bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of Medical Professionals on Carbapenem-Resistant Pseudomonas Aeruginosa: Moderation Effect of Workload Based on the Panel Data in China
Authors: Han Meng , Zhang Xinping
Published: June 2020

Background: Antimicrobial resistance (AMR) causes serious increase in morbidity, mortality and costs, especially carbapenem-resistant Pseudomonas aeruginosa (CRPA). Medical professionals play an important role in tackling AMR. Available studies overlooked the impact of workload on medical professionals in the relationship between medical professionals and AMR. This study explored the relationship between medical professionals and CRPA rate and the moderation effect of medical professionals’ workload in this relationship. Methods: Based on provincial-level panel data in China, hierarchical regression analysis was used to explore moderation effect of workload on medical professionals and CRPA rate. Fixed-effect model was applied to estimate the moderation effect models. Medical professionals were measured by the numbers of physicians, registered nurses, pharmacists, clinical microbiologists per 1000 populations. Workload was measured by the number of daily visits of physicians. Results: The numbers of physicians, registered nurses, pharmacists and clinical technicians were signiﬁcant negative with CRPA rate (Coef. = -0.889, -0.775,-1.176, -0.822; P= 0.003, 0.003, 0.011, 0.007, respectively). Workload had significant positive moderation effect between physicians, registered nurses, pharmacists, clinical technicians and CRPA rate (Coef.= 1.270, 1.400, 2.210, 1.634; P=0.004, 0.001, 0.035, 0.003, respectively). Conclusions: Increasing medical professionals may help curb CRPA. Measures to reduce medical professionals’ workload should be implemented to improve CRPA performance further.
The Prevention and Control of Tuberculosis: An Analysis Based On a Tuberculosis Dynamic Model Derived from the Cases of Americans
Authors: Wu Yan , Huang Meng , Wang Ximei , Li Yong , Jiang Lei , Yuan Yuan
Published: June 2020

Background: Tuberculosis (TB), a preventable and curable disease, is claimed as the second largest number of fatalities, and there are 9,025 cases reported in the United States in 2018. Many researchers have done a lot of research and achieved remarkable results, but TB is still a severe problem to the human beings. The study is a further exploration of the prevention and control of tuberculosis.Methods: In the paper, we propose a new dynamic model to study the transmission dynamics of TB, and then use global differential evolution and local sequential quadratic programming (DESQP) optimization algorithm to estimate parameters of the model. Finally, we use Latin hypercube sampling (LHS) and partial rank correlation coefficients (PRCC) to analyze the influence of parameters on the basic reproduction number (R0) and the total infectious (including the diagnosed, undiagnosed and incomplete treatment infectious), respectively.Results: According to the research, the basic reproduction is computed as 2.3597, which means TB will be an epidemic in the US. The diagnosed rate is 0.6082, which means the undiagnosed will be diagnosed after 1.6442 years. The diagnosed will recover after an average of 1.9912 years. Moreover, some diagnosed will end the treatment after 1.7550 years for some reason. From the study, it’s shown that 2.4% of the recovered will be reactivated, and 13.88% of the newborn will be vaccinated. However, the immune system will be lost after about 19.6078 years.Conclusion: Through the results of this study, we give some suggestions to help prevent and control the TB epidemic in the United States, such as prolonging the protection period of the vaccine by developing new and more effective vaccines to prevent TB; using the Chemoprophylaxis for incubation patients to prevent their conversion into active TB; raising people’s awareness of the prevention and control of TB and treatment after illness; isolating the infected to reduce the spread of TB. According to the latest report in the announcement that came at the first WHO Global Ministerial Conference on Ending tuberculosis in the Sustainable Development Era, we predict that it is challenging to control TB in 2030.
Validity and Item Response Theory Properties of the Patient Health Questionnaire-9 for Primary Care Depression Screening in Mozambique (PHQ-9-MZ)
Authors: Cumbe Vasco Francisco Japissane , Muanido Alberto Gabriel , Manaca Maria Nélia , Fumo Hélder , Chiruca Pedro , Hicks Leecreesha , Mari Jair de Jesus , Wagenaar Bradley H
Published: June 2020

