bluuebunny/crossref_metadata_2025 huggingface dataset:
Psyllium Supplementation is Associated with Changes in the Fecal Microbiota of Horses
Authors: Mienaltowski Michael J. , Belt Ashley , Henderson John D. , Boyd Tannah N. , Marter Nicole , Maga Elizabeth A. , DePeters Edward J.
Published: August 2020

Objective
Prophylactic supplementation of psyllium husk is recommended to enhance passage of ingested sand from the gastrointestinal tracts of horses. We hypothesized that psyllium supplementation would increase fecal sand passage and favorably alter bacterial populations in the hindgut. Six yearlings and six mature mares were fed a psyllium supplement in the diet daily for seven days. Voluntarily-voided feces were collected over the course of 29 days, prior, during, and after treatment. Feces were analyzed for acid detergent fiber (ADF) and acid detergent insoluble ash analyses. Microbial DNA was also isolated, and the V3/V4 region of the 16S ribosomal RNA gene was PCR-amplified and sequenced using MiSeq technology.
Results
Fecal ADF concentration was greater in adults while silica concentration was greater in yearlings. Mature mare fecal ADF decreased during and just after supplementation but thereafter increased. No changes in silica levels were noted in either group over time. Fecal microbial population phylogenetic diversity was greatest mid-supplementation and lowest at 11 days post-supplementation. Functional profiles of the microbial communities presented some benefits for psyllium supplementation. These findings provide compelling evidence for further detailed studies of prophylactic psyllium supplementation.
Chemotherapy Increases the Risk of Developing Severe Illness in Breast Cancer Patients with COVID-19: A Multi-Center Retrospective Study in Hubei, China
Authors: Wei Jielin , Wu Mengjiao , Liu Jing , Wang Xu , Yang Hua , Xia Pengfei , Peng Ling , Huang Yu , Liu Cuiwei , Xia Zihan , Chen Chuang , Zhao Yanxia
Published: August 2020

Background: The COVID-19 pandemic is a significant worldwide health crisis. Patients with malignancy are considered at substantially increased risk of infection and poor outcomes. Breast cancer patients with COVID-19 represent an urgent clinical need. This study aimed to identify clinical characteristics of breast cancer patients with COVID-19 and risks associated with anti-cancer treatment.Methods: This multicenter retrospective cohort study included 45 breast cancer patients with laboratory-confirmed COVID-19 at seven designated hospitals in Hubei, China. The medical records of breast cancer patients were collected from the records of 9559 COVID-19 patients from 13th January, 2020 to 18th March, 2020. Univariate and multivariate analyses were performed to assess risk factors for COVID-19 severity.Results: Of 45 breast cancer patients with COVID-19, 33 (73.3%) developed non-severe COVID-19, while 12 (26.7%) developed severe COVID-19, of which 3 (6.7%) patients died. The median age was 62 years, and 3 (6.7%) patients had stage IV breast cancer. Most patients developed fever (37, 82.2%), and most had bilateral lung involvement on chest CT (36, 80.0%). Univariate analysis showed the age over 75 and Eastern Cooperative Oncology Group (ECOG) score were associated with COVID-19 disease severity (P<0.05). Multivariate analysis showed patients received chemotherapy within 7 days had a significantly higher risk for severe COVID-19 (logistic regression model: RR=13.886, 95% CI 1.014-190.243, P=0.049; Cox proportional hazards model: HR=13.909, 95% CI 1.086-178.150, P=0.043), with more pronounced neutropenia and higher LDH, CRP and procalcitonin levels than patients else (P<0.05).Conclusions: The severity of COVID-19 in breast cancer patients was associated with baseline factors of the age over 75 and ECOG score, but not with tumor characteristics. Chemotherapy within 7 days before symptom onset was a risk factor for severe COVID-19, reflected by neutropenia and elevated LDH, CRP and procalcitonin levels.
Lactic acidosis associated with metformin in diabetic patients with chronic kidney disease: a multicentre case-control study using electronic health records
Authors: Ávila Mónica , Videla Sebastian , Gómez-Lumbreras Ainhoa , Manriquez Marcela , Prat Oriol , Morros Rosa , Pedrós Consuelo
Published: August 2020

Background

Several studies have assessed the risk of lactic acidosis with metformin use. However, data of this association in patients with renal impairment are still scarce and controversial. Our aim was therefore to assess the association between metformin and lactic acidosis in Spanish type 2 diabetic patients with chronic kidney disease.
Methods

A case-control study (ALIMAR-C2) was performed using the electronic health records from hospitals linked to their corresponding primary healthcare regions. The cases were adult (≥ 18 years) diabetic patients with chronic kidney disease, admitted to seven Spanish hospitals from 2010 to 2016. Ten controls (≥ 18 years, diabetic patients with chronic kidney disease) per case were selected from the population within the same primary healthcare region of the hospital cases. The patients’ hospital health records were linked to their corresponding primary healthcare information. Analyses included multivariable logistic regression and adjustment for potential confounders.
Results

Our study included 126 cases and 1,260 matched controls. The current use of metformin and administration at high doses (> 2 g) were associated with lactic acidosis (adjusted OR: 1.92, 95% CI: 1.21–3.03; OR: 3.13, 95% CI: 1.63–6.01, respectively). The estimated case fatality rate was 46.8% (95% CI: 38.3–55.5%). An increased risk of lactic acidosis was observed in patients with mild to moderate renal impairment (OR: 3.41, 95% CI: 1.48–7.85). As an unexpected finding, diuretic drugs use was also associated with lactic acidosis (OR: 2.73, 95% CI: 1.67–4.46).
Conclusions

