bluuebunny/crossref_metadata_2025 huggingface dataset:
Relationship of Metabolic Syndrome Defined by IDF or Revised NCEP with Glycemic Control among Malaysians with Type 2 Diabetes
Authors: Saif-Ali Riyadh , Kamaruddin Nor Azmi , AL-Habori Molham , Al-Dubai Sami A , Ngah Wan Zurinah Wan
Published: June 2020

Background Chronic complication of Type 2 Diabetes (T2D) such as macrovascular disease is amplified with the increase in the number of the metabolic syndrome (MetS) risk factors. Specific criteria for diagnosis of MetS are essential to help in glycemic control and reduce cardiovascular morbidity and mortality in diabetic patients with metabolic syndrome.Methods The study is cross-sectional observational study which involved 485 T2D patients who are receiving treatment at the University Kebangsaan Malaysia Medical Center (UKMMC), Kuala Lumpur, Malaysia. Metabolic syndrome among the T2D patients was diagnosed based on IDF and NCEP-R criteria. C-peptide and glycated hemoglobin (HbA1c) levels were determined by an automated quantitative immunoassay analyzer and high-performance liquid chromatography, respectively. The metabolic syndrome factors, glucose, triglyceride and HDL cholesterol were measured by spectrophotometer Results Application of IDF and NCEP-R criteria respectively resulted in 73% and 85% of T2D subjects being diagnosed with MetS. The concordance of these criteria in diagnosing MetS among T2D was low (κ =0.33, P<0.001). Both IDF and NCEP-R criteria indicated that T2D with five criteria of MetS had higher insulin resistance (P=2.1×10-13, P=1.4×10-11), C-peptide (P=1.21×10-13; 4.1×10-11), blood glucose (P=0.01; 0.021) and HbA1c (P=0.039; 0.018) than those T2D without MetS respectively. Conclusion Although, there is a low concordance between IDF and NCEP-R criteria in the diagnosis of MetS among T2D, both criteria showed that T2D with five criteria of MetS had higher insulin resistance, blood glucose and HbA1c.
Performance Comparison of Anomaly Detection Algorithms for Streaming Data
Authors: Hasani Zirije , Fondaj Jakup
Published: June 2020

Most of the today's world data are streaming, time-series data, where anomalies detection gives significant information of possible critical situations. Yet, detecting anomalies in big streaming data is a difficult task, requiring detectors to acquire and process data in a real-time, as they occur, even before they are stored and instantly alarm on potential threats. Suitable to the need for real-time alarm and unsupervised procedures for massive streaming data anomaly detection, algorithms have to be robust, with low processing time, eventually at the cost of the accuracy. In this work we compare the performance of our proposed anomaly detection algorithm HW-GA[1] with other existing methods as ARIMA [10], Moving Average [11] and Holt Winters [12]. The algorithms are tested and results are visualized in the system R, on the three Numenta datasets, with known anomalies and own e-dnevnik dataset with unknown anomalies. Evaluation is done by comparing achieved results (the algorithm execution time and CPU usage). Our interest is monitoring of the streaming log data that are generating in the national educational network (e-dnevnik) that acquires a massive number of online queries and to detect anomalies in order to scale up performance, prevent network downs, alarm on possible attacks and similar.
E-Consults: an effective way to decrease clinic wait times in Rheumatology
Authors: Patel Veena , Stewart Diana , Horstman Molly
Published: June 2020

Background: To evaluate the effect of E-consults on wait times and resource utilization for positive antinuclear antibody (ANA) referrals in outpatient rheumatology.Methods: We conducted a pre-post study of E-consult implementation for positive ANA referrals. We retrospectively reviewed “positive ANA” referrals from 1/2015-3/2017. A statistical process control chart was created to display monthly average wait times for in-person clinic visits and to identify special cause variation. Final Diagnoses, wait times and resource utilization were recorded and compared between E-consults and in-person referrals.Results: There were 139 referrals for positive ANA with 126 occurring after E-consult implementation in August 2015. Forty-four percent (55/126) of referrals were E-consults; 76% were resolved after initial electronic rheumatology recommendation. A control chart demonstrated special cause variation in the form of a shift from June 2016 – January 2017, suggesting a temporal association between decreased wait times and the implementation of E-consults. Eleven patients were diagnosed with ANA-associated rheumatic disease; the majority of patients (73%, 86/139) did not have a rheumatologic diagnosis. Overall E-consults utilized more labs than in-person visits, but this was not statistically significant. In-person visits utilized more imaging studies, which was statistically significant. Conclusion: E-consults are an effective way to address positive ANA consults without significant resource utilization and were temporally associated with decreased wait times for in-person visits.
Adolescents Nutritional Status and its association with Academic Performance in South Ethiopia; a facility-based cross-sectional study
Authors: Katiso Selamawit Woldeyohanes , Keribo Amene Abebe , Kastro Samson Dake
Published: June 2020

