bluuebunny/crossref_metadata_2025 huggingface dataset:
Prevalence and risk factors of falls among community-dwelling older people: results from three consecutive waves of the national health interview survey in Taiwan
Authors: Tsai Yih-Jian , Yang Ping-Yen , Yang Yi-Ching , Lin Mau-Roung , Wang Ying-Wei
Published: November 2020

Background: An aging society incurs great losses due to fall-related injuries and mortalities. The foreseeable increased burden of fall-related injury among older people requires a regular nationwide study on the fall epidemic and prevention strategies.Methods: The fall epidemic was examined using data from three consecutive waves of the National Health Interview Survey (2005, 2009, and 2013). Common explanatory variables across these surveys included sociodemographic factors (age, sex, and difficulty in performing activities of daily living (ADL) or instrumental ADL), biological factors (vision, comorbidities, urinary incontinence, and depressive symptoms), and behavioral risk factors (sleeping pill use, and frequency of exercise). After the univariate and bivariate analyses, the prevalence of falls was investigated using multiple linear regression models adjusted for age group, sex, and year of survey. A multivariate logistic regression model for falls with adjustments for these common explanatory variables was established across three waves of surveys. The effect of fall prevention programs was examined with the effect size in terms of age-specific and sex-specific prevalence of falls and fall-related hospitalization rates during 2005 and 2009.Results: For each survey, there were consecutively 2,722; 2,900; and 3,200 respondents with a mean age of 75.1, 75.6, and 76.4 years, respectively. The multiple linear regression model yielded a negative association between the prevalence of falls and year of survey. Several sociodemographic and biological factors, including female sex, difficulty in performing one basic ADL, difficulty in performing two or more instrumental ADLs, unclear vision, comorbidities, urinary incontinence, and depressive symptoms, were significantly associated with falls. In contrast to the universal positive effect on the prevalence of falls among older adults, the effect size of fall-related hospitalization rates revealed a 2% relative risk reduction only for those aged 65-74 years, but deteriorated for those aged 75-84 (-10.9%).Conclusion: Although the decline in fall prevalence over time supports existing fall intervention strategies in Taiwan, the differential prevention effect and identification of risk factors in older people suggest the necessity of adjusting fall prevention programs.
Development, reliability and validity of the Safe Use of Mobility Aids Checklist (SUMAC) for 4-wheeled walker use in people living with dementia
Authors: Hunter Susan , Divine Alison , Omana Humberto , Madou Edward , Holmes Jeffrey
Published: November 2020

Background: Balance and gait problems are common and progressive in dementia. Use of a mobility aid provides physical support and confidence. Yet, mobility aid use in people with dementia increases falls three-fold. An assessment tool of mobility aid safety in people with dementia does not currently exist. The objectives of this study were: 1) to develop a tool for the evaluation of physical function and safe use of a 4-wheeled walker in people with dementia, and 2) to evaluate its construct and criterion validity, inter-rater and test-retest reliability and minimal detectable change.Methods: Healthcare professionals (HCP) experienced in rehabilitation of people with dementia participated in focus groups for item generation of the new tool, The Safe Use of Mobility Aid Checklist (SUMAC). The SUMAC evaluates physical function (PF) and safe use of the equipment (EQ) on nine tasks of daily life. Reliability was evaluated by HCP (n=5) scored participant videos of people with dementia (n=10) using a 4-wheeled walker performing the SUMAC. Inter-rater and test-retest reliability was assessed using intra-class correlation coefficients (ICC). Construct validity evaluated scores of the HCPs to a consensus HCP panel using Spearman’s rank-order correlations. Criterion validity evaluated SUMAC-PF to the Performance-Oriented Mobility Assessment (POMA) gait subscale using Spearman’s rank-order correlations.Results: Three focus groups (n=17) generated a tool comprised of nine tasks and the components within each task for physical function and safe use. Inter-rater reliability was statistically significant for SUMAC-PF (ICC=0.92, 95%CI (0.81, 0.98), p<0.001) and SUMAC-EQ (ICC=0.82, 95%CI (0.54, 0.95), p<0.001). Test-retest reliability was statistically significant for SUMAC-PF (ICC=0.89, 95%CI (0.81, 0.94), p<0.001) and SUMAC-EQ (ICC=0.88, 95%CI (0.79, 0.93), p<0.001). As hypothesized, the POMA gait subscale correlated strongly with the SUMAC-PF (rs=0.84), but not EQ (rs=0.39).Conclusions: The focus groups and research team developed a tool of nine tasks with evaluation on physical function and safe use of a 4-wheeled walker for people with dementia. The SUMAC tool has demonstrated content validity for the whole scale and good construct and criterion validity for the SUMAC-PF and SUMAC-EQ. The subscores of the SUMAC demonstrated excellent to good inter-rater and test-retest reliability.
Prevalence and Correlates of Mycoplasma genitalium Infections among Patients Attending a Sexually Transmitted Infection Clinic in Guangdong, China a Cross-sectional Study
Authors: Zhang Xiaohui , Zhao PZ , Ke WJ , Wang LY , Tso Lai Sze , Chen ZY , Liao YY , Liang CM , Chen HR , Ren XQ , Huang JM , Ong JJ , Yang F , Yang Ligang
Published: November 2020

