bluuebunny/crossref_metadata_2025 huggingface dataset:
Acupoint injection of Bacillus Calmette–Guerin polysaccharide nucleic acid for patients with chronic urticaria
Authors: Cao Wei , Xiao Xianjun , Zhang Leixiao , Wang Lu , Zheng Qianhua , Zhou Siyuan , Liu Ying , Cao Yue , Chen Mingling , Li Chunxiao , Li Ying
Published: May 2020

Background:

To investigate the efficacy and safety of acupoint injection of Bacillus Calmette–Guerin polysaccharide nucleic acid (BCG-PSN) in the treatment of chronic urticaria (CU).

Methods:

The following databases will be searched from their inception: Medline, Embase, Pubmed, Web of Science, Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure Database, China Biomedical Literature Database, China Science Journal Database, and Wanfang Database. All databases will be searched from the date of creation until October 2019. In addition, we will manually search the list of medical journals as a supplement. The scope of the search included randomized controlled clinical studies related to acupoint injection of BCG-PSN for CU. The primary outcome is the disease activity control. Secondary outcomes include response rate, adverse events, and recurrence rates. The Cochrane RevMan V5.3 Deviation Assessment Tool will be used to assess bias assessment risk, data integration risk, meta-analysis risk, and subgroup analysis risk (if conditions are met). The average difference, standard mean difference and binary data will be used to represent continuous results.

Results:

This study will comprehensively review the existing evidence on the treatment of CU by acupoint injection of BCG-PSN.

Conclusion:

This systematic review will provide a judgment basis for the effectiveness and safety of acupoint injection of BCG-PSN in the treatment of CU.

Systematic review registration:

PROSPERO, CRD42019139885.
Subacute combined degeneration induced by nitrous oxide inhalation
Authors: Zhao Bing , Zhao Lixian , Li Zhixing , Zhao Renliang
Published: May 2020

Rationale:

Nitrous oxide (N2O), commonly known as “laughing gas,” is being increasingly abused by young people as a recreational drug; this can subsequently result in myelopathy and peripheral neuropathy, however, in China, few cases of neurologic deterioration by N2O abuse have been reported.

Patient concerns:

Herein, we present 2 patients who developed progressive limb weakness, numbness, and ataxia. Both of them had recreationally inhaled N2O intermittently for a long time.

Diagnosis:

Subacute combined degeneration (SCD) based on myelopathy and polyneuropathy after N2O abuse.

Interventions:

The 2 patients were treated with cessation of N2O inhalation, methylcobalamin capsule 500 μg tid (ter in die, which means 3 times a day), and compound vitamin B 1 tablet tid p.o.(per os, which means taken orally) for 1 month.

Outcomes:

The symptoms of altered sensation and the patients’ gait improved significantly.

Lessons:

The 2 cases raise awareness of the important mechanisms of N2O neurotoxicity, and clinicians should be made fully aware of such substance-related diseases. The incidence of N2O -induced neurotoxicity is insufficiently recognized and should be considered as an important cause of SCD, especially in adolescents with undifferentiated weakness and abnormal sensation; this is essential because serious complications such as irreversible paralysis can result from the absence of early diagnosis and treatment.
The cardiovascular risk of celecoxib for knee osteoarthritis
Authors: Cheng Shirui , Xin Ming , Zhou Jun , Cheng Ying , Xu Guixing , Zhou Yuanfang , Li Zhengjie , Liang Fanrong
Published: May 2020

Objective:

The aim of this systematic review and meta-analysis is to assess the cardiovascular (CV) risk of celecoxib on knee osteoarthritis (KOA) patients compared with the risk in those prescribed other non-selective non-steroidal anti-inflammatory drugs (NSAIDs), no intervention or placebo-controlled patients.

Methods:

The following databases will be searched: MEDLINE, EMBASE, the Cochrane Library, Web of Science, Chinese Biomedical Literature Database, Chinese Nation Knowledge Infrastructure, Wanfang Database, and the Chongqing VIP from inception to April 1, 2020. All randomized controlled trials (RCTs) of celecoxib that presented data on serious cardiovascular events among KOA patients will be included. Study selection, data extraction, quality assessment, and assessment of risk bias will be performed by 2 reviewers independently. Odds ratios and correlative 95% confidence intervals will be calculated to present the association between the celecoxib and CV risk using Review Manager version 5.3 when there is sufficient available data.

Ethics and dissemination:

This review does not require ethical approval. The results of this review may be published in a peer-reviewed journal or disseminated at relevant conferences.

PROSPERO registration number:

CRD42020166721.
Recent trends in tablet subdivision and factors affecting subdivision in South Korea
Authors: Son Kyung-Bok
Published: May 2020

Tablet subdivision by physicians or patients frequently occurs in various clinical settings for multiple reasons, including dose adjustment, alleviation of swallowing difficulties, or cost savings. However, not all tablets are suitable for subdivision, and it might cause side effects. It is informative to know which medicines are regularly subdivided, which healthcare institutions prescribe subdivided medicines, and to whom the medicines are prescribed from the perspectives of quality of care and patient safety. In this study, we aimed to examine recent trends in tablet subdivision and to address factors associated with subdivision of tablets both at the patient and healthcare institution levels.

