bluuebunny/crossref_metadata_2025 huggingface dataset:
Gender Discrimination as a Barrier to High-Quality Maternal and Newborn Health Care in Nigeria: Findings From a Cross-Sectional Quality of Care Assessment
Authors: Oduenyi Chioma , Banerjee Joya , Adetiloye Oniyire , Rawlins Barbara , Okoli Ugo , Orji Bright , Ugwa Emmanuel , Ishola Gbenga , Betron Myra
Published: September 2020

BackgroundPoor reproductive, maternal, newborn, child, and adolescent health outcomes in Nigeria can be attributed to several factors, not limited to low health service coverage, a lack of quality care, and gender inequity. Providers’ gender-discriminatory attitudes, and men’s limited positive involvement correlate with poor utilization and quality of services.MethodsWe conducted a cross-sectional, observational, baseline quality of care assessment from April-July 2016 to inform a maternal and newborn health project in health facilities in Ebonyi and Kogi States. We observed 435 antenatal care consultations and 47 births, and interviewed 138 providers about their knowledge, training, experiences, working conditions, gender-sensitive and respectful care, and workplace gender dynamics. The United States Agency for International Development’s Gender Analysis Framework was used to analyze findings.ResultsSixty percent of providers disagreed that a woman could choose a family planning method without a male partner’s involvement, and 23.2% of providers disagreed that unmarried clients should use family planning. Ninety-eight percent believed men should participate in health services, yet only 10% encouraged women to bring their partners. Harmful practices were observed in 59.6% of deliveries and disrespectful or abusive practices were observed in 34.0%. No providers offered clients information, services, or referrals for gender-based violence. Sixty-seven percent reported observing or hearing of an incident of violence against clients, and 7.9% of providers experienced violence in the workplace themselves. Over 78% of providers received no training on gender, gender-based violence, or human rights in the past three years.ConclusionAddressing gender inequalities that limit women’s access, choice, agency, and autonomy in health services as a quality of care issue is critical to reducing poor health outcomes in Nigeria. Inherent gender discrimination in health service delivery reinforces the critical need for gender analysis, gender responsive approaches, values clarification, and capacity building.
Technical Potential of Biogas Technology Adoption in Replacing Firewood, Kerosene and Chemical Fertilizer: The Case of Misrak and Mirab Estie Districts, in Northern Ethiopia
Authors: Fentie Haile , Sime Getachew
Published: September 2020

Background: The depletion of bioenergy sources has caused significant deforestation, low agricultural production and energy crisis. This study evaluates the technical potential of biogas technology adoption in replacing firewood, charcoal, kerosene and chemical fertilizer in Northern Ethiopia. Methods: Questionnaire household survey, key informant interview, focus group discussion and field obervation were used for data collection. Results: Biogas technology adoption reduced the use of firewood, charcoal, dung cake, and kerosene consumption by 58%, 36%, 71%, and 74%, respectively. It also reduced the use of chemical fertilizer by 94% and the combined use of chemical fertilizer and manure by 91%. Adoption turned the majority of households (65.4%) to use combination of bio-slurry and chemical fertilizer. It helped the majority (89.95%) of adopters to construct and connect toilets to biogas operational system. In doing so, adoption reduced defecation in the field and improved environmental sanitation and human health. It further enabled saving of about 38% of adopters’ time, which otherwise would be expended for firewood and dung collection. It similarly enhanced adopters’ income through decreasing expenses for chemical fertilizer, kerosene, and other fuel sources. Conclusions: Biogas technology has huge potential of replacing traditional fuel sources for domestic consumption, and of reducing the consumption of kerosene and chemical fertilizers as well as of increasing income and decreasing time for biofuel collection.
Is Serum Vasohibin 1 Level Associated With the Development of Nephropathy in Diabetic Patients?
Authors: Sezal Didem Tutuncu , Seyithanoglu Muhammed , Sahin Murat , Ozturk Ilyas , Senel Mahmut Egemen , Erken Ertugrul , Gungor Ozkan , Altunoren Orcun
Published: September 2020

Background: Glomerular filtration surface area and glomerular filtration rate (GFR) are increased in patients with diabetic nephropathy, especially in the early phase of the disease. Glomerular neoangiogenesis contributes to this increased GFR. Increased GFR is associated with glomerular neoangiogenesis. Vasohibin-1 is an inhibitor of neoangiogenesis. The aim of this study is to evaluate serum vasohibin-1 levels of diabetic patients with and without diabetic nephropathy (DN). Methods: One hundred and five diabetic patients and 39 healthy controls matched for age and gender were included in the study. Diabetic patients with eGFR<60 ml/min/1,73m2 and/or those who had persistent proteinuria (>200 mg/gr) measured by urine protein/creatinine ratio (UP/C) were diagnosed as overt diabetic nephropathy (DN) if they haven’t any other known kidney diseases. Serum vasohibin-1 levels were measured by ELISA. Serum creatinine, eGFR, UP/C and vasohibin-1 levels were recorded.Results: Thirty-four percent of diabetic patients had DN. Systolic blood pressure and UP/C were higher in diabetic patients than healthy controls and age, sex, eGFR were similar. Diabetic patients have nonsignificantly lower serum vasohibin-1 levels than healthy controls. Patients with DN had higher UP/C, lower eGFR and long-standing diabetes compared to diabetic patients without nephropathy. Serum vasohibin-1 levels were similar between diabetic patients with and without DN. There was no correlation between vasohibin-1 levels and eGFR or UP/C.Conclusions: In this study for the first time we showed that diabetic patients have slightly lower vasohibin-1 levels than healthy subjects but there was no difference between diabetic patients with and without nephropathy in terms of serum vasohibin levels. Because, vasohibin-1 exhibits its anti-angiogenetic properties by acting via autocrine-paracrine pathways; local vasohibin activity at the tissue level may be more important than the circulating levels.
The Association of Clinical Characteristics With Cytogenetic Testing in Miscarriage Tissues: A Retrospective Review
Authors: Feng Chun , Yang Yan , Tao Xiao-Ling , Du Xin , Duan Jie
Published: September 2020

