bluuebunny/crossref_metadata_2025 huggingface dataset:
Factors predicting the oral health behaviors of the Iranian students in the District 1 Tehran, Iran
Authors: Pourhaji Fatemeh , Delshad Mohammad Hossein , Tavafian Sedigheh Sadat , Hidarnia Alireza , Niknami Shamsodin
Published: May 2020

Aim: The purpose of this examination is determining the predictors of oral health behaviors among Iranian students in district 1 Tehran based on the health belief model with added commitment to plan construct. Methods: This cross-sectional study was conducted on 351 four grade female students in the first district of Tehran, Iran in 2017. The multi‑stage random cluster sampling method was used to recruit students. The inclusion criteria were being in four – graded level of elementary schools of the 1st district in Tehran, being female students aged between 9-11 years and being physically and psychologically healthy student. Logistic regression analysis was used to identify the variables that predict oral health behaviors. Results: Totally, (N= 31.8%) students  reported that they were brushing less than twice a day and (N=   55.2% ) students claimed  using of dental floss once a week or less than once a day. The results indicated that perceived self-efficacy (OR=1.46, 95% CI=0.57-3.78, P<0.001), commitment to plan (OR=1.13, 95% CI=1.04-1.23, P<0.001) and cues to action (OR=1.42, 95% CI=1.14–1.76, P=0.002) were the significant predicting variables of brushing twice a day, and use of dental floss once a day or more (OR=1.02, 95% CI=0.23-3.53, P=0.003). Conclusion: This study has shown the effectiveness of the health belief model with added commitment to plan construct to predict oral health behavior in female students. Thus, it seems that the model as a acceptable framework for designing training programs to improve oral health behavior in students.
Probabilidade em livros didáticos de matemática dos anos finais
Authors: Lima Ewellen Tenorio de
Published: May 2020

No presente artigo, a partir da análise das coleções de livros didáticos de Matemática aprovadas pelo PNLD 2017, volta-se o olhar para a distribuição das atividades que trabalham com a Probabilidade nas diferentes coleções e em seus volumes, bem como para as diferentes concepções de Probabilidade presentes neste material didático. Ao todo, foram identificadas 875 atividades, quantitativo que não está homogeneamente distribuído entre as coleções, nem, tampouco, em seus volumes. No que se refere às concepções de Probabilidade abordadas, como esperado, foi constatado que uma maioria absoluta de problemas trabalha com a probabilidade clássica (81%). Os resultados encontrados apontam para a necessidade de grandes mudanças nas próximas edições destes materiais didáticos, tendo-se em vista as prescrições apresentadas pela BNCC, que trazem grande destaque ao trabalho com a Probabilidade no Ensino Fundamental, e, em especial, à probabilidade frequentista nos Anos Finais.
Transcendência e o aprender a aprender
Authors: Correa Alessandra de Abreu , Rocha Filho João Bernardes da
Published: May 2020

O presente artigo é parte integrante de um estudo de doutoramento realizado sobre as articulações existentes entre os elementos transdisciplinares e as práticas docentes relacionadas ao ensino de Estatística nos anos finais do ensino fundamental. Buscou-se descrever e analisar as possíveis aproximações entre a Educação Estatística e os estudos transdisciplinares, compreendendo suas potencialidades nas práticas mobilizadas pelos docentes. As análises emergiram das concepções docentes que foram evidenciadas, na entrevista episódica, respondida por duas participantes graduadas em Matemática da cidade de Canela/RS. A análise dos dados foi realizada com base na Análise Textual Discursiva, sendo uma abordagem qualitativa e compreensiva. As conclusões apontam que existem vínculos entre os indicadores de transdisciplinaridade e as práticas docentes que perpassam a dimensão profissional e alcançam uma atitude transdisciplinar que pode ocorrer por meio da transcendência e o aprender a aprender.
FONDENOXAVID: A Retrospective Analysis on Utility of Thromboprophylaxis with Fondaparinux and Enoxaparin in Patients with COVID19 Infection in Italy
Authors: Viggiano Giuseppe Vito , Cardillo Giuseppe , Russo Vincenzo , Mangiacapra Sara , Cavalli Antonella , Pesci Chiara , Fontanella Andrea , Agrusta Federica , Bellizzi Annamaria , Amitrano Maria , Iannuzzo Mariateresa , Sacco Clara , Lodigiani Corrado , Di Micco Pierpaolo
Published: May 2020