Background: Depression is one of the leading causes of disability in Mozambique; however, few patients with depression are identified in primary care. To our knowledge, there are no validated tools for depression screening in Mozambique. The aim of this study was to validate the Patient Health Questionnaire-9 (PHQ-9) for use in primary care settings in Mozambique.Methods: The PHQ-9 was adapted using a structured multi-phase process led by a team of bilingual experts followed by a review by lay individuals and pilot-testing including cognitive interviews. The final Mozambican PHQ-9 (PHQ-9-MZ) was applied among 502 individuals randomly selected from antenatal, postpartum, and general outpatient consultations in three Ministry of Health primary healthcare clinics in Sofala Province, Mozambique. The PHQ-9-MZ was evaluated against the MINI 5.0-MZ as a gold standard diagnostic tool.Results: The majority of participants were female (74%), with a mean age of 28. Using the MINI 5.0-MZ, 43 (9%) of the sample tested positive for major depressive disorder. Items of the PHQ-9-MZ showed good discrimination and factor loadings. One latent factor of depression explained 54% of the variance in scores. Questions 3 (sleep) and 5 (appetite) had the lowest item discrimination and factor loadings. The PHQ-9-MZ showed good internal consistency, with a Cronbach’s alpha of 0.84, and an area under the receiver operating characteristic curve (AUROC) of 0.81 (95% CI: 0.73, 0.89). The PHQ-2-MZ had an AUROC of 0.78 (95% CI: 0.70, 0.85). Using a cut-point of ≥9, the PHQ-9-MZ had a sensitivity of 46.5% and a specificity of 93.5%. Using a cut-point of ≥2, the PHQ-2-MZ had a sensitivity of 74.4% and a specificity of 71.7%. Increasing the cut-point to ≥3, the PHQ-2-MZ has a sensitivity of 32.6% and a specificity of 94.6%. Conclusions: The PHQ-9-MZ and PHQ-2-MZ emerge as two valid alternatives for screening for depression in primary health care settings in Mozambique. Depending on program needs and weighing the value of minimizing false positives and false negatives, the PHQ-9-MZ can be employed with cut-points ranging from ≥8 to ≥11, and the PHQ-2-MZ with cut-points ranging from ≥2 to ≥3.
Effect of low-dose exogenous surfactant on infants with acute respiratory distress syndrome after cardiac surgery: A retrospective analysis
Authors: Zhang Rongyuan , Wang Xu , Li Shoujun , Yan Jun
Published: June 2020

Background: To evaluate the effect of low-dose exogenous surfactant therapy on infants suffering acute respiratory distress syndrome (ARDS) after cardiac surgery. Methods: We conducted a retrospective case-control study of infants diagnosed with moderate-severe ARDS after cardiac surgery. A case was defined as a patient that received surfactant and standard therapy, while a control was defined as a patient that underwent standard therapy. The primary endpoint was the improvement in oxygenation index (OI) after 24-hour of surfactant treatment; and secondary endpoints were the ventilator time and PICU time. Results: 22 infants treated with surfactant were matched with 22 controls. Early low-dose (20mg/kg) surfactant treatment was associated with improved outcomes. After surfactant administration for 24-hour, the surfactant group was much better compared with the control group at the 24-hour in OI (difference in average change from baseline, -6.7 [95% CI, -9.3 to -4.1]) (P < 0.01) and VI (mean difference, -11.9 [95% CI, -18.1 to -5.7]) (P < 0.01). Ventilation time and PICU time were significantly shorter in the surfactant group compared with the control group (133.6h±27.2 vs 218.4h±28.7, P < 0.01 ; 10.7d±5.1 vs 17.5d±6.8, P < 0.01). Infants in the surfactant group under 3 months benefit more from OI and VI than the infants over 3 months in a preliminary exploratory analysis.Conclusions: In infants with moderate-severe ARDS after cardiac surgery, early low-dose exogenous surfactant treatment could prominently improve oxygenation and reduce mechanical ventilation time and PICU time. Infants younger than 3 months may get more benefit of oxygenation than the older ones.
Youth vaping and smoking and parental vaping: a panel survey
Authors: Green Michael , Gray Linsay , Sweeting Helen
Published: June 2020

Background: Concerns remain about potential negative impacts of e-cigarettes including possibilities that: youth e-cigarette use (vaping) increases risk of youth smoking; and vaping by parents may have impacts on their children’s vaping and smoking behaviour.Methods: With panel data from 3291 youth aged 10-15 years from the 7th wave of the UK Understanding Society Survey (2015-2017), we estimated effects of youth vaping on youth smoking (ever, current and past year initiation), and of parental vaping on youth smoking and vaping, and examined whether the latter differed by parental smoking status. Propensity weighting was used to adjust for measured confounders and estimate average effects of vaping for all youth, and among youth who vaped. E-values were calculated to assess the strength of unmeasured confounding influences needed to negate our estimates.Results: Associations between youth vaping and youth smoking were attenuated considerably by adjustment for measured confounders. Estimated average effects of youth vaping on youth smoking were stronger for all youth (e.g. OR for smoking initiation: 32.5; 95% CI: 9.8-107.1) than among youth who vaped (OR: 4.4; 0.6-30.9). Relatively strong unmeasured confounding would be needed to explain these effects. Associations between parental vaping and youth vaping were explained by measured confounders. Estimates indicated effects of parental vaping on youth smoking, especially for youth with ex-smoking parents (e.g. OR for smoking initiation: 11.3; 2.7-46.4) rather than youth with currently smoking parents (OR: 1.0; 0.2-6.4), but these could be explained by relatively weak unmeasured confounding.Conclusions: While measured confounding accounted for much of the associations between youth vaping and youth smoking, indicating support for underlying propensities, our estimates suggested residual effects that could only be explained away by considerable unmeasured confounding or by smoking leading to vaping. Estimated effects of youth vaping on youth smoking were stronger among the general youth population than among the small group of youth who actually vaped. Associations of parental vaping with youth smoking and vaping were either explained by measured confounding or could be relatively easily explained by unmeasured confounding.
Intracellular expression of arginine deiminase activates the mitochondrial apoptosis pathway by inhibiting cytosolic ferritin and inducing chromatin autophagy
Authors: Feng Qingyuan , Bian Xuzhao , Liu Xuan , Wang Ying , Zhou Huiting , Ma Xiaojing , Quan Chunju , Yao Yi , Zheng Zhongliang
Published: June 2020

