bluuebunny/crossref_metadata_2025 huggingface dataset:
Can Natural Language Processing Help Differentiate Inflammatory Intestinal Diseases in China? Models Applying Random Forest and Convolutional Neural Network Approaches
Authors: Tong Yuanren , Lu Keming , Yang Yingyun , Li Ji , Lin Yucong , Wu Dong , Yang Aiming , li yue , Yu Sheng , Qian Jiaming
Published: July 2020

Background: Differentiating between ulcerative colitis (UC), Crohn’s disease (CD) and intestinal tuberculosis (ITB) using endoscopy is challenging. We aimed to realize automatic differential diagnosis among these diseases through machine learning algorithms. Methods: A total of 6399 consecutive patients (5128 UC, 875 CD and 396 ITB) who had undergone colonoscopy examinations in the Peking Union Medical College Hospital from January 2008 to November 2018 were enrolled. The input was the description of the endoscopic image in the form of free text. Word segmentation and key word filtering were conducted as data preprocessing. Random forest (RF) and convolutional neural network (CNN) approaches were applied to different disease entities. Three two-class classifiers (UC and CD, UC and ITB, and CD and ITB) and a three-class classifier (UC, CD and ITB) were built.Results: The classifiers built in this research performed well, and the CNN had better performance in general. The RF sensitivities/specificities of UC-CD, UC-ITB, and CD-ITB were 0.89/0.84, 0.83/0.82, and 0.72/0.77, respectively, while the values for the CNN of CD-ITB were 0.90/0.77. The precisions/recalls of UC-CD-ITB when employing RF were 0.97/0.97, 0.65/0.53, and 0.68/0.76, respectively, and when employing the CNN were 0.99/0.97, 0.87/0.83, and 0.52/0.81, respectively.Conclusions: Classifiers built by RF and CNN approaches had excellent performance when classifying UC with CD or ITB. For the differentiation of CD and ITB, high specificity and sensitivity were achieved as well. Artificial intelligence through machine learning is very promising in helping unexperienced endoscopists differentiate inflammatory intestinal diseases.
Prognostic Value of the Creatinine-Albumin Ratio in Acute Pancreatitis Debridement
Authors: ZHAO Zhifeng , YU Yeping , XIE Rongli , YANG Kaige , XU Dan , LI Li , LIN Jiayun , ZHENG Lei , ZHANG Chihao , XU Xin , CHEN Ying , XU Zhiwei , CHEN Erchen , LUO Meng , FEI Jian
Published: July 2020

Background Increases in the levels of serum C-reactive protein (CRP) and creatinine (Cr) and decreases in those of albumin (Alb) are commonly observed in acute pancreatitis (AP). We aimed to evaluate the efficacy of the Cr/Alb and CRP/Alb ratios in the prediction of surgical treatment effect in AP patients. Methods This study retrospectively analyzed clinical data obtained from 140 AP patients who underwent debridement from January 2008 to November 2018 in Shanghai Ruijin Hospital. The Cr/Alb and CRP/Alb ratios at admission and before surgery were assessed in the analysis of clinical statistics, prediction of prognoses, and logistic regression analysis. Results The admission Cr/Alb had the best predictive value of the four ratios. This value was significantly higher in patients with re-operation and those who died (P < 0.05) and was correlated with the Acute Physiology and Chronic Health Evaluation (APACHE II) score, admission CRP/Alb, preoperative Cr/Alb, and post-operative complications. The admission Cr/Alb could predict the risk of AP-related re-operation and mortality with sensitivities, specificities and areas under the curve of 86.3%, 61.7% and 0.824, and 73.4%, 81.3% and 0.794, respectively. At a cut-off value of 3.43, admission Cr/Alb values were indicative of a worse clinical state, including impaired laboratory test values, APACHE II scores, rates of post-operative complications and re-operation, and mortality (P < 0.05). In the logistic regression analysis, admission Cr/Alb values were independently related to the APACHE II score, post-operative renal failure, and mortality. Conclusion Cr/Alb is a novel but promising, easy-to-measure, reproducible, non-invasive prognostic score for the prediction of the effect of debridement in AP patients.
Evaluation of a training program for soft skill education and financial literacy to community health workers in India: a quasi-experimental study
Authors: Sharma Shantanu , Arora Kanishtha , Chandrashekhar Chandrashekhar , Sinha Rajesh Kumar , Akhtar Faiyaz , Mehra Sunil
Published: July 2020

Background: The soft skills of community health workers (Accredited Social Health Activists, ASHA) are known to be effective in negotiating behaviour change in the community; however, there has been a meagre focus towards improving them. Considering this gap, we adopted a comprehensive training program, known as Personal Advancement and Career Enhancement (P.A.C.E.), to empower ASHAs on soft skills and financial literacy. The present study intends to assess the training program in two districts of Uttar Pradesh, India, by examining changes in knowledge, perceptions, and practices of ASHAs about soft skills and financial literacy.Methods: We conducted a quasi-experimental, non-randomized, controlled study with pre- and post-test assessments. Data were collected on socio-demographic characteristics, knowledge, and practices related to soft skills (communication skills, self-confidence, problem–solving and decision-making skills, time and stress management skills) and financial literacy. Additionally, perceptions regarding changes in practices related to gender issues, soft skills, and savings at the personal, community, and workplace levels were obtained from the intervention group. Factor analysis was performed to obtain the change patterns by assessing the degree to which the four domains of soft skills, financial literacy, and domains of perceptions of change in practices were correlated to each other. A general linear regression model was performed to assess associations among change pattern scores and socio-demographic variables.Results: The data of 171 ASHAs were analyzed (intervention group:86 and control group:85). There was a significant improvement in the average post-test scores of all the soft skills and financial literacy in the intervention group (p<0.001). Three distinct change patterns were found post-training in the intervention group. Factor 1 (high loadings for perceptions related to change in practices) was positively associated with ASHAs aged 38 years and above and with experience of ≤12 years. On the contrary, the change in financial literacy and self-confidence scores was common among ASHAs with more than 12 years of experience.Conclusions: The P.A.C.E training program was found effective in improving the soft skills and financial literacy of ASHAs in India.
A Systems Biology Workflow for Drug and Vaccine Repurposing: Identifying Small-molecule BCG Mimics to Prevent COVID-19 Mortality
Authors: Hajjo Rima , Tropsha Alexander
Published: July 2020

