) on two 2019-nCoV datasets obtained from Kaggle in March 30th 2020. We used 'country', 'age' and 'gender' as features to predict outcome for both datasets. Including the patient's 'disease' history (only present in the second dataset) to predict outcome for the second dataset. Results: The use of a patient's 'disease' history improves the prediction of 'death' by more than a 7-fold. Models ignoring a patent's 'disease' history performed poorly in test predictions. Conclusion: Our findings indicate the potential of using a patient's 'disease' history as part of the feature set in machine learning techniques to improve 2019-nCoV predictions. This can have a positive effect on predictive patient treatment and result in ease for current overburdened healthcare systems worldwide, especially with an increasing prevalence of second and third wave re-infections in some countries.
Impact of the COVID-19 Pandemic on Urology Practice in Indonesia: A Nationwide Survey
Authors: Rasyid Nur , Birowo Ponco , Parikesit Dyandra , Rahman Fakhri
Published: July 2020

Background.Coronavirus disease 2019 (COVID-19) has affected daily practices in health care services. This study aimed to investigate the impact of COVID-19 on urology practice in Indonesia.Methods.This was a cross-sectional study using web-based questionnaire (Survey Monkey), which was distributed and collected within a period of three weeks. All practicing urologists in Indonesia were sent an e-questionnaire link via E-mail, WhatsApp Messenger application, and/or short message service, and the chief of residents in each urology centre distributed the e-questionnaire to urology residents.ResultsThe response rate was 369/485 (76%) among urologists and 220/220 (100%) among urology residents. Less than 10 percent of the responses in each section were incomplete. There are 35/369 (9.5%) Nine percent of urologists and 59/220 (26.8%) of urology residents had been suspected as COVID-19 patients, of whom seven of them were confirmed to be COVID-19 positive. The majority of urologists (66%) preferred to continue face-to-face consultations with a limited number of patients, and more than 60% of urologists preferred to postpone the majority (66%) or all elective surgery. Most urologists also chose to postpone elective surgery in patient with COVID-19-related symptoms and patient who required post-operative ICU-care. Urologist and urology residents reported high rates of using personal protective equipment, except for medical gowns and N95 masks, which were in short supply. Several uro-oncology surgeries were considered to be the top priority for Indonesian urologist during COVID-19 epidemic period.Conclusion.The COVID-19 pandemic has had a major impact on urology practice in Indonesia.
The Value of 18F-FDG PET/CT in avoiding overtreatment of 131l Avidity Pulmonary Metastasis of Differentiated Thyroid Cancer
Authors: Xu Zhongyun , Li Chao , Fang Feng , Zhang Linlin , Wang Hui , Fu Hongliang , Wu Shuqi
Published: July 2020

Background: We usually use 131 I whole body scan and serum thyroglobulin (Tg) values to determine whether differentiated thyroid cancer (DTC) patients need to receive 131 I treatment, but not all 131 I-avid (functioning) patients have good responses, which is more likely to cause the 131 I-avid patient to receive overtreatment. Our study aims to assess the date of 18 F-FDG PET/CT to avoid 131 I overtreatment and research the status of 131 I-avid pulmonary metastases (PMs) and the prognosis of the patients. Methods: The 131 I-avid PMs of DTC patients who underwent 18 F-FDG PET/CT scans were included. The SUVmax (maximum standardized uptake value), MTV (metabolic tumour volume) and TLG (total lesion glycolysis) were used to estimate 18 F-FDG uptake. The mean follow-up period was 34.14 ± 18.64months. Progression-free survival (PFS) was estimated by the Kaplan-Meier method.The study was based on per-patient and per-lesion analyses. Results: Among the 42 included patients, 34 (34/42, 81%) showed 18 F-FDG uptake, which was defined as abnormal foci (SUVmax >1.0) in the lungs. SUVmax, MTV and TLG and tumour size were the factors that influenced the outcome of 131 I treatment based on Tg levels (p=0.000,0.016,0.000,0.000). The only independent factor was the size of the lesion. There was a significant difference in response to 131 I therapy between PMs with F-I+ and F+/I+ according to both Tg levels and RECIST (version 1.1) (p= 0.044,0.001), according to the per-lesion analysis. When the changes in size or metabolism of some lesions are inconsistent with therapeutic efficacy of patients, it indicates that these patients have a poor prognosis (P=0.003). Conclusions: We concluded that higher 18 F-FDG uptake and larger tumour size predict poor therapeutic effects and a high risk of disease progression in 131 I-avid PMs of DTC. For evaluating the efficiency of 131 I treatment, per-lesion analyses and assessing the data of 18 F-FDG PET/CT would be more reliable than per-patient evaluation only. The increasing 18 F-FDG uptake or diameter of PMs may lead to a poor prognosis for the patient, and early focal treatment modalities may improve their life span.
Effects of microbiome rare taxa filtering on statistical analysis
Authors: Cao Quy Xuan , Sun Xinxin , Rajesh Karun , Chalasani Naga , Gelow Kayla , Katz Barry , Shah Vijay H. , Sanyal Arun J. , Smirnova Ekaterina
Published: July 2020

