bluuebunny/crossref_metadata_2025 huggingface dataset:
Multicentre Cohort Study of the Impact of Percutaneous Coronary Intervention on Patients With Concurrent Cancer and Ischaemic Heart Disease
Authors: Nishikawa Tatsuya , Morishima Toshitaka , Okawa Sumiyo , Fujii Yuki , Otsuka Tomoyuki , Kudo Toshihiro , Fujita Takeshi , Kamada Risa , Yasui Taku , Shioyama Wataru , Oka Toru , Tabuchi Takahiro , Fujita Masashi , Miyashiro Isao
Published: November 2020

Background: The incidence of concurrent cancer and ischaemic heart disease (IHD) is increasing; however, the long-term patient prognoses remain unclear.Methods: Five-year all-cause mortality data pertaining to patients in the Osaka Cancer Registry, who were diagnosed with colorectal, lung, prostate, and gastric cancers between 2010 and 2015, were retrieved and analysed together with linked patient administrative data. Patient characteristics (cancer type, stage, and treatment; coronary risk factors; medications; and time from cancer diagnosis to index admission for percutaneous coronary intervention (PCI) or IHD diagnosis), were adjusted for propensity score matching. Three groups were identified: patients who underwent PCI within 3 years of cancer diagnosis (n=564, PCI+ group), patients diagnosed with IHD within 3 years of cancer diagnosis who did not undergo PCI (n=3058, PCI-/IHD+ group), and patients without IHD (n=27,392, PCI-/IHD- group). Kaplan-Meier analysis was used for comparisons. Results: After propensity score matching, the PCI+ group had better prognosis (n=489 in both groups, hazard ratio 0.64, 95% confidence interval 0.51–0.81, P<0.001) than the PCI-/IHD+ group. PCI+ patients (n=282) had significantly higher mortality than those without IHD (n=280 in each group, hazard ratio 2.88, 95% confidence interval 1.90–4.38, P<0.001). Conclusions: PCI might improve the long-term prognosis in cancer patients with IHD. However, these patients could have significantly worse long-term prognosis than cancer patients without IHD.
Unraveling US National COVID-19 Racial/Ethnic Disparities using County Level Data Among 328 Million Americans
Authors: Li Daniel , Gaynor Sheila , Quick Corbin , Chen Jarvis , Stephenson Briana , Coull Brent , Lin Xihong
Published: November 2020

Racial and ethnic disparities in COVID-19 outcomes reflect the unequal burden experienced by vulnerable communities in the United States (US). Proposed explanations include socioeconomic factors that influence how people live, work, and play, and pre-existing comorbidities. It is important to assess the extent to which observed US COVID-19 racial and ethnic disparities can be explained by these factors. We study 9.8 million confirmed cases and 234,000 confirmed deaths from 2,990 US counties (3,142 total) that make up 99.8% of the total US population (327.6 out of 328.2 million people) through 11/8/20. We found national COVID-19 racial health disparities in US are partially explained by various social determinants of health and pre-existing comorbidities that have been previously proposed. However, significant unexplained racial and ethnic health disparities still persist at the US county level after adjusting for these variables. There is a pressing need to develop strategies to address not only the social determinants but also other factors, such as testing access, personal protection equipment access and exposures, as well as tailored intervention and resource allocation for vulnerable groups, in order to combat COVID-19 and reduce racial health disparities.
ΔNp63 is a pioneer factor that binds inaccessible chromatin and elicit chromatin remodeling
Authors: Yu Xinyang , Singh Prashant K. , Tabrejee Shamira , Sinha Satrajit , Buck Michael
Published: November 2020

Background: ΔNp63 is a master transcriptional regulator playing critical roles in epidermal development and other cellular processes. Recent studies suggest that ΔNp63 functions as a pioneer factor that can target its binding sites within inaccessible chromatin and induce chromatin remodeling. Methods: In order to examine if ΔNp63 can bind to inaccessible chromatin and to determine if specific histone modifications are required for binding we induced ΔNp63 expression in two p63 naive cell line. ΔNp63 binding was then examined by ChIP-seq and the chromatin at ΔNp63 targets sites was examined before and after binding. Further analysis with competitive nucleosome binding assays was used to determine how ΔNp63 directly interacts with nucleosomes. Results: Our results show that before ΔNp63 binding, targeted sites lack histone modifications, indicating ΔNp63’s capability to bind at unmodified chromatin. Moreover, the majority of the sites that are bound by ectopic ΔNp63 expression exist in an inaccessible state. Once bound ΔNp63 induces acetylation of the histone and the repositioning of nucleosomes at its binding sites. Further analysis with competitive nucleosome binding assays reveal that ΔNp63 can bind directly to nucleosome edges with significant binding inhibition occurring within 50 bp of the nucleosome dyad. Conclusion: Overall, our results demonstrate that ΔNp63 is a pioneer factor that binds nucleosome edges at inaccessible un-modified chromatin sites and induces histone acetylation and nucleosome repositioning.
Synthesis and characterization of Na-P1 (GIS) zeolite using a kaolinitic rock
Authors: Novembre Daniela , Gimeno Domingo , Vecchio Alessandro Del
Published: November 2020

This work focuses on the hydrothermal synthesis of Na-P1 zeolite by using a kaolinite rock coming from Romana (Sassari, Italy). The kaolin is calcined at a temperature of 650 °C and then mixed with calculated quantities of NaOH. The synthesis runs are carried out at ambient pressure and at variable temperatures of 65 ° and 100 °C. For the first time compared to the past, the Na-P1 zeolite is synthesized without the use of additives and through a protocol that reduces both temperatures and synthesis times. The synthesis products are analysed by X-ray diffraction, high temperature X-ray diffraction, infrared spectroscopy, scanning electron microscopy and inductively coupled plasma optical emission spectrometry. The cell parameters are calculated using the Rietveld method. Density and specific surface area are also calculated. The absence of amorphous phases and impurities in synthetic powders is verified through quantitative phase analysis using the combined Rietveld and reference intensity ratio methods.The results make the experimental protocol very promising for an industrial transfer.
Fuzzy Ideal Supra Topological Spaces
Authors: Abbas Fadhil
Published: November 2020