Background It is known little about to what extent the cytogenetic abnormalities association with clinical factors including maternal age, history of miscarriage, fertilization way and ultrasonographic finding in miscarriage tissues. A comprehensive investigation had informed to reveal the relevance of the profiles of these clinical factors of miscarriage with chromosomal abnormalities and propose feasible recommendations. Methods 478 cases of miscarriage tissue were performed by chromosomal microarray analysis between January 1, 2019, and December 31, 2019, the collected clinical data and the genetic findings were assessed using chi-squared analysis. Results 261 cases (54.7%) were identified as chromosomal abnormalities. Trisomy took place more frequency in advanced age of pregnancy women (p＜0.05), and it was closely related to the history of miscarriage. trisomy 16 (24.1%) was predominant in the ＜35 years group, whereas trisomy 15 (25.0%) was significantly more frequent in ≥35 years group. Trisomy 16, 15 and 13 were significantly more frequent in the first miscarriage, the second miscarriage and more than two times miscarriage, respectively. The positive rate in more than two times miscarriage in＜35 years group and ≥35 years group was 40.9% and 87.5%, respectively. More than two times miscarriages in ＜35 years was significantly difference with ≥35 years (P=0.02). Conclusion It is necessary to perform cytogenetic analysis to the miscarriage cases which are considered about the maternal age combined with history of miscarriage.
Design of a Motion Simulation System to Assist Respiratory Gating for Radiation Therapy
Authors: Wu Jian-Kuen , Chen Shih-Han , Hsu Feng-Ming , Liao Shu-Hsien , Wang Yu Jen
Published: September 2020

Background
Stereotactic ablative radiotherapy (SABR) aims to deliver high doses of radiation to kill cancer cells and shrink tumors in less than or equal to 6 fractions. However, organ motion during treatment is a challenging issue for this kind of technique. We develop a control system via Bluetooth technology to simulate and correct body motion during SABR.
Methods
Radiation doses were analyzed, and the radiation damage protection capability was checked by external beam therapy 3 (EBT3) films irradiated by a linear accelerator. A wireless signal test was also performed. A validation was performed with 8 previously treated patient respiratory pattern records and 8 healthy volunteers.
Results
The homemade simulation system consisted of 2 linear actuators, one movable stage with a maximal moving distance of 6.5 cm x 12.5 cm x 5 cm to simulate the respiratory pattern of 8 patients precisely with a median error of 0.36 mm and a maximal motion difference of 1.17 mm, and 3.17 and chipset transited signals to display them as a waveform. From the test with 8 volunteers, the chip could detect deep respiratory movement up to 3 cm. The effect of the chip on a radiation dose of 400 monitor units (MUs) by 6 MV photons and 200 MUs by 10 MV photons showed high penetration rates of 98.8% and 98.6%, respectively.
Conclusions
We invented a tubeless and wireless respiratory gating detection chip. The chip has minimal interference with the treatment angles, good noise immunity and the capability to easily penetrate a variety of materials. The simulation system consisting of linear actuators also successfully simulates the respiratory pattern of real patients.
Postoperative mortality among surgical patients with COVID-19: A systematic review and meta-analysis
Authors: Abate semagn , Mantefardo Bahiru , Basu Bivash
Published: September 2020

Background: The coronavirus disease 2019 (COVID-19) pandemic puts perioperative providers and staff at risk of viral exposure to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) during aerosol-generating procedures, particularly in asymptomatic carriers. However, the perioperative risk for adverse outcomes in SARS-CoV-2 infected patients remain uncertain and the topic of debate. The current study was designed to determine the postoperative mortality in COVID-19 patients based on a systematic review and meta-analysis of the global published peer-reviewed literature.Methods: A comprehensive search was conducted in PubMed/Medline; Science direct and LILACS from December 29, 2019, to August15, 2020, without language restriction. All observational studies reporting the prevalence of mortality were included while case reports and reviews were excluded. The data from each study were extracted with two independent authors with a customized format excel sheet and the disagreements were resolved by the third author. The methodological quality of included studies was evaluated using a standardized critical appraisal Tool adapted from the Joanna Briggs Institute.Results: A total of 715 articles were identified from different databases and 45 articles were selected for evaluation after the successive screening. Twenty-three articles with 2947 participants were included. The meta-analysis revealed a very high global rate of postoperative mortality among COVID-19 patients of 20% (95% CI: 15 to 26) and a postoperative ICU admission rate of 15% (95% confidence interval (CI):10 to 21). Conclusion: The unexpected high postoperative mortality rate in SARS-CoV-2 infected patients of 20% in the global literature mandates further scrutiny in assuring appropriate surgical indications and perioperative surgical safety measures in this vulnerable cohort of patientsRegistration: This systematic review and meta-analysis was registered in Prospero's international prospective register of systematic reviews (CRD42020203362) on August 10, 2020.
Weighted Gene Co-Expression Network Analysis to Construct Competitive Endogenous RNAs Network in Chromogenic Renal Cell Carcinoma
Authors: Chen Yon-Bo , Gao Liang , Tang Liang-You , Tian Yu-Chang , Tian Guan-Qiang , You PingHong
Published: September 2020

