bluuebunny/crossref_metadata_2025 huggingface dataset:
Towards Improving the Identification of Anterior Cruciate Ligament Tears in Primary Point-of-Care Settings
Authors: Whittaker Jackie L , Chan Michelle , Pan Bo , Hassan Imran , Defreitas Terry , Hui Catherine , Macedo Luciana , Otto David
Published: March 2020

Background: Only a small proportion of anterior cruciate ligament (ACL) tears are diagnosed on initial healthcare consultation. Current clinical guidelines do not acknowledge that primary point-of-care practitioners rely more heavily on a clinical history than special clinical tests for diagnosis of an ACL tear. This research will assess the accuracy of combinations of patient-reported variables alone, and in combination with clinician-generated variables to identify an ACL tear as a preliminary step to designing a primary point-of-care clinical decision support tool.
Methods: Electronic medical records (EMRs) of individuals aged 15-45 years, with ICD-9 codes corresponding to a knee condition, and confirmed (ACL + ) or denied (ACL - ) first-time ACL tear seen at a University-based Clinic between 2014 and 2016 were eligible for inclusion. Demographics, relevant diagnostic indicators and ACL status based on orthopaedic surgeon assessment and/or MRI reports were manually extracted. Descriptive statistics calculated for all variables by ACL status. Univariate between group comparisons, clinician surveys (n=17), availability of data and univariable logistic regression (95%CI) were used to select variables for inclusion into multivariable logistic regression models that assessed the odds (95%CI) of an ACL-tear based on patient-reported variables alone (consistent with primary point-of-care practice), or in combination with clinician-generated variables. Model performance was assessed by accuracy, sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios (95%CI).
Results: Of 1,512 potentially relevant EMRs, 725 were included. Participant median age was 26 years (range 15-45), 48% were female and 60% had an ACL tear. A combination of patient-reported (age, sport-related injury, immediate swelling, family history of ACL tear) and clinician-generated variables (Lachman test result) were superior for ACL tear diagnosis [accuracy; 0.95 (90,98), sensitivity; 0.97 (0.88,0.98), specificity; 0.95 (0.82,0.99)] compared to the patient-reported variables alone [accuracy; 84% (77,89), sensitivity; 0.60 (0.44,0.74), specificity; 0.95 (0.89,0.98)].
Conclusions: A high proportion of individuals without an ACL tear can be accurately identified by considering patient-reported age, injury setting, immediate swelling and family history of ACL tear. These findings directly inform the development of a clinical decision support tool to facilitate timely and accurate ACL tear diagnosis in primary care settings.
Determinants of Isoniazid Preventive Therapy Completion among People Living with HIV Attended Care and Treatment Clinics from 2013 to 2017 in Dar es Salaam Region,Tanzania. A cross-sectional analytical study
Authors: Robert Masanja , Todd Jim , Ngowi Bernard J , Msuya Sia , Ramadhani Angella , Sambu Veryhel , Jerry Isaya , Mujuni Martin R , Mahande Michael J , Ngocho James S , Maokola Werner
Published: March 2020

Background: Tuberculosis (TB) disease is a common opportunistic infection among people living with HIV (PLHIV). WHO recommends at least six months of isoniazid Preventive Therapy (IPT) to reduce the risk of active TB. It is important to monitor completion of IPT, as a suboptimal dose may not protect PLHIV from TB infection. This study determined IPT completion and its determinants among PLHIV aged 15 years or more in Dar es Salaam region, Tanzania. Methods: A Cross-sectional analytical study was conducted using secondary analysis of routine data from 58 care and treatment clinics in Dar es Salaam region. The study recruited clients who screened negative for TB symptoms and initiated IPT between January 2013 and June 2017. Modified Poisson regression model with robust standard errors were used to estimate prevalence ratios (PR) and 95% confidence interval (CI) for factors associated with IPT completion. Multilevel analysis was used to account the health facility random effects in order to estimate independent factors associated with IPT completion. Results : A total of 29,382 clients were initiated on IPT, with 21,808 (74%) female. Overall 17,092 (58%) completed IPT, increasing from 42% (773/1,857) in year 2013 to 76% (2,929/3,856) in 2017. Multilevel multivariable model accounting for health facility as clusters, found that clients with CD4 counts between 100 to 349 cells/ had 3% lower prevalence of IPT completion as compared to those with 100 cells/ (PR:0.97: 95%CI:0.94-1.01). Patients who were not on ART had 46% lower IPT completion compared to those were on ART (PR: 0.54: 95%CI: 0.45-0.64). There was lower IPT completion among clients who transferred to another clinic compared to those attended the same clinic where they were initiated IPT (PR: 0.63: 95% CI (0.54-0.74). Conclusion: IPT completion is low at care and treatment clinics although it increased over time. Lower IPT completion was seen in PLHIV with CD4 counts between 100 to 349 cells/ , those who transferred to other clinics and those not on ART. Thus it indicates the need for better IPT interventions with greater support PLHIV in those groups.
Serum Lipids Profiling Perturbance in Patients with Stable Ischemic Heart Disease and Ischemic Cardiomyopathy
Authors: Yang Lin , Wang Liang , Deng Yangyang , Sun Lizhe , Low Bowen , Yuan Zuyi , Wu Yue , Zhou Bo , Liu Junhui , She Jianqing
Published: March 2020