BackgroundThough evidence about the magnitude of malnutrition is well established in Ethiopia, the evidence is scarce about the association of nutritional status with academic performance among adolescents. Thus, this study aimed at determining the association of nutritional status with academic performance among adolescents attending secondary schools in Wolaita Sodo town, Southern Ethiopia.MethodsA facility-based cross-sectional study was conducted among 670 systematically selected adolescents in secondary schools of Wolaita Sodo town from April to June 2019. The academic performance of the adolescents was measured using the average mark score of two consecutive semester's results of the overall subjects. Data were analyzed with STATA software Version 15. Descriptive statistics, Pearson Correlation, and linear regression were used in the statistical analysis, and p-value < 0.05 was considered as statistically significant.ResultsThe mean academic performance of students was 69.21 ± 0.42 (95% CI: 68.34%-70.02%). An average mark score of students increased by 1.89 (β = 1.89; 95%CI: 1.14, 2.64) for a unit increase in BMI for age z-score. Being female decreased an average mark score by 2.63 (β=-2.63; 95%CI: -4.28, -0.98) and being from a separated parents decreased by 4.73 (β=-4. 73; 95%CI: -6.73, -2.74). An average mark score of students from the lowest wealth class decreased by 9.92(-9.92; 95%CI: -12.79, -7.04) as compared to students from the highest wealth class. Attending private schools increased the average mark score of students by 4.18 (β = 4.18; 95%CI: 2.46, 5.90).ConclusionInterventions targeted at adolescents’ nutritional status should be designed and implemented. The town education office and concerned bodies should launch a school feeding program for government schools. Development and income-generating activities should target households with the lowest wealth status. Schools should give tutorial classes for female students.
A Comparative Case Study of Prescribing and Non-Prescribing Physiotherapists and Podiatrists
Authors: Carey Nicola , Edwards Judith , Otter Simon , Gage Heather , Williams Peter , Courtenay Molly , Moore Ann , Stenner Karen
Published: June 2020

BackgroundIncreasing numbers of nurses, pharmacists and allied health professionals across the world have prescribing rights: over 90,000 of the eligible United Kingdom workforce are qualified as non-doctor prescribers. In order to inform future developments, it is important to understand the benefits and impact of prescribing by allied health professionals including physiotherapists and podiatrists.Aim: to compare outcomes of Physiotherapist and Podiatrist Independent Prescriber (PP- IP) patients with those of Physiotherapist and Podiatrist non-prescribers (PP-NPs). Outcome measures included patient satisfaction, ease of access to services, quality of life and cost implications.Design: a mixed method comparative case studyMethods: Using mixed methods of data collection, outcomes were compared between 7 sites where care was provided from a PP-IP (3 podiatrist and 4 physiotherapist IPs) and 7 sites from a PP-NP (3 podiatrist and 4 physiotherapist NPs). Patients were followed up for 2 months (2015-2016).Results: 488 patients were recruited: n=243 IP sites, and n=245 NP sites. Independent prescribing was found to be highly acceptable, and equivalent in terms of quality of life (p>0.05) and patient satisfaction (p≤0.05) compared to care provided by NPs. PP-IP care delivery was found to be more resource intensive than NP-PP, with longer consultation duration for IPs (around 6.5 mins), and a higher proportion of physiotherapy patients discussed with medical colleagues (around 9.5 minutes). ConclusionThis study provides new knowledge that PP-IPs provide high levels of care. PP-IP care delivery was found to be more resource intensive. Further research is required to explore cost effectiveness. A more focussed exploration within each profession using targeted outcome measures would enable a more robust comparison, inform future developments around the world and help ensure non-doctor prescribing is recognised as an effective way to alleviate shortfalls in the global workforce.
Comparative Study on Optic Disc Features of Premature Infants and Term Infants
Authors: Feng Xiaofen , Nan Yan , Pan Jiandong , Zou Ruitao , Shen Lijun , chen feng
Published: June 2020

Background
To study optic disc features of premature infants and compare to that of term infants to explore the pattern and features of newborn optic disc development and provide the basis for the diagnosis of newborn optic disc disease.
Methods
This is a prospective clinical research. Newborns underwent newborn fundus disease screening from January 1st, 2016 to October 31st, 2016 in the neonatal ward of Ruian City Maternal and Child Health Hospital were selected. RetCam 3 Version6.1.25.0 Wide-Field Digital Pediatric Retinal Imaging System developed by Clarity Medical Systems, Inc was adopted to conduct fundus examination on both eyes, 130 degree wide-angle lens was used to film the images centering optic disc.
Results
For both premature infants and term infants, vertical diameter of the optic disc to lateral diameter of the optic disc ratio was > 1, and the shape of the optic disc was a vertical oval. The difference of each optic disc parameter between premature infants and term infants was not statistically significant (P > 0.05). There’s a difference of constitution of sclerotic ring type on optic disc between premature infants and term infants. Among which, the proportion of single ring type and double ring type in premature infants was higher than that in term infants (P < 0.05). The proportion of no ring type in term infants was higher than that in premature infants (P < 0.05). The proportion of mixed type had no significant difference (P > 0.05) between premature infants and term infants.
Conclusions
We found that The proportion of mature types (single ring type and double ring type) in term infants was higher than that in premature infants. While there’s no statistical difference of the proportion of mixed types between premature infants and term infants.Double ring type is a normal stage of the development of optic disc.
The prevalence rate and demographic correlates of perceived stress in Alberta during the COVID-19 pandemic: A one-week cross-sectional study
Authors: Vuong Wesley , Gusnowski April , Surood Shireen , Shalaby Reham , Hrabok Marianne , Mrklas Kelly , Urichuk Liana , Greenshaw Andrew J. , Li Xin-Min , Agyapong Vincent V. I. O.
Published: June 2020