Background: After the outbreak of a novel coronavirus (i.e. SARS COV2) in China and its diffusion around the world, great attentions was reserved to the increased incidence of venous thromboembolism in these patients. A specific antiviral action of heparins toward SARS COV2 has been reported in vitro such as a well know action of heparins to prevent VTE in inpatients with infective disease has already been reported since several years. Yet, because fondaparinux represent the pharmacological antithrombotic active sequence of all heparins and because its clinical indication o prevent VTE in inpatients is similar to heprains, we realized a retrospective analysis in inpatients with SARS COV2 on the incidence of VTE during pharmacological prophylaxis with enoxaparin or fondaparinux. This retrospective analysis was named FONDENOXAVID. Methods: We conducted a retrospective cohort study that used patients with SARS COV2 during the Italian outbreak from February 18, 2020 to April 30, 2020. Our aim was to compare the clinical characteristics, prophylactic treatment and outcomes in inpatients positive to SARS COV2 at risk to develop venous thromboembolism, in particular venous thrombosis with or without pulmonary embolism, during in-hospital primary thromboprophylaxis with enoxaparin (40 mg or 60 mg once daily) or fondaparinux (2.5 mg once daily). Statistical analysis was conducted with using MatLab R2016B and eventually ad hoc functions. Results: There were not significative differences in clinical characteristics between patients that used enoxaparin or fondaparinux as thromboprpophylaxis for SARS COV2. The cumulative incidence of thrombotic events was not different in patients that used enoxaparin or fondaparinux as thromboprpophylaxis. No differences were found also in d-dimer and fibrinogen levels test at the admission and after 3 weeks as markers of prolonged inflammation due to SARS COV2. Discussion: The increased incidence of VTE in vivo has been reported in several studies although prophylaxis with low molecular weight heparin was conducted in some of them. The clinical indication to prevent VTE was similar for heparins and fondaparinux. In our results a non-inferiority to prevent VTE was recorded when inpatients with SARS COV2 were treated with prophylactic doses of enoxaparin or fondaparinux according to international guidelines. The incidence of VTE in this retrospective analysis showed that Fondaparinux at fixed doses of 2.5 mg daily was not inferior to enoxaparin (4000 UI daily). Our results testify that fondaparinux and enoxaparin showed the same efficacy to reduce the incidence of VTE in inpatients with SARS COV2.
Non-Anticoagulant Heparan Sulfate from the Ascidian Phallusia nigra Prevents Colon Carcinoma Metastasis in Mice by Disrupting Platelet-Tumor Cell Interaction
Authors: Silva Christiane da Fonseca Sobral , Motta Juliana Maria , Teixeira Felipe Castro Oliveira de Brito , Gomes Angélica Maciel , Vilanova Eduardo , Kozlowski Eliene Oliveira , Borsig Lubor , Pavão Mauro Sérgio Gonçalves
Published: May 2020

Although metastasis is the primary cause of death on patients with malignant solid tumors, efficient antimetastatic therapies are not clinically available thus far. Sulfated glycosaminoglycans from marine sources have shown promising pharmacological effects, acting in different steps of the metastatic process. Oversulfated dermatan sulfate from ascidians is effective in preventing metastasis by inhibition of P-selectin, a platelet surface protein involved in the platelet-tumor cell emboli formation. We report in this work that the heparan sulfate isolated from the viscera of the ascidian Phallusia nigra drastically attenuates metastasis of colon carcinoma cells in mice. Our in vitro and in vivo assessments demonstrate that the P. nigra glycan has very low anticoagulant and antithrombotic activities and a reduced hypotension potential, although efficiently preventing metastasis. Therefore, it may be a promising candidate for the development of a novel anti-metastatic drug.
Expression and Purification of Active Human Kinases Using Pichia pastoris as A General-Purpose Host
Authors: Aziz May H. Abdel , Fan Yao , Liu Lijun , Moasser Mark , Fu Haian , Jura Natalia , Arkin Michelle R.
Published: May 2020

Background: The heterologous expression of human kinases in good purity and in a monomeric, soluble and active form can be challenging. Most of the reported successful attempts are carried out in insect cells as a host. The use of E. coli for expression is limited to a few kinases and usually is facilitated by large solubility tags that can limit biophysical studies and affect protein–protein interactions. In this report, we evaluate the methylotrophic yeast Pichia pastoris (P. pastoris) as a general-purpose host for expression of human kinases. Methods: Six diverse kinases were chosen due to their therapeutic importance in human cancers. Tested proteins include serine/threonine kinases cyclin-dependent kinases 4 and 6 (CDK4 and 6) and aurora kinase A (AurKA), receptor tyrosine kinase erbB-2 (HER2), and dual specificity kinase mitogen-activated protein kinase kinase 3 (MKK3b). Noting that positively charged kinases expressed with higher yield, we sought to improve expression of two challenging targets, CDK6 and HER2, by fusing the highly basic, N-terminal domain of the secreted tyrosine-protein kinase VLK. A standard expression procedure was developed for P. pastoris, followed by purification using affinity chromatography. Purity and activity of the proteins were confirmed and compared to published values. Results: Some kinases were purified with good yield and purity and with comparable activity to commercially available versions. Addition of the VLK domain improved expression and decreased aggregation of CDK6 and HER2. Conclusions: P. pastoris is a promising host for expression of soluble and active human kinases.
Associations of Demographic, Clinical and Laboratory Profiles of Patients with type II Diabetes Mellitus with its Microvascular Complications in Bangladesh
Authors: Rashid Mamunur , Mukit Abdul , Ahmed Khawza Iftekhar Uddin , Mostafa Raqibul , Parveen Sharmin , Mahbub Md. Shahriar , Khandoker Ahsan H
Published: May 2020

Objective: The aim of this study was to investigate the associations of makers from demographic, clinical, and laboratory profiles with microvascular complications in a cohort of type II diabetic population in Bangladesh. Methods: In this cross-sectional study 103 participants [47 Men and 56 Women; Age 40~70 years] having type II diabetes for more than 10 years were randomly recruited during their routine visits to a major Diabetic Hospital in Dhaka, Bangladesh. The associations of prevalence of microvascular complications [Cardiac Autonomic Neuropathy(CAN), Diabetic Peripheral Neuropathy(DPN), Diabetic Nephropathy(Nep), Diabetic Retinopathy(Ret)] with demographic, clinical, and laboratory profiles were assessed by multivariate logistic regression (p<0.05 and Odds ratio (OR)> 1.0). Results: The prevalence rates of CAN, DPN, Ret and Nep were 68%, 43.69%, 6.8%, and 4.8% respectively. The overall prevalence of diabetic-associated microvascular complication is 94.36% in this cohort of diabetic patients. BMI (p=0.0330, OR=1.90) and HbA1c (p=0.0535, OR=3.08) were found to be the most significant risk factors in the development of all microvascular complications. However, HbA1c for CAN; HbA1c, Microalbuminuria and Urinary creatinine for DPN; years of Diabetes, Systolic blood pressure and albumin creatinine ratio for Nep, HbA1c and Microalbuminuria for Ret were found to be most significantly associated in this Diabetes patients’ cohort. Conclusion: The proportion of microvascular complications was found to be significantly high among patients with Type II diabetes mellitus in this cohort. Controlling HbA1c could help reduce all four types of complications. However, controlling microalbuminuria could prevent DPN and Ret. This emphasizes the need for screening and prevention program toward early, symptomless identification of type II diabetes microvascular complications.
The Impact of Nipple Repair in the Treatment of Lactating Nipple Injury
Authors: GAO HAIFENG , Wang jie , Ding Songtao , Li Yan , Zhang Yi , Gao Yajun , He Xiangping , Chen Si , Liu Xingxing , Zhang Hongwei , Liu Hongyan , Chen Ying
Published: May 2020