Purpose: Coronavirus disease 2019 (COVID-19) is expected to continue to cause worldwide fatalities until the World population develops ‘herd immunity’, or until a vaccine is developed and used as a prevention. However, the vaccine may prove ineffective due to rapid changes in viral antigenic determinants. Bacillus Calmette–Guérin (BCG) vaccine has been recognized for its off-target beneficial effects on the immune system, therefore, can be exploited to boast immunity and protect from emerging novel viruses.Methods: We developed a systems biology workflow capable of identifying small-molecule antiviral drugs and vaccines that can boast immunity and impact a wide variety of viral disease pathways to protect from the fatal consequences of emerging viruses. Results: We show that BCG affect the production and maturation of naïve T cells, which results in enhanced long-lasting trained innate immune responses to tackle novel viruses. Our workflow identified small-molecule BCG mimics, including antiviral drugs such as raltegravir and lopinavir as high confidence hits. Strikingly, top hits emetine and lopinavir were validated to inhibit the growth of SARS-CoV-2 in vitro.Conclusions: Our results provide systems biology support for using BCG and small-molecule BCG mimics as a protection measure from the lethal consequences of emergent viruses including SARS-CoV-2.
The feasibility of transfer learning for differentiation H1N1 Influenza from COVID-19 on chest CT
Authors: Sotoudeh Houman , Tasorian Baharak , Tabatabaei Seyed Mohsen , Sotoudeh Ehsan , Moini Abdollatif
Published: July 2020

Objectives: It is unlikely that by fall and winter of 2020, standard vaccine or treatment is available for COVID-19 infection. In this period, differentiation between COVID-19 and Influenza induced pneumonia will be critical for patient management. To develop an automated platform to perform this task, artificial intelligence models were developed by using the transfer learning techniques on chest CT.Methods: Chest CT images from known cases of COVID-19, H1N1 Influenza induced pneumonia (before December 2019), and normal chest CTs were collected. Different pre-trained Convolutional Neural Networks (CNN) models, including VGG 16, VGG 19, ResNet-50, Wide ResNet, InceptionV3, and SqueezNet were fine-tuned on this data set. 60% of the dataset was used for training, 20% for validation, and 20% for test the final models. Accuracy, Precision, Recall and F1 score of each model were calculated.Results: For differentiation of COVID-19 pneumonia versus H1N1 Influenza pneumonia versus normal CTs, the ResNet-50 (accuracy above 92%) outperformed other models followed by InceptionV3 and wide ResNet.Conclusions: The pre-trained image classification AI models are feasible to be fine-tuned and used for differentiation COVID-19 versus H1N1 Influenza pneumonia. In this context, ResNet-50 and then InceptionV3 architectures appear more promising and are suitable start points for further development. We share the source code and trained models in the supplement of this manuscript to be used by other researchers for further development.
Health and socioeconomic resource provision for older people in South Asian countries: Bangladesh, India, Nepal, Pakistan and Sri Lanka
Authors: Matthews Natasha Roya , Porter George James , Varghese Mathew , Sapkota Nidesh , Khan Murad Moosa , Lukose Ammu , Paddick Stella-Maria , Dissanayake Malathie , Khan Naila Zaman , Walker Richard
Published: July 2020

BackgroundThe global population is ageing rapidly, with low- and middle-income countries (LMICs) undergoing a fast demographic transition. This necessitates effective services to address the increasing physical and mental health needs of multimorbid and frail older people in LMICs. We review the current provision of health and socioeconomic resources for older people in South Asian countries: Bangladesh, India, Nepal, Pakistan and Sri Lanka, to identify gaps in available resources and assess areas for improvement. MethodsWe conducted a search of grey and published literature via Google Search and Compendex, EBSCO, JSTOR, Medline, Ovid, ProQuest databases, Scopus and Web of Science to extract data on population demographics, human resources, health funding and social security provision for older people. Local informants were consulted to supplement and verify the data. ResultsIn most study countries, care of the elderly is provided by general physicians or primary care doctors, nurses and community health workers, though in very low numbers per capita. The number of geriatricians and specialist allied health professionals were largely unknown, with minimal postgraduate programmes available for specific training in geriatric medicine or psychiatry. Total average healthcare expenditure as a percentage of GDP was between 2.5-5.5%, markedly below the global average of 10.0%, with between 48.1-72.0% of healthcare costs covered by out-of-pocket payments. All countries, except Pakistan, had a social pension offering a minimum level of protection against financial constraints, but with varying coverage of those eligible. Financial provision for people with dementia was only available in India and Nepal. A modest number of state and charity-run care homes were established in all countries, though numbers were disproportionate to the growing number of older adults requiring long term care.ConclusionsInadequate health funding, a lack of specific healthcare and training and insufficient government pension and social security schemes are a current threat to achieving universal health coverage in LMICs. Governing bodies must establish geriatrics and geriatric psychiatry as specialities and scale up training programmes for specific healthcare providers for the elderly. This needs to occur alongside increased social protection provision to improve access to those in need and prevent catastrophic health expenditure.
Effects of different PTSD modeling methods on fear and depressive behavior in rats: a protocol for systematic review and network meta analysis
Authors: Song Kai , Xiong Fanjie , Huang Ailing , Zhang Hong
Published: July 2020

