bluuebunny/crossref_metadata_2025 huggingface dataset:
National Early Warning Score 2 (NEWS2) and 3-Level Triage Scale as Risk Predictors in Frail Older Adults in the Emergency Department
Authors: Kemp Kirsi , Alakare Janne , Harjola Veli-Pekka , Strandberg Timo , Tolonen Jukka , Lehtonen Lasse , Castren Maaret
Published: October 2020

Background The aim of the emergency department (ED) triage is to recognize critically ill patients and to allocate resources. No strong evidence for accuracy of the current triage instruments, especially for the older adults, exists. We evaluated the National Early Warning Score 2 (NEWS2) and a 3-level triage assessment as risk predictors for frail older adults visiting the ED.Methods This prospective, observational study was performed in a Finnish ED. The data were collected in a six-month period and included were ≥75-year-old residents with Clinical Frailty Scale score of at least four. We analyzed the predictive values of NEWS2 and the three-level triage scale for 30-day mortality, hospital admission, high dependency unit (HDU) and intensive care unit (ICU) admissions, a count of 72-hour and 30-day revisits, and ED length-of-stay (LOS). Results A total of 1711 ED visits were included. Median for age, CFS, LOS and NEWS2 were 85 years, 6 points, 6.2 hours and 1 point, respectively. 30-day mortality was 96/1711. At triage, 69, 356 and 1278 of patients were assessed as red, yellow and green, respectively. There were 1103 admissions, of them 31 to an HDU facility, none to ICU.With NEWS2 and triage score, AUCs for 30-day mortality prediction were 0.70 (0.64-0.76) and 0.62 (0.56-0.68); for hospital admission prediction 0.62 (0.60-0.65) and 0.55 (0.52-0.56), and for HDU admission 0.72 (0.61-0.83) and 0.80 (0.70-0.90), respectively.The NEWS2 divided into risk groups of low, medium and high did not predict the ED LOS (p=0.095). There was a difference in ED LOS between the red/yellow and as red/green patient groups (p<0.001) but not between the yellow/green groups (p=0.59).There were 48 and 351 revisits within 72 hours and 30 days, respectively. With NEWS2 AUCs for 72-hour and 30-day revisit prediction were 0.48 (95% CI 0.40-0.56) and 0.47 (0.44-0.51), respectively; with triage score 0.48 (0.40-0.56) and 0.49 (0.46-0.52), respectively.Conclusions The NEWS2 and a local 3-level triage scale are statistically significant, but poor in accuracy, in predicting 30-day mortality, and HDU admission but not ED LOS or revisit rates for frail older adults. NEWS2 also seems to predict hospital admission
Incidence and Risk Factors for High-level BK viruria -A Single Center Study in China
Authors: Xiong Rui , Ye Haimin , Liu Zhujing , Li Xinchang
Published: October 2020

Background BK virus allograft nephropathy (BKVAN) is a serious complication after kidney transplantation, and the effect of pre-emptive intervention for high-level BK viruria has been verified, but protocols after kidney transplantation for early identification of high-level viruria are lacking.Methods This was a single-center study. The clinical data of the kidney transplant recipients and their donors in our center from January 1, 2015 to December 31, 2018, were collected. The patients were divided into the high-level BK viruria group (Group A) and a non-high-level BK viruria group (Group B) according to the qPCR results of BK virus DNA loads in urine samples. Significant variables were screened out by univariate analysis, and then the results were incorporated into a multivariate logistic regression model to analyze the independent risk factors for high-level BK viruria.Results A total of 262 recipients were included in the study. The incidence of high-level BK viruria was 13.4% (n=35), and the median time of detection was 181 (range 91~1119) days. Univariate analysis showed that donor type ( =21.770, P < 0.001), history of ATG/ATG-F application ( =4.543, P=0.033), acute rejection (AR) ( =8.313, P=0.004) and delayed graft function (DGF) ( =21.170, P < 0.001) were related to high-level BK viruria. After the inclusion of the multivariate logistic regression model, the results showed deceased brain and cardiac donors (P=0.032, OR=3.927, 95% CI: 1.122~13.746), AR (P=0.022, OR=4.709, 95% CI: 1.253~17.697) and DGF (P=0.001, OR=6.682, 95% CI: 2.288~19.518).Conclusions Donation by deceased brain and cardiac patients, history of AR and DGF were independent risk factors for high-level BK viruria after kidney transplantation.
Interpersonal trauma and its relation to childhood psychopathic traits: what does ADHD and ODD add to the equation?
Authors: Marshall John , Sorman Karolina , Durbeej Natalie , Thompson Lucy , Lundström Sebastian , Minnis Helen , Hellner Clara , Gillberg Christopher
Published: October 2020