Background: Mycoplasma genitalium (MG) causes urogenital tract infections and is associated with reproductive morbidity. Although MG has been reported across many regions and population groups, it is not yet routinely tested for in China. Our study contributes to current research by reporting the prevalence and correlates of MG infection in patients attending a sexually transmitted infection (STI) clinic in Guangdong from Jan 2017-May 2018.Methods: Urethral (from 489 men) and endo-cervical (from 189 women) samples, blood samples, and patient histories (via questionnaires) were collected. Doctors clinically diagnosed anogenital warts (GW) during the examination (n=678). The presence of MG was evaluated using an in-house via polymerase chain reaction protocol. We also tested all participants for herpes simplex virus-2 (HSV-2), Neisseria gonorrhoeae (NG), Chlamydia trachomatis (CT), syphilis and HIV. Univariate and multivariate logistic regression were used to evaluate factors associated with MG.Results: MG was detected in 7.2% (49/678) of the patients (men, 7.4%; women, 6.9%). The MG positivity rate was 14.2% among symptomatic patients, and 5.6% for asymptomatic patients, respectively. Only 36.7% (18/49) Mg positive patients were symptomatic. Among the MG-infected patients, 10.2% were co-infected with CT, 6.1% with NG, 8.2% with HSV-2, 4.1% with syphilis and 22.4% with GW. Presentation with clinical symptoms was significantly associated with MG infection [OR=2.52 (2.03-3.13)]. In our analysis, MG was not associated with other STIs.Conclusions: MG is a relatively common infection among individuals attending an STI clinic in Guangdong Province. Routine testing of symptomatic patients may be necessary, and more epidemiological studies are needed to provide evidence for future testing guidelines.
Reducing Suicidal Ideation among Turkish Migrants in the Netherlands and in the UK: The Feasibility of a Randomised Controlled Trial of a Guided Online Intervention
Authors: Eylem Ozlem , Straten Annemieke van , de Wit Leonore , Rathod Shanaya , Bhui Kamaldeep , Kerkhof Ad J.F.M.
Published: November 2020

Background: The evidence for the effectiveness of e-mental health interventions among ethnic minorities is still preliminary. This mixed methods study investigates the feasibility of a culturally adapted, guided online intervention with the intention to understand how it works and for whom to inform refinement. It also examines its likely effectiveness in reducing suicidal ideation when compared with the treatment as usual.Methods: Turkish migrants with mild to moderate suicidal thoughts were recruited from the general population using social media and newspaper advertisements. The intervention group obtained direct access to a 6 weeks guided online intervention while participants in the waiting list condition had to wait for 6 weeks. The intervention is based on an existing online intervention and was culturally adapted. Participants in both conditions completed baseline, post-test, and follow up questionnaires on suicidal ideation (primary outcome), depression, worrying, hopelessness, suicide attempt and self-harm, acculturation, quality of life, and usability. In addition, participants were interviewed to examine the feasibility and mechanisms of action in more depth. The responses were analysed by inductive thematic analysis.Results: 85 people signed up via the study website and we included 18 (10 intervention, 8 waitlist control). While the therapeutic benefits were emphasised (e.g. feeling connected with the intervention), the feasibility was judged to be low. The main reasons given were: not having severe suicidal thoughts and not being represented by the culturally adapted intervention. No suicide attempts were recorded during the study. The suicidal ideation, depression and hopelessness scores were improved in both groups.Conclusion: Although intended to be a definitive trial, the current study became a feasibility study with process evaluation to understand the components and how they operate. The online intervention was not superior to the control condition. Future studies need to attend the implementation issues raised including measures of stigma, acculturation, careful cultural adaptations alongside more attention to coaching and relational support. They should also consider how to improve engagement alongside selection of those who are motivated to use online interventions and offer alternatives for those who are not.Trial registration: NTR5028. Registered 1 March 2015, https://www.trialregister.nl/trial/4926
Estrogen re-enhanced prenatal stress-related visceral sensitization and pain regulation
Authors: Chen Jinghong , Sun Ying , Wei Jinbao , Ju Peijun , Li Qinjie , Winston John H.
Published: November 2020

Background: Visceral pain is one of the most common sign of irritable bowel syndrome (IBS). Chronic stress during pregnancy may increase visceral pain sensitivity of offspring in a sexdependent way. Combining adult stress in offspring will increase this sensitivity. Based on the evidence implicating estrogen exacerbates visceral hypersensitivity in female rodents in pre-clinical models, we predicted that chronic prenatal stress (CPS) plus chronic adult stress (CAS) will maximize visceral pain sensitivity; and estrogen plays an important role in this hyperalgesia.Methods: The CPS plus CAS rodent model was established in which the balloon was used to distend colorectum. Meanwhile, the single fiber recording in vivo and patch-clamp experiments in vitro were used to monitor neuronal activity. The RT-PCR, Western Blot, and Immunofluorescence were used to study the effects of CPS and CAS on colon primary afferent sensitivity and molecular or transmission changes. We use Ovariectomy and Letrozole to treate female rats respectively in order to assess the role of estrogen in female-specific enhanced primary afferent sensitization. Letrozole mainly used to reduce estrogen levels.Results: As predicted, CPS significantly increased single unit afferent fiber activity in L6-S2 dorsal roots in response. Activity was further enhanced by CAS. And the activity in offspring females was significantly greater than the males. Besides, the excitability of colon-projecting dorsal root ganglion (DRG) neurons increases in CPS + CAS rats that was associated with a decrease in transient A-type K+ current. Letrozole treatment decreases the colon DRG neuron excitability in females by decreasing the estrogen levels. Conclusions: This study adds to the growing evidence for the development of chronic stress induced visceral hypersensitivity in female, which involves estrogen-dependent sensitization of primary afferent colon neurons. Understanding this neurophysiological mechanisms will spur the development of female pain specific therapies.
The Effect of Group-Dynamics, Collaboration and Tutor Style on the Perception of Professional Stereotypes: A Quasi-Experimental Pre-Post-Design on Interdisciplinary Tutorial Groups.
Authors: Chiriac Eva Hammar , Sjøvold Endre , Hjelm Alexandra Björnstjerna
Published: November 2020