In this paper, we introduce the notion of fuzzy ideals in fuzzy supra topological spaces. The concept of a fuzzy s-local function is also introduced here by utilizing the s-neighbourhood structure for a fuzzy supra topological space. These concepts are discussed with a view to nd new fuzzy supra topologies from the original one. The basic structure, especially a basis for such generated fuzzy supra topologies and several relations between different fuzzy ideals and fuzzy supra topologies are also studied here. Moreover, we introduce a fuzzy set operator ΨS and study its properties. Finally, we introduce some sets of fuzzy ideal supra topological spaces (fuzzy *-supra dense-in-itself sets, fuzzy S*-supra closed sets, fuzzy *-supra perfect sets, fuzzy regular-I-supra closed sets, fuzzy-I-supra open sets, fuzzy semi-I-supra open sets, fuzzy pre-I-supra open sets, fuzzy α-I-supra open sets, fuzzy β-I-supra open sets) and study some characteristics of theses sets and then we introduce some fuzzy ideal supra continuous functions.
Benefit Class of Second-line Anti-diabetic Medication on Types of Dementia in Type 2 Diabetes: A Nationwide Real-world Longitudinal Study
Authors: Kim Won Jun , Noh Jung Hyun , Han Kyungdo , Park Cheol-Young
Published: November 2020

BackgroundTo investigate the association between treatment of anti-diabetic agents and dementia in type 2 diabetes mellitus using an extensive dataset from the Korean National Health Insurance System and Health Screenings. MethodsAfter excluding anyone younger than 40, those taking no anti-diabetic medications within 1 yr of the examination, anyone diagnosed with dementia before the examination or its development within 1 yr of the examination, and those with missing data, 1,578,322 individuals with diabetes prescribed an anti-diabetic agent (metformin (Met), sulfonylurea (SU), thiazolidinedione (TZD), dipeptidyl peptidase-4 inhibitor (DPP-4i), meglitinide (Megl), alpha-glucosidase inhibitor(AGI) and/or insulin) between 2009 and 2012 were identified from the Korean National Health Insurance Service Database, where 701,193 individuals taking oral dual therapy were tracked until 2017. All-cause, Alzheimer’s (AD) and vascular dementia (VaD) were investigated by oral dual therapy. Adjustments were made for age, sex, income, diabetes duration, hypertension, dyslipidaemia, smoking, drinking, exercise, BMI, glucose level and estimated glomerular filtration rate. Results Compared with dual therapy with Met + SU, dual therapy with Met + DPP-4i, Met + TZD, and SU + TZD, was associated with lower all-cause dementia (HR (95% CI) = 0.904 (0.879-0.929), 0.804 (0.767-0.844), and 0.962 (0.929-0.996), respectively) and VaD (HR (95% CI) = 0.865 (0.806-0.928), 0.725 (0.64-0.822), and 0.911 (0.833-0.995), respectively) after adjustment. Also, compared with the group treated with Met + SU, those treated with Met + DPP-4i and Met + TZD were associated with a significantly lower risk of AD (HR (95% CI) = 0.922 (0.894-0.951) and 0.812 (0.77-0.857)) except for SU + TZD (HR (95% CI) = 0.971 (0.934-1.01)). Dual therapy with TZD was associated with a significantly lower risk of all-cause dementia, AD, and VaD than nonusers of TZD (HR (95% CI) = 0.918 (0.892-0.944), 0.925 (0.896-0.955) and 0.859 (0.798-0.924), respectively). Conclusions Adding TZD or DPP-4i instead of SU as second-line treatment in combination with first-line Met may be considered for delaying or preventing dementia. Also, TZD users relative to TZD non-users on dual therapy had a significantly lower risk of all types of dementia.
Parameterization of physical properties of layered body structure into equivalent circuit model
Authors: Lee Jiho , Park Sung
Published: November 2020

BackgroundThis study presents a novel technique to develop an equivalent circuit model (ECM) for analyzing the responses of the layered body structure to transcutaneous electrical nerve stimulation (TENS) by parameterizing electrical and geometrical properties. Many classical ECMs use custom meta-parameters instead of the physically driven parameters because of the difficulty in projecting physical properties directly into ECM. However, the difference in what parameters are customized hampers general agreement in modeling the responses to TENS. To overcome this limitation, we propose a tissue property-based (TPB) approach for the direct parameterization of the layered body structure.ResultsThe proposed method was first validated through in vitro phantom studies and then was applied in-vivo to analyze the TENS on the forearm. The TPB-ECM calculated the impedance network in the forearm and corresponding the responses to TENS. In addition, the modeled impedance was in good agreement with well-known impedance properties that have been achieved empirically.ConclusionsThe TPB approach uses the physical parameters instead of meta-parameters, thus overcoming the disagreement problem of conventional ECMs. Therefore, the TPB-ECM has a potential for widely-applicable TENS analysis and could provide impactful guidance in the TENS parameter design.
Algal Magnetic Nickel Oxide Nanocatalyst in Accelerated Synthesis of Pyridopyrimidine Derivatives
Authors: Buazar Foad , Moavi Javad , Sayahi Mohammad Hosein
Published: November 2020

