bluuebunny/crossref_metadata_2025 huggingface dataset:
Protocol for a Randomised Controlled Feasibility Study of Psychologically Informed Vestibular Rehabilitation for People With Persistent Dizziness (INVEST Trial)
Authors: Herdman David Rhys , Norton Sam , Pavlou Marousa , Murdin Louisa , Moss-Morris Rona
Published: December 2020

Background: Dizziness is a common complaint that often persists and leads to disability and distress. Several cognitive and behavioural responses may contribute to the neurobiological adaptations that maintain persistent vestibular symptoms. This paper will present the protocol of a two-arm parallel group feasibility randomised controlled trial designed to determine whether a fully powered efficacy trial is achievable by examining the feasibility of recruitment, acceptability and potential benefits of an integrated cognitive behavioural therapy and vestibular rehabilitation (CBT-VR) treatment for people with persistent dizziness. Methods: Forty adult patients will be recruited from a tertiary vestibular clinic with persistent movement triggered dizziness for three months or longer who have moderate-high levels of dizziness handicap. Participants will be 1:1 randomised, using a minimisation procedure, to six sessions (12-14 weeks’) of either CBT-VR (intervention arm) or VR only (control arm). Measures will be collected at baseline and 4 months post randomisation. The primary feasibility outcomes include descriptive data on numbers meeting eligibility criteria, rates of recruitment, numbers retained post randomisation, treatment adherence and an acceptability questionnaire. Treatment effects on self-report outcomes will be estimated to determine that 95% confidence intervals for the effects are consistent with anticipated effects and minimum clinically important differences, and to provide information needed for the power calculation of an efficacy trial. A nested qualitative study will be conducted post-intervention (intervention group only) to explore the acceptability of the intervention and identify any areas in need of improvement. Discussion: If a trial of CBT-VR is feasible, acceptability data will be used to enhance the intervention if needed and refine the multicentre RCT protocol. Future studies will need to consider the training required for other physiotherapists to deliver the intervention.Trial registration: ISRCTN 10420559
Impact of Down-Stream Processing on Functional Properties of Yeasts in Diets of Atlantic Salmon (Salmo Salar): Implications for Gut Health
Authors: Agboola Jeleel , Schiavone Marion , Øverland Margareth , Morales-Lange Byron , Lagos Leidy , Arntzen Magnus , Lapeña David , Eijsink Vincent , Horn Svein , Mydland Liv , François Jean , Mercado Luis , Hansen Jon
Published: December 2020

Yeasts are becoming popular as novel ingredients in fish feeds because of their potential to support better growth and concomitantly ensure good fish health. Here, three species of yeasts (Cyberlindnera jadinii, Blastobotrys adeninivorans and Wickerhamomyces anomalus), grown on wood sugars and hydrolysates of chicken were subjected to two down-stream processes, either direct heat-inactivation or autolysis, and the feed potential of the resulting yeast preparations was assessed through a feeding trial with Atlantic salmon fry. Histological examination of distal intestine based on widening of lamina propria, showed that autolyzed W. anomalus was effective in alleviating mild intestinal enteritis, while only limited effects were observed for other yeasts. Our results showed that the functionality of yeast in counteracting intestinal enteritis in Atlantic salmon was dependent on both the type of yeast and the down-stream processing method, and demonstrated that C. jadinii and W. anomalus have promising effects on gut health of Atlantic salmon.
Elevated Serum Chloride Level Contributes to the Poor Prognosis of IgA Nephropathy
Authors: Zhai Yaling , Yao Xingchen , Qi Yuanyuan , Gao Jingge , Chen Yazhuo , Wang Xinnian , Zhao Zhanzheng
Published: December 2020

IntroductionFinding reliable prognostic factors is crucial for IgA nephropathy (IgAN). Here, we determined the relationship between prognosis of IgAN with serum chloride.MethodsPrimary IgAN diagnosed by renal biopsy from January 1, 2015 to April 1, 2019 were recruited. Patients were divided into lower group and higher group based on the best cut-off value of survival receiver operating characteristics (ROC) curves. The baseline clinicopathological characteristics were retrospectively compared. Cox proportional hazard models were used to demonstrate the prognostic value of serum chloride in IgAN. Prognosis prediction model was built by multivariate Cox regression. ResultsCompared to higher group , age、24-hour urinary protein and serum creatinine(Cr) in the lower group were significantly lower, hemoglobin(Hb)、albumin were significantly higher(all P<0.05),the degree of endothelial cell proliferation (E) and renal tubule atrophy or renal interstitial fibrosis (T) were significantly lighter (all P<0.05). Univariate and multivariate Cox analysis revealed that serum chloride ≥105.4 mmol/l was an independent risk factor for the prognosis of IgAN(P<0.05). Serum chloride, Cr, T, hypertension, and Hb were screened out as features in predictive prognosis model. The c-index of the model was 0.85、0.82 and 0.77 for 1、2 and 3 years respectively, and brier scores were 0.06 、0.09 and 0.16 respectively. ConclusionsSerum chloride ≥105.4 mmol/l was an independent risk factor for the prognosis of IgAN. A predictive prognosis model including serum chloride, Cr, T, hypertension and Hb exhibited a relatively good prediction effect.
Impact of Preterm Birth and Post-Discharge Growth on Cardiometabolic Outcomes at School Age: A Case Control Study
Authors: Yun Jungha , Jung Young Hwa , Shin Seung Han , Song In Gyu , Lee Young Ah , Shin Choong Ho , Kim Ee-Kyung , Kim Han-Suk
Published: December 2020