Background: Posttraumatic stress disorder (PTSD) is a debilitating mental disorder that occurs after exposure to traumatic events. This disorder can result in a interference to personal and family functioning, causing great threat to people's life and public health. Animal models remain the effective tools to the pathophysiological study of PTSD, There are many model paradigms of PTSD, and the purpose of this study is to evaluate the effect of different model paradigms of PTSD on depression-like and fear-like behavior using systematic review and network meta-analysis (NMA).Methods: The authors will retrieve a total of seven electronic databases by April 2020. After a series of screening, the two researchers will use Aggregate Data Drug Information System (ADDIS) and Stata software to analyze the data extracted from randomized controlled animal studies in PTSD rats . Ultimately, the evidence grade of the results will be evaluated.Discussion: The results of this study will provide references for evaluating the influence of different rats models of PTSD on depression-like and fear-like behavior, and provide decision-making references for clinical practice. Systematic review registration: PROSPERO CRD42020182389.
A Comprehensive Analysis of the MAGE Family as Prognostic and Diagnostic Markers for Hepatocellular Carcinoma
Authors: Li Rong , Gong Jiao , Xiao Cuicui , Zhu Shuguang , Hu Zhongying , Liang Jinliang , Li Xuejiao , Yan Xijing , Zhang Xijian , Li Danyang , Liu Wei , Chong Yutian , Jie Yusheng
Published: July 2020

Background: The Melanoma Antigen Gene (MAGE) family is a large, highly conserved group of proteins that share a common MAGE homology domain. Multiple MAGEs are aberrantly expressed in a variety of cancers. However, the function of distinct MAGE genes in hepatocellular carcinoma (HCC) is largely unclear. Our study aimed to comprehensively analyze the MAGE family as prognostic and diagnostic markers for HCC. Methods: In this research, all HCC data were obtained from NCBI GEO DataSets, The Cancer Genome Atlas (TCGA) and our clinical center. UALCAN was used to reveal the expression profile of distinct MAGEs in HCC and further evaluate the association between the expression of MAGEs and the clinicopathological characteristics of HCC patients, including clinical stage, tumor grade. Kaplan-Meier Plotter (KM-Plot) was used to evaluate the correlation between MAGEs expression and the overall survival (OS) of HCC patients. qRT-PCR was used to detection the expression levels of MAGEs in HCC samples. cBioPortal was used to analyze the genetic alterations in MAGEs and their associations with OS of HCC patients. Gene Set Variation Analysis (GSVA) algorithm was used to do functional enrichment analysis of MAGE genes in HCC to reveal the molecular mechanisms of MAGEs functioned in HCC. Results: Our research showed that many MAGE genes were dysregulated in HCC and most of them were highly expressed. Among them, MAGEA1、MAGEC2、MAGED1、MAGED2、MAGEF1 and MAGEL2 were significantly correlated with clinical stage and differentiation of HCC patients. MAGED1、MAGED2、MAGEA6、MAGEA12、MAGEA10、MAGEB4、MAGEL2 and MAGEC3 had significant correlation with HCC prognosis. Further functional enrichment analysis suggested the dysregulated MAGEs may play important roles in signal transduction. Conclusions: Taken together, our research revealed that multiple MAGEs were dysregulated in HCC and they might play important roles in the development of HCC and can be exploited as useful biomarkers for diagnosis and treatment for HCC.
CD45+ Erythroid Progenitor Cell Contribute to Antiangiogenic Drug Resistance Through Reactive Oxygen Species in Lymphoma.
Authors: Wei Xia , Yang Sainan , Pu Xin , He Silian , Yang Zailin , Sheng Xiaomin , Chen Wen , Zhang Yong
Published: July 2020

Background: More than half of lymphoma patients are complicated with anemia. Anemia often indicates a poor prognosis, but the mechanism is still unclear. Erythroid progenitor cells (EPCs) are precursors of erythrocytes and play an important role in maintaining the homeostasis of erythrocytes. Here we investigated the role and mechanism of EPCs in promoting lymphoma progression.Materials and methods: Ki-67, CD31, P-AMPK and CPT1A expression was detected by immunohistochemical staining. CD45+ EPCs were detected and sorted by flow cytometry. Animal experiments were used to detect the effect of CD45+ EPCs on lymphoma.Results: Our study found that the proportion of CD45+ EPCs in diffuse large B-cell lymphoma (DLBCL) patients with anemia was significantly higher, which is positively correlated with the expressions of P-AMPK and CPT1A in lymphoma tissues. Interestingly, we found that in hypoxic conditions, CD45+ EPCs regulated lipid metabolism and enhanced energy metabolism of lymphoma cells through AMPK-ACC-CPT1A pathway, further promoted cell proliferation and inhibited apoptosis of lymphoma cells. Animal experiments showed that CD45+ EPCs transplantation significantly increased the resistance of antiangiogenic drugs. Reactive oxygen species (ROS) played a key role in these processes. Conclusion: CD45+ EPCs contributed to antiangiogenic drug resistance through ROS in lymphoma.
The Value and Clinical Significance of ZNF582 gene Methylation in the Diagnosis of Cervical Cancer
Authors: Zhang Chunhe , Fu Shaowei , Wang Luyue , Wang Fang , Wu Dan , Zhe Xiangyi , Xin Huizhen , Li Hongtao , Li Dongmei , Jin Fuyuan , Shao Renfu , Pan Zemin
Published: July 2020