Background: Ischemic heart disease(IHD) is a common cardiovascular disorder associated with inadequate blood supply to the myocardium. Chronic coronary ischemia leads to ischemic cardiomyopathy (ICM). Despite their rising prevalence and morbidity, few studies have discussed the lipids alterations in these patients. Methods: In this cross-sectional study, we analyzed serum lipids profile in IHD and ICM patients using a lipidomics approach. Consecutive patients admitted to the hospital for stable IHD and ICM were enrolled. Serum samples were obtained after overnight fasting. Nontargeted metabolomics was applied to demonstrate lipids metabolic profile in control, stable IHD and ICM patients. Results: A total of 63 and 62 lipids were detected in negative and positive ion mode respectively. Among them, 16:0 Lyso PI, 18:1 Lyso PI in negative ion mode, and 19:0 Lyso PC, 12:0 SM d18:1/12:0, 15:0 Lyso PC, 17:0 PC, 18:1-18:0 PC in positive ion mode were significantly altered both in IHD and ICM as compared to control. 13:0 Lyso PI, 18:0 Lyso PI, 16:0 PE, 14:0 PC DMPC, 16:0 ceramide, 18:0 ceramide in negative ion mode, and 17:0 PE, 19:0 PC, 14:0 Lyso PC, 20:0 Lyso PC, 18:0 PC DSPC, 18:0-22:6 PC in positive ion mode were significantly altered only in ICM as compared to IHD and control. Conclusion: Using non-targeted metabolomic profiling, we have successfully identified a group of circulating lipids that were significantly altered in stable IHD and ICM. The lipids metabolic signatures shed light on potential new biomarkers and therapeutics for preventing and treating ICM.
Prescribing antidepressants and anxiolytic medications to pregnant women: Comparing perception of risk of foetal teratogenicity between Australian Obstetricians and Gynaecologists, Speciality trainees and upskilled General Practitioners
Authors: Williams Summer , Bruxner George , Ballard Emma , Kothari Alka
Published: March 2020

Background: The decision of whether to prescribe antidepressants (AD) and anxiolytics (AX) to pregnant women is complex, with serious potential ramifications. Clinicians’ perception of the risk of teratogenicity significantly influences their prescribing decisions and in turn impacts maternal decision making. Our cross-sectional study sought to discern differences in perceived risk between Obstetricians and Gynaecologists (O&Gs) and General Practitioners (GPs) when prescribing these medications in pregnancy. Furthermore, we investigated factors impacting perception, clinicians’ willingness to prescribe and their approach to provision of patient information. Methods: This cross-sectional study was conducted via a nation-wide online SurveyMonkey extended to Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) database-derived affiliates: GP diplomates, fellows and trainees (5409 survey invitations: 545 respondents). O&Gs and GPs were compared using Pearson Chi-squared test for categorical variables and the Student t-test for continuous variables. Results: GPs reported higher rates of being aware of up-to-date medication prescription recommendations (57.6%) compared with O&Gs (44.2%). GPs also reported higher rates of training adequacy in psychotropic prescription (56.1% versus 29.0%). There was evidence to suggest GPs level of confidence in knowledge base, initiation and prescription of AD and AX was higher than those of O&Gs. The mean perception of patient non-compliance was similar between clinician groups (approximately 35%), but GPs perceived the extent of patient anxiety as higher compared to O&Gs (mean 73.7% (SD 21.3) versus 63.1% (SD 24.1), p<0.001). Both groups showed a strong preference for improved training rather than patient-focused technology (above 70% for both groups). Conclusion: Further development of clinician training in perinatal psychotropic prescription is warranted.
Detection of Mycobacteria in Paraffin-Embedded Ziehl–Neelsen-Stained Tissues using Digital Pathology
Authors: Sua Luz Fernanda , Bolaños Jhon Edwar , Maya Juliana , Sanchez Aura , Medina Giovanna , Zúñiga-Restrepo Valeria , Fernández-Trujillo Liliana
Published: March 2020

Background Tuberculosis is the first infection-related cause of death worldwide. Early diagnosis of paucibacillary tuberculosis represents a challenge, even with direct tissue examination. Digital pathology allows the digital analysis of tissues to identify microorganisms. We aim to develop a program to detect and quantify typical and atypical mycobacteria in paraffin-embedded Ziehl–Neelsen-stained tissues. Methods Program development: The building of the program, named Pat-Scan, included pathology, systems engineering, and scientific applications. The iScan Coreo Au scanner® was used, and 9 variables were adjusted: Temp Directory Path, Output Directory Path, Server Path, Focus Approach, Focus Mode, AOI Detection Approach, Scan at, No. of Z Layers, and Z Delta. Software parameter settings : Brightness, contrast, sharpness, and red/green/blue. Control module scan and analysis : Ten Ziehl–Neelsen-stained samples were fragmented into 2,000 images and analyzed by a multidisciplinary team to validate the reproducibility of the bacilli images in the tissue, as detected by the software. Results Pat-Scan included software and a scanner that were used to detect and quantify bacilli in paraffin-embedded Ziehl–Neelsen-stained tissues. HD quality image segmentation was performed, and nine planes of the Z-axis were scanned with a 1-micron distance between planes. Image magnification: 40x–80x. Scan time: 10–12 minutes. All samples containing mycobacteria were successfully analyzed by the scanner, and the bacilli could be detected; these results were validated by expert pathologists by microscopy examination, and the presence of bacilli was confirmed in all cases. Conclusions Pat-Scan allowed the identification and quantification of mycobacteria in paraffin-embedded Ziehl–Neelsen-stained tissues, offering a reproducible diagnostic method that reduces the time for diagnosis and does not affect precision. Further validation is needed for application in the clinical setting.
Taxonomic scheme of the order Chaetophorales (Chlorophyceae, Chlorophyta) based on Chloroplast genomes
Authors: Author) Benwen Liu(Former Corresponding , Hu Yu Xin , Hu Zheng Yu , Liu Guo Xiang , Author) Huan Zhu(New Corresponding
Published: March 2020