Background: This study aimed to construct the competing endogenous RNA (ceRNA) network in chromophobe renal cell carcinoma (ChRCC). Methods: Clinical and RNA sequence profiles of patients with ChRCC, including messenger RNAs (mRNAs), microRNAs (miRNAs), and long noncoding RNAs (lncRNAs), were obtained from The Cancer Genome Atlas (TCGA) database. “EdgeR” and “clusterProfiler” packages were utilized to obtain the expression matrices of differential RNAs (DERNAs) and to conduct gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses. Weighted gene co-expression network analysis (WGCNA) was performed to screen the highly related RNAs, and miRcode, StarBase, miRTarBase, miRDB, and TargetScan datasets were used to predict the connections between them. Univariate and multivariate Cox proportional hazards regressions were performed in turn to elucidate prognosis-related mRNAs in order to construct the ceRNA regulatory network. Results: A total of 1628 DElncRNAs, 104 DEmiRNAs, and 2619 DEmRNAs were identified. WGCNA showed significant correlation in 1534 DElncRNAs, 98 DEmiRNAs, and 2543 DEmRNAs, which were related to ChRCC. Fourteen DEmiRNAs, 113 DElncRNAs, and 43 DEmRNAs were screened. Nine mRNAs (ALPL, ARHGAP29, CADM2, KIT, KLRD1, MYBL1, PSD3, SFRP1, SLC7A11) significantly contributed to the overall survival (OS) of patients with ChRCC (P < 0.05). Furthermore, two mRNAs (CADM2, SFRP1) appeared to be independent risk factors for ChRCC. Conclusion: The findings revealed the molecular mechanism of ChRCC and potential therapeutic targets for the disease.
How FDI attracted? A Configurational Analysis for Regional Competitiveness in Mechanism of FDI Entry and Exit: Evidence from China
Authors: Zheng Yi
Published: September 2020

The economic benefits and spillover effects from FDI could lead accelerating the innovation of local economy and technological concept, which make it welcome in underdeveloped countries' authorities. This paper focuses on the entry and exit mechanism of FDI in 31 provinces of China from 2001 to 2016. The optimized diamond model associated with multi-theoretical cooperation is adopted to set up the regional competitiveness configuration for attracting FDI. It revealed that FDI attempts to enter regions with certain economic basis and favorable government conditions; but if the market fluctuates, even if there are favorable policy conditions, FDI will restructure because of their profit-seeking. Based on the conclusions, local governments can use the minimum resources to attract FDI in appropriate circumstances, and can optimize policies in time when it is not suitable for the entry and maintenance of FDI, so as to focus on develop local markets.
Sexual Assault Magnitude, Complications and Associated Factors among Females Who Visited Gynecologic Outpatient Department of Hawassa University Comprehensive Specialized Hospital
Authors: Ayele Abebaw Nigussie , Workneh Gelagay Zewudie , Gelaw Misganaw Worku
Published: September 2020

Background

Sexual assault is a major form of sexual violence affecting one out of every five women in the world. It is a complex problem with many consequences including sexually transmitted infections, posttraumatic stress disorder and risk of unintended pregnancy in reproductive-aged survivors of sexual assault.
Objective

To assess the magnitude, complication and factors associated with sexual assault among female visited gynecologic outpatient department of Hawassa University Comprehensive Specialized Hospital.
Methods

Cross sectional study was conducted from January 1 to October 30, 2019. Self-administered questionnaire developed using variables taken from WHO multi-country study on women health and from sexual violence medical evaluation certificate format were used to collect data. Descriptive analysis was done on sexual assault related characteristics and binary and multivariate logistic regression analysis were done to identify factors associated with sexual assault.
Results

399 clients were participated in the study and prevalence of sexual assault was 10.8% (43) of which 79.1% (34) of the victims were under the age of 18 years. 25% of the victims tested for pregnancy were positive and 7% (3) of each were positive for Hepatitis B and Trichomonas vaginalis. Age less than 18 years [AOR = 95.9, 95%CI (17.93, 512.96)], being single [AOR = 9.2, 95% CI (2.11, 40.42)], being in primary school [AOR = 18.0, 95% CI (1.63, 199.19)] and monthly income of < 1500 birr [AOR = 6.7, 95% CI (1.54, 29.50)] were significantly associated with sexual assault.
Conclusions

In this study, Age, marital status, monthly income and educational level were significantly associated with sexual assault.
Thoracoscopic Resection of Bilateral Multiple Superior Mediastinal Neurofibromas
Authors: Azuma Yoko , Tochigi Naobumi , Sano Atsushi , Sakai Takashi , Koezuka Satoshi , Otsuka Hajime , Iyoda Akira
Published: September 2020

Background: The indications for surgical resection concerning multiple bilateral neurofibromas in the superior mediastinum remain controversial, because vascular injury or development of postoperative Horne syndrome are concerned.Case presentation: A 60-year-old woman presented with multiple nodules in her right neck and bilateral chest cavity tops which indicated neurofibromatosis. The thoracic masses grew slowly over 9 years, and she then underwent a 2-stage resection starting with the left to right side. Bilateral tumors were completely removed via video-assisted thoracic surgery. The patient’s postoperative course was uneventful, without postoperative Horner syndrome. Conclusions: To the best of our knowledge, this is the first case of multiple bilateral superior mediastinal neurofibromas resected from the pulmonary apices via thoracoscopy. We selected a minimally invasive pure video-assisted thoracoscopic surgery approach and enucleated some tumors to avoid nerve injury. This approach may be safe and useful for multiple neurofibromas in patients with neurofibromatosis.
A New Method for Conservation of Ancient Colored Drawing on Hemp Textiles
Authors: Liu Jiaojiao , Li Yuhu , Xing Huiping , Hu Daodao , Chao Xiaolian , Cao Jing , Jia Zhihui
Published: September 2020