Background
Childhood trauma has demonstrated associations with callous-unemotional traits (e.g., reflecting lack of remorse and guilt, unconcern about own performance). Less is known about associations between trauma and multiple domains of child psychopathic traits. There has also been limited focus on the role of co-occurring disorders to psychopathy traits among children, namely, attention-deficit hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) and how they interact with childhood trauma.
Methods
We examined to what degree childhood interpersonal trauma can predict parent-rated psychopathic traits in a large population based Swedish twin sample (N = 5057), using a stringent definition of interpersonal trauma occurring before age 10. Two hundred and fifty-one participants met the interpersonal trauma criteria for analysis. The study explored the additional impact of traits of attention-deficit hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD).
Results
Linear regressions demonstrated statistically significant but clinically negligible effects of interpersonal trauma on total and subscale scores of parent-rated psychopathic traits. When exploring interaction effects of ADHD and ODD into the model, the effect increased. There were interaction effects between ODD and trauma in relation to psychopathic traits, suggesting a mediating role of ODD. Having been exposed to trauma before age 10 was significantly associated with higher parent rated psychopathy traits as measured by The Child Problematic Traits Inventory-Short Version (CPTI-SV), however the explained variance was small (0.3–0.9%).
Conclusions
The results challenge the notion of association between interpersonal trauma and youth psychopathic traits. They also highlight the need to gain an improved understanding of overlap between psychopathic traits, ADHD and ODD for clinical screening purposes and the underlying developmental mechanisms.
Care for neonates in Haiti’s health system: outcomes and lessons
Authors: Dev Alka , Casseus Michelucia , Baptiste Wilhermine Jean , Winter Emma Le , Simpher Katie , Werbel Alice , Joseph Patrice , Wright Peter
Published: October 2020

Background

The rate of facility births in Haiti has doubled over the past two decades, but without comparable reductions in maternal or neonatal mortality. To care for newborns requiring hospitalization in Haiti, we worked with the public health leadership in the Haitian department of the South (Sud) to establish a ward for compromised neonates in a large public hospital with over 3000 annual deliveries but no neonatal care capacity.
Methods

Significant investments were made in establishing basic neonatal services, training nurses, installing and managing a supply chain, and strengthening infrastructure. We present outcomes for 1399 neonates admitted to the ward during the first two years of operation.
Results

Two-thirds of admissions were made from the hospital’s maternity ward after birth, while the remaining babies were born at home or at referring facilities. Inborn neonates had better rates of hospital survival than those born elsewhere; they were also more likely to be born via cesarean section and to be admitted immediately following birth. Babies born elsewhere were more likely to die during their hospital stay. There were no differences between the proportion of premature or low-birth-weight babies born at the hospital or elsewhere. Nursing care proved to be a critical part of the care delivery system.
Conclusions

To support maternal and newborn care, we conclude that integrated, high-frequency nursing training is necessary for both maternity and neonatal nurses. Resources are needed to address prematurity as an important outcome, especially as it is indicative of poor prenatal care, regardless of place of birth.
Hemostatic Effect and Safety of TXA: An Umbrella Review
Authors: Jiang Mingyang , Deng Huachu , Liu Siyi , Xie Xiaoyong , Bo Zhandong
Published: October 2020