Objective To explore the effect of nipple repair in the treatment of lactating nipple injury.Methods Patients with nipple lesions admitted to the Maternal and Child Health Hospital of Haidian District from December 2015 to January 2020 were retrospective control study. The patients received nipple repair was the study group, the patients did not treated with medicine or surgery was the control group. Patients in both groups continued to be exclusively breastfeed with good sucking, The method of chi-square test was adopted by using SPSS24.0 statistical software to compare the difference of healing effect of nipple injury, pain relief rate, and recurrence rate of nipple injury.Results A total of 167 patients were enrolled, including in the 81 study group and 86 in the control group. The cure rates of the nipple injury in the study group and in the control group were 54.3% (44/81) and 26.7% (23/86) (χ2 = 13.451, P = 0.001). The complete pain relief rate was 48.1% (39/81) and 23.3% (20/86) (χ2 = 14.170, P = 0.001). The recurrence rate was 36.4% (16/44) and 34.8% (8/23) (χ2 = 0.016, P = 0.898).Conclusion For patients with no improvement in nipple damage after correction of etiology, nipple repair can improve the healing environment of nipple breakage, relieve nipple pain.
Using Best-Worst Scaling to Understand the Preferences of Stroke Survivors, their Relatives/Carers and the Public on Providing Stroke Thrombectomy Services in England
Authors: Flynn Darren , Lumley Hannah , Coughlan Diarmuid , Burgess David , Robinson Tomos , Ford Gary A , McMeekin Peter , White Phil
Published: May 2020

Background Outcomes for acute ischaemic stroke patients with large artery occlusion are significantly improved with endovascular thrombectomy (EVT). We aimed to identify preferences of stroke survivors, their relatives/carers and the public in England on: (i) EVT service organisation (localised versus centralised expert-delivered EVT services) and (ii) modelled outcomes for EVT effectiveness, equity of access and costs of EVT provision (based on increasing the number of comprehensive stroke centres across England that provide EVT from 24 to 30).Methods Stroke survivors, their relatives/carers and the public were engaged in an iterative co-design process to develop an accessible survey incorporating two Best-Worst Scaling (BWS) tasks: EVT service organisation (4 attributes each with 2 levels) and modelled outcomes (3 attributes each with 2 levels). On-line pilot testing was undertaken with 10 stroke survivors/carers. BWS data were transformed into standardised scores with corresponding 95% confidence intervals (CIs).Results 105 respondents completed the survey (stroke survivors [18%]; relative/carer of stroke survivor [32%]; member of public [50%]). Centralised (local) EVT provision by experienced and specialised medical teams was associated with the strongest positive preference (0.76, 95% CIs = 0.69, 0.82), followed by secondary inter-hospital transfer for EVT; associated with positive preferences whether required (0.15, 95% CIs = 0.07, 0.22) or not (0.30, 95% CIs = 0.22, 0.38). Travel times by emergency ambulance > 45 min (-0.29, 95% CIs=-0.37, -0.22) were associated with stronger negative preferences than length of stay < 48 hours [-0.16, 95% CIs=- 0.22, − 0.10). Maximal effectiveness of EVT (52% recovering with none/mild disability) was associated with stronger positive preferences (0.40, 95% CIs = 0.27, 0.53) than equity of access (71% or 72% of eligible patients) to EVT within 7 hours since onset of stroke symptoms, which was associated with marginal positive preferences. Costs of EVT provision were associated with negative preferences; maximal cost had the strongest negative preference (-0.29, 95% CIs=-0.40, -0.18).Conclusions Centralised stroke centres with experienced specialised teams and secondary transfers with travel times ≤ 45 minutes are likely to be acceptable to patients/carers and the public. Equity of access to EVT may be less of a priority than effectiveness, although both were considered more important than costs of EVT provision.
Kidney Injury Molecule-1 Mediated Autophagy Pathway Participates in Ischemic Preconditioning Evoked Renal Protection
Authors: Qian Subo , Li Xinyan , Gu Zhengqin , Shen Haibo
Published: May 2020

Background

Ischemia-reperfusion injury (IRI) is one of the most vital pathogenesis causing kidney injury, especially during the perioperative periods of partial nephrectomy and renal transplantation, but lacking of effective prevention and treatment strategies. This study was conducted to investigate the influences of ischemic preconditioning (IPC) on the pathological process of mouse bilateral IRI, and to figure out the role of kidney injury molecule-1 (KIM-1) mediated autophagy pathway in this process.
Methods