Background: Adverse metabolic outcomes later in life have been reported among children or young adults who were born small for gestational age. This study was conducted to examine the impact of preterm birth and subsequent growth after hospital discharge on cardiometabolic risks among early school-aged children. Methods: This case-control study included school-aged children born prematurely (n = 60) and at term (n = 110). Body size, fat mass, blood pressure (BP), glucose, insulin, leptin, adiponectin, and lipid profiles were measured. Weight z-score changes between discharge and early school-age period were also calculated, and factors associated with BP and insulin resistance were analyzed.Results: Early school-aged children who were born preterm had lower fat masses, higher systolic BP and diastolic BP, and higher values of fasting glucose, insulin, and homeostatic model assessment of insulin resistance (HOMA-IR), compared to children born at term. Preterm birth was correlated with HOMA-IR and BPs after adjusting for various factors, including fat mass index and weight z-score changes. Weight z-score changes were associated with HOMA-IR, but not with BPs. Conclusions: Although early school-aged children born prematurely showed lower weight and fat mass, they had higher BPs, fasting glucose, HOMA-IR, and leptin levels. The associations of preterm birth with cardiometabolic factors were independent of weight, fat mass and weight gain velocity.
The prognostic value of tumor size in penile cancer: A Surveillance,Epidemiology, and End Results database study
Authors: Zheng Wenwen , Zhang Zhiyu , Xie Xilei , Zhu Weiwei , Li Kangqi , Wu Qingna , Chen Jiaojiao , Lu Congxiao , Zhao Quan , Yu Shengqiang , Guo Chenyu
Published: December 2020

Background: The objective of this study was to investigate the prognostic value of tumor size on cancer-specific mortality (CSM) and lymph node metastasis for patients with penile squamous cell carcinoma (PSCC).Method: The patients diagnosed with PSCC between 2004 and 2015 were selected from the Surveillance, Epidemiology, and End Results (SEER) database. Restricted cubic spline functions were calculated to characterize the association between tumor size and the risk of CSM. The competing-risks model was used to evaluate the impact of tumor size on the cumulative incidence of CSM. The logistic regression analysis was performed to examine the association between tumor size and lymph node metastasis.Results: Totally, 1365 PSCC patients were analyzed, with 52.3% having tumors ≤30 mm, and 47.7% >30 mm. The restricted cubic splines showed that the risks of CSM increased as tumors enlarged. Following adjustment of competing events, the PSCC patients with tumors >30 mm were more likely to succumb to CSM in comparison with those with tumors ≤30 mm (hazard ratio [HR]=1.57, 95% confidence interval [CI]: 1.23-2.01, P<0.001). In subgroup analyses, tumor size >30 mm was significantly associated with an increased risk of CSM relative to tumor size ≤30 mm among patients with T1 (HR=1.56, 95%CI: 1.03-2.37, P=0.036) and T3 (HR=2.51, 95%CI: 1.41-4.45, P=0.002) classifications. On logistic regression analysis, tumors >30 mm were significantly associated with lymph node metastasis (odds ratio [OR]=1.46, 95% CI: 1.03-2.07, P=0.034).Conclusion: Larger tumors (>30 mm) were significantly associated with higher risks of CSM and increased likelihood of lymph node metastasis for PSCC patients, which could be integrated into the development of a staging system for penile cancer.
Transcriptomic Analysis Reveals the Contribution of QMrl-7B to Wheat Root Growth and Development
Authors: Liu Jiajia , Li Hanwen , Zhang Na , Meng Deyuan , Zhi Liya , Ren Xiaoli , Ji Jun , Su Zhenqi , Li Junming , Fan Xiaoli , Song Liqiang
Published: December 2020

Backgound: Roots are the major organs for water and nutrient acquisition and substantially affect plant growth, development and reproduction. Improvements to root system architecture are highly important for increasing yield potential of bread wheat. QMrl-7B, a major stable quantitative trait locus (QTL) that controls maximum root length (MRL), strongly contributes to an improved root system in wheat. Results: To further analyse the biological functions of QMrl-7B in root development, two types of Triticum aestivum near isogenic lines (NILs), one with superior QMrl-7B alleles from cultivar Kenong 9204 (KN9204) and another with inferior QMrl-7B alleles from cultivar Jing 411 (J411), were subjected to transcriptomic analysis. Among all the mapped genes analysed, 4871 genes were identified as being differentially expressed between the pairwise NILs under different nitrogen (N) conditions, with 3543 genes expressed under normal-nitrogen (NN) condition and 2689 genes expressed under low-nitrogen (LN) condition. These genes encode proteins that include mainly NO3- transporters, phytohormone signalling components and transcription factors (TFs), indicating the presence of a complex regulatory network involved in root determination. In addition, among the 13524 LN-induced differentially expressed genes (DEGs) detected in this assay, 4308 were specifically expressed in the A-NIL which brings superior alleles, and 2463 were expressed specifically in the B-NIL which brings inferior alleles. These DEGs reflect different responses of the two types of NILs to varying N supplies, which likely involve LN-induced root growth. Conclusions: These results explain the better-developed root system and increased root vitality provided by the superior alleles of QMrl-7B and provide a deeper understanding of the genetic underpinnings of root traits, pointing to a valuable locus suitable for future breeding efforts for sustainable agriculture.
Prevalence of Use of Smart Devices in Children Aged Five Years or Less and Associated Factors in Kuwait
Authors: Shamsah Abdullah , Al-Twari Basma , Jamal Fatma , Al-farhan Latifa , Al-mass Madawi , Al-majran Abdullah , Shamsah Sara
Published: December 2020

