bluuebunny/crossref_metadata_2025 huggingface dataset:
Financial risk protection of Thailand’s Universal Health Coverage: results from series of national household surveys between 1996 and 2015
Authors: Tangcharoensathien Viroj , Tisayaticom Kanjana , Suphanchaimat Rapeepong , Vongmongkol Vuthiphan , Viriyathorn Shaheda , Limwattananon Supon
Published: June 2020

Background: Thailand, an upper-middle income country, has demonstrated exemplary outcomes of Universal Health Coverage (UHC). The country achieved full population coverage and a high level of financial risk protection since 2002, through implementing three public health insurance schemes. UHC has two explicit goals of improved access to health services and financial protection where use of these services does not create financial hardship. Prior studies in Thailand do not however provide evidence of long-term UHC financial risk protection. This study assessed financial risk protection as measured by the incidence of catastrophic health spending and impoverishment in Thai households prior to and after UHC in 2002.Methods: We used data from a fifteen-year series of annual national household socioeconomic surveys between 1996 and 2015, which were conducted by the National Statistical Office. The survey covered about 52,000 nationally representative households in each round. Descriptive statistics were used to assess the incidence of catastrophic payment as measured by the share of out-of-pocket payments for health by households exceeding 10% and 25% of household total consumption expenditure, and the incidence of impoverishment as determined by the additional number of non-poor households falling below the national and international poverty lines after making health payments. Results: Using the 10% threshold, the incidence of catastrophic spending dropped from 6.0% in 1996 to 2% in 2015. This incidence reduced more significantly when the 25% threshold was applied from 1.8% to 0.4% during the same period. The incidence of impoverishment against the national poverty line reduced considerably from 2.2% in 1996 to approximately 0.3% in 2015. When the international poverty line of US$ 3.1 per capita per day was applied, the incidence of impoverishment was 1.4% and 0.4% in 1996 and 2015 respectively; and when US$ 1.9 per day was applied, the incidence was negligibly low. Conclusion: The significant decline in the incidence of catastrophic health spending and impoverishment was attributed to the deliberate design of Thailand’s UHC, which provides a comprehensive benefits package and zero co-payment at point of services. The well-founded healthcare delivery system and favourable benefit package concertedly support the achievement of UHC goals of access and financial risk protection.
Correlates of Ghanaian households’ use of clean cooking fuels: insight from the 2014 demographic and health surveys
Authors: Dadzie Seth Sylvester , Kenney Paul Lawer , Emmanuel Nakua Kweku , Herman Agboh Nuake Kofi , Henry Duah Ofori , Veronica Dzomeku Millicent , Pascal Agbadi
Published: June 2020

Background: Globally, about 2.9 billion persons, the majority of whom are from low and middle-income countries, depend on poorly combusted biomass and coal for cooking and heating. Given the negative toll the use of poorly combusted fuels have on people’s health and quality of life, homes are admonished to use for cooking clean fuels that promote optimal health such as liquefied petroleum gas (LPG), natural gases, electricity, and improved biomass cook-stoves. The use of clean cooking fuels has other co-benefits such as reduce deforestation and lower climate-changing emissions. Although information on the prevalence of access to clean cooking energy is known, studies on the social, economic, and geographic factors that may explain the low adoption in households are rare. In this paper, we aim to determine the major covariates of households’ access to clean cooking energy in Ghana.Methods: The study used the data of the cross-sectional demographic and health surveys conducted in 2014. Chi-square test of independence was used to identify the covariates that were statistically significant related to households’ use of CF&HPFs for the multivariable model. In the multivariable model, we reported prevalence ratios using the generalized linear model (glm), setting the family to “Poisson” and the link to “log.” The estimation adjusted for the study designed and the household sampling weights.Results: The main finding was that rich households were 8.85 times likely to use CF&HPFs compared to poor households. We further found that the following factors were associated with a higher probability of a Ghanaian household to use climate-friendly and health-promoting fuels for cooking: male-headed households, households’ headed by persons between 24years and 55 years, households with heads that were currently married or never married, households with heads that have attained at least a primary level education, households with less than eight members, households with at least two women, and households in Western, Central, Greater Accra, Volta, Eastern, Ashanti, Brong Ahafo, Upper East region. Conclusion: In view of these findings, we recommend: a national effort to subsidize and make affordable the purchase of LPG and the stoves that burn it even to the poorest household; education on efficient and sustainable consumption must be intensified and incorporated in the basic school’s curriculum to ensure the future generation are more environmental sustainability and health-conscious; creation of multiple LPG refilling outlets in all the regions in Ghana.
Down regulating PHGDH affects the lactate production of Sertoli cells in varicocele
Authors: Guo Wen-bin , Huang Zhen-hui , Yang Cheng , Lv Xian-yuan , Xia Hui , Tian Hu , Yang Jian-kun , Zhou Qi-zhao , Chen Ming-kun , Xue Kang-yi , Liu Cun-dong
Published: June 2020