Background This study aimed to determine whether ZNF582 gene methylation and tissue protein expression can be used as a tool with high sensitivity and specificity for cervical cancer screening. We analyzed the correlation between promoter methylation of the zinc finger protein 582 (ZNF582) gene and cervical cancer and high risk HPV16/18 infection. Methods Tissue samples of normal cervical or chronic cervicitis (n=51), CIN (cervical intraepithelial neoplasia) (n=35), and cervical carcinoma (n=68) were tested for HPV16/18 infection by polymerase chain reaction (PCR). We also detected the methylation status of the ZNF582 gene promoter in the same tissues by methylation specific PCR (MSP), then analyzed the correlation between ZNF582 promoter methylation and HPV16/18 infection. Immunohistochemistry was used to analyze ZNF582 gene expression in 152 cervical tissues. We detected ZNF582 mRNA expression in cervical tissues (including cancer and non-cancer) by real-time fluorescence quantitative PCR (qRT-PCR).Results Among 93 high grade cervical lesions (CINII and above) and cervical cancer samples, 57 cases were positive for HPV16/18 infection and 36 cases were negative. ZNF582 gene methylation occurred in 9 out of 51 cases in normal cervical tissues (17.6%), 16 of 35 cases in CIN tissues (45.7%), and 50 of 68 cases in cervical cancer (73.5%). The differences in methylation rate of the three groups were statistically significant (P<0.05). The ZNF582 methylation rate in the positive HPV16/18 infection group was 73.7%, while the negative group was 63.9%. Compared with normal tissues, ZNF582 protein was highly expressed in cervical cancer tissues, but mRNA expression was low.Conclusion While ZNF582 protein is highly expressed in cervical cancer tissues, it was not sufficient for use as a standard for cervical cancer staging. On the other hand, ZNF582 promoter methylation had high specificity and sensitivity in detecting CINII and highly diseased cervical lesions and could be used as a diagnostic marker for cervical cancer of women.
Prognostic significance of lymph node dissection on stage-specific survival for patients with primary small intestine tumor treated with enterectomy: A population-based study, 2004-2015
Authors: Chen Yifei , He Fei , Guo Dan , Li Yarui , Wang Ruhua , Zhang Xu , He Shuixiang
Published: July 2020

Background: The positive rate of lymph node detection(LND) can be used as a predictor of prognosis for patients undergoing radical resection of small bowel tumors; thorough local LND may be crucial for the accurate staging and management of the disease.The purpose of our study was to determine the effect of the LND in specific stages. Methods: This study included 5413 patients with primary small intestine tumors after enterectomy within SEER database from 2004-2015. A multivariable COX model and Kaplan-Meier plots survival curves were used to analyze survival.Results: Of the 5413 patients, 4675(86.4%) underwent lymphadenectomy, and 3896(72.0%) were moved 4 or more than 4 lymph nodes. LND was performed in 67.8%, 83.3%, 87.9%, 89.3% in pT1/2/3/4 disease. In multivariable Cox regression analyses, LND was associated with OS and CSS, and the extended LND are better than limited LND (all P<0.05 except pT2). Kaplan-Meier plots survival curves showed that LND can benefit patients.Conclusions: The removal of LND with 4 or more lymph nodes in pT1/3/4 patients has relatively obvious benefits for survival. The effect of LND with more lymph nodes is significantly better than limited LND. For pT1, pT3 and pT4, LND can be considered.
Persistently Gadolinium Enhancing Lesion is Predictor of Poor Prognosis in NMOSD Attack: A Clinical Trial
Authors: Xu Yun , Li Xindi , Xu Wangshu , Wang Xinli , Duan Yunyun , Liu Yaou , Zhang Xinghu , Tian De-Cai
Published: July 2020

Background: Gadolinium (Gd)-contrast MRI, reliable detecting blood-brain barrier (BBB) breakdown, is widely used in neuromyelitis optica spectrum disorder (NMOSD) attack. To investigate the predictive value of persistently Gadolinium-enhanced lesions to long-term outcome after attack.Methods: Data for this analysis come from an ongoing prospective cohort study to assess the clinical and imaging patterns of neuroinflammation diseases in China (CLUE). NMOSD patients with acute attack were enrolled from January 2019 to March 2020. All patients underwent Gadolinium-contrast Magnetic Resonance Imaging (MRI) at baseline and 1 month, and disability was assessed using the Expanded Disability Status Scale (EDSS) at baseline and month 1 and 6. Primary outcome was EDSS score improvement from baseline to month 6. Multiple logistic regression identified predictors for poor recovery of NMOSD attack.Results: 41 participants were analyzed, of which 21 patients with persistently Gd-enhancing lesions. Patients in non-continuous enhancement (nCE) group showed statistically significant shift in the 6-month EDSS distributions compared with continuous enhancement (CE) group (p = 0.002). Poor recovery rate of CE group was higher than that of nCE group at 6 months (p = 0.033). In patients with AQP4-IgG positive, first attack, transverse myelitis or high-dose steroid treatment, the improvement of EDSS scores in CE group was still less compared to nCE group (p < 0.05). The presence of persistently Gd-enhancing lesion appears to be associated with poor recovery after acute attack (OR = 5.473, 95% CI 1.417-21.115, p = 0.014).Conclusion: NMOSD patients with persistently gadolinium-enhancing lesions have worse outcome at 6 months. Persistently Gd-enhancing lesion is a poor prognosis predictor after NMOSD attack.Trial registration: This clinical trial named Clinical and Imaging Patterns of Neuroinflammation Diseases in China (CLUE), which has registered with ClinicalTrials.gov (NCT04106830). The date of registration was September 27, 2019 (Retrospectively registered). The URL is https://clinicaltrials.gov/ct2/show/NCT04106830?term=NCT04106830&cntry=CN&draw=2&rank=1.
Two Novel Likely Pathogenic Variants of HARS2 Identified in a Chinese Family With Perrault Syndrome
Authors: yu jing , jiang Wei , cao Li , Na xiaoxue , Yang jiyun
Published: July 2020