Background

Coronavirus Disease 2019 (COVID-19) continues to have an unprecedented global effect on health and daily life, with many countries struggling to adapt to the adverse pandemic impact. While strict public health measures are necessary to slow the virus’ spread, these measures may adversely affect individual mental health and wellbeing. Texting-based programs offer organizations a feasible and cost-effective option to deliver mental health supports and to collect population-level data. This study reports on the prevalence rate and demographic correlates of perceived stress on the one-week data obtained from Text4Hope enrollees during the COVID-19 pandemic.
Methods

This was a cross-sectional study that used the Perceived Stress Scale to determine the one-week prevalence for perceived stress in Alberta. Univariate and binomial logistic regression analysis were used to determine the demographic correlates (i.e., gender, age, ethnicity, educational attainment, employment status, relationship status, and housing status) of moderate/high perceived stress.
Results

One week after the program launch, 32,805 individuals were enrolled. 6,041 enrollees completed the baseline survey (18.4% response rate). 84.7% of respondents reported moderate/high stress. All demographic variables, except ethnicity, were significantly associated with moderate/high stress (p < 0.001). Females were 1.5 times more likely to report moderate/high stress (95% CI = 1.2–1.9) than males. Compared to respondents in the 26–40 years, 41–60 years, and > 60 years of age categories, those ≤ 25 years of age were 1.9 (95% CI = 1.1–3.4), 3.4 (95% CI = 1.9–6.3), and 5.3 (95% CI = 2.8–10.0) times more likely to report moderate/high stress, respectively. Unemployed individuals were 2.5 times more likely to report moderate/high stress (95% CI = 1.8–3.6) than employed individuals. Retirees were 1.6 times less likely to report moderate/high stress (95% CI = 1.1–2.2) than employed respondents. Respondents renting a home were 1.7 times more likely to report moderate/high stress (95% CI = 1.3–2.1) than home owners.
Conclusion

Prevalence rate for perceived stress during the COVID-19 pandemic is very high in Alberta, signaling detrimental pandemic impacts on mental health. Our demographic correlates of perceived stress align with research results from other jurisdictions.
Trail registration:

The study was approved by the University of Alberta Human Research Ethics Board (Pro00086163).
The relationship between leukocyte level and hypertension in elderly patients with hyperuricemia.
Authors: Shen Lijin , Zhao Wei , Li Mingzhen , Sun Bei , Zhou Zhichao , Zhang Jing , Liu Yanjie , Dong Ya
Published: June 2020

Background : This study was to evaluate the change of leukocyte level caused by hyperuricemia and explore the relationship between leukocyte level and hypertension in elderly patients with hyperuricemia. Methods: A cross-sectional study of serum uric acid level was conducted in 1352 elderly people over 65 years old . The study samples were divided into three categories according to the tertiles of leukocyte: Tertile 1, leukocyte≤5.2 × 10 9 /L; Tertile 2, leukocyte=5.3~6.3 × 10 9 /L; and Tertile 3, leukocyte≥6.4 × 10 9 /L. Multiple logistic regression models were used for modeling relationships between leukocyte, hyperuricemia and hypertension. In vitro, human vascular endothelial cells (HUVECs) were treated by different concentrations of UA (0, 4, 8, 16 mg/dl) for 24 h, then cells were collected. Some cytokines were measured. Reactive oxygen species (ROS) were analyzed with a fluorescence microscope. Results: The levels of leukocyte were higher in elderly patients with hyperuricemia than without hyperuricemia( P <0.01). In multiple logistic regression, hyperuricemia was an independent risk factor of leukocyte in Tertile 3 (OR=1.657, 95%CI: 1.180～2.328, P =0.004). The prevalences of hypertension were higher in elderly patients with hyperuricemia than without hyperuricemia (77.0% vs 63.5%, χ 2 =11.447, P =0.001). In multiple logistic regression (Model 1), hyperuricemia was an independent risk factor of hypertension (OR=1.536, 95%CI: 1.026～2.302, P =0.037). Leukocyte in Tertile 3 was an independent risk factor of hypertension in Model 2 (OR= 1.333, 95%CI: 1.031~1.724, P =0.028). Expression levels of IL-1β, iNOS and TNF-α were obviously higher in the 8mg/dl UA group and 16mg/dl UA group than that in the control group ( P <0.05). Expression level of eNOS was obviously lower in the 8mg/dl UA group and 16mg/dl UA group than that in the control group ( P <0.05). The production of ROS in the 8mg/dl UA group and in the 16mg/dl UA group were obviously higher than that in the control group ( P <0.05). Conclusion: The present study demonstrated that hyperuricemia was associated with an increased risk for hypertension. The chronic inflammation caused by hyperuricemia maybe one of important pathogenesis of incident hypertension in patients with hyperuricemia.
Study on a supplemental test to improve the detection of bovine tuberculosis in individual animals and herds
Authors: Carneiro Paulo , Sousa Eliomar de Moura , Viana Rinaldo Batista , Monteiro Bruno Moura , Kzam Aline do Socorro Lima , de Souza Damazio Campos , Coelho Anderson Silva , Filho José Dantas Ribeiro , Jordao Ricardo Spacagna , Tavares Maria Regina Madruga , Kaneene John B.
Published: June 2020