Background: Although varicocele is considered to be one of the leading causes of male infertility, the precise mechanism underlying how varicocele leads to male infertility is not completely understood. We found the lactate concentration on the varicocele side of the patients was decreased compare with peripheral venous blood. In the testicles, the lactate produced by the sertoli cells through the glycolysis pathway provides most of the energy needed for spermatogenesis, the reduction of lactate will affect spermatogenesis. The objective of this study was to investigate the mechanism of this abnormal energy metabolism phenomenon in varicocele.Methods: In this study, we collected the testicular tissue from patients with varicocele, the glycolysis related proteins PHGDH was identified by iTRAQ proteomics technology. Experimental rat varicocele model was constructed according to our new clip technique, the mRNA and protein expression levels of PHGDH were examined with qRT-PCR and Western blotting. We constructed a sertoli cell of PHGDH down-regulation model, and then detected the glucose consumption, LDH activities and lactate production in the sertoli cells. Western blot was conducted to investigate the effects of PHGDH on the expression of phosphoserine phosphatase (PSPH) and Pyruvate kinase M2 (PKM2). Flow cytometry was used to detect the cell apoptosis and cell cycle in sertoli cells.Results: The results showed that testicular protein PHGDH was down-regulated in patients with varicocele and in experimental rat varicocele model. Down-regulation of PHGDH in sertoli cells significantly decreased the glucose consumption, LDH activities and lactate production in the sertoli cells, indicating that the low expression of PHGDH ultimately led to a decrease in lactate production by affecting the glycolysis. The Western blot results showed that the down-regulation of PHGDH significantly reduced the expression of pathway protein PSPH and PKM2, leading to the reduction of lactate production. Moreover, PHGDH knockdown can promote apoptosis and inhibit cell cycle to affect cell growth.Conclusions: Overall, we conformed that varicocele lead to the decreasing of testis lactate production. Down-regulation of PHGDH in sertoli cells may mediate the process of abnormal glucose metabolism. Our study provide new insight into the mechanisms underlying metabolism-associated male infertility and suggests a novel therapeutic target for male infertility.
Optical Coherence Tomography Angiography (OCTA) findings in Serpiginous Choroiditis
Authors: Macedo Sergio , Pohlmann Dominika , Lenglinger Matthias , Pleyer Uwe , Joussen Antonia M. , Winterhalter Sibylle
Published: June 2020

Background. To describe changes in the retina/choroid in patients with Serpiginous Choroiditis (SC) by Optical Coherence Tomography Angiography (OCTA) in a multimodal imaging approach.Methods. Prospective, monocentric study of 24 eyes of 12 consenting patients diagnosed with SC, who underwent OCTA, which was analyzed and compared to other methods such as enhanced depth imaging-OCT, fluorescein angiography, indocyanine green angiography, and fundus autofluorescence. Results. The study group consisted of 9 patients with peripapillary SC, 1 macular SC, and 2 atypical cases. All eyes presented an inactive SC confirmed by standard imaging. OCTA demonstrated the lesions tridimensionally in great detail. There was no difference in the angioarchitecture among the 3 forms of SC. A loss of the choriocapillaris/retinal pigment epithelium left a “window-defect”, where the vessels of larger caliber of the choroid became recognizable and their appearance inverted (“white-on-black”). A relationship between the presence of segmentation errors (SE) in the slabs and low visual acuity was established with a one-way ANOVA.Conclusions. OCTA was able to non-invasively assess vascular lesions of the choroid/retina in patients with SC with a high degree of correlation to other diagnostic modalities. Consequent long-term assessments could lead to a better understanding of disease progression.
Brief Evidence-Based Interventions for Universal Child Health Services: a restricted evidence assessment of the literature
Authors: Newham James J , McLean Karen , Ginja Samuel , Hurt Lisa , Molloy Carly , Lingam Raghu , Goldfeld Sharon
Published: June 2020

Background: Universal child health services (UCHS) provide an important pragmatic platform for the delivery of universal and targeted interventions to support families and optimize child health outcomes. We aimed to identify brief, evidence-based interventions for common health and developmental problems that could be potentially implemented in UCHS. Methods: A restricted evidence assessment (REA) of electronic databases and grey literature was undertaken covering January 2006 to August 2019. Studies were eligible if (i) outcomes related to one or more of four areas: child social and emotional wellbeing (SEWB), infant sleep, home learning environment or parent mental health, (ii) a comparison group was used, (iii) universal or targeted intervention were delivered in non-tertiary settings, (iv) interventions did not last more than 4 sessions, and (v) children were aged between 2 weeks postpartum and 5 years at baseline. Results: Seventeen studies met the eligibility criteria. Of these, three interventions could possibly be implemented at scale within UCHS platforms: (1) a universal child behavioural intervention which did not affect its primary outcome of infant sleep but improved parental mental health, (2) a universal screening programme which improved maternal mental health, and (3) a targeted child behavioural intervention which improved parent-reported infant sleep problems and parental mental health. Key lessons learnt include: (1) Interventions should impart the maximal amount of information within an initial session with future sessions reinforcing key messages, (2) Child SEWB Interventions should see the family as a holistic unit by considering the needs of parents with an emphasis on identification, triage and referral, and (3) Brief interventions may be more acceptable for stigmatized topics, but still entail considerable barriers that deter the most vulnerable. Conclusions: Delivery and evaluation of brief evidence-based interventions from a UCHS could lead to improved maternal and child health outcomes through a more responsive and equitable service. We recommend three interventions that meet our criteria of “best bet” interventions.
Prevalence and factors associated with intestinal parasites among food handlers in Medebay Zana District, North West Tigray, Northern Ethiopia.
Authors: Regassa Kebrom , Tedla Kiros , Bugssa Gessessew , Gebrekirstos Gebretsadkan , Gebreyesus Hailay , Shfare Mebrahtu
Published: June 2020