This research presents a novel biological route for the biosynthesis of nickel oxide nanoparticles (NiO NPs) using marine macroalgae extract as a reducing and coating agent under optimized synthesis conditions. XRD and TEM analyses revealed that phytosynthesized NiO NPs are crystalline in nature with a spherical shape having a mean particle size of 11±1 nm. It is found that biogenic NiO NPs is a highly efficient catalyst for benign one-pot preparation of pyridopyrimidine derivatives using aqueous reaction conditions. This environmentally friendly procedure takes considerable advantages of shorter reaction times, excellent product yields (up to 96%), magnetically reusable nanocatalyst (7 runs), low catalyst loadings, and free toxic chemical reagents.
CPAP Treatment In COVID-19 Patients: A Retrospective Observational Study In The Emergency Department
Authors: Capsoni Nicolò , Privitera Daniele , Mazzone Annamaria , Airoldi Chiara , Albertini Valentina , Angaroni Laura , Bergamaschi Marta , Molin Alberto Dal , Forni Elisa , Pierotti Federico , Rocca Eugenia , Vincenti Fabrizio , Bellone Andrea
Published: November 2020

Background

During COVID-19 outbreak, with the increasing number of patients presenting with acute respiratory failure (ARF), a large use of non-invasive positive pressure ventilation (NIPPV) was done in the Emergency Departments (EDs) and medical wards despite the lack of recommendations. We aimed to assess the use of continuous positive airway pressure (CPAP) in the ED. The primary endpoint was the rate of CPAP failure and the need of endotracheal intubation (ETI). Secondary endpoints were in-hospital mortality and intensive care unit (ICU) and in-hospital length of stay.
Methods

A retrospective observational study enrolling adult patients admitted to the ED of Niguarda Hospital, Milan, Italy, with ARF due to COVID-19 pneumonia from March 18th to April 18th 2020, was conducted. Only patients who strictly followed a local CPAP protocol were enrolled.
Results

A total of 52 patients were included in this study. 38 patients (73%) were judged eligible for ETI. 18 (34.6%) were intubated. 16 (30.8%) patients died: 7 (38.9%) and 9 (26.5%) in the ETI and non-ETI group respectively. The median hospital length of stay was different in ETI and non-ETI patients: 26 days [IQR 16–37] vs 15 days [IQR 9–17] (p = 0.005). The median invasive mechanical ventilation time was 11 days [IQR 7–21] with an ICU length of stay of 14.5 days [IQR 10–28]. During the CPAP trial, variations between ETI and non-ETI patients over time were found for positive end-expiratory pressure (PEEP) (p = 0.003) and respiratory rate (RR) (p = 0.059).
Conclusionss

A short closed monitored CPAP trial could be considered for ARF due to COVID-19 pneumonia before considering ETI. A progressive PEEP titration should target patient’s RR reduction. More studies are needed to evaluate the efficacy and predictors of failure of CPAP and NIPPV in patients with ARF due to COVID-19 pneumonia.
Plasma neurofilament light and cerebrospinal fluid biomarkers are associated with white matter damage in Alzheimer's disease
Authors: Nabizadeh Fardin , Balabandian Mohammad , Rostami Mohammad Reza , Kankam Samuel Berchi
Published: November 2020

The most replicated blood biomarker for monitoring Alzheimer’s disease is neurofilament light (NFL). Recent evidence revealed that the plasma level of the NFL has a strong predictive value in cognitive decline and is elevated in AD patients. The Diffusion Tensor Imaging (DTI) is understood to reflect white matter disruption, neurodegeneration largely, and synaptic damage in AD. However, there is no investigation of the association between plasma NFL and white matter microstructure integrity. we have investigated the cross-sectional associations of plasma NFL, CSF tau, p tau, and Aβ with white matter microstructural changes as measured by DTI in 92 mild cognitive impairment (MCI) participants. We investigated potential correlations of the DTI values of each region of the MNI atlas, with plasma NFL, CSF total tau, CSF p tau, and as well as CSF Aβ, separately using a partial correlation model controlled for the effect of age, sex and APOE ε4 genotype. Our findings revealed a significant correlation between plasma and CSF biomarkers with altered white matter microstructural changes in widespread brain regions. Plasma NFL has a negative correlation with FA and positive correlation with RD, AD, and MD values in different regions. Plasma NFL promises to be an early biomarker of microstructural changes in MCI and for MCI progression to AD.
Plasma p tau 181 are associated with white matter microstructural changes in Alzheimer’s disease
Authors: Nabizadeh Fardin , Jameie Seyed Behnamedin , Khani Saghar , Rezaei Aida , Deravi Niloofar
Published: November 2020

Alzheimer’s Disease (AD) is characterized by cognitive impairments and memory difficulties, which cause daily activities, personal and behavioural problems. In recent years blood-based biomarkers like plasma phosphorylated tau protein at threonine 181 (p tau 181) emerged as new tools and showed a sufficient power in detecting AD patients from healthy people. Here we investigate the correlation between p tau 181 and white matter microstructural changes in AD. We add 41 Alzheimer diagnosed patients, 155 participants with mild cognitive impairments and 43 healthy controls with baseline plasma p tau 181 level and DTI values for each region of interest from the ADNI database. The analysis revealed that the plasma level of p tau 181 could predict changes of MD( Mean Diffusivity), RD(Radial Diffusivity), DA(Axial Diffusivity) and FA(Fractional Anisotropy) parameters in widespread regions and there is a significant association between white matter pathways alteration in different regions and p tau 181 plasma measurement within each group. In conclusion, our findings showed that plasma p tau 181 levels are associated with cellular and molecular changes in AD, which enhance this biomarker's for diagnostic procedures and support the application of plasma p tau 181 as a biomarker for white matter changes and neurodegeneration. Longitudinal studies are also necessary to prove the efficacy of these biomarkers and predicting role in structural changes.
National Lockdown to Cope with COVID-19 Pandemic: Effects (Contradictory) on Public Health and (Negative) on Economic System
Authors: Coccia Mario
Published: November 2020