Background
With a worldwide occurrence, bovine tuberculosis (bTB) is a zoonotic disease that is difficult to control, mainly due to the lack of a diagnostic testing to detect infected animals at all stages. Furthermore, the current standard diagnostic test, the Tuberculin Skin Test (TST), is logistically difficult and time consuming. To address this challenge, the aim of this study was to evaluate the sensitivity and specificity of a multiplex enzyme-linked immunosorbent assay (ELISA) comparing with the TST used for the diagnosis of tuberculosis in cattle in Brazil. The study included 400 Nelore females raised for beef on five farms, in different municipalities in Brazil. The comparative cervical test (CCT) was done and on the day of inoculation of the Purified Protein Derivative (PPD) blood samples were obtained and stored for further analysis of the ELISA IDEXX™ Mycobacterium bovis immunoassay.
Results
Lack of agreement between CCT and ELISA IDEXX™ was observed. No diagnosis described as positive reactor on the CCT was positive at the ELISA, indicating two false positive reactors and 22 negative reactors by CCT were positive by the ELISA IDEXX™. The ELISA IDEXX™ showed sensitivity significantly higher than the official CCT and no significant differences in specificity was observed. ELISA also detected infected animals and herds undetected by the CCT. The parallel use of CCT and ELISA increased sensitivity and the feasibility bTB screening, thus improving the cleaning of the herds.
Conclusions
The results obtained here suggest that the ELISA IDEXX™ may be a supplemental test for the detection of Mycobacterium bovis infection in regions without routine testing and slaughter, where the disease generally progresses to more advanced stages and antibody responses are likely to be more prevalent. The results provided evidence to support the validation of the ELISA IDEXX™ as a supplemental test for bTB eradication programs.
Quercetin attenuates the production of pro-inflammatory cytokines in H292 human lung epithelial cells infected with Pseudomonas aeruginosa, by modulating ExoS production
Authors: Ahn Hye In , Park Ji-Won , Jang Hyun-Jae , Kwon Ok-kyoung , Kim Jung Hee , Oh Sei-Ryang , Han Sang-Bae , Ahn Kyung-Seop
Published: June 2020

Background The type three secretion system (T3SS) is a major virulence system of Pseudomonas aeruginosa (P. aeruginosa). The effector protein Exotoxin S (ExoS) produced by P. aeruginosa is secreted into the host cells via the T3SS. For the purpose of screening the inhibitors with regard to ExoS secretion, we developed the sandwich-type enzyme-linked immunosorbent assay (ELISA) system. From the initial screening, quercetin was selected because it has the prominent effect of ExoS inhibition and also is known to have anti-inflammatory and antioxidant effects on mammalian cells.Results In this study, we investigated the effects of quercetin on the expression and secretion of ExoS using the ELISA and Western blot analysis methods. The results showed that the secretion of ExoS was significantly decreased in a dose-dependent manner by quercetin. Also, pscF and popD, which are composed of the T3SS needle, are reduced by quercetin at the mRNA level, and we confirmed the inhibitory effect of quercetin on cytokines in P. aeruginosa-infected H292 cells by real-time polymerase chain reaction (PCR). Conclusion Collectively, quercetin inhibits the secretion of ExoS by reducing both ExoS production and the expression of the needle protein of T3SS. Furthermore, these results suggest that quercetin has the potential
“There Are Still a Lot of Things that I Need”: A Qualitative Study Exploring Opportunities to Improve the Health Services of First Nations People with Arthritis seen at an On-reserve Outreach Rheumatology Clinic
Authors: Loyola-Sanchez Adalberto , Pelaez-Ballestas Ingris , Crowshoe Lynden , Lacaille Diane , Henderson Rita , Rame Ana , White Tyler , Linkert Tessa , Barnabe Cheryl
Published: June 2020

Background Arthritis is a highly prevalent disease and leading cause of disability in the Indigenous population. A novel model of care consisting of a rheumatology outreach clinic in an on-reserve primary healthcare center has provided service to an Indigenous community in Southern Alberta since 2010. Despite quality assessments suggesting this model of care improves accessibility and is effective in meeting treatment targets, substantial improvements in patient-reported outcomes have not been realized. Therefore, the objective of this study was to explore the experiences of Indigenous persons with arthritis and healthcare providers involved in this model of care to inform the development of health service improvements that enhance patient outcomes.Methods This was a narrative-based qualitative study involving a purposeful sample of 32 individuals involved in the Indigenous rheumatology model of care. Semi-structured in-depth interviews were conducted to elicit experiences with the existing model of care and to encourage reflections on opportunities to improve it. A two-stage analysis was conducted. The first stage aimed to produce a narrative synthesis of sensitizing concepts through a dialogical method comparing people with arthritis and health providers’ narratives. The second stage involved a collective effort to crystalize these sensitizing concepts in specific recommendations to improve the quality of the current model of care. Triangulation, through participant checking and discussion among researchers, was used to increase the validity of the final recommendations.Results Ten Indigenous people with arthritis lived experience, 14 health providers and 8 administrative staff were interviewed. One main overarching theme was identified, which reflected the need to provide services that improve people’s functioning. Further, the following specific recommendations were identified: 1) enhancing patient-provider communication, 2) improving the continuity of the healthcare service, 3) increasing community awareness about the presence and negative impact of arthritis, and 4) increasing peer connections and support among people living with arthritis.Conclusions Improving the quality of the current Indigenous rheumatology model of care requires implementing strategies that improve functioning, patient-provider communication, continuity of care, community awareness and peer support. A community facilitator in a role of a patient navigator could facilitate the implementation of these strategies.
Case Report of 78 –year-old man with meningitis, Pulmonary Thromboembolism & SARS-Coronavirus-2 infection
Authors: Moghimi Minoosh , Ghodrati Samad , Abbaspourrad Zahra , Mojhdehi Amirhossein Moghtader , Jafari Sattar , Mansouri Reza , Khodadadi Kasra , Muhammmadi Muhammmad Javad
Published: June 2020