Background ： Based on its low toxicity, arginine starvation therapy has the potential to cure malignant tumors that cannot be treated surgically. The Arginine deiminase (ADI) gene has been identified to be an ideal cancer-suppressor gene. ADI expressed in the cytosol displays higher oncolytic efficiency than ADI-PEG20 (Pegylated Arginine Deiminase by PEG 20,000). However, it is still unknown whether cytosolic ADI has the same mechanism of action as ADI-PEG20 or other underlying cellular mechanisms. Methods: The interactions of ADI with other protein factors were screened by yeast hybrids, and verified by co-immunoprecipitation and immunofluorescent staining. The effect of ADI inhibiting the ferritin light-chain domain (FTL) in mitochondrial damage was evaluated by site-directed mutation and flow cytometry. Control of the mitochondrial apoptosis pathway was analyzed by Western Blotting and real-time PCR experiments. The effect of p53 expression on cancer cells death was assessed by siTP53 transfection. Chromatin autophagy was explored by immunofluorescent staining and Western Blotting. Results: ADI expressed in the cytosol inhibited the activity of cytosolic ferritin by interacting with FTL. The inactive mutant of ADI still induced apoptosis in certain cell lines of ASS- through mitochondrial damage. Arginine starvation also generated an increase in the expression of p53 and p53AIP1, which aggravated the cellular mitochondrial damage. Chromatin autophagy appeared at a later stage of arginine starvation. DNA damage occurred along with the entire arginine starvation process. Histone 3 (H3) was found in autophagosomes, which implies that cancer cells attempted to utilize the arginine present in histones to survive during arginine starvation. Conclusions: Mitochondrial damage is the major mechanism of cell death induced by cytosolic ADI. The process of Chromatophagy does not only stimulate cancer cells to utilize histone arginine but also speeds up cancer cell death at a later stage of arginine starvation.
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.
Patient-specific instrument-assisted minimally invasive internal fixation of calcaneal fracture for rapid and accurate execution of a preoperative plan: A retrospective study
Authors: Wang Chenggong , Xu Can , Li Mingqing , Li Hui , Xiao Han , Zhong Da , Liu Hua
Published: June 2020

Background: Traditional methods for minimally invasive internal fixation (MIIF) of calcaneal fractures require extensive intraoperative fluoroscopy, and fracture recovery is usually not ideal. We developed a new surgical procedure using digital surgical simulation and constructed a patient-specific instrument (PSI) for calcaneal fracture that we used during the operation. This study investigated whether PSI-assisted MIIF of calcaneal fracture enables rapid and accurate execution of the preoperative plan.Methods: We retrospectively analyzed patients with Sanders type III or IV fresh calcaneal fractures who had undergone PSI-assisted MIIF at our hospital from January 2016 to December 2018. We analyzed perioperative data including intraoperative fluoroscopy time, concurrence of internal fixation actual usage (IFAU) with the preoperative plan, surgery time, and complications. We also compared pre- and postoperative actual measurements from X-ray radiographs and computed tomography images including Böhler, Gissane, and calcaneus valgus angles; subtalar joint width; and calcaneal volume overlap ratio with the preoperative design. All patients had been followed up and their American Orthopedic Foot and Ankle Score (AOFAS) score was available.Results: Mean intraoperative fluoroscopy time was 3.95±1.78 h; IFAU in 16 patients (16 feet) was the same as the preoperative plan; mean surgery time was 28.16±10.70 min; and none of the patients developed complications. Böhler, Gissane, and calcaneus valgus angles and subtalar joint width did not differ between pre- and postoperative plans; however, the actual preoperative values of each of these parameters differed significantly from those measured postoperatively. The calcaneal volume overlap ratio with the preoperative design was 91.2%±2.3%. AOFAS scores increased with time, with significant differences in the score at each time point.Conclusions: The newly developed PSI-assisted calcaneal fracture MIIF method can rapidly and accurately execute the preoperative plan.
The Therapeutic Efficacy of Adjunct Therapeutic Plasma Exchange for Septic Shock with Multiple Organ Failure: A Single Center Retrospective Review
Authors: Keith Philip , Wells Adam H , Hodges Jeremy , Fast Stephen H , Adams Amber , Scott L Keith
Published: June 2020

