bluuebunny/crossref_metadata_2025 huggingface dataset:
Overhydration and low serum prealbumin predict peritoneal dialysis-related peritonitis in continuous ambulatory peritoneal dialysis patients
Authors: Quy Quyen Dao Bui , Huy Tuan Pham Ngoc , Duc Loc Nguyen , Van My Pham , Huu Dung Nguyen , Duy Toan Nguyen , Viet Tien Tran , Do Quyet , Viet Thang Le
Published: September 2020

Background: In this study, we focused on the role of overhydration (OH) and low serum prealbumin concentration in predicting 3-year peritonitis in continuous ambulatory peritoneal dialysis (CAPD) patients.Methods: We measured serum prealbumin concentration and OH by body composition monitor on 278 CAPD patients (159 males and 119 females) with mean age of 46 years and the median peritoneal dialysis (PD) duration of 21 months. PD-related peritonitis was collected for 3 years. Results: After the 3-year follow-up, 44 patients diagnosed PD-related peritonitis (15.8%). Low education, serum albumin, prealbumin, high CRP-hs and OH were independent risk factors for predicting peritonitis during 36 months in CAPD patients. Based on the ROC curve model and Kaplan–Meier analysis, we realized that patients with low prealbumin and high OH were the independent predictors of 3-year peritonitis in CAPD patients (Prealbumin: AUC = 0.838, cut-off value = 32.5 mg/dL, Se= 90.9%, Sp = 32.9%; OH: AUC = 0.851, cut-off value = 1.33 L, Se = 79.5%, Sp = 85.5%; and Log-rank test p < 0.001, respectively). Conclusion: Overhydration and low serum prealbumin level were the independent predictors of PD-related peritonitis in CAPD patients.
Special foods and local herbs used to enhance breastmilk production in Ghana: rate of use and beliefs of efficacy
Authors: Ali Zakari , Bukari Mohammed , Mwinisonaam Anita , Abdul-Rahaman Abdul-Latif , Abizari Abdul-Razak
Published: September 2020

Background: Inadequate breastmilk production is one of the key factors associated with suboptimal breastfeeding. In most local African homes, special herbs and some food items are commonly used to promote breastmilk production (known as lactogogue/galactogogue). We describe the use and characterize the herbs and food items used to promote breastmilk production in two regions of Ghana.Methods: We conducted a cross-sectional study in 2018 involving 402 lactating mothers. The range of foods used as lactogogues was obtained from 20 participants through focus group discussions. Quantitative data on demographics, lactogogue use and feeding practices were obtained through questionnaire administration. Results: The mean age of women was 29.2years and children were 10 months. Breastmilk production problems were low (22.4%) and majority of lactating mothers felt they had adequate breastmilk (70.4%) but awareness about lactogogues was widespread in both regions (88.8%) and highest in the Brong-Ahafo region (90.0%). Information about lactogogues was mainly from grandparents (24.6%), parents (31.6), health facilities (16.5%) and friends (12.8%), while the media had little influence (<1%). Majority of the mothers used lactogogues to enhance breatmilk production (67.7%), yet a quarter of them used lactogogues because of their tradition (25.2%). Prevalence of lactogogue use was 83.8%, lactogogues were prepared separate from household meals (59.4%) and consumed 1 to 3 times a day (89.6%). Users felt the effectiveness within 24hrs of use (98.5%). The most common lactogogues included; groundnut/peanut soup prepared with Bra leaves (Hibiscus sabdariffa), hot black tea, Werewere/Agushi (Citrulus colocynthis) prepared with Bra leaves, and Abemudro (a polyherbal formulation). Only 13.2% of lactating mothers also used lactogogues during pregnancy.Conclusion: Special foods and selected herbs are widely used to enhance breastmilk production in Ghana and constitute an important part of the diet of lactating mothers. These results could contribute to understanding breastfeeding behaviours and stimulate further research into evaluating the safety and scientific efficacy of these products in Ghana.
ReactionCode: Format for Reaction Searching, Analysis, Classification, Transform, and Encoding/Decoding
Authors: Delannée Victorien , Nicklaus Marc C.
Published: September 2020

In the past two decades a lot of different formats for molecules and reactions have been created. These formats were mostly developed for the purposes of identifiers, representation, classification, analysis and data exchange. A lot of efforts ha ve been made on molecule formats but only few for reactions where the endeavors have been made mostly by companies leading to proprietary formats. Here, we developed a new open-source format which allows to encode and decode a reaction into multi-layers machine readable code, which aggregates reactants and products into a condensed graph of reaction (CGR). This format is flexible and can be used in a context of reaction similarity searching and classification. It is also designed for database organization, machine learning applications and as a new transform reaction language.
Blocking of Efflux Transporters in Rats Improves Translational Validation of Brain Radioligands
Authors: Shalgunov Vladimir , Xiong Mengfei , L'Estrade Elina T , Raval Nakul R , Andersen Ida Vang , Edgar Fraser G , Speth Nikolaj Raahauge , Bærentzen Simone Larsen , Hansen Hanne Demant , Donovan Lene Lundgaard , Nasser Arafat , Peitersen Siv Thorlund , Kjær Andreas , Knudsen Gitte Moos , Syvänen Stina , Palner Mikael , Herth Matthias Manfred
Published: September 2020