One of the policy responses to cope with effects of COVID-19 pandemic in society is the national lockdown applied by many countries worldwide. Literature lacks of studies that show whether the effects of this public policy on public health, environment and socioeconomic systems have been effective or not during the first wave of the COVID-19 pandemic. Empirical analysis of this study focuses on some European countries that have applied different containment measures based on national lockdown with longer period (more than a month) and a shorter period (of max 15 days). The evidence shows that longer period of national lockdown by governments seem to generate contradictory effects on public health, whereas on economic growth induces a negative impact given by high contraction of real GDP growth %. This result here can be helpful to policymakers for new policy choices directed to design appropriate measures of containment based on a shorter temporal duration and applied on selected areas and places at risk, rather than general and uniform interventions of lockdown and reduction of mobility. This new perspective of public policy to cope with pandemic crisis of the COVID-19 and future epidemics of similar viral agents can balance the likely positive effects on public health without to deteriorate the structural indicators of economic system.
Development of a multivariable model predicting COVID-19 mortality risk from comorbidities in an Italian cohort of 18,286 confirmed cases aged 40 years or older
Authors: Andreano Anita , Murtas Rossella , Tunesi Sara , Greco Maria Teresa , Consolazio David , Guido Davide , Gervasi Federico , Gattoni Maria Elena , Sandrini Monica , Riussi Antonio , Russo Antonio Giampiero
Published: November 2020

Background: large studies on the predictive role of chronic conditions on mortality from COVID‑19 are scarce. We developed a predictive model of death from COVID‑19 in an Italian cohort aged 40 years or older.Methods: we conducted a cohort study on prospectively collected data. The cohort included all (n=18,286) swab positive cases ≥40 year-old in patients registered with the Agency for Health Protection (AHP) of Milan up to 27/04/2020. Data on comorbidities were obtained from the chronic condition administrative database of the AHP. A multivariable logistic regression model, including age and gender and the selected conditions, was fitted to predict 30-day mortality risk and internally validated. External validation and recalibration were performed in a cohort of untested subjects with COVID-19 like symptoms. R software was used for the analysis.Results: chronic conditions having the largest model-adjusted odds ratio (OR) of dying within 30 days from COVID-19 infection were chronic heart failure (OR=1.9, 95%CI 1.5-2.5), tumors (OR=1.8, 95%CI 1.4-2.3), complicated diabetes (OR=1.6, 95%CI 1.1-2.2) and dialysis-dependent chronic kidney disease (OR=1.5, 95%CI 1.0-2.2). Bootstrap-validated c-index was 0.78. The model fitted on the validation cohort had a c-index of 0.93, but required recalibration. With this latter model, at a 10% risk of death threshold, 11% of the AHP population aged 40 years or older is considered at high risk.Conclusion: we identified a selected number of comorbidities predicting early risk of death in a large COVID-19 cohort aged 40 years or older. In a new epidemic wave, our results will help physicians and health systems to identify high-risk subject to target for prevention and therapy in this specific age group.
Biomechanical study on the stress distribution of the knee joint after distal femoral fracture malunion with residual varus-valgus deformity 
Authors: Li Ming , Hu Pan , Ma Lijie , Zhang Di , Chang Wenli , Zhang Tao , Wei Ning , Chen Wei , Zhu Yanbin
Published: November 2020

Background: To investigate the effect of residual varus and valgus deformity on the stress distribution of knee joint after distal femoral fracture malunion. Methods: Fourteen adult cadaver specimens with formalin were selected to establish the femoral fractures models, which were fixed subsequently at neutral position (anatomical reduction) and malunion positions (at 3 degrees, 7 degrees, 10 degrees valgus positions and 3 degrees, 7 degrees, and 10 degrees varus positions). The stress distribution on the medial and lateral plateau of the tibia was quantitatively measured using ultra-low pressure sensitive film technology. The change of stress distribution of knee joint after femoral fracture malunion and the relationship between stress value and residual varus varus or valgus deformity were analyzed.Results: Under 400 N vertical load, the stress values on the medial and lateral plateau of the tibia at the neutral position were 1.162±0.114 MPa and 1.103±0.144 MPa, respectively. When compared with the stress values measured at the neutral position, the stress on the medial plateau of tibia were significantly higher at varus deformities and lower at valgus deformities, and the stress on the lateral plateau was significantly higher at valgus deformity and lower at varus deformities (all P<0.05). The stress values on the medial plateau of tibia were significantly higher than the corresponding data on the lateral plateau at neutral and 3 degrees, 7 degrees, 10 degrees varus deformities, respectively (all P<0.05), and significantly lower than the corresponding data on the lateral plateau at 3 degrees, 7 degrees, 10 degrees valgus deformities, respectively (all P<0.05). Conclusions: Residual varus and valgus deformity after femoral fracture malunion can cause obvious changes of the stress distribution of knee joint. Therefore, the distal femoral fracture should be anatomically reduced and rigidly fixed to avoid residual varus-valgus deformity and malalignment of lower limbs.
Analysis of gastroscopy results among healthy people undergoing a medical checkup: A retrospective study
Authors: Huang Haosu , Rong Yanting , Wang Meng , Guo Zimeng , Yu Yanghua , Long Zhenpu , Chen Xiaoxiao , Wang Hanyue , Ding Junjie , Yan Lu , Peng Jie
Published: November 2020