Aim

To evaluate the hemostatic effect and safety of tranexamic acid (TXA).
Methods

Meta-analyses were retrieved from databases. Risk ratios (RR), odds ratios (OR), weighted mean difference (WMD), standard mean difference (SMD) and 95% confidence intervals (CI) were extracted to compare the effeteness of TXA in reducing TBL, transfusion rate, Hb drop, mortality, DVT, PE.
Results

In total, 136 trials (396 comparisons) including 17 kinds of surgeries were retrieved. The evidence for TXA using in total knee arthroplasty (TKA), total hip arthroplasty (THA), postpartum bleeding, intertrochanteric fractures, orthopaedic surgery, spinal surgery, shoulder arthroplasty, hip fracture surgery, cardiac surgery, menstrual bleeding, plastic surgery, myomectomy, nasal surgery was assessed as possible for the association of reducing TBL. The evidence for TXA using in TKA, THA, postpartum bleeding, orthopaedic surgery, shoulder arthroplasty was assessed as probable for the association of reducing transfusion rate. The evidence for TXA using in liver surgery, spinal surgery, hip fracture surgery, cancer, cardiac surgery was considered to be possible for the association of reducing transfusion rate. The evidence for TXA using in intertrochanteric fractures, orthopaedic surgery, hip fracture surgery was assessed as probable for the association of reducing Hb drop. The evidence for TXA using in TKA, THA, postpartum bleeding, shoulder arthroplasty was considered to be possible for the association of reducing Hb drop. The evidence for TXA using in trauma, gastrointestinal bleeding was assessed as probable for the association of reducing mortality.
Conclusion

This umbrella review indicated that TXA were regarded as effective to reduce TBL, transfusion rate, Hb drop, mortality, and did not increase the incidence of DVT and PE. However, more convincing evidence should be provided to further clarify the level of efficacy and safety of TXA.
Latent Profiles of Patients with Borderline Pathology Based on the Alternative DSM-5 Model for Personality Disorders
Authors: Gamache Dominick , Savard Claudia , Leclerc Philippe , Payant Maude , Côté Alexandre , Faucher Jonathan , Lampron Mireille , Tremblay Marc
Published: October 2020

Background

There have been multiple attempts to try to parse out heterogeneity within borderline pathology by identifying patient subtypes; thus far, these works have yielded few consistent results. Recent developments in the operationalization of borderline pathology may provide new opportunities to identify clinically and conceptually meaningful subgroups of patients. The Alternative DSM-5 Model for Personality Disorders (AMPD) offers a categorical-dimensional operationalization of Borderline personality disorder (BPD) that has yet to be tested for identification of patient subgroups. The purpose of the present study is to test whether the combination of the Criterion A elements (pertaining to level of severity) and the seven pathological traits from Criterion B that define BPD in the AMPD can yield meaningful patient profiles.
Methods

A total of 211 outpatients from a specialized PD treatment program (133 women, Mage = 33.66, SD = 10.97) were selected based on the presence of at least moderate borderline pathology according to cutoffs recently proposed for the Borderline Symptom List-23. Valid Criterion A (Self and Interpersonal Functioning Scale) and B (Personality Inventory for DSM-5-Short Form) self-reports were administered to measure elements and traits that define BPD in the AMPD model; these variables were used as indicators in a Latent profile analysis (LPA).
Results

The optimal solution generated by LPA yielded four distinct profiles: (a) Borderline traits; (b) Low borderline pathology with Impulsivity; (c) Moderate borderline pathology with Identity problems and Depressivity; and (d) Severe borderline pathology. Clinically meaningful distinctions emerged between profiles on AMPD indicators and external variables relevant to PD, especially aggression and impulsivity.
Conclusions