As a kind of textile, hemp artifact is a valuable cultural heritage. Suffering from several degradation factors in the preservation of cultural relics, some ancient hemp colored-paintings have been damaged, further affected their ornamental values. Therefore, it is urged to take the suitable conservation measures to protect the precious hemp artifacts for the historical culture succession. In this paper, an examination and analysis of the hemp colored paintings were the first step to propose an appropriate conservation treatment. Ultra-depth-of-field microscope was used to identify the kinds of fiber, and scanning electron microscope (SEM) was utilized to observe their condition and surface morphology. The element distribution and composition were identified by SEM, energy disperse spectroscopy (EDS) and X-ray fluorescence spectroscopy (XRF). Gas chromatography-mass spectrometer (GC-MS) was applied to identify the kinds of binding media and amino acid composition. Moreover, novel reinforcement materials and technology were proposed with the principle of compatibility and feasibility. The properties of tensile strength, aging resistance and chromatic aberration were tested before and after dry heat aging, wet heat aging and UV light aging. After systematic examination and evaluation of the hemp colored paintings and reinforcement materials, the optimal conservation treatment was finally established, and the Chinese hemp painting as an example has been protected successfully. This paper provides new methods and ideas for the restoration and protection of the linen cultural relics, which would promote the progress of protecting valuable cultural heritages.
Circulating Omentin-1, Insulin Resistance and Lipid Profile Responses Following 8-weeks Aerobic Training Intervention Among Smokers Vs. Non-smokers
Authors: Mousavi Seyed Maysam , Heidarianpour Ali , Tavassoli Hassan
Published: September 2020

Background: Omentin-1 is a recently circulating adipokine that plays a crucial role in modulating insulin resistance and diabetes. We investigated the effect of eight weeks aerobic exercise training on serum omentin-1, insulin resistance and lipid profile in the smoker and non-smokers with normal-weight. Methods: Nineteen healthy men and twenty smoker men were randomly assigned into healthy control group (C), healthy exercise group (E), control smoker group (CS) and exercise smoker group (ES). Exercise groups participated in an 8-weeks aerobic exercise training program (three times a week, 45 min per session at 65%-80% of maximum heart rate). Serum omentin-1 and insulin values were determined by ELISA and HOMA-IR, glucose and lipid profile were measured at pre and post of the intervention. Paired Sample t-test, one-way analysis of variance (One-way ANOVA) and post-hoc Tukey test were applied to analyze the data (p<0.05).Results: Aerobic exercise improved both serum omentin-1 and high lipoprotein cholesterol (HDL-C) in the exercise groups (p<0.05). Also, Exercise training reduced insulin, blood sugar, HOMA-IR, total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) levels (p<0.05). Omentin-1 were significantly associated with insulin (r=-0.40, P=0.01), HOMA-IR (r=-0.38, P=0.04), TG (r=-0.40, P=0.01), TC (r=-0.49, P=0.02), LDL-C (r=-0.70, P=0.02) and HDL-C (r=0.55, P=0.03).Conclusion: The findings suggest that aerobic exercise-induced changes in omentin-1 in exercise trained smokers may be associated with the beneficial effects of exercise on reduced insulin and lipid profile.
Development and Validation of an Immune-Related Gene-Pair Model of High-Grade Serous Ovarian Cancer After Platinum-Based Chemotherapy
Authors: Lin Jiaxing , Sun Dan , Li Tianren
Published: September 2020

Background: High-grade serous ovarian cancer (HGSOC) is a common cause of death from gynecological cancer, with an overall survival rate that has not significantly improved in decades. Reliable bio-markers are needed to identify high-risk HGSOC to assist in the selection and development of treatment options.Method: The study included ten HGSOC cohorts, which were merged into four separate cohorts including a total of 1526 samples. We used the relative expression of immune genes to construct the gene-pair matrix, and the Least absolute shrinkage and selection operator regression was performed to build the prognosis model using the training set. The prognosis of the model was verified in the training set (363 cases) and three validation sets (of 251, 354, and 558 cases). Finally, the differences in immune cell infiltration and gene enrichment pathways between high and low score groups were identified.Results: A prognosis model of HGSOC overall survival rate was constructed in the training set, and included data for 35 immune gene-related gene pairs and the regression coefficients. The risk stratification of HGSOC patients was successfully performed using the training set, with a p-value of Kaplan-Meier of < 0.001. A score from this model is an independent prognostic factor of HGSOC, and prognosis was evaluated in different clinical subgroups. This model was also successful for the other three validation sets, and the results of Kaplan-Meier analysis were statistically significant. The model can also predict patient progression-free survival with HGSOC to reflect tumor growth status. There were differences in some immune cells between the high-risk and low-risk groups as defined by the model. There was a lower infiltration level of M1 macrophages in the high-risk group compared to that in the low-risk group (p < 0.001). Finally, many of the immune-related pathways were enriched in the low-risk group, with antigen processing and presentation identified as the most enriched pathways.Conclusion: The prognostic model based on immune-related gene pairs developed is a potential prognostic marker for high-grade serous ovarian cancer treated with platinum. The model has robust prognostic ability and wide applicability. More prospective studies will be needed to assess the practical application of this model for precision therapy.
Long Non-Coding RNA-DUXAP8 Regulates TOP2A in the Growth and Metastasis of Osteosarcoma via MicroRNA-635
Authors: Yang Ting , Quo Jian Ping , Li Fan , Xiu Chao , Wang Hua , Duan Xian Liang
Published: September 2020

