bluuebunny/crossref_metadata_2025 huggingface dataset:
Postnatal Growth of Preterm Infants During The First Two Years of Life: Catch-Up Growth Accompanied by Risk of Overweight
Authors: Han Junyan , Jiang Yuan , Huang Jun , Zhang Yue , Zhang Ying , Zhang Yi , Chen Xiaotian , Li Yun , Yan Weili
Published: July 2020

Background: Early postanal growth of preterm infants has many effects on early and late health. However, evidence on growth pattern in Chinese preterm infant population during early life is insufficient. This study aims to describe the growth trajectory, catch-up growth, and risk of overweight of preterm infants during the first two years of life in a Chinese community population. Methods: All preterm infants (n=10624) received routine childcare in one primary maternal and child healthcare network in eight years were included. Body weight and length/height at corrected age (CA) 40 weeks, CA 3 months, 6 months, 9 months, 12 months, 18 months, and 24 months were extracted and converted to z-scores based on the World Health Organization (WHO) standards. According to the intrauterine growth status, infants were divided into small for gestational age (SGA), appropriate for gestational age (AGA), and large for gestational age (LGA) infants. Changes of z-score were used to describe the growth velocity. Generalized estimating equation (GEE) model was used to analyze growth trajectory trends over time. Results: Body weight and length/height were overall above the WHO standards during the first two years of life. Z-score increased significantly by 0.08 (95%CI: 0.06-0.10) in weight and 0.07 (95%CI: 0.04-0.09) in length/height from CA 40 weeks to 3 months, and then levels off until CA 24 months after adjustment. Over 90% AGA/LGA preterm infants achieved catch-up growth before CA 24 months, with the majority did before CA 3 months. It took more time for SGA infants to achieve catch-up growth than AGA/LGA infants. However, risk of overweight appeared along with catch-up growth, the proportion of infants with risk of overweight being at the peak (25.6% of all preterm infants and 39.4% of LGA infants) at CA 3 months. Growth trajectories of SGA showed declining trends, but those of LGA showed increasing trends during the first two years.Conclusions: Body weight and length/height of preterm infants are above the WHO standards in the Chinese community population during the first two years of life. Catch-up growth is accompanied by the risk of overweight as early as CA 3 months.
Outcomes after renal transplantation of obese patients: a French cohort-based study
Authors: Foucher Yohann , Lorent Marine , Albano Laetitia , Roux Solène , Garrigue Valérie , Lequintrec Moglie , Legendre Christophe , Buron Fanny , Morelon Emmanuel , Girerd Sophie , Ladrière Marc , Glotz Denis , Lefaucher Carmen , Kerleau Clarisse , Dantal Jacques , Branchereau Julien , Giral Magali
Published: July 2020

Background.
Whilst there are numbers of publications comparing the relationship between the body mass index (BMI) of kidney transplant recipients and graft/patient survival, no study was performed in French patients.
Methods.
In this study, cause-specific Cox models were used to study patients and graft survival and several other different times-to-event. Logistic regressions were performed to study surgical complications at 30 days post-transplantation as well as delayed graft function.
Results.
Among the 4691 included patients, 747 patients were considered obese with a BMI level higher than 30 kg/m². We observed a higher mortality of obese recipients (HR = 1.37, p = 0.0086) and higher risks of serious bacterial infections (HR = 1.24, p = 0.0006) and cardiac complications (HR = 1.45, p < 0.0001). We reported a trend with death censored graft survival (HR = 1.22, p = 0.0666) and no significant increased risk of early surgical complications.
Conclusions.
We showed that obesity increased the risk of death and serious bacterial infections and cardiac complications in French kidney transplant recipients. Further epidemiologic studies aiming to compare obese recipients versus obese candidates staying in dialysis are needed for improving the guidelines of access to transplantation of obese patients.
Score for Predicting Active Cancer in Patients with Ischemic Stroke: A Retrospective Study
Authors: Jiang Jiwei , Wang Jirui , Cao Meihui , Zhao Jinming , Shang Xiuli
Published: July 2020

Background: We aimed to examine the differences between the clinical characteristics of patients with ischemic stroke and active cancer and those without cancer and develop a clinical score for predicting occult cancer in patients with ischemic stroke.Methods: This retrospective study enrolled consecutive adult patients with acute ischemic stroke, who were admitted to our department between December 2017 and January 2019. The demographic, clinical, laboratory, and neuroimaging characteristics of patients with ischemic stroke with active cancer and those without cancer were compared. Multivariate analysis was performed to identify independent factors associated with active cancer. Subsequently, a predictive cancer-risk score was developed using the area under the receiver operating characteristic curve.Results: Fifty-three (6.63%) of 799 patients with ischemic stroke had active cancer. The absence of a history of hyperlipidemia [odds ratio (OR)=0.17, 95% confidence interval (CI): 0.06–0.48, P<0.01], elevated serum fibrinogen (OR=1.72, 95% CI: 1.33–2.22, P<0.01) and D-dimer levels (OR=1.43, 95% CI: 1.24–1.64, P<0.01), and stroke of undetermined etiology (OR=22.87, 95% CI: 9.91–52.78, P<0.01) were independently associated with active cancer. Thus, a score based on the absence of hyperlipidemia and serum fibrinogen ≥4.00 g/L and D-dimer ≥2.00 μg/mL predicted active cancer with an area under the curve of 0.83 (95% CI: 0.77–0.89, P<0.01). The probability of active cancer was 59% at a supposed prevalence of 6.63%, if all three independent factors were present in a patient with ischemic stroke.Conclusions: We devised a score to predict active cancer in patients with ischemic stroke based on the absence of a history of hyperlipidemia and elevated serum D-dimer and fibrinogen that highlights the importance of hypercoagulability in these patients and may help determine early intervention and management.
Assessments of immune response to vaccines of transmissible gastroenteritis virus inactivated by different agents
Authors: Zhao Fujie , Liu Lintao , Xu Menglong , Shu Xiangli , Zheng LanLan , Wei Zhanyong
Published: July 2020