Background: The association of upper gastrointestinal endoscopic findings with sex, age, and Helicobacter pylori infection in asymptomatic healthy people is unclear. The aim of this study was to retrospectively determine the associations of upper gastrointestinal endoscopic findings in asymptomatic healthy people with sex, age, and H. pylori infection.Methods: A retrospective study was conducted on 2923 patients from a health examination center in Xiangya Hospital between September 2015 and September 2019. Data on sex, age, H. pylori infection, and gastroscopy results were collected.Results: Among 2923 asymptomatic patients who underwent gastroscopy, 2911 (99.59%) had abnormal results. The top three results were chronic gastritis (95.11%), peptic ulcer (17.45%), and duodenitis (9.17%). Inflammation of the gastric mucosa in chronic gastritis was more severe in the H. pylori-positive group. The incidence of peptic ulcer decreased with increasing age and was higher in men, patients aged <30 years, and H. pylori-positive patients. The incidence of polyps was higher in women (9.54%) than in men (5.94%), and the incidence in individuals aged ≥60 years (11.63%) was higher than that in those aged <60 years (6.83%). The pathological results of gastric polyps depended on the location of the lesion.Conclusion: The incidence of abnormal upper gastrointestinal endoscopic results is high in asymptomatic healthy people undergoing a check-up and is associated with sex, age, and H. pylori infection. Gastroscopy should be considered part of a routine health check.
Influence of diabetes on short-term outcome after major hepatectomy – an underestimated risk?
Authors: Fischer Alexander , Fuchs Juri , Stravodimos Christos , Hinz Ulf , Billeter Adrian , Büchler Markus W. , Mehrabi Arianeb , Hoffmann Katrin
Published: November 2020

BackgroundPatient-related risk factors such as diabetes mellitus and obesity are increasing in western countries. At the same time the indications for liver resection in both benign and malignant diseases have been significantly extended in recent years. Major liver resection is performed more frequently in a patient population of old age, comorbidity and high rates of neoadjuvant chemotherapy. The aim of this study was to evaluate whether diabetes mellitus, obesity and overweight are risk factors for the short-term post-operative outcome after major liver resection.MethodsFour hundred seventeen major liver resections (≥3 segments) were selected from a prospective database. Exclusion criteria were prior liver resection in patient’s history and synchronous major intra-abdominal procedures. Overweight was defined as BMI ≥ 25 kg/m 2 and < 30 kg/m 2 and obesity as BMI ≥ 30 kg/m 2 . Primary end point was 90-day mortality and logistic regression was used for multivariate analysis. Secondary end points included morbidity, complications according to Clavien-Dindo classification, unplanned readmission, bile leakage, and liver failure. Morbidity was defined as occurrence of a post-operative complication during hospital stay or within 90 days postoperatively.ResultsFifty-nine patients had diabetes mellitus (14.1%), 48 were obese (11.6%) and 147 were overweight (35.5%). There were no statistically significant differences in mortality rates between the groups. In the multivariate analysis, diabetes was an independent predictor of morbidity (OR = 2.44, p = 0.02), Clavien-Dindo grade IV complications (OR = 3.6, p = 0.004), unplanned readmission (OR = 2.44, p = 0.04) and bile leakage (OR = 2.06, p = 0.046). Obese and overweight patients did not have an impaired post-operative outcome compared patients with normal weight.ConclusionsDiabetes has direct influence on the short-term postoperative outcome with an increased risk of morbidity but not mortality. Preoperative identification of high-risk patients will potentially decrease complication rates and allow for individual patient counseling as part of a shared decision-making process. For obese and overweight patients, major liver resection is a safe procedure.
Business models for primary health care delivery in low and middle income countries: a scoping study of nine social entrepreneurs
Authors: Lokman Lutfi , Chahine Teresa
Published: November 2020

Background: Social enterprises are organizations created to address social problems that use business models to sustain themselves financially. Social enterprises can help increase access to primary health care in low resource settings. Research on social enterprises in health care have focused either on high-income countries, or on secondary and tertiary care in low- and middle-income countries, where common business models include differential pricing to cross-subsidize low income populations. This is the first study to examine social enterprises providing primary health care in low- and middle-income countries using primary data. The purpose is to determine whether social enterprise is a viable model in this setting and to identify common patterns and characteristics that could inform the work of social entrepreneurs, funders, and researchers in this area.Methods: We identify social entrepreneurs working to deliver primary care in low- and middle-income countries who have been vetted by international organizations dedicated to supporting social entrepreneurship. Through in-depth interviews, we collect information on medical processes, business processes, social impact, and organizational impact according to the Battacharyya et al framework. We then conducted qualitative analysis to identify common patterns emerging within these four categories.Results: Common characteristics in the business models of primary health care social enterprises include flat rate rather than differential pricing; cross-subsidizing across services rather than patients. Subscription packages and in-house IT systems were utilized to generate revenue and increase reach through telemedicine, franchising, and mobile units. In some cases, alternate revenue streams are employed to help break even. About half of the social enterprises interviewed were for-profit, and about half non-profit. The majority faced challenges in engaging with the public sector. This is still a nascent field, with most organizations being under ten years old.Conclusions: Social enterprise has been demonstrated as a feasible model for providing primary care in low resource settings, with key characteristics differing from the previously commonly studied social enterprises in tertiary care. There are opportunities to complement existing public health systems, but most organizations face challenges in doing so. More research and attention is needed by researchers, governments and funders to support social entrepreneurs and avoid parallel systems.
Localization of recurrent lesions following ileocolic resection for Crohn's disease
Authors: Ikeuchi Hiroki , Uchino Motoi , Bando Toshihiro , Horio Yuki , Kuwahara Ryuichi , Minagawa Tomohiro , Goto Yoshiko , Kusunoki Kurando , Ikeda Masataka , Beppu Naohito , Takesue Yoshio
Published: November 2020