Profiles reflected both the “severity” and “style” components imbedded within Criterion A and B of the AMPD, as they were mainly distinguished by a continuum of severity but also by some meaningful qualitative differences that may have important clinical implications for treatment planning and contracting. Results also suggest that the four Criterion A elements have independent value to identify important differences in patients with borderline pathology. They also highlight that some Criterion B traits that define BPD in the AMPD may be especially important to identify subgroups of patients, mainly Impulsivity and Depressivity.
Modified Taohong Siwu Decoction Improved Heart Function After Myocardial Infarction by Inhibiting Inflammatory Factor and Promoting Chemotactic and Pro-Angiogenic Factors
Authors: Luo Zhi-rong , Li Han , Xu Yan-wu , Xuan Shou-song , Cai Hao , Wang Lei , Guo Hai-dong
Published: October 2020

BackgroundTraditional Chinese medicine has been applied to prevent and treat myocardial infarction (MI) in the clinic for a long history. We recently found that Taohong Siwu decoction (THSWD) exerted a beneficial effect on heart function after MI through improving the local hostile microenvironment. However, the improvement of cardiac function after THSWD administration was moderate. In this study, four Chinese medicine herbs, which have the properties of warming Yang or removing phlegm, were added into THSWD to constitute a new and multifunctional Chinese herbal compound, named modified THSWD (MTHSWD). MethodsA rat model of MI was established by the ligation of left anterior descending coronary artery and MTHSWD was intragastrically administered for 2 weeks. The heart function was examined by echocardiography, cell apoptosis was detected by TUNEL staining and the infarct size was determined by Masson's trichrome staining. The expressions of cytokines, including chemotactic and inflammatory factors, were examined by ELISA in the infarcted myocardium and serum. The level of p-Akt and VEGF in the damaged myocardial tissues was further detected by Western blot. ResultsMTHSWD improved heart function and decreased infarct size and collagen deposition in the infarcted area. In addition, MTHSWD increased the expression of cTnT and Cx43, reduced cell apoptosis in the infarcted area by activating Akt signal and promoted angiogenesis by increasing the expression of VEGF. Interestingly, MTHSWD significantly increased the level of IGF-1, SDF-1 and TNF-α, and significantly reduced the expression of IL-1β in the infarcted myocardium. MTHSWD could also significantly increase the expression of IGF-1, SDF-1 and SCF in the serum. ConclusionsMTHSWD reduced cell apoptosis, promoted angiogenesis and improved heart function after MI probably through the downregulation of inflammatory factor IL-1β, upregulation of chemotactic factors SDF-1 and SCF as well as pro-angiogenic factor VEGF, and activation of Akt signaling pathway.
Synergistic Effect of Genetic Polymorphisms in TLR6 and TLR10 Genes on The Risk of Pulmonary Tuberculosis in Moldavian Population
Authors: Varzari Alexander , Deyneko Igor V. , Tudor Elena , Grallert Harald , Illig Thomas
Published: October 2020

BACKGROUND: Host immunity is essential for efficient recognition and clearance of M. tuberculosis infection. Polymorphisms in genes that regulate immune response have been reported to influence the susceptibility/resistance to pulmonary tuberculosis (TB). Here we evaluated associations between 14 polymorphisms in 12 core genes involved in immune responses and pulmonary TB in Moldavian population, and investigated whether interactions between these and previously analyzed polymorphisms could exist and modulate the risk of pulmonary TB.METHODS: Polymorphisms VDR rs7975232, VDR rs1544410, VDR rs2228570, MR1 rs1052632, TLR1 rs5743618, TLR2 rs111200466, TLR10 rs11096957, SLC11A1 rs2276631, IL1B rs1143643, IL10 rs1800896, IFNG rs2430561, TNF rs1800629, IRAK1 rs1059703, and FOXP3 rs2232365 were genotyped in 271 Moldavian pulmonary TB cases and 251 community-matched healthy controls. Associations were tested using Fisher test and logistic regression. Complemented with the data from our previous study (PMID: 30529560), investigation of gene-gene interactions was performed for a total of 43 loci. Significance level was adjusted by the Bonferroni correction.RESULTS: Single polymorphism analysis revealed a nominal association between TNF rs1800629 and pulmonary TB (Fisher exact test p-value = 0.01843). Marginal differences between cases and controls were observed for haplotypes in the gene cluster TLR1-TLR6-TLR10 and gene TLR2. In the pairwise interaction analysis, the combination of genotypes TLR6 rs5743810 GA and TLR10 rs11096957 GT was significantly associated with an increased genetic risk of pulmonary TB (OR = 2.48, 95% CI = 1.62–3.85; Fisher exact test p-value = 1.5 x 10-5, significant after Bonferroni correction).CONCLUSION: The TLR6 rs5743810 and TLR10 rs11096957 two-locus interaction confers a significantly higher risk for pulmonary TB and has potential as a novel biomarker for predicting TB susceptibility.
CT Imaging Characteristics Correlated with Overall Survival Time in Patients with AIDS-Related non-Hodgkin’s Lymphoma
Authors: Li Xueqin , Pan Ziang , Zheng Meizhu , Hu Tianli , Wang Xing , Li Li , Ye Wen , Jiang Dongmei , Liu Song , Tang Ruowei , Qi Ziyu , Shen Wen , Liu Jinxin , Shi Yuxin , Xia Shuang , Li Hongjun
Published: October 2020