The yearly claims data in 2016 retrieved from the National Patients Sample provided by the Health Insurance Review and Assessment (HIRA-NPS). This study used descriptive statistics to examine characteristics of medicines that were frequently prescribed in subdivided forms, and retrieved information regarding the medicines to assess the appropriateness for tablet splitting. Then, we selected five medicines, and performed a multivariate logistic regression analysis to estimate the effect of the variables of interest on tablet subdivision.

We presented the top 25 medicines prescribed in subdivided forms in 2016, and confirmed these medicines could be relevantly halved according to their Summary of Product Characteristics. Of the 25 medicines, 14 (56%), 5 (20%), and 3 (12%) medicines belonged to the respiratory system (R), nervous system (N), and systemic hormonal preparations (H), according to the first category of Anatomical Therapeutic Chemical (ATC) classification system, respectively. Being female at the patient level and tertiary healthcare institutions and private owned institutions at the institution level were positively associated with subdivision of medicines.

Subdivision of tablets frequently occurred for vulnerable populations with various reasons. Female and geriatric patients are prescribed split medicines for clinical reasons, while low-income patients are prescribed nonsplit medicines for cost savings. It would be better if medicines were not so small, and if they had dividing lines on their surfaces to enable successful splitting of the tablet and to protect the health of vulnerable patients. Furthermore, avoid splitting those pharmacotherapies with a narrow therapeutic range, and provide a pharmacist assistance and a splitting device for unavoidable splitting.
Traditional Chinese medicine may reduce the dosage of systemic glucocorticoids in required patients with acute exacerbation of chronic obstructive pulmonary disease
Authors: Zhao Keni , Chen Keling , Huang Qingsong , Gao Peiyang , Zhang Chuantao , Yang Hongjing , Gan Wenfan , Xiao Wei , Sun Zengtao , Xie Xiaohong , Long Kunlan , Zhang Song , Chen Jun
Published: May 2020

Introduction:

Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) involves a severe inflammatory response. Systemic glucocorticoids are very important for the treatment of the acute exacerbation period; however, their use causes serious adverse effects. There is still no evidence on whether traditional Chinese medicine (TCM) can be used to reduce the dosage of systemic glucocorticoids in the treatment of patients with AECOPD.

Methods:

In this trial, we plan to enroll 204 eligible patients with AECOPD who will be randomly assigned to receive TCM or a placebo. The effect of TCM in the treatment of patients with AECOPD will be measured by the dosage of systemic glucocorticoids (at which COPD assessment test [CAT] scores improve by 50%). Safety will also be assessed.

Trial registration:

ChiCTR2000029568.
Development and evaluation of a venous computed tomography radiomics model to predict lymph node metastasis from non-small cell lung cancer
Authors: Cong Mengdi , Yao Haoyue , Liu Hui , Huang Liqiang , Shi Gaofeng
Published: May 2020

The objective of this study was to develop a venous computed tomography (CT)-based radiomics model to predict the lymph node metastasis (LNM) in patients with non-small cell lung cancer (NSCLC). A total of 411 consecutive patients with NSCLC underwent tumor resection and lymph node (LN) dissection from January 2018 to September 2018 in our hospital. A radiologist with 20 years of diagnostic experience retrospectively reviewed all CT scans and classified all visible LNs into LNM and non-LNM groups without the knowledge of pathological diagnosis. A logistic regression model (radiomics model) in classification of pathology-confirmed NSCLC patients with and without LNM was developed on radiomics features for NSCLC patients. A morphology model was also developed on qualitative morphology features in venous CT scans. A training group included 288 patients (99 with and 189 without LNM) and a validation group included 123 patients (42 and 81, respectively). The receiver operating characteristic curve was performed to discriminate LNM (+) from LNM (−) for CT-reported status, the morphology model and the radiomics model. The area under the curve value in LNM classification on the training group was significantly greater at 0.79 (95% confidence interval [CI]: 0.77–0.81) by use of the radiomics model (build by best 10 features in predicting LNM) compared with 0.51 by CT-reported LN status (P < .001) or 0.66 (95% CI: 0.64–0.68) by morphology model (build by tumor size and spiculation) (P < .001). Similarly, the area under the curve value on the validation group was 0.73 (95% CI: 0.70–0.76) by the radiomics model, compared with 0.52 or 0.63 (95% CI: 0.60–0.66) by the other 2 (both P < .001). A radiomics model shows excellent performance for predicting LNM in NSCLC patients. This predictive radiomics model may benefit patients to get better treatments such as an appropriate surgery.
Improvement of a massage chair (BEG-100) on height growth in children with average
Authors: Lee Sun Haeng , Kim Mia , Jeon Chuljin , Cho Soohyun , Choi Min Hyung , Hwang Tae Hwan , Lee Jihong , Chang Gyu Tae , Lee Jin Yong
Published: May 2020

Background:

Studies that examine the growth effects of massage at ages beyond infancy are rare. A recently developed massage chair (BEG-100) targets teenagers who want to increase their growth. The chair can stretch areas around the knee after fixating the knee and ankle areas.

Methods:

This is a clinical study that included 38 children aged 11 years whose heights ranged from 145.0 to 155.0 cm. We aim to observe the potential of a 24-week massage for growth promotion. We will also evaluate the changes in height percentile, height, height standard deviation score, bone age, height standard deviation score for bone age, growth rate, predicted height estimated from bone age, seated height-to-standing height ratio, weight, and body mass index. To confirm safety, the associated adverse events will be investigated.