HARS2 is one of the genetic causes of Perrault syndrome, characterized by sensorineural hearing loss (SNHL) and ovarian dysfunction. Here, we identified two novel putative pathogenic variants of HARS2 in a Perrault syndrome pedigree including two affected male siblings, c.349G>A (p.Asp117Asn) and c.908T>C (p.Leu303Pro), through targeted next-generation sequencing methods. The two affected siblings (13 and 11 years old) presented with early-onset, rapidly progressive SNHL. The affected siblings did not have any inner ear malformations or delays in gross motor development. Combined with preexisting clinical reports, these findings further expanded the existing spectrum of HARS2 variants and Perrault syndrome phenotypes, which will assist in molecular diagnosis and genetic counselling of patients with Perrault syndrome.
How do Iranian High School Students Explain Social Undesirability of Hookah Smoking? A Qualitative Study
Authors: Keshavarzian Khadijeh , Mohammadpourasl Asghar , Allahverdipour Hamid , Nadrian Haidar
Published: July 2020

Background: Despite the speculations in literature regarding the importance of “social undesirability of hookah smoking”, to our knowledge, no study has yet clearly attempted to define this phenomenon and to make sense of it in terms of the meanings adolescents bring to the concept. The present study was aimed to explore the perceptions of high school students on Social Undesirability of Hookah Smoking (SUoHS).Method: In this qualitative study, 31 students (16 boys and 15 girls) at the range of 15 to 17 years of age in Tabriz, Iran, were invited to participate in semi-structured individual interviews (18 participants) and focus group discussions (FGDs) (13 participants). The data were managed applying MAXQDA-10, and analyzed using interpretative thematic analysis. Results: The SUoHS was viewed at the “highly negative attitude towards hookah smoking and hookah smokers”. The students also explained the SUoHS in “the disvaluing to hookah smoking and smokers in the society”, “the negative attitude towards hookah smokers and their families”, and “the consequences of hookah smoking”. Conclusion: The SUoHS originates from the social context of society, and is rooted from the social values and norms within communities. These social values may affect the attitude and subjective norms of adolescents toward the behavior. Adolescents’ conceptions on SUoHS should be considered while designing hookah smoking prevention/cessation programs with the hope to bridge the gap between their recognition of SUoHS and subsequent behavior change.
Temporomandibular Joint Hypermobility - Diagnosis Based on Auscultation and Signals Analysis
Authors: Lemejda Justyna Agnieszka , Kajor Marcin , Grochala Dominik , Iwaniec Marek , Iwaniec Joanna , Loster Jolanta E.
Published: July 2020

BackgroundThe temporomandibular joint is a well-known anatomical structure a vast majority of dentists doesn’t know how to treat patients with temporomandibular disorders. What is more, even physiological sounds accompanying joint movement can deceitfully indicate pathological features. An example of TMD is temporomandibular joint hypermobility, a disorder which still requires comprehensive study and analysis.MethodsForty seven volunteers were diagnosed with the RDC/TMD questionnaire and auscultated with electronic stethoscope Littmann 3200 on both sides simultaneously. Recorded TMJ sounds were sent to the computer via Bluetooth for further numerical analysis.ResultsTwo patients with TMJH were diagnosed. In the first case the RDC/TMD based diagnosis were discovered as Ia (myofascial pain) and IIIa (arthralgia). The second person was diagnosed with no disorder according to RDC/TMD questionnaire. However the RDC/TMD examination does not support recognition of TMJH. Therefore in this paper it was proved that such recognition can be performed based on the digital time-frequency analysis of the TMJ sound.ConclusionsTMJH is rare case, at ours research 4% patients. The recognition of dysfunction can be based on the characteristic time-frequency features presented in the spectrogram representation of TMJ sound.Trial registration﻿The Jagiellonian University Bioethics Committee gave consent for examination, number 1072.6120.71.2019 from the 24th of April 2019 year. All participants were informed about the objectives of the study. Each of them expressed their written consent to participate in the examination and signed the consent form before the study. During the procedures, the rules of Good Clinical Practice were applied and the Helsinki Declaration was followed.
Antibiotic Appropriateness and Adherence to Local Guidelines in Perioperative Prophylaxis: Results from an Antimicrobial Stewardship Intervention
Authors: Segala Francesco Vladimiro , Murri Rita , Taddei Eleonora , Giovannenze Francesca , Vecchio Pierluigi Del , Birocchi Emanuela , Taccari Francesco , Cauda Roberto , Fantoni Massimo
Published: July 2020