Purpose: Osteosarcoma (OS) is a malignant tumor disease with high morbidity and mortality in children and adolescents. Evidence indicates that long non-coding RNAs (lncRNAs) may be important players in human cancer progression, including OS. In this study, we identified the role of lnc-DUXAP8 in the development of OS.Materials and Methods: Expression of lncRNA DUXAP8 was determined by real-time quantitative PCR and Western blotting in OS tissues. Cell proliferation was evaluated using CCK8 and colony formation assay; Transwell assay was conducted to measure cell invasion. Cell migration was evaluated using Wound Healing assay. The binding site between the lnc-DUXAP8 and miR-635 RNAs was evaluated using a luciferase reporter assay. Results: The expression of the lnc-DUXAP8 was significantly upregulated in OS samples and OS cell lines compared to normal tissue. High expression of lncRNA DUXAP8 was associated with shorter overall survival. Knockdown of lncRNA DUXAP8 inhibited proliferation and migration, and invasion in OS cells. More importantly, mechanism investigation revealed that lncRNA DUXAP8 was predominantly acted as a competing endogenous RNA (ceRNA) in OS by regulating miR-635/ TOP2A axis. Conclusion: LncRNA DUXAP8 is upregulated in OS, and LncRNA DUXAP8 knockdown plays a vital anti-tumor role in OS cell progression through a miR-635/ TOP2A axis. Our study suggests that LncRNA DUXAP8 may be a novel, promising biomarker for diagnosis and prognosis of OS.
Critical Illness Polyneuropathy and Myopathy in COVID-19 Patients: A Prospective Observational Intensive Care Unit Cross-Sectional Cohort Study
Authors: Frithiof Robert , Rostami Elham , Kumlien Eva , Virhammar Johan , Fällmar David , Hultström Michael , Lipcsey Miklós , Ashton Nicholas , Blennow Kaj , Zetterberg Henrik , Punga Anna Rostedt
Published: September 2020

Background: Several reports on neurological complications associated with SARS-CoV-2 infection have been published. However, systematic description on intensive care unit acquired weakness (ICUAW) are still missing. Methods: The objective was to determine the incidence and characteristics of critical illness polyneuropathy (CIN) and myopathy (CIM) in patients with severe COVID-19. We also aimed to describe the electrophysiological features and their relation to plasma biomarkers for neuronal injury. This was a prospective observational intensive care unit cohort study. All adult patients admitted to the general intensive care unit (ICU) at Uppsala University Hospital, Uppsala, Sweden, between March 13 and June 8, 2020 were screened for inclusion. Patients with PCR confirmed COVID-19 were included. All patients were admitted to intensive care treatment due to severe COVID-19, including intravenous anaesthesia, opioid anaelgesia, neuromuscular blockade and mechanical ventilation. Associations of clinical, electrophysiological (sensory and motor conduction studies and electromyography) and biomarker data [neurofilament light chain (NfL), glial fibrillary acidic protein (GFAp) and tau] were studied between COVID-19 patients who developed CIN/CIM and those who did not. Results: 111 COVID-19 patients were included, 11 (11 males, mean age: 64 years) developed CIN/CIM whereas 100 (74 males, mean age: 61 years) did not (non-CIN/CIM). The CIN/CIM incidence was higher in COVID-19 patients compared to a general ICU-population treated during 2019 (9.9% vs 3.4%). In particular CIN was more frequent in the COVID-19 ICU cohort (50%) compared with the non-COVID-19 ICU cohort (0%, p=0.008). NfL and GFAp levels were higher in the CIN/CIM group both at the early (<9 days) and late time points (>11 days) compared with the non-CIN/CIM group (both p=0.001) and correlated with nerve amplitudes. Conclusions: CIN/CIM, in particular CIN, were more prevalent among COVID-19 patients than an ICU treated control cohort and should be considered in the differential diagnostic workup and the further rehabilitation of COVID-19 patients. COVID-19 patients who later developed ICUAW had significantly higher NfL and GFAp in the early phase of ICU care, which suggests their potential as predictive biomarkers. Trial registration: The study protocol was registered (ClinicalTrialsID:NCT04316884). Mechanisms for Organ Dysfunction in Covid-19 (UMODCOVID19) March 18, 2020.
Design of the Pilot, Proof of Concept REMOTE-COVID Trial: Remote Monitoring Use in Suspected Cases of COVID-19 (SARS-CoV 2) A Trial Protocol
Authors: Iqbal Fahad Mujtaba , Joshi Meera , Davies Gary , Khan Sadia , Ashrafian Hutan , Darzi Ara
Published: September 2020