The novel corona virus infection involve both Central & Peripheral Nervous System . Some of the presentations include: acute cerebrovascular disease, impaired consciousness, transverse myelitis, encephalopathy, encephalitis and epilepsy. Our patient was 78 year –old man with dementia and diabetic nephropathy which was admitted two times for possibly COVID19 infection. At the first hospitalization, the patient is treated with hydroxychloroquine and kaletra based on clinical symptoms and initial laboratory findings due to suspicion of COVID19 . After the negative RT-PCR test of nasopharyngeal sample for covid19 and evidence of aspiration pneumonia in CT scan, the patient was discharged with oral antibiotics. Five weeks later, he was rehospitalized with loss of consciousness, fever and hypoxemia in physical exam he had neck stiffness in all directions, So the CNS infection was suspected, the CSF sample was in favor of aseptic meningitis and second RT-PCR test of nasopharyngeal sample for COVID19 was positive but Brain MRI just showed small vessel disease without evidence of encephalitis. In the second hospitalization, he had acute renal failure, which was treated with supportive care, and also suffered from pulmonary embolism with cavitary lesions in his lungs. Meningitis with pulmonary embolism and acute renal failure have not yet reported. Our patient is the first one, so we decided to share it. This case showed different presentation of COVID19 without typical lung involvement. So we must pay attention to any sign & symptoms in a patient suspected of having a COVID19 .
Health Workers’perspectives on Vacuum Extraction in Mulago Hospital, Uganda
Authors: Capelle Manuela , Nolens Barbara , Lule John , Byamugisha Josaphat , Roosmalen Jos van , Akker Thomas van den
Published: June 2020

Background: The objective of this manuscript is toexplore perceptions of health workersregardingthe use of vacuum extraction, two years after the implementation of training programme, in Mulago Hospital, Uganda. Methods: A cross-sectional survey among midwives, residents and consultant obstetricians,was performed. It was composed of questions pertaining to vacuum extraction, addressing reasons for low use, recommendations to increase use, preferred mode of birth, views aboutwho is suited to perform the procedure and contraindications.Results: Eighty-threeof 134(61.9%) participants returned the survey. The most frequent reasons for low use of vacuum extraction were lack of training (60/83, 72.3%) andequipment (59/83, 71.1%). Skills training and improved supply of equipment were recommended. Most participants (57/83, 68.8%) chose vacuum extraction over caesarean section as hypothetical mode of birth forthemselves or a relative. There was a tendency to cite contraindications not identified as such in international guidelines (big baby, caput succedaneum, moulding). Midwives and doctors with appropriate training were generally allconsideredsuited to perform vacuum extraction. Conclusion: Health workers generally conveyed a positive attitude towards vacuum extraction, despite some perceived barriers, often unsupported by evidence.Organisation of skills training, supply of equipment and focus on knowledge of indications are essential to increase its use.
Radiological evaluation of malignant pleural mesothelioma - defining distant metastatic disease
Authors: Collins Dearbhaile Catherine , Sundar Raghav , Constantidinou Anastasia , Dolling David , Yap Timothy Anthony , Popat Sanjay , O’Brien Mary E , Banerji Udai , de Bono Johann Sebastian , Lopez Juanita Suzanne , Tunariu Nina , Minchom Anna
Published: June 2020

Background
Malignant pleural mesothelioma (MPM) is traditionally characterized by local destructive spread of the pleura and surrounding tissues. Patient outcomes in MPM with distant metastatic dissemination are lacking.
Methods
In this retrospective study, we reviewed a cohort of 164 MPM patients referred to a Phase I trials unit, describe identified metastatic sites, and correlate with clinical outcomes.
Results
67% of patients were diagnosed with distant metastatic disease with a high incidence of bone (19%), visceral (14%), contralateral lung (35%) and peritoneal metastases (22%). Peritoneal metastases were more likely in epithelioid versus biphasic/ sarcomatoid MPM (p = 0.015). Overall survival was 23.8 months with no statistical difference in survival between those with distant metastases and those without.
Conclusions
This report highlights the frequency of distant metastases and encourages further radiological investigations in the presence of symptoms. In particular, given the relatively high incidence of bone metastases, bone imaging should be considered in advanced MPM clinical workflow and trial protocols. The presence of distant metastases does not appear to have prognostic implications under existing treatment paradigms. This cohort of MPM patients gives an indication of patterns of metastatic spread that are likely to become prevalent as prognosis improves with emerging treatment paradigms.
Co-composting of green waste, food waste and phosphoric rock. Comparison of two-stage composting with traditional composting.
Authors: Hernandez-Gomez Angelica Maria , Ríos Marcos , Portela Anauribeth , Sánchez-Torres Viviana , Domínguez Isabel , Oviedo-Ocaña Ricardo , Komilis Dimitrios
Published: June 2020