Objectives: Surgical antibiotic prophylaxis (SAP) represents a major indication of antibiotic consumption worldwide. The present study aims to report the results of an enabling, long-term AMS intervention conducted between 2013 and 2019 on an Italian University Hospital performing more than 40.000 surgical interventions per year.Methods: SAP inappropriateness was defined according to the ASHP guidelines and divided in four main categories: indication, selection and dosing, duration, timing. Between 2013 and 2019, we conducted a continuative AMS intervention over 14 surgical departments that included enablement, review of selected clinical records and feedback. Results: We collected a total of 789 SAP prescribed to 735 patients (mean age 56.7 ± 17.8y). Overall, guideline adherence improved from 36.6% (n = 149) at baseline to 57.9% (n = 221) post-intervention (P<0.0001). A significant improvement (P<0.001) was also detected for each category: indication (from 58.5% to 93.2%), selection and dosing (from 58.5% to 80.6%), timing (from 92.4 to 97.6%), duration (from 71% to 80.1%). Conclusions: Though results cannot be generalized to all hospital populations, enabling AMS interventions may be effective in establishing a sustained improvement in SAP appropriateness rates. Once identified the main causes of SAP inappropriateness, tailored AMS interventions for each department may be beneficial. Further studies are needed to evaluate specific outcomes as incidence of surgical site infections and antimicrobial resistance.
Reducing dietary cation–anion difference seldom affects rumen fermentation, cellulolytic bacteria populations, and microbiota in goats
Authors: Yang Kang , Tian Xingzhou , Jian Shiyan , Sun Lun , Han E , Wang Fei , Guo Ziyi , Ma Zhengfa , He Tengbing , Wu Wenxuan
Published: July 2020

Background: Dietary cation–anion difference (DCAD) has been receiving increased attention in recent years; however, information on the rumen fermentation, cellulolytic bacteria populations, and microbiota of goats fed a low-DCAD diet is less. This study aimed to evaluate the feasibility of feeding a low-DCAD diet for goats with emphasis on rumen fermentation parameters, cellulolytic bacteria populations and microbiota. Growth performance, urine pH, and plasma metabolites were also analyzed as well. Materials and method: Eighteen goats were randomly allocated to 3 treatments with six replicates of each treatment and 1 goat per replicate. Animals were fed diets with varying DCAD levels at +338 (High DCAD; HD), +152 (Control; CON), and −181 (Low DCAD; LD). This study includes 15-d experimental period and 30-d adaption period. Results: The DCAD level did not affect the rumen fermentation parameters including pH, buffering capability, acetic acid, propionic acid, butyric acid, total volatile fatty acids, and ratio of acetic acid/propionic acid (P > 0.05). The 4 main ruminal cellulolytic bacteria populations including Fibrobacter succinogenes, Ruminococcus flavefaciens, Butyrivibrio fibrisolvens and Ruminococcus albus did not differ from DCAD treatments (P > 0.05). The DCAD levels did not affect bacterial richness and diversity indicated by the indices Chao, Ace and Simpson and Shannon, respectively (P > 0.05). Both weighted UniFrac and unweighted UniFrac showed no difference in the composition of rumen microbiota for CON, HD and LD (P > 0.05). At the phylum level, Bacteroidetes was the predominant phylum followed by Firmicutes, Synergistetes, Proteobacteria, Spirochaetae, and Tenericutes, and they showed no difference (P > 0.05) in relative abundances except for Firmicutes, which was higher in HD and LD compared to CON (P < 0.05). At the genus level, relative abundance of 11 genera were not affected by DCAD treatments (P > 0.05). Level of DCAD had no effect (P > 0.05) on growth performance including dry matter intake, average net gain, average daily gain, and feed conversion ratio; and nutrients digestibility of crude protein, neutral detergent fiber, acid detergent fiber, and organic matter (P > 0.05). Urine pH in LD was lower than HD and CON (P < 0.05). LD resulted in higher plasma calcium than HD and CON (P < 0.05) but not for other plasma metabolites (P > 0.05). Conclusion: We conclude that, with regard to the great importance of rumen fermentation, these results suggest that reducing DCAD is unharmful for rumen status and provide the feasibility of feeding a low-DCAD to goats.
A Conceptual Framework for Mental Model-based Repeated Multifaceted Intervention Design to Improve Preventive Health Behaviors and Outcomes
Authors: Ahamad Mazbahul G , Tanin Fahian
Published: July 2020

Background: Improving the effectiveness of health interventions is a major challenge in public health research and program development. A large body of literature found low or no impact of health education and promotional interventions, especially in low- and middle-income countries.Objectives: To develop a conceptual framework in support of intervention designs of preventive health behavior improvement programs and outcomes.Methods: An overview of systematic and scoping reviews along with empirical literature was conducted to assess the limitations of preventive health education and promotion interventions using water, sanitation, and hygiene (WASH) programs and outcomes as examples.Results: We analyzed the limitations of the less effective or ineffective field interventions cited in peer-reviewed articles. We found three major limitations regarding the mental model’s balance of treatment and comparison groups, treatment groups’ willingness to adopt suggested behaviors, and the type, length, frequency, intensity, and sequence of treatments. To minimize the influence of these concerns, we proposed a mental model-based repeated multifaceted (MRM) intervention design framework.Conclusions: Our proposed framework aims to provide an intervention design for improving health education and promotional programs. Further studies using this framework are essential to examine our hypotheses and advance the understanding of how MRM design can improve preventive health behaviors and outcomes.
Effect of Echinacea purpura’s extract on the expression of VEGF-A gene and antiproliferative, induction of apoptosis, inhibition of cell migration, and colony formation on gastric cancer cell line AGS
Authors: Moradian Fatemeh , Sadeghi Azar , Sabouni Farzaneh , Sanjarian Forough
Published: July 2020