Background CT can provide useful information for treatment regimens and prognosis prediction of patients with AIDS-related non-Hodgkin’s lymphoma (AR-NHL). It is necessary to investigate the prediction of CT imaging and clinical characteristics for overall survival (OS) in patients with AR-NHL.Methods Data of 121 AR-NHL patients [median age: 41 (range 22-78), 112 male] between July 2012 and November 2019 were retrospectively reviewed. Patients were divided into two groups by median OS time and data were compared between two groups. K-M survival analysis and Cox proportional hazards regression analysis were used to determine the prognostic risk factors for OS.Results The median OS time was 17 months. In the K-M survival analysis, presence of extracapsular infiltration (p=0.032), necrosis (p=0.005), CD4 ≤ 100 cells/μL (p=0.020), period from finding mass to admission﹥1 month (p=0.013), without chemotherapy (p﹤0.001), liver involved (p﹤0.001), gastrointestinal tract involved (p=0.015) and mediastinal or hilar lymph nodes involved (p=0.022) were associated with shorter OS. In the multivariate Cox regression analysis, liver involved (HR=2.48, 95%CI 1.45–4.25, P=0.001), mediastinal or hilar lymph nodes involved (HR=1.70, 95%CI 1.02–2.83, P=0.042), necrosis in lesion (HR=2.02, 95%CI 1.21–3.36, P=0.007) and CD4 ≤ 100 cells/μL (HR=2.66, 95%CI 1.42–4.98, P=0.002) were independently risk factors for shorter OS. Chemotherapy (HR=0.48, 95%CI 0.26–0.89, P=0.020) was independently protective factor for shorter OS. The predictive models based on Cox regression has good discrimination (Harrell’s C-index=0.716) and good calibration (Hosmer-Lemeshow test, p=0.620). Conclusion When the tumor had necrosis and extracapsular infiltration, involvement of mediastinal or hilar lymph nodes, liver, gastrointestinal tract in CT images, the overall prognosis was poor. And intensive chemotherapy regimens and more frequent follow-up should be considered.
Primary sinonasal renal cell-like adenocarcinoma: a case report and review of the literature
Authors: Gou Xiaoxia , Wang Yanzhe , Chen Fang , Liu Xiaoli , Ruan Peigang , Tian Xin , Wu Jinzhi , Ma Hu
Published: October 2020

