bluuebunny/crossref_metadata_2025 huggingface dataset:
Population Genetic Diversity and Structure of Threatened Magnolia Species in Western Mexico
Authors: Muñiz-Castro Miguel Angel , Lopez-Barrera Gabriela , Ochoa-Zavala Maried , Castro-Felix Patricia , Vazquez-Garcia Jose Antonio , Oyama Ken
Published: November 2020

Background: Genetic diversity is needed to preserve the capability of a species to survive to environmental changes. Due to the presence of small isolated populations, relict species such as Magnolia are at an elevated extinction risk. In recent years, many new species of Magnolia have been described in Mexico, each one classified by its category of risk. To achieve conservation, knowledge of their basic level of biological diversity is essential to design adequate conservation plans and avoid the negative consequences of genetic loss. Here, we implemented nuclear microsatellite markers to assess 13 populations of three new species of Magnolia that were all previously considered to be Magnolia pacifica. We aimed to evaluate the genetic agreement with the distinction of these three different morphological species (e.g., their species integrity) and to determine their levels of genetic diversity and their geographic distribution to propose conservation strategies. Results: We found high levels of genetic diversity compared to other Magnolia species with no sign of inbreeding. We found a small effective population size and a prevalence of bottlenecks in some populations. The patterns of genetic subdivision did not support the current morphological distinction of three different species. Instead, we suggest that the genetic structure pattern is the result of historical connectivity and the continuous natural fragmentation of the forest. Thus, an isolation by distance pattern may have had an important role in shaping allele frequencies, producing local genetic differences. Conclusions: We argue that a major threat underlies the actual trends of habitat loss, which can directly impact the loss of genetic diversity in the current adult individuals and consequently, increase the risk of extinction in further generations. For conservation purposes, we suggest combining in situ and ex situ conservation of populations with the maintenance of connectivity among the local populations.
Close up to the Surface: Reflections on a Preliminary Forensic Study of Four Chinese Bronze Mirrors from a Hong Kong Private Collection
Authors: Liang Jiafang , Parker Quentin
Published: November 2020

This article presents an objective, evidence based, forensic study undertaken within the HKU Architectural Conservation Laboratory (ACLab) and Department of Physics conducted on 4 very different bronze mirrors from a private collection. They nominally cover the period from the Warring States (475-221BC), Han (206 BC to 220AD) and later Song (960-1279AD) dynasties. Comprehensive, mostly non-invasive, analytical methods and techniques were applied in this endeavour. These included surface microscopy of tool marks, patina, corrosion and any residual archaeological evidence. Ultraviolet radiation examination, chemical spot testing and polarised light microscopy of ground-up patina samples was also undertaken. More sophisticated “pXRF” X-ray fluorescence and “MARS” tomographic X- ray scanning analysis of the bronze alloy, corrosions and any earthen encrustations were also performed. This was all done to uncover as much forensic evidence as possible concerning these unprovenanced bronze mirrors. The combined results have revealed key metallurgical information of those four mirrors along with surface patina morphology and details of the corrosion and residual surface archaeology. A database on the physical condition of these 4 mirrors has been established and burial/treatment history revealed. Mirrors 1 and 2 appear to have been heavily cleaned, polished and treated with abrasives in modern times. Both of them but mirror 2 in particular have some problematic corrosion and inconclusive alloy composition. Mirror 3 and 4 both have archaeological evidence and no contrary forensic data that questions their authenticity. The issue of the possible authenticity of an object when archaeological context is lacking is discussed but this was not the ultimate goal of this research. The key aim is to establish what can be learnt from technological forensic investigation when studying bronze mirrors without archaeological context and records, and what firm evidence can be extracted from such close forensic examination to shed light on their true nature.
A Risk Assessment Tool for Resumption of Research Activities During the COVID-19 Pandemic
Authors: Simkovich Suzanne M , Thompson Lisa M. , Clark Maggie , Balakrishnan Kalpana , Bussalleu Alejandra , Checkley William , Clasen Thomas , Davila-Roman Victor , Diaz-Artiga Anaite , Fuentes Lisa de las , Harvey Steven , Kirby Miles , Lovvorn Amy , McCollum Eric , Peel Jennifer , Quinn Ashlinn , Rosa Ghislaine , Underhill Lindsay , Williams Kendra , Young Bonnie , Rosenthal Joshua
Published: November 2020

Rationale: The spread of severe acute respiratory syndrome coronavirus-2 has suspended many non-COVID-19 related research activities. Where restarting research activities is permitted, investigators need to evaluate the risks and benefits of resuming data collection and adapt procedures to minimize risk. Objectives: In the context of the multicountry Household Air Pollution Intervention (HAPIN) trial, we developed a framework to assess the risk of each trial activity and to guide protective measures. Our goal is to maximize integrity of reseach aims while minimizing infection risk based on the latest understanding of the virus. Methods: We drew on a combination of expert consultations, risk assessment frameworks, institutional guidance and literature to develop our framework. We then systematically graded clinical, behavioral, laboratory and field environmental health research activities in four countries for both adult and child subjects using this framework. Results: Our framework assesses risk based on staff proximity to the participant, exposure time between staff and participants, and potential aerosolization while performing the activity. One of of four risk levels, from minimal to unacceptable, is assigned and guidance on protective measures is provided. Those activities which can potentially aerosolize the virus are deemed the highest risk. Conclusions: By applying a systematic, procedure-specific approach to risk assessment for each trial activity, we can compare trial activities using the same criteria. This approach allows us to protect our participants and research team and to uphold our ability to deliver on the research commitments we have made to our participants, local communities, and funders. The trial is registered with clinicaltrials.gov (NCT02944682).
Innovation Research of the"Internet plus" Volleyball Teaching System in the Context of the Information Age
Authors: Tian Yang
Published: November 2020