Background: Transmissible gastroenteritis virus (TGEV) could cause swine enteric infection, which is characterized by vomiting, severe diarrhea and dehydration, and the mortality in suckling piglets is often high up to 100%. Vaccination is an effective measure to control the disease caused by TGEV.Methods: In this study, cell-cultured TGEV HN-2012 strain was inactivated by formaldehyde (FA), β-propiolactone (BPL) or binaryethylenimine (BEI), respectively. Then the inactivated TGEV vaccine was prepared with freund's adjuvant, and the immunization effects were evaluated in mice. The TGEV-specific IgG level was detected by ELISA.Results: The results showed that the FA group (n=17) developed earlier and stronger TGEV-specific IgG level, while the BEI group could produce much longer-term IgG level. Lymphocyte proliferation test demonstrated that the BEI group showed a stronger inducibility of spleen lymphocyte proliferation. The BEI group got higher positive rates of CD4+ and CD8+ T lymphocyte subsets of peripheral blood lymphocyte than that of the FA and BPL groups through flow cytometry assay. The BPL group had the highest positive rate of CD4+IFN-γ+ T lymphocyte subset, while the positive rate of CD4+IL-4+ T lymphocyte subset was got the best in FA group. Moreover, there were no obvious pathological changes between the vaccinated mice and control group by the macroscopic and histopathological examination.Conclusions: These results indicated that the three experimental groups both induced cellular and humoral immunities, and the FA group had better effect on humoral immunity, while the BEI group showed its excellent effect on cellular immunity.
Distribution of Microbial Generalists and Habitat Specialists in Soils Along a Climate Gradient in the Chilean Coastal Cordillera
Authors: Moskwa Lisa-Marie , Oses Rómulo , Wagner Dirk
Published: July 2020

Background: Recent studies have made significant progress in understanding how microbial composition varies across the major terrestrial biomes. However, they neglected large-scale environmental gradients and a defined set of global environmental predictors, which are applicable within biomes and across gradients, are elusive. We identified the soil microbial community composition on a broad continental scale along the Chilean Coastal Cordillera based on the generalist-specialist concept. Thereby, encompassing surface and subsurface soils from arid, semi-arid, mediterranean, and humid-temperate climate conditions.Results: Our results showed that soil communities from different climate regions are composed of the same subset of taxonomic groups. We further identified generalists, comprising taxa that predominated in all four regions, and habitat specialists that predominated in one or two regions only. We obtained higher proportions of habitat specialists (34 groups) than generalists (22 groups) with an increase of the generalist-to-specialist index along our gradient from North to South. The arid climate region revealed a unique hotspot of microbial specialization (60.1%). Contrary, the mediterranean and semi-arid regions featured mainly boundary-crossing specialists (35.5%).Conclusions: Our study supports that species sorting in response to local environmental factors is a key determinant of microbial community composition and further, the degree of microbial specialization can potentially be linked to the overall ecosystem stability.
Modified CBT for Social Anxiety and Social Functioning in Young Adults with Autism Spectrum Disorder
Authors: Bemmer Emily R , Boulton Kelsie A , Thomas Emma E , Larke Ben , Lah Suncica , Hickie Ian B , Guastella Adam John
Published: July 2020

Background: There is a strong research imperative to investigate efficacious treatment options for adolescents and adults with Autism Spectrum Disorder (ASD). Elevated social anxiety, difficulties with social functioning, and poor mental health have all been identified as core treatment targets for this group. While theoretical models posit a strong bidirectionality between social anxiety and ASD social functioning deficits, few interventions have targeted both domains concurrently. Of the two group interventions previously conducted with adolescents and adults with ASD, significant results have only been observed in either social anxiety or social functioning, and have not generalised to changes in overall mood. The aim of this study was to evaluate the efficacy of a group intervention in young adults with ASD. Primary treatment outcomes were social anxiety symptoms and social functioning difficulties; secondary outcomes were self-reported mood and overall distress. Method: Participants completed an eight-week, modified Cognitive Behavioural Therapy (CBT) group intervention targeting both social anxiety and social functioning. Sixty adolescents and young adults with ASD, without intellectual impairment, aged between 16 and 33 (M = 22.23; SD = 4.62), were recruited from the community, Headspace, and referrals to the Autism Clinic for Translational Research. Outcomes (social anxiety, social functioning and mood) were measured pre- and post-intervention via self-report questionnaires, and participants were invited to provide feedback on the intervention (at the mid-point and end of the intervention).Results: Participants demonstrated statistically significant improvements on all outcome measures in response to the intervention. Specifically, social anxiety symptoms decreased, and social functioning difficulties improved post intervention, particularly in overall social functioning, social awareness and restricted interests and repetitive behaviours. Self-reported symptom improvements also generalised to mood (depression, anxiety and stress). All improvements demonstrated small-to-medium effect sizes. Participant feedback was positive and indicated strong satisfaction with the program.Limitations: The absence of a control group and use of a randomized controlled trial, reliance on self-report instruments as outcome measures, and the exclusion of those with intellectual disability represent significant limitations to this study. Conclusions: These findings indicate that a group CBT intervention is an efficacious treatment for self-reported social anxiety, social functioning and overall mental health in adolescents and young adults with ASD. The standalone nature of the intervention combined with positive participant feedback indicates potential clinical utility, and warrants further study in a randomised-controlled, follow-up design.
Comprehensive Analysis of Mutation-Based and Expressed Genes-Based Pathways in Head and Neck Squamous Cell Carcinoma
Authors: Keam Bhumsuk , Park Jin Young , Kim Jinpyo , Kim Gun Do , Yu Yunsuk , Cho Sang Hee , Kim Sangwoo , Ahn Hee Kyung , Chun Sang Hoon , Kwon Jung Hye , Yun Tak , Kim Ji-Won , Kim Ji Eun , Ahn Myung-Ju , Kim Joo-Hang , Yun Hwan Jung
Published: July 2020