Background Positron Emission Tomography (PET) is a molecular imaging technique that can be used to investigate the in vivo pharmacology of drugs. Initial preclinical evaluation of PET tracers is often conducted in rodents due to the accessibility of disease models as well as economic considerations. Compared to larger species, rodents display a higher expression and/or activity of efflux transporters such as the P-glycoprotein (P-gp). Low brain uptake could, therefore, be species-specific and uptake in rodents not be predictive for that in humans. We hypothesized that a better prediction from rodent data could be achieved when a tracer is evaluated under P-gp inhibition. Consequently, we compared the performance of eight neuroreceptor tracers in rats with and without P-gp inhibition including a specific binding blockade. This data set was then used to predict the binding of these eight tracers in pigs.Methods PET tracers targeting serotonin 5-HT2A receptors ([18F]MH.MZ, [18F]Altanserin, [11C]Cimbi-36, [11C]Pimavanserin), serotonin 5-HT7 receptors ([11C]Cimbi-701, [11C]Cimbi-717 and [11C]BA-10) and dopamine D2/3 receptors ([18F]Fallypride) were used in the study. The brain uptake and target-specific binding of these PET radiotracers were evaluated in rats with and without inhibition of P-gp. Rat data were subsequently compared to the results obtained in pigs.Results Without P-gp inhibition, the amount of target-specific binding in the rat brain was sufficient to justify further translation for three out of eight evaluated tracers. With P-gp inhibition, results for five out of eight tracers justified further translation. The performance in pigs could correctly be predicted for six out of eight tracers when rat data obtained under P-gp inhibition were used, compared to four out of eight tracers without P-gp inhibition.Conclusions P-gp strongly affects the uptake of PET tracers in rodents, but false prediction outcomes can be reduced by evaluating a tracer under P-gp inhibition.
Transitioning To Digital First Line Intervention – Validation Of A Brief Online Screener For Early Identification Of A Suspected Eating Disorder: Study Protocol
Authors: Bryant Emma , Miskovic-Wheatley Jane , Touyz Stephen , Crosby Ross D , Koreshe Eyza , Cao Li , Maguire Sarah
Published: September 2020

Background: Only one in four people with eating disorders seeks treatment, and of those who do seek treatment, 20% go on to experience a chronic course. Early intervention has been associated with better prognosis, with those seeking specialised intervention in the early stages of their illness more than twice as likely to achieve remission. Current screening measures typically require expert administration and are rarely validated across a spectrum of DSM-5 eating disorder presentations or for online use. In light of COVID-19 and increasing reliance on telehealth technologies in the intervention and delivery of mental health services, online assessments suitable for self-referral are likely to be the first step to seeking care. InsideOut Institute has developed a 6-item online screening tool for the purposes of identifying eating disorder risk and symptomatology, aimed specifically at increasing help-seeking behaviour in subsyndromal and early presentations. Methods: This study investigates the reliability and validity of the InsideOut Institute Screener (IOI-S), using a cross-sectional survey research design. Participants aged 14 and over will complete an extensive baseline survey battery for evaluation. 50% of participants will be randomly selected for one follow-up re-test of the IOI-S only, two weeks post initial testing. The IOI-S will be analysed for statistical reliability on two parameters: internal consistency and test re-test reliability, and for statistical validity on four parameters: concurrent validity, sensitivity and specificity, convergent and discriminant validity. Discussion: The rapid and ongoing shift to digital intervention has highlighted gaps and opportunities in our pathways to care. Adequate screening for eating disorders is a major gap. This study aims to validate an online screening tool for use in telehealth early intervention, designed for users seeking information for a suspected eating disorder. The screener meets those at risk ‘where they are’ (i.e. online) and may improve timely referrals to relevant services. This is of particular salience as face-to-face healthcare and traditional frontline interventions are disrupted, and we are challenged to re-design our practices to deliver diagnostic and treatment services in highly adaptive digital contexts.Trial registration: N/A
Weighted gene coexpression network analysis-based identification of key modules and hub genes associated with drought sensitivity in rice
Authors: Yu Baiyang , Liu Jianbin , Wu Di , Liu Ying , Cen Weijian , Wang Shaokui , Li Rongbai , Luo Jijing
Published: September 2020

Background: Drought stress is an adverse factor with deleterious effects on several aspects of rice growth. However, the mechanism underlying drought resistance in rice remains unclear. To understand the molecular mechanism of the drought response in rice, drought-sensitive CSSL (Chromosome Single-substitution Segment Line) PY6 was used to map QTLs of sensitive phenotypes and to reveal the impact of the QTLs on transcriptional profiling.Results: The QTL dss-1 was mapped onto the short arm of chromosome 1 of rice. According to transcriptomic analysis, the identified differentially expressed genes (DEGs) exhibited a downregulated pattern and were mainly enriched in photosynthesis-related GO terms, indicating that photosynthesis was greatly inhibited under drought. Further, according to weighted gene coexpression network analysis (WGCNA), specific gene modules (designating a group of genes with a similar expression pattern) were strongly correlated with H2O2 (4 modules) and MDA (3 modules), respectively. Likewise, GO analysis revealed that the photosynthesis-related GO terms were consistently overrepresented in H2O2-correlated modules. Functional annotation of the differentially expressed hub genes (DEHGs) in the H2O2 and MDA-correlated modules revealed cross-talk between abiotic and biotic stress responses for these genes, which were annotated as encoding WRKYs and PR family proteins, were notably differentially expressed between PY6 and PR403.Conclusions: We speculated that drought-induced photosynthetic inhibition leads to H2O2 and MDA accumulation, which can then trigger the reprogramming of the rice transcriptome, including the hub genes involved in ROS scavenging, to prevent oxidative stress damage. Our results shed light on and provide deep insight into the drought resistance mechanism in rice.
Seven-day Fasting as a multimodal complex interventionfor Adults with Type 1 Diabetes – Feasibility, Benefit and Safety in a Controlled Pilot StudyFeasibility of Fasting for Adults with Type 1 Diabetes 
Authors: Berger Bettina , Jenetzky Ekkehart , Köblös Diana , Stange Rainer , Baumann Andrea , Simstich Johannes , Michalsen Andreas , Schmelzer Kurt , Martin David D.
Published: September 2020