Due to the rapid development of internet technology, big data, artificial intelligence, multimedia and other new technologies are updated rapidly, and all walks of life have an increasingly urgent demand for information technology. As a base for teaching and cultivating talents, schools should adapt to the development of the times and make full use of information technology to carry out educational activities. For example, "Internet plus" can be used for innovation in school teaching mode. This paper mainly talks about the innovation research of "Internet plus" volleyball teaching system in the context of the information age. This paper analyzes the influence of "Internet plus" on the teaching mode in universities and colleges, and studies how to use the "Internet plus" to change the teaching mode of Volleyball in universities. The results of this paper show that the "Internet plus" volleyball teaching is a new teaching system that is united and common. It helps to break the traditional volleyball teaching mode in universities and colleges, and improve the single teaching form, the limitation of time and space, and so on. The confidence interval of SPSS17.0 is 0.96. The use of multimedia in the "Internet plus" volleyball teaching system improves the volleyball performance of students, and promotes the smooth progress of Volleyball Teaching in Colleges and universities.
Method for Monitoring and Increasing the Quality of Experience in Cellular Networks Based on Interconnections Between Key Quality Indicators Using Spline-Approximation
Authors: Azzeh Jamil Al , Odarchenko Roman , Abakumova Anastasiia , Bondar Serhii
Published: November 2020

Sustainable and balanced development of the communications industry is inextricably linked with increasing numbers of subscribers and services provided. The current level of development of the cellular services market, qualitative changes in the means and methods of providing services, and the increased volume and diversity of information circulating in cellular networks have evoked the need for service quality assessment system improvement. To maintain competitiveness, the main efforts of operators are aimed at improving quality and increasing the service life of subscribers in the network by ensuring the required level of customer satisfaction in high quality services through a system of organizational-technical and socio-economic measures to bring the achieved level of quality of service (QoS) provision in accordance with the existing, emerging, or projected needs of subscribers. These circumstances determine the relevance of the studied tasks related to the assessment and management of the quality of cellular services and the development of approaches to their solution.To achieve improved QoS provision, a functional relationship between network parameters has been established, i.e., the impact of key performance indicators on a key quality indicator through the use of cubic Hermitian splines (CHS) has been determined. The use of splines, as a signal model, can significantly improve the quality of signal processing due to the continuity of values and partial derivatives in the joints of spline gluing. CHS are characterized by calculation simplicity, as they provide high speed computing, which, in turn, is important for real time work when processing large data sets. Experimentally, it was shown that the use of splines allows for the ability to calculate statistical estimates of the required parameters of spline approximations, but also their confidence intervals, which increases the accuracy and probability of further calculations and is a distinct advantage of this approachThe methods of service quality management through machine learning have been improved, which are effective tools for modeling integrated indicators of communication services quality control, monitoring their condition in terms of final copies of services, determining the causes of degradation, and reporting. It monitors the service performance provided by the cellular operator. In addition, the method checks the readiness and availability of services, detects network nodes through which quality degradation occurs, collects various quality metrics, and compares them with pre-installed quality indicators.
Paeonol Ameliorates Inflammation and Cartilage of Chondrocytes in Osteoarthritis by Upregulating SIRT1
Authors: Shang Peng , Liu Ying , Jia Junqing
Published: November 2020

Objective: To explore the possible role of paeonol on chondrocyte inflammation and cartilage protection in osteoarthritis (OA).Methods: Primary chondrocytes were isolated from rat stifle joints, and were identified through toluidine blue staining and immunofluorescence staining of type II collagen. The chondrocytes were transfected with sh-SIRT1 or/and paeonol (0, 20, 50, 100, 200, 1000 mg/L) before OA modeling induced by IL-1β. ELISA determined the expressions of TNF-α, IL-17 and IL-6, and apoptotic rate was examined by flow cytometry. qRT-PCR and Western blot quantified the expressions of MMP-1, MMP-3, MMP-13, TIMP-1, cleaved-caspase-3, Bax, Bcl-2, and the proteins related to NF-κB pathway.Results: Increases in TNF-α, IL-17, IL-6, MMP-1, MMP-3 and MMP-13 and decrease in TIMP-1 were found in IL-1β stimulated chondrocytes. The apoptotic rate as well as the expressions of cleaved-caspase-3 and Bax was up-regulated, and Bcl-2 expression was suppressed in response to IL-1β treatment. NF-κB pathway was activated in IL-1β-stimulated chondrocytes. Paeonol enhanced SIRT1 expression to inactivate NF-κB pathway, thus ameliorating the secretion of inflammatory cytokines, extracellular matrix degradation and chondrocyte apoptosis.Conclusion: Paeonol inhibits IL-1β induced inflammation and extracellular matrix degradation in chondrocytes through up-regulating SIRT1 and suppressing NF-κB pathway.
Benign Clinical and Epidemiological Outcomes-Associated Factors of COVID-19 from a Solved Epidemic with a Low Case Fatality Rate
Authors: Hu Gang , Liu Jian , He Peng Yuan , Ouyang Li Juan , Zou Bao Jia , Peng Xiao Mou
Published: November 2020