Background: Over- or under-expression of mRNA results from genetic alterations. Comprehensive pathway analyses based on mRNA expression are as important as single gene level mutations. This study aimed to compare the mutation-and mRNA expression-based signaling pathways in head and neck squamous cell carcinoma (HNSCC), and to match these with potential drug or druggable pathways.Methods: Altogether, 93 recurrent/metastatic HNSCC patients were enrolled. We performed targeted gene sequencing using Agilent 244 customized gene panel for NGS, and nanostring nCounter® for mRNA expression. mRNA expression was classified into over- or under expression groups based on the expression levels that showed 2-fold change in tumor compared with non-tumor tissues. We investigated mutational and nanostring data using the CBSJukebox® system, which is a big-data driven platform to analyze druggable pathways, genes, and protein-protein interaction. Analyses were based on 14 databases related to protein interaction, signaling pathways and drugs such as NCBI, Uniprot, KEGG, Biogrid, DIP, HPRD, and Drugbank. High score interaction genes were mapped to investigate druggable pathways. We calculated Treatment Benefit Prediction Score (TBPS) to identify suitable drugs. Results: By mapping the high score interaction genes to identify druggable pathways, we found that highly related signaling pathways with mutation mapping were Influenza A, pathways in cancer, EBV, HPV, HTLV-1 pathways. Based on mRNA expression and interaction gene scoring model, several pathways were found to be associated with over- and under-expression. Comparison between mutation-based pathway and over-/under-expressed genes-based pathways, we observed that 19.8% of NGS based pathways matched with mRNA over-expressed genes-based pathways, and 43.2% of NGS based pathways consist with mRNA under-expressed genes-based pathways. TBPS found several matching drugs such as immune checkpoint inhibitors, EGFR inhibitors, and FGFR inhibitors.Conclusions: Mutation-based pathway was associated with mRNA under-expressed genes-based pathway. These results suggest that HNSCCs are mainly caused by the loss-of-function mutations. However, big data based platform for druggable pathway can find potential matching drugs.
Establishment and Verification of the Nomogram That Predicts the 3-year Recurrence Risk of Epithelial Ovarian Carcinoma
Authors: Hu Jun , Jiao Xiaobing , Zhu Lirong , Guo Hongyan , Wu Yumei
Published: July 2020

Background As we all know, patients with epithelial ovarian carcinoma have poor prognosis and high recurrence rate. It is critical and challenging to screen out the patients with high risk of recurrence. At present, there are some models predicting the overall survival of epithelial ovarian carcinoma, however, there is no widely accepted tool or applicable model predicting the recurrence risk of epithelial ovarian carcinoma patients. The objective of this study was to establish and verify a nomogram to predict the recurrence risk of EOC. Methods We reviewed the clinicopathological and prognostic data of 193 patients with EOC who achieved clinical complete remission after cytoreductive surgery and chemotherapy between January 2003 and December 2013 in Peking University First Hospital. The nomogram was established with the risk factors selected by LASSO regression. The medical data of 187 EOC patients with 5-year standard follow-up in Peking University Third Hospital and Beijing Obstetrics and Gynecology Hospital were used for external validation of the nomogram. AUC curve and Hosmer-Lemeshow test were used to evaluate the discrimination and calibration.Results The nomogram for 3-year recurrence risk was established with FIGO stage, histological grade, histological type, lymph node metastasis status and serum CA125 level at diagnosis. The total score can be obtained by adding the grading values of these factors together. In the external validation, the AUC (C statistics) was 0.803 [95%CI, 0.738-0.867] and the Chi-square value is 11.04 (P=0.135>0.05). With the threshold value of 198, the sensitivity, specificity, positive predictive value, negative predictive value and correct index of the monogram were 75.7%, 77.0%, 83.2%, 67.9%, and 0.52 respectively.Conclusions We established and validated a nomogram to predict 3-year recurrence risk of patients with EOC who achieved clinical complete remission after cytoreductive surgery and chemotherapy. This nomogram with good discrimination and calibration might be useful for screening out the patients with high risk of recurrence.Precis: Establishment and verification of the nomogram predicting the 3-year recurrence risk of EOC
Deferasirox Shows Inhibition Activity Against Cervical Cancer in vitro and in vivo
Authors: Zhou Nan , Cui Yan , Kuang Yuhuan , Hou Jianyuan , Zhu Yumeng , Chen ShuBo , Xu Xin , Tan Ke , Cao Pengxiu , Duan Xianglin , yumei Fan
Published: July 2020