Metformin was associated with an increased risk of lactic acidosis in patients with type 2 diabetes mellitus and chronic kidney disease. New data is needed to confirm the association between diuretic drugs and lactic acidosis in this group of patients.
Production of common carp donor-derived offspring from goldfish surrogate broodstock
Authors: Franěk Roman , Kašpar Vojtěch , Gela David , Pšenička Martin
Published: August 2020

Background: Common carp is the fourth most-produced species in worldwide aquaculture. Significant efforts are invested in breeding and preservation of genetic integrity of this important species. However, maintaining carp gene bank in situ can be considered as demanding due to its big body size. Recent progress in reproductive biotechnologies in fish allows improving some unfavourable characteristics of a target species using surrogate reproduction. Germ stem cells (gamete precursors) from one species are transplanted into different surrogate species with small body size. After maturation, surrogates are producing donor-derived progeny. Efficient protocols for cryopreservation of carp male and female germ stem cells have been developed lately. Thus, the next logical goal was to assess the potential of goldfish surrogate to produce donor-derived gametes of common carp after intraperitoneal transplantation of testicular cells. Results: High transplantation success was achieved when 44% of the surviving goldfish produced pure donor-derived gametes of common carp. More importantly, both viable eggs and sperm giving rise to pure common carp progeny were produced, witnessing sustainability of the presented method. Donor-derived identity of the offspring was confirmed by genotyping and typical phenotype corresponding to the donor species. Reproductive performance of chimeras was similar to goldfish controls. Assessment of gamete characteristics showed that the size of donor-derived eggs is between control carp and goldfish eggs. Interestingly, flagellum length in donor-derived spermatozoa was comparable to common carp flagellum and significantly shorter than goldfish flagellum. Conclusions: In this study, we succeeded in the production of pure common carp progeny from surrogate goldfish recipients transplanted intraperitoneally by testicular germ cells. Here we reported production of viable eggs between most distant species up to date. Good reproductive performance of goldfish germline chimeras gives a promising prospect for further analysis about the long-term reproductive performance of surrogates, recovery of cryopreserved germ cells or production of monosex stocks. Presented technology is ready to ease needs for carp breeds preservation and their recovery using many times smaller goldfish surrogates.
Neurological Complications and Noninvasive Multimodal Neuromonitoring in Critically ill COVID-19 Patients
Authors: Battaglini Denise , Santori Gregorio , Chandraptham Karthikka , Iannuzzi Francesca , Bastianello Matilde , Tarantino Fabio , Ball Lorenzo , Giacobbe Daniele Roberto , Vena Antonio , Bassetti Matteo , Rocco Patricia Rieken Macedo , Patroniti Nicolò , Brunetti Iole , Pelosi Paolo , Robba Chiara
Published: August 2020

Background: The incidence and clinical presentation of neurological manifestations of coronavirus disease 2019 (COVID-19) remain unclear. No data regarding the use of neuromonitoring tools in this group of patients are available. Methods: This is a retrospective study of prospectively collected data. The primary aim was to assess the incidence and type of neurological complications in critically ill COVID-19 patients and their effect on survival, as well as on hospital and intensive care unit (ICU) length-of-stay. The secondary aim was to describe cerebral hemodynamic changes detected by noninvasive neuromonitoring modalities such as transcranial doppler (TCD), optic nerve sheath diameter (ONSD), and pupillometry. Results: Ninety-four patients with COVID-19 receiving mechanical ventilation and admitted to an ICU from February 28 to June 30, 2020, were included in this study. Fifty-three patients underwent noninvasive neuromonitoring. Neurological complications were detected in 47/94 patients (50%), with delirium as the most common manifestation. Patients with neurological complications, compared to those without, had longer hospital (36.8±25.1 vs. 19.4±16.9 days, p <0.001) and ICU (31.5±22.6 vs. 11.5±10.1 days, p <0.001) stay. The duration of mechanical ventilation was independently associated with risk of developing neurological complications (OR 1.100, 95%CI 1.046-1.175, p=0.001). Patients with increased intracranial pressure (ICP) measured by ONSD (19% of the overall population) had longer ICU stays. Conclusions: In conclusion, neurological complications are common in critically ill patients with COVID-19 receiving invasive mechanical ventilation and are associated with prolonged ICU length-of-stay. Multimodal noninvasive neuromonitoring systems are useful tools for early detection of cerebrovascular changes in COVID-19. Registration number: 163/2020
Challenges Encountered by Family Caregivers of Prostate Cancer Patients: A Qualitative Inquiry
Authors: Owoo Benedicta , Ninnoni Jerry Paul , Ampofo Evelyn Asamoah , Seidu Abdul-Aziz
Published: August 2020

BackgroundIn Ghana, prostate cancer is more prevalent than all other cancers with a mortality rate of 75% partly as a result of late presentation to the health care facilities. Limited health services provision across the country and shortages of skilled nurses place a significant demand on family caregivers who are often ill-equipped for the caring role resulting in a lot of challenges. As they are expected to provide complex care at home with little resources, information, and support, yet, the healthcare system rarely addresses the challenging needs of these family caregivers. This study explored the Challenges encountered by family caregivers of people with prostate cancer. MethodsA qualitative phenomenological descriptive study was adapted using a semi-structured interview guide to conduct in-depth interviews with twelve (12) family caregivers of prostate cancer patients selected through a purposive sampling technique at the Cape Coast Teaching Hospital. All interviews were recorded, transcribed, and analyzed thematically.Findings The significant statement extracted from verbatim transcripts (analysis of transcripts) produced three main themes as key challenges relating to; Education and Training needs, Resources and Caregiver-nurse relationship issues with seven (7) sub-themes that collectively hindered the family caregivers ability to effectively perform their caring role. Thus making it difficult for them to meet the care demands. Sub-themes that emerged were; lack of preparedness towards the caring role, lack of knowledge about condition/ treatment, misconception about the condition, lack of accommodation facilities, financial constraints, poor communication and poor staff attitude.ConclusionCaregiving is associated with significant challenges that hinder family caregiver’s ability to effectively care for the patient; further diminishing caregiver’s quality of life and quality of patient care. Healthcare professionals especially nurses should, therefore, consider these challenges faced by family caregivers and put in measures to obviate them through education, preparation, and support.
Network Pharmacology Revealed the mechanism of Platycodon grandiflorum in Lung Cancer Treatment
Authors: Chen Xiang-Jing , Zhang Ran , Wang Ren-Zhong , Yao Cheng-Fang
Published: August 2020