Objective:

The aim of this study was to investigate the growth-promoting effect of BEG-100 in children with average height.

Trial registration:

KCT0004673 (Clinical Research Information Service).
Clinical efficacy and safety of 6-thioguanine in the treatment of childhood acute lymphoblastic leukemia
Authors: Chen Liang , Yan Huai-Xiu , Liu Xiao-Wei , Chen Wen-Xin
Published: May 2020

Background:

To systematic review the efficacy and safety of 6-thioguanine (6-TG) in the substitute of 6-mercaptopurine (6-MP) in the treatment for patients with childhood acute lymphoblastic leukemia (ALL) in the maintenance phase, and to explore its clinical application value. It provides theoretical guidance for the maintenance treatment of ALL in children from the perspective of evidence-based medicine.

Methods:

By means of computer retrieval, Chinese databases were searched: Chinese Biomedical Database (CBM), China national knowledge internet (CNKI), Chongqing Weipu Database (VIP), and Wanfang Database; Foreign databases: PubMed, The Cochrane Library, Embase, and Web of Science were applied to find out randomized controlled trial (RCT) for 6-TG in childhood acute lymphoblastic leukemia. By manual retrieval, documents without electronic edition and related conference papers were retrieved. The retrieval time ranges from the beginning of the establishment of the databases to September 1st, 2019. According to the inclusion, and exclusion criteria by 3 researchers, the literature screening, data extraction, and research methodological quality evaluation were completed. RevMan 5.3 software was applied to evaluate the quality of the included literature, and Stata 12.0 software was used to conduct meta-analysis of the outcome indicators of the included literature.

Results:

This study systematically evaluated the efficacy and safety of 6-TG in the substitute of 6-MP as a maintenance drug for childhood acute lymphoblastic leukemia. Through the key outcome indicators, this study is expected to draw a scientific, practical conclusion for 6-TG in the treatment of childhood acute lymphoblastic leukemia. This conclusion will provide evidence-based medical direction for clinical treatment.

Conclusion:

The efficacy and safety of 6-TG in the substitute of 6-MP in the maintenance treatment of childhood acute lymphoblastic leukemia will be confirmed through this study. The conclusions will be published in relevant academic journals.

Registration:

PROSPERO (registration number is CRD42020150466).
Eye-acupuncture with rehabilitation therapy for stroke
Authors: Shao Yan , Wang Pengqin , Wang Qi , Yu Lihua , Zhang Lixin , Wang Wei
Published: May 2020

Background:

Stroke survivors are accompanied by dysfunctions, greatly declining their activities of daily living and bringing burden to families and societies. Although modern rehabilitation therapy has a systematic program in post-stroke motor rehabilitation, numbers of patients still recover slowly. Eye-acupuncture (EA), as an important type of acupuncture, has been widely applied effectively in rehabilitation of stroke for about 50 years. So we combine EA with modern rehabilitation which has achieved successful results. Therefore, we need to adopt an objective and accurate evaluation method to study the effect of this method.

Methods:

We aim to design a multi-center, block randomized, parallel control trial to assess the effect of eye-acupuncture combined with rehabilitation training therapy for patients with hemiplegia in the convalescent stage of stroke. 360 patients will be enrolled from 6 centres, with half of them (n = 180) in the control group (routine treatment group) and others (n = 180) in the experimental group (eye-acupuncture combined with routine treatment group). Stratified block randomization will be used in the study and the serial number 001-360 which corresponds to a participant will be assigned to each center randomly. We will use the sequentially sealed envelopes to hide the generating of assignment sequence. The cases of dropouts will be recorded with reasons. And the clinical CRFs will be filled in accurately, completely, and timely for statistical analysis.

Results:

To verify the clinical effects, we will measure the change of bellows from visit 1 to visit 4. Primary outcomes: activity of daily living (ADL) scales (modified Barthel index); simple Fugl–Meyer motor function score; functional magnetic resonance imaging (fMRI) of the brain in the resting state. Secondary outcomes: traditional Chinese medicine (TCM) syndrome score scale; western aphasia battery (WAB); water swallow test; Montreal cognitive assessment (MoCA); growth-associated protein-43 (GAP-43); microtubule-associated protein-2 (MAP-2).

Conclusion:

The results of this study will provide present evidence on assessing effectiveness of EA combined with rehabilitation training for patients with hemiplegia in the convalescent stage of stroke.

Trial registration:

This trial has been registrated in Chinese Clinical Trail Registry with the registration number as ChiCTR1900027835 (http://www.chictr.org.cn/).
Pain-Related Drug Use Among Older Adults With Activity Limiting Pain Who Received Home Care Services
Authors: Beissner Katherine , Brooks Gary , Neville Kevin , Trachtenberg Melissa , Murtaugh Christopher M. , Reid M. Carrington
Published: May 2020