Background: Group processes in inter-professional Problem-Based Learning (iPBL) groups have not yet been studied in health-care educational context. In this paper we present findings on how group-dynamics, collaboration and tutor style influence the perception of professional stereotypes of students collaborating in iPBL groups. Health-care students are trained in iPBL groups to increase their ability for collaboration between healthcare professionals. Previous research focusing iPBL in healthcare, infers that more systematic studies are desired, especially concerning interaction between group processes, and internalized professional stereotypes. The aim of this study is to investigate if changes in group processes, collaboration and if tutor style, influence the perception of professional stereotypes of physician- and nurse-students. Methods: The study is a quasi-experimental pre- post-design. The participants included 30 students from five different healthcare professions, mainly medicine and nursing. Other professions were physiotherapy, occupational therapy and speech therapy. The students were divided into four iPBL groups, each consisting of six to nine students and a tutor. Data were collected through systematic observation using four video-recorded tutorials. SPGR (Systematizing the Person Group Relation), a computer-supported method for direct and structured observation of behavior, were used to collect and analyze data. Results: Traditional stereotypical professional behaviors were identified in the first observed group meeting. Although the groups followed different paths of development, the group-dynamics changed in all groups over the six weeks of collaboration. Two of the groups became more cohesive, one more fragmented and one more polarized. Stereotypical behaviors became less frequent in all groups. Our findings indicate that tutor behavior has a strong influence on the development of the group’s dynamics. Conclusion: Our findings strongly suggest iPBL is a mean to reduce stereotypical behaviors, that may positively increase member’s ability for inter-professional collaboration. Although the pattern of dynamics took different forms in different groups, we argue that iPBL forces students to see the colleague behind his or her profession, thus breaking professional boundaries. The tutor style significantly influenced the IPBL groups development. This study contributes to our field by emphasizing the effect of group-processes to increase mutual understanding across professions.
Comparison of Growth Performance and Meat Quality Traits of Commercial Cross-bred Pig versus Large Black Pig Breeds
Authors: Wang Yongjie , Thakali Keshari , Morse Palika , Shelby Sarah , Chen Jinglong , Apple Jason , Huang Yan
Published: November 2020

BackgroundThe meat quality of different pig breeds is associated with their different muscle tissue physiological processes, which involves a large variety of genes related with muscle fat and energy metabolism. Understanding the differences of biological processes of muscle after slaughter is helpful to reveal the meat quality development of different breeds. Therefore, 8 domestic Large Black pigs (BP), a domestic breed with high fat contents in meat, and 7 Cross-bred commercial pig (CP), which has a high feed efficiency with high lean meat, was used to investigate the differences of their meat quality and genotype.ResultsThe average daily gain (ADG) and hot carcass weight (HCW) of CP were higher than BP, but the back-fat thickness of BP was higher than CP ( P < 0.05). The CP had higher a* but lower h value than BP ( P < 0.05). The metmyoglobin (MMb) percentage of CP was higher ( P < 0.05) than BP. The fat content and oxygen consumption of longissimus dorsi (LD) muscle in BP were higher ( P < 0.05) than CP. BP had higher SFA and MUFA content, but CP had higher PUFA content ( P < 0.05). The RNA-seq was applied to compare the genome differences between the two pig breeds. The RNA-seq data highlighted 201 genes differentially expressed between breeds ( P < 0.05), with 75 up-regulated and 126 down-regulated genes in BP compared with CP. The real-time PCR was used to validate the results of RNA-seq for 8 genes, and the genes related with lipid and energy metabolism were highly expressed in BP ( P < 0.05).ConclusionsBased on the results, BP had superior general meat quality to CP, while the growth performance of CP was better, and the genotype differences between these two breeds may cause the meat quality and growth performance variance.
Pulse Radar Randomly Interrupted Transmitting and Receiving Optimization Based on Genetic Algorithm in Radio Frequency Simulation
Authors: LIU Xiaobin , Zhao Feng , Ai Xiaofeng , Wu Qihua
Published: November 2020