BackgroundThis study aimed to find prevalence of use of smart devices in children aged five years or less and associated factors in KuwaitMethodsA cross-sectional study of 964 parents conducted by distributing a questionnaire. Following the American Academy of Pediatrics (AAP) recommendations for the smart devices use in children, our population was divided into two groups (less than 2 years old and 2-5 years old).Results Reported prevalence of use was 53.2% in children less than 2 years old and 86.3% in 2-5 years old. A significantly higher mean age of fathers was seen in children who used smart devices compared to those who did not in both age groups. The use of smart devices in children less than 2 years was significantly associated with Kuwaiti nationality, family income and governorate. In addition, the higher the family income, the more the use of smart devices. The highest use of smart devices was seen in Capital (60%) and Ahmadi (58.3%). While the lowest was seen in Jahra (30%). In both age groups, most of the parents who reported the smart devices use in their children knew that its use at early age might harm their child. ConclusionYoung children use of smart devices is prevalent in Kuwait. Campaigns need to be carried out to increase parents’ knowledge about the potential risks of smart devices on children’s brains and development.
The Effects of Interval Training on Peripheral Brain Derived Neurotrophic Factor (BDNF) In Young Adults: A Systematic Review and Meta-Analysis
Authors: García-Suárez Patricia , Rentería Iván , Plaisance Eric , Moncada-Jiménez José , Jiménez-Maldonado Alberto
Published: December 2020

The aim of the current meta-analysis was to determine the effects of acute and chronic interval training (IT) on peripheral BDNF concentrations in healthy young adults. A literature search was performed using six databases until February 2020. The TESTEX scale was used to assess the quality of studies. Effect sizes (ES) were computed and two-tailed α values <0 .05 and non-overlapping 95% confidence intervals (95% CI) were considered statistically significant. Heterogeneity, inconsistency (I2), and small-study effects using the Luis Furuya-Kanamori (LFK) index were examined. Fifteen studies (n=277 participants, age =24±3 yr.) were included. The overall effects of IT on circulating BDNF concentrations were moderate and non-significant (ES =0.64, 95%CI = -0.01, 1.30, heterogeneous (p<0.001), highly inconsistent (I2=90%), and with major asymmetry (LFK index =2.85). The acute effect of IT on peripheral BDNF levels was large and significant (ES =1.22, 95%CI =0.08), homogenous (p<0.001), with considerable inconsistency (I2=93%), and major asymmetry (LFK index =3.34). The chronic effect of IT on circulating BDNF was large and significant (ES =0.93, 95%CI =0.40), homogenous (p<0.001), with moderate inconsistency (I2=70%), and minor asymmetry (LFK index =1.21). Acute and chronic IT, elicited a moderate increase in peripheral BDNF concentrations in a healthy young population.
Glioblastoma Invasion Factor ODZ1 is Induced by Microenvironmental Signals Through Activation of A Stat3-Dependent Transcriptional Pathway 
Authors: Vidal Veronica , Gutierrez Olga , Talamillo Ana , Velasquez Carlos , Fernandez-Luna Jose
Published: December 2020

We have previously shown that the transmembrane protein ODZ1 serves for glioblastoma (GBM) cells to invade the surrounding tissue through activation of RhoA/ROCK pathway. However, the transcriptional machinery used by GBM cells to regulate the expression of ODZ1 is unknown. Here we show that interaction with tumor microenvironment elements, mainly activated monocytes through IL-6 secretion, and the extracellular matrix protein fibronectin, induces the Stat3 transcriptional pathway and upregulates ODZ1 which results in GBM cell migration. This signaling route is abrogated by blocking the IL-6 receptor, inhibiting Jak kinases or knocking down Stat3. Furthermore, we have identified a Stat3 responsive element in the ODZ1 gene promoter, about 1 kb from the transcription start site. Luciferase-reporter assays confirmed that the promoter responds to the presence of monocytic cells and this activation is greatly reduced when the Stat3 site is mutated or following treatment with a neutralizing anti-IL-6 receptor antibody or transfecting GBM cells with a dominant negative variant of Stat3. Overall, we show that monocyte-secreted IL-6 and the extracellular matrix protein fibronectin activate the axis Stat3-ODZ1 and promote migration of GBM cells. This is the first described transcriptional mechanism used by tumor cells to promote the expression of the invasion factor ODZ1.
Specific Contribution of Neurons From the Dbx1 Lineage to The Piriform Cortex
Authors: Shabangu Thando , Chen Hung-Lun , Zhuang Zi-hui , Pierani Alessandra , Chen Chien-Fu , Chou Shen-Ju
Published: December 2020