Pain is a common problem for patients receiving home care, often limiting mobility and contributing to functional decline. Pharmacological pain management is common, but all drugs bring some risk of side effects and adverse reactions. The opioid epidemic has brought into question analgesic prescribing patterns across all care settings. This study, which used data collected between 2012 and 2014, examines the pain medications used by older adults with activity-limiting pain receiving home care physical therapy in a large metropolitan home care agency. Eighty-five percent of subjects took at least one analgesic medication on admission to home care, and of these, 51.3% were using an opioid, 33.1% used acetaminophen, and 23.2% used nonsteroidal anti-inflammatory drugs (NSAIDs). At the 60-day follow-up, the most common medication classes taken by participants included acetaminophen (38%), opioids (35.9%), and NSAIDs (31.6%). We found racial/ethnic differences in analgesic use at baseline but not at follow-up. At baseline, analgesic use differed by pain type, but there were no differences at follow-up. The high use of medications to control pain by patients receiving home care, particularly opioid use, underscores the importance of providers being alert to potential adverse drug reactions.
Inclusion and Quality of Life for Older Adults
Authors: Reimer-Kirkham Sheryl , DaCosta Ashley , De Boer Melissa , Dresselhuis Andrea , Hall Barbara , Optland Paula , Pan Melody , Williams Gwendolyn
Published: May 2020

Social inclusion and social determinants of health (SDH) are key to healthy aging, and a failure to adequately address these influences can lead to negative health consequences such as the development and worsening of chronic conditions. Health policy is needed that prioritizes aging well in place as an “upstream” approach to address SDH and thereby improve health outcomes and promote quality of life. Globally, nurses are well positioned to advocate for such policy, given their commitment to fostering social inclusion and quality of life for older adults. This article presents a policy submission, made by nurses enrolled in a graduate health policy course, to Canada's Standing Committee on Human Resources and Social Development and the Status of Persons with Disabilities, for the Committee's report on Advancing Inclusion of and Quality of Life for Seniors (Canada, 2018).
Morvan Syndrome and Diffuse Large B-Cell Lymphoma in the Central Nervous System
Authors: Jiang Chao , Zhang Jing , Jia Chuanyu , Hong Michael , Wang Jiarui , Yang Yining
Published: May 2020

Introduction:

The origin of contactin-associated protein-like 2 (Caspr2) antibodies in patients with Morvan syndrome is currently unknown. This case report investigated a possible association between the production of Caspr2 antibodies and aberrant proliferation of B lymphocytes.

Case Report:

We admitted a critically ill 65-year-old female patient with a suspected infection of the central nervous system (CNS). In addition to acquired neuromyotonia and CNS involvement, Caspr2 antibodies detected in her serum led to the presumptive diagnosis of Morvan syndrome. However, steroid and immunoglobulin treatment did not result in a satisfactory therapeutic outcome. On the basis of findings from immunohistochemistry, flow cytometric analysis, and immunoglobulin/T-cell receptor gene rearrangement detection of cerebrospinal fluid cells, we also made a concurrent diagnosis of diffuse large B-cell lymphoma in the CNS of this patient. The patient then received 4 cycles of rituximab and methylprednisolone therapy with an interval of 2 weeks, which temporarily led to a near-complete remission of her symptoms. Upon follow-up, her symptoms relapsed at 3 months after the last treatment with rituximab and methylprednisolone.

Conclusions:

This is a first reported case of a patient who was concurrently diagnosed with Morvan syndrome and diffuse large B-cell lymphoma in the CNS. Additional studies are needed to determine whether aberrantly proliferating B lymphocytes are responsible for the production of Caspr2 antibodies.
Good Relationships With Parents During Childhood as Buffers of the Association Between Childhood Disadvantage and Adult Susceptibility to the Common Cold
Authors: Cohen Sheldon , Chiang Jessica J. , Janicki-Deverts Denise , Miller Gregory E.
Published: May 2020

Objective

Children reared by parents of low socioeconomic status (SES) go on to have elevated rates of physical health problems and premature mortality. However, many children reared in low-SES families remain healthy throughout the life-span. Here, secondary analyses of archival data tested the hypothesis that a positive relationship with parents during childhood acts as a buffer of the increased risk of adult susceptibility to infectious illness associated with low childhood SES.

Methods

One hundred seventy-six healthy adults reported their childhood SES and the quality of their relationships with their parents during childhood. Relationship quality was defined as parental care, love and support, lack of conflict with parents, and family cohesiveness. Afterward, participants were exposed to a respiratory virus and monitored in quarantine for 5 days for the development of a “common cold” as indicated by infection and objective markers of illness.

Results

The increased risk of developing a cold associated with being reared in a low SES household was attenuated by a positive relationship with parents during childhood (b(SE) = 0.08 (0.03), p = .010). This buffering of disease risk held up across the four components of relationship quality (p values < .05). The association was independent of adult SES, demographics, prechallenge immunity to the virus, current levels of neuroticism and stress, parental divorce during childhood, and number of siblings (p values < .05).

Conclusions

Individuals with positive relationships with their parents during childhood are buffered from the increased risk of adult susceptibility to an infectious disease associated with low childhood SES.
Iranian Nurses' Experiences of Workplace Violence in Prehospital Emergency Care
Authors: Rahmani Azad , Dadashzadeh Abbas , Hassankhani Hadi , Boyle Malcolm , Mohammadi Eesa , Campbell Suzanne
Published: May 2020