Background: Since December 2019, COVID-19 has been confirmed in more than18.8 million patients and leads to 0.70 million deaths worldwide. The mortality and disease severity predictors of COVID-19 have been investigated in many studies. However, they are based on early or partial datasets from high epidemic areas. Here, we retrospect benign clinical and epidemiological outcomes-associated factors from a solved epidemic in a low epidemic area. Methods: All 98 laboratory-confirmed COVID-19 patients in a local epidemic (Zhuhai, China) from January 17, 2020 to March 10, 2020 were enrolled. Data were updated until all patients having final outcomes. Results: Patients were all hospitalized. The case fatality rate was 1.0%. There were no local secondary infection cases. The median age was 46.3 years. Underlying diseases were found in 33.7% patients. The severe/critical rate was 19.4%. The mean period from disease onset to admission was 4.4 days. Compared with serious/critical cases, mild/common cases on admission were much younger, lacks of comorbidities and normal in functions of vital organs and indicators of secondary bacterial infections. The lymphocyte counts in serious/critical cases began to be significantly lower 3 days before their identification dates. The absence of lymphopenia before the eighth day from disease onset can exclude the possibility of 78.5% to be serious/critical ill. Most patients (88.8%) received antiviral treatments. Early antiviral treatment significantly shortened the viral RNA-negative conversion time. The delayed antiviral treatment was associated with critical patients.Conclusions: Younger age, lack of aging-related diseases and early hospitalization of all patients to conduct antiviral treatment and prevention of secondary epidemic were the important benign clinical and epidemiological outcomes-associated factors of COVID-19. In combating COVID-19, the active intervention strategies are crucial in low epidemic areas and the continuous monitoring of lymphocytes may be useful to sort patients reasonably in high epidemic areas.
NADPH Oxidase 4 Signaling in a Ventilator-Induced Lung Injury Mouse Model
Authors: Lee Sang Hoon , Shin Mi Hwa , Leem Ah Young , Lee Su Hwan , Chung Kyung Soo , Kim Young Sam , Park Moo Suk
Published: November 2020

BackgroundFor patients with acute respiratory distress syndrome (ARDS), a ventilator is essential to supply oxygen to tissues, but it may also cause lung damage. In this study, we investigated the role of NOX4 in lung injury using NOX4 knockout (KO) mice and NOX4 inhibitors in a ventilator-induced lung injury (VILI) model.MethodsWild-type male C57BL/6J mice and NOX4 KO male mice were divided into five groups: (1) control group: wild-type (WT) mice + non-ventilator; (2) high tidal ventilation (HTV) group: WT mice + HTV; (3) NOX4 KO group: NOX4 KO + non-ventilator; (4) NOX4 KO with HTV group: NOX4 KO mice + HTV; (5) NOX4 inhibitor group: WT mice + HTV + post-treatment (anti-GKT 137831 inhibitor). In the VILI model, the supine position was maintained at 24 mL/kg volume, 0 cm H2O PEEP, 100/min respiratory rate, and 0.21 inspired oxygen fraction. In the NOX4 inhibitor group, 50 μL anti-GKT 137831 inhibitor was injected intraperitoneally, 2 h after ventilator use. After 5 h of HTV, mice in the ventilator group were euthanized, and their lung tissues were obtained for further analysis. In addition, the relationship between EphA2 (which is related to lung injury) and NOX4 was investigated using EphA2 KO mice, and NOX4 levels in the bronchoalveolar lavage fluid (BALF) of 38 patients with pneumonia were examined.ResultsCell counts from BALFs were significantly lower (p<0.01) in the NOX4 KO with HTV group compared to that in the HTV group. In the NOX4 inhibitor group, cell counts and protein concentrations were significantly lower than those in the HTV group (both, p<0.001). In the NOX4 KO mouse group and the NOX4 inhibitor group, EphA2 levels were significantly lower than those in the HTV group (both, p<0.001). In patients with respiratory disease, NOX4 levels were significantly higher in patients with pneumonia and patients who received ventilator treatment in the intensive care unit.ConclusionsIn the VILI model, NOX4 expression is significantly associated with Eph-ephrin signaling. It may be possible to block VILI using NOX4 antibodies.
Setting the global research agenda for community-based HIV service delivery through the faith sector
Authors: Ndlovu-Teijema Martha , Kok Maarten O , Elsland Sabine L van , Smeets Hilleen , Barstow David , Rooyen Lyn van , Furth Marceline van
Published: November 2020

