bluuebunny/crossref_metadata_2025 huggingface dataset:
Dentists’ Perception and Clinical use of Preformed Metal Crowns to Restore Primary Molar Defects in Chengdu City, China: A Cross-Sectional Study
Authors: Jiang Qingsong , Wang Yan , Zou Jing , Zhang Qiong
Published: October 2020

Background: Preformed metal crowns (PMCs) are recommended for the enduring restoration of primary molar defects. However, the PMC technique is not implemented in China as well as that in Western countries. Aim: This study aimed to assess the clinical use of the PMC technique and its effective factors among dentists in Chengdu, China.Methods: The questionnaires were distributed among 1000 dentists practicing in Chengdu via an online questionnaire platform. Data, including sociodemographic characteristics of the respondents and their perception and use of PMCs, were collected. Results: The response rate was 45%. Most respondents (69.6%) did not use PMCs. Academic qualification, working specialty and working experiences were associated with dentists’ use of PMCs. The lack of knowledge about PMCs technique was the main obstacle for the dental practitioners using PMCs (41.7%). The lack of understanding of the rationale of PMCs was the main reason for parents accepting PMC restorations(43.6%). Attending continuing education programs was the main approach to learn the PMC restorative technique(59.1%).Conclusion: The clinical use of PMCs was not very popular in Chengdu city. To promote the use of this restorative technique, the knowledge and practical training should be incorporated into routine courses of undergraduate dental education.
Safety of measles, mumps, and rubella vaccine in egg allergy:in vivo and in vitro management
Authors: Magistà Stefania , Albanesi Marcello , Chaoul Nada , Bona Danilo Di , Leo Elisabetta Di , Nettis Eustachio , Caiaffa Maria Filomena , Macchia Luigi
Published: October 2020

Background Egg allergy is the second most prevalent form of food allergy in childhood. In spite of the evidence accumulated, inoculating egg allergy children with attenuated vaccines grown on chick embryo cell cultures, such as the measles, mumps, and rubella (MMR) vaccine, is regarded (erroneously) as potentially dangerous or even anaphylactogenic, by many. An issue perceived as particularly conflicting also by Health Professionals.Case presentation A 15-year-old boy, with a history of severe egg allergy in early infancy, who was still sensitized to egg allergens, including baked egg, had never received MMR vaccination, in fear of possible anaphylaxis, in spite of the fact that this vaccination is mandatory in the first year of life, in Italy. Because of that, he was not allowed to attend school, longer, and was referred to us in order to assess the potential risk of MMR vaccination. Upon thorough allergologic workup, sensitization to MMR vaccine components was excluded by an in vivo approach, consisting in skin prick tests, intradermal tests, and subcutaneous injection test, corroborated by vaccine-specific B-lymphocyte proliferation assay, ex vivo. T-cell proliferation in response to MMR vaccine was also excluded. Eventually, the boy was inoculated with MMR vaccine and was readmitted to school.Conclusions The diagnostic strategy adopted appears feasible and easy-to-perform and may be adopted in controversial cases (as the one reported), characterized by previous severe allergic reactions to egg. The B-lymphocyte proliferation assay we developed may represent a useful and reliable tool not only in research but also in clinical practice.
Intestinal Parasites In Children of Cochabamba – Bolivia
Authors: Alvarez Ivana Camacho , Goyens Philippe , Jacobs Frédérique , López J. Marcela Luizaga
Published: October 2020

Background: A high percentage of the population in Latin America lives with intestinal parasitic infections, neglected tropical diseases frequently not treated. Intestinal parasitism is associated with nutritional diseases but the information about the epidemiological situation in countries like Bolivia is scarce. Environmental conditions play an important role in the prevalence of certain parasites. The main objective was to know the current situation of parasitic infections among children under twelve years old from different geographical areas of the department of Cochabamba – Bolivia. Methods: We analysed the laboratory reports of four second-line hospitals of different areas and the Tertiary Care Hospital. Results of stool examinations performed between 2011 and 2015 in children under twelve years of age were collected. Results: We gathered the results of 23221 examinations. The 89 % of children were less than five years old. Pathogenic parasites were found in 31 %. Entamoeba histolytica and Giardia lamblia were the two most prevalent parasites in all areas. Helminths were found in only 19% of positive samples and Ascaris lumbricoides was the most prevalent. Parasitic infections are more frequent in tropical area and helminths are highly concentrated in this area. Discussion and Conclusions: Parasitic infections in children are still very prevalent in Bolivia. Protozoan infections are the major problem while the prevalence of helminths seems to be decreasing. The most vulnerable population is still concentrated in tropical areas where the risk of parasitic infection is probably increased due to the environmental conditions. Our results will enable the planning of more efficient policies to control parasitic diseases.
Changes After Cancer Diagnosis and Return to Work: Moving Forward Without Direction
Authors: Bae Ka Ryeong , Cho Juhee
Published: October 2020