Introduction: Several epidemiological studies suggest that the prevalence of intestinal parasites is high, especially in developing countries, and are amongst the major public health challenges facing Sub-Saharan Africa. The aim of the study was to determine the prevalence of intestinal parasites and its associated factors among food handlers in Medebay Zana District, Tigray, Ethiopia.Methods: A cross-sectional study was conducted among 401 food handler individuals selected by systematic random sampling. Binary and multivariable logistic regression was used to determine the possible association between the independent variable and outcome variables. Statistical significance was declared at p-value <0.05 with a 95% confidence interval. Result: The prevalence of intestinal parasites was 33.2% within this sample. The dominant parasite was Entamoeba coli 50(37.4%), followed by Entamoeba histolytica/dispar 24(18%), Entamoeba hartmanni 18(13.5), Giardia lamblia 17(12.8%), Schistosoma mansoni 8(6%), Hymenolepis nana 7(5.3%), Enterviousvermicularies 6(4.5%) and Taenia species 3(2.5%).Conclusion: This study revealed a high prevalence of intestinal parasites among food handlers for a range of intestinal parasites. The significant predictors were the source of water, washing hands before food preparation, washing hands with soap and water after visiting the toilet, shower installation at workplace, washing the body regularly, and eating raw vegetables and raw meat. Hence, local health planners should implement appropriate interventional measures for the novel risk factors to mitigate the problem.
Differential expression of receptors mediating receptor-mediated transcytosis (RMT) in brain microvessels, brain parenchyma and peripheral tissues of the mouse and the human
Authors: Zhang Wandong , Liu Qing Yan , Haqqani Arsalan S. , Leclerc Sonia , Liu Ziying , Fauteux Francois , Baumann Ewa , Delaney Christie E. , Ly Dao , Star Alexandra T. , Brunette Eric , Sodja Caroline , Hewitt Melissa , Sandhu Jagdeep K. , Stanimirovic Danica B.
Published: June 2020

Receptor-mediated transcytosis (RMT) is a principal pathway for transport of macromolecules essential for brain function across the blood-brain barrier (BBB). Antibodies or peptide ligands which bind RMT receptors are often co-opted for brain delivery of biotherapeutics. Constitutively recycling transferrin receptor (TfR) is a prototype receptor utilized to shuttle therapeutic cargos across the BBB. Several other BBB-expressed receptors have been shown to mediate transcytosis of ligands including insulin receptor (INSR) and insulin-like growth factor-1 receptor (IGF1R), lipid transporters LRP1, LDLR, LRP8 and TMEM30A, solute carrier family transporter LAT1 (subunit CD98hc) and leptin receptor (LEPR). In this study, we analyzed expression patterns of genes encoding RMT receptors in isolated brain microvessels, brain parenchyma and peripheral organs of the mouse and the human using RNA-seq approach. IGF1R, INSR and LRP8 were highly enriched in mouse brain microvessels compared to peripheral tissues. In human brain microvessels only INSR was enriched compared to either the brain or the lung. The expression levels of SLC2A1, LRP1, IGF1R, LRP8 and TFRC were significantly higher in the mouse compared to human brain microvessels. The protein expression of these receptors analyzed by quantitative Western blot and immunofluorescent staining of the brain microvessels correlated with their transcript abundance. This study provides a molecular transcriptomics map of key RMT receptors in mouse and human brain microvessels and peripheral tissues, important to translational studies of biodistribution, efficacy and safety of antibodies developed against these receptors.
pH-Dependent Nanodiamonds Enhance the Mechanical Properties of 3D-Printed Hyaluronic Acid Nanocomposite Hydrogels
Authors: Lim Dae Gon , Kang Eunah , Jeong Seong Hoon
Published: June 2020

Nanocomposite hydrogels capable of undergoing manufacturing process have recently attracted attention in biomedical applications due to their desired mechanical properties and high functionality. 3D printing nanocomposite hydrogels of hyaluronic acid (HA)/nanodiamond (ND) revealed that the addition of ND with the low weight ratio of 0.02 wt % resulted in higher compressive force and gel breaking point, compared with HA only nanocomposites. These HA nanocomposite hydrogels loaded with surface functionalized ND allowed for the enforced compressive stress to be tuned in a pH-dependent manner. HA nanocomposite hydrogels with ND-OH at pH 8 showed an increase of 1.40 fold (0.02%: 236.18 kPa) and 1.37 fold (0.04%: 616.72 kPa) the compressive stress at the composition of 0.02 wt % and 0.04 wt, respectively, compared to those of ND-COOH (0.02%: 168.31 kPa, 0.04%: 449.59 kPa) at the same pH. Moreover, the compressive stress of HA/ND-OH (0.04 wt %) at pH 8 was mechanically enhanced 1.29 fold, compared to that of HA/ND-OH (0.04 wt %) at pH 7. These results indicate that the tunable buffering environment and interaction with the long chains of HA at the molecular level have a critical role in the dependency of the mechanical properties on pH. Due to the pH stability of the ND-OH nanophase, filament-based processing and layer-based deposition at microscale attained enforced mechanical properties of hydrogel. Fine surface tuning of the inorganic ND nanophase and controlled 3D printing leads to improved control over the pH-dependent mechanical properties of the nanocomposite hydrogels reported herein.
Acupuncture for diabetic peripheral neuropathy: study protocol for a randomized, placebo-controlled, single-blinded trial
Authors: Deng Haiping , Shu Yu , Lv Peiran , Zhao Ling , Cheng Ke , Zhang Tingting , Song Yi , Yang Hua , Tang Hong , Pei Jian , Shen Xueyong
Published: June 2020