The authors have requested that this preprint be removed from Research Square.
PGK1, a promising biomarker and therapeutic target for patients with acute myeloid leukemia who are susceptible to disease relapse
Authors: Gao Junyan , Chu Xinran , He Shan , Gao Li , Hou Hui , Fang Fang , Pan Jian , Hu Shaoyan
Published: July 2020

Background: Glycolysis, a multi-step enzymatic reaction, is considered to be the root of cancer development and progression. The aim of this study is to figure out the glycolytic enzyme, phosphoglycerate kinase 1 (PGK1) whether participate in the progression of acute myeloid leukemia (AML) and its possible mechanisms. Methods: Four datasets (GSE106096, GSE75086, GSE107968 and GSE106748) containing 30 leukemic blast cell samples of AML at diagnosis, 17 leukemic blast cell samples of AML relapse and 3 bone marrow CD34+ cell samples of healthy donors were downloaded from Gene Expression Omnibus (GEO) database and PGK1 was screened out as a potential survival biomarker in AML. Then we did a series of clinical sample verifications and gene set enrichment analysis (GSEA) focusing on PGK1. We further knocked down expression of PGK1 in myelogenous leukemia cell lines and explored its potential effects. Results: PGK1 expression was up-regulated among AML at diagnosis versus healthy control, AML relapse versus AML at diagnosis and AML relapse versus healthy control datasets. Through a serial of bioinformatic analyses (differentially expressed genes [DEGs] selection, function and pathway enrichments and protein-protein interaction [PPI] network establishment), PGK1 was identified as the most meaningful gene in AML progression. Furthermore, the generally high expression of PGK1 was confirmed in AML samples comparing with healthy controls in our single center and the high-expression PGK1 was associated with a comparatively low complete remission (CR) rate, a significantly high 5-year cumulative incidence of relapse (CIR), a poor 5-year event-free survival (EFS) rate, and a poor 5-year overall survival (OS) rate. The GSEA revealed that high-expression PGK1 in AML was associated with many pathways including cytosolic DNA sensing, pentose phosphate, base excision repair and DNA replication. In vitro, the transfected U937 and K562 cells with PGK1 knock-down showed decreased cell viability and increased apoptotic rate. PGK1 inhibition could greatly decrease the half maximal inhibitory concentrations (IC50) of cytarabine (Ara-C) and daunorubicin (DNR) in U937 and K562 cell lines.Conclusions: High-expression PGK1 was associated with poor prognosis in AML. PGK1 may serve to predict the AML progression and provide a novel therapeutic target for AML.
Conceptualizations of Clinical Decision-Making: A Scoping Review in Geriatric Emergency Medicine
Authors: Gamborg Maria Louise , Mehlsen Mimi , Paltved Charlotte , Tramm Gitte , Musaeus Peter
Published: July 2020

Background: Clinical decision-making (CDM) is an important competency for young doctors, especially under complex and uncertain conditions, which is present in geriatric emergency medicine (GEM). Research in this field is however characterized by an unclear conceptualization of CDM. To evolve and evaluate evidence-based knowledge of CDM, it is thus important to identify different definitions and their operationalisations in studies on GEM.Objective: A scoping review of empirical articles was designed to provide an overview of the documented evidence of findings and conceptualizations of CDM in GEM.Methods: A detailed search for empirical studies focusing on CDM in a GEM setting was conducted in PubMed, ProQuest, Scopus, EMBASE and Web of Science. In total, 52 publications were included in the analysis, utilizing a data extraction sheet, following the PRISMA guidelines. Reported outcomes were summarized.Results: Four themes of operationalization of CDM emerged; CDM as dispositional decisions, CDM as cognition, CDM as a model, and CDM as clinical judgement. Study results and conclusions differed according to how CDM was conceptualized. It was evident how especially frailty- heuristics lead to biases in treatment of geriatric patients, and that the complexity of this patient group was seen as a challenge for CDM.Conclusions: This scoping review summarizes how different studies in GEM use the term CDM. It provides a snapshot of findings in GEM. Potentially, findings from CDM research can guide implementation of adequate CDM strategies in clinical practice but this requires application of more stringent definitions of CDM in future research.
Different source of sample strains corresponds to different characteristics of patients with non-tuberculous mycobacterium.
Authors: Pan Xinling , Zhao Jin , Jin Xiaoling , Ji Songjun
Published: July 2020

Background: The non-tuberculous mycobacteria (NTM) strains are important in the diagnosis of pulmonary diseases. However, the different source of the sample may correspond to different characteristics of both NTM disease and infected patients and these aspects have not been investigated. Methods: Samples isolated from different sources in inpatients with NTM strains were comprehensively analyzed in this study, including basic information, laboratory examination and coexisting diseases.Results: A total of 242 inpatients with NTM strains were considered in this study. Sputum (n=129) and bronchoalveolar lavage fluid (BALF, n=50) were the most common samples among patients with NTM strains from whom a sample was collected from a single source (n=179). The patients with NTM-positive BALF differed in age, gender, acid fast assay, the percentage of presence of chronic obstructive pulmonary disease (COPD) and bronchiectasis, and symptom duration compared to the patients with NTM-positive sputum. The patients with COPD were older and mainly male, with longer symptom duration, with higher rates of smoking history and prostatic hyperplasia than those without COPD. Patients with bronchiectasis were mainly females, with a lower percentage of them with a tuberculosis history and smoking history compared to patients without bronchiectasis. Excluding the patients with COPD and bronchiectasis, patients with NTM-positive sputum were older, with positive results in acid-fast assay and T. spot assay compared to patients with NTM-positive BALF. Conclusions: The different specimen source in NTM patients was associated with different patients’ characteristics, and its choice could be influenced by presence of COPD and bronchiectasis. Patients with COPD and bronchiectasis differed in gender and smoking history, thus, these aspects should be comprehensively analyzed during the investigation of patients with pulmonary NTM infection.
An Evaluation of Bioenergy Industry Sustainability Impacts on Forest Degradation in The EU 28 Region
Authors: Alsaleh Mohd , Abdul-Rahim A.S.
Published: July 2020