Background: Traditional Chinese Medicine has demonstrated increasingly unique advantages in the treatment of lung cancer. Through literature review, it was found out that Platycodon grandiflorum had immunomodulatory and anti-inflammatory effects, and it had a special targeting effect on the lung. Purpose：In order to determine the molecular mechanism of Platycodon grandiflorum in lung cancer treatment. Network pharmacology theory was used to do a systematic study.Methods: The active compounds of Platycodon grandiflorum were screened from TCMSP database. Then, compounds targets were predicted with the assistance of Swiss Target Prediction and STITCH. The targets of lung cancer were screened form TTD and DisGeNET database. The common targets of compounds and lung cancer were screened out for following analysis. A Protein-Protein Interaction (PPI) Network was constructed by STRING. Subsequent to topological analysis, the hub targets were screened out for KEGG pathway and GO Enrichment. Molecular docking by AutoVina was performed to investigate the binding ability between the hub targets and compounds. Results: There were 4 active compounds screened out, including Acacetin, Spinasterol, cis-Dihydroquercetin and Luteolin. There were 80 targets screened as the common target of compounds and lung cancer. After topological analysis TP53, AKT1, VEGFA, CASP3, IL6, EGFR and MAPK1 were identified as hub targets. The 7 hub targets might be involved in 81 biological annotation and in the regulation of 23 pathways to intervene lung cancer. The main functional annotation was negative regulation of apoptotic process. Almost all of the pathways were directly or indirectly associated with the PI3K-Akt signal pathway and MAPK signal pathway. According to Affinity score of molecular docking the best binding protein for Luteolin was EGFR, and the best binding protein for Acacetin was CASP3. This meant that the Platycodon grandiflorum was easier to combine these two targets than other targets.Conclusion: Our study affirmed the effectiveness of Platycodon grandiflorum in treatment of lung cancer from molecular level. And we found that EGFR and CASP3 were the most likely targets for the direct action of Platycodon grandiflorum. The most important pathways that Platycodon grandiflori might interfere with were PI3K-Akt signaling pathway and MAPK signaling pathway.
Dosimetric comparison between helical tomotherapy, volume modulated arc-therapy and Fixed-Field intensity modulated radiation therapy in postoperative adjuvant radiotherapy for cervical cancer
Authors: Yu Deyang , Wang Lei , Hu Xueyuan , Li Xin , Bai Yanling , Yang Shanshan
Published: August 2020

Background: To evaluate the dosimetric parameters among three different radiotherapy techniques in patients with postoperative cervical cancer, including the Helical Tomotherapy (HT), the Volume Modulated Arc-Therapy (VMAT), and the Fixed-Field intensity modulated radiation therapy (FF-IMRT). Methods: Fifteen cervical cancer patients treated with postoperative radiotherapy were re-planning with HT, VMAT and FF-IMRT. The prescribed target dose of the patients was 1.8/45Gy. The paired-samples t-test was used to compare the dosimetric parameters of the planning target and OARs (Organs at risk), and the efficiency of radiation delivery. Results: Compared with the VMAT and FF-IMRT, the HT plans showed significant improvement in the conformity index (CI) and the homogeneity index (HI). In addition, the HT plans also significantly reduced the volume of high-dose region of the OARS, especially in the V30, V40 of small bowel, rectum and bladder. Meantime, the advantage of VMAT is that it reduced the treatment time and improved the efficiency of radiation delivery obviously, compared with the HT (293.8 ± 12.8s Vs. 557.6 ± 51.9s, P < 0.001) and FF-IMRT (293.8 ± 12.8s Vs. 581.8 ± 26.1s, P < 0.001). Conclusion: Our result reveals that HT showed better CI and HI for the target and reduced high dose volumes to OARs compared with VMAT and FF-IMRT, but the lower dose volumes to OARs increased slightly. As for the benefit of VMAT, it demonstrated the shortest treatment time. Our results could provide guidance for selecting the appropriate radiation technologies for cervical cancer patients who undergoing postoperative adjuvant pelvic radiotherapy.
NLRP3 is dispensable for D-galactosamine/Lipopolysaccharide-induced fulminant hepatitis
Authors: Zhang Wen , Tao Shou-Song , Wang Ting , Li Ya-Ting , Chen Hui , Zhan Yi-Qun , Yu Miao , Ge Chang-Hui , Li Chang-Yan , Ren Guang-Ming , Yin Rong-Hua , Yang Xiao-Ming
Published: August 2020