Background: The purpose of this study was to understand the unmet needs of cancer patients and identify the necessary factors to develop a vocational intervention program based on cancer patients’ work-related experience after cancer diagnosis.Methods: Semi-structured individual in-depth interviews were conducted with 50 cancer patients who were working at the time of diagnosis at a university hospital in Seoul, South Korea from July to September of 2017. Interview data were analyzed using qualitative content analysis.Results: ‘The changes patients experienced after cancer diagnosis’ were categorized into Personal and socio-environmental changes. ‘Personal changes’ were changes within the patient that were further divided into ‘physical’, ‘psychological’ and ‘spiritual’ changes while ‘socio-environmental changes’ were changes in either ‘attitude’ and ‘relationship’ of other people cancer patients encountered. In addition to these post-diagnosis changes, the following 4 major factors related to return-to-work were identified to affect patients’ experience: ‘fear of cancer recurrence’, ‘financial status’, ‘informational support’, and ‘working environment’.Conclusion: Cancer patients’ working status was determined by the interaction between the patients’ post-diagnosis changes and 4 factors related to return-to-work, with the factors’ positive or negative effect leading to return-to-work. In particular, cancer patients faced difficulties processing and appropriately responding to the potential changes occurring after cancer diagnosis due to lack of information. Based on these findings, we plan to develop an educational intervention reflecting these factors to promote cancer patients’ return-to-work. Educational materials and intervention programs informing patients on these changes and factors may facilitate their return-to-work after diagnosis.
Time Trends and Regional Disparities of Maternal Mortality Ratio: Evidences From China, 1990-2018.
Authors: Chen Lu , Feng Penghui , Shaver Lance , Wang Zengwu
Published: October 2020

Introduction China is one of the few countries to achieve Millennium Development Goal 4 and 5. This study aimed to access the levels and trends of maternal mortality ratio (MMR) in China from 1990 to 2018. Methods Using descriptive epidemiology, we collected the data from the China Health Statistics Yearbooks and the China Statistical Yearbooks to describe changes in MMRs, hospital delivery rate, per capita GDP, policies, health expenditure indictors and per capita annual income by region from 1990 to 2018. Spearman correlation analysis was used to assess the relevance between MMR and health expenditure indicators. Results The MMR decreased by 79.4% from 1990 to 2018 in China, and the MMR was remarkably lower in the eastern China than that in the western China. In the context of the widening gap between urban and rural wealth from 1990 to 2018, the urban-rural MMR gap narrowed. The MMR in China has always been higher in rural areas than in urban areas. After the implementation of the Two-Child policy in 2015, the urban MMR continued to decline in 2015-2018, and the rural MMR rebounded in 2017. The hospital delivery rate in China has been on the rise, with almost all pregnant women giving birth in hospital by 2018. The MMR was negatively correlated with the percentage of government health expenditure in the total health expenditure. Obstetric hemorrhage has always been the leading cause of maternal death from 1990 to 2018 in urban and rural areas. Conclusions China has made remarkable progress in maternal survival, despite regional differences still exist. The implementation of the Two-Child policy slowed down the decline of MMR in rural areas. Chinese government should focus on the maternal health in western provinces, rural areas, and the floating population in urban areas.
Comparing Primary Care Interprofessional and Non-interprofessional Teams on Access to Care and Health Services Utilization in Ontario, Canada: A Retrospective Cohort Study
Authors: Haj-Ali Wissam , Hutchison Brian , Moineddin Rahim , Wodchis Walter , Glazier Rick
Published: October 2020

Background: Many countries, including Canada, have introduced primary care reforms to improve health system functioning and value. The purpose of this study was to examine the association between receiving care from interprofessional primary care teams and access to care and health services utilization. Methods: We conducted a retrospective cohort study linking population-based administrative databases to Ontario’s Health Care Experience Survey (HCES) between 2012 and 2018. We adjusted for physician group characteristics as well as individual physician and patient characteristics while assessing the relationship between receiving care from interprofessional teams and the outcomes of interest.Results: As of March 31st, 2015, there were 465 physician groups with HCES respondents of which 177 (38.0%) were interprofessional teams and 288 (62.0%) were non-interprofessional teams in the same blended capitation reimbursement model. In this period, there were 4,518 physicians with HCES respondents, of whom 2,131 (47.2%) were in interprofessional teams and 2,387 (52.8%) were in non-interprofessional teams. There were 10,102 HCES respondents included in this study, of whom 42.4% were in interprofessional teams and 42.3% were in non-interprofessional teams. After adjustment, we found that being in an interprofessional team was associated with an increase in the odds of patients reporting same/next day access to care by 12.0% (OR=1.12 CI=1.00 to 1.24 p-value 0.0436) and a decrease in the odds of patients reporting walk-in clinic use by 16% (OR=0.84 CI=0.75 to 0.94 p-value 0.0019). After adjustment, there were no significant differences in patient-reported after-hours access to care and emergency department use.Conclusions: Ontario has invested heavily in interprofessional primary care teams. As compared to patients in non-interprofessional teams, patients in interprofessional teams self-reported more timely access to care and less walk-in clinic use but no significant difference in self-reported access to after-hours care or in emergency department use. For jurisdictions aiming to expand physician voluntary participation in interprofessional teams, our study results inform expectations around access to care and health services utilization.
A New Personalised Telehealth Model in Chronic Pediatric Diseases and Disability During The COVID-19 ERA
Authors: Mercuri Eugenio , Zampino Giuseppe , Morsella Alisha , Pane Marika , Onesimo Roberta , Angioletti Carmen , Valentini Piero , Rendeli Claudia , Ruggiero Antonio , Nanni Lorenzo , Chiaretti Antonio , Vento Giovanni , Korn David , Meneschincheri Emilio , Sergi Paolo , Scambia Giovanni , Ricciardi Walter , Cambieri Andrea , De Belvis Antonio Giulio
Published: October 2020