Background: Accuracy of microbial community detection in 16S rRNA marker-gene and metagenomic studies suffers from contamination and sequencing errors that lead to either falsely identifying microbial taxa that were not in the sample or misclassifying the taxa of DNA fragment reads. Filtering is defined as removing taxa that are present in a small number of samples and have small counts in the samples where they are observed. This approach reduces extreme sparsity of microbiome data and has been shown to correctly remove contaminant taxa in cultured "mock" datasets, where the true taxa compositions are known. Although filtering is frequently used, careful evaluation of its effect on the data analysis and scientific conclusions remains unreported. Here, we assess the effect of filtering on the alpha and beta diversity estimation, as well as its impact on identifying taxa that discriminate between disease states. Results: The effect of filtering on microbiome data analysis is illustrated on four datasets: two mock quality control datasets where same cultured samples with known microbial composition are processed at different labs and two disease study datasets. Results show that in microbiome quality control datasets, filtering reduces the magnitude of differences in alpha diversity and alleviates technical variability between labs, while preserving between samples similarity (beta diversity). In the disease study datasets, DESeq2 and linear discriminant analysis Effect Size (LEfSe) methods were used to identify taxa that are differentially expressed across groups of samples, and random forest models to rank features with largest contribution towards disease classiffcation. Results reveal that filtering retains significant taxa and preserves the model classification ability measured by the area under the receiver operating characteristic curve (AUC). The comparison between filtering and contaminant removal method shows that they have complementary effects and are advised to be used in conjunction. Conclusions: Filtering reduces the complexity of microbiome data, while preserving their integrity in downstream analysis. This leads to mitigation of the classification methods' sensitivity and reduction of technical variability, allowing researchers to generate more reproducible and comparable results in microbiome data analysis.
WITHDRAWN: Radiation-Induced Acute Injury of Intensity-Modulated Radiotherapy vs. Three-Dimensional Conformal Radiotherapy in Induction Chemotherapy Followed by Concurrent Chemoradiotherapy for Locoregionally Advanced Nasopharyngeal Carcinoma: A Prospective Cohort Study
Authors: Yao Zexin , Lei Xiaoxuan , Chen Zhiyan , Pang Mengru , Huang Jialin , Cheng Biao
Published: July 2020