Background: Sepsis remains a common condition with high mortality when multiple organ failure develops. The evidence for therapeutic plasma exchange (TPE) in this setting is promising but inconclusive. Our study aims to evaluate the efficacy of adjunct TPE for septic shock with multiple organ failure compared to standard therapy alone. Methods: A retrospective, observational chart review was performed, evaluating outcomes of patients with catecholamine resistant septic shock and multiple organ failure in Intensive Care Units at a tertiary care hospital in Winston Salem, North Carolina from August 2015- March 2019. Adult patients with catecholamine resistant septic shock (≥ 2 vasopressors) and evidence of multiple organ failure were included. Patients who received adjunct TPE were identified and compared to patients who received standard care alone. A propensity score using age, gender, chronic co-morbidities (HTN, DM, CKD, COPD), APACHE II score, SOFA score, lactate level, and number of vasopressors was used to match patients, resulting in 40 patients in each arm. Results: Mean baseline APACHE II and SOFA scores were 32.5 and 14.3 in TPE patients versus 32.7 and 13.8 in control patients. The 28-day mortality rate was 40% in the TPE group versus 65% in the standard care group (p=0.043). Improvements in baseline SOFA scores at 48 hours were greater in the TPE group compared to standard care alone (p=0.001), and patients receiving adjunct TPE had a more favorable fluid balance at 48 hours (p=0.01). Patients receiving adjunct TPE had longer ICU and hospital lengths of stay (p=0.003 and p=0.006). Conclusions: Our retrospective, observational study in adult patients with septic shock and multiple organ failure demonstrated improved 28-day survival with adjunct TPE compared to standard care alone. Hemodynamics, organ dysfunction, and fluid balance all improved with adjunct TPE, while lengths of stay were increased in survivors. The study design does not allow for a generalized statement of support for TPE in all cases of sepsis with multiple organ failure but offers valuable information for a prospective, randomized clinical trial.
TgROP18 Targets IL20RB for Host-Defense-Related-STAT3 Activation During T. gondii Infection
Authors: Kong Ling , Jiang Dan , He Cheng , Xia Jing , We Haixia , Zhou Lijuan , Peng Hong-Juan
Published: June 2020

Background: Toxoplasma gondii is an opportunistic protozoan infecting almost one-third of the world’s population. T. gondii rhoptry protein 18 (TgROP18) is a key virulence factor determining the parasite’s acute virulence and is secreted into host cells during infection. We previously identified the interaction of TgROP18 and host cell immune-related receptor protein IL20RB, and observed the activation of STAT3 in human keratinocytes (HaCaT) cells infected by the rop16 knockout RH strain, though TgROP16 is regarded as being responsible for host STAT3 activation during T. gondii invasion. Therefore, we hypothesize TgROP18 can activate host STAT3 through binding to IL20RB.Methods: CRISPR-CAS9 technology was used to generate the ROP16 and ROP18 double knockout RH strain, RH-∆rop16∆rop18. SDS-PAGE and Western blot were used to detect STAT3 activation in different HaCaT cells with high endogenous IL20RB expression treated with T. gondii tachyzoites infection, recombinant ROP18, or IL-20. FRET and co-immunoprecipitation (Co-IP) was used to detect the protein-protein interaction. Results: We observed that TgROP18 was involved in a synergic activation of the host JAK/STAT3 pathway together with TgROP16 in human HaCaT cells infected with T. gondii or treated with recombinant TgROP18 protein, stimulating host proinflammatory immune responses such as expression of TNF-a. The effect of recombinant ROP18 on STAT3 phosphorylation was presented in a dose-dependent manner. Additionally, TgROP18 was identified to target IL20RB on its extracellular domain. When we treated different cell lines with the recombinant ROP18, STAT3 phosphorylation could only be observed in the cells with endogenous IL20RB expression, such as HaCaT cells. Conclusions: These findings indicate that TgROP18-IL20RB interaction upon T. gondii invasion was involved in STAT3 activation, which is associated with host cell defense.
Brazilian National Policy of Comprehensive Women’s Health Care and Mortality during Climacteric Period: Has Anything Changed?
Authors: Sorpreso Isabel Cristina Esposito , Figueiredo Francisco Winter dos Santos , Ramos José Lucas Souza , Zuchelo Lea Tami SuzuKi , Adami Fernando , Baracat Edmund Chada , Júnior José Maria Soares
Published: June 2020

Background: The National Policy for Integral Attention to Women’s Health was implemented more than two decades ago, with the monitoring of potential benefits being explored. One of the life cycles of women contemplated in this health policy is the importance of health care during the climacteric. Prevention and health promotion actions carried out by the Brazil National Health System - Unified Health System and enshrined in health Brazilian policies for women. Thus, our purpose was to identify climacteric women’s main causes of death as well as the mortality trend of such causes, especially after PNAISM implementation. Methods: An ecological study was conducted by Disciplina de Ginecologia da Faculdade de Medicina da Universidade de São Paulo from 2018–2019. Data were retrieved from the Brazilian Health Department by accessing the mortality information system of the National Health Information, divided into periods 1996–2004 and 2005–2006 according to implementation of the National Police. The death records of Brazilian women aged 35 to 64 years who had a diagnosis were retrieved. Trends and differences between periods were evaluated using linear regression. The significance level was set at 5%. Results: The main causes of death in women were circulatory system diseases (29.39%, 736,972 deaths), neoplasms (26.17%, 656,385 deaths), respiratory system diseases (7.29%, 182,812 deaths), endocrine , nutritional and metabolic diseases (6.81%, 170,881 deaths), and external causes of morbidity and mortality (5.49%, 137,674 deaths). Implementation of PNAISM led to a further reduction in mortality from circulatory system diseases (β=-0.58; 95% CI, -0.68 to -0.48; r²=0.93; p<0.001), and any significant changes in neoplasm mortality (β=0.07; 95% CI, -0.01. 0.15; r²=0.22; p=0.070). Conclusions: The leading causes of death during climacteric are circulatory system diseases, neoplasms, respiratory system diseases, nutritional, metabolic, and endocrine diseases, and external causes of morbidity and mortality, with no changes in neoplasms and respiratory system diseases. Thus, the analysis of women’s health indicators, such as mortality rates, is fundamental in order to enable the monitoring of benefits and results related to PNAISM as well as directing the design and implementation of other new health policies to be developed for women.
Circulating miR-660-5p is associated with no-reflow phenomenon in patients undergoing primary percutaneous coronary intervention
Authors: zhang Jian-Wei , Hu Cheng-Ping , Zhao Ying-Xin , He Ling-Jie
Published: June 2020