Nephron major histocompatibility complex class II (MHC II) conditional knockout (cKO) mice (Six2-Cre+/−; MHC II flox/flox) and the age- and sex-matched littermates from the Six2-Cre−/−; MHC II flox/flox colony (Ctrl) were established to investigate these issues. A 15-minute period of IPC was performed 4 days before the 30-minute of bilateral renal vessel occlusion. Severity of renal IRI in cKO and Ctrl mice with or without IPC were analyzed respectively and correspondingly.
Results

MHC II cKO mice presented severer kidney injury in both acute and chronic phase of renal IRI. IPC could significantly attenuate ischemia/reperfusion-induced serum creatinine (sCr) and blood urea nitrogen (BUN) increasing, as well as histological KIM-1 expression. However, MHC II cKO mice undergoing IPC showed more deteriorated kidney injury when compared with Ctrl mice, with higher levels of sCr, BUN, KIM-1 expression in the acute phase, and aggravated interstitial fibrosis in the chronic phase.
Conclusions

IPC could attenuate renal IRI functionally and histologically. KIM-1 mediated autophagy pathway plays a vital role in the IPC induced renal IRI protection.
Decline in independence after three years and its association with dietary patterns and frailty factors in community-dwelling older people: an analysis by sex and age stage
Authors: Kodama Sayuri , Hoshi Tanji , Kurimori Sugako
Published: May 2020

Background
Support based on sex and age is required to implement longevity strategies. This study clarified the association between declining independence after three years and the dietary patterns and frailty factors of community-dwelling independent older people. We analyzed sex and age stages for people between 65 and 75 years (earlier-stage) and people aged 75 years or above (latter-stage), respectively.
Methods
In a longitudinal study of 25 Japanese prefectures from 2013 to 2016, 3,693 respondents completed baseline and follow-up questionnaires. We analyzed 2,250 participants (1,294 men), after excluding individuals younger than 65 years (n = 510), deceased (n = 35), with missing data (n = 866), or disabled (n = 32). Independence was evaluated based on Instrumental Activities of Daily Living (IADL) scores (maximum = 12). Disability was defined as scoring lower than 9. Dietary patterns were derived from a principal component analysis of 7 food groups. Frailty factors showing a significant relationship with baseline IADL scores were selected. Multivariate logistic regression analysis revealed an association between baseline factors and declining independence after three years.
Results
The average IADL score three years from baseline was 11.5 ± 1.1. There were two IADL score groups: “high independence” (69.6%) and “low independence” (30.4%). Three baseline dietary patterns were identified: “dietary diversity,” “high meat frequency,” “low fruit, vegetable, and dairy product frequency.” The multivariate-adjusted model in the earlier-stage revealed that BMI ≥ 30 (odds ratio (OR) = 0.97, 95% confidence interval (CI): 0.12-7.61) showed no significant difference from 18.5 < BMI (OR = 1). In the latter stage, subjective health and exercising three or more times a week with enjoyment were associated with a lower odds ratio. High meat frequency was related to high OR in all groups, especially latter-stage older women (OR = 1.59, 95% CI: 1.17‐2.15).
Conclusions
Effective integrated support for maintaining independence may be associated with weight management for earlier-stage men, the mental/psychological factors in subjective health and exercise enjoyment for latter-stage older people, and limited meat consumption, especially for latter-stage older women.
Is there any difference in the outcome of geriatric and non-geriatric severely injured patients? – A seven-year, retrospective, observational cohort study with matched-pair analysis
Authors: Jensen Kai Oliver , Lempert Maximilian , Sprengel Kai , Simmen Hans-Peter , Pothmann Carina , Schlögl Mathias , Bischoff-Ferrari Heike , Hierholzer Christian , Pape Hans-Christoph , Neuhaus Valentin
Published: May 2020

Background:
The aging population has a tremendous impact on health care. Geriatric trauma is expected to increase due to the lifestyle and activity of the aging population and will be one of the major future challenges in health care. Therefore, the aim of this study was to investigate differences between polytraumatized geriatric and non-geriatric patients regarding 1) mortality, 2) length of stay, and 3) complications with a matched pair analysis.
Methods:
We included patients older than 17 years with an Injury Severity Score (ISS) of 16 or more admitted to our level 1 trauma center between January 2008 and December 2015. The cohort was stratified into two groups (age < 70 years “non-geriatric”, age ≥ 70 years “geriatric”). One-to-one matching was performed based on gender, ISS, mechanism of injury (penetrating/blunt), Glasgow Coma Scale (GCS), base excess, and the presence of coagulopathy (INR ≥ 1.4). Outcome was compared using the paired t-test and McNemar-test.
Results:
A total of 1457 patients with a mean age of 62 (± 21) years were identified. There were 1022 male (72%) and 435 female patients. Three hundred forty six patients (24%) were older than 70 years. Matching resulted in 57 pairs. 1) Mortality (25% vs 32% respectively; p = 0.219) as well as 2) length of stay (12.5 (± 13.3) days vs 11.8 (± 11.8) days respectively, p = 0.754) were comparable between geriatric and non-geriatric polytraumatized patients. 3) The complication rate (34% vs. 56%, p = 0.031) was significantly higher in geriatric patients.
Conclusion:
Despite significantly higher complication rates amongst the geriatric trauma patients, there were no significant differences regarding mortality and length of stay in this matched pair analysis – indicating the possibility of similar outcome in geriatric polytraumatized patients receiving optimal care.
Research Article – BMC Health Service Research (IF -1.93) Barriers and Facilitators to Implementing Evidence Based Bleeding Management in Australian Cardiac Surgery Units: A Qualitative Interview Study Analysed With the Theoretical Domains Framework and COM-B Model
Authors: Pearse Bronwyn Louise , Keogh Samantha Louise , Rickard Claire , Fung Lin Yoke
Published: May 2020