The interrupted transmitting and receiving (ITR) can be used in anechoic chamber to solve the coupling between the transmitted and reflected signals. When the ITR periods are random, the fake peaks in high resolution range profile (HRRP) of ITR echo can be reduced. Then, by utilizing the piecewise sparse property of ITR echo, the HRRP is reconstructed based on compressive sensing (CS). However, the periods of ITR determine the restricted isometry property (RIP) condition and the HRRP reconstruction performance. In order to improve the HRRP reconstruction performance, the ITR periods sequence optimization method based on genetic algorithm (GA) is proposed in this paper. The correlation coefficient of the sensing matrix columns is minimized after optimization so that the RIP of sensing matrix can be well satisfied . Simulation results illustrate that the optimization method converges fast and the HRRP reconstruction performance is improved with the optimized ITR periods .
Myanmar Continues to Curb Malaria amid Coronavirus Disease-2019 Crisis
Authors: Thapa Badri , Thi Aung , Than Wint Phyo , Win Kyawt Mon , Khine San Kyaw
Published: November 2020

Background: Myanmar has targeted Plasmodium falciparum malaria elimination by 2025 and all human malaria elimination by 2030. Coronavirus Disease-2019 (COVID-19) pandemic could jeopardize the current gains. The objective of the study is to assess the impact of COVID-19 on epidemiology and malaria services in Myanmar. Methods: This is cross sectional study using retrospective routine programme data reported by Ministry of Health and Sports (for COVID-19) and National Malaria Control Programme (NMCP) (for malaria) during January – September 2019 and 2020. Results: Myanmar implemented whole of society COVID-19 response since its first 2 cases were detected on 23 March 2020. NMCP mobilized US$ 7 mil to support, protect and mitigate COVID-19 impact on malaria through implementation of tailored guidelines, job aids and risk communication materials starting April 2020. Front line health workers were protected through supplies of surgical masks, hand sanitizer, aprons, gloves, non-contact digital thermometers among others. During January-September 2020, reported malaria cases, severe cases and deaths declined by 11%, 34% and 27%, respectively in the same period in 2019. Total P. falciparum cases declined by 55% with minimal increase in tests (0.14%). 80% of cases and 98% of foci were investigated in 2020 in comparison to 68% and 54% in 2019, respectively (p<0.05). In 2020, NMCP distributed 72% of the targeted long-lasting insecticidal nets (vs 49% in 2019) (p<0.05). Integrated Community Malaria Volunteers (ICMVs) trained in 2020 was 49% in comparison to 94% in 2019 (P<0.05), while number of functional ICMVs remained at 91% (vs 94% in 2019). Overall monthly reports from all reporting units received slightly dropped by 5%. In 2020, NMCP was able to conduct 59% supervision visits at various levels, which was higher than 2019 (56%). Conclusions: Malaria cases, severe cases and deaths continued to decline amid COVID-19 in Myanmar with 55% decline in P. falciparum . Programme need to continue essential malaria services during the upsurge of COVID-19 and simultaneously plan proactively to ensure uninterrupted supply of essential malaria commodities for 2021 to ensure P. falciparum elimination by 2025.
Insecticide Resistance Exerts Significant Fitness Costs in Immature Stages of Anopheles Gambiae in Western Kenya.
Authors: Osoro Joyce K , Machani Maxwell Gesuge , Ochomo Eric , Wanjala Christine , Omukunda Elizabeth , Munga Stephen , Githeko Andrew K. , Yan Guiyun , Afrane Yaw A.
Published: November 2020

Background: Despite increasing documentation of insecticide resistance in malaria vectors against public health insecticides in sub-Saharan Africa, there is a paucity of information on the potential fitness costs of pyrethroid resistance in malaria vectors which is important in improving the current resistant management strategies. This study aimed to assess the fitness cost effects of insecticide resistance on the development and survival of immature Anopheles gambiae from western Kenya.Method: Two-hour old first instar larvae (L1) were introduced and raised in basins containing soil and rainwater in a semi-field setup. Each day the number of surviving individuals per larval stage was counted and their stage of development were recorded until they emerged as adults. The larval life history trait parameters measured include mean larval development time, daily survival and pupal emergence. Pyrethroid selected resistant colony of An. gambiae s.s and unselected colony originating from the same site and with same genetic background were used. Kisumu laboratory susceptible colony was used as a reference.Results: The selected resistant colony had a significantly longer larval development time through the developmental stages than the unselected susceptible colony. The selected colony took an average of 2 days longer to develop from first instar (L1) to fourth instar (L4) (8.8 ± 0.2 days) compared to unselected colony (6.6 ± 0.2 days). The development time from first instar to pupa formation was significantly longer by 3 days in the selected colony (10.28 ± 0.3 days) than in unselected colony (7 ± 0.2 days). The time from egg hatching to adult emergence was significantly longer for the selected colony (12.1 ± 0.3 days) than the unselected colony (9.2 ± 0.2 days). The pupation rate (80%; 95% [CI: 77.5-83.6] vs 83.5%; 95% [CI: 80.6-86.3]) and adult emergence rate (86.3% vs 92.5%) did not differ between the selected and unselected colonies respectively. The sex ratio of the females to males for the selected (1:1.21) and unselected colonies (1:1.07) was significantly different.Conclusion: The study showed that pyrethroid resistance in An. gambiae had a fitness cost on their pre-imaginal development time and survival. Insecticide resistance delayed the development and reduced the survivorship of An. gambiae larvae. The study findings are important in understanding the fitness cost of insecticide resistance vectors that could contribute to shaping resistant management strategies.
Controlled Ovarian Stimulation Should Not Be Recommended for Male Infertility Treated With IUI
Authors: Tang Yan , He Qian-Dong , Zhang Ting-Ting , Wang Jing-Jing , Huang Si-Chong , Ye Yun
Published: November 2020

