bluuebunny/crossref_metadata_2025 huggingface dataset:
Propensity score analysis comparing survival between definitive chemoradiotherapy and esophagectomy with adjuvant chemoradiotherapy in patients with esophageal squamous cell carcinoma
Authors: Chang Yi Lin , Cheng Ya-Fu , Chen Hui-Shan , Wu Siao-Chi , Hung Wei-Heng , Chen Heng-Chung , Huang Chang-Lun , Cheng Ching-Yuan , Wang Bing Yen
Published: March 2021

Background: The purpose of the current study is to compare definitive chemoradiotherapy and esophagectomy with adjuvant chemoradiotherapy in patients with cT1-3/N0-3 esophageal squamous cell carcinoma in survival.Methods: Records from 2008 to 2014 of 4931 patients with clinical T1-3/N0-3 esophageal squamous cell carcinoma receiving definitive chemoradiotherapy or esophagectomy with adjuvant chemoradiotherapy were obtained from the Taiwan Cancer Registry. Univariable and multivariable analyses were performed and propensity score matching was used to minimize the bias. Overall survival was compared between definitive chemoradiotherapy and esophagectomy with adjuvant chemoradiotherapy, and also in the three different clinical stages.Results: Definitive chemoradiotherapy was performed on 4381 patients, and 550 patients received esophagectomy adjuvant chemoradiotherapy. Each group produced 456 patients for comparison after propensity score matching. The 1-year, 2-year, and 3-year overall survival rates for matched patients in with definitive chemoradiotherapy group were 57.18%, 31.92%, and 23.8%. The 1-year, 2-year, and 3-year overall survival rates for matched patients treated in the esophagectomy with adjuvant chemoradiotherapy group were 72.35%, 45.74%, and 34.04%(p<0.0001). In multivariable analysis, treatment modality was an independent prognostic factor. Esophagectomy with adjuvant chemoradiotherapy provided better survival outcome than definitive chemoradiotherapy for patients with clinical stage II/III disease. As for patients with clinical stage I disease, there was no significant survival difference between definitive chemoradiotherapy and esophagectomy with adjuvant chemoradiotherapy.Conclusions: Esophagectomy with adjuvant chemoradiotherapy provided better survival than definitive chemoradiotherapy in clinical II/III esophageal squamous cell carcinoma. However, more data are needed to conduct a convincing conclusion in clinical stage I patients.
Sustainment of Proactive Physical Therapy for Individuals with Early-Stage Parkinson’s Disease: A Quality Improvement Study over 4 years
Authors: MacDonald Jillian , Doyle Laura , Moore Jennifer L , Rafferty Miriam R
Published: March 2021

Background: Implementation science frameworks aided the development of a new, evidence-based clinical physical therapy program. The purpose of this report is to describe the process of sustaining a clinical program in practice for over four years. We present a framework for integrating tools for sustainability with the Knowledge-to-Action model in the context of a proactive physical therapy program (PAPT) for individuals with early stage Parkinson’s disease.Methods: Sustainability of implementation strategies was addressed using the Dynamic Sustainability Framework and sustainability assessment tools. Repeated retrospective medical record reviews and semi-structured interviews were used to evaluate the reach and adoption of the PAPT over four years. Characteristics of those who engaged with PAPT, implementation fidelity, and clinical effectiveness were assessed for Year 1 and Year 3. Sustainability was measured using RE-AIM, NHS Sustainability Model, and Clinical Sustainability Assessment Tool.Results: Reach increased from 28 to 110 total patients per year and spread occurred from one to three sites. PAPT user age, sex, Hoehn & Yahr rating, time since diagnosis and type of insurance were similar in Year 1 and Year 3 (p>0.05). The program sustained its effect to help participants increase or maintain self-reported exercise (Y1: 95%, Y3: 100%). However, upon evaluation PAPT users in Year 3 had longer time since symptom onset and worse UPDRS motor scores compared to the PAPT users in Year 1 (p<0.05). All sites sustained the core intervention components, with sustainability scores of 71/100 (± 9.9) on the NHS Sustainability Model and 6.1/7 (± 0.9) on the Clinical Sustainability Assessment Tool.Conclusions: Integrating multiple sustainability models and assessments supported continued effectiveness, spread, and sustainment of PAPT for four years. Effective planning, anticipating common healthcare changes, and addressing sustainability determinants early in program implementation were essential aspects of long-term success.
Greater preferences for death in hospital and mechanical ventilation at the end of life among non-whites recently diagnosed with cancer
Authors: Boyce David , Liao Kaiping , Miller Christopher , Peterson Susan K. , Elting Linda , Guadagnolo B. Ashleigh
Published: March 2021

Purpose: Minority cancer patients receive more aggressive care near death. This may indicate low quality end-of-life (EOL) care if discordant with patient preferences. We investigated preferred potential place of death and preferences regarding use of mechanical ventilation in a cohort of Texas cancer patients.Methods: A population-based convenience sample of recently diagnosed cancer patients from the Texas Cancer Registry was surveyed using a multi-scale inventory between March 2018 and June 2020. Item responses to questions about preferences regarding location of death and mechanical ventilation were the outcome measures of this investigation. Inverse probability weighting analysis was used to construct multivariable logistic regression examining the associations of covariates. Results: Of 1460 respondents, a majority (82%) preferred to die at home compared to 8% who preferred dying at the hospital. In total 25% of respondents expressed a preference for undergoing mechanical ventilation at the EOL. Adjusted analysis showed increased preference among Black (OR=1.81; 95% CI: 1.19-2.73) and other non-white, non-Hispanic race individuals (OR=3.53; 95% CI: 1.99-6.27) for dying at a hospital. Males, married individuals, those of higher education and poor self-reported health showed significantly higher preference for dying at home. Minority respondents of all non-white races were more likely to prefer mechanical ventilation at the EOL as were individuals who lived with another person at home. Conclusion: Minority cancer patients were more likely to express preferences coinciding with aggressive EOL care including dying at the hospital and utilizing mechanical ventilation. These findings were independent of other sociodemographic characteristics, including decisional self-efficacy.
Geochemical and statistical evaluation of groundwater in the Thamirabarani river basin, south India
Authors: Chellaiah Gajendran , Basker  , Pravin Hima , Joshi Suneel Kumar , Gautam Sneha
Published: March 2021