Bioenergy industry is a proven option to replace fossil fuels in the heat supply and partly in the transport sector and generation of electricity. The aim of this study is to investigate the empirical model pertaining whether bioenergy use and institutional quality impact forestry destruction in European Union countries. To achieve this, a selection of 28 European countries covering 1990–2018 was employed. Also, the Pooled OLS, Fixed Effect, Random Effect and Least Square Dummy Variable Corrected approaches were applied to regress the developed model. The findings referred that bioenergy use within institutional framework significantly participated to reduce forest degradation in the European Union countries. In developed countries, institutional quality indicator was negatively pertained to forest degradation. This shows that efficient institutions and governments can add to reducing forest degradation in the developed countries in European Union. The reduction of forest degradation in European Union countries can be achieved by interacting bioenergy use and government effectiveness indicators. Thus, policy makers should (1) stimulate the sustainability criteria of bioenergy application end-uses (2) intensify the quality of institutions, and (3) ensure the bioenergy use under effective governance.
Insights Into The Broad Antibacterial Spectrum Of Bacteriocin Isolated From Probiotic Lactobacillus Fermentum LMEM22 Strain
Authors: Halder Debashis , Mandal Manisha , Pal Nishith Kumar , Mandal Shyamapada
Published: July 2020

This communication aims to validate the probiotic attributes of the Lactobacillus fermentum LMEM22 strain, safety profiling, 16S rRNA gene sequence analysis, and bacteriocin characterization. The bacteriocin of 13.1 kDa (based on the glycine-SDS-PAGE analysis) was isolated from L. fermentum LMEM22 curd strain (NCBI GenBank with accession No. MH380182), the identity for which was confirmed by 16S rRNA gene sequence analysis. The probiotic properties and safety profiles were authenticated in vitro systems. The zone diameter of inhibition from the L. fermentum LMEM22 bacteriocin action, following agar-well diffusion, ranged 19 – 23 mm and 17 – 24 mm, respectively, for gram-negative and gram-positive bacteria. On enzymatic treatment with proteinase K and trypsin the bacteriocin lost the bacterial growth inhibition capacity, and it was found insensitive against α-amylase action, authenticating its proteinaceous nature. The γ-haemolytic L. fermentum LMEM22 strain, for which gelatinase and DNase activities were negative, had tolerance to high sodium chloride concentration range (2 – 6.5%), low pH (2 – 4%), and bile salts (0.125 – 0.5%). This study, thus, authenticated the probiotic attributes of L. fermentum LMEM22 strain for safe consumption by the people, and the usefulness of bacteriocin isolated, as a valued protein antibiotic for the prevention and treatment of multidrug resistant bacterial infection.
Improving surgical patient’s knowledge about safe use of opioids: A Randomized Controlled Trial
Authors: Doherty Helen R , Lam Enoch , Garstka Maria , Chuang Junior , Wong David Tai , Urbach David R , DiRenna Tania , Chung Frances , Wong Jean
Published: July 2020

Background Currently, it is not routine practice to provide standardized patient education for safe postoperative opioid use. The objective of our study was to evaluate the impact of an educational pamphlet for surgical patients on knowledge about safe use, proper storage, and disposal of opioids.Methods This multi-center randomized controlled study recruited 100 patients in the pre-operative clinic. Inclusion criteria were English-speaking, ≥ 18 years, able to give informed consent, and not on opioids for chronic pain or within the past 30 days. All patients completed a baseline knowledge questionnaire (maximum score 38) on opioid safety. Patients were randomized to intervention: educational pamphlet, or control: standard care (no pamphlet) group. Questionnaires were repeated immediately post-education in the intervention group, and at 15, and 30 days after surgery in both groups. The primary outcome was change in knowledge score post-education in the intervention compared to control group. Secondary outcomes were immediate post-education, 15, and 30-day score, and answering safe storage, and disposal questions correctly.Results Between groups, the post-education score immediately after the intervention was higher in the intervention vs. control group baseline 34.2 [95% CI 33.1–35.3] vs 28.3 [95% CI 26.6–29.9]; P < 0.0001). In the intervention vs control group, mean scores were higher 31.6 (95% CI 30.5–32.7) vs 29.1 (95% CI 27.9–30.2; P = .002) at 15 days, and 32.4 (95%CI 31.4–33.5) vs 30.5 (95% CI 29.2–31.7; P = .017) at 30 days. Within the intervention group, the mean score immediately post-education (34.2 [95% confidence interval (CI) 33.1–35.3]) was higher than baseline (27.8 [95% CI 26.3–29.3]); P < 0.0001. Within the intervention group, the difference in mean score versus baseline was 3.8 (95% CI 2.1–5.5) at 15 days, and 4.6 (95% CI 2.9–6.3) at 30 days, (P < 0.05 for all timepoints). For safe disposal, a correct answer was given (intervention vs control group) by 100% vs 89.7% at 30 days (P = 0.04).Conclusions Within the intervention group, there was a significant improvement in knowledge on safe opioid use immediately post-education, and retention of knowledge at 15 and 30 days postoperatively. The intervention group had better knowledge scores compared to the baseline control group, and 15 and 30 days after surgery.Trial Registration: This study was registered in clinicaltrials.gov: NCT03959787 on May 22, 2019.