The piriform cortex (PC) is a major cortical processing center for the sense of smell that receives direct inputs from the olfactory bulb. In mice, the PC consists of three neuronal layers, which are populated by cells with distinct developmental origins. One of developmental origins of PC is the Dbx1-expressing neural progenitors located in the ventral pallium at the pallial-subpallial boundary. Since the precise mechanisms of PC neuron development are largely unknown, we sought to define the distribution, timing of neurogenesis, morphology and projection patterns of PC neurons from the Dbx1 lineage. We found that Dbx1-lineage neurons are preferentially distributed in layer 2 and enriched in the ventral portion of the PC. Further, Dbx1 neurons are early-born neurons that contribute to most neuronal subtypes in the PC. Our data also revealed an enrichment of Dbx1-lineage neurons located in the ventral anterior PC that project to the orbitofrontal cortex. These findings suggest a specific association between developmental origin of PC neurons and their neuronal properties.
Frequency Domain Measurements of Melt Pool Recoil Force Using Modal Analysis
Authors: Cullom Tristan , Lough Cody , Altese Nicholas , Bristow Douglas , Landers Robert , Brown Ben , Hartwig Troy , Barnard Andrew , Blough Jason , Johnson Kevin , Kinzel Edward
Published: December 2020

Recoil pressure is a critical factor affecting the melt pool dynamics during Laser Powder Bed Fusion (LPBF) processes. Recoil pressure depresses the melt pool, providing layer-to-layer fusion without introducing porosity. If the recoil pressure is too low, the process operates in a conduction mode where layers will not properly fuse, while excessive recoil pressure leads to a keyhole mode, which results in gas porosity. Direct recoil pressure measurements are challenging because it is localized over an area proportionate to the laser spot size producing a force in the mN range. This paper reports a vibration-based approach to quantify the recoil force exerted on a part in a commercial LPBF machine. The measured recoil force is consistent with estimates from high speed synchrotron imaging of entrained particles, and the results show that the recoil force scales with applied laser power and is inversely related to the laser scan speed. These results facilitate further studies of melt pool dynamics and have the potential to aid process development for new materials.
Circulating levels of soluble tumor necrosis factor receptor 2 are associated with progressive diabetic kidney disease in patients with type 2 diabetes mellitus
Authors: Wu Tsung-Hui , Chang Li-Hsin , Chu Chia-Huei , Hwu Chii-Min , Chen Harn-Shen , Lin Liang-Yu
Published: December 2020

Background

Chronic low-grade inflammation is considered one of the major mechanisms for the progression of diabetic kidney disease. We investigated the prognostic value of circulating soluble tumor necrosis factor receptor 2 (sTNFR2) for early nephropathy in patients with type 2 diabetes.
Materials and methods

A total of 346 patients with type 2 diabetes and an estimated glomerular filtration rate (eGFR) ≥ 30 mL/min/1.73 m2 were followed up for a median of 4 years. Renal outcomes were defined as a composite of either or both a > 30% decline in the eGFR and/or albuminuria stage progression determined with consecutive tests.
Results

Sixty-nine patients developed renal composite events. Serum concentrations of sTNFR2 were strongly associated with the risk of renal function decline and progressive changes in albuminuria. Through a receiver operating characteristic curve analysis, a serum sTNFR2 level of 1.608 ng/mL was adopted as the discriminator value for predicting renal outcomes (area under the curve 0.61, 95% confidence interval 0.54–0.68, p = 0.005), yielding a sensitivity of 73.9% and a specificity of 48.7%. The association of sTNFR2 levels ≥ 1.608 ng/mL to renal outcomes was significant after adjusting for relevant variables (hazard ratio 1.95, 95% confidence interval 1.01–3.74, p = 0.046) and remained consistent across subgroups stratified by age, sex, systolic blood pressure, eGFR, albuminuria, and the use of renin-angiotensin system blockers.
Conclusions

Higher circulating levels of sTNFR2 are independently associated with an eGFR decline and progressive albuminuria in patients with type 2 diabetes.
A Robust 4-channel Micro-power Low-noise Neural Recording Amplifier for Hippocampal Cognitive Prosthesis
Authors: Ni Ming , Han Yan , Lei Jian , Kim Hakbong
Published: December 2020

Background: Recording of electrical activity of neurons is indispensable for decoding the information in the brain. The amplitude of signals recorded by electrodes is small, and it must be amplified to the level that can be digitalized by the analog-to-digital convert (ADC). A micro-power low-noise neural recording amplifier is indispensable for implant hippocampal cognitive prosthesis. When the process turns into deep submicron, the gate leakage current of the metal oxide semiconductor (MOS) transistor becomes larger and mismatch between devices becomes worsen. It is necessary to keep the neural amplifier robust in all process corners. Methods: The proposed circuit is a two-stage amplifier which can achieve a good trade-off between power consumption and noise. Four second-stage amplifiers share a common reference amplifier to reduce area and power consumption. A pseudo-resistor with high resistance is utilized to realize a very-low frequency high pass corner without external components. In order to minimize process variation, a bulk-compensated (BC) technique is adopted to maintain adequate tolerance in all corner case. Results: The 4-channel neural amplifier is designed and fabricated in a 40 nm standard complementary metal oxide semiconductor (CMOS) process. It achieves a mid-band gain of 54 dB, a bandwidth of 70 Hz to 7.7 kHz, a total input-referred noise of 3.2 μVrms , and a Noise Efficiency Factor (NEF) of 3.3 while consuming 4.68 µW from the 1.1 V supply. The core area of one channel is only 0.032 mm 2 . Conclusion: A 4-channel integrated neural recording amplifier chip with bias-compensated circuits is presented in this paper. Extensive simulations insure that the design is “center”. The chip layout is verified using design rules check (DRC) and layout versus schematic (LVS) design check with the help of verification tools. Test results shows that it is less sensitive to process variation and consumes less power compared with amplifier without bulk-compensated circuit. This makes the design robust and uniquely appropriate for low-power implant application.
Nurses’ Viewpoints on the Quality of Care: A Qualitative Study in Timor-Leste
Authors: Luan Bernadethe Marheni , Lopes Paulo , Soares Domingos
Published: December 2020