Background: The NOD-like receptor family protein 3 (NLRP3) inflammasome is involved in the progression of liver inflammation. NLRP3 inactivation has been shown to protect mice against multiple types of experimental liver injury. However, it is unclear whether NLRP3 contributes to D-Galactosamine (DGalN) plus lipopolysaccharide (LPS) induced fatal hepatitis. This study aims to examine the function of NLRP3 inflammasome in DGalN/LPS induced acute liver failure.Method: The expression of inflammasomes was detected by quantitative PCR. Wild type (WT) mice and NLRP3 knockout mice were given an intraperitoneal injection of DGalN plus LPS. Liver damage was examined at 6 h post DGalN/LPS administration by histological analysis and serum aminotransferases measurement. Hepatocyte apoptosis and pyroptosis was detected with TUNEL assay, immunohistochemistry (IHC) staining, and western blot. Hepatic macrophages (F4/80+) and neutrophils (Ly6G+) were analyzed by IHC staining. The proinflammatory cytokines levels in serum and liver were examined using cytometric bead array and quantitative PCR. Hepatic IL1β level was further detected by western blot.Result: The hepatic NLRP3 activity was upregulated in WT mice treated with DGalN/LPS. Nlrp3−/− and WT mice showed similar mortality against lethal dose of DGalN/LPS. Serum aminotransferases levels and liver necrosis area of Nlrp3−/− mice did not differ from that in WT mice after DGalN/LPS injection. The numbers of liver TUNEL positive cells and cleaved caspase3 positive hepatocytes were comparable between Nlrp3−/− and WT mice. The hepatic GSDMDNterm peptide production also showed no difference between Nlrp3−/− and WT mice. Mice treated with DGalN/LPS displayed significantly increased numbers of intrahepatic F4/80+ cells and Ly6G+ cells, but the cell numbers in Nlrp3−/− mice livers were similar to those in WT mice. Consistently, serum and hepatic TNFα, IL6, and MCP-1 levels were similar between Nlrp3−/− and WT mice upon DGalN/LPS administration, but serum IL1β and hepatic mature IL1β level in Nlrp3−/− mice was reduced.Conclusions: NLRP3 ablation does not protect mice from DGalN/LPS induced acute liver failure, nor affect hepatocyte apoptosis and pyroptosis. Deficiency of NLRP3 has a limited effect on intrahepatic inflammatory response induced by DGalN/LPS treatment. NLRP3 inflammasome does not appear to be a major contributor to DGalN/LPS induced fatal hepatitis.
The physical and mental health for the medical staff caring for patients with COVID-19 in Wuhan Huoshenshan Hospital: A structural equation modeling
Authors: Wang Jinyao , Li Dan-Hong , Bai Xiu-Mei , Cui Jun , Yang Lu , Mu Xin , Yang Rong
Published: August 2020

Background: Early in the epidemic of corona virus disease 2019 (COVID-19), Chinese government had recruited a portion of military healthcare workers to support the designated hospital (Wuhan Huoshenshan Hospital) to relieve the front-line workload in Wuhan, China. It was reported that the majority of the front-line medical staff (FLMS) suffered from adverse effects, but their physical and psychological health status and its relationship were still unknown. Hence, a structural equation modeling (SEM) was conducted to establish and test the latent relationship among variables.Methods: This is a cross-sectional study. Totally 115 convenience samples of military medical staff from Xinqiao Hospital in Chongqing were enrolled during February 17th to February 29th, 2020. The medical staff assisting in Huoshenshan Hospital were selected as experimental group(n=55), the other medical staff were control group(n=60). Self-reported sleep status, fatigue status, resilience status and anxiety status were examined.Results: During COVID-19, the medical staff underwent some impairments of physical and psychological health. The anxiety score of experimental group was (42.84±9.44), the fatigue score was (52.85±9.33), and the resilience score was (67.58±11.75). And the score of anxiety, fatigue, resilience of control group were (46.27±9.94), (49.33±11.20), (65.42±14.54) respectively. For experimental group, we found the different working duration and different attitude to work in Wuhan both had significant differences in fatigue scores (P<0.05); As for resilience scores and anxiety scores, only different current perceived health status of participants showed a statistically significant difference (P<0.05). The SEM results indicated the direct path from resilience to fatigue (β=-0.129, P=0.032) and anxiety (β=-0.026, P=0.043) were both significant, it revealed that resilience were negatively associated with the level of fatigue and anxiety, and the indirect path showed fatigue had a significant mediating effect between resilience and anxiety (β=-0.146, P=0.039) of the Huoshenshan Hospital medical staff.Conclusion: During an explosive pandemic, motivating the effect of individual’s internal resilience and making use of proper external interventions is a promising way to protect the physical and mental health of the front-line medical staff.
Enhanced Gait Variability Index in Older Asian Adults and Increased Physiological Fall Risk: Results from the Yishun Study
Authors: Jabbar Khalid Abdul , Seah Wei-Ting , Lau Lay Khoon , Pang Benedict Wei-Jun , Ng Daniella Hui-Min , Tan Queenie Lin-Ling , Chen Kexun Kenneth , Jagadish Mallya Ullal , Ng Tze-Pin , Wee Shiou-Liang
Published: August 2020