BackgroundBleeding during cardiac surgery is a common complication that often requires the transfusion of blood products. The combination of bleeding and blood product transfusion incrementally increases adverse outcomes including infection and mortality. Following bleeding management guideline recommendationscould assist with minimising risk but adherence is not high, and the cause for lack of adherence is not well understood. This study aimed to identify barriers and facilitators to practicing and implementing evidenced-based bleeding management in Australian cardiac surgery units. MethodsWe used a qualitative descriptive design to conduct semi-structuredinterviews with Australian cardiac surgeons, anaesthetists and perfusionists.The Theoretical Domains Framework (TDF) was utilised toguide interviews and thematically analyse the data. Categorised data were then linkedwith the three key domains of the COM-B model (capability, opportunity, and motivation) to explore and understand behaviour.ResultsSeventeen interviews were completed. Nine of the 14 TDF domains emerged as significant. Analysis revealedkey themesto improving capabilityincluded, standardisation, monitoring, auditing, and feedback of data and cross discipline training. Opportunity for change was improved with interpersonal and interdepartmental collaboration through shared goals, and more efficient and supportive processes allowing clinicians to navigate unfamiliar business and financial models of health care. Results suggest as individuals, clinicians had the motivation to make change and healthcare organisations have an obligation and a responsibility to partner with clinicians to support change and improve goal directed best practice. ConclusionUsing a theory-based approachit was possible to identifyfactors which may be positively or negatively influencing clinicians ability to implement best practice bleeding management in Australian cardiac surgical units.
Toward a Recognition of Key Role Players in Community Pharmacy
Authors: Afzali Monireh , Rajabzadeh Ali , Soleymani Fatemeh , Kebriaeezadeh Abbas , Nikfar Shekoufeh
Published: May 2020

Background: Although private community pharmacies are identified as health care facilities, they are highly affected by business management issues and different stakeholders. This study aims to identify, classify and analyze private community pharmacy stakeholders.Methods: A focus group was conducted with key informants to analyze and classify stakeholders using three-dimensional matrix. Identified stakeholders were analyzed regarding three attributes of power, legitimacy and urgency. The results of the focus group were converted to a structured questionnaire and confirmed in several face-to-face interviews until the saturation level.Results: four main levels of relationship and eight category of stakeholders differentiated through an analysis. The core stakeholders group possesses all the attributes and include pharmacy licensee, licensee-owner, responsible pharmacist, customer, prescriber, health insurance, regulatory body, and staff.Conclusion: The core stakeholders are directly involved in decision making. Further deliberations are necessary to analyze the behavior of stakeholders and investigate the communication model.
Dynamic Service Migration in Ultra-Dense Multi-Access Edge Computing network for High Mobility Scenarios
Authors: Lin Haowei , Xu Xiaolong , Zhao Juan , Wang Xinheng
Published: May 2020

The Multi-Access Edge Computing (MEC) has higher computing power than user equipment and lower latency than remote cloud computing, making new types of services and mobile applications keep emerging. However, the movement of users could induce service migration or interruption in the MEC network. Especially for highly mobile users, they accelerate the frequency of services' migration and handover, impacting on the stability of the total MEC network. In this paper, we propose a hierarchical multi-access edge computing architecture, setting up the Infrastructure for dynamic service migration in the ultra-dense MEC networks. Moreover, we propose a new mechanism for users with high mobility in the ultra-dense MEC network, efficiently arranging service migrations for users with high mobility and ordinary users together. Then, we propose an algorithm for evaluating migrated services to contribute to choose the suitable MEC servers for migrated services. The results show that the proposed mechanism can efficiently arrange service migrations and more quickly restore the services even in the blockage. On the other hand, the proposed algorithm is able to make a supplement to the existing algorithms for selecting MEC servers because it can better reflect the capability of migrated services.
Racial and Socioeconomic Disparities in Percutaneous Endoscopic Gastrostomy (PEG) Tube Placement among elderly patients with dementia in the United States from the National inpatient sample
Authors: Kochar Tanureet , Abugroun Ashraf , Nayyar Asma , Rahman Manar Abdel- , Patel Pragnesh J
Published: May 2020

Background

Placement of percutaneous endoscopic gastrostomy (PEG) tube in patients of advanced dementia has not been shown to improve nutritional status or mortality. The objective is to assess racial and socioeconomic disparities for PEG tube placement from National Inpatient Sample.
Methods

In a cross-sectional study, the National inpatient sample (NIS) registry was queried for all patients aged ≥ 70 who were diagnosed with dementia during the year 2016. Patients with dementia were identified using the Tenth revision (ICD-10) codes (F0150, F0151, F0280, F0281, F0390, F0391, G300, G301, G308, G309, G3109, G3183). Patients who received PEG tube were identified using ICD-10 diagnosis codes (Z431). Multivariable logistic regression models were utilized to determine the likelihood of PEG tube placement with adjustment for Patients demographics, socioeconomic factors, degree of frailty and comorbidities.
Results

Out of 1,745,028 patients with dementia, 35,075 patients had PEG tube placed. Majority of patients who received PEG tube were females (54.8%), of white race (45.5%) with a mean age of 82.3 years (SEM 0.02). Compared to controls, those who had PEG tube placement were more frail, had higher prevalence of chronic lung disease, diabetes, stroke, psychosis and nutritional deficiency anemias. On multivariable analysis, higher risk for PEG tube placement was seen in African Americans and Hispanics compared to Caucasians with a-OR 3.76 [95%CI: 3.47–4.07], p < 0.001 and 2.59 [95%CI:2.33–2.88], p < 0.001 respectively. A higher risk was also seen in patients with low income with a-OR 1.1(95%CI: 1.04–1.19), p = 0.002 and among those having Medicaid compared to Medicare insurance with a-OR 1.53 [95%CI: 1.30–1.80], p < 0.001. Compared to males, females were found to have low chances for PEG tube placement with a-OR: 0.78 [95%CO:0.74–0.82], p < 0.001. Hospital ownership, bed size and teaching status were found to have no impact on PEG tube utilization.
Conclusion