Green waste (GW) co-composting has limitations due to the content of slowly degradable compounds (i.e. lignocellulosic substances). The introduction of amendment and bulking materials has improved organic matter degradation and end-product quality. However, recent studies have included additional strategies such as two-stage composting (TSC). This research evaluates the effect of TSC on the process and end-product quality of co-composting of GW, food waste, sawdust and phosphoric rock. In our knowledge, TSC has not been studied together with strategies like the addition of co-substrates such as FW and phosphoric rock to improve GW composting. A pilot-scale study was developed using two triplicate treatments: TA: TSC and TB: Traditional composting. The two treatments used the same mixture (wet weight): 46% GW, 19% unprocessed food waste, 18% processed food waste, 13% sawdust, and 4% phosphoric rock. TB had a higher degradation rate of organic matter during the mesophilic and thermophilic phases compared to TA. This is related to the higher temperatures for longer periods during these two phases, with a higher degradation of volatile solids. Nonetheless, during the cooling and maturation phases, the two treatments had similar behavior on temperature, pH, and electrical conductivity with ash and lignin contents without significant differences at the end of the process. End-products in both treatments lacked statistically significant differences and fulfill quality criteria for use as soil improvers. However, end-products from traditional composting had lower nutrient content (NTotal and PTotal) that can be associated with nitrogen volatilization or the use of nutrients by the microorganisms during the active process phases. These results indicate that at the end of the process, there were no significant differences in the total processing time, degradation rate or end-product quality among TSC and traditional composting. Evaluation of complementary strategies must continue to improve GW composting.
Expired Probiotics: What is Really in Your Cabinet?
Authors: Wilcox Hannah , Carr Charles , Seney Shannon , Reid Gregor , Burton Jeremy
Published: June 2020

Background: The popularity of using probiotics has surged, since they became widely accepted as safe and help improve general health. Inevitably, some of these products are used after expiration when microbial cell viability is below the recommended effective dose. Given that probiotics are live microorganisms administered in adequate amounts, the aim of this study was to measure viability in expired products and assess how packaging and storage conditions impact efficacy, if at all.Results: Thirty-three expired probiotic products were evaluated, of which 26 were stored in conditions recommended by the manufacturer. The viable microbial counts were enumerated and representative isolates identified by 16S and ITS rRNA gene sequencing. While the products had a mean past expiration time of 11.32 (1 to 22) years, 22 still had viable contents, and 5 were within or above the original product cell count claim. Product formulation, and number of species present did not appear to impact the stability of the products. However, overall packaging type, storage conditions and time since expiry were found to affect viability. All products with viable cells had the strain stipulated on the label.Conclusion: Despite some selected probiotic products retaining viability long past their expiry date (indicating long term storage is possible), the total counts were mostly well below that required for efficacious use as recommended by the manufacturer. Consuming expired probiotics may not yield the benefits for which they were designed.
An Efficient Data Collection Path Planning Scheme in Wireless Sensor Networks with Mobile Sink
Authors: Chang Jau-Yang , Jeng Jin-Tsong , Sheu Yung-Hoh , Jian Z-Jie , Chang Wei-Yeh
Published: June 2020

Wireless sensor networks with mobile sink provide a mobile device to move into the sensing area for collecting the sensing data. It increases the flexibility and convenience of data gathering in such systems. Taking into account the energy consumption of mobile sink, the moving distance of mobile sink must be reduced efficiently. Hence, it is important and necessary to develop an efficient path planning scheme for the mobile sink in large-scale wireless sensor networks systems. According to the greedy-based algorithms, we adopt an angle bisector concept to create the moving path for the mobile sink. In this paper, a novel efficient data collection path planning scheme with an inner center approach is proposed to reduce the moving distance and to prolong the lifetime of mobile sink in wireless sensor networks. The relationship among moving path, moving distance, and number of sensor nodes are analyzed and discussed. Considering the communication range limitation of sensor nodes and the sensing area with obstacles, the proposed scheme makes an adaptive decision for creating the moving path of mobile sink. Simulation results demonstrate that the reasonable moving path planning can be achieved and the moving distance can be reduced for a mobile sink in wireless sensor networks.
MRI Study on Tibial Nerve of the Ankle Canal and Its Branches: A method of multiplanar reconstruction with three-dimensional dual-excitation balanced steady-state free precession sequence
Authors: Zhang Yan , He Xucheng , Li Juan , Ye Ju , Han Wenjuan , Zhou Shanshan , Zhu Jianzhong , Wang Guisheng , Chen Xiaoxia
Published: June 2020