BackgroundResearch on quality of care revealed nurse-to-patient ratio and skill mix as key elements in quality of care. However, those studies were done in countries where the nursing workforce had a higher proportion of professional nurses with bachelor degrees. The findings of the research studies may have overlooked health system challenges such as the auxiliary nursing services found in lesser developed small island countries with higher proportions of auxiliary nurses. Working in under-resourced places, nurses in Timor-Leste might have differing viewpoints on the aspects that contribute to quality of care perspectives.MethodsFocus group discussions (FGDs) were conducted in 2017, in three districts that included staff and senior nurses from three levels of health care facilities: primary, secondary, and tertiary. Data were analyzed using content analysis method.ResultsTwo themes emerged from the FGDs data: “patients as the center focus of the service” and “gaps in providing quality of care”. Aside from attributes of quality care such as equality, efficiency, and patient-centeredness in the delivery of care, the first theme also identified the importance of identifying nurses’ value system in order to support a specific level of quality of care. The second theme included quality care milieu amplifying distinctive factors facing a health system in under-resourced places. Problems related with structural dimension of quality of care such as facility infrastructure and staffing were described. Nurses were unable to improve the quality of care in healthcare facilities when faced with inadequate and deficient infrastructure, equipment, supplies, financing, management, and staffing support. Conclusions Compared to nurses in countries with a better workforce skill mix, nurses in lesser developed small island countries and nurses working in under-resourced places, face additional challenges that uniquely influence the quality of care. Findings from this study provide evidence that it is important to develop human resources for health (HRH) policies that contribute to professional management of the nursing workforce as the largest health workforce cadre, thus strengthening their ability to improve patient care service.
Analysis of the Situation of Unmet Health Care Need Among Extremely Rare Disease of Gaucher
Authors: Qi Xinye , Xu Jiao , Shan Linghan , Li Ye , Cui Yu , Liu Huan , Wang Kexin , Gao Lijun , Kang Zheng , Wu Qunhong
Published: December 2020

BackgroundThe diagnosis and health care of patients with rare diseases present a tremendous challenge worldwide. This study estimated the health service utilization, cost of illness, and patients with Gaucher disease (GD)’s/caregivers’ health-related quality of life in China.MethodAn online retrospective survey of patients with GD and their caregivers was conducted during May-June 2018. Socio-demographic, health service utilization, disease-related expenses, social support, sleep quality (Pittsburgh Sleep Quality Index [PSQI]), and the Short Form Health Survey (SF-36) were investigated. Using self-reported information, we estimated the annual cost of illness, including direct medical, direct non-medical, and indirect medical costs. ResultsForty patients and their 49 caregivers were surveyed. The patients’ onset age of GD was 9.3±10.9; their disease course was 3.5±3.1 years. 21 (42.9%) patients had ≥2 caregivers, but 35 (71.4%) caregivers reported have no experience as a caregiver. 79.6% caregivers have stopped working, and 87.8% changed weekly working schedule. Before final diagnosis, patients visited 3.9±3.1 (max=20) hospitals and took 1.2±1.7 (max=6.6) years for confirmed diagnosis. On average, 5.0±9.6 misdiagnoses occurred, and the per-patient diagnoses cost was USD ($) 7,576. After GD confirmation, 8 (16.3%) patients received no treatment, 40 (81.6%) received pharmacotherapy, 10 (20.4%) received surgery, 38 (77.6%) received outpatient service (8.8±9.1 times/annually), and 37 (77.5%) received inpatient service (4.0±3.5 times/annually). Annual per-patient cost was USD ($) 49,925 (95% confidence interval: 29,178, 70,672). Average direct medical cost was $41,816, including pharmaceutical ($29,908), inpatient ($7,451), and outpatient ($1,838). Productivity loss per-caregiver was $1,980, and their Zarit Burden Inventory score was moderate-severe (48.6±19.6). Both patients/caregivers reported lower social support (32.4±7.4, 34.9±7.6), two times higher PSQI (7.9±2.9, 8.7±3.6), and half lower SF-36 (41.3±18.6, 46.5±19.3) than those reported for healthy Chinese individuals.Conclusion﻿This study finds out that fill the unmet need for extremely rare diseases is very challenging. The high misdiagnosis rate, together with delayed diagnosis, substantial costs, and deteriorated health-related quality of life of GD patients as well as their heavy care burden, calls for extreme attention from policymakers in China. Further efforts of government and society are urgently demanded, including pharmaceutical reimbursement, screening newborns, developing precise diagnostic tools, and training doctors.
Small Extracellular Vesicles From Human Adipose-derived Stem Cells: A Potential Promoter of Keeping Fat Graft Survival
Authors: Chen Aizhen , Tang Shijie , He Jiawei , Li Xiangyu , Peng Guohao , Zhang Haoruo , Chen Jinghua , Chen Liangwan , Chen Xiaosong
Published: December 2020