In the present study, an attempt has been made to develop the dictate metrics using a multi-proxy approach, i.e., spatial-temporal analysis, statistical evaluation, and hydrogeochemical analysis for 45 water samples located in the Thamirabarani river basin in Tamil Nadu, India. In order to evaluate the aptness of developed metrics for agriculture and domestic needs, eleven years dataset was analyzed and compared with national and international standards. Monitoring and analysis results revealed that the concentration of calcium and chloride ion was on the higher side in all the selected locations. These higher values may be attributed to the regional point sources such as untreated water disposal and off-peak sources such as agriculture practices. The principal component analysis resulted in 84.2% of the total variance in the post-monsoon season dataset. The major analyzed cations and anions were observed in the following order: Na+> Ca2+> Mg2+> K+ and Cl−> HCO3−> SO42−> NO3−, respectively. Overall, this study revealed that the studied area's groundwater quality was significantly affected by the high salinity in the region, probably due to anthropogenic activities and unprotected river sites.
Preparation of Bi3.64Mo0.36O6.55 by Reflux Method and Its Application in Photodegradation of Organic Pollution
Authors: Peng Chundong , Jia Zeyu , Zhong Yi , Ao Weihua , Chen Daimei , Wang Ruizhe , Ding Hao , Wu Xiangfeng , Wang Jiao , Du Gaoxiang
Published: March 2021

Bismuth molybdate (γ-Bi2MoO6) photocatalyst has drawn numerous attentions in the field of photocatalysis because of its band gap (2.5eV ~ 2.8eV) and good visible light response (420 ≤ λ ≤ 500 nm). However, as a kind of bismuth molybdates, there are still few studies on Bi3.64Mo0.36O6.55 (BMO), thus further exploration is needed. Herein, a simple reflux method was developed to synthesize the cubic phase BMO. This method is simple and easy to operate under atmospheric pressure, showing the great potential for large-scale production. In contrast with the nanosheet structure of Bi2MoO6, the morphology of BMO is mixture of nanorod and nanoparticle-like structure. The Motts curves show that conduction band position and the valence band position of BMO was 2.77 eV, -0.33eV and 2.44eV, respectively. A new mixed phase of 3Bi2O3•2MoO3 was appeared in BMO crystal, showing that the phase transition of BMO began at 400℃. When BMO was calcined at 300℃, photocatalytic degradation rate is up to maximu. The photocatalytic activity of visible-light range was tested and compared with γ-Bi2MoO6. BMO had a better photodegradation activity than that of the Aurigillius phase γ-Bi2MoO6 due to its larger band gap and the strong oxidation ability.
Clinical Presentation, Management and Outcome of Staffs with COVID-19 Disease: a large tertiary Oil and Refinery Grand Hospital Study
Authors: Dehghan Bahram , abeshtan Ahmad , Sarami Abdullah , Saeidimehr Saied , Maraghi Elham , Rahim Fakher
Published: March 2021

Objective

The aim of the present study was to assess clinical characteristics, managing and controlling, and in-hospital outcome of COVID-19 among oil refinery workers in a single referral center.
Methods

This cross-sectional study was conducted in a non-COVID single referral center from March to August 2020. At the Naft grand Hospital, the COVID-19 specimen collection and molecular detection unit was established with staff trained to collect suitable samples (sufficiently deep swabs), storage, packaging, and transportation. The diagnosis of COVID-19 infection (SARS-CoV-2) was confirmed by real-time reverse transcription polymerase chain reaction (RT-PCR) assay.
Results

Overall, 500 patients with confirmed COVID-19 infection were included, of which the most common comorbidities were hypertension (52.2%) and diabetes (45.6%). Moreover, 298 patients (59.6%) had one to three comorbidities, 148 patients (29.6%) had four to six cases, and two patients (0.4%) had seven and more comorbidities. Finally, 23 people (4.6%) have cancer and 206 people (41.2%) have other diseases. 390 (78.8%) received Kaletra, and 387 (78.02%) receive Azithromycin. Overall, PCR test result was positive in 377 (75.4%) patients, computed tomography scan (CT-scan) test was positive in 413 (82.6%) patients, and CRP test had positive result in 335 patients (67%) patients.
Conclusion

Most referred cases were survivors with mild to moderate symptoms, and a few of them were unfortunately non-survivor. This could be due to those people with mild COVID-19 symptoms may respond well to the treatment and institutional isolation. Thus, good and evidence-based clinical care combined with strong public health interventions will save the lives of thousands, if not millions, worldwide.
The Circadian Temperature Trajectory Predicts the Severity and Prognosis in Critically Ill Patients
Authors: Deng Hongbin , Yu Xianqiang , Lin Jiajia , Liu Yang , Tong Zhihui , Wei Yongyue , Li Weiqin
Published: March 2021