Background: Order Chaetophorales currently includes six families, namely Schizomeridaceae, Aphanochaetaceae, Barrancaceae, Uronemataceae, Fritschiellaceae, and Chaetophoraceae. The phylogenetic relationships of Chaetophorales have been inferred primarily through phylogenetic analysis based on rDNA sequences. Most studies have primarily focused on intergeneric phylogenetic relationships within this order and the phylogenetic relationships with four other Chlorophycean orders (Chaetophorales, Chaetopeltidales and Oedogoniales, and Volvocales). The phylogenetic relationships among families in order Chaetophorales remain unclear. This study aimed to phylogenetically reconstruct order Chaetophorales and determine the taxonomic scheme and to further the current understanding of the evolution of order Chaetophorales .
Results: In the present study, seven complete and five fragmentary chloroplast genomes
were harvested. Phylogenomic and comparative genomic analysis were performed to determine the taxonomic scheme within Chaetophorales. Consequently, Oedogoniales was found to be a sister to a clade linking Chaetophorales and Chaetopeltidales. Schizomeriaceae, and Aphanochaetaceae clustered into a well-resolved basal clade in Chaetophorales, inconsistent with the results of phylogenetic analysis based on rDNA sequences. Comparative genomic analyses revealed that the chloroplast genomes of Schizomeriaceae and Aphanochaetaceae were highly conserved and homologous, highlighting the closest relationship in this order. Germination types of zoospores precisely correlated with the phylogenetic relationships.
Conclusions: chloroplast genome structure analyses, synteny analyses, and zoospore germination analyses were concurrent with phylogenetic analyses based on the chloroplast genome, and all of them robustly determined the unique taxonomic scheme of Chaetophorales and the relationships of Oedogoniales, Chaetophorales, and Chaetopeltidales.
Genomic Characterization of an Emerging Enterobacteriaceae Species: the First Case of Co-infection With a Typical Pathogen in a Human Patient
Authors: Zhang Zhao , Li Daixi , shi xing , Zhai Yao , Guo Yatao , Zheng Yali , Zhao Lili , He Yukun , Chen Yusheng , Wang Zhanwei , Su Jianrong , Kang Yu , Gao Zhancheng
Published: March 2020

Background: Opportunistic pathogens are important for clinical practice as they often cause antibiotic-resistant infections. However, little is documented for many emerging opportunistic pathogens and their biological characteristics. Here, we isolated a strain of extended-spectrum β-lactamase-producing Enterobacteriaceae from a patient with a biliary tract infection. We explored the biological and genomic characteristics of this strain to provide new evidence and detailed information for opportunistic pathogens about the co-infection they may cause.Results: The isolate grew very slowly but conferred strong protection for the co-infected cephalosporin-sensitive Klebsiella pneumoniae. As the initial laboratory testing failed to identify the taxonomy of the strain, great perplexity was caused in the etiological diagnosis and anti-infection treatment for the patient. Rigorous sequencing efforts achieved the complete genome sequence of the isolate which we designated as AF18. AF18 is phylogenetically close to a few strains isolated from soil, clinical sewage, and patients, forming a novel species together, while the taxonomic nomenclature of which is still under discussion. And this is the first report of human infection of this novel species. Like its relatives, AF18 harbors many genes related to cell mobility, various genes adaptive to both the natural environment and animal host, over 30 mobile genetic elements, and a plasmid bearing blaCTX-M-3 gene, indicating its ability to disseminate antimicrobial-resistant genes from the natural environment to patients. Transcriptome sequencing identified two sRNAs that critically regulate the growth rate of AF18, which could serve as targets for novel antimicrobial strategies. Conclusions: Our findings imply that AF18 and its species are not only infection-relevant but also potential disseminators of antibiotic resistance genes, which highlights the need for continuous monitoring for this novel species and efforts to develop treatment strategies.
Predictors of physical activity in older adults experiencing an emergency hospital admission: a prospective cohort study
Authors: Hartley Peter , Dewitt Amanda L , Forsyth Faye , Romero-Ortuno Roman , Deaton Christi
Published: March 2020

Background Reduced mobility may be responsible for functional decline and acute sarcopenia in older hospitalised patients. The drivers of reduced in-hospital mobility are poorly understood, especially during the early phase of acute hospitalisation. We investigated predictors of in-hospital activity during a 24-hour period in the first 48 hours of hospital admission in older adults. Methods This was a secondary analysis of a prospective repeated measures cohort study. Participants aged 75 years or older were recruited within the first 24 hours of admission. At recruitment, patients underwent a baseline assessment including measurements of pre-morbid functional mobility, cognition, frailty, falls efficacy, co-morbidity, acute illness severity, knee extension strength and grip strength, and consented to wear accelerometers to measure physical activity during the first 7 days (or until discharge if earlier). In-hospital physical activity was defined as the amount of upright time (standing or walking). To examine the predictors of physical activity, we limited the analysis to the first 24 hours of recording to maximise the sample size as due to discharge from hospital there was daily attrition. We used a best subset analysis including all baseline measures. The optimal model was defined by having the lowest Bayesian information criterion in the best-subset analyses. The model specified a maximum of 5 covariates and used an exhaustive search. Results Seventy participants were recruited but eight were excluded from the final analysis due to lack of accelerometer data within the first 24 hours after recruitment. Patients spent a median of 0.50 hours (IQR: 0.21; 1.43) standing or walking. The optimal model selected the following covariates: functional mobility as measured by the de Morton Mobility Index and two measures of illness severity, the National Early Warning Score, and serum C-reactive protein. Conclusions Physical activity, particularly in the acute phase of hospitalisation, is very low in older adults. The association between illness severity and physical activity may be explained by symptoms of acute illness being barriers to activity. Interdisciplinary approaches are required to identify early mobilisation opportunities.
PM2.5 exposure on daily cardio-respiratory mortality in Lima, Peru, from 2010 to 2016.
Authors: Tapia Vilma , Steenland Kyle , Vu Bryan , Liu Yang , Vasquez Vanessa , Gonzales Gustavo Francisco
Published: March 2020