Background: Small extracellular vesicles (sEVs) with genetic information secreted by cells play a crucial role in the cellular microenvironment. In this study, our purpose is to explore the characteristics of the small extracellular vesicles of human adipose-derived stem cells (hADSC-sEVs) and studied the role of hADSC-sEVs in improving the survival rate of grafted fat.Methods: In the present study, we used the transmission electron microscopy, nano-tracking analysis, nanoflow surface protein analysis, zeta potential value to identify sEVs. SEVs' trajectory was traced dynamically to verify whether hADSC-sEVs can be internalized into human umbilical vein endothelial cells (HUVECs) in vitro. The angiogenic property of hADSC-sEVs was observed by measuring the volume, weight and histological analysis of the grafted fats in nude mice modles. Results: Our research showed that the extracellular vesicles were sEVs with double-layer membrane structure and the diameter of which is within 30-150nm. hADSC-sEVs exert biological influence mainly through internalization into cells. Compared with the control group, the hADSC-sEVs group had a significantly higher survival rate of grafted fat, morphological integrity and a lower degree of inflammation and fibrosis. And immunohistochemistry showed that hADSC-sEVs significantly increased the neovascularisation and the expression of CD34, VEGFR2 and KI-67 in the graft tissue. Conclusions: As a potential nanomaterial, hADSC-sEVs has been explored in the field of cell-free application of stem cell technology. hADSC-sEVs promoted the survival of grafted fats by promoting the formation of new blood vessels, which is another promising progress in the field of regenerative medicine. We believe that hADSC-sEVs will have a broad application prospect in the field of regenerative medicine in the future.
The Influence of Male and Female Overweight/obesity on IVF Outcome: A Cohort Study Based on Registration in Western China
Authors: liu xiang , Sun Jianhua , Xue Xia , Zhang Zhou , Shi Juanzi , Xing Junping
Published: December 2020

Background: Overweight/obese couples are more likely to present with a lower fertility, but it is still unclear whether the Overweight/obese can reduce the successful rate of in vitro fertilization-embryo transform (IVF-ET).This systematic review uses strict Chinese BMI criterias to evaluate whether male and female overweight/obesity will affect embryo quality and IVF outcomes, and whether there are gender differences.Methods: We reviewed the IVF-ET data of Northwest Women and Children's Hospital from 2015.01 to 2019.06, and divided the included population into four groups: Group 1 (n = 3413, male and female BMI: 18.5≤BMI＜24kg/m2, the control group);Group 2 (n = 1437, female BMI≥24 kg/m2 and male BMI18.5≤BMI＜24 kg/m2, the experimental group 1); Group 3 (n=4283, female BMI18.5≤BMI＜24 kg /m2 and male BMI≥24 kg/m2, the experimental group 2) and Group 4 (n=2176, female BMI≥24 kg/m2 and male BMI≥24 kg/m2, the experimental group 3). .Primary outcomes were clinical pregnancy rate,（CPR), live birth rate(LBR)，available embryo rate and normal fertilization rate.Results: The study found that the overweight/obesity of the independent female group or the combined male and female group manifested with a much less number of available embryos and a much less number of high-quality embryos (p <0.05). Meanwhile, the independent male group displayed a significant reduction of IVF-ET cleavage rate (p=0.019) and the independent female group displayed a significant reduction of the fertilization rate (p=0.029) and the normal fertilization rate (p=0.004). The combined male and female group manifested with a significant reduction of the available embryo rate (p=0.026), the fertilization rate (p=0.010) and the normal fertilization rate (p=0.003)，but overweight/obesity has no significant effect on CPR、LBRand abortion rates. Conclusion: overweight/obesity affects the embryo quality, the fertilization rate, and the cleavage rate, and there exists gender differences. Therefore, in order to improve the embryo quality, the fertilization rate and the cleavage rate of IVF of overweight/obese couples, it is still recommended that one partner or both couples should manage to reduce their weight to a normal value before IVF treatment.
An ex Situ Underground Coal Gasification Experiment with a Siderite Interlayer. Course of the Process, Production Gas, Temperatures and Energy Efficiency
Authors: Wiatowski Marian , Kapusta Krzysztof , Nowak Jacek , Szyja Marcin , Basa Wioleta
Published: December 2020

A 72-hour ex situ hard coal gasification test in one large block of coal was carried out. The gasifying agent was oxygen with a constant flow rate of 4.5 Nm3/h. The surroundings of coal were simulated with wet sand with 11% moisture content. A 2-cm interlayer of siderite was placed in the horizontal cut of the coal block. As a result of this process, gas with an average flow rate of 12.46 Nm3/h was produced. No direct influence of siderite on the gasification process was observed; however, measurements of CO2 content in the siderite interlayer before and after the process allowed to determine the location of high-temperature zones in the reactor. The greatest influence on the efficiency of the gasification process was exerted by water contained in wet sand. At the high temperature that prevailed in the reactor, this water evaporated and reacted with the incandescent coal, producing hydrogen and carbon monoxide. This reaction contributed to the relatively high calorific value of the resulting process gas, averaging 9.41 MJ/kmol, and to the high energy efficiency of the whole gasification process, which amounted to approximately 70%.
Mechanism of Abnormal Surface Subsidence Induced by Fault Instability
Authors: Zhang Gangyan
Published: December 2020