Background: Disrupted circadian temperature is commonly observed in patients in the intensive care unit (ICU). The aim of this study is to examine the association between body temperature (BT) circadian rhythm and mortality critically in patients receiving ICU admission for at least 24h.Method: Adult patients with a complete record of temperature during the first 24 hours of ICU stay in the Multi-parameter Intelligent Monitoring in Intensive Care III (MIMIC-III) database were included in this retrospective cohort study. Body temperature circadian rhythm ratio (BTCRR) was calculated according to the value of mean nighttime divided by daytime mean temperature. All patients were divided into the nocturnal BT rising (NBTR) group (BTCRR >1) and the non-NBTR group (BTCRR≤1). Five subgroups were also built according to different quantile of BTCRR (5%, 10%, 30%, 50%). The associations of NBTR, subgroup, and BTCRR with 28-day mortality were assessed separately using Cox proportional hazards model.Findings: The overall cohort comprised 32419 patients. The non-NBTR group (n=20148) had higher 28-day mortality than the NBTR group (n=12271). After adjusting for covariates, the analysis showed that NBTR was significantly associated with mortality at 28 days (hazard ratio: 0.923; 95% CI, 0.888–0.960, P<0.05). All results of subgroup analysis showed obvious statistical significance, and similar results persisted in the patients with different groups. The % BTCRR had a significant non-linear (p < 0.05) association with 28d-mortality after adjusting for other variables (p < 0.05). Increasing the percentage up to 101% resulted in a hazard ratio (HR) to reduced mortality (HR: 0.96; 95%, 0.941–0.972, P<0.001), while increases above 101 % didn’t make a significant suggestion in mortality.Conclusions: The findings of this study suggest that both low and high BTCRR indicates a poor outcome, such that having a BTCRR of 101% had a survival advantage. BTCRR may aid in the early identification of critically ill patients at high risk of 28-day mortality. These findings may provide a basis for future randomized controlled trials comparing temperature control of ICU patients.
Inorganic and black carbon hotspots constrain blue carbon mitigation services across tropical seagrass and temperate tidal marshes
Authors: Gallagher John Barry , Prahalad Vishnu , Aalders John
Published: March 2021

Total organic carbon (TOC) sediment stocks as a CO2 mitigation service require exclusion of allochthonous black (BC) and particulate inorganic carbon corrected for water–atmospheric equilibrium (PICeq). For the first time, we address this bias for a temperate salt marsh and a coastal tropical seagrass in BC hotspots that represent two different blue carbon ecosystems of Malaysia and Australia. Seagrass TOC stocks were similar to the salt marshes with soil depths < 1 m (59.3 ± 11.3 and 74.9 ± 18.9 MgC ha− 1, CI 95% respectively). Both ecosystems showed larger BC constraints than their pristine counterparts did. However, the seagrass meadows’ mitigation services were largely constrained by both higher BC/TOC and PICeq/TOC fractions (38.0% ± 6.6% and 43.4% ± 5.9%, CI 95%) and salt marshes around a third (22% ± 10.2% and 6.0% ± 3.1% CI 95%). The results provide useful data from underrepresented regions, and, reiterates the need to consider both BC and PIC for more reliable blue carbon mitigation assessments.
High Dependency Renal Unit (HDRU) for the management of COVID-19 in patients with severe acute or chronic kidney disease
Authors: Thakare Sayali , Modi Tulsi , Gandhi Chintan , Bose Sreyashi , Deb Satrupa , Katyal Abhinav , Saxena Nikhil , Patil Ankita , Patil Sunil , Pajai Atim , Bajpai Divya , Jadhav Pratap , Jamale Tukaram
Published: March 2021

Background: COVID-19 in patients on dialysis for acute or chronic kidney disease is associated with high mortality. We evaluated the effect of high dependency renal unit (HDRU) with nephrologists as primary care physicians for management of these patients. Methods: This was an observational, cohort study conducted at a tertiary care teaching hospital in western India. Patients needing dialysis for COVID-19 associated Acute Kidney Injury (AKI-D) and patients with End-Stage-Renal-Disease (ESRD) hospitalized for COVID-19 were included in the study. After 2 months into the pandemic (28 March to 28 May), HDRU was commissioned for management of these patients. With nephrologists as primary care physicians, the components of care included completion of care bundle focusing on key nephrology and COVID-19 related issues, checklist-based clinical monitoring, integration of multispecialty care, and training of nurses and doctors. Primary outcome of the study was in hospital mortality compared between pre-HDRU and HDRU cohorts. Secondary outcomes were- dialysis dependence in AKI-D, and predictors of death. ﻿Results: 238 of 4052 (5.87%) patients with COVID-19 admitted from 28th March to 30th September had severe renal impairment (116 AKI-D and 122 ESRD). 133 of 238 (56.8%) has severe COVID-19. HDRU care was delivered from 28th May to 30th August. Kaplan-Meier survival analysis showed significant improvement in survival after implementation of HDRU [19 of 52 (36.5%) in pre-HDRU versus 35 of 160 (21.9%) in HDRU died, p=<0.01]. 44 (67.7%) AKI-D survivors were dialysis dependent at discharge. Male sex, breathlessness and altered mental status at presentation, development of shock during hospital stay and leukocytosis predicted mortality. Conclusions: HDRU managed nephrologists as primary care physicians is feasible and potentially effective approach to improve the outcomes of patients with COVID-19 and severe renal impairment.
Forgone Care in Patients With Type 2 Diabetes: A Cross-Sectional Study
Authors: Jalilian Habib , Heydari Somayeh , Mir Habibeh , Fehresti Saeedeh , Hatamzadeh Nasser , Khodayari-Zarnaq Rahim
Published: March 2021