Background: Suspending ordinary care activities during the COVID-19 pandemic made it necessary to find alternative routes to comply with care recommendations not only for acute health needs but also for patients requiring follow-up and multidisciplinary visits. We present the ‘Contactless’ model, a comprehensive operational tool including a plurality of services delivered remotely, structured according to a complexity gradient, aimed to cover diagnostic procedures and monitor disease progression in chronic pediatric patients. Methods: A multidisciplinary and multiprofessional project team was recruited, in collaboration with patients’ associations, to map a panel of available Evidence-Based solutions and address individual needs in full respect of the concept of personalized medicine. The solutions include a number of services from videoconsultations to more structure videotraining sessions.Results: A modular framework made up of four three Macro-levels of complexity - Contactless Basic, Intermediate and Advanced - was displayed as an incremental set of services and operational planning establishing each phase, from factors influencing eligibility to the delivery of the most accurate and complex levels of care. Conclusion: The multimodal, multidisciplinary ‘Contactless’ model allowed the inclusion of all Units of our Pediatric Department and families with children with disability or complex chronic conditions. The strengths of this project rely on its replicability outside of pediatrics and in the limited resources needed to practically impact patients, caregivers and professionals involved in the process of care. Its implementation in the future may contribute to reduce the duration of hospital admissions, money and parental absence from work.
A Simple Method for Diagnosing Gallbladder Malignant Tumors with Subserosa Invasion by Endoscopic Ultrasonography
Authors: Sugimoto Mitsuru , Irie Hiroki , Takasumi Mika , Hashimoto Minami , Oka Yuka , Takagi Tadayuki , Konno Naoki , Suzuki Rei , Asama Hiroyuki , Sato Yuki , Nakamura Jun , Kato Tsunetaka , Kobashi Ryoichiro , Hashimoto Yuko , Marubashi Sigeru , Hikichi Takuto , Ohira Hiromasa
Published: October 2020

Background: If the depth of gallbladder malignant tumor (GBMT) invasion is deeper than the subserosa (ss), cholecystectomy is insufficient. In past reports that used endoscopic ultrasonography (EUS) to diagnose the depth of tumor invasion, it was difficult to diagnose GMBT invasion in the ss without a narrow or disrupted lateral hyperechoic layer (LHEL). Therefore, we developed a simple preoperative method to diagnose GBMTs with ss invasion. Methods: Forty-nine GBMT patients who underwent both EUS and surgery were enrolled: 15 patients whose tumors invaded the mucosa (m) or muscularis propria (mp) were classified as the “shallow group”, and 34 patients whose tumors invaded the ss were classified as the “deep group”. The EUS findings were compared between the two groups.Results: An irregular (narrow or thickened) LHEL was significantly more frequently observed on EUS in the deep group than in the shallow group. The diagnosis of ss invasion based on an irregular LHEL had the highest sensitivity and accuracy among the EUS imaging parameters (sensitivity 97.1% (33/34), specificity 86.7% (13/15), accuracy 93.8% (46/49)). When the deep group was limited to patients with a tumor depth of ss, the results were similar. When an irregular LHEL was used, the diagnosability of GBMTs with ss invasion was not significantly different between EUS specialists and beginners.Conclusions: An irregular (thickened or narrow) LHEL observed on EUS could be a reliable and simple method of diagnosing GBMTs with ss invasion and could contribute to choosing an appropriate surgical method.Trial Registration: not applicable
Enhancing Sleep Quality for Nursing Home Residents with Dementia: A Pragmatic Randomized Controlled Trial of an Evidence-Based Frontline Huddling Program
Authors: Snow A. Lynn Lynn , Loup Julia , Morgan Robert O. , Richards Kathy , Parmelee Patricia , Baier Rosa , McCreedy Ellen , Frank Barbara , Brady Cathie , Fry Liam , McCullough Megan , Hartmann Christine W.
Published: October 2020

Background

Disturbed sleep places older adults at higher risk for frailty, morbidity, and even mortality. Yet, nursing home routines frequently disturb residents’ sleep through use of noise, light, or efforts to reduce incontinence. Nursing home residents with Alzheimer’s disease and or related dementias—almost two-thirds of long-stay nursing home residents—are likely to be particularly affected by sleep disturbance. Addressing these issues, this study protocol implements an evidence-based intervention to improve sleep: a nursing home frontline staff huddling program known as LOCK. The LOCK program is derived from evidence supporting strengths-based learning, systematic observation, relationship-based teamwork, and efficiency.
Methods

This study protocol outlines a NIH Stage III, real-world hybrid efficacy-effectiveness pragmatic trial of the LOCK sleep intervention. Over two phases, in a total of 27 non-VA nursing homes from 3 corporations, the study will (1) refine the LOCK program to focus on sleep for residents with dementia, (2) test the impact of the LOCK sleep intervention for nursing home residents with dementia, and (3) evaluate the intervention’s sustainability. Phase 1 (1 year; n = 3 nursing homes; 1 per corporation) will refine the intervention and train-the-trainer protocol and pilot-tests all study methods. Phase 2 (4 years; n = 24 nursing homes; 8 per corporation) will use the refined intervention to conduct a wedge-design randomized, controlled, clinical trial. Phase 2 results will measure the LOCK sleep intervention’s impact on sleep (primary outcome) and on psychotropic medication use, pain and analgesic medication use, and activities of daily living decline (secondary outcomes). Findings will point to inter-facility variation in the program’s implementation and sustainability.
Discussion