BackgroundWhile leading AIDS organisations expect faith and health collaborations to play a crucial role in organising and scaling up community-based HIV services, it is unclear how this can be realised. Little primary research has been conducted into which strategies for collaboration and service provision are most effective, efficient, scalable and sustainable. Seeking to align research with urgent needs, enhance coordination and increase the likelihood that results are used, this study aimed to set an inclusive global research agenda that reflects priority research questions from key stakeholders at the intersection of HIV healthcare and faith. MethodsIn order to develop this global research agenda, we drew from document analyses, focus group discussions, interviews with purposively selected key informants from all continents (policymakers, healthcare providers, faith leaders, academics and HIV activists), an online questionnaire, and expert meetings at several global conferences. ResultsParticipants worked in 54 countries, with the majority having research experience (84%), experience with policy processes (73%) and/or experience as a healthcare provider (60%) and identifying as religious (79%). From interviews (N=53) and questionnaires (N=110), we identified ten research themes: addressing sexuality, stigma, supporting specific populations, counselling and disclosure, agenda setting, mobilising and organising funding, evaluating faith-health collaborations, advantage of faith initiatives, gender roles, and education. Respondents emphasized the need for more primary research and prioritised two themes: improving the engagement of faith communities in addressing sexuality and tackling stigma. ConclusionsA wide range of respondents participated in developing the research agenda. To align research to the prioritised themes and ensure that results are used, it is essential to further engage key users, funders, researchers and other stakeholders, strengthen the capacity for locally embedded research and research uptake and contextualise priorities to diverse religious traditions, key populations and local circumstances. ­­
Time-Series Transcriptome Sheds Light on Anthocyanin Metabolism and Species Diversification Between two Lonicera Japonica Thunb Cultivars
Authors: Li Jianjun , Ye Chenglin , Ma Jingxiao , Cheng Ting , Lv Yan , Chang Cuifang
Published: November 2020

Background：‘Yujin 2’ is new variety of Lonicera japonica Thunb and its flower color can change from red to yellow; hence, it is a good model for investigating flower color development mechanisms. Results：High throughput transcriptome sequencing of seven flower development stages of Yujin No.2 was carried out, and 133,487 unigenes were annotated, among which 73,088 were differentially expressed. Then the real-time PCR analysis was carried out. Further, the number of up-regulated DEGs was higher than those that were down-regulated. Of these annotated DEGs, plant hormone signal transduction, phenylpropanoid biosynthesis, and flavonoid biosynthesis were active throughout the flowering process during each stage, whereas carotenoid biosynthesis was inactive in the S1-6 stages. Furthermore, phenylalanine synthesis was enhanced in the S1 phase; however, anthocyanin synthesis was weakened in the S5 and S6 phases, which may be consistent with the changes in petal color of ‘Yujin 2’ from red (S1) to white (S5) and gold (S6). The results showed that 114 unigenes were associated with anthocyanin metabolism, and 72 were significantly upregulated or downregulated. According to the analysis of TFs in anthocyanin metabolism, we obtained 47 transcription factors, which belonged to 18 families. The LjDFR, LjABCB1, LjMYC6, LjDDB2, and LjANS genes rapidly increased during the first three stages. However, only LjF3'5'H expression was significantly down-regulated at S5, which was consistent with anthocyanin accumulation. Conclusions：This study developed a transcriptome profile of flower color generation for L. japonica as well as annotated unigene sets of seven anthesis phases, thereby providing possibilities for improving the germplasm of L. japonica with genetic engineering technologies and cultivating new varieties of different colors.
Making It Stick: Use of Active Learning Strategies in Continuing Medical Education Running Head: Active Learning Strategies in Continuing Medical Education
Authors: Bucklin Brenda , Asdigian Nancy , Hawkins Joy , Klein Ulrich
Published: November 2020

BackgroundDespite the known benefits of active learning (AL), the predominate educational format in higher education is the lecture. The reasons for slow adaptation of AL in medical education are not well understood. The purpose of this survey was to determine knowledge, usage, attitudes, and barriers to AL use in academic Continuing Medical Education (CME).MethodA 20-item questionnaire was developed and sent with a link to an online questionnaire to the Society of Academic Continuing Medical Education (SACME) listserv of ~350 professionals representing academic medical centers, teaching hospitals, and medical specialty societies in the United States (U.S.) and Canada. Responses were collected with SurveyMonkey® from October-November, 2019. Data were analyzed using the SPSS®.ResultsResponses from 146 SACME members in 91 CME units yielded a ~42% survey response rate. Many respondents reported their self-perceived knowledge of AL as high. Advanced training (e.g., certificate, Master of Education degree) was positively correlated with AL knowledge. AL methods were reportedly used in half of the CME activities in the majority (80%) of institutions. Higher levels of self-perceived knowledge were correlated with an increased percentage of AL-related CME activities. Commonly perceived barriers to use of AL were presenters’ lack of familiarity and a need for more time-consuming preparation. Conclusions﻿More efforts are needed to increase innovation and incorporate evidence-based AL strategies in medical education, especially to foster learner engagement, critical thinking, and problem-solving ability.
Buyang Huanwu Decoction Alleviates Cerebral Ischemia-Reperfusion Injury via Sirtuin 1/Autophagy Pathway
Authors: Li Han , Lu Xin-Yi , Peng Dong , Zhang Yang , Lin Hao , Zhang Shi-Jie , Guan Li
Published: November 2020