Background: The display of tibial nerve and its branches in the ankle canal is helpful for the diagnosis of local lesions and compression, and also for clinical observation and surgical planning.The aim of this study was to investigate the feasibility of three-dimensional dual-excitation balanced steady-state free precession sequence (3D-FIESTA-C) multiplanar reconstruction (MPR) display of tibial nerve and its branches of the ankle canal.The subjects were 20 healthy volunteers (40 ankles), aged 22-50, with no history of ankle joint desease. 3D-FIESTA-Csequence was used in the 3.0t magnetic resonance equipment for imaging. During the scanning, each foot was at a 90-degree angle to the tibia so that the results of measurement are more accurate .The tibial nerve of the ankle canal and its branches were displayed and measured at the same level through multiplanar reconstruction.Results: Most of the tibial nerve bifurcation points were located in the ankle canal (57.5%), few (42.5%) were located at the proximal end of the ankle canal, and none was found away from the distal end. The bifurcation between the medial plantar nerve and the lateral plantar nerve is on the line between the tip of the medial malleolus and the calcaneus, and it’s angle is between 6° and 35°.The average cross-sectional diameter of the medial plantar nerve is about mm, and the lateral plantar nerve about mm. In MPR images, the display rates of both the medial calcaneal nerve and the subcalcaneal nerve were 100%, and the starting point of the subcalcaneal nerve was always at the distal end of the starting point of the medial calcaneal nerve. In 55% of cases, there were more than 2 medial calcaneal nerve innervations.Conclusion: The 3D-FIESTA-C MPR can display the morphological features and positions of tibial nerve and its branches. By measuring the distance between each bifurcation point, the tip of the medial malleolus and the angle between this line and the horizontal line that passes the tip of the medial malleolus, the bifurcation point’s projection position on the body surface can be accurately marked. This method not only benefited the imaging diagnosis of tibial nerve and branch-related lesions of the ankle canal, but also provided a good imaging basis to plan the clinical operation of the ankle canal and avoid surgical injury.
Numerical Modeling of Rehabilitation Exercise when Distal Radius Fracture Treated by Splint
Authors: Hua Zhen , Liu Mingming , Wu Mao , Xie Bin , Zhang Yufeng , Wang Jianwei
Published: June 2020

Background

Rehabilitation exercise plays a key role in bone fracture healing. Although traditional clinical experiments and observations are adopted to evaluate the effect of rehabilitation exercise, the biomechanical mechanism is still unclear. There are few reports on the mechanical analysis model of elbow flexion rehabilitation exercise of the complete upper limb model previously. Because the upper limb structure is complex, the previous model is so simplified that soft tissue structure is not considered. It cannot reflect the change and distribution of the stress and stress state during elbow flexion exercise.
Methods

From the perspective of biomechanics, based on the CT scanning images of forearm for an aged female volunteer, a 3-D distal radius fracture forearm model is established. By introducing the soft tissues and the splint, a complete 3-D forearm model is finally reconstructed. The model includes ulna, radius, humerus, muscle, ligament, joint, wrist, skin and splint. The correctness of the model is verified by comparing the results of numerical simulation with the results of previous literature and clinical experiments.
Results

When the elbow flexion angle increases from 0 to 120 degrees, the stress increases from 0.21 Mpa to 0.83 Mpa. When the elbow flexion angle increases from 0 to 120 degrees, the strain increases from 2–23%, and the maximum strain at the fracture end is about 22.5%. Also an analytical formula of the relationship fracture end strain and different elbow flexion angles is obtained by nonlinear fitting based on the simulation results, which is convenient for clinicians to predict fracture end strain.
Conclusions

During elbow flexion rehabilitation exercise, the stress of biceps brachii is large, and with the increase of elbow flexion angle, the stress shows an increasing trend. The stress in the area of distal radius fracture is also concentrated. Moderate stress concentration is helpful to the process of bone remodeling, so as to shorten the time of fracture healing. There was no obvious stress concentration in metacarpal bone and has little effect on the activity of metacarpophalangeal joint. The fretting strain at the fracture site can improve the speed of fracture healing, because the generation of early callus can absorb a lot of energy generated by fretting strain, which has an impact on the mechanical properties and plastic deformation ability of callus, and plays an important role in the stimulation of late osteogenesis.
Association of Serum Calcium Levels with Renal Impairment and All-Cause Death in Chinese Patients with Newly Diagnosed Multiple Myeloma: A Cross-Sectional, Longitudinal Study
Authors: Cheng Jun , Zhang Wen , Zhao Yi , Li Xiayu , Lv Rong , Li Heng , Chen Jianghua
Published: June 2020

Background: A number of studies have shown that serum calcium has a crucial role in many types of cancers. However, few studies have determined the association between serum calcium levels and renal impairment (RI) and all-cause death in Chinese patients with multiple myeloma (MM).Methods: Two hundred forty-six of 566 participants who were followed for > 6 months from a MM cohort at our institution between January 2011 and June 2017 were eligible for the retrospective study. A generalized additive model and smooth curve fitting were conducted to investigated the cross-sectional relationship between serum calcium level and RI and eGFR at baseline；Multivariate-adjusted Cox regression models were fitted to assess associations between baseline serum calcium levels and onset of end-stage renal disease(ESRD) or death in patients with MM followed for > 6 months.Results: Using the IMWG criteria,162 of 566 patients (28.6%) with newly diagnosed MM presented with RI . The mean duration of follow-up was 26.64 months. Twenty-one patients (8.54%) died and 28 patients（11.52%）had ESRD.The serum calcium level was independently associated with the occurrence of MM-related RI. There was a non-linear relationship between the serum calcium level and the presence of RI in patients with MM in the cross-sectional analysis of the baseline data. Cox regression analysis showed that baseline serum calcium levels were consistently associated with a higher risk of all-cause death after adjustment for various clinical and laboratory factors, but were not associated with the occurrence of ESRD. When patients were categorized into 2 groups according to baseline mean serum calcium level, deaths occurred in 13 patients (15.1%) with mean serum calcium level > 2.44 mmol/L compared to 8 patients (5.0%) with mean serum calcium level < 2.44 mmol/L (p < 0.05); Eighteen patients (11.46%) with a mean serum calcium level < 2.44 mmol/L progressed to ESRD compared to 13 patients (11.6%) with a serum calcium level > 2.44 mmol/L (p > 0.05).Conclusions: This observational study showed that there was a non-linear relationship between the serum calcium level and the occurrence of RI. An elevated baseline calcium level can predict all-cause death in patients with MM, but cannot predict the occurrence of ESRD, suggesting that the serum calcium level may serve as a useful clinical biomarker for the survival rate of patients with MM followed for > 6 months. Additional data from larger prospective longitudinal studies are required to validate our findings.
Dynamic Clinical Features During the Para-Exacerbation Period of Critical COVID-19 Patients
Authors: Bao Aihua , Zhou Yan , Yunfei Lu , Qiao Lihua , Ding Fengming , Lu Hongzhou , Zhang Min
Published: June 2020