This is the first study to our knowledge that applies a dementia sleep intervention to systematically address known barriers to nursing home quality improvement efforts. This innovative study has future potential to address clinical issues beyond sleep (safety, infection control) and expand to other settings (assisted living, inpatient mental health). The study’s strong team, careful consideration of design challenges, and resulting rigorous, pragmatic approach will ensure success of this promising intervention for nursing home residents with dementia.
Trial registration:
NCT04533815, ClinicalTrials.gov, August 20, 2020.
Association between Psychiatric Disorders and Glomerular Disease.
Authors: Desmond Hailey E. , Lindner Clare , Troost Jonathan P. , Held Zack , Modes Meg , Callaway Andrea , Oh Gia J. , Lafayette Richard , O’Shaughnessy Michelle , Elliot Matthew , Adler Sharon , Kamil Elaine S. , Pesenson Anne , Selewski David T. , Gipson Patrick E. , Carlozzi Noelle E. , LaVigne Joseph , Gipson Debbie S. , Massengill Susan F.
Published: October 2020

Background: Patients with chronic health conditions are at heightened risk for psychiatric disorders; yet, little is known about the occurrence of psychiatric disorders or associations with patient and disease characteristics in glomerular disease.Methods: This study included patients with glomerular disease enrolled in the Kidney Research Network multisite patient registry. Registry data includes encounter, diagnoses, medication, lab, and vital signs data extracted from participants’ electronic health records. ICD9/10 diagnosis codes were used to identify subset of psychiatric disorders focused on anxiety, mood, and behaviorial disorders. Time-varying Cox proportional hazards models were used to analyze time from onset of kidney disease to diagnosis of psychiatric disorder. Models adjusted for age, sex, race, ethnicity, and time-varying treatment, estimated glomerular filtration rate (eGFR), and proteinuria. Analogous models examined diagnosis of psychiatric disorder as a predictor of time to end stage kidney disease (ESKD).Results: Data were available for 943 participants with a median of 58 months of follow-up. 109 (12%) participants were ever diagnosed with a psychiatric disorder during follow up. Estimated risk of psychiatric diagnosis after kidney disease was 14.7 cases per 1,000 person-years, and was highest among adolescents. Adjusted analyses found adolescent age (vs. Adult, HR=2.03, CI=1.23-3.35), Asian race (vs. White, HR=0.34, 95% CI=0.16-0.70) and steroid therapy (HR=2.27, 95% CI=1.53-3.38) were associated with psychiatric diagnosis. Psychiatric diagnosis was also associated with progression to ESKD (HR=2.47, 95% CI=1.55-3.95) after adjusting for kidney diagnosis, eGFR at onset, proteinuria over time, and steroid therapy.Discussion: Psychiatric disorders were documented in approximately one eighth of patients with glomerular disease and correlated with clinical disease characteristics. Conclusions: These findings suggest mental health screening may be warranted in patients with glomerular disease.
Evaluation of Underlying Causative Factors for Earthquake-Induced Landslides and Landslide Susceptibility Mapping in Upper Indrawati Watershed, Nepal
Authors: Gautam Pawan , Kubota Tetsuya , Aditian Aril
Published: October 2020

The main objectives of this study are to assess the underlying causative factors for landslide occurrence due to earthquake in upper Indrawati Watershed of Nepal and evaluating the region prone to landslide using Landslide Susceptibility Mapping (LSM). We used logistic regression (LR) for LSM on geographic information system (GIS) platform. Nine causal factors (CF) including slope angle, aspect, elevation, curvature, distance to fault and river, geological formation, seismic intensity, and land cover were considered for LSM. We assessed the distribution of landslide among the classes of each CF to understand the relationship of CF and landslides. The northern part of the study area, which is dominated by steep rocky slope have a higher distribution of earthquake-induced landslides. Among the CF, 'slope' showed the positive correlation as landslide distribution is increasing with increasing slope. However, LR analysis depict 'distance to the fault' is the best predictor with the highest coefficient value. Susceptibility map was validated by assessing the correctly classified landslides under susceptibility categories, generated in five discrete classes using natural break (Jenk) methods. Calculation of area under curve (AUC) and seed cell area index (SCAI) were performed to validate the susceptibility map. The LSM approach shows good accuracy with respective AUC value for success rate and prediction rate of 0.795 and 0.702. Similarly, the decreasing SCAI value from very low to very high susceptibility categories advise satisfactory accuracy of LSM approach.
Fixed Versus Flexible Antagonist Protocol in Women with Predicted High Ovarian Response except PCOS : A Randomized Controlled Trial
Authors: Luo Xiu , Pei Li , Li Fujie , Li Chunli , Huang Guoning , Ye Hong
Published: October 2020

Background: No previous study directly compares the fixed day-5 initiation versus the flexible initiation of GnRH antagonist administration in IVF/ICSI for those patients who are predicted as high ovarian responders without PCOS. To evaluate whether the number of oocytes retrieved is different by using the two GnRH antagonist protocols in Chinese women with predicted high ovarian response except PCOS.Methods: A randomized controlled trial of 201 infertile women with predicted high ovarian response except PCOS undergoing in vitro fertilization. Ovary stimulation was performed using recombinant FSH and GnRH antagonists. GnRH antagonist ganirelix (0.25 mg/d) was started either on day 5 of stimulation (fixed group) or when LH was >10 IU/L, and/or a follicle with mean diameter >12 mm was present, and/or serum E2 was >300pg/ml. Patient monitoring was initiated on day 3 of stimulation in flexible group.Result(s): No significant difference was observed between the fixed and flexible groups regarding the number of oocyte retrieved(16.72±7.25 vs. 17.47±5.88, P=0.421), the Gonadotropin treatment duration(9.53±1.07 vs. 9.67±1.03, P=0.346)and total Gonadotropin dose(1427.75±210.6 vs. 1455.94±243.44, P=0.381). GnRH antagonist treatment duration in fixed protocol was statistically longer than the flexible protocol (6.57±1.17 vs 6.04±1.03, P=0.001). There was no premature LH surge in either protocol. Conclusion(s): Fixed GnRH antagonist administration on day 5 of stimulation appear to achieve a comparable oocyte retrieved compared with flexible antagonist administration.Trial registration: NCT02635607 posted on December 16, 2015 in clinicaltrials.gov.
Plasma Matrilysins MMP-7 and MMP-26 Concentrations as Diagnostic Biomarkers for Breast Cancer Patients
Authors: Piskór Barbara Maria , Przylipiak Andrzej , Dąbrowska Emilia , Sidorkiewicz Iwona , Niczyporuk Marek , Szmitkowski Maciej , Ławicki Sławomir
Published: October 2020