Background
Diabetic peripheral neuropathy (DPN) is the most common chronic complication of diabetes mellitus that has a considerable impact on quality of life, but there are few effective therapeutic strategies. The aim of this trial is to determine the efficacy and safety of manual acupuncture (MA) versus sham acupuncture (SA) for DPN.
Methods/design:
This is a study protocol for a randomized, two-arm, single centre, clinical trial. A total of 118 patients with DPN will be recruited and randomly assigned to the MA group or the SA group in a 1:1 ratio. All patients will receive 24 sessions over 12weeks. Participants will complete the trial by visiting the research centre at month 6 for a follow-up assessment. The primary outcome is the peroneal motor nerve conduction velocity (peroneal MNCV) at week 12 compared with baseline. Secondary outcomes include the peroneal motor nerve action potential amplitude (peroneal MNAP) and latent period(peroneal MNLP), the sural sensory nerve conduction velocity (sural SNCV), action potential amplitude (sural SNAP) and latent period (sural SNLP), fasting plasma glucose(FPG), 2-hour postprandial blood glucose (2hPG), glycated hemoglobin (HbAlc) at week 12 compared with baseline, the Michigan Neuropathy Screening Instrument (MNSI) score and Diabetes Specific Quality of Life scale(DSQL) at week 12 and month 6 compared with baseline. Safety is assessed during the whole trial. Masking effectiveness is assessed by patients.
Discussion
This trial may provide high-quality evidence for evaluating the efficacy and safety of MA treatment for DPN compared with SA treatment. The results of this study will be published in peer-reviewed journals.
Trial registration:
Chinese Clinical Trials Registry, ID: ChiCTR1800020444. First registered on 29 December 2018 - Retrospectively registered, http://www.chictr.org.cn/showproj.aspx?Proj =31063
LncRNA ZFAS1 promotes pancreatic adenocarcinoma metastasis via the RHOA/ROCK2 pathway by sponging miR-3924
Authors: Liu Jinyang , Zhu Yaqin , Ge Chunlin
Published: June 2020

Background: The mortality and morbidity rates of pancreatic adenocarcinoma have been increasing over the past two decades, and an understanding of the mechanisms underlying pancreatic adenocarcinoma progression is urgently needed. The long non-coding RNA ZFAS1 has been demonstrated to be an oncogene in some cancers, but its function and mechanism in pancreatic adenocarcinoma remain unclear.Methods: The ZFAS1 expression level in pancreatic adenocarcinoma was predicted by bioinformatic analysis, and the expression level of ZFAS1 in pancreatic adenocarcinoma tissue samples and cell lines was further investigated by quantitative real-time PCR and in situ hybridization. The functions of ZFAS1 in pancreatic adenocarcinoma in vitro and in vivo were investigated by further bioinformatic analysis. Dual-luciferase reporter assays were used to investigate the binding of ZFAS1/miR-3924 and miR-3924/ROCK2, and rescue assays were performed to further investigate the underlying mechanism.Results: ZFAS1 overexpression in pancreatic adenocarcinoma was predicted and experimentally verified. ZFAS1 silencing inhibited pancreatic adenocarcinoma metastasis in vitro and in vivo. The competing endogenous RNA mechanism of ZFAS1 was also identified.Conclusions: Our results demonstrated the promotive effect of ZFAS1 on pancreatic adenocarcinoma metastasis and suggested its potential role as a novel regulator of ROCK2.
Natural disease progression and novel survival prediction model for hepatocellular carcinoma with spinal metastases: a 10-year single-center study
Authors: Phinyo Phichayut , Boonyanaruthee Chonmavadh , Paholpak Permsak , Pruksakorn Dumnoensun , Phanphaisarn Areerak , Sangsin Apiruk
Published: June 2020

Background: Individual prediction of life expectancy in patients with spinal metastases from hepatocellular carcinoma (HCC) is key for optimal treatment selection, especially when identifying potential candidates for surgery. Most reported prognostic tools provide categorical predictions, and only a few include HCC-related factors. This study aimed to investigate the natural progression of the disease and develop a prognostic tool that is capable of providing individualized predictions.Methods: Patients with HCC-derived metastatic spinal disease were identified from a retrospective cohort of patients with spinal metastases who were diagnosed at Chiang Mai University Hospital between 2006 and 2015. Kaplain–Meier methods and log-rank tests were used to statistically evaluate potential factors. Significant predictors from univariable analysis were included in the flexible parametric survival regression for the development of a prognostic prediction model. Results: Of the 1,143 patients diagnosed with HCC, 69 (6%) had spinal metastases. The median survival time of patients with HCC after spinal metastases was 79 days. In the multivariable analysis, a total of 11 potential clinical predictors were included. After backward elimination, four final predictors remained: patients aged > 60 years, Karnofsky Performance Status, total bilirubin level, and multifocality of HCC. The model showed acceptable discrimination at C-statistics 0.73 (95% Confidence interval 0.68–0.79) and fair calibration. Conclusion: Four clinical parameters were used in the development of the individual survival prediction model for patients with HCC-derived spinal metastases of Chiang Mai University or HCC-SM CMU model. Prospective external validation studies in a larger population are required prior to the clinical implication of the model.
Clinical efficacy and safety in patients treated with teicoplanin with a target trough concentration of 20 μg/mL using a regimen of 12 mg/kg for five doses within the initial 3 days
Authors: Ueda Takashi , Takesue Yoshio , Nakajima Kazuhiko , Ichiki Kaoru , Ishikawa Kaori , Takai Yoshiko , Yamada Kumiko , Tsuchida Toshie , Otani Naruhito , Takahashi Yoshiko , Ishihara Mika , Takubo Shingo , Ikeuchi Hiroki , Uchino Motoi , Kimura Takeshi
Published: June 2020