BackgroundThe outbreak of SARS-CoV-2 (coronavirus, COVID-19), declared a pandemic by the World Health Organisation (WHO) is global health problem with ever-increasing attributed deaths. Vital sign trends are routinely used to monitor patients with changes in these parameters often preceding an adverse event. Wearable sensors can measure vital signs continuously (e.g. heart rate, respiratory rate, temperature) remotely and can be utilised to recognise early clinical deterioration. MethodsWe describe the protocol for a pilot, proof-of-concept, observational study to be conducted in an engineered hotel near London airports, United Kingdom. The study is set to continue for the duration of the pandemic. Individuals arriving to London with mild symptoms suggestive of COVID-19 or returning from high risk areas requiring quarantine, as recommended by Public Health England, or healthcare professionals with symptoms suggestive of COVID-19 unable to isolate at home will be eligible for a wearable patch to be applied for the duration of their stay. Notifications will be generated should deterioration be detected through the sensor and displayed on a central monitoring hub viewed by nursing staff, allowing for trend deterioration to be noted. The primary objective is to determine the feasibility of remote monitoring systems in detecting clinical deterioration for quarantined individuals in a hotel. DiscussionThis trial should prove the feasibility of a rapidly implemented model of healthcare delivery through remote monitoring during a global pandemic at a hotel, acting as an extension to a healthcare trust. Potential benefits would include reducing infection risk of COVID-19 to healthcare staff, with earlier recognition of clinical deterioration through ambulatory, continuous, remote monitoring using a discrete wearable sensor. We hope our results can power future, robust future randomised trials.Trial registrationClinicalTrials.gov Identifier: NCT04337489
Successes, Challenges and Opportunities Towards Universal Health Coverage for Maternal and Child Health in South East Asian Countries: A Systematic Review
Authors: perera Upuli Amaranganie Pushpakumari , Gilks Charles , Alemu Yibeltal
Published: September 2020

Background: Sustainable Development Goal 3 (SDG-3) aims to ensure healthy lives and promote wellbeing for all. Universal Health Coverage (UHC) assures delivering health services to all who need without suffering from financial hardships. This paper aims to identify the successes, challenges and opportunities towards achieving UHC for maternal and childcare in countries in the World Health Organization, South East Asian Region (SEAR). Methods: We conducted a systematic review of the literature. We searched PubMed, Embase, Scopus, CINAHL, PsycINFO, WHO research portal and Google scholar for studies published in English from 2010 to 2020. We included studies conducted in maternal and childcare focusing on challenges, opportunities or successes towards UHC in countries in SEAR. Data was synthesized and presented as a narrative description, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.Results: We identified 62 studies with different study designs from eight SEAR countries , majority were from India. We observed successes or opportunities in access and quality in MCH with government cash transfer schemes and private sector contribution in India, Bangladesh and Indonesia. Politically prioritized MCH care was identified as an opportunity in a state of India. Inadequate healthcare infrastructure including trained human resources, medical products and other supplies were identified as the main challenges in the region. Facilities are overcrowded in Bangladesh and Indonesia. From provider perspective, health care workers’ knowledge and skills as well as attitudes and behaviors were also identified as issues in the region. Lack of health literacy, misconceptions and cultural barriers are identified as challenges from clients’ side. Difficulties in geographical distribution and transport were contributing to poor healthcare access in four countries. Deficiencies in government policies and administration were identified in some fields. Poverty was detected as an overarching barrier.Conclusions: SEAR countries have demonstrated improvements in access, quality and equity on MCH towards UHC. There are, however, challenges related to human and other resources, health care facilities and socio-economic determinants of health. Regional bodies as well as authorities in individual countries should work on these issues to address challenges to achieve UHC.Registration: PROSPERO: CRD42020166404
Identiﬁcation and Validation of Two Prognostic Autophagy-related Models in Clear Cell Renal Cell Carcinoma
Authors: Sun Xiong-Lin , Zhu Jun-Ming , Lin Fei , Ke Zhi-Bin , Li Xiao-Dong , Cai Hai , Huang Fei , Xue Xue-Yi , Zheng Qing-Shui , Chen Shao-Hao , Xu Ning
Published: September 2020

Background: Clear cell renal cell carcinoma (ccRCC) is one of the most frequent malignancies. Increasing evidence has highlighted the critical roles of autophagy-related genes and autophagy-related long non-coding RNA (lncRNA) in ccRCC development and progression. Therefore, it is necessary to identify novel biomarkers associated with autophagy in ccRCC.Methods: A total of 507 ccRCC patients were included in our study and then randomly divided into a training cohort (n=255) and testing cohort (n=252). Univariate Cox regression models, Lasso regression analyses and multivariate Cox regression models were successively used for constructing gene model and lncRNA model. Receiver-operating characteristic (ROC) curve analysis, Kaplan-Meier (K-M) analysis and more functional analyses were applied for verifying the accuracy of the two models.Results: The autophagy-related genes (ARGs) prognostic model was constructed based on the six ARGs (EIF4EBP1, IFNG, BID, BIRC5, CX3CL1 and RAB24) and five autophagy-related lncRNAs (AC093278.2, AC010326.3, AC099850.3, AC016773.1 and AC009549.1) and then ccRCC patients were significantly stratified into high- and low-risk groups in terms of overall survival (OS). K-M survival analyses indicated that low-risk group had a lower mortality rate than high-risk group in the six-gene prognostic risk model (training cohort: P=4.138e-07; testing cohort: P=1.125e-03) and the same results were obtained in the case of the five-lncRNA prognostic risk model (training cohort: P=4.564e-09; testing cohort: P=2.485e-03). The results of time-dependent ROC curves revealed six-gene prognostic risk model had a higher area under curve (AUC) of 0.765 than the five-lncRNA prognostic risk model at an AUC of 0.759. Therefore, the gene model is an indicator as good as the model constructed by lncRNAs. In addition, further functional analysis indicated these genes were functionally involved in regulation of endopeptidase activity, regulation of peptidase activity, autophagy, human cytomegalovirus infection, shigellosis, autophagy-animal and HIF-1 signaling pathway.Conclusions: A total of six OS-related ARGs and five autophagy-related lncRNA were identified in our current study. The two autophagy-related prediction models including genes and lncRNAs are reliable prognostic and predictive biomarkers for ccRCC.
An Evaluation of the Patient Clinical Complexity Level (PCCL) Method for the Complexity Adjustment in the Korean Diagnosis-Related Groups (KDRG)
Authors: Kim Sujeong , Choi Byoongyong , Lee Kyunghee , Lee Sangmin , Kim Sukil
Published: September 2020