Background: Metalloproteinases (MMPs) are a group of proteolytic enzymes involved in the maintenance of a proper structure of extracellular matrix (ECM). Matrilysins (MMP-7 and MMP-26) are the one of the group of MMPs that could represent potential breast cancer (BC) markers. The aim of the study was to evaluate plasma levels of MMP-7, MMP-26 and CA 15-3 individually and in combination and assess the a diagnostic utility of studied matrilysins in BC patients. Methods: The study group consisted of 120 patients with BC, the control group consisted of 40 patients with benign breast cancer and 40 healthy women. Concentrations of MMP-7 and MMP-26 were determined by Enzyme-Linked Immunosorbent Assay, CA 15-3 by Chemiluminescent Microparticle Immunoassay.Results: The plasma levels of MMP-7 were significantly higher in the entire BC group than in the control group. Concentrations of MMP-26 and CA 15-3 were the highest in the III and IV stage of disease. The highest diagnostic sensitivity was observed in the III and IV stage of cancer for set of all tested markers (92.5%). The highest diagnostic specificity was noted for all tested parameters in all studied BC group (95.0%). The area under the receiver operating characteristic (ROC) curve (AUC) set of markers (MMP-7+MMP-26+CA 15-3) was the largest (0.9138) in III and IV stage. Also individual marker analysis showed that MMP-7 had the highest AUC (0.8894) in advanced stages of disease. Conclusions: Data suggested that MMP-7 can be considered as additional marker improving diagnostic utility of CA 15-3 in early stages of BC patients. Therefore, combined analysis of MMP-7 and MMP-26 with CA 15-3 might be useful in detection of disease progression. Future investigation is needed to evaluate whether matrilysins might be a potential markers improving diagnosis of BC.
Low Incidence of ABL-Class And JAK-STAT Signaling Pathway Alterations In Uniformly Treated Pediatric And Adult B-Cell Acute Lymphoblastic Leukemia Patients Using MRD Risk-Directed Approach – A Population-Based Study
Authors: Norvilas Rimvydas , Dirse Vaidas , Semaskeviciene Ruta , Mickeviciute Orinta , Gineikiene Egle , Stoskus Mindaugas , Vaitkeviciene Goda , Rascon Jelena , Griskevicius Laimonas
Published: October 2020

Background: ABL-class and JAK-STAT signaling pathway activating alterations have been associated with both poor post-induction minimal residual disease (MRD) response and inferior outcome in B-cell acute lymphoblastic leukemia (B-ALL). However, in most of the studies patients received non-uniform treatment. Methods: We performed population-based analysis of 160 (122 pediatric and 38 adult) Lithuanian BCR-ABL1-negative B-ALL patients who had been uniformly treated according to MRD-adapted NOPHO ALL-2008 protocol. Targeted RNA sequencing and FISH analysis was performed in cases without canonical B-ALL genomic alterations (high hyperdiploids and low hypodiploids included). Results: We identified ABL-class fusions in 3 (1.9%) B-ALL patients (exclusively in adults (p=0.032)). JAK-STAT pathway fusions were present in 4 (2.5%) cases. Of note, P2RY8-CRLF2 fusion was absent in both pediatric and adult B-ALL cases. Patients with ABL-class or JAK-STAT pathway fusions had poor MRD response and were assigned to the higher risk groups, had worse event-free survival (EFS) and overall survival (OS) compared to patients without these fusions. In multivariate analysis, positivity for ABL-class and JAK-STAT fusions was a risk factor for worse EFS (p=0.043) but not for OS (p=0.278) in adults. Conclusions: We show low overall frequency of ABL-class and JAK-STAT fusions and the absence of P2RY8-CRLF2 gene fusion in the Lithuanian BCR-ABL1 negative B-ALL cohort. Poor event-free survival in ABL-class / JAK-STAT fusion-positive adult patients despite MRD-directed therapy should be confirmed in future studies.
The Safety of Early Administration of Oral Fluid Following General Anesthesia in Children Undergoing Tonsil Operation: A Prospective Randomized Controlled Trial
Authors: Wu Meng-Hang , Liu Chang-qing , Zeng Xiao-qi , Jia An-na , Yin Xiao-rong
Published: October 2020

Background: The feasibility and safety of giving a small amount of water to children in the recovery period after tonsillectomy under general anesthesia to reduce the thirst and its associated restlessness reaction remain unknown. Methods: This study was approved by our institutional ethics committee, and which adhered to CONSORT guidelines. Pediatric patients undergoing tonsil surgery who met the inclusion and exclusion criteria of our study were randomized into the experimental and control groups. In the experimental group, patients were given a small amount of water instantly after recovering from the general anesthesia, which included the recovery of cough and deglutition reflex, and attaining grade V of muscle strength. The control group was given a small amount of water 4 to 6 hours after the operation. The incidence of nausea and vomiting and the degree of thirst relief were measured and compared between the two groups. Results：300 patients were randomized into each group. There was no significant difference in the incidence of nausea and vomiting 20 minutes after drinking water between the two groups (P>0.05). The thirst score of children over 5 years old in the experimental group was significantly lower than that of the control group (P<0.05). Conclusion: The early administration of a small amount of oral fluid in children undergoing tonsil surgery and recovering from the general anesthesia is not only safe but also effective in reducing postoperative thirst. Trial registration: Current Controlled Trials ChiCTR1800020058, 12-12-2018.
Association Between Knowledge, Attitudes and Practices (KAP) Towards The COVID-19: A Cross-Sectional Study in South Korea
Authors: Lee Minjung , Kang Bee-Ah , You Myoungsoon
Published: October 2020