BackgroundStroke accounts for a large proportion of deaths from disease around world. Buyang Huanwu Decoction (BHD) is used to protect against stroke and stroke-induced disability for many years in China. However, the mechanism of BHD to protect against stroke is still confused. MethodsThe middle cerebral artery occlusion and reperfusion (MCAO-R) model was used to investigate in this study. The animals were administrated with BHD (5, 10 and 20 g/kg) or rapamycin respectively. Infarct size and modified neurological severity score (mNSS) on day 5 were calculated. Cellular changes around ischemic penumbra were showed by HE staining and Nissl staining. Protein expressions of nestin, brain-derived neurotrophic factor (BDNF), doublecortin on the X-chromosome (DCX) and autophagy-related protein in the cerebral peri-ischemic area were detected. ResultsIn results, the post-treatment with BHD relieved brain infarct size and improved neurological deficits in MCAO-R rats. BHD protected against MCAO-R-induced neuronal necrosis, obviously enhanced autophagy (increased Beclin 1 and LC3Ⅱ, decreased P62) and increased the protein expressions of nestin, BDNF and DCX. Meanwhile, BHD promoted the expression of Sirtuin1（SIRT1）, an important regulator of autophagy. Conclusions﻿In conclusion, our data suggested that post-treatment with BHD could protect rat brain from ischemia-reperfusion injury via SIRT1/autophagy pathway.
The Slums in the Mirror of Health: A Systematic Review Analysis from IRAN
Authors: Raoofi Azam , Amirkhani Manzar , Monjazeb Maryam , Peykari Niloofar
Published: November 2020

Background: One billion worldwide population are living in slum areas that mostly accompanied with high rates of poverty, illiteracy, unemployment, unhealthy situation, and inappropriate health-care services. The prediction of enormous growth of slums by 2030, led to a raise to address the “plight of slums” in Sustainable Development Goals (SDGs). To address evidence based health related priorities, we conducted a systematic review to summarizing evidences on health situations of slums population in Iran.Methods: Six electronic databases were systematically searched for published studies without any restriction on age, time and language to assess health situations of slums in Iran by following the PRISMA protocol. All identified articles were screened, quality assessed and data extracted by two authors independently.Results: The finding of this systematic review in addition to overall view categorized in five categories: Health System, Reproductive Health, Infectious Diseases, Non-communicable Diseases and Their Risk Factors, Social Issues besides overall situation of Slums.Conclusions: Community-based participatory interventions with socioeconomic approach on modifiable risk factors; active response of health system; establishment new health care centers in slum areas; augmenting the quality of care; active case finding; and elevating health knowledge, attitude, and practice among slum dwellers is crucial to achieving SDGs.
Clinically Useful and Cost-Effective of Recombinant Human Thrombopoietin in Treatment of Chemotherapy Induced Thrombocytopenia
Authors: Wang Wenxian , Xu Yibing , Shao Lan , Song Zhengbo , Zhang Yiping
Published: November 2020

BackgroundThe bone marrow suppression during chemotherapy will cause severe platelet decline in the human body, resulting in critical organ hemorrhage and intracranial hemorrhage. Therefore, the efficacy and economics of recombinant human thrombopoietin (rhTPO) in treating different degrees of thrombocytopenia caused by chemotherapy were analyzed. MethodsFrom January 2018 to July 2019, 233 with diagnosed lung cancer treated with the course of chemotherapy or chemoradiotherapy were enrolled. After treatment with chemotherapy or chemoradiotherapy, they all happened thrombocytopenia and received rhTPO. We divided patients into three groups according to the level of platelet decline. Changes in blood platelet count, treatment plan and cost performance between them were analyzed. ResultsOf all the included patients, 39.5% was undergoing concurrent radiotherapy or chemotherapy; 42.9% had thrombocytopenia of grade II; 40.3% had thrombocytopenia of grade III; 16.7% had thrombocytopenia of grade IV; 52.8% postponed the next cycle of chemotherapy or radiotherapy due to platelet decline; 12.0% changed the treatment plan for malignant tumors due to severe platelet decline; 15.5% reduced the dose of chemotherapy drugs due to thrombocytopenia; 23.6% had platelet transfusions during this period. During the extended hospitalization period caused by thrombocytopenia, the medical expenses of patients would increase significantly, which was dominated by the cost of rhTPO. ConclusionsFor different degrees of thrombocytopenia, the treatment of rhTPO could increase platelet counts effectively. During the treatment, patients might have varying degrees of economic and the difference between the treatment duration of different patients.
Risk Areas and Spatial Variations in Temporal Trends of Pulmonary Tuberculosis and Their Determinants in a High Burden City From São Paulo State- Brazil.
Authors: Berra Thaís Zamboni , Ramos Antônio Carlos Vieira , Arroyo Luiz Henrique , Crispim Juliane de Almeida , Alves Yan Mathias , Santos Felipe Lima dos , Costa Fernanda Bruzadelli Paulino da , Santos Márcio Souza dos , Alves Luana Seles , Fiorati Regina Célia , Monroe Aline Aparecida , Gomes Dulce , Arcêncio Ricardo Alexandre
Published: November 2020