Background and objective: Diabetes mellitus is a complex chronic disease requiring appropriate continuous medical care and delayed, or forgone care may exacerbate the severity of the disease. This study aimed to investigate the factors affecting forgone care in diabetic patients.Materials and methods: This was a cross-sectional study involving 1139 patients with type 2 diabetes aged 18 years and older in East Azerbaijan. Data collected using a researcher-made questionnaire and analyzed using SPSS software version 22. Results: Of the 1139 patients, 510 patients (45%) reported forgone care during the last year. The percentage of forgoing care was higher in patients without supplementary insurance coverage (P=0.01), those with complications (P=0.01) and those with the history of hospitalization (P=0.006). The majority of patients (41.5%) reported that the most important reason for forgoing care is financial barriers resulting from disease treatment costs. Of the main four factors, quality of care had the highest impact on forgone care at 61.28±39.74, followed by accessibility (37.01±25.12), awareness and attitude towards disease (18.52±18.87) and social support (17.22±18.80).Conclusion: The results showed that, despite the implementation of the Islamic Republic of Iran on a fast-track to beating non-communicable diseases (IraPEN), a considerable number of diabetics had a history of forgoing care, and the most important reasons for forgoing care were related to the financial pressure and dissatisfaction with the quality of care. Therefore, not only more financial support programs should be carried out, but the quality of care should be improved.
Ultra-efficient Copper Ions Adsorption of Chitosan-montmorillonite Composite Aerogel for Wastewater Treatment
Authors: Ye Xin , Shang Sisi , Zhao Yifan , Cui Sheng , Zhong Ya , Huang Longjin
Published: March 2021

The modified montmorillonite(MMT) has a two-dimensional stable and ordered lamellar structure. The addition of chitosan(CS) cross-links the two-dimensional sheets to build a three-dimensional network structure with a high specific surface area. We have prepared the best MMT-based water treatment materials that have been reported. This new type of aerogel can efficiently adsorb heavy metal ions in wastewater. The structure and performance of the composite material were characterized in this article. Besides, the adsorption kinetics, adsorption thermodynamics, pH influence, and recycling performance are all focused on. The adsorption equilibrium time of CS-MMT2 is 50 min. The removal rate of Cu2+ is as high as 98.21%. The maximum adsorption capacity is 86.95 mg/g. The adsorption process of Cu2+ by CS-MMT composite aerogel conforms to the quasi-second-order kinetic model and the Langrangian adsorption isotherm. After three cycles, the removal rate of Cu2+ by CS-MMT2 remained above 80%. This article also involves the discussion of the material's adsorption mechanism for Cu2+. This is a kind of environmentally friendly material that can be mass-produced, cheap, efficient, and excellent, which is of great significance to the development of environmental protection.
Optimization and Modelling of the Wear in Piston Ring and Cylinder Liner Using Taguchi Method and Artificial Neural Networks
Authors: cesur Idris , Çoban Aslan , Eren Beytullah
Published: March 2021

Alternative energy sources are needed to meet the energy needs of the rapidly increasing population and developing industry and to increase the efficiency of the systems. In internal combustion engines, biodiesel is used as an alternative fuel for both being an alternative energy source and having a better efficiency compared to diesel fuel. Efficiency loss in the engines is largely due to friction and wear between the piston ring (PR) and the cylinder liner (CL). Different lubrication regimes in engines have substantial effects on wear and friction. In the present study, the effects of diesel and biodiesel (chicken oil methyl ester, COME) fuels on friction and wear in different loads (40-60-80-100 N) and speeds (60-90-120-150 rpm) were examined using the Taguchi experimental design method. In addition, an artificial neural networks (ANNs) model is utilized for modeling the wear at the cylinder liner (CL) and the piston rings (PR) using different fuel types, speeds and loads. As a result of the study, biodiesel fuel has a lower friction coefficient and abrasion in all load and cycle intervals due to its high viscosity and lubrication properties compared to diesel fuel. Besides, the developed ANN model has good predictive capability for the wear at the CL and the PR according to perfect match between experimental and modeling results.
Occurrence and Distribution Characteristics of Antibiotic Resistance Genes in Sediments Between Urban and Rural of the Liaohe River Basin, China
Authors: Na Guangshui , Zhang Keyu , Gao Hui , Li Ruijing , Jin Shuaichen , Zhao Fuqiang , Zhang Haibo , Li Shisheng
Published: March 2021

Antibiotic Resistance Genes (ARGs) are considered to be emerging pollutants related to human activities. The rapid development of global urbanization has expanded human activities, thereby exacerbating the global human health risks caused by antibiotic resistance genes. The effects of urban and rural environments are multifarious, which makes the source and distribution of ARGs in the environment diversification. Understanding the distribution and spread of ARGs is essential for studying the environmental behavior of ARGs. In this study, the occurrence 296 genes were detected by the high-throughput qPCR technology, and FC value was used to analyze the diversity of ARGs and Mobile Genetic Elements (MGEs) in sediments between urban and rural areas of the Liaohe River Basin, China. The co-occurrence of MGEs and ARGs was analyzed using network to decipher core genes. A total of 187 ARGs and 10 MGEs were detected in all sediment samples. The average number of genes detected in urban sites is 89 higher than that in rural sites. The high abundance and various types of ARGs and MGEs detected in urban river sediments indicates that the occurrence of urban ARGs is more complex. MGEs were detected high levels and were significantly correlated with the abundance and diversity of ARGs in river sediments providing evidence that MGEs were related to the occurrence and distribution of ARGs and tnpA(tnpA-07, tnpA-01 and tnpA-03) gene were at the key position of co-occurrence of various types of ARGs.
Quantifying Shedding and Degradation Rates of Environmental DNA (eDNA) from Pacific Crown-of-thorns Seastar (Acanthaster cf. Solaris)
Authors: Kwong Sarah Lok Ting , Villacorta-Rath Cecilia , Doyle Jason , Uthicke Sven
Published: March 2021