Despite the evidence against placement of PEG tubes in dementia patients, our findings confirm that PEG tubes are still being placed in frail and demented elderly. Apart from these, elderly patients with low income, African American origin and Medicaid enrollees have higher incidence of PEG tube placements. Efforts are needed to educate clinicians and community about worse outcomes of PEG tube placement in advanced dementia.
Low Carb (LCD) and Ketogenic (KD) Diets Increase Quality of Life, Physical Performance, Body Composition and Metabolic Health of Women with Breast Cancer Better Than a Standard Diet (SD)
Authors: Kämmerer Ulrike , Klement Rainer J. , Sütterlin Marc , Reuss-Borst Monika
Published: May 2020

Background: Breast Cancer (BC) patients often ask for a healthy diet. Here, we compared three different diets which could support BC patients during the rehabilitation process: a healthy standard diet (SD), a low carb diet (LCD) and a ketogenic diet (KD).Patients and Methods:KOLIBRI was a one-site nutritional intervention trial, combining inpatient and outhouse phases for 20 weeks. Female BC patients (n=152; mean age 51.7 years) could select their diet. Data collected were: quality of life (QoL), spiroergometry, body composition, blood biochemistry. 30, 92 and 30 patients started the KD, LCD and SD, respectively. Of those, 20, 72 and 25 completed the final examination.Results:Patients rated all diets as feasible in daily life. No adverse effects occurred in any diet group. KD offered the highest amount of energy and protein. All groups improved in QoL, body composition and physical performance. KD was superior in improving fatigue, insomnia and physical functioning. KD participants finished with the best physical performance and the highest muscle/fat ratio. Despite their increased cholesterol, KD patients had the best triglyceride/HDL ratio and HOMA-IR. Most metabolic parameters significantly improved in the LCD group. SD participants ended with remarkably low cholesterol levels, but did not improve triglyceride/HDL or HOMA-IR.Conclusions:A well-defined KD and LCD are safe and beneficial for BC. Both diets could thus be recommended for patients wanting to self-support their rehabilitation process.Trial registration IDNCT02092753 Protocol Registration date:02/26/2014Ketogenic Or LOGI Diet In a Breast Cancer Rehabilitation Intervention (KOLIBRI)URL: https://clinicaltrials.gov/ct2/show/NCT02092753?cond=KOLIBRI&draw=2&rank=1
TLR2 deficiency promotes IgE and inhibits IgG1 class-switching following ovalbumin sensitization
Authors: Li Yuqin , Chen Qiu , Ji Wei , Fan Yujie , Huang Li , Chu Chu , Zhou Wei-fang
Published: May 2020

Background: To explore the roles of Toll-like receptor (TLR)2 in Th2 cytokine production and immunoglobulin (Ig) class switching following ovalbumin (OVA) sensitization. Methods: TLR2-/- and wild-type C57BL/6 mice were sensitized by intraperitoneal injection with OVA. Lung pathology was assessed by hematoxylin and eosin staining. Abundance of interleukin (IL)4, IL5, IL13, and IL21 transcripts in the lungs was quantified by RT-PCR. OVA-specific IgG1, IgG2a, IgG2b, IgE and IgM were quantified by enzyme-linked immunosorbent assay. Phosphorylated signal transducer and activator of transcription (STAT)3 in lung tissue was detected by immunohistochemistry staining and nuclear factor (NF) κB activation was measured by immunofluorescence staining. STAT3 activation was inhibited using cryptotanshinone (CPT) treatment. Germline transcripts (Iμ-Cμ, Iγ-Cγ, Iα-Cα or Iε-Cε), post-recombination transcripts (Iμ-Cγ, Iμ-Cα or Iμ- Cε) and mature transcripts (VHDJH-Cγ, VHDJH-Cα or VHDJH-Cε) were analyzed from splenic B cells of OVA-sensitized wild-type mice (with or without CPT treatment) and TLR2-/- mice (with or without IL21 treatment). Results: The lungs of TLR2-/- mice showed a lesser degree of inflammation than wild-type mice after OVA sensitization. Following OVA sensitization, levels of IL4, IL13, and IL21, but not IL5, were significantly lower in TLR2-/- compared with wild-type mice. Moreover, OVA-specific IgG1 and IgE titers were markedly lower and higher, respectively, in TLR2-/- mice. TLR2 deficiency inhibited STAT3 activation but not NF-κB p65 activation. CPT treatment reduced IgG1 titers via inhibition of Stat3 phosphorylation. Both TLR2 knockout and CPT treatment reduced the frequencies of Iγ1-Cγ1, Iγ3-Cγ3 and Iα-Cα transcripts, but IL21 treatment compensated for the effects of TLR2 deficiency. Conclusion: These results suggest a role of TLR2 in restricting OVA-sensitized lung inflammation via promotion of IgG1 and inhibition of IgE class switching regulated by IL21 and STAT3.
Comprehensive analysis of DNA methylation and gene expression profiles in rectal cancer
Authors: Zhang Cheng , Meng Di , Chao Songjie , Ge Chunlin
Published: May 2020