BACKGROUNDTuberculosis is the leading cause of global deaths from a single infectious agent. This study aimed to identify areas of spatial and space-time risk for pulmonary tuberculosis, to identify areas with variation in the temporal tendency for this event, and to identify factors associated with the epidemiological situation in one municipality. METHODSAn ecological study carried out in Ribeirão Preto, São Paulo, Brazil. The population consisted of pulmonary tuberculosis cases reported in the Tuberculosis Patient Control System between 2006 to 2017. To check the behavior of tuberculosis over the period, the Seasonal Trend Decomposition using Loess decomposition method was used. Spatial and spatiotemporal scanning statistics were used to identify risk areas, and Spatial Variation in Temporal Trends (SVTT) was used to detect clusters with changes in the temporal trend. Finally, Pearson's chi-square test was performed to identify factors associated with the epidemiological situation in the municipality.RESULTSBetween 2006 and 2017, 1760 cases of pulmonary tuberculosis were reported in the municipality. With spatial scanning, four groups of clusters were identified with relative risks (RR) from 0.19 to 0.52 (95%CI:0.09-0.69); 1.73 (95%CI:1.49-1.99); 2.07 (95%CI:1.70–2.32) and from 2.68 to 2.72 (95%CI:2.00-3.77). With the space-time scan, four clusters were also identified with RR of 0.13 [2008-2013] (95%CI:0.03-0.26); 1.94 [2010-2015] (95%CI:1.77-2.11); 2.34 [2006 to 2011] (95%CI:1.67-2.94) and 2.84 [2014-2017] (95%CI:2.50-3.90). With the SVTT, a cluster was identified with RR 0.11, an internal time trend of growth (+0.09%/year) and an external one of decrease (-0.06%/year). Finally, three risk factors and three protective factors associated with the epidemiological situation in the municipality were identified, being: race/brown color (OR: 1.26), without education (OR: 1.71), retired (OR: 1.35), 15 years old or more of study (OR: 0.73), not having HIV (OR: 0.55) and not having diabetes (OR: 0.35).CONCLUSIONThe importance of using spatial analysis tools in the identification of areas that should be prioritized is highlighted, and greater attention is needed to individuals who fit the profile indicated as risk for the disease, in order to undertake social and health actions in an attempt decrease the mortality of the disease.
Role of Financial Incentives in Family Planning Services in India: A Qualitative Study
Authors: Lalchandani Kamlesh , Gupta Aditi , Srivast Ashish , Usmanova Gulnoza , Maadam Ashwarya , Sood Bulbul
Published: November 2020

Background: In an effort to encourage Family Planning (FP) adoption, since 1952, the Government of India has been implementing various centrally sponsored schemes that offer financial incentives (FIs) to acceptors as well as service providers, for services related to certain FP methods. However, understanding of the role of FIs on uptake of FP services, and the quality of FP services provided, is limited and mixed. Methods: A qualitative study was conducted in Chatra and Palamu districts of Jharkhand state. A total of 64 interviews involving multiple stakeholders were conducted. The stakeholders included recent FP acceptors or clients, FP service providers of public health facilities including community health activists (ASHAs), government health officials managing FP programs at the district and state level, and members of development partners supporting FP programs in Jharkhand. Data analysis included both inductive and deductive strategies. It was done using the software Atlas ti version 8. Results: It emerged that there is a strong felt need for family planning among majority clients, and FIs may be a motivator for uptake of FP methods only among those belonging to the lower socio economic strata. For ASHAs, FI is the primary motivator for providing FP related services. There may be a tendency among them and nurses to promote methods which have more financial incentives linked with them. There are mixed opinions on discontinuing FIs for clients or replacing them with non-financial incentives. Delays in payment of FIs to both clients and the ASHAs is a common issue and adversely effects the program.Conclusion: FIs for clients have limited influence on their decision to take up a FP method while different amounts of FIs for ASHAs and nurses, linked with different FP methods, may be influencing their service provision. More research is needed to determine the effect of discontinuing FP related FIs for clients.
Listening to Caregivers: Narratives of Health Seeking for Children Under Five with Pneumonia and Diarrhea: Insights from the NIGRAAN Trial in Pakistan
Authors: Huda Maryam , Shipton Leah , Aftab Wafa , Khan Kausar S , Marini Maria Giulia , Rabbani Fauziah
Published: November 2020

Background Access to health services is an important way to reduce child mortality and is influenced by health-seeking behaviors of caregivers. There are numerous contextual factors that affect health-seeking behaviors, such as distance to health services, transportation, treatment cost, caregiver access to household finances, perceived quality of available health providers, availability and comprehension of health information, social and religious norms (including gender-based mobility), and perceived severity of illness. Objective The objective of this study (embedded in a larger trial called Nigraan) was to gather caregiver narratives in order to develop a comprehensive understanding of the context and process of care giving for children under five with pneumonia and diarrhea, in order to highlight the complexities and dynamics of health seeking in rural Sindh, Pakistan. Methods This study used a narrative interview approach gathering information in the form of stories from care givers of children under five with pneumonia and diarrhea. Twenty caregivers from 11 households participated in this exercise. All data collection was conducted privately in participants’ homes.Results The role of joint family households is integral in health seeking for pneumonia and diarrhea in children under five. Elders and female relatives, especially the child’s paternal grandmother, are an important and trusted source of knowledge regarding child sickness in the household. Furthermore, practice of home remedies is inherited from mother-in-law and older sisters-in-law in the household, and oftentimes their recommendations are taken as authority. Caregivers were generally dissatisfied with doctors in public sector who provide free consultation and associated higher quality care with private doctors who charge more and had shorter waiting times. Joint family households were generally observed to increase the support available to address the financial and practical considerations of health seeking and implementing treatment plans for pneumonia and diarrhea. Conclusions Policy and research on community-based health programs and interventions would be more comprehensive if a health education intervention considered the context of decision making and social influences at the household level rather than focusing on individual caregivers.
The Association Between Early in Marriage Fertility Pressure from in-laws’ and Family Planning Behaviors, Among Married Adolescent Girls in Bihar and Uttar Pradesh, India.
Authors: Dixit Anvita , Bhan Nandita , Benmarhnia Tarik , Reed Elizabeth , Kiene Susan M. , Silverman Jay , Raj Anita
Published: November 2020