Background: A trough concentration (Cmin) ≥20 μg/mL of teicoplanin is recommended for the treatment of serious methicillin-resistant Staphylococcus aureus (MRSA) infections. However, sufficient clinical evidence to support the efficacy of this target Cmin has not been obtained. Even though the recommended high Cmin of teicoplanin was associated with better clinical outcome, reaching the target concentration is challenging.Methods: Pharmacokinetics and adverse events were evaluated in all eligible patients. For clinical efficacy, patients who had bacteremia/complicated MRSA infections were analyzed. The primary endpoint for clinical efficacy was an early clinical response at 72–96 h after the start of therapy. Five dosed of 12 mg/kg or 10 mg/kg was administered as an enhanced or conventional high loading dose regimen, respectively. The Cmin was obtained at 72 h after the first dose.Results: Overall, 512 patients were eligible, and 76 patients were analyzed for treatment efficacy. The proportion of patients achieving the target Cmin range (20–40 μg/mL) by the enhanced regimen was significantly higher than for the conventional regimen (75.2% versus 41.0%, p < 0.001). In multivariate analysis, Cmin ≥20 μg/mL was an independent factor for an early clinical response (odds ratio 3.95, 95% confidence interval 1.25–12.53). There was no significant difference in the occurrence of adverse events between patients who did or did not achieve a Cmin ≥20 μg/mL.Conclusion: A target Cmin ≥20 μg/mL might improve early clinical responses during the treatment of difficult MRSA infections using 12 mg/kg teicoplanin for five doses within the initial 3 days.
Near-source characteristics of two-phase gas-solid outbursts in roadways
Authors: Zhou Aitao , Zhang Meng , Wang Kai , Elsworth Derek
Published: June 2020

Coal and gas outbursts compromise two-phase gas-solid mixtures as they propagate as shock waves and flows from their sources. Propagation is influenced by the form of the outburst, proximity to source, the structure and form of the transmitting roadways and the influence of obstacles. The following characterizes the propagation of coal and gas outbursts as two-phase gas-solid flows proximal to source where the coupled effects of pulverized coal and gas flows dominate behavior. The characteristics of shock wave propagation and attenuation are systematically examined for varied roadway geometries using experiments and numerical models. The results demonstrate that the geometry of roadway obstructions is significant and may result in partial compression and sometimes secondary overpressurization in blocked and small corner roadways leading to significant attenuation of outburst shock waves. The shock waves attenuate slowly in both straight and abruptly expanding roadways and more significantly in T-shaped roadways. The most significant attenuation appears in small angle corners and bifurcations in roadways with the largest attenuation occurring in blocked roadways. These results provide basic parameters for simplifying transport in complex roadway networks in the far-field, and guidance for the design of coal and gas outburst prevention facilities and emergency rescue.
Pre-Exposure Prophylaxis During COVID-19 Pandemic: Can PrEP Prevent Flu-Like Symptoms?
Authors: Fernandes Danilo Euclides , Ferreira Paulo Roberto Abrão , Kirsztajn Gianna Mastroianni
Published: June 2020

Background: Considering speculations on an eventual contribution of antiretroviral drugs to treat novel coronavirus, PrEP regular use may provide useful information and clarify its role in preventing flu-like symptoms.Objective: To identify risk and/or protective factors against flu-like symptoms during COVID-19 pandemic among PrEP regular users.Methods: Phone call interview or digital investigation (through WhatsApp® or e-mail) about PrEP regular use during the novel coronavirus pandemic, social distancing, exposure to suspected or confirmed cases of COVID-19 and recent flu-like symptoms.Findings: Among 108 individuals, the majority were cisgender, white, and gay men. Although most of the individuals were in social distancing (68,52%), they did not stop taking PrEP (75,93%). Fewer people had had contact with suspected or confirmed cases of COVID-19 (12,04%), but some did have flu-like symptoms the month before the interview (27,78%) including rhinorrhea (56,67%), cough (53,33%), asthenia (50,00%) and headache (43,33%). Also, PrEP regular use was a protective factor against flu-like symptoms (OR = 0.26, 95% CI 0.07-0.96, p = 0.04) and was associated with social distancing adherence (OR = 7.2, 95% CI 2.74-19.02, p < 0.001).Conclusion: In our sample, regular use of PrEP was a protective factor against flu-like symptoms and was related to the accomplishment of social distancing during the COVID-19 pandemic in São Paulo, Brazil.
Cancer Patient Management Strategy in a Cancer Center of Zhejiang, China During the COVID-19 Pandemic
Authors: Xu Song-xiao , Cheng Xiang-dong , Pan Zhi-wen , Song Qian , Wang Yi-hong , Xiong Juan , Chen Yong-yi , Fan Fan , Zhu Jing , Wu Wan-ying , Deng Xue-ying , Yu Yan-pin , Xu Xiao-hong , Chen Wen-hu , Zhu Tao , Yu Yang , Liu Kai-zhong , Shao Guo-liang , Chen Ming , Yu En-yan
Published: June 2020