Aims/Hypothesis: Intermittent as well as prolonged fasting are receiving considerable attention and appear favorable in conditions like the metabolic syndrome, type 2 diabetes, rheumatic diseases and others. Fasting for people with type 1 diabetes is generally considered too risky. However, the ability and possibility to change from carbohydrate to ketone-based fuel supply might also be relevant for people with type 1 diabetes. The aim of this patient-led research was to investigate the feasibility, benefit and safety of a seven-day multimodal fasting intervention in people with type 1 diabetes. Methods: A non-randomized controlled pilot study, with 20 participants with and 10 without type 1 diabetes. Data acquisition took place prior, post and four months after the intervention and daily during intervention. Results: 29 of 30 participants finished the intervention. Mean ß-hydroxybutyrate as representative ketone body increased to 2.8 ± 1.9 mmol/L on day 7 while average glucose remained between 4.9 ± 1.5 to 7.5 ± 2.3 mmol/L [89 ± 27 and 136 ± 40 mg/dL]. Fasting-related side effects were all temporary, and slightly more prevalent in those with type 1 diabetes. Mean daily insulin dose was adjusted from 24.4 (3-50) IU on the day before fasting to 7.6 (0-26.7) IU on day 7. Quality of life (WHO-5) normalized from 54.0 ± 4.4 to 68.8 ± 15.0 (p = 0.01) after fasting. There was a decrease from before until the follow-up four month later of weight from 77.6 ± 20.4 kg to 76.6 ± 20.9 kg (p = 0.023) and for the BMI from (27.68 ± 7.04) to (26.74 ± 7.15) kg/m2 (p = 0.008). Diastolic blood pressure increased from 69.75 ± 11.41 mmHg to 75.74 ± 8.42 mmHg (p = 0.028) and stayed in a healthy range on average. Conclusions/Interpretation: This study demonstrates the feasibility, benefits and safety aspects of a 7-day fast in adults with type 1 diabetes.
Proficiencies of Military Medical Officers in Intubating Difficult Airways
Authors: Lim Jonathan Zhao Min , Chew Shi Hao , Chin Benjamin Zhao Bin , Siew Raymond Chern Hwee
Published: September 2020

Background This study sheds light on the proficiency of military medical officers who had received between 2-3 years of post-graduate training, in the handling of the difficult airway in a trauma manikin simulator using direct and video laryngoscopes. Method 133 doctors from the Singapore Armed Forces Medical Officer Cadet Course were assessed using high-fidelity simulator models with standardised difficult airways (simulator with tongue-swelling and cervical collar). They used the Macintosh direct laryngoscope (DL), King Vision channelled-blade laryngoscope (KVC), King Vision non-channelled blade laryngoscope (KVNC), and the McGrath (MG) laryngoscope on the same model in a randomised sequence. The intubation success rates and time to intubation were recorded and analysed for the study. Results The medical officers had a 71.4% intubation success rate with the DL on the difficult airway trauma simulator model and the mean time to intubation of 40.1s. With the KVC, the success rate is 86.5% with mean intubation time of 40.4s. The KVNC produced 24.8% success rate, with mean time to intubation of 53.2s. The MG laryngoscope produced 85.0% success rate, with a mean time of intubation of 37.4s. Conclusion Military medical officers with 2-3 years of post-graduate training had a success rate of 71.4% success rate intubating a simulated difficult airway in a trauma setting using a DL. Success rates were improved with the use of KVC and the MG laryngoscope, but was worse with the KVNC.
How Contexts Affect the Willingness of People to Register for the Deceased Organ Donation Program?
Authors: AlHajri Lamia , AlHebsi Amna , AlSuwaidi Maryam
Published: September 2020

Background: The deceased organ donation program is new in the United Arab Emirates (UAE), and to heighten acceptability, a broad understanding of public perspectives thought to be helpful. Therefore, this study aims to explore the extent by which context plays a role in willingness to register for the deceased organ donation program in UAE, Dubai.Methods: A qualitative methodology was used and this study was gauged by tenets of socioecological model and lay knowledge. Audio-recorded semi-structured interviews were conducted with 17 participants who were recruited purposefully. Then, data was analysed thematically.Results: Four themes emerged from the dataset including: fear and body integrity, family, relational ties and the identify of recipient, religious conviction and knowledge and personal experiences. Participants feared the whole process, were not aware of the religious outlook and their knowledge regarding the program was scarce. Also, family related factors were major influencer, there should not be overlooked. Conclusion: Using the socioecological model and lay knowledge helped to unravel contextual factors that affected their willingness to participate. Therefore, enabled developing a holistic understanding of the phenomenon of interest. Responses were mainly stemming from their contexts, hence, awareness campaigns should elucidate people about the technical aspects and address their contextual concerns.
Detailed Cost of Robotic-assisted Surgery in the Australian Public Health Sector: From Implementation to a Multi-specialty Caseload
Authors: McBride Kate , Steffens Daniel , Stanislaus Christina , Solomon Michael , Anderson Teresa , Thanigasalam Ruban , Leslie Scott , Bannon Paul G.
Published: September 2020