Background: Iron depletion may be a novel therapeutic strategy for cancer. As an oral iron chelator, deferasirox (DFX) is expected to become an anticancer agent. This study aimed to assess the effects of DFX on cervical cancer.Methods: The effects of DFX on cellular iron metabolism, cell viability, cell cycle and apoptosis, and cell invasion were assessed in two cervical cancer cell lines. The effects of DFX on the expression of cell cycle regulators cyclin D1, cyclin E and proliferating cell nuclear antigen (PCNA) were examined. The expression of N-myc downstream regulated gene 1 (NDRG1) and c-myc, and the activation of the MEK/ERK signaling pathway were investigated. The effect of DFX on tumor burden was assessed using a murine xenograft model.Results: DFX decreased the viability of HeLa and SiHa cells, induced cell cycle and apoptosis, and decreased cell invasion. The expression of NDRG1 was upregulated while that of c-myc was downregulated. The activation of the MEK/ERK signaling pathway was inhibited by DFX. DFX also significantly suppressed xenograft tumor growth with no serious side effects, decreased ferritin levels in nude mice serum, and decreased ferritin heavy chain (FTH) expression in xenograft tumor tissue.Conclusions: The inhibitory effect of DFX on cervical cancer cells and xenograft tumor growth was related to its effective depletion of iron in tumor cells. These results demonstrate that DFX has potential as a therapeutic agent for cervical cancer.
Expression, Purification, Refolding and Characterization of A Neverland Protein from Caenorhabditis Elegans
Authors: Mao Shuhong , Song Zhan , Wu Mian , Wang Xiaorui , Lu Fuping , Qin Hui-Min
Published: July 2020

Background: Steroid hormones serving as vital compounds are required for a variety of organisms’ development and metabolism. The neverland (NVD) family genes encode conserved Rieske-type oxygenases, which are accountable for the dehydrogenation during the synthesis and regulation of steroid hormones. However, the His-tagged NVD protein from Caenorhabditis elegans expresses as inclusion bodies in E. coil BL21(DE3). This neck bottle can be solved through refolding by urea or introduction of maltose-binding protein (MBP) tag at N-terminus. Results: Further research on purification after introduction of maltose-binding protein (MBP) tag at N-terminus, CD measurement and fluorescence-based thermal shift assay indicated that MBP was favorable for the NVD proteins’ solubility and stability, which may be beneficial for large-scale manufacture of NVD protein for further research. The structural model contained Rieske [2Fe-2S] domain and non-heme iron-binding motif, which were similar with 3-ketosteroid 9 α-hydroxylase.Conclusions: The successful introduction of maltose-binding protein (MBP) tag at N-terminus could increase the soluble expression of CeNVD, is advantageous for further purification and improvement of thermostability. Our study provides a persuasive case for soluble expression of Rieske-domain oxygenase in E. coli.
An international multi-center investigation on the accuracy of radionuclide calibrators in nuclear medicine theranostics
Authors: Vargas Clarita Saldarriaga , Bauwens Matthias , Pooters Ivo NA , Pommé Stefaan , Peters Steffie MB , Segbers Marcel , Jentzen Walter , Vogg Andreas , Velden Floris HP van , Viol Sebastiaan L Meyer , Gotthardt Martin , Mottaghy Felix M , Wildberger Joachim E , Covens Peter , Wierts Roel
Published: July 2020

Background: Personalized molecular radiotherapy based on theranostics requires accurate quantification of the amount of radiopharmaceutical activity administered to patients both in diagnostic and therapeutic applications. This international multi-center study aims to investigate the clinical measurement accuracy of radionuclide calibrators for 7 radionuclides used in theranostics: 99mTc, 111In, 123I, 124I, 131I, 177Lu and 90Y.Methods: In total, 32 radionuclide calibrators from 8 hospitals located in the Netherlands, Belgium and Germany were tested. For each radionuclide, a set of four samples comprising two clinical containers (10-mL glass vial and 3-mL syringe) with two filling volumes were measured. The reference value of each sample was determined by two certified radioactivity calibration centers (SCK CEN and JRC) using two secondary standard ionization chambers. The deviation in measured activity with respect to the reference value was determined for each radionuclide and each measurement geometry. In addition, the combined systematic deviation of activity measurements in a theranostic setting was evaluated for 5 clinically-relevant theranostic pairs: 131I/123I, 131I/124I, 177Lu/111In, 90Y/99mTc and 90Y/111In.Results: For 99mTc, 131I, and 177Lu, a small minority of measurements were not within ±5% range from the reference activity (percentage of measurements not within range: 99mTc: 6%, 131I: 14%, 177Lu: 24%) and almost none were outside ±10% range. However, for 111In, 123I, 124I and 90Y more than half of all measurements were not accurate within ±5% range (111In: 51%, 123I: 83%, 124I: 63%, 90Y: 61%) and not all were within ±10% margin (111In: 22%, 123I: 35%, 124I: 15%, 90Y: 25%). A large variability in measurement accuracy was observed between radionuclide calibrator systems, type of sample container (vial vs syringe), and source-geometry calibration/correction settings used. Consequently, we observed large combined deviations (percentage deviation > ±10%) for the investigated theranostic pairs, in particular for 90Y/111In, 131I/123I and 90Y/99mTc.Conclusions: Our study shows that substantial over- or under-estimation of therapeutic patient doses are likely to occur in a theranostic setting due to errors in the assessment of radioactivity with radionuclide calibrators. These findings underline the importance of thorough validation of radionuclide calibrator systems for each clinically-relevant radionuclide and sample geometry.
Clinical application of pedicled thoracoacromial artery perforator flaps for tracheal reconstruction
Authors: Deng Di , Xu Feng , Liu Jifeng , Li Bo , Li Linke , Liu Jun , Chen Fei
Published: July 2020