Background: There have been no studies of air pollution and mortality in Lima, Peru. We evaluate whether daily environmental PM 2.5 exposure is associated to respiratory and cardiovascular mortality in Lima during 2010 to 2016.
Methods: We analyzed 86,970 deaths from respiratory and cardiovascular diseases in Lima from 2010-2016. Estimated daily PM 2.5 was assigned based on district of residence. Poisson regression was used to estimate associations between daily district-level PM 2.5 exposures and daily counts of deaths.
Results: An increase in 10 µg/m 3 PM 2.5 on the day before was significantly associated with daily all-cause (respiratory and circulatory) mortality (RR 1.029; CI 95% CI: 1.01 – 1.05) across all ages and in the age group over 65 (RR 1.04; 95% CI: 1.005 – 1.09) which included 74% of all deaths. We also observed associations with circulatory deaths for all age groups (RR 1.06; 95% CI: 1.01 – 1.11), and those over 65 (RR 1.06; 95% CI 1.00 - 1.12). A borderline significant trend was seen (RR 1.05; 95% CI 0.99 – 1.06; p = 0.10) for respiratory deaths in persons aged over 65. Trends were driven by the highest quintile of exposure.
Conclusions: PM 2.5 exposure is associated with daily all-cause, cardiovascular and respiratory mortality in Lima, especially for older people. Our data suggest that the existing limits on air pollution exposure are too high.
Arthroscopic pie-crusting release of the posteromedial c omplex of the knee for surgical treatment of medial meniscus injury
Authors: Han Xu , Wang Peizhao , Yu Jinyang , Wang Xiao , Tan Honglue
Published: March 2020

Background: The posteromedial complex (PMC), including the posterior part of the MCL and the posterior oblique ligament (POL), has a restrictive effect on the opening of the posteromedial gap of the knee in the half-extension position. We evaluated the radiological and clinical results of pie-crusting release of the PMC for arthroscopic meniscal surgery in tight knees.Methods: Sixty patients with posterior injury of the medial meniscus were reviewed. All patients accepted arthroscopic pie-crusting release of the PMC. Fourty patients accepted meniscoplasty, and 20 patients accepted meniscal suturing. To evaluate the arthroscopic opening of the medial gap in 20° half-extension under 11-kg valgus stress, the width of the medial space before and after release were measured. During follow-up, the medial stability was evaluated by radiographic measurements of the joint space width (JSW). MRI was conducted to evaluate healing of the MCL and meniscus. Knee functions were evaluated using VAS, Lysholm, IKDC and Tegner scoring systems.Results: In all patients, meniscus operations were performed without iatrogenic cartilage injury. After PMC release, the arthroscopic width of the medial space was 5.7 ± 0.5 mm, larger than that before release (2.5 ± 0.5 mm, p < 0.01). The follow-up time was 21.93 ± 7.04 months, there was no residual valgus laxity of the knee. The radiographic JSW was 5.97 ± 0.8 mm preoperatively, 9.2 ± 1.1 mm in the 1st week postoperatively, and 6.1 ± 0.9 mm by the 3rd postoperative month, showing no differences between preoperative and 3 months postoperative measurement (p > 0.05). For sutured meniscus, MRI showed healing in 15 patients while five had two-grade abnormal signals. VAS, Lysholm, IKDC and Tegner scores were 1.80 ± 0.51, 80.08 ± 3.74, 82.17 ± 4.64 and 5.48 ± 0.59, respectively, showing significant differences compared with the preoperative scores (5.57 ± 0.69, 48.17 ± 4.22, 51.42 ± 4.02 and 3.20 ± 0.68, respectively, P < 0.01).Conclusions: Pie-crusting release of the PMC can increase the posteromedial space and improve the visual field of the knee under arthroscopy, while neither causing no residual valgus instability of the knee nor affecting the clinical outcome at the final follow-up.
Epidemiologic relationship between periodontitis and type 2 diabetes mellitus
Authors: Wu Chenzhou , Yuan Yihang , Liu Hang-hang , Li Shensui , zhang Bowen , Chen Wen , an zijian , chen siyu , wu yongzhi , han bo , li chunjie , li longjiang
Published: March 2020