Surface movement and deformation with faults differ significantly from that without faults, which the surface movement and deformation at the fault outcrop generally abnormally increase when a fault occurs in the overlying strata and loses stability as a result of mining. To explore the mechanism of abnormal surface subsidence induced by fault instability due to mining in the hanging wall and footwall, mechanical models for the fault slip and soil cantilevers were separately established. Moreover, based on numerical and similarity simulation experiment, the difficulty degrees of fault instability were compared and analysed during mining in hanging wall and footwall. The research results show that: (1) the abnormal surface subsidence at fault outcrop is caused by fracture of soil mass at the fault outcrop due to the cantilever effect. (2) The fault zone that can be stabilised during mining in the hanging wall is broader than that during mining in the footwall, and a fault remains stable when mining in hanging wall and the surface at fault outcrop is more likely to experience stepped subsidence when mining in the footwall. (3) Fault stability worsens with the growth of the fault dip angle when mining in hanging wall, the fault is certainly subjected to slip and instability when fault dip angle is lower than the internal friction angle of the rock mass within the fault zone and fault stability strengthens with increasing fault dip angle during mining in the footwall. (4) When mining in the footwall, the ratio of shear stress to normal stress at the fault outcrop is about five times that when mining in the hanging wall and the fault is more likely to undergo slip and instability during mining in the footwall. (5) As a natural weak plane in the rock mass, a fault exerts a blocking effect on the transfer of mining-induced stress and overburden movements.
Bacterial Profile of Nurses’ Uniforms: A Descriptive Cross-sectional Study
Authors: Bayuo Jonathan , Obour Emmanuel , Bonsu Felix , Agyei Frank , Asante Akua , Abeasi Doreen , Akyem Samuel , Nabaale Stephen
Published: December 2020

Background: The bacterial profile associated with nurses’ uniforms have not been empirically ascertained within the Ghanaian setting. Objective: To evaluate the bacterial profile of scrubs worn by nurses over a 24-hour period. Methods: A descriptive cross-sectional approach was used with 20 conveniently recruited Registered Nurses spread across a 24-hour shift period. Sterile scrubs were provided and at the end each shift, four zones were swabbed (axilla, anterior trunk, posterior trunk, and posterior aspects of the trousers). The laboratory isolation processes proceeded through colony identification, gram staining, catalase test (Gram-positive), lactose fermenter (Gram-negative), Triple Sugar Iron and Motility Indole Ornithine (Enterobacteria). Results: Both Gram-negative and Gram-positive bacteria were identified which may suggest that irrespective of the unit in which nurses worked, their uniforms served as surfaces of bacterial habitation. At least, one organism was isolated at all the areas swabbed suggesting that nurses’ uniforms are contaminated at the end of their shift.Conclusion: The findings suggest a need for collective efforts to ensure that uniforms are not worn beyond the confines of the healthcare setting as well as strict adherence to infection prevention and control policies within the hospital.
Diversity of 3’ Variable Region of cagA Gene in Helicobacter Pylori Strains Isolated from Chinese Population
Authors: Xue zhijing , You Yuanhai , He Lihua , Gong Yanan , Sun Lu , Han Xiurui , Fan Ruyue , Zhai Kangle , Yang Yaming , Zhang Maojun , Yan Xiaomei , Zhang Jianzhong
Published: December 2020

Background: CagA is one of the most important virulence factors of Helicobacter pylori (H. pylori). There is a highly polymorphic Glu-Pro-Ile-Tyr-Ala (EPIYA) repeat region in the CagA 3’ variable region. This repeat region is thought to play an important role in the pathogenesis of gastrointestinal diseases. The aim of this study was to investigate the diversity of CagA 3’ variable region and the amino acid polymorphisms in the EPIYA segments, and their association with gastroduodenal diseases.Methods: A total of 515 H. pylori isolates from patients in 14 different geographical regions of China were collected and the genomic DNA was extracted. The 3’ variable region of the cagA was amplified by polymerase chain reaction (PCR) and then followed by DNA sequencing, and the amino acid sequences were analyzed with MEGA 7.0 software.Results: A total of 503 (97.7%) H. pylori isolates were cagA-positive and 1,587 EPIYA motifs were obtained, including 12 types of EPIYA or EPIYA-like sequences. In addition to the four reported major segments, several rare segments (e.g., B’, B’’ and D’) were defined and 20 different sequence types (e.g., ABD, ABC) were found in our study. A total of 481 (95.6%) strains were East Asian type, most of them were ABD subtype (82.1%). Only 22 strains were Western type, including types AC, ABC, ABCC and ABCCCC. The CagA-ABD subtype had statistical difference in different geographic regions (P=0.006). There are seven amino acid polymorphisms in the sequences surrounding the EPIYA motifs, among which amino acid residue 893 and 894 had a statistical difference with gastric cancer (P=0.004).Conclusions: In this study, 503 CagA sequences was studied and analyzed in depth. In Chinese population, most H. pylori isolates are of the CagA-ABD subtype and its presence was associated with gastroduodenal disease. Amino acid polymorphisms at residue 893 and 894 flanking the EPIYA motif had a statistically significant association with gastric cancer.
Prospective Observational Study of an Eye-measuring Device Aiming at Application to Periodic Health Checkups for Under 12 Months of age Infants; The Feasibility of Gazefinder
Authors: Fukushima Shuntaro , Takahashi Tomoo , Tsukamoto Kazuki , Matsumura Misaki , Takigawa Ryo , Sakai Yasuo , Maniwa Sokichi , Murphy Lynne , Taketani Takeshi
Published: December 2020