Purpose: Induction chemotherapy (IC) followed by concurrent chemoradiotherapy (CCRT) was the new standard treatment for locoregionally advanced nasopharyngeal carcinoma (LANPC). We aimed to address whether the addition of intensity-modulated radiotherapy (IMRT) compared to three-dimensional conformal radiotherapy (3D-CRT) aggravate radiation-induced acute injury of these patients.Methods: We conducted a prospective study of consecutive patients in the stage III to IVb with biopsy-proven nonmetastatic LANPC who newly underwent radiotherapy and sequentially received IC, followed by CCRT at our institution. Among 182 patients included, 87 (47.80%) were treated with IMRT and 95 (52.20%) with 3D-CRT. Occurring time of radiation-induced toxicities were estimated and compared using the Kaplan-Meier method and Log-rank test. Results: The most severe acute toxicities included oral mucositis in 97.25% and dermatitis in 90.11%. Subset analysis revealed that Grade 3-4 acute dermatitis were significantly higher in the IMRT than 3D-CRT (P=0.0482). Oral mucositis and dermatitis were the earliest occurrence of acute injuries (2 years: 60.44% and 17.58%). Patients in IMRT group achieved significantly lower risk of bone marrow toxicity (Hazard ratio [HR]= 0.426, P=0.0009), but higher risk of leukopenia (HR=1.444, P=0.0344) and gastrointestinal injury (HR=2.383, P=0.0103). Multivariate analyses also demonstrated that IMRT (HR=0.429, P=0.0211), female gender (HR=2.070, P=0.0531) and hepatitis (HR=2.152, P=0.0552) were the independent prognostic factors for bone marrow toxicity. The use of IMRT was a predictive factor of significantly better short-term efficacy, whereas anemia was a significant independent predictor.Conclusions: In a combined regimen of IC followed by CCRT for the treatment of LANPC, IMRT seems to be an aggressive technique with a trend towards increased gastrointestinal and hematological toxicities, but decreased bone marrow toxicity than those treated with 3D-CRT.
Combination of SB431542, Chir9901, and Bpv as a Novel Supplement in the Culture of Umbilical Cord Blood Hematopoietic Stem Cells
Authors: Afzal Elaheh , Zarrabi Morteza , Asghari Mohammad Hassan , Ebrahimi Marzieh
Published: July 2020

Background: Small molecule compounds have been well recognized for their promising power in generation, expansion and maintenance of embryonic or adult stem cells. The aim of this study was to identify a novel combination of small molecules in order to optimize the ex vivo expansion of umbilical cord blood derived-CD34+ cells. Methods: Considering the most important signaling pathways involved in the self-renewal of hematopoietic stem cells, CB-CD34+ cells were expanded with cytokines in the presence of seven small molecules including SB, PD, Chir, Bpv, Pur, Pμ and NAM. Eliminativism approach was used to find the best combination of selected small molecules for effective ex vivo expansion of CD34+ cell. In each step, proliferation, self-renewal, and clonogenic potential of the expanded cells as well as expression of some hematopoietic stem cell related genes were studied. Finally, the engraftment potential of expanded cells was also examined by the mouse intra-uterine transplantation model. Results: Our data shows that simultaneous use of SB431542 (TGF-β inhibitor), Chir9901 (GSK3 inhibitor) and Bpv (PTEN inhibitor), resulted in a 50-fold increase in the number of CD34+CD38- cells. This was further reflected in approximately 3 times increase in clonogenic potential of the small molecule cocktail-expanded cells. These cells, also, showed a 1.5-fold higher engraftment potential in the peripheral blood of NMRI model of in utero transplantation. These results are in total conformity with up-regulation of HOXB4, GATA2 and CD34 marker gene as well as CXCR4 homing gene. Conclusion: Taken together, our findings introduce a novel combination of small molecules to improve the yield of existing protocols used in the expansion of hematopoietic stem cells.
Pregnant Women's Perceptions of Anaemia in Pregnancy at the Urban Health Facility in Ahougnansou (Centre-north Côte D'ivoire)
Authors: ANOUA Adou Serge Judicaël
Published: July 2020

Background

Anaemia in pregnancy is an issue of concern in the reduction of reproductive health morbidity in Côte d’Ivoire. This research aimed to describe the meaning of anaemia and analyze its explanatory factors from the perspective of pregnant women in a hospital setting in Ahougnansou in the city of Bouaké in the Centre-North of Côte d’Ivoire.
Methods