Background: Gait variability (GV) of various spatiotemporal parameters has been investigated in association with falls as well as physical and cognitive decline. However, the lack of consensus regarding the best approach to quantify GV as well as the lack of a composite score to represent the variabilities of the various spatiotemporal gait parameters, had dampened the reporting and acceptance of GV, especially among Asian researchers. The main objective of this study was to derive an Enhanced Gait Variability Index (EGVI) and reference values in an Asian population and to evaluate its validity as an indicator of physiological fall risk.Methods: This cross-sectional study was conducted in a large residential town of Yishun in Singapore. Random sample of community-dwelling adults (N = 511, 21 – 90 years old) categorized into 3 groups – reference group (N = 268, 21 – 64 years), low fall-risk (N = 182, ≥ 65 years) and high fall-risk (N = 61, ≥ 65 years). Physiological Profile Assessment (PPA) score of ≥ 2.0 was used to differentiate high fall-risk and low fall-risk groups. EGVI were derived from 5 spatiotemporal parameters: step length(cm), step time(s), stance time(s), single support time(s) and stride velocity(cm/s), with reference values from among participation less than 65 years of age.Results: Our Asian population showed greater overall gait variability than the European cohort in which the original EGVI was derived. This Asian EGVI displayed a non-linear relationship with both ageing and gait speed – significant changes in the EGVI were observed for those older than 60 years of age and in those whose habitual gait speed was lesser than 120cm/s. The EGVI discriminated between older adults with and without high fall risk and showed weak to moderate correlation with a number of the functional mobility and balance tests in both high and low fall risk groups.Conclusion: We derived an Asian Enhanced Gait Variability Index and reference values and validated its performance to discriminate high fall-risk and low fall-risk among older adults.
Epidemiological Characteristics of Leprosy and the Effects of its Control in Chongqing, China, 1949-2018
Authors: Wu Mingyue , Xiao Peng , Xiao Dayong , Yuan Yi , Xie Jiaja , Wang Yi , Du Jielin , Huang Wenjing , Deng Dan
Published: August 2020

Objective: To analyse the epidemiological characteristics of leprosy in Chongqing from 1949 to 2018 and evaluate the prevention and treatment effects over time to provide a basis for improving leprosy prevention and treatment strategies in Chongqing.Methods: Epidemiological indicators such as the incidence rate, prevalence rate, and annual estimated percentage change (EAPC) were used to evaluate the prevalence of leprosy. The prevention and treatment of leprosy patients were evaluated by indexes representing delay in diagnosis, the cure rate and the course of the disease. The statistical software used mainly include SPSS20.0, GraphPad Prism 8, ArcGIS 10.7.Results: From 1949 to 2018, a total of 3698 cases of leprosy were reported in Chongqing, with a sex ratio (male:female) of 3.814:1. The incidence of leprosy in the city peaked at 0.848/105 people in 1960 and remained below 0.100/105 people after 2004, achieving the World Health Organization (WHO) standard for the elimination of leprosy. The mortality rate remained at or below 0.100 per 100,000 people. The median time between disease onset and diagnosis in the whole population was 3.576(1.435, 7.621) years.The early detection rate was 31.314%, and the rate of patients with grade 2 disability was 31.989%, which decreased significantly over time (χ2=5.063, P=0.024). Compared with dapsone(DDS), multidrug therapy (MDT) was associated with a higher cure rate and a shorter disease course (χ2=608.346, P=0.000).Conclusions: Currently, leprosy in Chongqing remains in a low epidemic state. However, to maintain the status of meeting the WHO standards for the elimination of leprosy, there are some challenges that should not be overlooked by leprosy prevention workers. For example, the early detection of leprosy and the prevention and treatment of related disability still need to be strengthened.
Rapid Carbapenem Inactivation Method (rCIM): A New Phenotypic Method for Rapidly Detecting Carbapenemase-Producing Enterobacterales
Authors: Liu Yameng , Luan Liang , Liu Jing , Wan Nan
Published: August 2020

Background: Rapid and accurate methods for detecting carbapenemase-producing Enterobacterales (CPE) are essential for improving patient prognosis and preventing the spread of these microbes. In this study, 103 carbapenem-resistant Enterobacterales (CRE) isolates were collected from clinical specimens; of these, 55 CRE isolates were included in the retrospective analysis, and 48 CRE isolates were included in the prospective evaluation. Using sequencing results as the gold standard, we evaluated the performance of the rapid carbapenem inactivation method (rCIM) for detecting carbapenemases in comparison with the modified carbapenem inactivation method (mCIM) and CNPt-Direct test. In rCIM, the test isolate was incubated with meropenem (MEM) disks, and the supernatant obtained via centrifugation was incubated with the indicator strain Escherichia coli ATCC 25922. Growth of the indicator strain was monitored using a nephelometer. Results: The cut-off value of rCIM was 0.50 McFarland units. In retrospective analysis, the percent positive agreement and percent negative agreement of rCIM for detecting carbapenemase were 97.1% and 100%, respectively, and these values were higher than those for mCIM and the CNPt-Direct test. In the prospective evaluation, rCIM was linked to a sensitivity and specificity of 96.4% and 95%, respectively. Conclusion: rCIM may be a rapid (<3 h), economical, simple, and reliable method for screening CPE isolates, and it is expected to be routinely implemented in clinical microbiology laboratories.
Detection of Legionella Species and the Influence of Precipitation on the Amount of Legionella DNA Present in Aerosols from Outdoor Sites Near Asphalt Roads in Toyama Prefecture, Japan, with Microbiome Analysis
Authors: Kanatani Jun-ichi , Watahiki Masanori , Kimata Keiko , Kato Tomoko , Uchida Kaoru , Kura Fumiaki , Amemura-Maekawa Junko , Isobe Junko
Published: August 2020