Background: A barrier to the uptake of robotic-assisted surgery (RAS) continues to be the perceived high costs. A lack of detailed costing information has made it difficult for public hospitals in particular to determine whether use of the technology is justified. This study aims to provide a detailed description of the patient episode costs and the contribution of RAS specific costs for multiple specialties in the public sector. Methods: A retrospective descriptive costing review of all RAS cases undertaken at a large public tertiary referral hospital in Sydney, Australia from August 2016 to December 2018 was completed. This included RAS cases within benign gynaecology, cardiothoracic, colorectal and urology, with the total costs described utilizing various inpatient costing data, and RAS specific implementation, maintenance and consumable costs.Results: Of 211 RAS patients, substantial variation was found between specialties with the overall median cost per patient being $19,269 (IQR: $15,445 to $32,199). The RAS specific costs were $8,828 (46%) made up of fixed costs including $4,691 (24%) implementation and $2,290 (12%) maintenance, both of which are volume dependent; and $1,848 (10%) RAS consumable costs. This was in the context of 37% robotic theatre utilisation. Conclusions: There is considerable variation across surgical specialties for the cost of RAS. It is important to highlight the different cost components and drivers associated with a RAS program including its dependence on volume and how it fits within funding systems in the public sector.
Functional improvement in hip pathology improves anxiety, depression, and pain catastrophizing: an intricate link between physical and mental well-being
Authors: Gudmundsson Paul , Nakonezny Paul , Lin Jason , Owhonda Rebisi , Richard Heather , Wells Joel E.
Published: September 2020

BackgroundPain catastrophizing, anxiety, and depression represent risk factors that can be treated alongside physical care given to orthopedic patients. While these factors have been shown to be common in patients with hip pathology, there is limited literature that follows these conditions throughout treatment. The purpose of this study was to track psychological factors in patients with various hip pathology to determine if they improved alongside functional measures following treatment.MethodsPatients presenting to a specialist hip clinic were prospectively evaluated for outcomes of pain catastrophizing, anxiety, depression, and hip function. Pre- and post-treatment assessments were undertaken: Pain Catastrophizing Scale, the Hospital Anxiety Depression Scale, the Hip Outcome Survey, and Hip Disability and Osteoarthritis Outcome Score (HOOS). Patient characteristics were recorded. A correlation analysis, using the Spearman partial correlation coefficient (rs), was conducted to evaluate the relationship between change in psychological factors with change in functional outcomes.ResultsA total of 201 patients (78 male, 123 female) were included, with diagnoses of hip dysplasia (n = 35), femoroacetabular impingement (n = 35), lateral trochanteric pain syndrome (n = 9), osteoarthrosis (n = 109), and avascular necrosis of the hip (n = 13). Statistical analysis revealed a significant negative relationship between change in function level (as measured by HOOS ADL) and change in pain catastrophizing (rs = -0.373, p < 0.0001), depression (rs = -0.363, p < 0.0001), and anxiety (rs = -0.264, p = 0.0002). Pain catastrophizing, depression, and anxiety improved with function. Spearman correlation coefficients also revealed that pain catastrophizing, HADS anxiety, and HADS depression improved with improvement in other patient-reported functional outcomes.ConclusionsPatients with hip pathology often exhibit pain catastrophizing, anxiety, and depression, but improvements in hip functionality are associated with decreased severity of these psychological comorbidities. Establishing this connection demonstrates the impact that musculoskeletal impairment has on psychosocial outcomes and mental health. Perioperative multidisciplinary assessment may be a beneficial part of comprehensive orthopaedic hip care.
Antitumor effects of lactate transport inhibition on esophageal adenocarcinoma cells
Authors: Chueca Eduardo , Grasa Laura , Arechavaleta Samanta , García-González María Asunción , Sáenz María Ángeles , Lanas Ángel , Piazuelo Elena
Published: September 2020

BackgroundAs a consequence of altered glucose metabolism, cancer cells intake is increased, producing large amounts of lactate which is pumped out the cytosol by monocarboxylate transporters (MCTs).MCTs are frequently overexpressed in tumors, MCT1 in the well oxygenated areas and MCT4 in hypoxic regions, and recent evidence has reported that MCT inhibition can exert antineoplastic effects, but this aspect has not been investigated in esophageal adenocarcinoma (EAC) yet. In the present study, MCT1 and MCT4 levels were assessed in EAC cells and the effects of MCT-1 selective inhibitor AZD3965, hypoxia and a glucose overload were evaluated in vitro .MethodsTwo EAC cell lines (OE33 and OACM5.1C) were treated with different concentrations of AZD3965 (10-100nM) in the presence or absence of a glucose overload under normoxic or hypoxic conditions and parameters of cytotoxicity, oxidative stress, intracellular pH (pHi) and lactate levels were evaluated.ResultsMCT1 was present in both cell lines whereas MCT4 was expressed in OE33 cells and only in a small population of the metastatic cells.Glucose addition did not have any effect on apoptosis nor cell proliferation.AZD3965 increased apoptosis and reduced proliferation of OACM5.1C cells, effects which were abrogated when cells were growing in hypoxia.MCT1 inhibition increased intracellular lactate levels in all the cells evaluated, but this increase was higher in cells expressing only MCT1 and did not affect oxidative stress.AZD3965 induced a decrease in pHi of cells displaying low levels of MCT4, and also increased NHE-1 expression on these cells. ConclusionThese data provide in vitro evidence supporting the potential of MCT inhibitors as novel antineoplastic drugs for EAC and highlight the importance of achieving a complete MCT inhibition.
Views of medical residents on a research training program: a qualitative study
Authors: Khalil Pamela Abi , Honein-AbouHaidar Gladys , Achi Dina El , Al-Hakim Lara , Tamim Hani , Akl Elie A.
Published: September 2020