Background: Some studies stated that intra-uterine insemination (IUI) with controlled ovarian stimulation (COS) might increase the chance of pregnancy, while others suggested that IUI in natural cycle (NC) should be the treatment of first choice. Whether it is necessary to use COS at the same time, when IUI is applied to treat male infertility solely? There is still no consensus.Objective: To investigate the efficacy of IUI with COS in male infertility solely?Methods: 544 IUI cycles from 280 couples who sought medical care for male infertility from January 2010 to February 2019 were divided into two groups: group NC-IUI and group COS-IUI. Besides, the COS-IUI group was further divided into two subgroups according to the number of pre-ovulatory follicles on the day of HCG: cycles with monofollicular development (1 follicle group) and cycles with at least two pre-ovulatory follicles (≥ 2 follicles group). The outcome of IUI, including clinical pregnancy rate, live birth rate, spontaneous abortion rate, ectopic pregnancy rate and multiple pregnancy rate were compared.Results: The clinical pregnancy rate, live birth rate, early spontaneous abortion rate, and ectopic pregnancy rate were comparable between NC-IUI group and COS-IUI group. Similar results were observed among NC-IUI group, 1 follicle group and ≥ 2 follicles group. However, when it comes to the multiple pregnancy rate, a trend toward higher multiple pregnancy rate was observed in the COS-IUI group compared that in the NC-IUI group (10.5% (2/19) vs. 0 (0/42), P=0.093), furthermore, a significant difference was found between NC-IUI group and ≥ 2 follicles group (0 vs. 20%, P =0.034).Conclusion: For male infertility, since in cycles with COS, especially in those with at least two pre-ovulatory follicles cycles, the multiple pregnancy rate increased without substantial gain in overall pregnancy rate, COS in IUI should not be recommended. If COS is required, one stimulated follicle and one health baby should be the goal considering the safety both for mothers and fetuses.
A time-domain phase diagram of metastable states in a charge ordered quantum material
Authors: Ravnik Jan , Diego Michele , Gerasimenko Yaroslav , Vaskivskyi Yevhenii , Vaskivskyi Igor , Mertelj Tomaz , Vodeb Jaka , Mihailovic Dragan
Published: November 2020

Metastable self-organized electronic states in quantum materials are of fundamental importance, displaying emergent dynamical properties that may be used in new generations of sensors and memory devices. Such states are typically formed through phase transitions under non-equilibrium conditions and the final state is reached through processes that span a large range of timescales. By using time-resolved optical techniques and femtosecond-pulse-excited scanning tunneling microscopy (STM), the evolution of the metastable states in the quasi-two-dimensional dichalcogenide 1T-TaS2 is mapped out on a temporal phase diagram using the photon density and temperature as control parameters on timescales ranging from 10-12 to 103 s. The introduction of a time-domain axis in the phase diagram enables us to follow the evolution of metastable emergent states created by different phase transition mechanisms on different timescales, thus enabling comparison with theoretical predictions of the phase diagram and opening the way to understanding of the complex ordering processes in metastable materials.
Methodology for Triage of Urologic Surgical Cases in the Setting of A Pandemic
Authors: Aboumohamed Ahmed , Gottlieb Josh , DeMasi Matthew , Barry Emily , Watts Kara
Published: November 2020

Purpose: The COVID-19 pandemic forced our healthcare system in the Bronx, New York to cancel nearly all surgeries. With the possible second wave approaching, we developed a framework for the prioritization of Urologic surgeries that can be used as a model for those experiencing surges elsewhere. Methods: Each surgeon in the department was asked to rank their cancelled surgeries by priority (Level 1 – least urgent; Level 2 – moderately urgent; Level 3 – most urgent). A committee of urologists assigned a subclass to Level 3 and 2 cases (3a – least urgent; 3b – moderately urgent; 3c – most urgent; 2a – lower priority; 2b – higher priority). The committee then reviewed cases by urgency to arrive on a final priority ranking. Results: A total of 478 total cases were categorized: 250 Level 1, 130 Level 2, 98 Level 3 (73 adult, 25 pediatric). Level 3c involved renal cell carcinoma ≥ T2b, high-grade bladder urothelial carcinoma, adrenal mass/cancer > 6 cm, testicular cancer requiring radical orchiectomy, and penile cancer. Level 3b involved T2a renal masses requiring nephrectomy; high-risk prostate cancer and symptomatic nephrolithiasis were classified as 3a. Level 2 included testicular cancer requiring retroperitoneal lymph node dissection and complicated benign prostatic hyperplasia. Surgeries for urologic reconstruction, erectile dysfunction, and incontinence were considered Level 1.Conclusions: Our disease-specific approach to surgical rescheduling offers appropriate guidance for triaging Urologic surgeries. Our system can provide guidance to other institutions as COVID-19 surges in different regions and with the growing possibility of a second wave.
Myogenic Transdifferentiation of Pig Fibroblasts Using the Porcine MYOD1 Inducible Vector
Authors: Jeong Jinsol , Choi Kwang-Hwan , Kim Seung-Hun , Lee Dong-Kyung , Oh Jong-Nam , Lee Mingyun , Choe Gyung Cheol , Lee Chang-Kyu
Published: November 2020