Background: Legionellosis can be caused by the inhalation of aerosolized water contaminated with Legionella. In this study, we investigated the prevalence of Legionella species in aerosols collected from outdoor sites near asphalt roads, bathrooms in public bath facilities, and other indoor sites such as buildings and private homes using culture methods, quantitative PCR with ethidium monoazide treatment (EMA-qPCR), and 16S rRNA gene amplicon sequencing. Results: Legionella species were not detected in culture. However, Legionella DNA was detected in 114/151 (75.5%) air samples collected near roads (geometric mean ± standard deviation was 1.80 ± 0.52 log10 copies/m3); these numbers were comparable to those obtained from bathrooms [15/21 (71.4%), 1.82 ± 0.50] and higher than those obtained from other indoor sites [11/30 (36.7%), 0.88 ± 0.56] (P < 0.05). By EMA-qPCR, Legionella DNA was detected in 20/30 (66.7%) samples collected near roads, indicating the presence of membrane-intact Legionella cells in the air. The amount of Legionella DNA correlated with the monthly total precipitation (r = 0.25, P < 0.01). It was also directly and inversely correlated with the daily total precipitation for seven days (r = 0.21, P = 0.01) and one day (r = −0.29, P < 0.01) before the sampling day, respectively. In addition, 16S rRNA gene amplicon sequencing revealed that the three most abundant bacterial genera in the samples collected near roads were Sphingomonas (21.1%), Streptococcus (14.6%), and Methylobacterium (1.6%); Legionella species were detected in 9/30 samples (30%) collected near roads (mean proportion of reads, 0.11%). At the species level, L. pneumophila was detected in 2/30 samples collected near roads (mean proportion of reads, 0.11% and 0.09% in the detected samples).Conclusions: DNA from Legionella species, including Legionella pneumophila, were widely detected in aerosols collected from outdoor sites near asphalt roads, especially during the rainy season. Our findings suggest that there may be a risk of exposure to Legionella species in the areas surrounding asphalt roads.
COVIDXception-Net: A Bayesian Optimization Based Deep Learning Approach to Diagnose COVID-19 from X-Ray Images
Authors: Arman Shifat E , Rahman Sejuti , Deowan Shamim Ahmed
Published: August 2020

Background: The Coronavirus Disease 2019 (COVID-19) is highly contagious and spreading around the world like wildfire. For this reason, fast and accurate diagnosis of COVID-19 is of tremendous importance. Chest X-rays can be used to diagnose COVID-19 but there is a global shortage of radiologists who can interpret X-rays. This study aims to develop an artificial intelligence system that can diagnose COVID-19 from chest X-rays with no human intervention.Methods: In this study, we used four pre-trained architectures - VGG16, MobileNetV2, InceptionV3 and Xception to detect COVID-19 from chest x-ray images. The architectures are optimized using Bayesian optimization and we used a weighted loss function to get better generalization capability in our models.Results: Of the four architectures we optimized, our proposed model called COVIDXception-Net performed best on the test set with an accuracy 0.94, precision 0.95, recall 0.94, and F1-score 0.94. It outperforms previous state-of-the-art methods in terms of these evaluation metrics on similar datasets. In the ablation studies, we found that the accuracy of our model dropped from 0.994 to 0.950 when we used random search instead of Bayesian optimization and 0.994 to 0.983 when we used regular loss function instead of a weighted loss function. Conclusions: In this study, we developed a model called COVIDXception-Net to diagnose COVID-19 from X-ray images. We hope that our research will assist all those involved in handling this pandemic.
Prerequisites for provision of spiritual care in the neonatal intensive care unit in Iran: a qualitative study
Authors: Heidari Haideh , Mehrnoush Nasrin , Karimollahi Mansoureh
Published: August 2020

Background: Spiritual care in line with the holistic and comprehensive care is the important need for families with children who are hospitalized in an intensive care unit. Objectives: This study aimed to explore perceptions of health care providers' regarding the spiritual care of parents with a newborn in the neonatal intensive care unit in Iran.Materials/Patients and Methods: This study was conducted using qualitative content analysis which includes open coding, creating classification, and abstraction. Eight nurses and one doctor were chosen to be interviewed by a purposeful sampling method.Results: Based on data analysis three categories of nurses' support need for spiritual care and the necessity of changes in structural conditions were identified.Conclusions: Hospital administrators must adopt measures to change the neonatal intensive care unit circumstances. Also, it is mandated that nurse managers plan training about the importance of providing spiritual care to patients and families.
Dynamic buoyancy-the cause of aircraft lift
Authors: zhou yanhui
Published: August 2020

The stone floating in the rapids and airplane rising in the air should follow the same principle. Through analyzing and calculating the problem that high-speed water flow makes the stone float, puts forward the concept of dynamic buoyancy, proves that dynamic buoyancy is the cause of stone floating, and applies this result to the problem of aircraft lift, the calculation formula of aircraft lift is derived, namely FX=ρv2Sx/2+ρgV, and solves the defects of current lift theory. Dynamic buoyancy is the cause of the lift produced by the aircraft.
Azithromycin exposure induces transient microbial composition shifts and decreases the airway microbiota resilience from PM2.5 stress in healthy adults: a randomized, double-blind, placebo-controlled trial
Authors: Du Sisi , Zou Xiaohui , Deng Xiaoyan , Shang Lianhan , Sun Aihua , Mu Shengrui , Zhao Jiankang , Wang Yimin , Feng Xiaoxuan , Li Binbin , Wang Chunlei , Liu Shuai , Lu Binghuai , Liu Yingmei , Zhang Rongrong , Tong Yigang , Wang Chen , Cao Bin
Published: August 2020