Background COVID-19 has been currently spread all over the world with high mortality reported in severe COVID-19 patients. Many severe COVID-19 patients exacerbated from mild illness several days after hospital admissions. Pathophysiological evolution within this para-exacerbation period remain unclear.Methods Twenty-two confirmed COVID-19 patients who underwent at least one exacerbation were included. Epidemiological, clinical, laboratory, and radiological data were extracted from electronic medical records and compared between the records of hospital admission day and the exacerbation day. Dynamic profiles of critical parameters were explored during the para-exacerbation period.Results Most of the patients were elder (67, IQR63-79), male (81.8%), coexisted with comorbidities (72.7%), multi-segments radiologically involved and exacerbated from mild to severe illness with anoxia at a median interval of 4 days (IQR, 2-7) from hospital admissions. On exacerbations, various clinical parameters were worsened, including respiratory rate, PaO2/FiO2 rate (PFR), alveolar-arterial PO2 difference (A-aDO2), hematological cellularities, biochemical parameters and radiological abnormalities. Dynamic profiles showed that neutrophil/lymphocyte ratio (NLR), and serum level of lactic acid, lactate dehydrogenase and coagulation parameters started to increase even at four days before the exacerbation.Conclusions Anoxia due to impaired gas exchange progress pathophysiologically characterized the exacerbation of COVID-19 patients. Continuously monitoring crucial clinical parameters, such as NLR, serum albumin, LDH, lactic acid, and CT involvement scale will be helpful to improve the recognition of the disease progression in patients with COVID-19 at early stage.Trial registration: This retrospective study has been registered in Chinese Clinical Trial Registry (ChiCTR2000030580, www.chictr.org.cn)
Long-Term Follow-up of a Homozygous Familial Hypercholesterolemia Child with Progressive Aortic Stenosis and Coronary Atherosclerosis
Authors: Cai Gaojun , Jiang Long , Yang Ya , Sun Liyuan , Wang Xu , Zhou Yujie , Wang Lvya
Published: June 2020

Familial hypercholesterolemia (FH) is a severe autosomal-dominant disorder. We reported a case who firstly admitted to our institution for obvious cutaneous and tendinous xanthomas and high low-density lipoprotein cholesterol when he was 3.7 year old in 2005. DNA sequencing detected the homozygous mutation in LDLR exon9 c.1187-10G>A, a 3' splice acceptor mutation in poly-pyrimidine tract of intron 8. During the long-term follow-up, progressive aortic stenosis and coronary atherosclerosis was found, although given the lipid-lowing drugs. HoFH with c.1187-10G>A mutation in LDLR gene might lead to severe damage in cardiovascular system and unsatisfactory response to conventional lipid-lowing drugs. Other aggressive treatments should be used in HoFH patients with this mutation as early as possible.
Gross Hematuria in Patients with Wasp Sting: A Retrospective Study
Authors: wang wei , Wang Maohe , singh Prince , Tang Yong , Zhong Xiang , Chen Shasha , Li Guisen , Wang Li
Published: June 2020

Background: Wasp sting is common in the world, and gross hematuria after wasp sting has been reported in Asia to occur before AKI. Gross hematuria is often used by clinicians as a sign indicated for intensive care and blood purification treatment. However, there is no study on the clinical characteristics and prognosis of wasp sting patients complicated with gross hematuria. Methods: The demographic characteristics and clinical data of 363 patients with wasp sting admitted to Suining Central Hospital from January 2016 to December 2018 were retrospectively analyzed. At admission, the poisoning severity score was used as the criterion for severity classification. According to the presence of gross hematuria, the patients were divided into gross hematuria group and non-gross hematuria group. Multivariate logistic regression analysis was performed to explore the risk factors for gross hematuria.Results: Of the 363 wasp sting patients, 219 were male and 144 were female, mean age was 55.9±16.3 years. 51 (14%) had gross hematuria, 39(10.7%) had Acute Kidney Injury(AKI), 105 (28.9%) had rhabdomyolysis, 61(16.8%) had hemolysis, 56 (15.4%) had Multiple Organ Dysfunction Syndrome (MODS), 13 (3.6%) had Acute Respiratory Distress Syndrome (ARDS), 45(12.4%) went on to receive renal replacement therapy, and 14 (3.9%) died. Patients with gross hematuria group had significantly higher poisoning severity scores when admitted to the hospital than those without gross hematuria group (2.2±0.5 vs. 1.1±0.3, P<0.001).Conclusion: Gross hematuria is one of the early clinical symptoms of severe wasp sting patients. AKI incidence and mortality of patients with gross hematuria are significantly increased. Prompt treatment should be taken for wasp sting patients complicated with gross hematuria. The poisoning severity score can be used for early assessment of the severity of wasp sting patients.