Prehospital emergency care nurses experience severe workplace violence. However, despite the widespread violence they experience, this phenomenon has not been well studied among these nurses. Therefore, the purpose of this study was to explore the experiences of Iranian nurses working in prehospital setting regarding workplace violence with a focus on the factors leading to such violence. In this qualitative descriptive study, 23 prehospital nurses participated purposefully. The data were collected by individual face-to-face semistructured interviews and analyzed using content analysis methodology. Data analysis led to the identification of 4 main themes, including job competency mismatch, inadequate resources, criticality of the situation and circumstances, and inadequate awareness and misplaced expectations of society. These nurses have not completed specialized training courses, work in a system that is in a critical situation, and face many barriers and deficiencies in terms of intra- and interorganizational coordination. On the other hand, people in the community do not have sufficient awareness about the duties and services provided by prehospital nurses and thus have unrealistic expectations to receive services. The results showed that there was a deep gap between the prehospital emergency realities and public expectations, leading to workplace violence. Therefore, efforts to improve the working conditions of nurses with an emphasis on teaching specialized prehospital emergency courses, especially violence control courses, promoting intra- and interorganizational coordination, and increasing the equipment and personnel of ambulances for special missions, as well as raising the public awareness and outlining more realistic expectations, may reduce the prevalence of violence against prehospital nurses.
Critical Illness Neuropathy
Authors: Tankisi Hatice , de Carvalho Mamede , Z'Graggen Werner J.
Published: May 2020

Critical illness polyneuropathy (CIP) along with critical illness myopathy (CIM) is a frequent condition in critically ill patients. Similar to critical illness myopathy, the exact incidence, etiology, and mechanisms of CIP are not well understood. Although decreased compound muscle action potential amplitudes may be seen in both conditions, differentiation mostly relies on sensory nerve conduction studies which require special care to perform at intensive care units. In some instances, both CIP and critical illness myopathy are observed, and this condition is called critical illness neuromyopathy. In this review, nerve conduction studies and needle electromyography for the diagnosis of CIP and differentiation of CIP from critical illness myopathy and other conditions at intensive care units are summarized.
Cardioprotective diabetes drugs: what cardiologists need to know
Authors: Brown Jenifer M. , Everett Brendan M.
Published: May 2020

In patients with diabetes, where cardiovascular morbidity is highly prevalent, recent cardiovascular outcomes trials have identified therapies in the modern glucagon-like peptide 1 receptor agonist (GLP-1RA) and sodium-glucose cotransporter 2 inhibitor (SGLT2i) classes that significantly reduce cardiovascular events. A number of drugs in both classes have demonstrated reductions in the risk of the composite outcome of major adverse cardiovascular events (myocardial infarction, stroke, and cardiovascular death). In addition, SGLT2i drugs have a substantial impact on hospitalization for heart failure. Because GLP-1RA and SGLT2i are effective in reducing cardiovascular events, independent of their effects on blood glucose, cardiologists should be familiar with how to use them. This review outlines the evidence of cardiovascular benefit for current GLP-1RA and SGLT2i drugs, practical information for prescribing them, and putative mechanisms, so that these therapies can be incorporated along with antihypertensives, statins, and antiplatelet therapies into the routine care of patients.
Ventricular fibrillation associated with Graves' disease and amiodarone induced thyrotoxicosis
Authors: Cho Jake , Afolabi Bosede
Published: May 2020

This case involves a 55-year-old male patient with systolic heart failure and refractory atrial fibrillation due to thyrotoxicosis, who was electrically cardioverted but then developed torsade de pointes and ventricular fibrillation. Rate control was unsuccessful with digoxin, cardizem, labetalol, esmolol and amiodorone. Patient was externally cardioverted after which ECGs showed prolonged QT with frequent premature ventricular contractions. ECGs also showed ‘R-on-T' phenomenon leading to torsades and ventricular fibrillation. Atrial overdrive pacing was used to terminate the dangerous arrhythmia and the patient returned to sinus rhythm. Interestingly, he was found to have new onset thyrotoxicosis and started on methimazole.
Effects of aerobic and anaerobic exercise on glucose tolerance in patients with coronary heart disease and type 2 diabetes mellitus
Authors: Schwaab Bernhard , Kafsack Friderike , Markmann Edith , Schütt Morten
Published: May 2020

Objectives

In patients with coronary heart disease (CHD) and type 2 diabetes mellitus (T2DM), physical activity is strongly advised as nonpharmacological therapy. In general, a moderate aerobic exercise intensity is recommended. It was also proposed, however, that greater intensities tend to yield even greater benefits in HbA1c. Hence, the most appropriate exercise intensity seems not to be established yet. We compared the effect of moderate (aerobic) and vigorous (anaerobic) activity on postprandial plasma glucose.

Methods

In 10 consecutive patients (63 ± 12 years, BMI 28.3 ± 2.6 kg/m2, fasting plasma glucose 6.1 ± 1.2 mmol/l), 2-hour plasma glucose was ≥11.1 mmol/l in the oral glucose tolerance test at rest (OGTT-0). Cardiopulmonary exercise test (CPX) was performed until a respiratory exchange ratio (RER) ≥1.20, beeing anaerobic (CPX-1), followed by OGTT-1. A steady-state CPX of 30-minute duration was performed targeting an RER between 0.90 and 0.95, being aerobic (CPX-2), followed by OGTT-2.

Results

In CPX-1, maximum exercise intensity (maxIntensity) averaged at 99 ± 30 Watt and peak oxygen consumption (VO2peak) reached 15.9 ± 2.8 ml/min/kg. In CPX-2, aerobic intensity averaged at 29 ± 9 Watt, representing 31% of maxIntensity and 61% of VO2peak. After aerobic exercise, 2-hour plasma glucose was significantly reduced to an average of 9.4 ± 2.3 mmol/l (P < 0.05). Anaerobic exercise did not reduce 2-hour plasma glucose as compared to OGTT-0 (12.6 ± 2.2 vs 12.6 ± 3.9 mmol/l).