BackgroundAbnormal hypomethylation of oncogenes and hypermethylation of tumor suppressor genes play important roles in human tumorigenesis and cancer progression, including those of rectal cancer (RC). However, conjoint analysis of RC involving both gene expression and methylation profiling datasets remains rare. This study aimed to identify methylation-regulated differentially expressed genes (MeDEGs) and to evaluate their prognostic value in RC through bioinformatics analysis.MethodsGene expression (GSE20842 and GSE68204) and gene methylation (GSE75546) profiling datasets were obtained from the Gene Expression Omnibus database. GEO2R was adopted to identify differentially expressed genes (DEGs) and differentially methylated genes (DMGs). MeDEGs were obtained by overlapping the DEGs and DMGs and then subjected to protein–protein interaction (PPI) network analysis using STRING. Modules and hub genes within the network were identified using MCODE and CytoHubba, respectively. Prognostic MeDEGs were selected by univariate Cox regression. Finally, our findings were validated based on The Cancer Genome Atlas (TCGA) database.ResultsIn total, 243 upregulated-hypomethylated and 51 downregulated-hypermethylated genes were identified as MeDEGs. A PPI network of MeDEGs was constructed with 290 nodes and 578 edges. Three modules and three hub genes—COL3A1, FPR1, and PLK1—within the network were identified. Three MeDEGs—NFE2, COMP, and LAMA1—were found to be survival-related. Furthermore, the expression and methylation status of two hub genes (excluding FPR1) and the three prognostic MeDEGs were also significantly altered in TCGA and were consistent with our findings.ConclusionsWe identified novel MeDEGs and explored their relationship with survival in RC. Our methodology may provide an effective bioinformatics basis for further understanding of the methylation-mediated regulatory mechanisms in RC.
Lenvatinib Promotes the Antitumor Effects of Doxorubicin in Anaplastic Thyroid Cancer
Authors: Su Xi , Liu Jiaxin , Zhang Haihong , Gu Qingqing , Zhou Xinrui , Ji Meiju , Yao Demao
Published: May 2020

Background
Anaplastic thyroid cancer (ATC) is a kind of rare thyroid cancer with very poor prognosis. It is one of the deadliest cancers in human due to the aggressive behavior and resistance to treatment. Doxorubicin has been approved in ATC treatment as a single agent, but monotherapy still shows no improvement of the total survival in advanced ATC. Lenvatinib was investigated with encouraging results in treating the patients with radioiodine-refractory differentiated thyroid cancer (DTC). However, antitumor efficacy of combination therapy with lenvatinib and doxorubicin remains largely unclear.
Methods
The antitumor efficacy of combination therapy with lenvatinib and doxorubicin on ATC cell proliferation and was assessed by the MTT assay and colony formation. Flow cytometry were employed to assess ATC cells’ apoptosis and cell cycle arrest in response to combination therapy. Xenograft models were used to test its in vivo antitumor activity.
Result
Lenvatinib monotherapy was less effective than doxorubicin in treating ATC cell lines and xenografts model. The combination therapy of lenvatinib and doxorubicin significantly inhibited ATC cell proliferation and tumor growth in nude mice, and induced cell apoptosis and cell cycle arrest in compared to lenvatinib or doxorubicin monotherapy.
Conclusion
Lenvatinib promotes the antitumor effects of doxorubicin in ATC cell and xenografts model. Lenvatinib/doxorubicin combination may be a potential candidate therapeutic approach for ATC.
­ Comprehensive analysis of key genes associated with ceRNA networks in nasopharyngeal carcinoma based on bioinformatics analysis
Authors: Xu Yuanji , Huang Xinyi , Ye Wangzhong , Zhang Yangfan , Li Changkun , Bai Penggang , Lin Zhizhong , Chen Chuanben
Published: May 2020

Background

Nasopharyngeal carcinoma (NPC) is an epithelial malignancy with high morbidity rates in the east and southeast Asia. The molecular mechanisms of NPC remain largely unknown. We explored the pathogenesis, potential biomarkers, and prognostic indicators of NPC.

Methods

We analyzed mRNAs, long non-coding RNAs (lncRNAs), and microRNAs (miRNAs) in the whole transcriptome sequencing dataset of our hospital (five normal tissues vs. five NPC tissues) and six microarray datasets (62 normal tissues vs. 334 NPC tissues) downloaded from the Gene Expression Omnibus (GSE12452, GSE13597, GSE95166, GSE126683, and GSE70970, GSE43039). Differential expression analyses, gene ontology (GO) enrichment, kyoto encyclopedia of genes and genomes (KEGG) analysis, and gene set enrichment analysis (GSEA) were conducted. The lncRNA-miRNA-mRNA competing endogenous RNA (ceRNA) networks were constructed using the miRanda and TargetScan database, and a protein-protein interaction (PPI) network of differentially expressed genes (DEGs) was built using Search Tool for the Retrieval of Interacting Genes (STRING) software. Hub genes were identified using Molecular Complex Detection (MCODE), NetworkAnalyzer, and CytoHubba.

Results

We identified 61 mRNAs, 14miRNAs, and 10 lncRNAs as DEGs related to NPC. Changes in NPC were enriched in the chromosomal region, sister chromatid segregation, and nuclear chromosome segregation. GSEA indicated that the mitogen-activated protein kinase (MAPK) pathway, phosphatidylinositol-3 OH kinase/protein kinase B (PI3K-Akt) pathway, apoptotic pathway, and tumor necrosis factor (TNF) were involved in the initiation and development of NPC. Finally, 20 hub genes were screened out via the PPI network.