Background: Due to the increased risk of viral infection and the severe shortage of medical resources during the pandemic of COVID-19, most hospitals in the epidemic areas significantly reduced non-emergency admissions and services, if not closed. As a result, it has been difficult to treat cancer patients on time, which adversely affects their prognosis. To address this problem, cancer centers must develop a strategic plan to manage both inpatients and outpatients during the pandemic, provide them with the necessary treatment, and at the same time prevent the spread of the virus among patients, visitors and medical staff. Methods: Based upon the epidemic situation in Zhejiang Province, China, the number of running non-emergency medical wards in the Zhejiang Cancer Hospital was gradually increased in a controlled manner. All staff of the hospital received COVID-19 preventive training and was provided with three different levels of protection according to the risks of their services. Only patients without a known history of SARS-CoV-2 contact were eligible to schedule an appointment. Body temperature was measured on all patients upon their arrival at the hospital. Chest CT image, blood cell counting and travel/contact history were investigated in patients with fever. Respiratory tract samples, such as sputum and throat swabs, from all patients, including those clinically suspected of SARS-CoV-2 infection, were collected for nucleic acid detection of SARS-CoV-2 before treatment.Results: A total of 3697 inpatients and 416 outpatients seeking cancer treatment were enrolled from February 1 to April 3, 2020, in compliance with the hospital’s infection-control interventions. The clinicopathological parameters of the patients were summarized herein. 4237 samples from 4101 patients produced negative RNA testing results. Four clinically suspected patients all presented negative RNA test results and were excluded from the SARS-CoV-2 infection through follow-up retesting and monitoring. Seven patients with only N-gene positive results were retested, followed by CT scan and SARS-CoV-2 contact history investigation. All of them were finally diagnosed as non-infected patients. There was one outpatient who was confirmed positive by virus RNA test and then followed up. She might be an asymptomatic laboratory-confirmed case. During the study period, there was no SARS-CoV-2 infection among staff, patients and escorts of patients in the Zhejiang Cancer Hospital.Conclusion: This study suggested our infection-control interventions, including viral nucleic acid test, could be used as a reliable method to screen cancer patients in the area with moderate COVID-19 prevalence. Cancer may not be a high-risk factor of SARS-CoV-2 infection.
A modified technique for paravaginal repair for the treatment of anterior vaginal prolapse and cystocele: a retrospective study
Authors: Huang Shuai , Lv Qiubo , Li Ye , Li Min , Zhang Sichen
Published: June 2020

Background

We aimed to determine the efficacy and safety of a modified protocol for paravaginal repair for treating symptomatic paravaginal defect cystocele.
Methods

This study was an observational case series of 98 consecutive female patients, referred to our hospital between June 2014 and May 2018, with symptomatic grade II to IV paravaginal defects and cystocele. Our modified technique for paravaginal repair is based on the conventional protocol but incorporates reverse bridge repair and the cross-stitching of bilateral sutures. The curative effect of this new technique was evaluated subjectively and objectively during postoperative follow-up.
Results

All operations were successful. Patients were followed up for 12 to 48 months, until June 2019; the mean follow-up period was 32.4 months. Three months after surgery (98 cases), the subjective cure rate was 100%; in each case, the top of the vagina lay above the level of the sciatic spine. The objective cure rate was 100%. The objective cure rate was 94.9% (93 cases) twelve months after surgery (98 cases), 91.0% (61 cases) twenty-four months after surgery (71 cases), and 76.2% (16 cases) forty-eight months after surgery (21 cases). Four cases required a second round of surgery; three of these cases were treated with sacrocolpopexy, and one case was treated with sacrospinous ligament fixation.
Conclusion

Our modified technique for paravaginal repair was safe and effective for the treatment of anterior vaginal prolapse and cystocele, as confirmed by the results observed over a mean follow-up period of 32.4 months.
Application of Various Surgical Techniques in Orthotopic Liver Transplantation: a 10-year Experience at a Single Center
Authors: Chen Zhitao , Han Ming , Ju Weiqiang , Chen Maogen , He Xiaoshun
Published: June 2020

BackgroundLiver transplantation (LT) is considered the only curative treatment for end-stage liver disease (ESLD), and the surgical techniques of LT have continually evolved and have been modified. In this study, we prospectively analyzed a single-center case series in our center and compared the advantages and disadvantages of each method.MethodsIn total, 1,029 patients with OLT at our department were enrolled in this study. The recipient perioperative data were assessed and analyzed. Three types of LT techniques were utilized: modified classic, modified piggy-back (MPB) and classic piggy-back (PB) orthotopic LT, corresponding to groups A, B and C.ResultsCirrhosis was the most prevalent condition in group B, while tumors tended to be more common in group A. Patients in group C were in poorer general condition with higher creatinine, total bilirubin and PT-INR (P = 0.029, 0.011 and 0.026, respectively). Two hundred ninety-five patients had previous abdominal surgery, and the proportion was higher in group B (P = 0.017). The cold ischemia time in group B was longer than those in the other two groups (P<0.001). The mortality rate was 7.9% within 30 days and 11.7% within 90 days. Most of the deaths were not technique-related.ConclusionThe advantages and disadvantages are different for these three surgical techniques. A reasonable operation technique should be adopted considering the patient's unique condition to ensure the stability of hemodynamics.
Circulating Tumor Cells to Predict Microvascular Invasion and Dynamical Detection Indicate Prognosis of Hepatocellular Carcinoma
Authors: Zhou Jiangmin , Zhang Zhiwei , Zhou Honghao , leng Chao , Hou Bingwu , Zhou Chenyang , Hu Xinsheng , Wang Jinlin , Chen Xiaoping
Published: June 2020