This qualitative research was descriptive-interpretive. Using this approach, individual interviews were conducted with twenty (20) participating pregnant women. The research took place in the hospital environment of Ahougnansou in the city of Bouaké in Côte d’Ivoire. The data were analyzed using a conventional inductive content analysis supported by a thematic grid.
Results

Perceptions have identified anaemia in pregnancy as a life-threatening reproductive morbidity for both mother and child. Its specific image has been associated with a lack of blood in the body. Symptoms have included fever, dizziness, fatigue, lack of appetite, pallor and thinness. Its aetiology has been attributed to food bans. In addition, the explanatory logics noted its link with irrational health behaviours such as irregular consultations, inaccessibility to edifying advice, lack of early detection, lack of use of daily oral iron and folic acid supplementation, lack of mobilization of financial resources and non-observance of a balanced diet.
Conclusion

Examination of the social representation of anaemia in pregnancy leads to relevant insights into the irrational health behaviours of pregnant women. On the other hand, the search for appropriate and effective long-term solutions to this reproductive health morbidity requires the immersion of midwives in the living environment of pregnant women and specific community health actions in populations that can be located in space and time in order to circumscribe the reproductive practices involved in resistance to nutritional recommendations in the prenatal period.
Preterm birth determinants among newborns at six public hospitals in Northeast Amhara, Ethiopia: unmatched case-control study
Authors: Shiferaw Mesfin , Tebeje Nigusie Birhan , Mekonnen Habtamu Sewunet
Published: July 2020

Background: Preterm birth is a global public health problem. Worldwide, every year about 15 million newborns are born preterm and about 1.1 million of them die due to complications related to prematurity. More than 81% of preterm births were in Asia and Sub-Saharan Africa. Nowadays, preterm birth is the first leading cause of under-five mortality and is one of the limiting factors for achieving a reduction in under-five mortality rate. Therefore, the aim of this study was to identify the determinants of preterm birth at public hospitals in the Northeast Amhara, Ethiopia, 2019.Method: Hospital-based unmatched case-control study was conducted at public hospitals in Northeast Amhara, Ethiopia from March 15th to April 25th, 2019. Data were collected using interviewer-administered structured pre-tested tool and document review for cases and controls. Data were entered in to Epi Info version 7.2.2.6 and exported to SPSS version 23 software for data analysis. Bi-variable and multivariable binary logistic regression were used to measure the association between preterm birth and risk factors. Adjusted Odds ratio (AOR) at 95 % confidence interval (CI) was calculated and P value ≤0.05 declared statistically significant. Result: The study identified that ANC follow up less than four visits [AOR 2.267, Cl (1.205, 4.264)], pregnancy-induced hypertension [AOR 4.453, Cl (1.276, 15.536)], no iron/folic acid supplementation during pregnancy [AOR 4.175, Cl (1.632, 10.680)], anemia during pregnancy [AOR 4.776, Cl (1.492, 15.285)], and birth defect [AOR 6.160, Cl (l.896, 20.013)] were significantly associated determinants of preterm birth.Conclusion: Antenatal care follow up fewer than four visits, pregnancy induced hypertension, no iron/folic acid supplementation during pregnancy, being anemic during pregnancy, and birth defect were important determinants of preterm birth.
A Randomized Clinical Trial of Prehabilitation Using Aquatic Exercise in Older Adults with Knee Osteoarthritis Undergoing Total Knee Arthroplasty
Authors: Kim Sunghye , Hsu Fang-Chi , Groban Leanne , Williamson Jeff , Messier Stephen
Published: July 2020