Background: The no-reflow phenomenon (NRP) is an important factor affecting the prognosis of patients with acute myocardial infarction undergoing primary percutaneous coronary intervention (PPCI). This study aims to investigate the association of circulating miR-660-5p with NRP in patients with ST segment elevation myocardial infarction (STEMI) undergoing PPCI.Methods: Consecutive patients diagnosed with anterior STEMI within 12 h of pain onset were included in the study; in these patients, coronary angiography confirmed that the infarct-related artery was the left anterior descending (LAD) artery. Angiographic NRP was defined as a final TIMI flow of 2 or a final TIMI flow of 3 with a myocardial blush grade (MBG) < 2. High miR-660-5p was defined as a value in the third tertile. The relationship of circulating miR-660-5p with NRP was assessed using Spearman correlation analysis and multiple linear regression analysis.Results: Fifty-two eligible patients were finally included in this study (mean age: 56±12.4 years, >65 years: 53.8%, male: 76.9%, and mean BMI: 26.3±3.5). The incidence of NRP was 38.5%. Circulating miR-660-5p was significantly related to the mean platelet volume (MPV). Patients were divided into tertiles by miR-660-5p levels (Q1: ≤ 7.18, Q2: 7.18-11.31, Q3: > 11.31). Patients in the high microRNA-660-5p group had almost a 6-fold higher risk of NRP than those in the low microRNA-660-5p group [(odds ratio (OR)=5.68, 95% confidence interval (CI) 1.40-23.07, p=0.015). When analysed by tertiles, consistent trends of an increasing relative odds of NRP were reported (OR1 for Q2 VS. Q1: 1.25, 95% CI: 0.27-5.73, p=0.77; OR2 for Q3 VS. Q1: 5.96, 95% CI: 1.33-26.66, p=0.02), even after multivariable adjustment. Receiver operating characteristic curve analysis demonstrated that the microRNA-660-5p level of 10.17 was the best cut-off level to predict the incidence of the no-reflow phenomenon in patients undergoing primary percutaneous coronary intervention with an area under the curve (AUC) of 0.768 (95% CI: 0.636-0.890).Conclusion: Circulating miR-660-5p was significantly associated with NRP, and it may be a useful biomarker to predict the incidence of NRP in patients with STEMI undergoing PPCI.
A Novel Timing and Frequency Offset Estimation Algorithm for Filtered OFDM System
Authors: Feng Xingle , Wang Mengjie , Chen Li , Zhu Wenxia , Hua Kun
Published: June 2020

As a critical technology of 5G air interface waveform, F-OFDM not only inherits the technical advantages of OFDM, but also has outstanding advantages in system flexibility and spectrum efficiency. However, as a multi-carrier technology, it is still extremely sensitive to sample timing offset (STO) and carrier frequency offset (CFO). In this letter, an improved Park frequency domain training sequence (FS-Park) is proposed to complete STO and CFO estimation of F-OFDM system. Firstly, a real-value pseudorandom number (PN) sequence is sent to each subcarrier as training sequence in frequency domain, the corresponding time domain training symbol has a conjugate symmetry structure. Secondly, the training symbol is utilized for timing synchronization, then the fractional frequency offset is estimated based on the cyclic prefix in time domain. Finally, the integer frequency offset is estimated in frequency domain based on the auto-correlation of PN sequence. The simulation results illustrate that the FS-Park algorithm not only has a single pulse timing metric curve and great STO estimation accuracy, but also has better performance of CFO estimation than classical Park algorithm and Liang Xiao's method.
Agreement between Original and Rasch-Approved Neck Disability Index
Authors: LU ZE , MacDermid Joy C. , Nazari Goris
Published: June 2020