Objectives: To systematically review the epidemiologic relationship between periodontitis and type 2 diabetes mellitus (T2DM).Materials and Methods: Four electronic databases were searched up until December 2018. The manual search included the reference lists of the included studies and relevant journals. Observational studies evaluating the relationship between T2DM and periodontitis were included. Meta-analyses were conducted using STATA.Results: A total of 53 observational studies were included. The Adjusted T2DM prevalence was significantly higher in periodontitis patients (OR=4.04, p=0.000), and vice versa (OR=1.58, p=0.000). T2DM patients had significantly worse periodontal status, as reflected in a 0.61 mm deeper periodontal pocket, a 0.89 mm higher attachment loss and approximately 2 more lost teeth (all p=0.000), than those without T2DM. The results of the cohort studies found that T2DM could elevate the risk of developing periodontitis by 34% (p=0.002). The glycemic control of T2DM patients might result in different periodontitis outcomes. Severe periodontitis increased the incidence of T2DM by 53% (p=0.000), and this result was stable. In contrast, the impact of mild periodontitis on T2DM incidence (RR=1.28, p=0.007) was less robust.Conclusions: There is an evident bidirectional relationship between T2DM and periodontitis. Further well-designed cohort studies are needed to confirm this finding.Clinical Relevance: Both dentists and physicians need to be aware of the strong connection between periodontitis and T2DM. Controlling these two diseases might help prevent each other’s incidence.
Tumor Sidedness Could be a High-risk Factor in Patients with Stage II Colon Cancer
Authors: Iguchi Kenta , Mushiake Hiroyuki , Hasegawa Seiji , Inagaki Daisuke , Mikayama Yo , Fukushima Tadao , Numata Masakatsu , Tamagawa Hiroshi , Yukawa Norio , Rino Yasushi , Masuda Munetaka
Published: March 2020

Background : The search for high-risk factors in stage II colon cancer (CC) is ongoing and several high-risk factors for stage II CC have been identified; however, the effects of tumor sidedness on prognosis is not clear. This study aims to determine whether tumor sidedness could be identified as another high-risk factor for stage II CC.
Methods : We retrospectively analyzed 189 patients with stage II CC, following consecutive curative resection surgery performed between 2008 and 2014. We compared clinicopathological findings and long-term outcomes between the patients with right colonic cancer (RCC) and patients with left colonic cancer (LCC). Prognostic factors for survival were determined using univariate and Cox proportional regression analyses.
Results : A total of 72 patients were diagnosed with RCC and 117 patients were diagnosed with LCC. Patients with RCC were significantly older (p < 0.001) than those with LCC, and the number of harvested lymph nodes (HLNs) was greater in the RCC group (RCC: 25 vs. LCC: 19; p = 0.003). The overall survival (OS) was notably worse in the RCC group than the OS in the LCC group (5 year survival rate—RCC: 81.3% vs. LCC: 90.4%; p = 0.025), whereas no significant difference was observed in disease-free survival (5 year survival rate—RCC: 74.8% vs. LCC: 83.4%; p = 0.065). Cox proportional regression analysis showed that tumor sidedness (hazard ratio (HR): 3.78, 95% confidence interval (CI): 1.61–8.85, p = 0.022), gender (HR: 3.27, 95% CI: 1.27–8.47, p = 0.014), and the number of HLNs (HR: 4.58, 95% CI: 1.95–10.74, p < 0.001) were independent prognostic factors for OS.
Conclusion : Patients with a right-sided primary tumor location have more negative prognostic factors and worse long-term outcomes than those with a left-sided primary tumor location in stage II CC. Tumor sidedness is a high-risk factor in stage II CC patients.
A systematic review investigating the effectiveness of face mask use in limiting the spread of COVID-19 among medically not diagnosed individuals: shedding light on current recommendations provided to individuals not medically diagnosed with COVID-19
Authors: Marasinghe Keshini Madara
Published: March 2020

BackgroundFace masks are being used by individuals who are not medically diagnosed with COVID-19 as a means to limit the spread of COVID-19 in several countries around the world. While some countries recommend the use of face masks, other countries do not recommend their use to limit the transmission of COVID-19 among this specific population. Because of contradicting recommendations provided by health authorities of different countries, this paper aims to investigate the availability of scientific evidence on the effectiveness of face mask use in limiting the spread of COVID-19 among individuals who are not medically diagnosed with COVID-19 through a systematic review search. This paper will further discuss concerns around current recommendations provided to those who are not medically diagnosed with COVID-19 regarding face mask use in the context of available evidence.MethodsTo carry out the systematic review on the effectiveness of face mask use in limiting the spread of COVID-19 among individuals who are not medically diagnosed with COVID-19, databases Cochrane Library, EMBASE, Google Scholar, PubMed, and Scopus were searched for relevant studies. Two groups of keywords were combined: those relating to face masks and COVID-19.ResultsThe systematic review search did not find any studies that investigated the effectiveness of face mask use in limiting the spread of this specific virus, COVID-19 among this specific population, those who are not medically diagnosed with COVID-19.ConclusionsIn light of the finding of this systematic review search, which is a lack of scientific evidence on the effectiveness of face masks in limiting the spread of COVID-19 among those who are not medically diagnosed with COVID-19, the significance of this finding is highlighted and extensively discussed in this paper. This paper calls for, but does not limit to; 1) evidence-based recommendations; 2) considerations when providing recommendations in the absence of evidence; 3) evidence and knowledge transparency on current recommendations with the public; 4) global alignment on recommendations; and 5) further research.
A Novel Timing and Frequency Offset Estimation Algorithm for Filtered OFDM System
Authors: Feng Xingle , Wang Mengjie , Chen Li , Zhu Wenxia , Hua Kun
Published: March 2020