Population outbreaks of the corallivorous crown-of-thorns seastar (CoTS; Acanthaster spp.) are significant threats to the Indo-Pacific reefs. Although recent research demonstrated that environmental DNA (eDNA) techniques could improve CoTS monitoring and management, the interpretation of surveillance results has been limited by uncertainties about eDNA dynamics in aquatic environments. Here, we aimed to identify biotic and abiotic factors affecting the shedding and degradation rates of CoTS eDNA. Using laboratory-raised 8-month-old juvenile CoTS, aquarium experiments were conducted to test the effect of two temperatures (24 and 28°C) and three feeding treatments (no food, food available and food inaccessible) on eDNA shedding rate. Additionally, CoTS eDNA degradation rate was quantified under three temperatures (24, 26 and 28°C). We found that eDNA shedding rate was affected by feeding treatment (p < 0.0001) but not temperature. Specifically, the shedding rate under food accessible treatment was about 7 times higher than that of food inaccessible treatment (p < 0.0001), whereas the presence of coral reduced the shedding rate by half (food inaccessible vs no food, p = 0.0249). Degradation of CoTS eDNA was rapid (half-life = 14h) and not affected by temperature. Our results demonstrated that feeding activity increased eDNA release, but some of the released DNA was lost potentially due to binding to coral surface mucus layer or skeleton. The rapid degradation rate indicated that results of eDNA surveillance likely reflects recent and local occurrence of CoTS. Although further testing is needed, this study provided support for using eDNA as a novel detection tool for early life stages of CoTS on coral reefs.
Fabrication of Transition-metal (Zn, Mn, Cu)-based MOFs as Efficient Sensor Materials for Detection of H2 Gas by Clad Modified Fiber Optic Gas Sensor Technique
Authors: Meeran M Nagoor , Saravanan S.P. , Hegazy H.H
Published: March 2021

Recent research demonstrate that promising gas sensing materials are called metal-organic structures (MOFs) and their products due to their tunable form, elevated surface area, and extremely porous structure and physisorption towards gases with relatively low temperature.In this report, recent developments in transition-metal (Zn, Mn, Cu)-based MOFs and their derivatives are synthesized as sensing materials. The sensors samples were analyzed by XRD, SEM, TEM, BET and XPS in order to know the textural, structural and electronic state of the samples. Fiber optic clad modified sensors were fabricated and tested gas sensing properties towards H2 gas with various concentrations (0-1000 ppm). Among the three sensing material, Zn doped MOFs sensor showed outstanding selectivity with high sensitivity (115 counts/kpa) towards H2 gas. Moreover, it has shown high response (20 s) and recovery time (27 s) as well as long term stability. The designed sensors may be required to apply to the production of an outstanding sensor for H2 for commercial uses.
Direct and Indirect Costs Associated With Non-invasive Treatments in Obesity and Overweight Patients
Authors: Maaroufi Saman , Golestani Mina , Alizadeh Mohammad , Imani Ali , Dalal Koustuv
Published: March 2021

Background: Obesity and overweight are a global public health problem causing several chronic diseases which can lead to various degrees of morbidity and mortality. These medical conditions cause economic costs and complications. The purpose of the present study to estimate the direct and indirect costs incurred by obese and overweight patients with non-invasive treatments in Tabriz, north-western Iran.Methods: The number of 247 patients were studied by cross-sectional approach and used cost of illness's prevalence approach assessing the total costs (direct and indirect) of obesity and overweight through interview and assessing relevant clinical records. The study conducted over three months from December 2018 to February 2019 in Tabriz, capital of East Azerbaijan province, Iran. Direct costs included hospitalization, para-clinical medications and outpatient visits for treatment of obesity and overweight. Loss of productivity, days of restricted activity and days in bed, cost of wasting time, transportation costs and nursing expenditure were estimated as indirect costs in the present study. For estimating direct and indirect costs, we used the bottom-up costing approach. The foreign exchange rate used in the analysis was 42000 Iranian Rial = 1US$ (December-February 2018).Results: The mean three months cost per patient is 38529697 IRR (equivalent to $91.73 USD), Direct medical costs have a most significant part of total costs with 36765292 IRR (87.53USD) per three months (95%). Direct non-medical costs were 1380484 IRR (3.28USD) per patient (4%) and indirect costs were estimated 383981 IRR ($0.9USD) per patient (1%). The results of the analysis of variance showed that there was a significant difference between the four strategies in three months. Among the therapeutic strategies, the most changes in body mass index (BMI) occurred in patients who used Basic diet with several types of medicines strategy (p<0.001). Tukey post hoc showed BMI Changes in a patient with a Basic diet with herbal remedies was minimum (p<0.001). According to results in the first month, BMI has a significant reduction over three months. Regarding costs, the analysis showed that Patients who used the Basic diet strategy incurred the lowest costs (p<0.001) and the highest costs are related to patients with a Basic diet with several types of medicines (p<0.001).Conclusions: The results of the present study are useful in improving health policymakers and researchers in motivating to do more studies in particular for adopting new policies depending on the level of insurance coverage and their problems which patients deal with during the treatment period.
CD28 Monoclonal Antibody Improve Sepsis Mortality by Amending Th17/Treg Balance
Authors: Wu Yu , Li Dai , Xie Jian , Wang Han , Meng Yan , Wu Guosheng , Deng Xiaoming , Wan Xiaojian
Published: March 2021