Background: Given the high prevalence of neck pain, the neck disability index (NDI) has been used to evaluate patient status and treatment outcomes. Modified versions were proposed as solutions to measurement deficits in the NDI. However, the original 10-item NDI scored out of 50 is still the most administered. Examining the extent of agreement between traditional and Rasch-based versions using Bland-Altman (B&A) plots will inform our understanding of score differences that might rise from using different versions. Therefore, the objective of current study was to describe the extent of agreement between different versions of NDI.Methods: The current study was a secondary data analysis where the study data was compiled from two prospectively collected data sources. We performed a comprehensive literature search to identify Rasch approved NDI within four databases including Embase, Medline, PubMed, and Google Scholar. Alternate forms and scoring were compared to each other and the standard NDI. We graphed B&A plots and calculated the mean difference and the 95% limits of agreement (LoA; ±1.96 times the standard deviation).Results: Two Rasch approved alternative versions (8 vs 5 items) were identified from 303 screened publications. We analyzed data from 201 (43 males and 158 females) patients attending community clinics for neck pain. We found that the mean difference was approximately 10% of the total score between the 10-item and 5-item (-4.6 points), whereas the 10-item versus 8-item and 8-item versus 5-item had smaller mean differences (-2.3 points). The B&A plots displayed wider 95% LoA for the agreement between 10-item and 8-item (LoA: -12.0, 7.4) and 5-item (LoA: -14.9, 5.8) compared with the LoA for the 8-item and 5-item (LoA: -7.8, 3.3). Conclusion: Two Rasch-based NDI solutions (8 vs 5 items) that differ in number of items and conceptual construction are available to provide interval level scoring. They both provide scores that are substantially different from the ordinal NDI, which does not provide interval level scoring. Smaller differences between the two Rasch solutions exist and may relate to the items included. Due to the size and unpredictable nature of the bias between measures, they should not be used interchangeably.
Protocol registration issues of systematic review and meta-analysis studies: a survey of global researchers
Authors: Tawfik Gehad Mohamed , Giang Hoang Thi Nam , Ghozy Sherief , Altibi Ahmed M. , Kandil Hend , Le Huu-Hoai , Eid Peter Samuel , Radwan Ibrahim , Makram Omar Mohamed , Hien Tong Thi Thu , Sherif Mahmoud , Hossain As-Saba , Thang Tai Luu Lam , Puljak Livia , Salem Hosni , Numair Tarek , Moji Kazuhiko , Huy Nguyen Tien
Published: June 2020

Background: Although protocol registration of systematic reviews/meta-analysis (SR/MA) is still not mandatory, authors are strongly suggested to publish their SR/MA protocols prior to submitting their manuscripts for publication as recommended by the Cochrane guidelines for conducting SR/MAs. We aimed to assess awareness, obstacles, and opinions of SR/MA authors about the protocol registration process. Methods: A cross-sectional survey study included all authors who published SR/MAs during the period from 2010 to 2016 were contacted for participation in our survey study. They were identified through the literature search of SR/MAs in Scopus database. Upon receiving their approval to join our study, an online questionnaire was sent via e-mail to each participant. We received 275 responses from 6650 successfully sent emails.Results: A total of 270 authors' responses were complete and were included in the final analysis. Our results showed that PROSPERO was the most commonly used database for protocol registration (71.3%). The registration-to-acceptance interval in PROSPERO was less than one month (99.1%). Almost half of the authors (44.2%) did not register their protocols prior to publishing their SR/MAs and their opinion that lack of knowledge of its importance and mandance to be registered was the most commonly reported reason (44.9%). A significant proportion of respondents (37.4%) believed that people would steal their ideas from protocol databases, while only 5.3% reported that their SR/MA had been stolen. However, the majority (72.9%) of participants agreed that protocol registries have a role in preventing unnecessary duplication of reviews. Finally, 37.4% of participants agreed that SR/MA protocol registration should be mandatory. Conclusion: About half of the participants seemed that the primary reason for not registering such protocols, that was not knowing that protocols must or should be mandatory. Therefore, tools should be available to mandate protocol registration of any SRs beforehand and increasing awareness about the benefits of protocol registration among researchers.
Fetal circulating human resistin increases in diabetes during pregnancy and impairs placental mitochondrial biogenesis
Authors: Jiang Shaoning , Teague April M. , Tryggestad Jeanie B. , Lyons Timothy J. , Chernausek Steven D.
Published: June 2020

Background: Diabetes during pregnancy affects placental mitochondrial content and function, which has the potential to impact fetal development and the long-term health of offspring. Resistin is a peptide hormone originally discovered in mice as an adipocyte-derived factor that induced insulin resistance. In humans, resistin is primarily secreted by monocytes or macrophages. The regulation and roles of human resistin in diabetes during pregnancy remain unclear. Methods: Fetal resistin levels were measured in cord blood from pregnancies with (n=42) and without maternal diabetes (n=81). Secretion of resistin from cord blood mononuclear cells (CBMCs) was measured. The actions of human resistin in mitochondrial biogenesis were determined in placental trophoblastic cells (BeWo cells) or human placental explant.Results: Concentrations of human resistin in cord sera were higher in diabetic pregnancies (67 ng/ml) compared to healthy controls (50 ng/ml, P< 0.05), and correlated (r=0.4, P=0.002) with a measure of maternal glycemia (glucose concentration 2 h post challenge). Resistin mRNA was most abundant in cord blood mononuclear cells (CBMCs) compared with placenta and mesenchymal stem cells (MSCs). Secretion of resistin from cultured CBMCs was increased in response to high glucose (25 mM). Exposing BeWo cells or human placental explant to resistin decreased expression of peroxisome proliferator-activated receptor gamma coactivator 1-alpha (PGC-1α), mitochondrial abundance, and ATP production. Conclusions: Resistin is increased in fetal circulation of infants exposed to the diabetic milieu, potentially reflecting a response of monocytes/macrophages to hyperglycemia and metabolic stresses associated with diabetes during pregnancy. Increased exposure to resistin may contribute to mitochondrial dysfunction and aberrant energy metabolism characteristic of offspring exposed to diabetes in utero.
Erenumab in highly therapy-refractory migraine patients First German Real-world evidence
Authors: Scheffler Armin , Messel Olga , Wurthmann Sebastian , Nsaka Michael , Kleinschnitz Christoph , Glas Martin , Naegel Steffen , Holle-Lee Dagny
Published: June 2020