Background: Azithromycin, widely used in recent years, can change the airway microbiota in patients with chronic lung diseases. Little data exists regarding the effects of azithromycin administration on airway microbiota among healthy adults. Therefore, we conducted a randomized, double-blind, placebo-controlled trial to assess the process of variation and re-establishment of the airway microbiota after azithromycin exposure in healthy adults. Methods: Forty-eight healthy volunteers were enrolled and randomly assigned into two groups. 500mg azithromycin or placebo was administered once daily for 3 days. We collected the induced sputum at the day before the drugs administration (D0), the day after the treatment course was completed (D4), 14 days, 30 days and 60 days post-dosing. 16S rRNA gene sequencing and quantification were applied to the induced sputum samples. We collected the environmental information including air quality data [particulate matter (PM 2.5 ) and PM 10 , air quality index (AQI) values] that might have an influence on the airway microbiota during the study. The subjects’ respiratory tract infection (RTI) events during sampling were recorded. Results: Azithromycin didn’t alter bacterial load but significantly reduced species richness and Shannon index. Azithromycin exposure resulted in decrease in the detection rate and relative abundance of different families belonging to Veillonellaceae , Pasteurellaceae , Leptotrichiaceae , Neisseriaceae and Fusobacteriaceae . By contrast, the relative abundance of taxa belonging to Streptococcus increased immediately after azithromycin intervention. The shifts in the microbial community composition require about 14 days to recover while alpha-diversity recovered later. The high concentration of PM 2.5 contributed to a novel variability in microbial community composition of azithromycin group at D30 (30 days after baseline). The network analysis found that azithromycin altered the microbial interactions within airway microbiota. The influence was still obvious at D14 when the relative abundance of most taxa had returned to the baseline level. Conclusions: Azithromycin has transient effect in airway microbiota of healthy adults and decreases the ability of the airway microbiota resilient from PM 2.5 stress. The influence of azithromycin on microbial interactions is noteworthy though the airway microbiota has returned to the near-baseline level.Registration: Chinese Clinical Trial Registry (ChiCTR1800018494), September, 2018. http://www.chictr.org.cn/edit.aspx?pid=31269&htm=4
Examining the use of radiation therapy for cholangiocarcinoma: benefits through modern techniques
Authors: Gattermann Felix , Oertel Michael , Scobioala Sergiu , Wilms Christian , Schmidt Hartmut , Pascher Andreas , Haverkamp Uwe , Eich Hans Theodor
Published: August 2020

BackgroundCholangiocarcinoma (CCA) is a rare malignant tumor of the bile duct epithelium. At first diagnosis, only a minority of patients is eligible for surgery, which is regarded as the only curative treatment. This study examines the role of radiation therapy (RT) and chemoradiotherapy (CRT) in the definitive and adjuvant treatment situation.MethodsThe monocentric retrospective analysis included 39 patients (31 males, 8 females) with CCA undergoing 53 RT series. Data was collected from January 2005 to September 2018. There were 11 cases of CRT, 6 of which were definitive. Surgery was either palliative (n=6) or radical (n=15).ResultsAfter RT, median overall survival (OS) was 10.4 months (mo; 95% confidence interval [CI] 6.6-14.2), median progression-free survival (PFS) was 5.6 mo (95% CI 3-8.2), median duration of local control (DOLC) was 8.9 mo (95% CI 4.7-13.1) and 1-year OS rate was 44.7%. There was a significant difference between patients with and without locoregional lymph node metastasis (OS: 4.3 mo vs. 15.4 mo, p=0.031; PFS: 2.1 mo vs. 11.5 mo, p<0.0005; DOLC: 4.2 mo vs. 12.3 mo, p=0.02). After treatment of a primary tumor, DOLC was about twice as long as in the recurrent situation (10.4 mo vs. 5.4 mo, p=0.032). Conservative therapy significantly elevated the risk of local recurrence compared to radical surgery in univariate (HR 11.04, p=0.004) and multivariate (HR 98.34, p=0.024) analysis. Tomotherapy may be advantageous with respect to local recurrence and survival.Side effects were mostly classified as grade I-II according to CTCAE. There were 10 toxicities of grade III and 4 of grade IV, all affecting blood parameters. Termination of RT and increased glutamic pyruvic transaminase (GPT) were significantly less frequent after stereotactic body radiation therapy and hypofractionation.ConclusionRT can achieve local control in patients with CCA. However, since overall prognosis remains poor, effective combination therapies are needed. Toxicities of RT are manageable but require close clinical and laboratory follow-up.
Spatial inequality, characteristics of internal migration, and pulmonary tuberculosis in China, 2011–2016: A spatial analysis
Authors: He Wen-Chong , Ju Ke , Gao Ya-Min , Zhang Pei , Zhang Yin-Xia , Jiang Ye , Liao Weibin
Published: August 2020

Background: Human migration facilitate the spread of tuberculosis (TB). Migrants face an increased risk of TB infection. In this study, we aim to explore the spatial inequity of sputum smear-positive pulmonary TB (SS + PTB) in China; and the spatial heterogeneity between SS + PTB and internal migration.Methods: Notified SS + PTB cases in 31 provinces in mainland China were obtained from the national web-based PTB surveillance system database. Internal migrant data were extracted from the report on China’s migrant population development. Spatial autocorrelations were explored using the global Moran’s statistic and local indicators of spatial association. The spatial variation in temporal trends was performed using Kulldorff’s scan statistic. Four fixed effects models were used to explore the spatial inequity between SS + PTB and internal migration.Results: A total of 2 148 620 SS+PTB cases were reported in China between 2011 and 2016, of which, 1 549 664 (72.12%) were male and 598 956 (27.88%) were female. Over 70% of internal migrants were from rural households and had lower income and less educated. The spatial variation in temporal trend results showed that there was an 11.2% average annual decrease in the notification rate of SS + PTB from 2011 to 2016; and spatial clustering of SS + PTB cases was mainly located in western and southern China. The spatial autocorrelation results revealed significant spatial of internal migration each year (2011–2016), and the clusters were stable within most provinces. Internal emigrant and GDP per capita were significantly associated with SS + PTB, further, emigrant could explain more variation in SS + PTB in the eastern region in mainland. However, internal immigrant was not significantly associated with SS + PTB across China. Conclusions: Our study found a significant spatial inequity between SS + PTB and internal migration. Both emigration and GDP per capita were statistically associated with SS + PTB; the negative association was identified between emigrant and SS + PTB. Further, we found those migrants with lower income and less educated, and most of them were from rural households. These findings can help stakeholders to implement effective PTB control strategies for areas at high risk of PTB and those with high rates of internal migration.
Changes in Axial Length After Vitrectomy for Rhegmatogenous Retinal Detachment With Associated Choroidal Detachment
Authors: LI Jipeng , XU Jun , ZHAO Meng
Published: August 2020