Background
Large or complex trachea defects often require some tissue to reconstruct,various flaps have been reported for reconstructing this defect.However, pedicled thoracoacromial artery perforator flap have not been reported in tracheal reconstruction.Therefore,this study is to assess the efficacy and clinical application of pedicled thoracoacromial artery perforator flaps for tracheal reconstruction.
Methods
Eight patients who underwent tracheal reconstructions with pedicled TAAP flaps between December 2017 and October 2019 were retrospectively reviewed.
Results
All of the pedicled TAAP flaps in our study survived. The flap size ranged from 5 cm by 2 cm to 4 cm by 10 cm, and the size of each island of one double-island flap was 2.5 cm by 2 cm. The mean thickness was 0.6 cm, and the pedicle length varied between 6 cm and 9 cm (mean 7.9 cm). The mean time of flap harvest was 17 min. The mean age of the patients was 62.4 years and five elderly patients had comorbidities,such as diabetes,hypertension and asthma. One patient received a double-island flap for tracheal and esophageal reconstruction, and the other patient received simple tracheal reconstruction. One patient died due to cancer metastasis.Six patients obtained functional recovery of breathing, except one patients who did not experience closure of the tracheostomy opening due to uncompleted I131 treatment.
Conclusion
Pedicled TAAP flaps provide a hairless inner lining, short harvesting time, thin thickness and stable blood supply, and they do not require microsurgical skills. This flap is a good choice for the reconstruction of tracheal defects,especially in the aged or patients with comorbidities who are not able to tolerate prolonged surgery.
Long-term outcomes and prognostic factor analysis of resected Siewert type II adenocarcinoma of esophagogastric junction in China: a seven-year study
Authors: Feng Yiding , Jiang Youhua , Zhao Qiang , Liu Jinshi , Zhang Hangyu , Chen Qixun
Published: July 2020

BACKGROUND
The incidence rate of adenocarcinoma of esophagogastric junction (AEG) was significantly increased over the past two decades. Surgery remians the only way to cure. Indeed, there are currently few studies on Chinese AEG patients. The purpose of this study was to retrospectively analyze the survival and prognostic factors of AEG patients in our center.
METHODS
Between January 2008 and September 2014, 249 AEG patients who underwent radical resection were enrolled in this retrospective study, including 196 males and 53 females, with a median age of 64 (range 31–82). Prognostic factors were assessed with Log-rank test, Cox univariate and multivariate analysis.
RESULTS
The 5-year survival rate of all patients was 49%. The median survival time of all enrolled patients was 70.1 months. Pathology type, intraoperative blood transfusion, tumor size, adjuvant chemotherapy, hospital stay days, serum CA199, CA125, CA242 and CEA, pTNM stage, lymphovascular or perineuronal invasion, and the ratio of positive to negative lymph nodes (PNLNR) were significant associated with overall survival when analyzed with univariate analysis.
CONCLUSIONS
Our study found that intraoperative blood transfusion, tumor size, adjuvant chemotherapy, serum CEA and PNLNR, postoperative hospital stays were independent risk factors.
Cost-effectiveness of the Adaptive Implementation of Effective Programs Trial (Adept): Approaches to Adopting Implementation Strategies
Authors: Eisman Andria B , Hutton David , Prosser Lisa , Smith Shawna , Kilbourne Amy
Published: July 2020

Background
Theory-based methods to support clinician uptake of evidence-based practices (EBPs) are critical to improving mental health outcomes. Costs associated with effective implementation strategies can be substantial, and few have been rigorously evaluated. The purpose of this study is to conduct a cost-effectiveness analysis to identify the most cost-effective approach to deploying implementation strategies to enhance the uptake of Life Goals, a mental health EBP.
Methods
We used data from a previously conducted randomized trial to compare the cost-effectiveness of different augmentations to Replicating Effective Programs (REP) combined with external and/or internal facilitation to enhance uptake of Life Goals. REP is a low-level strategy that includes EBP packaging, training, and technical assistance. External facilitation (EF) involves external expert support, and internal facilitation (IF) augments EF with protected time for internal staff to support EBP implementation. We developed a decision tree to assess 1-year costs and outcomes for four implementation strategies: 1) REP only, 2) REP + EF 3) REP + EF add IF if necessary, 4) REP + EF/IF. The analyses used a 1-year time horizon and assumes a health payer perspective. Our outcome was quality-adjusted life years (QALYs). The economic outcome was the incremental cost-effectiveness ratio (ICER). We conducted deterministic and probabilistic sensitivity analysis (PSA).
Results
Our results indicate that REP + EF add IF is the most cost-effective option with an ICER of $593/QALY. The REP + EF/IF and REP + EF only conditions are dominated. One-way sensitivity analyses indicate that results are sensitive to utilities for REP + EF and REP + EF add IF. The PSA results indicate that REP + EF, add IF is the optimal strategy in 30% of iterations at the threshold of $100,000/QALY.
Conclusions
Our results suggest that the most cost-effective implementation support begins with a less intensive, less costly strategy initially and increases as needed to enhance EBP uptake. Using this approach, implementation support resources can be judiciously allocated to those clinics that would most benefit. Our results were not robust to changes in the utility measure. Further research is needed that incorporates robust and relevant utilities in implementation research to identify the most cost-effective strategies. This research advances economic evaluation of implementation by assessing costs and utilities across multiple implementation strategy combinations.
Trial registration:
ClinicalTrials.gov Identifier: NCT02151331, 05/30/2014
Vitamin D status in adults and children in Transcarpathia, Ukraine
Authors: Shchubelka Khrystyna
Published: July 2020