Background: With an aging population, knee osteoarthritis (KOA) is increasingly more prevalent. A significant number of patients with advanced KOA require total knee arthroplasty (TKA). Preoperative physical function predicts postoperative outcomes. We hypothesized that preoperative water exercise to improve preoperative physical function will improve postoperative outcomes after TKA.Methods: We conducted a randomized controlled trial in 43 participants who were scheduled for TKA and scored at or below 50th percentile in mobility assessment tool-sf (MAT-sf). All enrolled participants were assessed on 1) clinical osteoarthritis symptom severity using Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), 2) physical function using Short Physical Performance Battery (SPPB), 3) self-reported mobility using Mobility Assessment Tool-short form (MAT-sf), 4) depression using Geriatric Depression Scale-short form (GDS-sf), 5) cognitive function using Montreal Cognitive Assessment (MoCA). High-sensitivity-C-reactive protein (CRP), tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6) levels were analyzed. Participants were randomly assigned to the aquatic exercise intervention (AEI) or usual care group. The AEI was conducted three times a week for 4-8 weeks, with each session lasting for 60 minutes. Participants in both groups were evaluated within one week before their scheduled surgery, as well as 4 weeks after the surgery. Logistic regressions were used to examine the associations between the intervention and unfavorable outcomes.Results: The mean age was 67.1 (±6.2), 44% were female, 74% were White. There is no statistically significant difference in combined outcome of any complication, unscheduled ER visit, and disposition to nursing home or rehab facility by AEI. However, AEI was associated with more favorable functional outcomes including WOMAC scores, chair-stand, MAT-sf, as better mood and cognition and lower blood pressure in multivariable analyses.Conclusion: 4-8 weeks of aquatic exercise intervention resulted in improved functional outcomes in patients undergoing TKA. A larger study is warranted to explore the role of water exercise in clinical and functional outcomes of TKA.Trial registration: This clinical trial was registered at ClinicalTrials.gov with ClinicalTrials.gov Identifier of NCT02773745. The date of registration was March 16th 2016. The URL of the trial registry record is https://www.clinicaltrials.gov/ct2/show/NCT02773745?term=water&recrs=e&cond=Osteoarthritis%2C+Knee&cntry=US&draw=2&rank=2.
Association between open tibia fractures and acute compartment syndrome: a retrospective cohort study
Authors: Gamulin Axel , Wuarin Lydia , Zingg Matthieu , Belinga Patrick , Cunningham Gregory , Gonzalez Amanda I.
Published: July 2020

Background
the aim of this study was to determine if an open tibia fracture is at increased risk to be associated with acute compartment syndrome (ACS), when compared to a closed tibia fracture.
Methods
a cohort of 711 consecutive adult patients sustaining 725 tibia fractures between January 2005 and December 2009 were included in this retrospective study. The outcome measure was ACS, which was clinically diagnosed. The following variables were assessed: soft tissue condition (closed, open Gustilo type 1 or open Gustilo type 2 and 3); low- vs. high-energy injury; associated contiguous skeletal injury; type of fracture (proximal intra-articular, extra-articular, distal intra-articular). A logistic regression model was used to measure the association between ACS and the variables. Adjustment was performed for age and sex. Statistical significance was defined as p < 0.05.
Results
fractures occurred at a mean age of 44.6 ±17.4 years and among 477 (65.8%) men, and ACS occurred in 10.4% of proximal intra-articular fractures, 10.4% of extra-articular fractures and 3.3% of distal intra-articular fractures. ACS occurred in 8.7% of closed fractures, 7.8% of open Gustilo 1 fractures and 13.3% of open Gustilo 2 and 3 fractures. Open fractures were not associated with ACS occurrence when tibia fractures were considered as a whole. When stratifying by types of fractures, open Gustilo 2 and 3 fractures were associated with ACS in proximal intra-articular fractures. No association with closed or any type of open fractures was highlighted for extra-articular fractures. There were not enough ACS cases among distal intra-articular fractures to draw conclusions.
Conclusions
this study highlighted an association between open Gustilo type 2 and 3 lesions and occurrence of ACS in proximal intra-articular fractures only (AO/OTA 41B and C). This finding must raise the level of suspicion of any surgeon treating this kind of injuries, especially if the patient is intubated, sedated or obtunded. As ACS can occur with any type of open tibia fractures, clinicians should not be wrongly reassured by an open fracture, assuming that the wound would relieve the pressure inside the muscle compartments.
Minimally Invasive Surgery for Intra-Articular Calcaneus Fractures: A 9-year, Single-Center, Retrospective Study of A Standardized Technique Using A 2-Point Distractor
Authors: Rodemund Christian , Krenn Ronny , Kihm Carl , Leister Iris , Ortmaier Reinhold , Litzlbauer Werner , Schwarz Angelika , Mattiassich Georg
Published: July 2020