BackgroundPrimary sinonasal renal cell-like adenocarcinoma (SNRCLA) is an extremely rare neoplasm with unique clinical and pathological features. At present, there is no summary of its clinical and pathological characteristics. We treated one case and reported to here. Review the domestic and foreign literature, summarize its clinical pathological characteristics and diagnosis and treatment.CaseA 69-year-old female presented with repeated epistaxis, nasal obstruction of 2-years’ duration. Computed tomography (CT) was performed revealing an irregular mass of the right nasal cavity involving choana and nasopharynx. The patient was treated with endonasal endoscopic resection. Histologically, SNRCLA was very similar to clear cell renal cell carcinoma (RCC), the tumor cells were round or polygonal in size with abundant clear cytoplasm and uniform nuclei. The tumor cells positive for CK7, Vimentin, EMA, S-100, Ki-67 (5% +) and negative for CEA, P53, P63 by immunohistochemical staining,. The patient is free from recurrence over 27 months after the surgery.ConclusionSNRCLA seems to be a low-grade localized carcinoma associated with favorable prognosis. Surgical resection is recommended as the main stay of treatment.
Efficacy and Safety of Arbidol in Treatment of Patients with COVID-19 Infection: A Randomized Clinical Trial
Authors: ghaderkhani Sara , khaneshan Arezoo salami , Salami Amir , alavijeh Parvaneh ebrahimi , Kouchak Hamid Emadi , khalili Hossein , Naghi Seyed Ahmad Ali , Ahmadinejad Zahra , Rasolinejad Mehrnaz , Hajiabdolbaghi Mahboubeh , Jafari Sirous , Hasannezhad Malihe , Seifi Arash , abasian Ladan , ghiasvand fereshte , Avanaki Foroogh Alborzi , edalatifard Maryam , Rahimi Mojgan
Published: October 2020

Background: The outbreak of 2019-novel coronavirus has led to a high demand for finding effective antiviral agents. Preliminary experiments showed that Arbidol could inhibit coronavirus replication in vivo. There is limited data on the clinical efficacy of 2019-novel coronavirus-infected pneumonia (NCP). Therefore, we aimed to evaluate this medication based on clinical and laboratory results.Methods: The present study was designed as a clinical trial to investigate the advantages and disadvantages of this medicine compared to empirical treatment. For this purpose, multi-stage sampling was considered. 56 people were selected by accidental non-random sampling method. This sample size was subsequently divided into two groups by randomized block sampling (1:1). During the study, three patients left the case group. Their clinical symptoms were examined while taking these medicines in the disease course. The SPSS software was used for data analysis and the significance level was considered to be P<0.05.Results: On the seventh day, there were statistically significant differences in dry cough(p = 0.001), weakness(p = 0.004), gastrointestinal symptoms(p = 0.043) and shortness of breath (p = 0.001) between the two groups, and the Arbidol group had a faster recovery. During the disease course, there were statistically significant differences in Myalgia(p = 0.03), gastrointestinal symptoms(p = 0.047), and weakness(p = 0.007) were significantly different between the two groups.Conclusion: Symptoms improved faster in patients with mild to moderate disease who received Arbidol in their treatment regimen. In other words, adding Arbidol to the empirical treatment accelerated the recovery process of patients’ clinical symptoms.Registration: IR.TUMS.VCR.REC.1399.204, 04.13.2020 , http://ethics.research.ac.ir/IR.TUMS.VCR.REC.1399.204
Energy Cost of Walking and Functional Aerobic Capacity During Moderate Intensity Exercise in Adults with Obstructive Sleep Apnea: A Cross-Sectional Study
Authors: Aldhahi Monira Ibrahim , Puri Shipra , Jain Vivek , Herrick Jeffrey E.
Published: October 2020