Background
The American University of Beirut Medical Center (AUBMC) developed the Fellowship and Residency Research Program (FRRP) to provide residents and clinical fellows with a supervised and structured research experience.
Objective
To explore the views of FRRP participants about the training program and how to enhance it.
Methods
We conducted a qualitative study targeting residents in one of the post-graduate training programs at AUBMC. We invited potential participants through email and via snowball sampling. We continued the data collection until we reached data saturation. We used a thematic analysis to identify emerging themes.
Results
Four themes emerged from the content analysis: expectations of residents, coordination, mentorship, and capacity building. Residents expected the FRRP to provide them with capacity building activities in conducting research since they perceived themselves as novice researchers. In terms of coordination, few residents complained that the deadlines to submit the deliverables are not evenly distributed across the years, so they suggested moving the deadlines earlier to give more time to address any challenges. In terms of mentorship, participants appreciated the flexibility in choosing the mentor and the ability to choose their own research question in agreement with their mentor, however, they thought that there were few faculty members who conducted research and some lacked commitment due to either being busy or travelling, resulting in the slowing of their progress. In terms of capacity building activities, the participants found the lecture series, both real time and virtual, to be helpful and they were satisfied with the topics of the lectures. Finally, participants pointed out that the FRRP program is very supportive and most of them thought it should be mandatory.
Conclusion
In order to provide residents and clinical fellows with a supervised and structured research experience, we have built on our findings to introduce several changes to our program such as ensuring the availability and commitment of faculty mentors, providing capacity building activities to the program participants and revising the program educational offerings to better cover the ABCs of research using mostly interactive and hands on sessions.
Cost Analysis of Pediatric Intensive Care: A Low-Middle Income Country Perspective
Authors: Kaur Amrit , Jayashree Muralidharan , Prinja Shankar , Singh Ranjana , Baranwal Arun K.
Published: September 2020

Background: Globally, Pediatric Intensive Care Unit (PICU) admissions are amongst the most expensive. This makes it important to gain insights into the cost of pediatric intensive care units. We undertook this study to calculate the health system cost and out of pocket expenditure incurred per patient during Pediatric Intensive Care Unit (PICU) stayMethods: Prospective study conducted in a state of art tertiary level PICU of a teaching and referral hospital. Bottom-up micro costing methods were used to assess the health system cost. Annual data regarding hospital resources used for PICU care was collected from January 2018 to December 2018. Data regarding out of pocket expenditure (OOP) was collected from 299 patients who were admitted from July 2017 to December 2018. The study period was divided into four intervals, each of 4 and a half months duration and data was collected for 1 month in each interval. Per patient and per bed day costs for treatment were estimated both from health system and patient’s perspective. Results: The median (inter-quartile range, IQR) length of PICU stay was 5(3–8) days. Mean ± SD PRISM score of the study cohort was 22.23 ± 7.3. Of the total patients, 55.9% (167) were ventilated. Mean cost per patient treated was US$ 2,078(₹ 144,566). Of this, health system cost and OOP expenditure per patient were US$ 1,731 (₹ 120,425) and 352 (₹ 24,535) respectively. OOP expenditure of a ventilated child was twice that of a non‐ ventilated child. Conclusions: The fixed cost of PICU care were 3.5 times more than variable costs. Major portion of cost is borne by hospital. Severe illness, longer ICU stay and ventilation were associated with increased costs. This study can be used to set the reimbursement package rates under Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB-PMJAY). Tertiary care state of art intensive care in a public sector teaching hospital in India is far less expensive than developed countries.
Biomarkers in the rock outcrop of the Kazusa Group reveal paleoenvironments of the Kuroshio region
Authors: KAJITA HIROTO , Maeda Ayumi , Utsunomiya Masayuki , Yoshimura Toshihiro , Ohkouchi Naohiko , Suzuki Atsushi , Kawahata Hodaka
Published: September 2020

The classical biomarkers of long-chain alkenones and n-alkanes preserved in marine and lake sediment cores are widely used to reconstruct paleoenvironments. Here, we detected these biomarkers are preserved in the rock outcrop of the Kazusa Group exposed in central Japan, the most continuous sedimentary succession in the world, covering almost the entire Pleistocene. The alkenone unsaturation ratio and average chain length of n-alkanes appeared to reflect the glacial-interglacial changes in the sea surface temperature (SST) and terrestrial climate, respectively. Alkenone-based SSTs during 1.1–1.0 Ma were significantly higher than present-day SSTs in the same area, as supported by foraminiferal Mg/Ca-based temperatures, possibly reflecting the direct intrusion of the warm Kuroshio Current. Applying these biomarkers, which might be circumstantially preserved owing to their immunity to high temperature and consolidation stress during burial and uplift, we expect that the Kazusa Group should reveal detailed oceanic and atmospheric changes of the Kuroshio region.
Changes and Prognostic Impact of Inflammatory Nutritional Factors During Neoadjuvant Chemoradiotherapy for Patients with Resectable and Borderline Resectable Pancreatic Cancer
Authors: Oshima Minoru , Okano Keiichi , Suto Hironobu , Ando Yasuhisa , Kamada Hideki , Masaki Tsutomu , Takahashi Shigeo , Shibata Toru , Suzuki Yasuyuki
Published: September 2020