As a critical technology of 5G air interface waveform, F-OFDM not only inherits the technical advantages of OFDM, but also has outstanding advantages in system flexibility and spectrum efficiency. However, as a multi-carrier technology, it is still extremely sensitive to sample timing offset (STO) and carrier frequency offset (CFO). In this letter, an improved Park frequency domain training sequence (FS-Park) is proposed to complete STO and CFO estimation of F-OFDM system. Firstly, a real-value pseudorandom number (PN) sequence is sent to each subcarrier as training sequence in frequency domain, the corresponding time domain training symbol has a conjugate symmetry structure. Secondly, the training symbol is utilized for timing synchronization, then the fractional frequency offset is estimated based on the cyclic prefix in time domain. Finally, the integer frequency offset is estimated in frequency domain based on the auto-correlation of PN sequence. The simulation results illustrate that the FS-Park algorithm not only has a single pulse timing metric curve and great STO estimation accuracy, but also has better performance of CFO estimation than classical Park algorithm and Liang Xiao's method.
Severe Acute Respiratory Syndrome Coronavirus 2(SARS-CoV-2) infection during late pregnancy: A Report of 18 patients from Wuhan, China
Authors: Zhang Lu , Dong Lan , Ming Lei , Wei Min , Li Jun , Hu Ruheng , Yang Jing
Published: March 2020

Background Compared with Severe Acute Respiratory Syndrome(SARS) and Middle East Respiratory Syndrome(MESR), Corona Virus Disease 2019(COVID-19) spread more rapidly and widely. The population was generally susceptible. However, reports on pregnant women infected with SARS-CoV-2 were very limited. By sharing the clinical characteristics, treatments and outcomes of 18 patients with COVID-19 during late pregnancy, we hoped to provide some references for obstetric treatment and management. Methods: A total of 18 patients with COVID-19 treated in Renmin Hospital of Wuhan University were collected. The epidemiological characteristics, clinical manifestations, laboratory tests, chest CT and pregnancy outcomes were performed for analysis. Results: 1.18 cases of late pregnancy infected with SARS-CoV-2 pneumonia were delivered at 35 + 5 weeks to 41 weeks. According to the clinical classification of COVID-19, 1 case was mild type, 16 cases were ordinary type, and 1 case was severe type. 2 . According to Imaging examinations: 15 (83%) cases showed unilateral or bilateral pneumonia, 2 (11%) cases had pulmonary infection with pleural effusion, and 1(6%) case had no abnormal imaging changes. 3. Among the 18 newborns, there were 3 (17%) premature infants, 1 (6%) case of mild asphyxia, 5 (28%) cases of bacterial pneumonia, 1 (6%) case of gastrointestinal bleeding, 1 (6%) case of necrotizing enteritis, 2 (11%) cases of hyperbilirubinemia and 1 (6%) case of diarrhea. All the newborns were negative for the first throat swab test of SARS-CoV-2 after birth. 4. Follow-up to Mar 7, 2020, no maternal and neonatal deaths occurred. Conclusions: The majority of patients in late term pregnancy with COVID-19 were of ordinary type, and they less likely developed into critical pneumonia after early isolation and antiviral treatment. Vertical transmission of SARS-CoV-2 was not detected, but the proportion of neonatal bacterial pneumonia was higher than other neonatal diseases in newborns.
Impact of limb salvage versus amputation on overall survival in patients with osteosarcoma of the extremities: an update in the modern era using the National Cancer Database
Authors: Evans Daniel R. , Lazarides Alexander , Visgauss Julia D. , Somarelli Jason A. , III Dan G. Blazer , Brigman Brian E. , Eward William C.
Published: March 2020

Background: Historically, amputation was the primary surgical treatment for osteosarcoma of the extremities; however, with advancements in surgical techniques and chemotherapies limb salvage has replaced amputation as the dominant treatment paradigm. This study assessed the impact of the type of surgical resection on overall survival in the era of modern limb salvage. Methods: Utilizing the largest registry of primary osteosarcoma, the National Cancer Database (NCDB), we retrospectively analyzed patients with high grade osteosarcoma of the extremities from 2004 through 2015. Unadjusted five-year overall survival between patients who received limb salvage and amputation was assessed utilizing Kaplan Meier curves. A multivariate Cox proportional hazard model and propensity matched analysis was used to determine the variables independently correlated with survival. Results: From a total of 3,421 patients, 2,634 underwent limb salvage and 787 underwent amputation. After controlling for confounders, limb salvage was associated with a significant survival benefit over amputation (HR: 0.70; p<0.001). This survival benefit remained significant after propensity matched analysis of all significantly different independent variables (HR: 0.74; p=0.001). Chemotherapy and negative surgical margins were also independently associated with survival.Conclusion: Limb salvage is associated with a significant survival benefit over amputation, even when controlling for potentially confounding variables and differences between cohorts.
Identification of key genes controlling docetaxel resistance in patients with breast cancer
Authors: Jiang Yannan , Qian Yi , Qian Weifeng
Published: March 2020

Breast cancer is the most common malignant tumor in women. Chemotherapy is a very important part of its comprehensive treatment. Docetaxel is a commonly used chemotherapy drug in breast cancer treatment. However, some patients will develop drug resistance during use. To further explore this issue, we conducted an in-depth analysis on gene expression data of 24 breast cancer patients from GEO. Key module and hub genes were searched through WGCNA network construction, KEGG and GO function analysis, PPI network construction and other methods. Functional analysis revealed that the key module mainly related to drug transport events such as phagocytosis, cell-cell adhesion, and extracellular exosome. TCGA data were used to further verify these hub genes. Finally, we screened out 4 most important key genes, RPS2, EEF2, RPL15 and RPLP1, from 55 hub genes. These findings may highlight some therapeutic targets for predicting, avoiding or overcoming docetaxel resistance.
GLUT-1 as a predictor of worse prognosis in pancreatic adenocarcinoma: immunohistochemistry study showing the correlation between expression and survival.
Authors: Boira Maria del Mar Achalandabaso , Martino Marcello Di , Gordillo Carlos , Adrados Magdalena , Martín-Pérez Elena
Published: March 2020