Background: Calcitonin gene related peptide (CGRP) monoclonal antibodies (mAB) are the first specific migraine prophylactic medication. Erenumab is the only CGRP mAB targeting the CGRP receptor. Clinical data regarding efficacy and tolerability of erenumab in highly therapy-refractory patients are not available, yet, although many patients treated with CGRP mAB under real world conditions can be considered as highly therapy-refractory.Methods: Clinical routine data of highly therapy-refractory migraine patients treated with erenumab 70mg for three months between November 2018 and December 2019 in the West German Headache Center, University Hospital Essen, Germany, were analysed. Monthly migraine days (MMD), monthly headache days (MHD) and days of acute medication intake (AMD) were assessed. Statistical analysis was performed using the Wilcoxon test. Descriptive statistics were performed to evaluate changes of vegetative symptoms, acute medication response, side effects, as well as treatment satisfaction.Results: Complete clinical data were available for 26 episodic (EM) and 74 chronic (CM) migraineurs. Sixty-six % (n=49) of CM patients had an additional medication overuse headache (MOH). After three months 57.7 % of EM patients and 41.9 % of CM patients had a 50% or greater reduction of MMD. The mean number of MMD was reduced by 3.43 (SE 1.26) in EM, and by 4.72 (SE 0.87) in CM. Thirty-nine patients (52.7%) returned from chronic to episodic course of migraine. After three months, 23 patients (46.9%) were not suffering from a MOH anymore.Conclusions: Erenumab seems to be a promising therapeutic option in highly therapy-refractory migraine patients.Trial registration: Retrospective registered.
First month of the epidemic caused by COVID-19 in Italy: current status and real-time outbreak development forecast
Authors: Megna Rosario
Published: June 2020

Background: The first outbreaks of COVID-19 in Italy occurred during the second half of February 2020 in some areas in the North of the country. Due to the high contagiousness of the infection, further spread by asymptomatic people, Italy has become in a few weeks the country with the greatest number of infected people in the world. The large number of severe cases among infected people in Italy led to the hospitalization of thousands of patients, with a heavy burden on the National Health Service.Methods: We analyzed data provided daily by Italian Authorities for the period from 24 February 2020 to 30 March 2020. Considering such information, we developed a forecast model in real-time, based on the cumulative log-logistic distribution. Results: A total of 101,739 infected individuals were confirmed until 30 March 2020, of which 14,620 recovered or discharged, and 11,591 deaths. Until the same date patients quarantined at home were 43,752, whereas hospitalized patients were 31,776, of which 3,981 in intensive care. The active cases (i.e. the number of patients not yet recovered until that date) were 75,528. The forecast model estimated a number of infected persons for Italy of 234,000 about, and a duration of the epidemic of approximately 4 months. Conclusions: One month after the first outbreaks there seemed to be the first signs of a decrease in the number of infections, showing that we could be now facing the descending phase of the epidemic. The forecast obtained thanks to our model could be used by decision-makers to implement coordinative and collaborative efforts in order to control the epidemic. The pandemic due to novel Coronavirus must be a warning for all countries worldwide, regarding a rapid and complete dissemination of information, surveillance, health organization, and cooperation among the states.
Comparison of Conventional Fenestration Discectomy with Percutaneous Transforaminal Endoscopic Discectomy for Treating Lumbar Disc Herniation:Maximum 5 year follow-up in 1,100 patients
Authors: Li Quanyi , zhou yongchun
Published: June 2020