Background It is imperative for the public to routinely practice precautionary behaviors to contain transmission of COVID-19, as no vaccines and anti-viral treatments are available. This paper attempts to examine knowledge, attitudes, and practices related to COVID-19, and the relationship between them and identification of the vulnerable population.Methods The data collection took place over three days (June 26–29) through an online survey five months after the Korea Centers for Disease Control and Prevention (KCDC) confirmed the first case in South Korea; 970 subjects were included in the analysis.Results The level of knowledge, attitude and practice were examined. Knowledge directly affected both attitude (e.g., perceived risk and efficacy belief) and practice (e.g., preventive measures and social distancing). Among the influencing factors, efficacy belief turns out to be the most effective and significant factor on practice and also mediated the relationship between knowledge and all three preventive behaviors (wearing facial masks, practicing hand hygiene, and avoiding crowded places). Knowledge level varied by sociodemographic characteristics. Females (β = 0.06, p < 0.05) and individuals with higher level of education (β = 0.06, p < 0.05) had higher knowledge.Conclusion To successfully increase precautionary behaviors among the public, public health officials and policy makers must promote knowledge and efficacy belief. Also, the consequent interventions and policies should be developed and implemented in a way they reduce, rather than reinforce, health disparities, by embracing vulnerable populations to COVID-19.
Neuroendocrine Carcinoma of the Breast is More Aggressive Than Breast Invasive Ductal Carcinoma: A Propensity Score Matching Study Based on SEER Database
Authors: Chen Yu-Qiu , Xue Yu , Xu Xiao-Fan , Wang Xu-Lin , Huo Li-Qun , Wang Lu , Di Tian-Yu , Xu Jia-Wei , Gu Jun , Zhou Guo-hua
Published: October 2020

Background Neuroendocrine carcinoma (NEC) of the breast is a very rare malignant tumor whose clinic pathological features and prognosis are not well defined. The aim of this study was to compare the clinic pathological features and clinical outcome between breast neuroendocrine carcinoma and breast invasive ductal carcinoma (IDC) and to know the independent prognostic risk factors of NEC.Method Patients with breast NEC and breast IDC were identified through the Surveillance, Epidemiology, and End Results (SEER) database from 2010 to 2015. Then we compared the clinic pathological features and outcome between the two cohorts. Propensity score matching (PSM) was performed to balance the effects of baseline clinic pathological differences. Potential prognostic factors of breast NEC were identified by the univariate and multivariate Cox analysis.Results In total, we identified 208 patients with breast NEC and 275,878 cases with breast IDC.Compared with IDC, NEC was significantly correlated with higher stage, larger tumor size, more distant transfers and no population of HER2 enriched subtype. There were significant differences on the choice of treatment therapy between NEC and IDC (p=0.000). More patients chose not to undergo surgery (35.1% vs. 9.0%), and fewer patients chose breast conserving surgery than IDC patients (32.2% vs. 51.1%). Compared with IDC patients, NEC patients were more likely to choose chemotherapy (p=0.039) and more conservative in radiotherapy (p=0.000). The 66-month overall survival (OS) rate in NEC and IDC was 44.5% and 80.2% before PSM and was 49.8% and 71.4% after PSM, respectively. The 66-month breast cancer specific survival (BCSS) rate in NEC and IDC was 56.3% and 88.8% before PSM and was 54.1% and 80.5% after PSM, respectively. Finally, we identified independent prognostic factors, age, stage, pathological type, distant metastasis, chemotherapy, and molecular typing. Conclusions Breast NEC has distinct clinic pathological features and a significantly worse clinical outcome than common IDC.
Retrospective Analysis of Real-World Treatment Patterns and Clinical Outcomes in Patients With Advanced Non-Small Cell Lung Cancer Starting First-Line Systemic Therapy in the United Kingdom
Authors: Lester Jason , Escriu Carles , Khan Sarah , Hudson Emma , Mansy Talal , Conn Andrew , Chan Samuel , Powell Ceri , Brock Juliet , Conibear John , Nelless Lauren , Nayar Vaneet , Zhuo Xiaohui , Durand Adeline , Amin Amerah , Martin Peter , Zhang Xinke , Pawar Vivek
Published: October 2020