Background. Various parameters have been considered for predicting survival in pancreatic ductal adenocarcinoma. Information about western population is missing. The aim of this study is to assess the association between Glucose transporter type 1 (GLUT-1) expression and prognosis for patients with PDAC submitted for surgical resection in a European cohort.Methods. Retrospective analysis of PDAC specimens after pancreatoduodenectomy assessing GLUT-1 expression according to intensity (weak vs strong) and extension (low if <80% cells were stained, high if > 80%) was performed. Statistical analysis was performed using the exact Fisher test, Student t test or the Mann-Whitney U test. Survival was analysed using the Kaplan-Meier method and compared with the Log-rank test. The differences were considered significant at a two-sided p value of < 0.05. All statistical analyses were performed using SPSS® 23.0 for Windows (SPSS Inc., Chicago, IL, USA).Results. Our study consisted of 39 patients of which 58.9% presented with weak and 41.1% with strong intensity. The median extension was 90%: 28.2% cases presented with a low extension and 71.8% with a high extension. No significant differences related to intensity were found. The high-extension group showed a higher percentage of T3 PDAC (92.9% vs 63.6%, p=0.04) and LNR20 (35.7% vs 0%, p=0.03) as well as shorter disease-free survival (17.58 vs 54.46 months; p=0.05).Conclusions. Our findings suggest that GLUT-1 could be related to higher aggressivity in PDAC and could be used as a prognostic marker, identifying patients with a worse response to current therapies who could benefit from more aggressive treatments.
Shearwave elastography of the knee menisci
Authors: Bedewi Mohamed Abdelmohsen , Elsifey Ayman A , Saleh Ayman K , Alfaifi Tariq
Published: March 2020

Objectives: Sonoelastography is a relatively new technique used to evaluate the musculoskeletal system, but shear wave elastography of the knee menisci has not previously been reported. The purpose of this study is to study sonoelastographic features of the knee menisci. Methods: 34 knee joints were studied, in 17 healthy subjects. Shear wave elastography was used to evaluate the anterior horn of the medial meniscus. Normal sonoelastographic values were obtained. Results: The mean shear elastic modulus of the anterior horn of the right medial meniscus was 24.86 kPa (range 15.3- 36.1 ±6.35 SD), and 23.86 kPa (range14.6-37.6 ± 4.49 SD) for the anterior horn of the left medial meniscus. Inverse correlation was noted between the right medial meniscus elasticity and height. Inverse correlation was noted between the left medial meniscus elasticity and age, while positive correlation was noted between left medial meniscus elasticity and BMI. Conclusion: The elastic modulus of the knee menisci has been determined in healthy subjects and can serve as a reference when studying pathological conditions of these structures .
Evaluating antimicrobial appropriateness in a tertiary care pediatric ICU in Saudi Arabia: A retrospective cohort study
Authors: Kazzaz Yasser M , AlTurki Haneen , Aleisa Lama , Alahmadi Bashaer , Alfattoh Nora , Alattas Nadia
Published: March 2020

Background Two-thirds of antibiotic prescriptions administered in pediatric inpatient care are inappropriate. This inappropriate utilization is associated with the emergence of antimicrobial resistance (AMR) and a decline in antibiotic susceptibility in many pathogenic organisms isolated in intensive care units. Antibiotic stewardship programs (ASPs) have been recommended as a strategy to reduce and delay the impact of AMR. A crucial step in ASPs is understanding antibiotic utilization practices and quantifying the problem of inappropriate antibiotic use to support a targeted solution. We aim to characterize antibiotic utilization and determine the appropriateness of antibiotic prescription in a tertiary care pediatric intensive care unit in Saudi Arabia.Methods A retrospective cohort study was conducted at King Abdullah Specialized Children’s Hospital (KASCH), Riyadh, Saudi Arabia, over a 6-month period. Days of therapy (DOT) and DOT per 1000 patient-days were used as measures of antibiotic consumption. The appropriateness of antibiotic use was assessed by two independent pediatric infectious disease physicians based on the guidelines of the Centers for Disease Control (CDC) 12-step campaign to prevent antimicrobial resistance among hospitalized children.Results During the study period, 497 patients were admitted to the PICU, accounting for 3009 patient-days. A total of 274 antibiotic courses were administered over 2553 antibiotic days. Ceftriaxone, vancomycin, ceftazidime, and cefazolin were responsible for the highest rates of consumption (164.8, 150.5, 91.7, and 83.1 DOTs per 1000 patient-days, respectively). Forty-eight percent of antibiotic courses were found to be nonadherent to at least 1 CDC step. The top reasons were inappropriate antibiotic choice (empirically or definitive) (31.3%) and inappropriate prophylaxis (30.2%). Infectious disease service consultation decreased the likelihood of inappropriate consumption of antibiotics.Conclusions Antibiotic consumption was high in our setting, with significant inappropriate utilization mainly due to empiric choices and the duration of prophylaxis. These data could inform decision-making in antimicrobial stewardship programs and strategies. The CDC steps provide a more objective tool and limit biases when assessing antibiotic appropriateness.
Impact of the “Thinking while Moving in English” intervention on primary school children’s physical activity and academic outcomes: A cluster randomized controlled trial
Authors: Mavilidi Myrto F , Lubans David R , Miller Andrew , Eather Narelle , Morgan Philip J , Lonsdale Chris , Noetel Michael , Karayanidis Frini , Shaw Kylie , Riley Nicholas
Published: March 2020