BACKGROUND

The precise pre-operative measurements of axial length (AL) are essential for calculating intraocular lens power in cases undertaking pars plana vitrectomy (PPV) combined with cataract surgery. The changes in AL after PPV for rhegmatogenous retinal detachment (RRD) combined with choroidal detachment (CD) has not been reported. Here, we studied the postoperative AL changes in patients with RRD combined with CD (RRD-CD) and compared the changes in patients with RRD and tractional retinal detachment (TRD).
METHODS

In this retrospective cohort study, medical records of 129 patients who received PPV combined with silicone oil tamponade from January 2015 to December 2018 were reviewed. Patients included were divided into three groups, RRD-CD, RRD, and TRD. All patients had received AL measurements before PPV and before silicone oil removal (SOR). The changes in AL of three groups before PPV and before SOR were compared. The potential factors related to AL changes were analyzed.
RESULTS

The number of patients included in RRD-CD, RRD, TRD groups were 41, 43, and 45, respectively. In RRD-CD group, AL measured before SOR was longer than that measured before PPV with a median of 1.01 [0.37,1.79] mm (p = 0.02). There was no such significant difference in RRD group (0.15 [0.04, 0.42] mm, p = 0.58) or TRD group (0.07[-0.03,0.15] mm, p = 0.53). The amplitude of AL changes in RRD-CD group was greater than that in RRD group (p < 0.001) and that in TRD group (p < 0.001). AL increased 0.06 mm (0.06, R2 = 0.11, p = 0.03) in RRD-CD group and 0.02 mm (0.02, R2 = 0.11, p = 0.01) in RRD group when the IOP before SOR was 1 mmHg higher than that before PPV. After adjusting the effect of the factors as the presence of pathological myopia (p = 0.45), IOP before PPV (p = 0.86), sustained elevation of IOP in post-PPV follow up (p = 0.51), AL in RRD-CD group was 11.42 times (3.54, 46.80) more likely to increase for more than 1 mm compared to that in RRD group (p < 0.001, AIC = 86.15).
CONCLUSION

Patients with RRD-CD are very likely to have postoperative elongation of AL. The primary IOL implantation using pre-operative AL data may cause significant refractive error in combined surgery in patients with RRD-CD.
Boerhaave Syndrome Due to Excessive Alcohol Consumption: Two Case Reports
Authors: Haba Yuichiro , Yano Shungo , Akizuki Hikaru , Hashimoto Takashi , Naito Toshio , Hashiguchi Naoyuki
Published: August 2020

Background
Spontaneous esophageal rupture, or Boerhaave syndrome, is a fatal disorder caused by an elevated esophageal pressure derived from forceful vomiting, and subsequent presentation of chest pain, dyspnea, and shock.
Case presentation:
We present two cases of Boerhaave syndrome that were both triggered by excessive alcohol consumption and quickly detected in the emergency room. The first patient complained of severe chest pain, nausea, and vomited on his arrival: he was diagnosed with Boerhaave syndrome complicated with mediastinitis from the computed tomography (CT) and esophagogram findings. An emergency operation was successfully performed, where a 3-cm tear was found on the left-posterior wall of the distal esophagus. The patient subsequently suffered from anastomotic leakage but was discharged 41 days later. The second patient reported severe chest pain, nausea, vomiting, and hematemesis on his arrival: he was suspected of having Boerhaave syndrome without mediastinitis based on the CT findings. The symptoms gradually disappeared after a conservative treatment. Upper gastrointestinal endoscopy performed on the 9th day revealed a scar on the left wall of the distal esophagus. The patient was discharged 11 days later. In addition to the varying severity between the cases, the second patient was also differently diagnosed with Mallory-Weiss syndrome.
Conclusion
Emergency clinicians must accurately distinguish Boerhaave syndrome from Mallory-Weiss syndrome as they both have similar history and symptoms. CT can be a valuable and useful modality to detect any severity of Boerhaave syndrome.
A Stakeholder-based Evaluation of Engineering ESP Courses’ Effectiveness
Authors: Alemi Minoo , Pazoki Saeedeh Jafari
Published: August 2020

Investigating stakeholders’ perception about course success has been signified as a useful method for program evaluation. This study focused on evaluating English for Specific Purposes (ESP) programs in engineering departments at Iranian state universities through examining the view of stakeholders. Engineering students (N=100) and ESP practitioners (N=8) participated in interviews and non-participant observations were carried out to achieve a better insight into the actual learning and teaching contexts. Responses showed that some obstacles such as 1) low GE proficiency of students and heterogeneous classes, 2) limited time, 3) ministry decision for making the course elective, 4) students’ low motivation, 5) teachers’ low motivation, 6) inappropriate materials and teaching methods hindered course usefulness and effectiveness from the perspective of the participants. The findings urged the importance of comprehensive needs analysis to resolve the controversies among stakeholders about course objective and contents and to eliminate the mismatches between course objectives and students’ expectations.