Conclusion

Aerobic exercise intensity was very low in our patients with CHD and T2DM. Postprandial plasma glucose was reduced only by aerobic exercise. Larger studies on the optimal exercise intensity are needed in this patient cohort.
Ecologic correlation between underlying population level morbidities and COVID-19 case fatality rate among countries infected with SARS-CoV-2
Authors: Okpokoro Evaezi , Igbinomwanhia Victoria , Jedy-Agba Elima , Kayode Gbenga , Onyemata Ezenwa James , Abimiku Alash’le
Published: May 2020

Background

The ongoing Coronavirus disease 2019 (COVID-19) pandemic is unprecedented in scope. High income countries (HIC) seemingly account for the majority of the mortalities considering that these countries have screened more persons. Low middle income countries (LMIC) countries may experience far worse mortalities considering the existence of a weaker health care system and the several underlying population level morbidities. As a result, it becomes imperative to understand the ecological correlation between critical underlying population level morbidities and COVID-19 case fatality rates (CFR).

Method

This is an ecological study using data on COVID-19 cases, prevalence of COPD, prevalence of tobacco use, adult HIV prevalence, quality of air and life expectancy. We plotted a histogram, performed the Shapiro-Wilk normality test and used spearman correlation to assess the degree of correlation between COVID-19 case fatality rate (CFR) and other covariates mentioned above.

Result

As at the 31st of March 2020, there were a total of 846,281 cases of COVID-19 from 204 countries and a global case fatality rate of 5% (range 0% to 29%). Angola and Sudan both had the highest CFR of 29%, while Italy had the highest number of deaths (i.e. 12,428) as at 31st of March 2020. Adult HIV prevalence has a significant but weak negative correlation with CFR (correlation coefficient = - 0.24, p value =0.01) while all the other variables have positive correlation with CFR due to COVID-19 though not statistically significant. Of the 204 countries analyzed, only 11 countries (i.e. 5%) had complete datasets across all 5 population level morbidities (i.e. prevalence of COPD, prevalence of tobacco use, life expectancy, quality of air, and adult HIV prevalence variables). Correlations of CFR from these 11 countries were similar to that from the 204 countries except for the correlation with quality of air and prevalence of tobacco use. Conclusion: While we interpret our data with caution given the fact that this is an ecological study, our findings suggest that population level factors such as prevalence of COPD, prevalence of tobacco use, life expectancy and quality of air are positively correlated with CFR from COVID-19 but, adult HIV prevalence has a weak and negative correlation with COVID-19 CFR and would require extensive research.
An epidemic CC1-MRSA-IV clone yields false negative test results in molecular MRSA identification assays: a note of caution
Authors: Monecke Stefan , König Elisabeth , Earls Megan R. , Leitner Eva , Müller Elke , Wagner Gabriel , Poitz David M. , Jatzwauk Lutz , Vremerǎ Teodora , Dorneanu Olivia S. , Simbeck Alexandra , Ambrosch Andreas , Zollner-Schwetz Ines , Krause Robert , Ruppitsch Werner , Schneider-Brachert Wulf , Coleman David C. , Steinmetz Ivo , Ehricht Ralf
Published: May 2020

Background

A variety of rapid molecular PCR tests has been developed and commercialised that interrogate the junction site between the staphylococcal core genome, and the mobile genetic element (SCCmec) which harbours the gene responsible for methicillin-/beta-lactam-resistance.

Aim

The purpose of the present study was to investigate why a clinical MRSA isolate yielded false negative test results with widely used, commercial orfX/SCCmec junction site PCR tests.

Methods

A collection of isolates that belonged to the same epidemic strain as the index isolate were investigated with commercial MRSA assays and all isolates were sequenced in order to explain this observation.

Results

It was found that isolates of the epidemic “European CC1-MRSA-IV” clone, which likely originated in South-Eastern Europe and subsequently spread to Western Europe, generally exhibit this behaviour. The failure of the assays was attributable to a characteristic large insertion in the orfX/SCCmec integration site presumably targeted by such tests. In contrast to MW2 (GenBank BA000033.2, a CC1 “USA400” strain which also harbours SCCmec IVa), the European CC1 clone harbours an insertion of ca. 5,350 nucleotides adjacent to orfX. This sequence starts with a novel SCC terminal sequence alternate to dcs and encodes six different hypothetical proteins (E7MHX1, ydiL2, C5QAP8, A8YYX4, npd-SCC, H4AYD7; nucleotide positions 280,690–286,024 of GenBank RBVO000005.1). An SCCmec element with the same insertion was previously found in a Staphylococcus epidermidis isolate (GenBank MH188467.1) suggesting transfer between staphylococcal species.