Background: Vitamin D deficiency is a global health problem, it is assessed by measuring serum 25(OH)D, nevertheless epidemiological data for many countries remains underreported.Objectives: To study the prevalence of vitamin D deficiency throughout the calendar year in a large cohort recruited in a multiethnic Transcarpathian region of Ukraine.Methods: In this retrospective study 25(OH)D serum concentration was measured during all 12 months of the years 2019 by electrochemoluminescent assay “Elecsys Vitamin D total”, Roche® (Germany) on the automatic analyzer Cobas e411 in 1,823 subjects, including both children and adults (1551 females (85.03%) and 273 males (14.97%)).Results: Mean 25(OH) D concentration in adults shows significantly lower levels compared to children (22.67±8.63 ng/ml vs. 26.00±10.72 ng/ml respectively, p=0.00001). Adult women expressed significantly lower mean year serum 25(OH) D concentration in comparison to men (22.29±8.46 ng/ml vs. 25.75±9.38 ng/ml respectively, p= 0.0000003). On the other hand, children did not show a significant difference between sexes (girls 24.98±10.38 ng/ml vs. boys 27.01±11.01 ng/ml, p=0.2003). In the winter months, 25(OH)D levels fell below 20 ng/ml in 51,74 % of adult population of Thranscarpathia, and in 12.91%, - below 12 ng/ml.Conclusions: The results of this study contradict the previously reported evaluations of the vitamin D levels in Ukraine assessed by measuring serum 25(OH)D. Specifically, only around half of the studied population is vitamin D deficient during “low” winter season. This study features the most representative sample size in Ukraine to date.
Systematic Review and Bibliometric Analysis of African Anesthesia and Critical Care Medicine Research Part II: A Scientometric Analysis of the 116 Most Cited Articles
Authors: Kanmounye Ulrick Sidney , Tochie Joel Noutakdie , Mbonda Aime , Solam Cynthia Wafo , Daya Leonid , Atem Thompson Hope , Nyalundja Arsène Daniel , Eyaman Daniel Cheryl
Published: July 2020

Background Scientometrics is used to assess the impact of research in several health fields, including Anesthesia and Critical Care Medicine. The purpose of this study was to define the landscape and key players of Anesthesia and Critical Care Medicine research in Africa.Methods The authors searched Web of Science from inception to May 4, 2020, for articles on and about Anesthesia and Critical Care Medicine in Africa with ≥ 2 citations. Quantitative (H-index) and qualitative (descriptive analysis of yearly publications and interpretation of document, co-authorship, author country, and keyword) bibliometric analyses were done.Results The search strategy returned 116 articles that had a median of 5 (IQR: 3-12) citations on Web of Science. The most frequent journals were Anesthesia and Analgesia (18, 15.5%), World Journal of Surgery (13, 11.2%), and South African Medical Journal (8, 6.9%). Most (74, 63.8%) articles were published on or after 2013, and seven authors had more than 1 article in the top 116 articles: Epiu I (3, 2.6%), Elobu AE (2, 1.7%), Fenton PM (2, 1.7%), Kibwana S (2, 1.7%), Rukewe A (2, 1.7%), Sama HD (2, 1.7%), and Zoumenou E (2, 1.7%). The bibliometric coupling analysis of documents highlighted 10 clusters with the most significant nodes being Biccard BM, 2018; Baker T, 2013; Llewellyn RL, 2009; Nigussie S, 2014; and Aziato L, 2015. Dubowitz G (5) and Ozgediz D (4) had the highest H-indices among the authors referenced by the most-cited African Anesthesia and Critical Care Medicine articles. The U.S.A. had the largest global node, while South Africa and Uganda had the largest African nodes. The most prominent keywords were anesthesia, mortality, and surgery. Conclusion This study highlighted a decline in the number of top-cited African articles and the roles of the U.S.A, Southern African, and East African countries in scholarly output. Future studies should focus on understanding the time trends of the publications.
Atherogenic Index of Plasma is Associated with the Severity of Hidradenitis Suppurativa: A Case Control Study
Authors: Hernández José Luis , Baldeón Cristina , López-Sundh Ana Elísabet , Ocejo-Vinyals J Gonzalo , Blanco Ricardo , González-López Marcos Antonio
Published: July 2020

Background. Hidradenitis suppurativa (HS) is a chronic inflammatory disease associated with several comorbidities and vascular risk factors, such as dyslipidemia. The aim of the present study was to assess the possible associations between the lipid profile and atherogenic indexes and the severity of HS. Methods. This case-control study enrolled 78 HS patients and 62 healthy controls. Classic lipid profile and lipoprotein ratios, including the atherogenic index of plasma (AIP) (log10[triglycerides/HDL-c]) were evaluated. Severity of HS was measured by the HS Physician Global Assessment (PGA). Results. HS-patients had lower serum total cholesterol and HDL-c levels and higher AIP than the control group. AIP was positively correlated to BMI, waist perimeter, systolic and diastolic blood pressure, LDL-c, triglycerides, non-HDL-C, ApoB, HOMA and hs-CRP and negatively to HDL-c and ApoA1. For the overall lipid profile, only AIP was related to a more severe HS (PGA≥3) after controlling for age, sex, BMI, insulin resistance (IR), active smoking and statin use (r=0.268; p=0.023). Multivariable logistic regression adjusted for age, sex, BMI, IR, smoking status and statin use, showed that AIP≥0.5 was significantly associated with the severity of HS (OR, 4.38; CI 95%, 1.09-17.50; p=0.037). Conclusions. In conclusion, our results showed that AIP was significantly and independently associated with HS severity.
Secretory phospholipase A2-X (Pla2g10) is a novel progesterone receptor target gene exclusively induced in uterine luminal epithelium for uterine receptivity in mice
Authors: Park Hee Kyoung , Park So Hee , Lee Miji , Kim Gyeong Ryeong , Park Mira , Yang Seung Chel , Kim Yeon Sun , Kim Hye-Ryun , Song Haengseok
Published: July 2020