BackgroundInflammatory nutritional factors, such as the neutrophil/lymphocyte ratio (NLR), Glasgow Prognostic Score (GPS), modified GPS (mGPS), and C-reactive protein/albumin (CRP/Alb) ratio, have prognostic values in many types of cancer. In this study, the prognostic values of inflammatory nutritional scores were evaluated in the patients with resectable or borderline resectable pancreatic ductal adenocarcinoma (PDAC) after neoadjuvant chemoradiotherapy (NACRT).MethodsA total of 49 patients who underwent pancreatectomy after NACRT from September 2009 to May 2016 were enrolled. The NACRT consisted of hypofractionated external-beam radiotherapy (30 Gy in 10 fractions) with concurrent S-1 (60 mg/m2) delivered 5 days/week for 2 weeks before pancreatectomy. Inflammatory nutritional scores were determined before and after NACRT in this series. ResultsThe median NLR increased after NACRT (from 2.067 to 3.302), with statistical difference (p<0.001). In multivariate Cox regression analysis, high pre-NACRT mGPS (2 or 1; p=0.0478) and significant increase in CRP/Alb ratio after NACRT (≧0.077; p=0.0036) were associated with shorter overall survival. All patients were divided into two groups according to the ΔCRP/Alb ratio after NACRT: the group with high ΔCRP/Alb ratio (≧0.077) and the group with low ΔCRP/Alb ratio (<0.077). The group with high ΔCRP/Alb ratio after NACRT (n=13) not only had higher post-NACRT CRP levels (p<0.001) but also had lower post-NACRT Alb levels (p=0.002). Patients in the group with high ΔCRP/Alb ratio lost more body weight during NACRT (p=0.03).ConclusionIn addition to pre-NACRT mGPS, ΔCRP/Alb after NACRT could provide prognostic value in the patients with PDAC treated by NACRT.
Health Service Use of Australian Unemployment and Disability Benefit Recipients: A National, Cross-Sectional Study.
Authors: Collie Alex , Sheehan Luke , McAllister Ashley
Published: September 2020

Background: Healthcare is funded and delivered separately from social care programs such as unemployment and disability insurance. Greater understanding of the health service use (HSU) of social assistance benefit recipients would support more effective design and delivery of health and social care. This study aimed to characterise the HSU of disability and unemployment benefit recipients relative to people earning wages, and to identify personal, household and health-related factors associated with HSU in disability benefit recipients.Methods: A cross-sectional national survey of 9,520 working age Australian adults in three groups: (1) 638 receiving the disability support pension (DSP); (2) 442 receiving unemployment benefits; and (3) 8440 earning wages. Outcomes included count and frequency of health professional consultations, hospital attendance and admission in the past 12 months, as well as medication and supplement use in the past 2 weeks. Analyses compared DSP and unemployment benefit recipients to wage earners using age and sex adjusted risk ratios and incident rate ratios. Negative binomial regression models were constructed to examine factors associated with hospitalisation and general practitioner services in DSP recipients. Results: DSP recipients were significantly more likely than wage earners to have consulted 15 of 22 types of health professionals, had 2.5 times greater risk and 3.8 times higher rate of hospital admission, and 3.4 times greater risk of prescription medication use. Unemployment benefit recipients were significantly more likely than wage earners to have consulted 5 of 22 types of health professionals, had 1.5 times greater risk of hospital admission and 1.2 times greater risk of prescription medication use. Younger age, hypertension, more co-morbid conditions and poorer self-assessed health were associated with higher rate of hospital admission among DSP recipients. Conclusions: People receiving unemployment and disability insurance benefits use significantly more health services than wage earners. A range of personal and clinical characteristics are associated with greater HSU among disability benefit recipients. Greater coordination between health and social care systems may improve health, reduce HSU and improve work ability in unemployed and working age people.
Influenza Vaccination During Pregnancy And Influencing Factors In Korea: A Multicenter Questionnaires Study of Pregnant Women and Obstetrics and Gynecology Doctors.
Authors: Kang Byung Soo , Lee San Ha , Kim Woo Jeng , Wie Jeong Ha , Park In Yang , Ko Hyun Sun
Published: September 2020

BackgroundOur objective was to investigate: (1) the proportion of influenza vaccination, attitudes, and barriers among pregnant women, (2) the proportion of obstetrics and gynecology (OBGYN) doctors who routinely recommend influenza vaccination in pregnant women, and (3) the influencing factors in Korea, during the flu season of 2019-2020, following the introduction of free influenza vaccination program for pregnant women.MethodsTwo separate anonymized questionnaires were developed for pregnant or postpartum women and physicians, and distributed to public or private healthcare centers and clinics, in South Korea. The proportions of women who received influenza vaccination during pregnancy and OBGYN doctors who routinely recommend influenza vaccine for pregnant women were analyzed. Independent influencing factors of influenza vaccination and OBGYN doctors’ routine recommendation for pregnant women were analyzed using multivariate logistic regression analysis, respectively.Result The self-reported proportion of influenza vaccination during pregnancy among 522 women was 63.2%. Independent factors influencing maternal influenza vaccination were ‘(ever) received information about influenza vaccination during pregnancy’, ‘information obtained from OBGYN doctors’, and ‘2nd/3rd trimester or postpartum period’ (OR 8.988, 95% CI 4.21–19.188, p < 0.001, OR 2.611, 95% CI 1.705-3.998, p < 0.001 and OR 3.082, 95% CI 1.508–6.297, p < 0.001, respectively).In 372 OBGYN doctors, the proportion of doctors with the routine recommendation of influenza vaccine for pregnant women was 76.9%. Independent factors affecting the routine recommendation were: 1) affiliation with private hospital or clinic (OR 4.508, 95% CI 2.225–9.133, p<0.001); 2) awareness of guidelines (OR 3.153, 95% CI 1.118–8.894, p=0.03); (3) awareness of 2019 National free influenza vaccination program for pregnant women (OR 4.955, 95%CI 2.377–10.329, p<0.001). For a future recommendation of influenza vaccine for pregnant women, the guidelines proposed by the government or public health care [108 (46%)] and academic committees [59 (25%)] were most commonly chosen by OBGYN doctors.Conclusion This study demonstrated that providing information about maternal influenza vaccination and the recommendation by OBGYN doctors are crucial for increasing the vaccination coverage in pregnant women.
Systematic Profiling of Diagnostic and Prognostic Value of Autophagy-Related Genes for Sarcoma Patients
Authors: Wang Yuanhe , Li Jianyi , Shao Cheng , Tang Xiaojie , Du Yukun , Xu Tongshuai , Zhao Zheng , Hu Huiqiang , Sheng Yingyi , Hu Chuan , Xi Yongming
Published: September 2020