Background Myogenic transdifferentiation can be accomplished through ectopic MYOD1 expression, which is facilitated by various signaling pathways associated with myogenesis. In this study, we attempted to transdifferentiate pig embryonic fibroblasts (PEFs) myogenically into skeletal muscle through overexpression of the pig MYOD1 gene and modulation of the FGF, TGF-β, WNT, and cAMP signaling pathways.Results The MYOD1 overexpression vector was constructed based on comparative sequence analysis, demonstrating that pig MYOD1 has evolutionarily conserved domains across various species. Although forced MYOD1 expression through these vectors triggered the expression of endogenous muscle markers, transdifferentiated muscle cells from fibroblasts were not observed. Therefore, various signaling molecules, including FGF2, SB431542, CHIR99021, and forskolin, along with MYOD1 overexpression were applied to enhance the myogenic reprogramming. The modified conditions led to the derivation of myotubes and activation of muscle markers in PEFs, as determined by qPCR and immunostaining. Notably, a sarcomere-like structure was observed, indicating that terminally differentiated skeletal muscle could be obtained from transdifferentiated cells.Conclusions In summary, we established a protocol for reprogramming MYOD1-overexpressing PEFs into the mature skeletal muscle using signaling molecules. Our myogenic reprogramming can be used as a cell source for muscle disease models in regenerative medicine and the production of cultured meat in cellular agriculture.
Short-chain Fatty Acids can Improve Lipid and Glucose Metabolism Independently of the Gut Microbiota
Authors: Zhou Hua , Yu Bing , Sun Jing , Liu Zuohua , Chen Hong , Ge Liangpeng , Chen Daiwen
Published: November 2020

Background: Previous research has shown that exogenously short-chain fatty acids (SCFAs) infusion attenuated the body fat deposition in both mice, humans, and pigs. However, limited studies have evaluated the effects of SCFAs on lipid and glucose metabolism independently of the gut microbiota. Therefore, the present study was conducted to investigate the effects of exogenous infusion of SCFAs on lipid and glucose metabolism in a germ-free (GF) pig model. Methods: Twelve hysterectomy-derived newborn pigs were reared in six sterile isolators. All pigs were hand-fed Co60-γ-irradiated sterile milk powder for 21 days and switched from liquid to sterile solid feed for another 21 days. In the second 21-days period, GF pigs (n = 6) were orally infused with 25 mL/kg sterile saline per day, FA pigs (n = 6) were orally infused with 25 mL/kg SCFAs mixture (acetic, propionic, and butyric acids, 45, 15, and 11 mM, respectively) per day.Results: Orally infused with SCFAs tended to increase the concentration of adiponectin in serum, the activity of CPT-1 in longissimus dorsi, and the ANGPTL4 mRNA expression in colon (P < 0.10). Meanwhile, the mRNA abundances of ACC, FAS, and SREBP-1C in liver and CD36 in longissimus dorsi were decreased (P < 0.05), and the concentrations of ATP, ADP, or AMP in liver and longissimus dorsi were reduced (P < 0.05) in FA group. Besides, the mRNA expressions of PGC-1α in liver and LPL in longissimus dorsi were tended to (P < 0.10) increase and downregulate in FA group respectively. Moreover, the protein level of GPR43 was tended to increase (P < 0.10), and ACC was tended to decrease (P < 0.10), while the p-AMPK/T-AMPK ratio (P < 0.05) was upregulated in liver of FA group. Also, oral administration of SCFAs upregulated the mRNA expressions of SLC2a and GYS2 in liver (P < 0.05). Furthermore, the metabolic pathway associated with the biosynthesis of unsaturated fatty acids was significantly promoted (P < 0.05) by orally infused with SCFAs.Conclusions: Short-chain fatty acids could attenuate fat deposition and to some extent improve glucose control, and were occur independently of the gut microbiota.
Colo-pancreaticoduodenectomy for Locally Advanced Colon Carcinoma- Feasibility in Patients Manifesting as Acute Abdomen
Authors: Chen Joe-Bin , Luo Shao-Ciao , Chen Chou-Chen , Wu Cheng-Chung , Yen Yun , Chang Chuan-Hsun , Chen Yun-An , P’eng Fang-Ku
Published: November 2020