ObjectiveTo evaluate the performance of the Patient Clinical Complexity Level (PCCL) mechanism, which is the patient level complexity adjustment factor within the Korean Diagnosis-Related Groups (KDRG) patient classification system, for explaining the variation of resource consumption within Age Adjacent Diagnosis-related groups (AADRGs).MethodsWe used the inpatient claims data from a public hospital in Korea from January 1, 2017 to June 30, 2019, with 18,846 claims and 138 Age Adjacent Diagnosis-related groups (AADRGs). The differences in the total average payment between the four PCCL levels for each AADRG was tested using ANOVA and Duncan’s post-hoc test. The three patterns of the differences with R-squared were: the PCCL reflected the complexity well (Valid); the average payment of PCCL 2, 3, 4 was greater than PCCL 0 (Partially Valid); the PCCL did not reflect the complexity (Not Valid).ResultsThere were 9 (6.52%), 26 (18.84%), and 103 (74.64%) ADRGs included in VALID, PARTIALLY VALID and NOT VALID, respectively. The average R-squared in VALID, PARTIALLY VALID, and NOT VALID was 32.18%, 40.81%, and 35.41% respectively, with the average R-squared for all patterns of 36.21%.ConclusionsAdjusting using PCCL in the KDRG classification system exhibited low performance to explain the variation of resource consumption within Age Adjacent Diagnosis-related groups (AADRGs). As the KDRG classification system is used for reimbursement under the New DRG-based PPS pilot project with plans for expansion, there should be an overall review of the validity of the complexity and rationality of using the KDRG classification system.
Thromboprophylaxis, Delta Sofa and Main Outcomes in Ventilated Patients: an Analysis of the MIMIC-III Clinical Database
Authors: Bastola Mrigendra Mani , Locatis Craig , Fontelo Paul
Published: September 2020

Introduction: Critical care patients are at higher risk for thromboembolic disorders. There are limited studies regarding the effect of Heparin, Warfarin, Enoxaparin and Aspirin on ventilated patients, who are likely to both benefit from prophylaxis and suffer from adverse effects of blood thinners. Methods: This study analyzed the MIMIC-III clinical database on 4192 ventilated patients using Statistical Analysis Software (SAS, Version 9.4). Relevant data was systematically analyzed on the thromboprophylaxis agents and their effects on major treatment outcomes. Parameters studied were the length of ventilation, length of Intensive Care Unit (ICU) stays, ICU mortality, inpatient mortality, improvement in SOFA score, and occurrence of major thromboembolic events such as pulmonary embolism (PE) and deep venous thrombosis (DVT). Results: Except Aspirin, all thromboprophylactic agents showed statistically significant reduction on ICU mortality. None of the blood thinners showed statistically significant reduction in occurrences of pulmonary embolism and deep venous thrombosis. Heparin, Warfarin and Enoxaparin had adjusted Odds ratios of 0.59(p<0.01, 0.47-0.77), 0.23(p<0.05, 0.1-0.57) and 0.36(P<0.05, 0.16-0.83) for ICU mortality. Heparin, Warfarin and Enoxaparin had adjusted Odds ratios of 0.51(p<0.01, 0.38-0.68), 0.19(p<0.01, 0.06-0.59) and 0.42(P=0.06, 0.17-1.05) for overall ventilated patient hospital mortality, including after transfers to the inpatient ward.. Only Heparin (P<0.05, OR 1.52(1.07-2.15)) was associated with thrombocytopenia, which required platelet transfusion. None of the drugs showed statistically significant relationships with development of thromboembolic events after thromboprophylaxis. Only Heparin had mild effect on improvement in sequential organ failure assessment (delta SOFA) scores at 7 and 10 day after ICU admission (P<0.05, OR 1.17 (1.03-1.32)). Conclusion: Although the results supported the use of thromboprophylaxis in ventilated patients to improve treatment outcomes and decrease thromboembolic events, no benefits were indicated for using newer blood thinners (Enoxaparin) than older ones (Heparin & Warfarin). Heparin is related to both higher episodes of platelets transfusion and improvement of delta SOFA scores at end of first week of ICU admission. If validated by future research, the findings of this study might help practitioners and researchers to better understand thromboprophylaxis in ventilated patients.
Application of 99mTc-3PRGD2 Imaging for Early Prediction of Pathological Response to Neoadjuvant Chemotherapy in Breast Tumors and Axillary Lymph Nodes
Authors: Chen Zhenying , Fu Fangmeng , Lin Junyu , Huang Chao , Zheng Shan , Wang Chuan , Miao Weibing
Published: September 2020