Conclusion

In order to ensure the reliability of molecular MRSA tests, it is vital to monitor the emergence of new SCCmec junction sites, not only in Staphylococcus aureus but also in coagulase-negative staphylococci.
A novel deterministic forecast model for COVID-19 epidemic based on a single ordinary integro-differential equation
Authors: Köhler-Rieper Felix , Röhl Claudius H. F. , Micheli Enrico De
Published: May 2020

In this paper we present a new approach to deterministic modelling of COVID-19 epidemic. Our model dynamics is expressed by a single prognostic variable which satisfies an integro-differential equation. All unknown parameters are described with a single, time-dependent variable R(t). We show that our model has similarities to classic compartmental models, such as SIR, and that the variable R(t) can be interpreted as a generalized effective reproduction number. The advantages of our approach are the simplicity of having only one equation, the numerical stability due to an integral formulation and the reliability since the model is formulated in terms of the most trustable statistical data variable: the number of cumulative diagnosed positive cases of COVID-19. Once this dynamic variable is calculated, other non-dynamic variables, such as the number of heavy cases (hospital beds), the number of intensive-care cases (ICUs) and the fatalities, can be derived from it using a similarly stable, integral approach. The formulation with a single equation allows us to calculate from real data the values of the sample effective reproduction number, which can then be fitted. Extrapolated values of R(t) can be used in the model to make reliable forecasts, though under the assumption that measures for reducing infections are maintained. We have applied our model to more than 15 countries and the ongoing results are available on a web-based platform [1]. In this paper, we focus on the data for two exemplary countries, Italy and Germany, and show that the model is capable of reproducing the course of the epidemic in the past and forecasting its course for a period of four to five weeks with a reasonable numerical stability.
How many lives can be saved? A global view on the impact of testing, herd immunity and demographics on COVID-19 fatality rates
Authors: Sanchez-Romero Miguel , di Lego Vanessa , Prskawetz Alexia , L Queiroz Bernardo
Published: May 2020

In this work, we assess the global impact of COVID-19 showing how demographic factors, testing policies and herd immunity are key for saving lives. We extend a standard epidemiological SEIR model in order to: (a) identify the role of demographics (population size and population age distribution) on COVID-19 fatality rates; (b) quantify the maximum number of lives that can be saved according to different testing strategies, different levels of herd immunity, and specific population characteristics; and (d) infer from the observed case fatality rates (CFR) what the true fatality rate might be. Different from previous SEIR model extensions, we implement a Bayesian Melding method in our calibration strategy which enables us to account for data limitation on the total number of deaths. We derive a distribution of the set of parameters that best replicate the observed evolution of deaths by using information from both the model and the data.
Agent-Level Pandemic Simulation (ALPS) for Analyzing Effects of Lockdown Measures
Authors: Srivastava Anuj
Published: May 2020

This paper develops an agent-level simulation model, termed ALPS, for simulating the spread of an infectious disease in a confined community. The mechanism of transmission is agent-to-agent contact, using parameters reported for Corona COVID-19 pandemic. The main goal of the ALPS simulation is analyze effects of preventive measures – imposition and lifting of lockdown norms – on the rates of infections, fatalities and recoveries. The model assumptions and choices represent a balance between competing demands of being realistic and being efficient for real-time inferences. The model provides quantification of gains in reducing casualties by imposition and maintenance of restrictive measures in place.
Pandemic Lock-down, Isolation, and Exit Policies Based on Machine Learning Predictions
Authors: Evgeniou Theodoros , Fekom Mathilde , Ovchinnikov Anton , Porcher Raphael , Pouchol Camille , Vayatis Nicolas
Published: May 2020

The widespread lockdowns imposed in many countries at the beginning of the COVID-19 pandemic elevated the importance of research on pandemic management when medical solutions such as vaccines are unavailable. We present a framework that combines a standard epidemiological SEIR (susceptible-exposed-infected-removed) model with an equally standard machine learning classification model for clinical severity risk, defined as an individual’s risk needing intensive care unit (ICU) treatment if infected. Using COVID-19-related data and estimates for France as of spring 2020, we then simulate isolation and exit policies. Our simulations show that policies considering clinical risk predictions could relax isolation restrictions for millions of the lowest-risk population months earlier while consistently abiding by ICU capacity restrictions. Exit policies without risk predictions, meanwhile, would considerably exceed ICU capacity or require the isolation of a substantial portion of population for over a year in order to not overwhelm the medical system. Sensitivity analyses further decompose the impact of various elements of our models on the observed effects.

Our work indicates that predictive modelling based on machine learning and artificial intelligence could bring significant value to managing pandemics. Such a strategy, however, requires governments to develop policies and invest in infrastructure to operationalize personalized isolation and exit policies based on risk predictions at scale. This includes health data policies to train predictive models and apply them to all residents, as well as policies for targeted resource allocation to maintain strict isolation for high-risk individuals.
Mathematical model describing CoViD-19 in São Paulo State, Brazil – Evaluating isolation as control mechanism and forecasting epidemiological scenarios of release
Authors: Yang Hyun Mo , Junior Luis Pedro Lombardi , Castro Fabio Fernandes Morato , Yang Ariana Campos
Published: May 2020

We formulated a mathematical model considering young (below 60 years old) and elder (above 60 years) subpopulations to describe the introduction and dissemination of new coronavirus epidemics in the São Paulo State, Brazil. From the data collected in São Paulo State, we estimated the model parameters and calculated the basic reproduction number asR0= 6.828. Considering isolation as a control mechanism, we varied the releasing proportions of young and elder persons to assess their epidemiological impacts. The best scenarios were release of young persons, but maintaining elder persons isolated. To avoid the collapse of the health care system, the isolation must be at least 80%.
Multiscale Neural Modeling of Resting-state fMRI Reveals Executive-Limbic Malfunction as a Core Mechanism in Major Depressive Disorder
Authors: Li Guoshi , Liu Yujie , Zheng Yanting , Wu Ye , Li Danian , Liang Xinyu , Chen Yaoping , Cui Ying , Yap Pew-Thian , Qiu Shijun , Zhang Han , Shen Dinggang
Published: May 2020