Background: Sepsis is still developing exorbitantly high mortality. In response to microbial molecules, T cell activation plays a crucial role in sepsis’s initial innate immune reactions. The imbalance between CD4+IL-17+ T helper cells (Th17) and CD4+CD25+ regulatory T cells (Treg) participates in sepsis progression. CD28 signaling pathway was essential for the expression of inflammatory cytokines related to Th17, and play a crucial role in the maintenance of Treg. We investigated the correlations of the balance between Th17 and Treg to prognosis in sepsis patients and influence of anti-CD28 antibody on the ratio of Th17 to Treg in sepsis mice.Methods: 60 sepsis patients' baseline conditions were recorded, and the expressions of inflammatory factors in the peripheral blood and levels of procalcitonin (PCT) were detected. Peripheral blood mononuclear cells (PBMCs) were separated, subtypes of T cells and related biomarkers were measured by Fluorescence-activated cell sorting (FACS). Furthermore, the relationship between the above indicators and patients’ condition scoring (APACHEⅡand SOFA) and ICU hospitalization time were analyzed. To investigate effects of CD28 on the balance of Th17 between Treg, anti-CD28 antibody was intraperitoneal administrated to cecal ligation and puncture (CLP) mice. Results: Compared with septic patients who stay in ICU more than 14 days, the Th17/Treg ratio of patients with ICU hospitalization of fewer than 14 days was significantly lower. The sepsis patients with higher expression of CD28 in peripheral blood lymphocytes have lower APACHE II and SOFA scores. Moreover, the expression of CD28 was significantly higher in sepsis patients than that of healthy donors. After administration of CD28 monoclonal antibody, 7-day mortality and clinical score were significantly improved in septic mice, with splenocyte Th17/Treg ratio decreased. CD28 antibody alleviates the expression of pro-inflammatory factors and spleen injury related to apoptosis. Conclusions: Th17/Treg ratio revealed septic patient severity and can be used as a predictor of ICU stay. CD28 monoclonal antibody could improve 7-day mortality of septic mice by decreasing T cell apoptosis and amending the ratio of Th17/Treg.Trial registration: CHEC2019-133, CTR20191855. Registered 27 August 2019
A Simple-to-use Tool for Predicting Response to Peginterferon in HBV DNA Suppressed Chronic Hepatitis B Patients
Authors: Ren Peipei , Li Hu , Huang Yan , Jiang Jiayuan , Guo Simin , Cao Zhujun , Zhang Chenxi , Zhou Tianhui , Gan Qinyi , Zhao Shuang , Chen Lichang , Guo Qing , Cai Wei , Wang Hui , Hu Peng , Xie Qing
Published: March 2021

Background: Rational administration of peginterferon can remarkably reduce serum HBsAg level and improve the rate of HBsAg loss. Considering the high cost and low tolerability of peginterferon, we aimed to develop a simple-to-use scoring system at early stage of treatment to predict low HBsAg level or HBsAg loss at the end of treatment in virological suppressed chronic hepatitis B (CHB) patients.Methods: Non-cirrhotic CHB patients with NA (nucleoside/nucleotide analogues)-induced virological suppression initiated peginterferon treatment by either add-on or switch-to strategy for 48 weeks were enrolled from January 2012 to June 2017 in two tertiary centers. The retrospective design enrolled 320 subjects, including 189 patients in the training cohort and 131 patients in the validation cohort.Results: By logistic regression, a simple-to-use scoring system integrating baseline HBsAg level < 1000 IU/mL, HBsAg decline > 0.5 log at week 12 and ALT flare at week 12 was developed in the training cohort and high performance for predicting HBsAg < 100 IU/mL, HBsAg < 10 IU/mL and HBsAg loss at the end of 48-week treatment. The area under receiver operating characteristics curve was 0.84, 0.80 and 0.76 in the training cohort and 0.88, 0.87 and 0.84 in the validation cohort, respectively.Conclusions: Our simple-to-use scoring system can guide clinicians to decide whether to continue peginterferon treatment in CHB patients in order to achieve low HBsAg levels or HBsAg loss at the end of treatment, which might greatly improve the opportunity to reach a functional cure in these patients and lead more cost-effective treatment decision.
Attitude and Involvement of Male Partner in Maternal Health Care in Addis Ababa, Ethiopia: a Cross-sectional Study
Authors: Umer Zeytuna Mohammed , Sendo Endalew Gemechu
Published: March 2021

Background: The participation of men in maternal health care [MHC] is recognized as a crucial strategy to enhance maternal health care. Research assessing male participation in MHC and factors influencing their involvement in Ethiopia is minimal, despite the important role of men in maternity care.Objective: To assess the attitude and involvement of the male partner in maternal health care in Nifas Silk Lafto sub-city, Addis Ababa, Ethiopia.Methods: A community-based cross-sectional study was conducted from April to June 2020. A sample of 411 married men was recruited using a systematic random sampling technique. The data were collected using a structured interviewer-administered questionnaire. Data were entered in Epidata version 4.6 and SPSS version 25 used for analysis. The association between the dependent variable (Male partner involvement in maternal health care) and independent variables was checked using Multivariable logistic regression.Results: A composite score was obtained by adding the level of participation in all three aspects of maternity care together, and the overall level of participation in maternity care was 103 (25.1%) with good participation and 308 (74.9 %) with poor participation. Almost half of the study participants [48.7%] had a positive attitude towards maternal health care.In multivariate analysis, men whose spouse had unplanned pregnancy (AOR = 0.46, 95%, CI: 0.222 - 0.956), who did not reside with their partner (AOR = 0.09, 95 % CI: 0.011- 0.804), who did not obtain information in prenatal and postnatal clinics (AOR = 0.101, 95% CI: 0.056-0.181) were variables significantly correlated with male participation compared to their counterparts. Conclusion: The level of men’s involvement in maternity care was poor. In this study, access to information on men's involvement in maternity care, education, and living conditions were the determinants of men's participation in maternity care. These findings provide a useful guide for targeting future strategies for potential male participation.
Epidemiological and Clinicopathological Features of Breast Cancer in Mauritania
Authors: BRAHIM Selma MOHAMED , HAMED Cheikh Tijani , ZEIN EkhtElbenina , SALAME Malak , VETEN Fatimetou , ZEIN Mohamed Vall , KHYATTI Meriem , HOUMEIDA Ahmed , TOLBA Ahmedou
Published: March 2021