Background Crohn’s disease (CD) recurrence can occur not only at the site of anastomosis but also elsewhere in the bowel following an ileocolic resection (ICR) procedure. The aims of the present study were to assess long-term outcomes of a primary ICR procedure for CD in consecutive patients and examine the location of the reoperation causative lesion.Methods We examined cases of surgery with ICR initially performed at our institution. Those with simultaneous multiple bowel resection or bowel resection with strictureplasty were excluded. Results A total of 169 patients who underwent ICR due to CD were enrolled. The median follow-up period was 12.6 years (range 4-27 years). A reoperation was needed in 45 (26.6%), of whom 14 had lesions causative of the reoperation at other than the anastomotic site. The most common causative lesion location was in the colon rather than the oral side of the small intestine. Furthermore, we investigated the relationship between presence of residual lesions following the initial surgery and lesions causative of reoperation. In the group without residual disease (n=31), 29.0% (n=9) had non-anastomotic lesions involved in indications for reoperation, while that was 35.7% (n=5) in the group with residual disease (n=14).Conclusions Anastomotic site lesion is not the only causative factor for reoperation following ICR. Regular examinations and applicable treatment with awareness that the cause of reoperation is not limited to the site of anastomosis are important in these cases.
Intraoperative hypotension is not associated with adverse short-term postoperative outcomes after esophagectomy in esophageal cancer patients
Authors: Yeheyis Ephraim Teffera , Kassa Seyoum , Yeshitila Hiwot , Bekele Abebe
Published: November 2020

Background The effect of low systolic blood pressure and its subsequent postoperative outcome during esophagectomy for esophageal cancer is not well studied.MethodsA prospective study was conducted and data were collected on patients who underwent esophagectomy and esophagogastrostomy for esophageal cancer. Intraoperative Hypotension (IOH), defined as Systolic Blood Pressure (SBP) < 90 mm Hg lasting more than 5 minutes, was recorded. Patients’ 30 days post-operative composite outcome of mortality, anastomotic leak, and prolonged hospital stay were analyzed as outcome variables.ResultA total of 54 patients underwent esophagectomy for esophageal cancer during the study period. The mean age was 54 years. The mean duration of the surgery was 208 minutes. Intraoperative mean low SBP was 80mmHg while the lowest record was 55 mmHg. IOH occurred in 51 % (n=29) of patients. Anastomotic leak occurred in 7% (n=4) (OR 1.2, 95% CI 0.26-6.3; p=0.76). In-hospital mortality was 5 % (n=3) (OR 1.44, 95% CI 0.22- 9.3; p=0.7) and 33 % (n=18) had prolonged hospital stay (OR 0.53, 95% CI 0.14- 1.9; p=0.34).The overall anastomotic leak rate was 13% (n=7). The 30 days operative mortality was 9% and 55 % (30) of patients had prolonged hospital stay. Multivariate analysis (logistic regression model) showed SBP < 90mmHg for more than 5 minutes was not significantly associated either with individual or composite outcomes of mortality, anastomotic leak, and prolonged hospital stay (AOR 1.06, 95% CI 0.98-1.14; p=0.16)ConclusionIn patients undergoing esophagectomy for esophageal cancer, a systolic blood pressure < 90 mm Hg for greater than 5 min during surgery has no significant statistical association with composite adverse outcomes of mortality, anastomotic leak, and prolonged hospital stay.
A novel nomogram for predicting liver metastasis in patients with gastrointestinal stromal tumor: A SEER-based study
Authors: Zhou Guowei , Xiao Keshuai , Gong Guanwen , Wu Jiabao , Zhang Ya , Liu Xinxin , Jiang Zhiwei , Ma Chaoqun
Published: November 2020

Background: Liver metastasis (LIM) of gastrointestinal stromal tumor (GIST) is associated with poor prognosis. The present study aimed at developing and validating nomogram to predict LIM in patients with GIST, thus helping clinical diagnosis and treatment. Methods: The data of GIST patients derived from Surveillance, Epidemiology, and End Results (SEER) database from 2010 to 2016, which were then screened by univariate and multivariate logistic regression for the construction of LIM nomogram. The model discrimination of LIM nomogram was evaluated by concordance index (C-index) and calibration plots, while the predictive accuracy and clinical values were measured by decision curve analysis (DCA) and clinical impact plot. Furthermore, we validated predictive nomogram in the internal testing set. Results: A total of 3797 patients were enrolled and divided randomly into training and validating groups in a 3-to-1 ratio. After logistic regression, the significant variables were sex, tumor location, tumor size, N stage and mitotic rate. The calibration curves showed the perfect agreement between nomogram predictions and actual observations, while the DCA and clinical impact plot showed the clinical utility of LIM nomogram. C-index of the nomogram was 0.812. What’s more, receiver operating characteristic curves (ROC) also showed good discrimination and calibration in the training set (AUC=0.794, 95% CI: 0.778 to 0.808) and the testing set (AUC=0.775, 95% CI: 0.748 to 0.802). Conclusion: The nomogram for patients with GIST can effectively predict the individualized risk of liver metastasis and provide insightful information to clinicians to optimize therapeutic regimens.
Predictors and One-year Outcomes of Patients with Delayed Graft Function after Deceased Donor Kidney Transplantation
Authors: Chen Rao , Wang Haifeng , Song Lei , Hou Jianfei , Peng Jiawei , Dai Helong , Peng Longkai
Published: November 2020