Computational neuroimaging has played a central role in characterizing functional abnormalities in major depressive disorder (MDD). However, most of existing non-invasive analysis tools based on functional magnetic resonance imaging (fMRI) are largely descriptive and superficial, thus cannot offer a deep mechanistic understanding of neural circuit dysfunction in MDD. To overcome this limitation, we significantly improved a previously developed Multiscale Neural Model Inversion (MNMI) framework that can link mesoscopic neural interaction with macroscale network dynamics and enable the estimation of both intra-regional and inter-regional effective connectivity. We applied the improved MNMI approach to test two well-established competing hypotheses of MDD pathophysiology (default mode-salience network disruption vs. executive-limbic network malfunction) based on resting-state fMRI with a relatively large sample size. Results indicate that MDD is primarily characterized by aberrant circuit interactions within the executive-limbic network, rather than the default mode-salience network. Specifically, we observed reduced frontoparietal effective connectivity that potentially contributes to hypoactivity in the dorsolateral prefrontal cortex (dlPFC), and decreased intrinsic inhibition combined with increased excitation from the superior parietal cortex (SPC) that potentially leads to amygdala hyperactivity, together resulting in connectivity imbalance in the PFC-amygdala circuit that pervades in MDD. Moreover, the model unravels reduced PFC-to-hippocampus excitation but decreased SPC-to-thalamus inhibition in MDD population that potentially leads to hypoactivity in hippocampus and hyperactivity in thalamus, consistent with previous experimental data. Overall, our findings provide strong support for the long-standing limbic-cortical dysregulation model in major depression but also offer novel insights into the multi-scale pathophysiology of this deliberating disease.
Public knowledge, attitudes and practices towards COVID-19: A cross-sectional study in Malaysia
Authors: Azlan Arina Anis , Hamzah Mohammad Rezal , Sern Tham Jen , Ayub Suffian Hadi , Mohamad Emma
Published: May 2020

In an effort to mitigate the outbreak of COVID-19, many countries have imposed drastic lockdown, movement control or shelter in place orders on their residents. The effectiveness of these mitigation measures is highly dependent on cooperation and compliance of all members of society. The knowledge, attitudes and practices people hold toward the disease play an integral role in determining a society’s readiness to accept behavioural change measures from health authorities. The aim of this study was to determine the knowledge levels, attitudes and practices toward COVID-19 among the Malaysian public. A cross-sectional online survey of 4,850 Malaysian residents was conducted between 27th March and 3rd April 2020. The survey instrument consisted of demographic characteristics, 13 items on knowledge, 3 items on attitudes and 3 items on practices, modified from a previously published questionnaire on COVID-19. Descriptive statistics, chi-square tests, t-tests and one-way analysis of variance (ANOVA) were conducted. The overall correct rate of the knowledge questionnaire was 80.5%. Most participants held positive attitudes toward the successful control of COVID-19 (83.1%), the ability of Malaysia to conquer the disease (95.9%) and the way the Malaysian government was handling the crisis (89.9%). Most participants were also taking precautions such as avoiding crowds (83.4%) and practising proper hand hygiene (87.8%) in the week before the movement control order started. However, the wearing of face masks was less common (51.2%). This survey is among the first to assess knowledge, attitudes and practice in response to the COVID-19 pandemic in Malaysia. The results highlight the importance of consistent messaging from health authorities and the government as well as the need for tailored health education programs to improve levels of knowledge, attitudes and practices.
Lack of Evidence for a Reduced Late Positive Potential in Major Depressive Disorder
Authors: Nikolin Stevan , Chand Nicholas , Martin Donel , Rushby Jacqueline , Loo Colleen K. , Boonstra Tjeerd W.
Published: May 2020

Background

Individuals with major depressive disorder (MDD) present with deficits in emotional reactivity. Conflicting models have been proposed to explain this effect. We sought to test the emotional context insensitivity hypothesis, which suggests that reactivity to positive and negatively-valenced emotional stimuli is blunted in depression, in a preregistered study.

Methods

Forty-one depressed participants and 41 age- and gender-matched healthy controls were presented a series of unpleasant and neutrally-valenced pictures in a passive view paradigm while acquiring electroencephalography (EEG). The late positive potential (LPP), an EEG correlate of emotional reactivity, was compared between groups using mixed-effects repeated-measures models and exploratory cluster-based permutation tests. A sensitivity analysis was performed to assess the robustness of LPP findings by reanalysing the LPPs using 22 EEG pipelines from studies identified in the literature.

Results

We found no difference in LPP amplitudes between MDD and healthy individuals using the preregistered analysis pipeline. The sensitivity analysis revealed that the magnitude and direction of LPP effect sizes were affected by the analysis pipeline. Exploratory permutation analyses revealed an electrode cluster that showed a significant reduction in the LPP for MDD participants while viewing unpleasant pictures.

Conclusions

These results do not provide evidence in support of the emotional context insensitivity hypothesis, except for the exploratory data-driven approach. Methodological differences, in particular in the analysis pipeline, contribute to the heterogeneity of LPP modulation in depression. A standardised approach to quantify EEG correlates of emotional reactivity is needed to evaluate alternative models of emotional reactivity in depression.