Background: A fracture of the calcaneus can be a painful and disabling injury. Treatment modalities may be conservative or operative, as in open reduction and internal fixation (ORIF) via different approaches, including a number of minimally invasive methods. The aim of this study was to evaluate the treatment options and post-treatment complication rates for intra-articular calcaneal fractures at the Traumacenter Linz over a 9-year period.Methods: All patients with calcaneal fractures treated at the Traumacenter Linz between 2007 and 2016 were included in this study. The patients’ protocols were retrospectively reviewed, and the data, including demographic parameters, cause of injury, and the time between the accident and the first operative treatment were analyzed. Secondary operative interventions due to soft-tissue complications, hardware removal, and the long-term arthrodesis rate were evaluated. Results: A minimally invasive 2-point-distractor method was used in 85.8% (n=182) of all operatively managed calcaneal fractures (n=236) in our department. The majority of the operations (88.7%) were performed within two days after the accident. The secondary operation rate resulting from wound complications was 2.7% in the 2-point distractor group and 16.7% in the ORIF group. A secondary arthrodesis was performed in 4.7% (n=9) of the subtalar joints in the entire study population. Conclusions:Our data supported the assumption that severe wound complications would be less likely to occur after minimally invasive treatment compared to ORIF treatment. Additionally, our arthrodesis rate was comparable to that in the literature. Trial Registration: Not applicable, level of evidence IV.
Comparison of the Effectiveness of Existential, Cognitive-Existential, and Humanistic-Existential Group Psychotherapy on Psychosomatic Complaints in Women With Type 2 Diabetes Mellitus
Authors: Hanis Ghaffar Nasiri , Sadeghi Masoud , Gholamrezaei Simin
Published: July 2020

Background and aims: A significant amount of previous studies has confirmed the positive effect of existential, cognitive-existential, and humanistic-existential interventions on psychosocial problems with different populations. However, research on the effectiveness and comparison of the effect of these three independent variables on the problem of patients with type 2 diabetes mellitus is novel. So, the purpose of this research is to study the comparison of the effectiveness of existential, cognitive-existential, and humanistic-existential group psychotherapy on psychosomatic complaints among women with type 2 diabetes mellitus.Methods: The method of the research was semi-experimental, and its experimental design includes the pretest, post-test, and two-month follow-up tests with experimental and control parallel groups. Cases of this study included women with type 2 diabetes mellitus referring to the Specialist Diabetes Clinic of Tohid Hospital in Sanandaj in the first three months of 2019. 32 subjects selected by simple random sampling method of this society and were assigned to three experimental and one control group by substituting random method. The data collected based on the scale of psychosomatic complaints Takata & Sakata (2004). After the pre-test, the experimental groups participated in 120-minute sessions for 9 weeks. Data analyzed by the statistical test of repeated measures of the General Linear Model.Results: The results of repeated measures analysis showed that the effect of the interventions in experimental groups of psychosomatic complaints was significant and stable compared to the control group (computed using alpha = 0, 05). The effect of the group humanistic-existential psychotherapy on reducing psychosomatic complaints about women with type 2 diabetes mellitus is stable and significant compared to existential and cognitive-existential psychotherapy (The mean difference is significant at the 0,05 level).Conclusion: The findings show applying cognitive-existential more benefits than the other two method. So, existential-cognitive group therapy could be a selective therapy for reducing psychosomatic complaints about women with type 2 diabetes mellitus.
Efficacy of an online cognitive behavioral therapy program developed for healthcare workers during the COVID-19 pandemic: The REduction of STress (REST) study protocol for a randomized controlled trial
Authors: Weiner Luisa , Berna Fabrice , Nourry Nathalie , Severac François , Vidailhet Pierre , Mengin Amaury C.
Published: July 2020