Background: The number of preoperative CTC was correlated with the presence of MVI. The change of postoperative CTC count can predict the prognosis of patients. But the change trend of postoperative CTC is controversial.Methods: A total of 137 patients were recruited for the study. Preoperative blood samples of all patients were collected to detect CTC. The time points for blood collection were before the operation, during operation, and at one week, one month, two months, three months, six months, and one year after surgery. The power of predicting the presence of MVI was analyzed by the receiver operating characteristic curve (ROC). According to the survival status, 137 patients were divided into three groups: no recurrence, early recurrence, and non-early recurrence. Results: A threshold CTC value of 5 showed the most significant power to predict the existence of MVI. In a multivariate analysis, the parameters of preoperative CTCs, AFP, and tumor diameter were independent predictors of MVI (P < 0.05). A CTC value greater than or equal to 5 has better predictive value than AFP > 400μg/L or tumor diameter. The number of intraoperative CTCs in the three groups did not increase compared to before surgery (P > 0.05). The number of CTC in the non-recurrent group and the non-early recurrent group decreased significantly one week after surgery compared with intraoperative values (P < 0.001), although there was no statistical significance in the group with early recurrence (P = 0.95). The mean CTC in the early recurrence group was higher than that in the other two groups (P <0.001). Conclusion: The preoperative CTC counts in peripheral blood of patients with HCC is closely correlated to MVI. Intraoperative manipulation for the lesion by the surgeon does not increase the number of CTC in peripheral blood. Surgical removal of the tumor decreases the number of CTC. The persistence of CTC at a high level (≥ 5) after surgery suggests a risk of early recurrence.
The landscape of tumor mutational burden and its clinical significance in patients with lung cancer: a Multi-omics study with a meta-analysis
Authors: Wang Ying , Zhu Linhai , Xia Pinghui , Wang Zhitian , Yu Li , Lv Wang , Hu Jian
Published: June 2020

Background: Current research on tumor mutational burden (TMB) has focused on tumor immunotherapy responsiveness, but the role of TMB in non-immunotherapy patients is unclear. The purpose of this study is to explore the effect of TMB on lung cancer patients in order to clarify and expand the clinical significance of TMB in lung cancer.Methods: We download mutation data of lung cancer cases from The Cancer Genome Atlas (TCGA) database to analyze TMB and its composition, and study the relationship between TMB and clinicopathological characteristics of lung cancer patients. We then systematically retrieved and analyzed studies on the relationship between TMB and survival outcomes. The hazard ratio (HR) and its 95% confidence interval (CI) were used as an effective size to assess the survival outcomes. The subgroup analyses based on the pathological type, treatment method, TMB detection method and detection materials were also performed to explore the factors that might affect the interpretation of TMB results.Results: TMB in lung squamous cell carcinoma is lower than those in lung adenocarcinoma. In lung adenocarcinoma, patients with EGFR mutation have lower TMB than patients with EGFR wild-type. The summary analysis found that TMB is a better prognostic factor in small cell lung cancer, and more evident in small cell lung cancer receiving immunotherapy. TMB is a neutral or poor prognostic indicator in non-small cell lung cancer, but a better prognostic factor in non-small cell lung cancer receiving immunotherapy. In patients with lung adenocarcinoma, including those with EGFR mutation and receiving EGFR-targeted therapies, high TMB means worse survival. TMB detected by blood specimens is inconsistent and unstable compared to TMB detected by tissue. The clinical significance of TMB from blood specimens needs further study on extensive sample data.Conclusions: The pooled results indicated that TMB is a good prognostic factor in lung cancer patients receiving immunotherapy. But high TMB is connected with worse survival in non-small cell lung cancer without receiving immunotherapy, especially in lung adenocarcinoma. For lung adenocarcinoma patients with both EGFR mutation and high TMB, how to make a choice between EGFR-targeted therapy and immunotherapy is still a problem that requires further research.
Urinary Tract Infection Caused By Enterococcus Spp: Risk Factors And Mortality. An Observational Study.
Authors: Alvarez-Artero Elisa , Nuñez Amaia Campo , Garcia Inmaculada Garcia , Bravo Moises Garcia , Cores Olia , Perez Inmaculada Galindo , Pendones Jose , Bernus Amparo Lopez , Belhassen-Garcia Moncef , Lleidas Javier Pardo
Published: June 2020