Background: The treatment landscape for advanced non-small cell lung cancer (aNSCLC) has evolved rapidly since immuno-oncology (IO) therapies were introduced. This study used recent data to assess real-world treatment patterns and clinical outcomes in aNSCLC in the United Kingdom. Methods: Electronic prescribing records of treatment-naive patients starting first-line (1L) treatment for aNSCLC between June 2016 and March 2018 (follow-up until December 2018) in the United Kingdom were assessed retrospectively. Patient characteristics and treatment patterns were analyzed descriptively. Outcomes assessed included overall survival (OS), time to treatment discontinuation, time to next treatment, and real-world tumor response.Results: In all, 1003 patients were evaluated (median age, 68 years [range, 28-93 years]; 53.9% male). Use of 1L IO monotherapy (0%-25.9%) and targeted therapy (11.8%-15.9%) increased during the study period, but chemotherapy remained the most common 1L treatment at all time points (88.2%-58.2%). Median OS was 9.5 months (95% CI, 8.8-10.7 months) for all patients, 8.1 months (95% CI, 7.4-8.9 months) with chemotherapy, 14.0 months (95% CI, 10.7-20.6 months) with IO monotherapy, and 20.2 months (95% CI, 16.0-30.5 months) with targeted therapy. In the 28.6% of patients who received second-line treatment, IO monotherapy was the most common drug class (used in 51.6%).Conclusions: Although use of 1L IO monotherapy for aNSCLC increased in the United Kingdom during the study period, most patients received 1L chemotherapy. An OS benefit for first-line IO monotherapy vs chemotherapy was observed but was numerically smaller than that reported in clinical trials. Targeted therapy was associated with the longest OS, highlighting the need for improved treatment options for tumors lacking targetable mutations.
Morphological and Genetic Heterogeneity of Synchronous Multifocal Lung Adenocarcinoma in a Chinese Cohort
Authors: Zhu Donglin , Cao Dan , Shen Minghong , Lv Jinghuan
Published: October 2020

Background: Synchronous multifocal lung cancer (SMLC) is seen with increasing frequency in clinical practice globally. Because of innate variation in clinical management and outcome, it is vital to distinguish properly between synchronous multifocal primary lung cancer (SMPLC) and intrapulmonary metastasis (IM). The pathologic features and principal classification criteria of multifocal lung cancer remain unclear. Methods: We have collected a unique cohort of Chinese patients with SMLC, and fully explored the morphologic, immunohistochemical, and molecular features of the disease. Twenty-one SMLC patients with a total of 50 tumors were included in our study. The pathological features presented by these cases were analyzed, including tumor location, tumor size, pathological types, predominant pattern of adenocarcinoma, and immunohistochemical staining. We undertook molecular testing of nine driver oncogenes associated with lung cancer, including EGER, KRAS, BRAF, NRAS, ALK, ROS1, RET, HER2, and PIK3CA. Results: According to Martini-Melamed classification and refined standard, 8 and 17 cases were considered as SMPLC respectively. Gene mutations were identified in 18 tumors (36%). There were 12 patients had different gene mutations. Conclusions: We demonstrate that conventional morphological assessment is not sufficient to establish clearly the clonal relationship of SMPLC. Instead the evaluation of histological subtypes, including non-mucinous adherent components, is required. Multiplex genotypic analysis may also prove a useful additional tool.
The Complexity of Scaling Up an mHealth Intervention. SMS for Life: A Case Study from a Health Systems Integration Perspective
Authors: Fruchtman Carmen Sant , Mbuyita Selemani , Mwanyika-Sando Mary , Braun Marcel , de Savigny Don , Cobos Daniel
Published: October 2020

BackgroundThe objective of this study was to apply systems thinking to examine the opportunities and challenges of scaling up and integrating a new electronic health technology into a complex health system. We used the implementation cycle of the supply chain management solution (SMS for Life 1.0) in Tanzania as a case study. SMS for Life was one of the earliest large-scale implementations of mHealth innovations worldwide. It aimed to bring visibility to antimalarial stock-outs through the use of SMS technology.MethodsA qualitative case-study approach was used. This included a literature review, a document review of 61 project documents, a timeline of key events and the collection and analysis of 28 interviews with key stakeholders involved in or affected by the SMS for Life programme. Using the WHO mHealth Assessment and Planning for Scale (MAPS) Toolkit as a framework, we carried out a joint thematic analysis and identified the key reasons for the discontinuation of the programme.ResultsSMS for Life was reliable at scale and raised awareness of stock-outs with real-time monitoring. However, it was discontinued in 2015 after four years of a national rollout. The main reasons identified for the discontinuation were the programme’s failure to adapt to the continuous changes in Tanzania’s health system, the focus on stock-outs rather than ensuring appropriate stock management, and that it was perceived as costly by policy-makers.Despite its discontinuation, SMS for Life, together with co-existing technologies, triggered the development of the capacity to accommodate and integrate future technologies in the health system.ConclusionThis study shows the importance of engaging appropriate stakeholders from the outset, understanding and designing system-responsive interventions appropriately when scaling up and ensuring value to a broad range of health system actors. These shortcomings are common among digital health solutions and need to be better addressed in future implementations.
Predictive Factors of Bell’s Palsy: Neutrophil to Lymphocyte Ratio and Platelet to Lymphocyte Ratio
Authors: Pokharel Apar , Mayya Jaya Prakash
Published: October 2020

Objectives: Inflammation plays an important role in the pathogenesis of Bell’s palsy. Neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) are indicators of inflammation. The aim of this study was to find the prevalence of Bell's palsy and the mean of neutrophil to lymphocyte ratio and platelet to lymphocyte ratio among them. Result: Out of all patients who visited ENT outpatient department during the study period, the overall prevalence of Bell’s palsy was 0.6% (117) at a 95% confidence interval (0.5-0.72%). Among them, the mean neutrophil to lymphocyte ratio was 5.014±1.63, and the mean platelet to lymphocyte ratio was 207.38±54.59.Both NLR and PLR values were raised in Bell’s palsy. Therefore, NLR and PLR can be used as auxiliary param­eters in the management of Bell’s palsy.
Application of Artificial Intelligence in Chronic Liver Diseases: A Systematic Review and Meta-analysis
Authors: Decharatanachart Pakanat , Chaiteerakij Roongruedee , Tiyarattanachai Thodsawit , Treeprasertsuk Sombat
Published: October 2020