Background: Autophagy-related genes (ARGs) have been confirmed to have an important role in tumorigenesis and tumor microenvironment formation. Nevertheless, a systematic analysis of ARGs and their clinical significance in sarcoma patients is lacking.Methods: Gene expression files from The Cancer Genome Atlas (TCGA) database and Genotype-Tissue Expression (GTEx) were used to select differentially expressed genes (DEGs). Differentially expressed ARGs (DEARGs) were determined by matching the DEG and HADb gene sets, which were evaluated by functional enrichment analysis. Unsupervised clustering of the identified DEARGs was conducted, and associations with tumor microenvironment (TME), immune checkpoints, and immune cells were analyzed simultaneously. Two prognostic signatures, one for overall survival (OS) and one for disease-free survival (DFS), were established and validated in an independent set. Results: In total, 84 DEIRGs and two clusters were identified. TME scores, five immune checkpoints, and several types of immune cells were found to be significantly different between twp clusters. Two prognostic signatures incorporating DEARGs showed favorable discrimination and were successfully validated. Two nomograms combining signature and clinical variables were generated. The C-indexes were 0.818 and 0.636 for the OS and DFS nomograms, respectively.Conclusion: This comprehensive analyses of the ARG landscape in sarcoma showed novel ARGs related to carcinogenesis and the immune microenvironment. These findings have implications for prognosis and therapeutic responses, which reveal novel potential prognostic biomarkers, promote precision medicine, and provide potential novel targets for immunotherapy.
COL1A1, COL1A2, COL3A1 and DCN are Potential Biomarkers to Predict Progression from Smokers to Suffering from Lung Adenocarcinoma
Authors: Chen Jixin , Chen Shuqi , Wang Feiye , Wang Sumei , Wu Wanyin
Published: September 2020

Background: To explore novel related genes and potential biomarkers that predict progression from smokers to lung adenocarcinoma (LA). Methods: Three datasets from GEO (Gene Expression Omnibus) database were used to identify differentially expressed genes (DEGs) between LA tissue (LAT) and normal tumor adjacent tissue (TAT). The overlap of DEGs could be found and enriched in gene oncology (GO) and pathways to discover the potential biological mechanisms. Protein-protein interaction (PPI) network was applied to find the relationship among proteins. Survival analysis contributed to the definiteness of key genes. The expression of key genes in LA patients who smoke was verified. Furthermore, genetic alterations, co-expression and pathways of key genes were explored. To obtain more information, key genes were further analyzed in immune infiltration, drug target and the distribution of single cell in LA. Results: 245 DEGs were revealed in 3 datasets from GEO. In Kaplan Meier plotter, we found that high expression of COL1A1, COL1A2 and COL3A1 was associated with poorer survival while low expression of DCN was contributed to poorer survival in LAs who smoke. Thus, three up-regulated genes (COL1A1, COL1A2, COL3A1) and one down-regulated gene (DCN) were defined as key genes. Their genetic alterations were more common in female LA smokers and co-expression genes/proteins of them mainly functioned at extracellular matrix. Furthermore, COL1A1, COL1A2, COL3A1 genes had a common targeted drug called Collagenase clostridium histolyticum (DB00048) and DCN gene had a targeted drug called Tromethamine (DB03754). In the Single Cell Expression Atlas of EMBL-EBL, COL3A1 gene was specifically highly expressed in female LA patients with brain metastasis. Conclusions: COL1A1, COL1A2, COL3A1 and DCN could be regarded as novel potential biomarkers that predict progression from smokers to lung adenocarcinoma.
Kiguchi Method, A Novel Simplified Technique For Pancreaticojejunostomy In Minimally Invasive Pancreaticoduodenectomy, Significantly Reduces Postoperative Pancreatic Fistula Rate In Patients With A Soft Pancreatic Texture 
Authors: Kiguchi Gozo , Sugioka Atsushi , Nakauchi Masaya , Kojima Masayuki , Yasuda Akira , Nakajima Sanae , Tanahashi Yoshinao , Suda Koichi , Kato Yutaro , Uyama Ichiro
Published: September 2020