Background
Urinary tract infections (UTIs) are frequently caused by Enterococcus spp. We aim to define the risk factors involved in UTIs caused by Enterococcus. Determine the overall mortality and predictive risk factors.
Methods
A retrospective in-patients study was conducted with bacteriemic UTIs caused by Enterococcus spp. We compared bacteriemic UTIs caused by Enterococcus spp. vs. a random sample of 100 in-patients with bacteriemic UTIs caused by others enterobacteria.
Results
We found 106 in-patients with UTIs caused by Enterococcus spp., 51 of whom had concomitant positive blood cultures. Distribution by species was: 83% E. faecalis and 17% E. faecium, with a Charlson comorbidity index of 5.9 ± 2.9. When we compared bacteriemic UTIs caused by Enterococcus spp. vs. bacteriemic UTIs caused by others enterobacteria we found the following independent predictors of bacteriemic UTI by Enterococcus: male sex with an OR of 6.1 (95%CI 2.3–16.1), uropathy with an OR of 4.1 (1.6–10.1), nosocomial infection with an OR of 3.8 (1.4–10.3), urinary cancer with an OR of 6.4 (1.3–30.3) and previous antimicrobial treatment with an OR of 18 (5.2–62.1). Overall, in-patient mortality was 16.5%, which was associated with a higher Sequential Organ Failure Assessment (SOFA) score (> 4), severe comorbidity such as immunosuppression, malignant hemopathy and nephrostomy, or Enterococcus faecium species and its pattern or resistance to ampicillin or vancomycin (p < 0.05). Appropriate empiric antibiotic therapy was not associated with a better prognosis (p > 0.05).
Conclusions
Enterococcus spp. is a frequent cause of complicated UTI by a profile of risk factors. High mortality secondary to a severe clinical setting and high comorbidity may be sufficient reasons for implementing empiric treatment of patients at risk, although we did not show a higher survival rate in patients with this treatment strategy.
Genome-wide identification and expression analysis of beta-galactosidase family members in sweetpotato [ Ipomoea batatas (L.) Lam.]
Authors: li zongyun , hou fuyun , qin zhen , Du Taifeng , Xu Tao , Li Aixian , Dong Shunxu , Ma Daifu , Wang Qingmei , Zhang Liming
Published: June 2020

Background: Sweetpotato (Ipomoea batatas (L.) Lam.) serves as an important food source for human beings. β-galactosidase (β-gal) is a glycosyl hydrolase involved in cell wall modification, which plays essential roles in plant development and environmental stress adaptation. However, the function of β-gals genes in sweetpotato has yet to be reported.Results: In this study, 17 β-galactosidase genes (Ibbgal) were identified in sweetpotato, which were classified into seven subfamilies using interspecific phylogenetic and comparative analyses. The promoter regions of Ibbgals harbored several stress, hormone and light responsive cis-acting elements. The Ibbgal genes were specifically expressed in different tissues and varieties, and differentially expressed under various hormonal treatments, and abiotic and biotic stresses.Conclusions: These findings suggest that Ibbgals may involve in plant development and stress responses through regulating the metabolism of cell wall polysaccharides.
Long non-coding NEAT1 weakens the protective role of sevoflurane on myocardial ischemia/reperfusion injury by mediating the microRNA-140/RhoA axis
Authors: Rui Pengfei , Wang Junhua , Xu Jing
Published: June 2020

Background: The inhaled Sevoflurane (Sev) has been implicated to protect myocardial tissues against ischemia/reperfusion (I/R)-evoked injury. Nevertheless, the detailed mechanisms of Sev‐mediated cardioprotection remain basically unknown. This study intends to examine the roles of nuclear enriched abundant transcript 1 (NEAT1), a long non-coding RNA (lncRNA) during the cardioprotection exerted by Sev.Methods: We initially performed I/R surgery in mice, and Sev treatment was given during the perfusion, followed by the determination of cardiac function, myocardial infarction area and myocardial apoptosis for the validation of the model. Then, we conducted lncRNA microarray analysis on Sev-treated hearts to find out lncRNAs with significant differences in expression. The changes of myocardial I/R injury were evaluated by echocardiography, TTC staining and TUNEL assay after establishing mice with NEAT1 upregulation. Afterwards, the targeting miRNA of NEAT1 and the targeting mRNA of the miRNA were screened out through StarBase and microarray analyses to carry out rescue experiments.Results: NEAT1 was downregulated in Sev-treated cardiomyocytes. Overexpression of NEAT1 weakened cardiac function, increased infarct size and increased apoptosis in the presence of Sev. NEAT1 bound to microRNA (miR)-140, which was significantly upregulated in Sev-treated cardiomyocytes. Inhibition of miR-140 expression weakened the cardiac function of Sev-treated mice, increased infarct size and cardiomyocyte apoptosis. miR-140 mediated the RhoA pathway, and the RhoA activity inhibition attenuated miR-140 effects on Sev protection.Conclusion: Sev mitigates myocardial I/R injury by restoring NEAT1 expression and regulating the miR-140/RhoA axis.
A risk score-matched model analysis of 4,452 patients with small cell lung cancer: who will benefit from operative treatment
Authors: Tan Shuzhen , Kong Ying , Leng Shuilong , Zhu Xiao
Published: June 2020

Purpose: Small-cell lung cancer (SCLC) is difficult to cure. In this study, the SEER database was used to construct a model and explore the potential prognostic factors of SCLC patients. Methods: The data were sorted out and randomly divided into training cohort and verification cohort. Univariate and multivariate Cox regression were used in the training cohort to analyze the independent prognostic factors, then they be incorporated into the Nomogram model. Using the C-index, calibration algorithm and ROC in conjunction with the risk scores, the model was verified with the verification cohort. Finally, the overall survivals of those factors were evaluated in the total cases.Results: In the training cohort, we found that age, race, sex, total stage and extension were independent factors which were included in the Nomogram model. C-index(s) that obtained from the training and verification cohorts showed that the model has predictive power. Moreover, the calibration curves and AUC results proved that the model is of great consistency not only in the training cohort but also in the verification cohort. Finally, significant differences in survival were observed among the above-mentioned factors and the overall survivals decreased over time.Conclusions: Age, race, sex, total stage and extension degree are independent risk factors for overall survival of patients. The Nomogram model can better predict the 1-year, 3-year and 5-year survival probabilities, providing accurate reference for clinical individualized treatment.