Background: The gold standard for the diagnosis of liver fibrosis and nonalcoholic fatty liver disease (NAFLD) is liver biopsy. Various noninvasive modalities, e.g., ultrasonography, elastography and clinical predictive scores, have been used as alternatives to liver biopsy, with limited performance. Recently, artificial intelligence (AI) models have been developed and integrated into noninvasive diagnostic tools to improve their performance. Methods: We systematically searched for studies on AI-assisted diagnosis of liver fibrosis and NAFLD on MEDLINE, Scopus, Web of Science and Google Scholar. The pooled sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic odds ratio (DOR) with their 95% confidence intervals (95%CIs) were calculated using a random effects model. A summary receiver operating characteristic curve and the area under the curve was generated to determine the diagnostic accuracy of the AI-assisted system. Subgroup analyses by diagnostic modalities were performed.Results: We included 17 studies reporting the performances of AI-assisted ultrasonography, elastrography, computed tomography (CT), magnetic resonance imaging (MRI) and clinical parameters for the diagnosis of liver fibrosis and steatosis. For the diagnosis of liver fibrosis, the pooled sensitivity, specificity, PPV, NPV and DOR were 0.78 (0.70 – 0.84), 0.88 (0.79 – 0.94), 0.73 (0.58 – 0.84), 0.91 (0.88 – 0.94) and 29.57 (10.65 – 82.10), respectively, for cirrhosis; 0.86 (0.80 – 0.91), 0.87 (0.79 – 0.92), 0.85 (0.74 – 0.91), 0.88 (0.82 – 0.92) and 37.95 (15.52 – 92.77), respectively; for advanced fibrosis; and 0.86 (0.78 – 0.92), 0.81 (0.77 – 0.84), 0.88 (0.80 – 0.93), 0.77 (0.58 – 0.89) and 26.79 (14.47 – 49.62), respectively, for significant fibrosis. Subgroup analyses showed significant differences in performance for the diagnosis of fibrosis among different modalities. The pooled sensitivity, specificity, PPV, NPV and DOR were 0.97 (0.76 – 1.00), 0.91 (0.78 – 0.97), 0.95 (0.87 – 0.98), 0.93 (0.80 – 0.98) and 191.52 (38.82 – 944.81), respectively, for the diagnosis of liver steatosis. Conclusions: AI-assisted systems have promising potential for the diagnosis of liver fibrosis and NAFLD. Validations of their performances are warranted before implementing these AI-assisted systems in clinical practice.Trial registration: The protocol was registered with PROSPERO (CRD42020183295).
Mn2+ Induced Significant Improvement and Robust Stability of Radioluminescence in Cs3Cu2I5 for High Performance Nuclear Battery
Authors: Zeng Haibo , Li Xiaoming , Chen Jiaxin , Yang Dandan , Chen Xi , Geng Dongling , Jiang Lianfu , Wu Ye , Meng Cuifang
Published: October 2020

Fluorescent type nuclear battery (NB) consisting of scintillator and photovoltaic device (PVD) enables semipermanent power source for both small and large devices working under harsh circumstances without instant energy supply. In spite of the progress of device structure design, the development of scintillators with high light yield (LY) and longer emission wavelength catering to PVDs is far behind. Here, a novel Cs3Cu2I5: Mn scintillator, which exhibits an ultrahigh LY of ~ 67000 ph/MeV at an emission wavelength of 564 nm is presented, and this is the highest value at such a long wavelength based on low cost precursors. Besides, doping and intrinsic features endow Cs3Cu2I5: Mn with robust thermal stability and irradiation hardness that 71% or > 90% of the initial radioluminescence (RL) intensity can be maintained in an ultra-broad temperature range of 77 K-433 K or after a total irradiation dose of 38.7 Gy at 333 K, respectively. These superiorities allow the fabrication of an efficient and stable NB, which showed an output improvement of 337% respect to that without scintillator. Luminescence mechanisms including self-trapped exciton, energy transfer, and impact excitation are proposed for the dramatic RL improvement. It is expected that such a new and robust scintillator will open a window for the fields of NBs and radiography.
Age-associated cryptic transcription in mammalian stem cells is linked to permissive chromatin at cryptic promoters
Authors: McCauley Brenna , Sun Luyang , Yu Ruofan , Leeman Dena , Huang Yun , Webb Ashley , Dang Weiwei
Published: October 2020

Suppressing spurious cryptic transcription by a repressive intragenic chromatin state featuring trimethylated lysine 36 on histone H3 (H3K36me3) and DNA methylation is critical for maintaining self-renewal capacity in mouse embryonic stem cells. In yeast and nematodes, such cryptic transcription is elevated with age, and reducing the levels of age-associated cryptic transcription extends yeast lifespan. Whether cryptic transcription is also increased during mammalian aging is unknown. We show for the first time an age-associated elevation in cryptic transcription in several stem cell populations, including murine hematopoietic stem cells (mHSCs) and neural stem cells (NSCs) and human mesenchymal stem cells (hMSCs). Using DECAP-seq, we mapped and quantified age-associated cryptic transcription in hMSCs aged in vitro. Regions with significant age-associated cryptic transcription have a unique chromatin signature: decreased H3K36me3 and increased H3K4me1, H3K4me3, and H3K27ac with age. Furthermore, genomic regions undergoing such age-dependent chromatin changes resemble known promoter sequences and are bound by the promoter-associated protein TBP even in young cells. Hence, the more permissive chromatin state at intragenic cryptic promoters likely underlies the increase of cryptic transcription in aged mammalian stem cells.