Background
Aberration of estrogen (E2) and/or progesterone (P4) signaling pathways affects expression of their target genes, which may lead to failure of embryo implantation and following pregnancy. Although many target genes of progesterone receptors (PRs) have been identified in uterine stroma, only a few PR targets have been reported in the epithelium. Secretory phospholipase A2-(PLA2)-X, a member of the PLA2 family that releases arachidonic acids for the synthesis of prostaglandins that are important for embryo implantation, is dysregulated in the endometrium of patients suffering from repeated implantation failure. However, it is not clear whether sPLA2-X is directly regulated by ovarian steroid hormones for embryo implantation in the uterus.
Result
P4 induced the Pla2g10 encoding of secretory PLA2-X in the apical region of uterine LE of ovariectomized mice via PR in both time- and dose-dependent manners, whereas E2 significantly inhibited it. This finding is consistent with the higher expression of Pla2g10 at the diestrus stage, when P4 is elevated during the estrous cycle, and at P4-treated delayed implantation. The level of Pla2g10 on day 4 of pregnancy (Day 4) was dramatically decreased on Day 5, when PRs are absent in the LE. Luciferase assays of mutagenesis in uterine epithelial cells demonstrated that four putative PR response elements in a Pla2g10 promoter region are transcriptionally active for Pla2g10. Intrauterine delivery of small interfering RNA for Pla2g10 on Day 3 significantly reduced the number of implantation sites, reinforcing the critical function(s) of Pla2g10 for uterine receptivity in mice.
Conclusions
Pla2g10 is a novel PR target gene whose expression is exclusively localized in the apical region of the uterine LE for uterine receptivity for embryo implantation in mice.
Management of early breast cancer during the COVID-19 pandemic in Brazil
Authors: Cavalcante Francisco Pimentel , Novita Guilherme Garcia , Millen Eduardo Camargo , Zerwes Felipe Pereira , de Oliveira Vilmar Marques , Sousa Ana Luiza Lima , Junior Ruffo Freitas
Published: July 2020

Purpose: The COVID-19 pandemic has impacted early breast cancer (EBC) treatment worldwide. This study analyzed how Brazilian breast specialists are managing EBC. Methods: An electronic survey was conducted with members of the Brazilian Society of Breast Specialists between April 30 and May 11, 2020. Bivariate analysis was used to describe changes in how specialists managed EBC at the beginning and during the pandemic, according to molecular subtype and oncoplastic surgery. Results: The response rate was 34.4% (503/1,462 specialists). At the beginning of the pandemic, 43% changed their management approach. As the outbreak progressed, this proportion increased to 69.8% (p<0.001). For hormone receptor-positive tumors with the best prognosis (Ki67<20%), 47.9% and 17.7% of specialists would recommend neoadjuvant endocrine therapy for postmenopausal and premenopausal women, respectively. For tumors with poorer prognosis (Ki67>30%), 34% and 10.9% would recommend it for postmenopausal and premenopausal women, respectively. Menopausal status significantly affected whether the specialists changed their approach (p<0.00001). For tumors ≥1.0 cm, 42.9% of respondents would recommend neoadjuvant systemic therapy for triple-negative tumors and 39.6% for HER2+ tumors. Overall, 63.4% would recommend immediate total breast reconstruction, while only 3.4% would recommend autologous reconstruction. In breast-conserving surgery, 75% would recommend partial breast reconstruction; however, 54.1% would contraindicate mammoplasty. Furthermore, 84.9% of respondents would not recommend prophylactic mastectomy in cases of BRCA mutation.Conclusions: Important changes occurred in EBC treatment, particularly for hormone receptor-positive tumors, as the outbreak progressed in each region. Systematic monitoring could assure appropriate breast cancer treatment, mitigating the impact of the pandemic.
Most patients with COPD are unaware of their health threats and are not diagnosed: national-level study using pulmonary function test
Authors: PARK MYUNGBAE , Lee Ji-ho , Lee Jinhee
Published: July 2020

Background: There is public health risk due to COPD underdiagnosis. To decrease the rate of underdiagnosed COPD and to plan strategies for efficient screening for disease management, we investigated the national-level prevalence of COPD by airflow obstruction.Methods: We performed pulmonary function test (PFT) in 24,454 adults aged >40 years, based on 8 years (2010-2017) of data. FEV1/FVC ratio of <0.70 was defined as COPD. We performed multivariate logistic regression analysis by adjusting dependent variable to determine if each factor was related to COPD.Results: The annual COPD prevalence increased from 13.1% in 2010 to 14.6% in 2012 followed by 13.3% in 2017. The proportion of potential high-risk group that was not diagnosed with COPD and other respiratory diseases was 80.8% in 2010 and 78.1% in 2017 ranging between 73.0% and 86.2%. Multivariate logistic regression showed that ever smokers in the COPD diagnosed patient group had a 2.38 times higher rate of diagnosis than never smokers. Furthermore, the group with PY of 4Q had a 2.81 times higher diagnosis rate than that of 1Q. Regarding the potential high-risk group, the ever smokers, current smokers, and heavy smokers had a higher prevalence than never smokers.Conclusion: Although COPD prevalence was high in the ever, current, and heavy smokers, only the diagnosis rate of COPD in ever smokers was 2.38 times higher than never smokers, indicating that smoking is the most important cause of COPD.
Automated computed tomography quantification of fibrosis predicts prognosis in combined pulmonary fibrosis and emphysema in a real-world setting-A single-centre, retrospective study
Authors: Nemoto Masahiro , Nei Yuichiro , Bartholmai Brian , Yoshida Kazuki , Matsui Hiroki , Nakashita Tamao , Motojima Shinji , Aoshima Masahiro , Ryu Jay H.
Published: July 2020