BackgroundThe only curative option for locally advanced colon carcinoma invading duodenum and/or pancreatic head is the en-bloc right hemicolectomy plus pancreaticoduodenectomy (PD), so called colo-pancreaticoduodenectom (cPD). Patients with this disease may present as an acute abdomen. Emergent PD often has high postoperative morbidity and mortality. Here we aimed to evaluate the feasibility and outcomes of emergent cPD for such patients of advanced colon carcinoma, manifesting as life-threatening acute abdominal conditions.Patients and MethodsWe retrospectively review of 4,793 patients who underwent curative colectomy for the treatment of colorectal cancer in the period from 1993 and 2017. Among these patients, 30 had locally advanced right colon cancer and underwent a cPD. The cPD of 11 patients were performed in acute abdomen conditions (bowel obstruction 6, perforation 3, tumor bleeding 2). Selection criteria for emergent cPD were: (1) age ≦60 years, (2) body mass index <35 kg/m2, (3) no poorly-controlled comorbidities, and (4) perforation time ≤6 hours. Three patients who failed to meet these criteria received non-emergent cPD after a life-saving diverting ileostomy, and cPD was performed three months later. The patients clinicopathological characteristics, the early and long-term postoperative outcomes were compared between emergent cPD (e-group, n=11) and non-emergent cPD (non-e group, n=19). After cPD, staged pancreaticojejunostomy (PJ) was performed in all e-group, and on 15 of 19 non-e group patients.ResultsThe non-e group had significant higher patient age and higher incidence of associated comorbidities, while clinicopathological characteristics were otherwise similar. None of the patients in the two groups succumbed from cPD. Postoperative complication rate was 63.6% in the e-group, and 42.1% in the non-e group (p=0.449). The 5-year overall survival rate was 15.9% in the e-group, and 52.6% in the non-e-group (p=0.192).ConclusionsIn highly selected patients, emergent cPD is feasible by cooperation of experienced colorectal and pancreatic surgeons. The early and long-term outcomes of emergent and were similar to those after non-emergent cPD.
Mild Increases in Plasma Creatinine after High-Risk Abdominal Surgery Are Associated with Long-Term Renal Injury: A Retrospective Cohort Study
Authors: JOOSTEN Alexandre , Ickx Brigitte , Mokhtari ZAKARIA , Obbergh Luc Van , Lucidi Valerio , Collange Vincent , Naili Salima , Ichai Philippe , Samuel Didier , Antonio Sa Cunha , Alexander Brenton , Legrand Matthieu , Taccone Fabio Silvio , Harrois Anatole , Duranteau Jacques , Vincent Jean-Louis , Rinehart Joseph , Linden Philippe Van der
Published: November 2020

Background: The impact of mild acute kidney injury (AKI) observed in the immediate postoperative period after major surgery on long term renal function remains poorly defined. According to the “Kidney Disease: Improving Global Outcomes” (KDIGO) classification, a mild injury corresponds to a KIDIGO stage 1, characterized by an increase in creatinine of at least 0.3 mg/dl within a 48-hour window or 1.5 to 1.9 times the baseline level within the first week post-surgery. We tested the hypothesis that patients who underwent moderate-to high-risk abdominal surgery and developed mild AKI in the following days would be at an increased risk of long-term renal injury compared to patients with no postoperative AKI.Methods: In this single centre retrospective study, all consecutive adult patients with a plasma creatinine value ≤ 1.5 mg/dl who underwent high-risk abdominal surgery between 2014-2019 and who had at least three recorded creatinine measurements (before surgery, during the first seven postoperative days, and at long-term follow up [6 months-2 years]) were included. AKI was defined using a “modified” (without urine output criteria) KDIGO classification as mild (stage 1 characterised by an increase in creatinine of > 0.3 mg/dl within 48-hours or 1.5-1.9 times baseline) or moderate-to-severe (stage 2-3 characterised by increase in creatinine 2 to 3 times baseline or to ≥ 4.0 mg/dl). Development of long-term renal injury was compared in patients with and without postoperative AKI Results: Among the 815 patients included, 109 (13.4%) had postoperative AKI (81 mild [KDIGO 1] and 28 moderate-to-severe [KDIGO 2-3]). The median long-term follow-up was 360, 354 and 353 days for the three groups respectively (P=0.190). Patients who developed mild AKI had a higher risk of long-term renal injury than those who did not (odds ratio 3.1 [95%CI 1.7-5.5]; P<0.001). In multivariable analysis, mild postoperative AKI was independently associated with an increased risk of developing long-term renal injury (adjusted odds ratio 4.5 [95%CI 1.8-11.4]; P=0.002).Conclusions: Mild AKI after high-risk abdominal surgery is associated with a higher risk of long-term renal injury one year after surgery.
Intraoperative Hypotension during Liver Transplant Surgery is Associated with Postoperative Acute Kidney: A Retrospective Cohort Study
Authors: JOOSTEN Alexandre , Lucidi Valerio , Ickx Brigitte , Obbergh Luc Van , Germanova Desislava , Berna Antoine , Alexander Brenton , Desebbe Olivier , Carrier Francois-martin , Cherqui Daniel , Adam Rene , Duranteau Jacques , Saugel Bernd , Vincent Jean-Louis , Rinehart Joseph , Linden Philippe Van der
Published: November 2020