Background Eye-tracking to evaluate gaze patterns is effective screening and assessment tool for children with Autism Spectrum Disorder (ASD). Gazefinder, one of eye-tracking devices is can be easily and quickly used. Few studies have investigated whether Gazefinder can be applied to infants under 12 months of age, and then we examined the feasibility of this device in this age group aiming at applications to periodic health checkups for early identification of ASD in the future. Methods We conducted a prospective observational study from April 2019 to March 2020 that included infants between 4 and 11 months of age who underwent a periodic health checkup in Ohchi County, Shimane, Japan. Data on participants’ sex, age, gestational age, birth weight, and Japanese Developmental Quotient (DQ; the Enjoji Scale) were collected. We presented nine patterns of short movies, and measuring the gaze data, fixation time percentages, and patterns. Results Infants who fulfilled the inclusion criteria were recruited, and 93 gaze datapoints were analyzed. The mean age was 6.5 months and mean DQ was 88%. Subjects were divided into four groups by age: 4-5, 6-7, 8-9, and 10-11 months. The mean fixation time percentage of all sequences was 81.0% (standard deviation; 4.4), and there was no significant difference in each group. Infants in all groups showed a significantly higher predilection for eyes than for mouths. There was a positive association of age with human gaze and a negative association with geometric gaze. Moreover, we confirmed that joint attention skills were enhanced in accordance with their growth process. Conclusions The eye-tracking data were almost corresponding to previous studies and Gazefinder could be applied to infants starting at 4 months of age. For ASD screening in early infancy, more researches are needed.
Laparoscopic Surgery for Gallbladder Neuroendocrine Carcinoma: A Case Series and Literature Review
Authors: Chu Hongwu , Shi Ying , Dou Changwei , Wei Fangqiang , Zhang Chengwu , Zhang Jungang , Huang Dongsheng
Published: December 2020

Background: Gallbladder neuroendocrine carcinomas (GB-NECs) are a group of rare and heterogeneous neoplasms. There are few reports regarding laparoscopic surgery for GB-NEC cases diagnosed at advanced stage.Case presentation: Three patients, two females and one male, were admitted to our hospital. Two patients had the chief complaint of upper quadrant pain and one patient was found to have gallbladder occupation during a routine health checkup. No patient complained jaundice, weight loss, or carcinoid syndrome-related symptoms including diarrhea, edema, ﬂushing and wheezing. Contrast-enhanced computed tomography (CT) examination showed local wall thickening of the gallbladder. In addition, one patient showed focal liver parenchymal invasion, and none of the three patients' preoperative imaging examination revealed lymph nodes (LNs) metastases. All three patients underwent laparoscopic radical cholecystectomy according to intraoperative frozen pathological examination, and they were diagnosed as GB-NEC based on postoperative pathology and immunohistochemistry. TNM stages of these patients were ⅢA (T3N0M0), ⅢB (T3N1M0) and ⅣB (T3N2M0), respectively. Chromogranin A (CgA) and synaptophysin (Syn) were positive in all cases. No patient encountered postoperative bleeding, bile leakage, abdominal abscess, gastrointestinal fistulas or pulmonary complication. Two patients underwent postoperative chemotherapy with two cycles and seven cycles of etoposide plus cisplatin, respectively. Another patient did not receive postoperative chemotherapy due to his poor general condition. The overall survival time of three patients was 4.6 months, 16.8 months and 8.5 months, respectively. All three patients presented with liver and/or bile duct recurrence after surgery with the tumor-free survival time of 2.3 months, 3.3 months and 3.0 months, respectively.Conclusion: Laparoscopic surgery may be considered as a potential treatment for advanced GB-NEC in selected patients. However, further studies are needed to investigate the tumor-free survival benefit of laparoscopic surgery, and whether expanding the resection scope could reduce postoperative recurrence.
The Reliability of an Artificial Intelligence Tool, ‘Decision Trees’, in Emergency Medicine Triage
Authors: AYDIN Alp Giray , Eray Oktay , SAYRAC Ali Vefa , OSKAY Alten , ULUSAR Umit Deniz
Published: December 2020

Objective: Overcrowding is a challenge for emergency departments throughout the world. Triage systems categorize the patients based on medical emergencies in order to avoid the malpractices. The present study aimed to test the validity of an artificial intelligence tool, ‘Decision Trees’, in emergency medicine triage. Methods: This prospective, cross-sectional, clinical study was conducted in an emergency department of a tertiary care hospital. A total of 1999 patients over 18 years were included into the study. The triage stuff were trained before the study with the Australasian Triage Scale. Two independent observers rate the ultimate triage category of study patients. A new algorithym by ‘Decision Trees’ was constructed at the end of the study. Results: The mean age of the study patients were 41.1±17,2 and 49.1 % of them (n=981) were male. There were 867 patients (43.3%) with triage category of five and 14 (0.7%) patients with triage category one. The most common clinical descriptors of the patients were minimal pain with no high risk features 20.5% of them (n=409) and minor symptoms of low risk conditions 18.1% of them (n=362). There was an excellent consistency between two independent observers (kappa value: 0.997. The new algorithm by ‘Decision Trees’ rated wrong in only one patient. The accuracy rate was 99.9%. The consistency between ATS and ‘Decision Trees was excellent (kappa value: 0.999). There was average consistency between physicians and paramedics. (kappa value: 0.541).Conclusion: Decision trees as an artificial intelligence model should be used for producing practical triage algorithms as a decision support tool in emergency departments.