Background: Married adolescent girls are vulnerable to risky sexual and reproductive health outcomes. We examined the association of fertility pressure from in-laws’ early in marriage with contraceptive use ever, parity, time until first birth, and couple communication about family size, among married adolescent girls. Methods: Data were taken from a cross-sectional survey study with married girls aged 15-19 years (N=4,893) collected from September 2015 to July 2016 in Bihar and Uttar Pradesh, India. Multivariable regression assessed associations between in-laws’ fertility pressure and each outcome, adjusting for sociodemographic covariates. Results: We found that 1 in 5 girls experienced pressure from in-laws’ to have a child immediately after marriage. In-laws’ fertility pressure was associated with lower parity (Adj. β Coef. -0.10, 95% CI -0.17, -0.37) and couple communication about family size (AOR=1.77, 95% CI 1.39, 2.26), but not contraceptive use or time until birth. Conclusions: Our study adds to the literature identifying that in-laws’ pressure on fertility is common, affects couple communication about family size, and may be more likely for those yet to have a child, but may have little effect impeding contraceptive use in a context where such use is not normative.
Association Between CTLA-4 Gene Polymorphism and Risk of Rheumatoid Arthritis (RA): Evidence from a Meta-analysis Involving 21681 Cases and 23457 Controls.
Authors: Zhou Chuankun , Gao Shutao , Xi Yuan , Shu Zixing , Li Song , Sun Xuying , Xiao Jun , Liu Hui
Published: November 2020

Background: Genetic predisposition was well known to be involved in the pathogenesis of Rheumatoid arthritis (RA). Lots of genetic studies on association between Cytotoxic T lymphocyte-associated protein 4 (CTLA-4) polymorphisms and RA susceptibility had been accumulated in the past few decades, yet reporting inconsistent results. Therefore, we summarized the most-often 3 polymorphisms and performed a meta-analysis to comprehensively evaluate the effect of CTLA-4 gene polymorphisms on RA risk.Methods: Five electronic databases were searched for eligible studies till Oct. 2020. The pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated to assess the strength of association. Stratified analysis was conducted by ethnicity.Results: In total, 42 case-control studies including 21681 cases and 23457 controls were obtained. For rs3087243 polymorphism, significant association was detected in Asians (A vs. G: OR=0.77, 95%CI=0.65-0.90, P=0.001; AA vs. GG: OR=0.67, 95%CI=0.48-0.94, P=0.02) and Caucasians (A vs. G: OR=0.89, 95%CI=0.86-0.93, P<0.00001; AA vs. GG: OR=0.81, 95%CI=0.75-0.88, P<0.00001). For rs231775 polymorphism, significant association was observed in the overall (G vs. A: OR =1.16, 95%CI=1.08-1.25, P<0.0001; GG vs. AA: OR=1.29, 95%CI=1.12-1.50, P=0.0006), in Asians (G vs. A: OR=1.27, 95%CI=1.10-1.47, P=0.001; GG vs. AA: OR=1.58, 95%CI=1.24-2.01, P=0.0002), and not in Caucasians. However, there was no association between rs5742909 polymorphism and RA risk.Conclusion: This meta-analysis confirmed that rs3087243 and rs231775 polymorphism were associated with the risk of RA in both overall population and ethnic-specific analysis, but there was no association between rs5742909 polymorphism and RA risk.
The sooner the better? Anxiety and deliberate exposure to COVID-19 risk among young adults in France
Authors: Etilé Fabrice , Geoffard Pierre-Yves
Published: November 2020

The COVID-19 outbreak has generated significant uncertainty about the future, especially for young adults. Health and economic threats, as well as more diffuse concerns about the consequences of COVID-19, can trigger feelings of anxiety, leading individuals to adopt uncertainty-reducing behaviours. We tested whether anxiety was associated with an increase in willingness to be exposed to the risk of COVID-19 infection (WiRE) using an online survey administered to 3,110 French individuals aged between 18 and 35 years old during the lockdown period (April 2020). Overall, 56.5% of the sample declared a positive WiRE. Unemployment was associated with a higher WiRE (+8.2 percentage points (pp); 95% CI +0.9-15.4 pp). One standard deviation increases in income (+1160€) and psychological state anxiety raised the WiRE by +2.7 pp (95% CI: +1.1-4.4 pp) and +3.9 pp (95% CI: +1.6-6.2 pp), respectively. A one standard deviation increase in perceived hospitalisation risk was associated with a -4.1 pp (95% CI: -6.2-2.1 pp) decrease in the WiRE. Overall, our results suggest that both the prospect of economic losses and psychological anxiety can undermine young adults’ adherence to physical distancing recommendations. Public policies targeting young adults must consider both their economic situation and their mental health, and they must use uncertainty-reducing communication strategies.
Central and peripheral nervous system involvement by COVID-19: A systematic review of the pathophysiology, clinical manifestations, neuropathology, neuroimaging, electrophysiology, and cerebrospinal fluid findings
Authors: Guerrero Juan I. , Barragán Luis A. , Martínez Juan D. , Montoya Juan P. , Peña Alejandra , Sobrino Fidel E. , Tovar-Spinoza Zulma , Ghotme Kemel A.
Published: November 2020