Background: The acknowledgement of the mental health toll of the COVID-19 epidemic in healthcare workers has increased considerably as the disease evolved into a pandemic status. Indeed, high prevalence rates of depression, sleep disorders and post-traumatic stress disorder (PTSD) have been reported in Chinese healthcare workers during the epidemic peak. Symptoms of psychological distress are expected to be long-lasting and have a systemic impact on healthcare systems, warranting the need for evidence-based psychological treatments aiming at relieving immediate stress and preventing the onset of psychological disorders in this population. In the current COVID-19 context, internet-based interventions have the potential to circumvent the pitfalls of face-to-face formats, and provide the flexibility required to facilitate accessibility to healthcare workers. Online cognitive behavioral therapy (CBT) in particular has proved to be effective in treating and preventing a number of stress-related disorders in populations other than healthcare workers. The aim of our randomized controlled trial study protocol is to evaluate the efficacy of the ‘My Health too’ CBT program – a program we have developed for healthcare workers facing the pandemic -- on immediate perceived stress, and on the emergence of psychiatric disorders at 3- and 6-month follow-up compared to an active control group (i.e., bibliotherapy). Methods: Powered for non-inferiority testing, this six-site open trial involves the random assignment of 120 healthcare workers with stress levels >16 on the Perceived Stress Scale (PSS-10) to either the 7-session online CBT program or bibliotherapy. The primary outcome is the decrease of PSS-10 scores. Secondary outcomes include depression, insomnia, and PTSD symptoms, self-reported resilience and rumination, as well as credibility and satisfaction. Assessments are scheduled at pretreatment, mid-treatment (at 4 weeks), end of active treatment (at 8 weeks) and at 3-month and 6-month follow-up. Discussion: This is the first study assessing the efficacy and the acceptability of a brief online CBT program specifically developed for healthcare workers. Given the potential short- and long-term consequences of the COVID-19 pandemic on healthcare workers’ mental health, but also on healthcare systems, our findings can significantly impact clinical practice and management of the ongoing, and probably long-lasting, health crisis. Trial registration: NCT04362358, registered April 24, 2020.
microRNA-26a Inhibits the Malignant Tumor Behavior of Pancreatic Cancer Cells via Targeting E2F7
Authors: Wang Liang , Li Meijun , Chen Fei
Published: July 2020

Background: Dysregulation of microRNAs (miRNAs) plays important roles in the development of pancreatic cancer (PCa). miR-26a was reported as a tumor suppressor in multiple cancers. The aim of this study was to explore the potential role and molecular mechanism of miR-26a in the progression of PCa.Methods: The expression of miR-26a in PCa tissues and cells was detected by RT-qPCR. The effects of miR-26a on the growth of PCa cells were determined by the cell counting kit-8 (CCK-8) assay, colony formation and flow cytometry. The targets of miR-26a were predicted by miRDB database and confirmed by luciferase report assay. The protein level was detected by western blot. CHIP assay was performed to detect the effects of miR-26 on the transcription of E2F7 targets.Results: miR-26a was down-regulated in PCa tissues and cell lines. Ectopic expressed miR-26a suppressed the proliferation, colony formation and the tumor stem cell properties of PCa cells. The transcription factor E2F7 was identified as a target of miR-26a. MiR-26a bound the 3’-untranslated region (UTR) of E2F7 and inhibited the expression of E2F7 in PCa cells. Decreased miR-26a in PCa tissues was inversely correlated with that of E2F7. miR-26a transcriptionally reduced the expression of VEGFA via suppressing the binding of E2F7 with the promoter of VEGFA. Overexpression of E2F7 attenuated the suppressive role of miR-26a in the proliferation of PCa cells. Consistently, knockout of E2F7 further significantly inhibited the growth of PCa cells combined with miR-26a overexpression.Conclusion: Our results uncovered the novel function of miR-26a/E2F7/VEGFA in the malignancy of PCa, suggesting miR-26a as a potential target for the treatment of patients with PCa.