BACKGROUND: Acute kidney injury (AKI) occurs frequently after liver transplant surgery and is associated with significant morbidity and mortality. While the impact of intraoperative hypotension (IOH) on postoperative AKI has been well demonstrated in patients undergoing a wide variety of non-cardiac surgeries, it remains poorly studied in liver transplant surgery. We tested the hypothesis that IOH is associated with AKI following liver transplant surgery. METHODS: This historical cohort study included all consecutive patients who underwent liver transplant surgery between 2014 and 2019 except those with a preoperative creatinine > 1.5 mg/dl and/or who had combined transplantation surgery. IOH was defined as any mean arterial pressure (MAP) < 65 mmHg and was classified according to the percentage of case time during which the MAP was < 65 mmHg into three groups, based on the interquartile range of the study cohort: “short” (Quartile 1, < 8.6% of case time), “intermediate” (Quartiles 2-3, 8.6-39.5%) and “long” (Quartile 4, > 39.5%) duration. AKI stages were classified according to a “modified” “Kidney Disease: Improving Global Outcomes” (KDIGO) criteria. Logistic regression modelling was conducted to assess the association between IOH and postoperative AKI. The model was run both as a univariate and with multiple perioperative covariates to test for robustness to confounders. RESULTS: Of the 205 patients who met our inclusion criteria, 117 (57.1%) developed AKI. Fifty-two (25%), 102 (50%) and 51 (25%) patients had short, intermediate and long duration of IOH respectively. In multivariate analysis, IOH was independently associated with an increased risk of AKI (adjusted odds ratio [OR] 1.05; 95%CI 1.02-1.09; P < 0.001). Compared to “short duration” of IOH, “intermediate duration” was associated with a 10-fold increased risk of developing AKI (OR 9.7; 95%CI 4.1-22.7; P < 0.001). “Long duration” was associated with an even greater risk of AKI compared to “short duration” (OR 34.6; 95%CI 11.5-108.6; P < 0.001).CONCLUSION: Intraoperative hypotension is independently associated with the development of AKI after liver transplant surgery. The longer the MAP stays < 65 mmHg, the higher the risk the patient will develop AKI in the immediate postoperative period, and the greater the likely severity. Trial Registration: Not Applicable
Five Regions, Five Retinopathy Screening Programmes: A Systematic Review of the Portuguese Experience
Authors: Pereira Andreia Marisa Penso , Laureano Raul Manuel da Silva , Neto Fernando Buarque de Lima
Published: November 2020

Background: The implementation of a population-based screening programme for diabetic retinopathy involves several challenges, often leading to postponements and setbacks at high human and material costs. Thus, it is of the utmost importance to promote the sharing of experiences, successes and difficulties. However, factors such as the existence of regional programmes, specificities of each country's health systems, organizational and even linguistic barriers, make it difficult to create a solid framework that can be used as a basis for future projects. Methods: Web of Science and PubMed platforms were searched using appropriate key words. Were found 423 articles, 28 of which were selected and analysed. Web sites of all Portuguese governmental and non-governmental organizations, with a relevant role on the research topic, were inspected and 75 official documents were retrieved and analysed.Results: Since 2001, five regional screening programmes were gradually implemented under the guidelines of Portuguese General Health Department. However, complete population coverage was still not achieved. Among the main difficulties reported are the complex articulation between different levels of care providers, the low number of orthoptic technician in the national health system, the high burden that images grading and treatment of positive cases represents for hospitals ophthalmology services, and low adherence rates. Yet, the comparison between strategies adopted in the different regions allowed the identification of potential solutions: hire orthoptic technician for primary health care units, eliminating the dependence of hospital professionals; use artificial intelligence algorithms for automatic retinographies grading, avoiding ophthalmologists overload; adoption of proximity strategies, as the use of portable retinographers, to promote adherence to screening.Conclusion: Access to diabetic retinopathy screening remains remarkably variable in Portugal and needs urgent attention. However, several characteristics of effective screening programmes were found in Portuguese screening programmes, what seems to point toward promising outcomes.Registration PROSPERO registration ID CRD42020200115
Use of Selective Serotonin Reuptake Inhibitors During Pregnancy and Prevalence of Congenital Malformations: A Protocol for Systematic Review and Meta-analysis of Observational Studies from 2009-2020.
Authors: Fela-Thomas Ayodele Lucy , Nna Emmanuel Okechukwu , Anyahara Nnaemeka , Ojo Oluwafemi T , Motilewa Olugbemi , Okoh Emeka E , Alao Micheal A , Kaoje Umar A , Osi-Ogbu Ogugua , Ikeagwulonu Chinaza Richard , Okoye Ifeoma Joy
Published: November 2020

Background: The effect of antidepressants on the foetus is of great public concern on account of teratogenicity. However, evidence on this is quite controversial. This study aims to determine the risk of congenital malformations in offsprings of pregnant women placed on Selective Serotonin Reuptake Inhibitors (SSRIs) during pregnancy compared to the offsprings of pregnant women not on SSRIs. It also aims to assess if significant increase in risk occurs across trimesters. METHODS AND ANALYSIS:A search strategy is developed using MeSH, text words and entry terms. Nine databases will be searched: PubMed, Embase, CINAHL, AJOL, Google Scholar, Web of Science, Cochrane Library, Research gate and Scopus. Only Observational studies from 2009-2020, retrievable in the English Language will be included. The primary measurable outcome is risk of teratogenicity with SSRI use in pregnancy. All identified studies, imported into End note version 9, will be screened based on the inclusion/exclusion criteria; data will be exported into Microsoft excel. Extractable data will include first author’s name and year of publication, proportion of congenital malformations in women on SSRIs and women without SSRIs, trimester, time of initiation and duration of treatment. Pedro quality scores and Cochrane risk of bias for individual study will be reported. All studies will be assessed for methodological, clinical and statistical heterogeneity. Publication bias will be assessed using the funnel plot. Subgroup analysis will be performed. The different trimesters and time of initiation of treatment will be used as moderators. Meta-regression will be done using duration of treatment. The CMA version 3 will be used for statistical analysis and forest plots. Discussion:The study will require no ethical approval, it is based on published data. The results obtained from this review will provide relevant information on the use of SSRIs in pregnancy and the risk of congenital malformations. Furthermore, it will provide vital information on the levels and trend of risk at each trimester. The final report will be made available to mental health experts providing care to pregnant women.Trial Registration Number: This protocol is registered in PROSPERO, with number CRD42020213505