Background:Delayed graft function (DGF) is closely associated with the use of marginal donated kidneys due to deficits during transplantation and in recipients. We aimed to predict the incidence of DGF and evaluate its effect on graft survival.Methods:This retrospective study on kidney transplantation was conducted from January 1, 2018, to December 31, 2019, at the Second Xiangya Hospital of Central South University. We classified recipients whose operations were performed in different years into training and validation cohorts and used data from the training cohort to analyze predictors of DGF. A nomogram was then constructed to predict the likelihood of DGF based on these predictors.Results:The incidence rate of DGF was 16.92%. Binary logistic regression analysis showed correlations between the incidence of DGF and cold ischemic time (CIT), warm ischemic time (WIT), terminal serum creatine (Scr) concentration,, duration of pretransplant dialysis, primary cause of donor death, and usage of LifePort . The internal accuracy of the nomogram was 83.12%. One-year graft survival rates were 93.59% and 99.74%, respectively, for the groups with and without DGF (P<0.05).Conclusion:The nomogram established in this study showed good accuracy in predicting DGF after deceased donor kidney transplantation; additionally, DGF decreased one-year graft survival.
Visceral Adipose Tissue Promotes Pressure-Induced Heart Failure Associated with Circulating Fatty Acids
Authors: Shi Wenjiao , Peng Yuanzhi , Du Jianer , Weng Xiaojian
Published: November 2020

Visceral adipose tissue (VAT) is the main source of circulating fatty acids (FAs) that provides the energy substrate for the heart. Till now, studies have not shown a clear association between individual circulating FAs and heart failure (HF). In this study, we aimed to investigate the changes in circulating FAs in HF mice and their association with VAT by removing epididymal white adipose tissue (eWAT). Here, we found that the serum levels of four fatty acids, namely arachidic acid, behenic acid, lignoceric acid, and docosapentaenoic acid, were significantly decreased in pressure-induced HF mice via transverse aortic constriction (TAC) surgery accompanied with cardiac enlargement and fibrosis. Most importantly, removal of eWAT in mice led to a significant decrease in the levels of the above-mentioned fatty acids without any significant difference between the HF and sham groups. Accordingly, cardiac enlargement and fibrosis were significantly alleviated. We concluded that VAT excision alleviated TAC-induced cardiac failure by decreasing serum arachidic acid, behenic acid, lignoceric acid, and docosapentaenoic acid levels.
Govorno-motoričke sposobnosti djece s kašnjenjem u jezično-govornom razvoju
Authors:   Edukacijsko-rehabilitacijski fakultet Sveučilišta u Zagrebu, Zagreb, Hrvatska, Knežević Dora , Blaži Draženka ,   Edukacijsko-rehabilitacijski fakultet Sveučilišta u Zagrebu, Zagreb, Hrvatska, Hostonski Josipa ,   Specijalna bolnica za medicinsku rehabilitaciju Krapinske Toplice, Hrvatska
Published: November 2020

Djecu koja imaju ekspresivni rječnik manji od 50 riječi i/ili u dobi od 24 mjeseca još nisu dosegla fazu dvočlanih iskaza (Petinou, Constantinou i Kapsou, 2011) te kod koje uz kašnjenje u ekspresivnom i/ili receptivnom jeziku nisu prisutne kognitivne, neurološke, socio-emocionalne ili senzoričke teškoće nazivamo kasnim govornicima (late talkers) (Buschmann i sur., 2008). Literatura nam daje malo podataka o oralno-motoričkim sposobnostima kasnih govornika. Međutim, s obzirom na mogućnosti različitih ishoda i dijagnoza te zbog odabira što efikasnije terapije bilo bi dobro znati njihove karakteristike u području oralne motorike. Cilj ovog istraživanja bio je ispitati oralno-motoričke sposobnosti djece (KD = 3;07-8;11) kod koje je postojalo kašnjenje u jezično-govornom razvoju u dobi od 2 godine, usporediti ih s oralno-motoričkim sposobnostima djece tipičnog jezično-govornog razvoja te ispitati postoji li povezanost između rezultata na oralno-motoričkoj izvedbi i ostalim mjerama ekspresivnog i receptivnog jezika. Djeca s inicijalnom dijagnozom “kašnjenje u jezično-govornom razvoju” postižu statistički slabije rezultate od kontrolne skupine na oralno-motoričkim mjerama, a oralno-motoričke mjere pozitivno koreliraju s ekspresivnim jezičnim mjerama. Ovo istraživanje pokazuje važnost uključivanja i oralno-motoričkih mjera uz jezične mjere u procjenu kako bismo dobili širu sliku sposobnosti djece te što preciznije definirali odstupanja i sukladno tome odabrali odgovarajući terapijski pristup. Ključne riječi: kasni govornici, kašnjenje u jezično-govornom razvoju, govorno-oralno-motoričke sposobnosti, jezične teškoće, dječja govorna apraksija
Quality of Life Among Caregivers of Stroke Survivors in Accra, Ghana
Authors:   Department of Physiotherapy, School of Biomedical and Allied Health Sciences, College of Health Sciences, University of Ghana, Accra, Ghana / School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Netherlands / Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, UK, Quartey Jonathan , Lartey Felix Appiah ,   Physiotherapy Department, St. Patrick’s Hospital, Offinso, Ashanti Region, Ghana., Boakye Hosea ,   Department of Physiotherapy, LEKMA Hospital, Teshie, Accra, Ghana.4West Africa Football Academy, Sogakope, Ghana, Kwakye Samuel K. ,   West Africa Football Academy, Sogakope, Ghana.
Published: November 2020