Purpose: To compare the efficacy of conventional interlaminar fenestration discectomy (IFD) with percutaneous transforaminal endoscopic discectomy (PTED) for treating lumbar disc herniation (LDH). Methods: The clinical data of 1,100 patients who had been diagnosed with LDH between January 2012 and December 2017 were retrospectively analysed. IFD was performed on 605 patients in Group A, whereas PTED was performed on 505 patients in Group B. The Oswestry Disability Index, Visual Analogue Scale for pain and modified MacNab criteria were used to evaluate the outcomes. The surgery duration, intraoperative blood loss, postoperative off-bed activity and postoperative length of hospital stay were recorded. Results: The follow-up period ranged from 24 to 60 months, with an average of 43 months. The excellent and good outcome rates were 93.5% in Group A and 92.6% in Group B. There was no significant difference in efficacy between the groups (P > 0.05). However, Group B had significantly less intraoperative blood loss and shorter bed rest duration and postoperative length of hospital stay than Group A (P < 0.05). There were two cases of postoperative recurrence in Group A and three in Group B. Conclusions: Although conventional IFD and PTED had similar levels of efficacy in treating LDH, PTED had several advantages. There was less intraoperative bleeding, shorter length of hospital stay and shorter bed rest duration. It can be considered a safe and effective surgical option for treating LDH.
Comparison of oral health behaviour between dental and non-dental undergraduates in a university in southwestern China——exploring the future priority for oral health education
Authors: Li Mingming , Wu Zhiwu , Zhang Rui , Lei Lei , Ye Siqi , Cheng Ran , Hu Tao
Published: June 2020

Background: Based on a national survey in 2015, people’s oral health knowledge and attitudes in China have greatly improved after decades of oral health education (OHE). However, dental caries and periodontal disease are still serious oral problems. People’s oral health behaviour has not kept up with the pace of knowledge and attitudes. The objective of this study was to determine undergraduates’ oral health behaviour status and existing problems by comparing dental students and non-dental students at Sichuan University. We hope to provide some suggestions for future OHE.Methods: A quasi-experimental study designed with a pre-test and a post-test group was conducted. A total of 217 dental students and 135 non-dental students were enrolled. They were given a course of OHE focused on oral health behaviour. A survey about oral health behaviour and knowledge was conducted before and after the course.Results: According to the pre-course survey, dental students surpassed non-dental students in terms of toothbrushing frequency, method, time and flossing. Unfortunately, flossing was overlooked by all the students. After the course, both dental and non-dental students showed strong willingness to improve their oral health behaviour. More non-dental students than dental students were willing to use toothpicks and Chinese herbal toothpaste before and after the course.Conclusion: OHE focused on behaviour plays a positive role for university students. Future OHE and interventions should focus on flossing, toothbrushing methods, toothpicks, Chinese herbal toothpaste and modifications to adopt new media.
Socioeconomic inequalities trends in child health comparing within and between group inequalities: Food insecurity and malnutrition in Zimbabwe
Authors: Lukwa Akim Tafadzwa , Siya Aggrey , Zablon Karen Nelwin , Azam James , Alaba Olufunke A.
Published: June 2020

Background Food insecurity and malnutrition in children are pervasive public health concerns in Zimbabwe. Several studies previously done, only identified determinants of food insecurity and malnutrition with very little efforts have been done in assessing related inequalities and decomposing the inequalities across household characteristics in Zimbabwe. This study explored socioeconomic inequalities trends in child health using the decomposition approach to compare within and between group inequalities. Methods The study used Demographic Health Survey (DHS) data sets of 2010\11 and 2015. Food insecurity in children was determined based on the WHO dietary diversity score. Minimum dietary diversity was defined by a cut- off point of >4 therefore, in this study children with less than 3 of the 13 food groups were defined as food insecure. Malnutrition was assessed using weight for age Z-score, with children whose weight-for-age Z-score below minus two standard deviations (-2 SD) from the median considered malnourished. Concentration indices were computed to understand if malnutrition was dominant among the poor or rich. The study used the Theil index and decomposed the index by population subgroups (geographical clusters and socioeconomic status). Results Over the study period, malnutrition prevalence increased by 1.03 percentage points (p.p), while food insecurity prevalence decreased by 4.35p.p. Prevalence of malnutrition and food insecurity increased among poor rural children. Theil indices for nutrition status show socioeconomic inequality gaps to have widened, while food security status socioeconomic inequality gaps contracted for the period under review. Conclusion: Within-group inequalities are driving most of the socioeconomic inequalities in nutritional status and food security status among children in Zimbabwe. To address the socioeconomic inequalities, there is need to tackle the four pillars (availability, accessibility, utilization and stability of food supply) of food and nutrition security.
Use of Aspergillus oryzae during sorghum malting to enhance yield and quality of gluten free lager beers
Authors: Rubio-Flores Mónica , García-Arellano Arnulfo Ricardo , Perez-Carrillo Esther , Serna-Saldivar Sergio Othón
Published: June 2020

Sorghum has been used for brewing European beers but its malt generally lower beer yields and alcohol contents. The aim of this research was to produce lager beers using worts from sorghum malted with and without Aspergillus oryzae inoculation. Worts adjusted to 15°Plato from the sorghum malt inoculated with 1% A. oryzae yielded 21.5% and 5 % more volume compared to sorghum malt and barley malt worts, respectively. The main fermentable carbohydrate in all worts was maltose. Glucose was present in higher amounts in both sorghum worts compared to barley malt worts. Sorghum-A. oryzae beer had similar specific gravity and alcohol compared to the barley malt beer. Sorghum-A. oryzae beer contained lower amounts of hydrogen sulphide, methanethiol, butanedione, and pentadione compared to barley malt beer. Sorghum-A. oryzae lager beer had similar yield and alcohol content compared to the barley malt beer but differed in color, key volatiles and aromatic compounds.