Background: Combined pulmonary fibrosis and emphysema (CPFE) is a heterogeneous clinico-radiological syndrome without a consensus definition. There are limited data on the relation between the amount of parenchymal fibrosis and prognosis. In this study, we assessed the prognostic implications of the extent of fibrosis assessed by an automated quantitative computed tomography (CT) technique and the radiological and functional change over time in patients with a broad spectrum of fibrotic interstitial lung diseases (ILDs) encountered in a real-world setting.Methods: We conducted a single-centre, retrospective study of 228 consecutive patients with CPFE, encountered from 2007 to 2015 at Kameda Medical Center, Chiba, Japan. We investigated the prognostic value of automated CT fibrosis quantification and the subsequent course of CPFE. Results: Among 228 patients with CPFE, 89 had fibrosis affecting <5% of their lungs, 54 had 5 to <10% fibrosis, and 85 had ≥10% fibrosis at the time of diagnosis. Lower volume of fibrosis correlated with lower rates of mortality and acute exacerbation (p<0.001). In particular, among those with <5% fibrosis, only 4.5% died and none experienced acute exacerbation during follow-up, whereas 57.6% and 29.4% of those with ≥10% fibrosis experienced death and acute exacerbation, respectively. The Cox proportional hazard model for CPFE progression (defined by composite criteria of death, acute exacerbation, and decline in forced vital capacity or diffusing capacity) showed fibrosis proportion was a risk factor independent of age, sex, smoking pack-years, the Charlson Comorbidity Index, lung cancer, connective tissue disease, and idiopathic pulmonary fibrosis.Conclusions: Less severe (<5%) fibrosis at baseline was associated with disease stability and better prognosis compared to more severe fibrosis in CPFE occurring with fibrotic ILDs. Further studies including a validation cohort will be needed.Trial Registration: retrospectively registered
Occult Foreign Body Aspirations in Pediatric Patients: 20-years of Experience
Authors: Liu Bo , Ding Fengxia , An Yong , Pan Zhengxia , Wang Gang , Dai Jiangtao , Li Hongbo , Wu Chun
Published: July 2020

Background: The purpose of our study was to assess the frequency of occult foreign body aspiration (FBA) and to evaluate the diagnostic difficulties and therapeutic methods for these patients. Methods: Between May 2000 and May 2020, 3557 patients with the diagnosis of FBA were treated in our department. Thirty-five patients with occult FBA were included in this study. A retrospective analysis of medical records was performed. Results: Twenty-three male patients (65.7%) and 12 female patients (34.3%) were hospitalized due to occult FBA. The average age was 3.60 years (range 9 months-12 years). Most of the patients were younger than 3 years old (n=25, 71.4%). Coughing (n=35, 100%) and wheezing (n=18, 51.4%) were the main symptoms and signs. All the patients were found to have a FBA under the fiberoptic bronchoscope. The most common organic foreign bodies were peanuts (n=10) and the most common inorganic foreign bodies were pen caps (n=5). The extraction of foreign bodies under rigid bronchoscopy was applied successfully in 34 patients. Only one patient needed a surgical intervention. Conclusions: Occult FBA should always be considered in the differential diagnosis of chronic or recurrent respiratory diseases that are poorly explained, even in the absence of a previous history of aspiration.
Impact of emphysema on sputum culture conversion in male patients with pulmonary tuberculosis: a retrospective analysis
Authors: Takasaka Naoki , Seki Yoshitaka , Fujisaki Ikumi , Uchiyama Shota , Matsubayashi Sachi , Sato Akihito , Yamanaka Yumie , Odashima Kyuto , Kazuyori Taisuke , Seki Aya , Takeda Hiroshi , Ishikawa Takeo , Kuwano Kazuyoshi
Published: July 2020

Background Although cigarette smoking may have a negative impact on the clinical outcome of pulmonary tuberculosis (PTB), few studies have investigated the impact of smoking-associated lung diseases. Emphysema is a major pathological finding of smoking-related lung damage. We aimed to clarify the effect of emphysema on sputum culture conversion rate for Mycobacterium tuberculosis (MTB).Methods We retrospectively studied 79 male patients with PTB confirmed by acid-fast bacillus smear and culture at Jikei University Daisan Hospital between January 2015 and December 2018. We investigated the sputum culture conversion rates for MTB after starting standard anti-TB treatment in patients with or without emphysema. Emphysema was defined as Goddard score ≥1 based on low attenuation area < -950 Hounsfield Unit (HU) using computed tomography (CT). We also evaluated the effect on PTB-related CT findings prior to anti-TB treatment.Results Mycobacterial median time to culture conversion (TCC) in 39 PTB patients with emphysema was 52.0 days [interquartile range (IQR) 29.0–66.0 days], which was significantly delayed compared with that in 40 patients without emphysema (28.0 days, IQR 14.0–42.0 days) (p<0.001, log-rank test). Multivariate Cox proportional hazards analysis showed that the following were associated with delayed TCC: emphysema [hazard ratio (HR): 2.50; 95% confidence interval (CI): 1.24–5.04; p=0.011), cavities (HR: 2.20; 95% CI: 1.22–3.97; p=0.009) and baseline time to TB detection within 2 weeks (HR: 2.85; 95% CI: 1.60–5.08; p<0.0001). Cavities were more often identified by CT in PTB patients with than without emphysema (69.2% vs 45.0%; p=0.03).Conclusions This study suggests that emphysema poses an increased risk of delayed TCC in PTB. Emphysema detection by CT might be a useful method for prediction of the duration of PTB treatment required for sputum negative conversion.