Background:The impact of stroke on the quality of life of stroke caregivers is often given lower priority in its management, regardless of the consequences of caregiving and its economic benefits to the patient and community at large. Currently there is paucity of research data on quality of life among caregivers of stroke survivors in Ghana.Objective: To investigate the quality of life (QoL) among caregivers of stroke survivors.Methods:Fifty stroke survivors and their caregivers attending physiotherapy at Korle-Bu Teaching Hospital, Accra and fifty non-caregivers were purposively recruited for this cross-sectional study. World Health Organization Quality of Life Scale (WHOQoL)-Bref was used to obtain information regarding the QoL of the caregivers and non-caregivers. The level of functional independence of the stroke survivors was assessed with Barthel Index. Independent t-test and unpaired t-test were used to analyse the data obtained.Results:The mean age of the caregivers, stroke survivors and the non-caregivers were 41.6±14.2, 59.5±10.9, and 41.5±14.8 respectively. Out of the 50 caregivers, 31(62%) were females. The overall QoL of the caregivers and non-caregivers were 54.5±10.3 and 59.3±9.8 respectively. There was significant difference in the physical health between caregivers and non-caregivers. Conclusion: Caregivers of stroke survivors in Accra have reduced QoL. The level of functional independence of the stroke survivor, age and educational status of the caregiver can influence caregivers’ QoL. Keywords: Stroke, caregivers, stroke survivors, quality of life, non-caregiver
PROJETO ACOLHENDO MEMÓRIAS E PANDEMIA COVID-19 PROMOVENDO EDUCAÇÃO EM SAÚDE E ORIENTAÇÕES FISIOTERAPÊUTICAS PARA IDOSOS DE SANTA CRUZ: RELATO DE EXPERIÊNCIA
Authors: Fonseca Adna , Cavalcante de Carvalho Ana Beatriz , Giovana Carvalho da Silva Érika , Brito Macedo Liane , Freire Vieira Lima Núbia Maria
Published: November 2020

Introdução: o novo coronavírus vem atingindo preferencialmente a saúde da população idosa, considerada grupo de risco para o desenvolvido da doença. Objetivo: descrever atividades educativas e orientações fisioterapêuticas voltadas ao combate à pandemia do COVID-19 para idosos residentes na cidade de Santa Cruz/RN. Metodologia: trata-se de um relato de experiência realizado por discentes e docentes do projeto de extensão universitária “Acolhendo Memórias” sobre ações audiovisuais voltadas para o público idoso durante o período de isolamento social. Resultados e discussão: foram realizadas atividades em redes sociais e meio radiofônico sobre medidas de prevenção ao COVID-19, objetivando orientar com linguagem acessível essa população. Considerações finais: as ações desenvolvidas contribuiram para uma melhor assistência e qualidade de vida da população idosa.
AMAMENTAÇÃO x COVID-19
Authors: Fernandes Elaine , Sousa Juliany , Silva Raissi , Serquiz Alexandre
Published: November 2020

A Organização Mundial da Saúde declarou o surto da COVID-19 como pandemia, e até o momento não há documentação de transmissão vertical na amamentação. O objetivo foi elaborar um Procedimento Operacional Padronizado sobre a extração e armazenamento do leite de forma segura, em meio ao novo coronavírus, visando a continuidade do aleitamento exclusivo. Para o desenvolvimento do POP, foi realizada uma revisão bibliográfica dos últimos cinco anos e elencado opiniões seguras sobre o assunto abordado, destinado principalmente à empresas e instituições que têm como público-alvo puérpera e lactente. O produto deste trabalho é uma ferramenta de orientação sobre o manejo do aleitamento materno exclusivo diante da doença, tendo em vista que a opinião com maior respaldo científico é de que mães infectadas, com bom estado geral, devem manter a amamentação.

Palavras-chave: aleitamento materno; extração de leite; novo coronavírus.
EDUCAÇÃO POPULAR E SAÚDE DOS TRABALHADORES(AS) EM TEMPOS PANDEMIA
Authors: Maria Sousa de Castro Kamilla , Beatriz dos Santos Silva Milena , Gleice de Pontes Bezerra Jamile , Taurino Guedes Dimitri
Published: November 2020

Este artigo relata a experiência da construção de uma rede de apoio a trabalhadores(as) informais e pequenos produtores rurais, no interior do RN, durante a pandemia do Covid-19. Parte da perspectiva teórica da educação popular, delineando caminhos cuja intencionalidade é fortalecer a economia local. Assim, problematizando a realidade, são construídas estratégias conjuntas de soluções para manutenção da saúde e  luta pela dignidade. Na primeira etapa,  o mapeamento dos serviços foi implantado com parcerias estabelecidas (instituições e associações de trabalhadores). Na segunda etapa, foram elaborados materiais de divulgação e de educação em saúde (podcasts, mídias para instagram e a revista eletrônica), divulgados em blogs, linhas de transmissão, rede social do projeto e rádio comunitária. Essa ação tem contribuído para fortalecimento da economia local e construção de uma rede colaborativa.
FATO OU FAKE? UMA DÚVIDA DURANTE A PANDEMIA DA COVID-19: RELATO DE EXPERIÊNCIA
Authors: de almeida Silva Hugo Jario , Ferreira Pereira Nayara Karina , Nunes Pinheiro Eslia Maria , Carvalho Santos Jéssica Camila , Freire Vieira Lima Núbia Maria
Published: November 2020

Em virtude do novo coronavírus a OMS determinou uma série de medidas a seremadotadas pelos países, uma delas foi isolamento social. A internet se tornou uma dasprincipais fontes de informação da população, porém a disseminação das fakes newspodem atrapalhar o enfrentamento a pandemia. Sendo assim, este estudo tem porobjetivo fazer um relato de experiência de discentes e docentes de programas de pós-graduação no combate às fakes news. Para tal, foi desenvolvido um fluxograma dasações de extensão que apresenta as etapas a serem seguidas. Após isto foram elaboradosdois materiais, um esclarecendo fakes news acerca de medicamentos e outro trazendo asverdades por trás dos mitos. Banners informativos foram divulgados nas mídias sociaisdos programas de pós-graduação envolvidos na ação, tudo com base em fundamentaçãocientífica.