Conclusions

Our findings could offer insights into the biological mechanisms underlying NPC and identify potential therapeutic targets, biomarkers and prognostic indicators for NPC.
Investigation of the genetic variation in ACE2 on the structural recognition by the novel coronavirus (SARS-CoV-2)
Authors: Guo Xingyi , Chen Zhishan , Xia Yumin , Lin Weiqiang , Li Hongzhi
Published: May 2020

Background: The outbreak of coronavirus disease (COVID-19) was caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), through its surface spike glycoprotein (S protein) recognition on the receptor Angiotensin-converting enzyme 2 (ACE2) in humans. However, it remains unclear how genetic variations in ACE2 may affect its function and structure, and consequently alter the recognition by SARS-CoV-2. Methods: We have systemically characterized missense variants in the gene ACE2 using data from the Genome Aggregation Database (gnomAD; N = 141,456). To investigate the putative deleterious role of missense variants, six existing functional prediction tools were applied to evaluate their impact. We further analyzed structural flexibility of ACE2 and the protein-protein interface with the S protein of SARS-CoV-2 using our developed Legion Interfaces Analysis (LiAn) program. Results: Here, we characterized a total of 12 ACE2 putative deleterious missense variants. Of those 12 variants, we further showed that p.His378Arg could directly weaken the binding of catalytic metal atom to decrease ACE2 activity and p.Ser19Pro could distort the most important helix to the S-protein. Another seven missense variants may affect secondary structures (i.e. p.Gly211Arg; p.Asp206Gly; p.Arg219Cys; p.Arg219His, p.Lys341Arg, p.Ile468Val, and p.Ser547Cys), whereas p.Ile468Val with AF = 0.01 is only present in Asian. Conclusions: We provide strong evidence of putative deleterious missense variants in ACE2 that are present in specific populations, which could disrupt the function and structure of ACE2. These findings provide novel insight into the genetic variation in ACE2 which may affect the SARS-CoV-2 recognition and infection, and COVID-19 susceptibility and treatment.
The Added Value of An Open Narrative in Verbal Autopsies – A Mixed-Methods Evaluation from Malawi
Authors: Loh Patricia , Fottrell Edward , Beard James , Bar-Zeev Naor , Phiri Tambosi , Banda Masford , Makwenda Charles , Bird Jon , King Carina
Published: May 2020

Background: The World Health Organization’s standardised verbal autopsy (VA) instrument consists of closed questions, ascertaining signs and symptoms of illness preceding death, and an optional open narrative. As VA analyses increasingly use automated algorithms, the inclusion of narratives should be justified. We evaluated the role of open narratives on VA processes, data quality and respondent emotion.Methods: A mixed-methods analysis was conducted using VA process data for deaths of children aged 0–59 months between April 2013 and November 2016 in Mchinji district, Malawi. Deaths were randomised at the point of interview to receive closed questions only or an open narrative followed by closed questions. Upon concluding the VA, interviewers self-completed questions relating to respondent emotions. Logistic regression was conducted to determine associations with visible emotions during VAs. A group discussion with the interviewers was conducted at the project end, to understand field experiences and explore future recommendations. Qualitative data were coded using deductive themes.Results: A total of 2509 VAs were included, with 49.8% (n = 1341) allocated to open narratives. Narratives lasted a median of 7 minutes (range: 1–113 minutes). Interviewers reported improved respondent rapport and felt narratives improved data quality, although there was no difference in the proportion of deaths with an indeterminate cause (5.3% vs. 6.1%). The majority of respondents did not display visible emotions during VA (81%). Those with a narrative had higher, but not statistically significant, odds of displaying emotion (aOR: 1.20; 95% CI: 0.98, 1.47). Factors associated with visible emotions were: infant deaths compared to neonates; deaths at a health centre or en-route to hospital versus home; and higher socio-economic status. Non-parental respondents and increased time between death and interview were associated with lower odds of emotion.Conclusion: Conducting an open narrative at the start of the VA to build rapport, something valued by the interviewers, may outweigh the additional time taken and slight increase in respondents becoming emotional. However, undue burdens associated with narratives may be further justified if the quality and utility of information from the narrative was promoted through standardised recommendations.
Characteristics of Socially High-risk Pregnant Women in Telephone Triage
Authors: Ohkawa Kana , Ishikawa Momoko , Yoshida Hikaru , Ito Hijiri , Sagawa Tadashi
Published: May 2020

BackgroundTo clarify the frequency, co-occurrence of relationships, and characteristic words of socially high-risk pregnant women who contacted the night telephone triage for advice on pregnancy.MethodsWe performed a quantitative study involving 5,548 of 13,496 pregnancy cases recorded by telephone triage. The contents of telephone triage conversations were examined to determine whether they fulfilled the requirements for each category of socially high-risk pregnant women. The frequency, co-occurrence of relationships, and characteristic words of each category ofsocially high-risk pregnant women were analyzed.ResultsThere were 432 socially high-risk pregnant women. Among 15 categories of socially high-risk pregnant women, young pregnant women (183 cases), mental illness (88 cases), and no antenatal care (80 cases) were the top three categories. There was a strong co-occurring relationship between the following categories of socially high-risk pregnant women: out of touch and lack of supporters; no antenatal care and money matters; out of touch and unmarried; no antenatal care and no issue; money matters and lack of supporters; no issue and lack of supporters; and money matters and unmarried. In characteristic words, some words did not overlap with the top 10 words in other categories.ConclusionsA telephone triage that allows pregnant women to freely talk about their concerns with a coordinator might be useful for detecting socially high-risk pregnant women. To efficiently identify socially high-risk pregnant women, it might be necessary to understand the characteristic words of each category and subsequently determine if the client fulfills the criteria for more than one category of socially high-risk pregnant women.