Background: Minimally invasive pancreaticoduodenectomy (MIPD), including laparoscopic pancreaticoduodenectomy (LPD) and robotic pancreaticoduodenectomy (RPD), is especially demanding due to pancreaticojejunostomy (PJ). Postoperative pancreatic fistula (POPF) remains the most serious complication in MIPD as well as in open pancreaticoduodenectomy (OPD). Conventional PJ in MIPD did not improve the POPF rate and hospital stay, contrary to expectations. High POPF rates have been attributed to technical issues encountered during MIPD, including motion restriction and insufficient water tightness; therefore, we have developed the Kiguchi method as a novel PJ technique optimized for MIPD. Herein, we describe the technique and assess its impact in patients with a soft pancreatic texture, which has been reported to be significantly related to POPF.Methods: The retrospective study included 188 patients with a soft pancreatic texture. Briefly, 143 patients underwent OPD with conventional PJ (OPD group); 19 patients underwent MIPD with conventional PJ (Old-MIPD group), including 7 and 12 patients undergoing LPD and RPD, respectively; and 26 patients underwent MIPD using the Kiguchi method (New-MIPD group), including 15 and 11 patients undergoing LPD and RPD, respectively. Short-term outcomes were assessed, and POPF risk factors were determined using univariate and multivariate analyses.Results: The grade B/C POPF rate was significantly lower in the New-MIPD group than in the Old-MIPD and OPD groups (3.8% vs. 42.1% and 36.4%, respectively). The median hospital stay was significantly shorter in the New-MIPD group than in the Old-MIPD and OPD groups (23 vs. 33 and 31 days, respectively). By multivariate analysis, the PJ method and male sex were significant POPF risk factors. Among the patients without POPF, the hospital stay was significantly shorter in those undergoing MIPD than in those undergoing OPD, suggesting the advantage of MIPD. Conclusions: The novel Kiguchi method significantly reduced the POPF rate in patients with a soft pancreatic texture.
A Haptic Laparoscopic Trainer Based on Affine Velocity Analysis: Engineering and Preliminary Results
Authors: De Witte Benjamin , Barnouin Charles , Moreau Richard , Leleve Arnaud , Martin Xavier , Collet Christian , Hoyek Nady El
Published: September 2020

Background: General agreement exists upon the importance of acquiring laparoscopic skills outside the operation room. During the past two decades, simulation-based training and simulators have been more extensively used in surgeons’ training. Nevertheless learning through simulation-based systems is hindered by several flaws. High-fidelity simulators are cost-prohibitive which limits training opportunities. Their use also elicits a high cognitive load. Low-fidelity simulators lack in haptic, direct and summative feedback. Our goal is to develop a new low fidelity simulator integrating effective learning features as a new assessment variable while limiting the associated costs. We also aim at assessing its primary validity. Methods: We engineered a low fidelity simulator for teaching basic laparoscopic skills taking into account psychomotor skills, direct and summative feedback and engineering key features (haptic feedback and complementary assessment variables). Afterward, 77 participants with 4 different surgical skill levels (17 experts; 12 intermediates; 28 inexperienced interns and 20 novices) tested the simulator. We checked the content validity using a 10 point Likert scale. We also assessed the simulator discriminative power by comparing the 4 groups’ performance over two sessions. To do so, we used 3 variables: time, number of errors (collisions) and affine velocity. Results: The content validation mean value score was 7.57/10. The statistical analysis yielded performance discrepancies on the selected variables among the groups (p<0.001). Conclusion: We developed an affordable and validated simulator for testing and learning basic laparoscopic skills. The results exhibit three levels of performance on the selected variables. Experts and intermediates outperformed the inexperienced interns who in turn outperformed the novices. Results show that the embedded evaluation variables are complimentary and provide realistic results. The inclusion of a new variable and, meanwhile, haptic, direct and summative feedback is innovative regarding low-fidelity simulators. Limitations and implementation conditions of the simulator in the surgical curricula are discussed.
Molecular Epidemiological Investigation and Analysis of Toxoplasma Gondii Infection in Livestock, Poultry, and Pets in Henan Province, Central China
Authors: Zhang Xiao-Li , Zhu Rong-Hui , Huang Jia-Qi , Qiao Meng-Yuan , Xu xinxin , Bo Peng-Fei , Wang Shuai , Liu Shiguo
Published: September 2020

Background:Toxoplasma gondii (T.gondii ) is a protozoan parasite spread around the world and is concerned as one of the most important foodborne zoonotic parasites in the global world. This study aimed to determine the prevalence of T.gondii in foodborne animals in Henan Province, China.Methods:During 2012 to 2015, a total of 1879 samples of foodborne animal tissues or peripheral blood were collected from 12 slaughterhouses, eight pastures and 434 farmers in different areas of Henan province using systematic random sampling method. The genomic DNA was extracted by the phenol-chloroform method. Moreover, then a One-tube nested polymerase chain reaction (PCR) assay was performed to amplify the 529bp repetitive sequence of T.gondii in these samples.T.gondii infections in diverse animals is different in the study.Results:Of the 1879 samples,cat had the highest T.gondii infection(51.9%,28/54),followed by goose(24.3%,44/181), chicken(19.7%,91/462), cattle(12.6%,23/182), sheep(11.5%,22/191), duck(11.3%,24/212), dog(10.5%,13/124), pigeon(5.4%,16/297) and pig(4.6%,8/176). The total infection of T. gondii in these animals was 269/1879, and the positive rate was 14.3%.Conclusions:The results revealed that all the livestock, poultry, and pets in close contact with humans had toxoplasma infection, which suggest that the consumption of meat products in Henan may pose a potential threat to human health. Therefore, to strengthen the prevention and control of T.gondii infection in animals is an important measure to develop animal husbandry, support food safety, and protect human health.