Background and PurposeTechnetium 99m-dimeric cyclic RGD peptides with three polyethylene glycol spacers (99mTc-3PRGD2) had a good performance for diagnosing breast cancer. The prospective study was to assess the performance of 99mTc-3PRGD2 tumor imaging for predicting pathological complete response (pCR) outcomes to neoadjuvant chemotherapy (NAC) in breast cancer patients.Materials and MethodsForty-one patients were examined using both 99mTc-3PRGD2 and 18F-fluoro-deoxy-glucose (18F-FDG) imaging before NAC (baseline), and after the first and fifth NAC cycle. The tumor-to-background (T/B) ratios for 99mTc-3PRGD2 imaging and the maximum standardized uptake values (SUVmax) from the 18F-FDG imaging in breast tumors and axillary lymph node (ALN) metastases were separately calculated and analyzed—based on receiver operating characteristic (ROC) analysis. ResultsFinally, pCR was achieved in 13 of 41 patients after NAC. The area under curve (AUC) of T/B changes (ΔT/B) in breast tumors for predicting pCR after first and fifth cycle were 0.827 and 0.687, and 0.859 and 0.778 in ALN metastases, respectively. For SUVmax changes (ΔSUVmax), the ROC-AUC were 0.859 and 0.713, as well as 0.572 and 0.802, respectively. In breast tumors, the AUCs of ΔT/B1 and ΔSUVmax1 had no significant difference (P > 0.05). However, the AUC of ΔT/B1 was significantly higher than for ΔSUVmax1 in ALN metastases (Z = 2.10, P = 0.035). Additionally, the T/B1 trends for breast tumor and ALN in pCR group were higher than for non-pCR group in HER2-positive patients (P﹤0.05). ConclusionsCompared with 18F-FDG imaging, our study shows that use of 99mTc-3PRGD2 imaging offered a similar level of predictive performance for breast cancer pCR to NAC, and early T/B1 trends of ALN showed an higher performance for predicting pCR.Trial RegistrationClinicalTrials.gov ID: NCT02742168.
Institutional ownership, environmental, social, and governance performance and disclosure – a review on empirical quantitative research
Authors: Velte Patrick
Published: September 2020

Since the financial crisis of 2008–2009, nonfinancial-related shareholder activism increased, as public interest entities (PIEs) should strengthen their environmental, social, and governance (ESG) activities. This study aims to determine whether institutional ownership (IO) impacts ESG performance and disclosure and vice versa. Moreover, IO’s moderating and mediating influence on the relationship between ESG and firms’ financial consequences is included. This is the first literature review focusing on IO and ESG, describing IO as independent, dependent, moderator, and mediator variable. A structured literature review with 81 empirical-quantitative (archival) studies on that topic is presented based on an agency theoretical framework. Regarding the main results, long-term IO leads to increased ESG performance. Moreover, ESG performance promotes the ratio of institutional investors. Other relationships are rather heterogeneous and too low in an amount yet, stressing major research gaps.
ZEB1 as an additional predictor of tumor progression in Ewingʼs sarcoma. Results of a morphological study on a population of children and adolescents
Authors: Kit O. I. , Yurchenko D. Yu. , Ulyanova E. P. , Burtsev D. V. , Kuznetsov S. A. , Sagakyants A. B. , Frantsiyants E. M. , Mkrtchyan G. A. , Pak E. Ye. , Starzhetskaya M. V. , Bespalova A. I. , Popovyan O. P.
Published: September 2020

Relevance. Ewingʼs sarcoma (ES) is a classic representative of the extensive family of ES tumors, which occupies one of the leading positions among the malignant pathology of the musculoskeletal system in children and adolescents. This group is characterized by an extremely large variety of morphological, immunohistochemical, and molecular genetic characters among its representatives. The absence of specific pathognomonic markers for ES, as well as the presence of wide variability of clinical manifestations complicates the differential diagnosis. 

Materials and methods. The study included patients of childhood and adolescence with a localized and generalized form of ES/PNEТ of various localizations undergoing treatment in the conditions of the Department of Pediatric Oncology of the Federal State Budgetary Research Center for Oncology from 2009 to 2019. As the material, the tissue of the primary tumor of ES/PNEТ from paraffin blocks was used, obtained from 67 patients during the primary biopsy, as well as after the surgical stage as part of a combined or complex treatment. The expression of ZEB1 was determined immunohistochemically.

Results. The highest average level of expression of ZEB1 protein was observed in group 4 with a generalized form of ES (surgical material) and amounted to 60.8 ± 2.2 %, the minimum level was detected in group 2 with a localized form of ES (surgical material) and amounted to 29.2 ± 3.0 %. Between groups 2 (localized form) and 4 (generalized form) statistically significant differences were noted (p = 0.026).

Conclusion. As a result of an immunohistochemical study, the ZEB1 protein showed its prognostic significance when comparing groups with a localized and generalized form of ES (p = 0.026). The predominance of the expression level of ZEB1 protein in the group with the generalized form statistically significantly increased the chances of metastasis by 3.6 times (95 % CI 1.13-11.8).
Rare bleeding disorders
Authors: Florinskiy D. B. , Zharkov P. A.
Published: September 2020

Rare bleeding disorders include inherited deficiencies of fibrinogen, factors (F) II, FV, FVII, FX, FXI, FXII, and FV + FVIII, as well as a multiple deficiency of vitamin K-dependent coagulation factors. Some of these deficiencies are more studied, due to the large number of patients, some are extremely rare, so at this stage it is quite difficult for them to develop a universal approach to therapy and prophylactic treatment. The purpose of this review was to evaluate the frequency, clinical manifestations, genetic basis, possibilities and difficulties of diagnosis for these deficiencies.
Diagnosis and treatment of post-transfusion iron overload in pediatric hematology: literature review
Authors: Batmanova N. A. , Valiev T. T. , Kirgizov K. I. , Varfolomeeva S. R.
Published: September 2020

Packed red blood cells are important part of modern treatment recommendations of anemic syndrome in benign and malignant diseases of hematopoietic system in both adults and children. Special features of iron metabolism in the human body after erythrocytes-containing transfusions lead to its increased accumulation in organs and tissues and post-transfusion iron overload development. Clinical manifestation of post-transfusion iron overload varies, but in the absence of chelation therapy can lead to life-threatening complications. This literature review describes the main causes of iron overload, clinical features, and diagnosis and treatment of iron overload.