Background: The majority of children internationally are not sufficiently active. Integrating physical activity into academic lesson time may not only help increase children’s activity levels but also improve learning. The aim of this study was to assess the impact of a classroom-based physical activity intervention on primary school students’ physical activity levels and academic outcomes (i.e., on-task behavior, literacy and executive function skills). Methods: This cluster randomized controlled trial included students ( N = 283) from nine primary schools located in New South Wales, Australia. Schools were allocated to a control (n = 5 schools) or Thinking while Moving in English (TWM-E) (n = 4 schools) conditions. Teachers received professional learning (i.e. one day workshop), resources (e.g. drill ladders, lettered bean bags), and mentoring from the research team. Teachers in the TWM-E condition delivered three 40-min physically active English lessons per week for six weeks, whereas the control condition continued with the usual lessons. For both conditions, assessments occurred at baseline and post-test (six weeks). Children wore accelerometers on their wrists (Axivity) for one week during school time to measure their intensity of physical activity intensity (primary outcome). On-task behavior was assessed using a momentary time sampling procedure and expressed as a percentage of lesson time. Standardized tests were used to assess literacy skills (i.e., spelling, grammar and punctuation) and executive functioning (i.e, inhibition and task shifting). Results: No significant group differences were observed for physical activity outcomes, spelling or executive functions. Compared to the control group, the TWM-E group displayed improved on-task behavior (adjusted mean difference = 18.1% of lesson time, 95% CI [10.12 to 26.02], p < .001, d = 0.53), and improved grammar and punctuation scores (adjusted mean difference = 3.0, 95% CI [ 0.7 to 5.4], p = 0.018, d = 0.16). Conclusions: Despite minimal effect on overall physical activity levels, active lessons have important benefits for students’ on-task behavior and literacy.
Angiotensin AT1 and AT2 receptors heteromer expression in microglia correlates with Parkinson’s disease progression in the hemilesioned rat model of the disease
Authors: Rivas-Santisteban Rafael , Rodriguez-Perez Ana I. , Muñoz Ana , Reyes-Resina Irene , Labandeira-García José Luis , Navarro Gemma , Franco Rafael
Published: March 2020

Background/Aims : The renin-angiotensin system (RAS) is altered in Parkinson’s disease (PD), a disease due to substantia nigra neurodegeneration and whose dopamine-replacement therapy, using the precursor levodopa, leads to dyskinesias as the main side effect. Angiotensin AT 1 and AT 2 receptors, mainly known for their role in regulating water homeostasis and blood pressure and able to form heterodimers (AT 1/2 Hets), are present in the central nervous system. We assessed the functionality and expression of AT 1/2 Hets in Parkinson Disease (PD). Methods: Immunocytochemistry was used to analyze the colocalization between angiotensin receptors, bioluminescence resonance energy transfer was used to detect AT 1/2 Hets. Calcium and cAMP determination, MAPK activation and label-free assays were performed to characterize signaling. Proximity ligation assays was used to quantify receptor expression in microglial cells and brain striatal slices. Results: We confirmed that AT 1 and AT 2 receptors form AT 1/2 Hets that are expressed in cells of the central nervous system. AT 1/2 Hets are novel functional units with particular signaling properties. Importantly, the coactivation of the two receptors in the heteromer reduces the signaling output of angiotensin. Remarkably, AT 1/2 Hets that are expressed in both striatal neurons and microglia show a cross-potentiation, i.e. candesartan, the antagonist of AT 1 increases the effect of AT 2 receptor agonists. In addition, the level of expression in the unilateral 6-OH-dopamine lesion rat PD model increases upon disease progression and is maximal in dyskinetic animals. Conclusion: The results indicate that boosting the action of neuroprotective AT 2 receptors using an AT 1 receptor antagonist constitutes a promising therapeutic strategy in PD.
Using Mixed Methods to Adapt and Evaluate the Implementation of a Multicomponent Tobacco-Free Workplace Program within Behavioral Health Centers
Authors: Leal Isabel Martinez , Chen Tzu-An , Correa-Fernández Virmarie , Le Kathy , O’Connor Daniel P. , Kyburz Bryce , Wilson William T. , Williams Teresa , Reitzel Lorraine R.
Published: March 2020

The authors have withdrawn this preprint from Research Square
Integrated Human-Machine Intelligence for EV Charging Prediction in 5G Smart Grid
Authors: Sun Dedong , Ou Qinghai , Yao Xianjiong , Gao Songji , Wang Zhiqiang , Ma Wenjie , Li Wenjing
Published: March 2020

With the rapid development of the power infrastructures and the increase in the number of electric vehicles (EVs), vehicle-to-grid (V2G) technologies have attracted great interest in both academia and industry as an energy-management technology in 5G smart grid. Considering the inherently high mobility and low reliability of EVs, it is a great challenge for the smart grid to provide on-demand services for EVs. Therefore, we propose a novel smart grid architecture based on network slicing and edge computing technologies for the 5G smart grid. Under this architecture, the bidirectional traffic information between smart grids and EVs is collected to improve the EV charging experience and decrease the cost of energy service providers. In addition, the accurate prediction of EV charging behavior is also a challenge for V2G systems to improve the scheduling efficiency of EVs. Thus, we propose an EV charging behavior prediction scheme based on the hybrid artificial intelligence to identify targeted EVs and predict their charging behavior in this paper. Simulation results show that the proposed prediction scheme outperforms several state-of-the-art EV charging behavior prediction methods in terms of prediction accuracy and scheduling efficiency.