Background Breast cancer is the leading cause of death in African women. The aim of this retrospective study was to assess the incidence, clinico-pathological characteristics, risk factors and outcome of breast cancer in Mauritania.Methods Demographic and clinico‑pathological features of breast cancer were gathered from 11174 patient files of all cancer types referred to the Centre National d’Oncologie (CNO) between January 2009 and December 2020.ResultsBreast cancer was the most common type of cancer identified in women (30.7%). The diseaseincidence increased from 69 in 2009 to 209 in 2020 with a mean age of 49 year sat cancer detection. Grade 3 tumor was diagnosed in 31.8% patients. Stage 3 and metastasic stage were found respectively in 44.9 % and 22.6% of screened women. 40.4% of cancer patients with satisfactory immunohistochemical data were triple negative breast cancer (TNBC) but no significant variation was found in these features between TNBC and non TNBC groups. A 3‐year survival rate of 63% was observed.ConclusionsThese results support the already published studies on the likely genetic basis of breast cancer in our population.
Perception of Aging Modifies Social Adjustment of Iranian Veterans: a Randomised Controlled Trial
Authors: Asadollahi Abdolrahim , Ghahremani Leila , Maghsoudi Fatemeh
Published: March 2021

Background: Retirement is a challenge for veterans during their life course. The aim of this study was to investigate the effect of educational intervention on the perception of aging and social adjustment during retirement. Methods: This quasi-experimental study was performed on 100 military retirees in Shiraz, Iran. Data collection tools included a demographic questionnaire, Perception of Aging, and Social Adjustment. The educational intervention used included six training sessions on the subject of mindfulness, physical and psychological changes of aging, health and self-care management, attitudes toward aging, and social and family relationships in old age. Data were collected at the beginning of the study and two months after the intervention and then analyzed using SPSS version 25. Results: The results showed no significant difference between the control and intervention groups in terms of demographic variables, perception of aging, and social adjustment before the educational intervention. However, the perception of aging significantly decreased, and social adjustment increased in the intervention group after the educational intervention. Improving the perception of aging and parents' perceived role can positively affect social adjustment. Multiple regression analysis indicated a predictive model for social adjustment in later life. Conclusions: With increased knowledge of the retirees on self-care, their perceptions of aging and their role in later life improved and predicte social adjustment.
Structural Maintenance of Chromosomes 1A (SMC1A) regulated by KIAA1429 in m6A-independent manner promotes EMT progress in breast cancer
Authors: Zhang Xu , Dai Xin-Yuan , Qian Jia-Yi , Xu Feng , Wang Zhang-Wei , Xia Tian , Zhou Xu-Jie , Li Xiao-Xia , Shi Liang , Wei Ji-Fu , Ding Qiang
Published: March 2021

Background

As a component in the m6A ‘writers’, KIAA1429 was reported to promote breast cancer proliferation and growth in m6A-independent manners. However, the related mechanism of KIAA1429 in breast cancer metastasis have not been reported.
Methods

Western blots and quantitative real-time PCR were carried out to verify the expression of KIAA1429 in breast cancer cells SUM1315 and ZR-75-1 after KIAA1429 knockdown or overexpression. Transwell and in vivo metastasis assay were conducted to investigate the effects of KIAA1429 on migration and invasion of breast cancer cells. RIP and REMSA assay was performed to explore the direct correlation between KIAA1429 and SMC1A mRNA. ChIP assay combined with luciferase reporter assay were apply to explore the direct binding between SMC1A and SNAIL promotor region.
Results

KIAA1429 could significantly promote the migration and invasion of breast cancer cells. Knockdown of KIAA1429 could impede breast cancer metastasis in nude mice in vivo. The level of SNAIL expression and EMT progress was positively related with KIAA1429. Knockdown of KIAA1429 induced cell migration, invasion and EMT progress could be reversed by the upregulation of SNAIL. However, SMC1A, not KIAA1429 bound with SNAIL promoter region directly and promoted the transcription of SNAIL. Then, KIAA1429 could bind to the motif in the 3′-UTR of SMC1A mRNA directly and enhanced SMC1A mRNA stability.
Conclusions

In conclusion, our study revealed a novel mechanism of the KIAA1429/SMC1A/SNAIL axis in the regulation of invasion and metastasis of breast cancer, which may provide a potential biomarker and therapeutic target for breast cancer. Moreover, it firstly provided compelling evidences that KIAA1429 could regulate the targeted gene expression at posttranscriptional levels as an RNA-binding protein, unrelated the m6A modification.
HSPA2 Expression Predicts Early Postsurgical Relapse and Promotes Tumor Cell Migration and Invasion in Pancreatic Cancer
Authors: Zhai Lu-Lu , Qiao Pei-Pei , Sun Yue-Shen , Tang Zhi-Gang , Ju Tong-Fa
Published: March 2021