Background: SARS-CoV-2 can affect the human brain and other neurological structures. An increasing number of publications report neurological manifestations in patients with COVID-19. However, no studies have comprehensively reviewed the clinical and paraclinical characteristics of the central and peripheral nervous system's involvement in these patients. This study aimed to describe the features of the central and peripheral nervous system involvement by COVID-19 in terms of pathophysiology, clinical manifestations, neuropathology, neuroimaging, electrophysiology, and cerebrospinal fluid findings.Methods: We conducted a comprehensive systematic review of all the original studies reporting patients with neurological involvement by COVID-19, from December 2019 to June 2020, without language restriction. We excluded studies with animal subjects, studies not related to the nervous system, and opinion articles. Data analysis combined descriptive measures, frequency measures, central tendency measures, and dispersion measures for all studies reporting neurological conditions and abnormal ancillary tests in patients with confirmed COVID-19.Results: A total of 143 observational and descriptive studies reported central and peripheral nervous system involvement by COVID-19 in 10723 patients. Fifty-one studies described pathophysiologic mechanisms of neurological involvement by COVID-19, 119 focused on clinical manifestations, 4 described neuropathology findings, 62 described neuroimaging findings, 28 electrophysiology findings, and 60 studies reported cerebrospinal fluid results. The reviewed studies reflect a significant prevalence of the nervous system's involvement in patients with COVID-19, ranging from 22.5% to 36.4% among different studies, without mortality rates explicitly associated with neurological involvement by SARS-COV-2. We thoroughly describe the clinical and paraclinical characteristics of neurological involvement in these patients. Conclusions: Our evidence synthesis led to a categorical analysis of the central and peripheral involvement by COVID-19 and provided a comprehensive explanation of the reported pathophysiological mechanisms by which SARS-CoV-2 infection may cause neurological impairment. International collaborative efforts and exhaustive neurological registries will enhance the translational knowledge of COVID-19's CNS and PNS involvement and generate strategies for therapeutic decision-making.Registration: This review is registered in PROSPERO (CRD42020193140), July 24, 2020.
Esthetic and functional reconstruction of large mandibular defects using free fibula flap and implant-retained prosthetics - a case series with long-term follow-up
Authors: Sass Tamas , Piffko Jozsef , Braunitzer Gabor , Oberna Ferenc
Published: November 2020

Background: The reconstructive and rehabilitative management of large mandibular defects is challenging in many respects, especially in the vertical dimension. The free fibula flap is an under-utilised but efficient approach in this indication. The aim of this case series is to demonstrate its use and long-term success. Case presentation: Three cases are presented, where the patient had a large bone defect (at least 5 cm in length and 1 cm in the vertical dimension), but the continuity of the mandible was maintained. Two cases were related to pathological fracture and one was a large defect due to oncological surgery. Vertical augmentation with free microvascularised fibula flap was carried out, followed by implant-retained prosthetic therapy. Clinical status has been followed up for 5 to 6 years, with special attention to the condition of the peri-implant tissues and any radiographically detectable alterations or complications. No complications occurred during the follow-up. Function and esthetics have remained unchanged throughout. Conclusions: Free microvascularised fibula flap reconstruction combined with implant-retained prosthetics allows a lasting functional and esthetic solution in large vertical mandible defects.
Glutamate dehydrogenase 1 mediated glutaminolysis sustains HCC cells proliferation and survival under glucose deprivation
Authors: Zhou Yujiao , Zhou Yujiao , Yu Haibo , Yu Haibo , Cheng Shengtao , Cheng Shengtao , Ren Jihua , Ren Jihua , Ren Fang , Ren Fang , He Xin , He Xin , Zheng Lu , Zheng Lu , Chen Juan
Published: November 2020

Background: It is generally believed that tumor cells could sustain its proliferation and survival under different nutrient status according to a so-called metabolic flexibility. How the metabolic flexibility of glutamine metabolism of HCC cells behaves under different glucose conditions has not yet been fully elucidated. In this study, we investigated how the glutamine metabolism modulate the proliferation and survival of HCC cells in response to different glucose conditions and explored the underlying molecular mechanism.Methods: Two cell lines SK-Hep-1 and PLC/PRF/5 were used to evaluate the glutamine addiction of HCC cells. Then, the cells were cultivated in high glucose medium (25mM glucose) and low glucose medium (1.0 mM glucose), respectively, to investigate whether glutaminolysis changed in response to different glucose levels. And, the underlying mechanism of glutamate dehydrogenase 1 (GDH1) sustaining HCC cells survival under glucose deprivation was explored. Additionally, the underlying correlation of GDH1 and glutamate–oxaloacetate transaminase 1 (GOT1) in glucose -poor HCC tissue was investigated.Results: HCC cells were addicted to glutamine. The glutaminolysis of HCC cells was different in response to different glucose conditions. That is, glutamate transaminases GOT1 involved glutamine metabolism played a dominant role in regulating cell growth when glucose was sufficient, while deaminase GDH1 mediated glutaminolysis became dominant when glucose was limited. Mechanically, low-glucose treated HCC cells could induce an elevated expression of GDH1 to supplement the TCA cycles in respond to glucose deprivation. Additionally, we further uncovered an underlying negative association between GDH1 and GOT1 in HCC tissues with decreased glucose levelsConclusions: GDH1 mediated pathway played a leading role in maintaining cell proliferation and survival under low glucose condition. By contrast, GOT1 mediated pathway was activated under high glucose condition. Mechanically, highly expressed GDH1 could drive the TCA cycle in response to glucose deprivation. Besides, there was a potential negative correlation between GDH1 and GOT1 in glucose-poor HCC tissues.