Background: Heat shock protein A2 (HSPA2) is known to relate to the pathogenesis and progress of cancer. This study aimed to investigate the connection between HSPA2 and early postsurgical relapse, and the influences of HSPA2 on cell biological behaviors in pancreatic cancer (PC).Methods: Expression of HSPA2 in cancerous and noncancerous samples was determined by bioinformatics and immunostaining methods. The significance of HSPA2 expression in predicting early postsurgical recurrence was assessed. The biological role and potential mechanisms of HSPA2 in PC progression were uncovered by enrichment analysis. HSPA2 expression in human PC cells was detected by immunoblotting. Silencing of HSPA2 in BxPC-3 cells and upregulation of HSPA2 in PANC-1 cells were achieved with siRNA and overexpression plasmid, respectively, and then the impacts of HSPA2 downregulation and upregulation on cancer cell biological behaviors were estimated.Results: HSPA2 expression in tumor specimens was markedly elevated compared with nontumor specimens. HSPA2 overexpression could independently predict early postsurgical recurrence, and combined with malignant clinicopathological characteristics had greater predictive power and potential application value. Enrichment analysis revealed that HSPA2 expression was closely associated with PC progression. HSPA2 was expressed in BxPC-3, PANC-1 and SW1990 cells, with the highest and lowest levels in BxPC-3 and PANC-1 cells, respectively. Cell migration and invasion abilities were remarkably restrained in HSPA2-silenced BxPC-3 cells and significantly enhanced in HSPA2-overexpressed PANC-1 cells.Conclusion: HSPA2 expression predicts early postoperative recurrence and promotes cell migration and invasion, and is expected to become a useful molecular target of antitumor treatment in PC.
COVID-19 Re-infection or Relapse? A Retrospective Multi Center Cohort Study From Iran
Authors: Salehi Mohamadreza , SeyedAlinaghi SeyedAhmad , Darazam Ilad Alavi , Tabarsi Payam , Rabiei Mohammad Mahdi , Hatami Firouze , Ghadimi Somayeh , Koochak Hamid Emadi , Veisi Parastoo , Ghiasvand Fereshte , Asadollahi-Amin Ali
Published: March 2021

BackgroundMore than one year of emerging COVID 19 infection, no signs of the pandemic remission appear. Returning of symptomatic patients who had a history of recovered COVID-19 disease with a new positive SARS Cov-2 PCR test after several weeks to months of a negative PCR result is one of the novels challenging phenomena during the pandemic. In this study, we determined the clinical and laboratory characteristics of these Iranian patients and discussed possible reasons.METHODWe retrospectively investigated the SARS Cov-2 PCR tests performed in the three referral hospitals six months after the pandemic onset. All patients who had the following criteria were included in the study: two SARS COV2 PCR positive tests three months apart, have no symptoms, and a negative PCR between the two positive tests, access to the patient and his medical information. Then, retrospectively recorded the clinical and laboratory characteristics of the eligible patients. We also compare clinical and laboratory features of the second episode to the first.RESULTA total of 32,567 tests were performed, of which 1899 patients. Finally, 37 cases were eligible in the study based on our criteria. The majority of patients were male and nurses. The mean body mass index was 25.84±3.25. The mean age was 37.54 ±15.16 years old. Weakness, myalgia, and fever were the most clinical presentation symptoms in both episodes. Chest Computed Tomography (CT) scan showed pneumonia in 56.8% and 43.2% of cases in the first and second episodes, respectively. The mean duration between the discharge and second presentation was 117±61.42 days. Seven (18.9%) patients hospitalized in the second episode compared to 2 (5.4%) cases in the first. The clinical, radiological, and laboratory characteristics were not significantly different between the two episodes except for significantly more dexamethasone usage in the second one (p= 0.03).CONCLSIONAlthough we could not perform the phylogenic sequencing of SARS-CoV-2 and viral culture in the re-presenting symptomatic patients with positive RT-PCR, prolonged duration between two episodes suggest probably reinfection in our cases. Finally, this clinical phenomenon may be more common in healthcare providers without a significant consequence.
Truly-Optimized PWR Lattice for Innovative Soluble-Boron-Free Small Modular Reactor
Authors: Nguyen Xuan Ha , Jang Seongdong , Kim Yonghee
Published: March 2021

A novel re-optimization of fuel assembly (FA) and new innovative burnable absorber (BA) concepts are investigated in this paper to pursue a high-performance soluble-boron-free (SBF) small modular reactor (SMR), named autonomous transportable on-demand reactor module (ATOM). A truly optimized PWR (TOP) lattice concept has been introduced to maximize the neutron economy while enhancing the inherent safety of an SBF pressurized water reactor. For an SBF SMR design, the 3-D centrally-shielded BA (CSBA) design is utilized and another innovative 3-D BA called disk-type BA (DiBA) is proposed in this study. Both CSBA and DiBA designs are investigated in terms of material, spatial self-shielding effects, and thermo-mechanical properties. A low-leakage two-batch fuel management is optimized for both conventional and TOP-based SBF ATOM cores. A combination of CSBA and DiBA is introduced to achieve a very small reactivity swing (<1,000 pcm) as well as a long cycle length and high fuel burnup. For the SBF ATOM core, safety parameters are evaluated and the moderator temperature coefficient is shown to remain sufficiently and similarly negative throughout the whole cycle. It is demonstrated that the small excess reactivity can be well managed by mechanical shim rods with a marginal increase in the local power peaking, and a cold-zero shutdown is possible with a pseudo checker-board control rod pattern. In addition, a thermal-hydraulic-coupled neutronic analysis of the ATOM core is discussed.