Background: Autonomic dysregulation associated with obstructive sleep apnea (OSA) may limit cardiopulmonary responses to exercise which, in turn, may impair functional aerobic capacity (FAC) and walking economy. We aimed to characterize walking economy and FAC in OSA patients compared with healthy adults (non-OSA) and examine their relationship with OSA severity (apnea-hypopnea index [AHI]). Participants: In this cross-sectional study, a total of 26 adults (OSA: n=13; non-OSA: n=13) participated in the study. In this study, the participants with OSA were adults between the ages of 25 and 60 with a body mass index between 25 kg/m2 and 39 kg/m2 who had undergone a recent third-party sleep study with an AHI of 5 or greater. Methods: Participant completed a maximal integrated cardiopulmonary exercise test, three separate exercise bouts of a constant work rate (CWR) treadmill test at 85% of anaerobic threshold (AT), and a 10-minute walk test (10MWT). Multiple linear regression corrected for weight, age, and BMI was conducted to examine the associations. Results: There were significant differences between OSA and Non-OSA participants in VO2peak (29.7±5.6mL/kg/min vs. 37.5±6.5mL/kg/min, p=0.03) and in Net VO2 during CWR (12.7±5 vs.19±6mL/kg/min, p=0.02). The 10MWT speed, distance, and energy expenditure were significantly lower in the OSA group (all p<0.001). The AHI scores associated with 10MWT distance (R2=0.85, p<0.001), energy cost of walking (R2=87, p<0.001), VO2 at anaerobic threshold (R2=0.92, p<0.001). Conclusions: The findings of this study show that patients with OSA have reduced FAC and have a higher energy cost of walking. AHI explained 87% of the variance in the energy cost of walking during the 10MWT. The results suggest that individuals with more severe obstructive sleep apnea experience greater impairment in functional performance.
Fatal Cross-Border Plague in Zombo District, Uganda, March 2019
Authors: Gonahasa Doreen Nsiimire , Amia Winifred C , Basuta Bernadette M. , Nabatanzi Sandra , Kwesiga Benon , Bulage Lilian , Ario Alex R. , Ocom Felix , Harris Julie R. , Zhu Bao-Ping
Published: October 2020

Background: Plague, which is caused by Yersinia pestis, is a priority zoonotic disease targeted for elimination in Uganda. Untreated bubonic plague, resulting from a flea bite, can develop into pneumonic plague, or pneumonic plague may be transmitted in respiratory droplets from person to person. On 6 March 2019, the Uganda Ministry of Health was notified of a patient in Zombo District with clinical presentation similar to pneumonic plague, and a positive plague rapid diagnostic test (RDT). The patient had family links to the Democratic Republic of Congo (DRC). We determined the scope of the outbreak, determined the mode of transmission, and recommended evidence-based control and prevention measures.Methods: A suspected pneumonic plague case was ≥2 of: cough (bloody or wet), chest pain, difficulty in breathing, or fever in a resident of Zombo District during February 1-March 31, 2019. A confirmed case was a suspected case testing positive for Yersinia pestis by rapid diagnostic test, culture or serology. We actively searched for case-patients, traced contacts and took samples as appropriate. We performed descriptive epidemiology of the outbreak.Results: We identified one suspected and one confirmed pneumonic plague case. On February 26, 2019, a 4-year-old boy was buried in DRC near the Uganda border after reportedly succumbing to a disease consistent with bubonic plague. Case-patient A (35-year-old mother to the boy), fell ill with suspected pneumonic plague while attending to him. She was referred to a health facility in Uganda on February 28 but died on arrival. On March 4, Case-patient B (23-year-old sister to Case-patient A), who attended to Case-patient A, presented with pneumonic plague symptoms to the same Uganda facility and tested plague-positive by RDT, culture, and serological tests. Contacts (n=114) were traced and given antibiotics as prophylaxis; no new cases were reported.Conclusion: This fatal plague outbreak started as bubonic and later manifested as pneumonic. There was cross-border spread from DRC to Uganda with no cross-border efforts at prevention and control. Person-to-person transmission appears to have occurred. The quick and effective response likely minimized spread.
A Magnatic Resonance Imaging Morphometric Study of Lumbar Epidural Fat Distribution: Implications for Lumbar Epidural Lipomatosis
Authors: Jiang Haowei , Wang Yongli , Nie Jiangbo , Jin Mingchao , Fang Tianshun , Jiang Xuesheng
Published: October 2020

Background. To the best of our knowledge, no published English literatures has provided detailed parameters about the normal epidural fat and other contents in lumbar spinal canal. Our objective was to quantify reference data of epidural fat and the contents of lumbar spinal canal to guide the diagnosis of lumbar epidural lipomatosis.Methods. 178 content lumbar MRI cases were analysis on Picture Archiving and Communication Systems (PACS).Results. the mean anteroposterior ( AP ) diameters ± standard deviation(SD) of lumbar vertebral body ( V )、dural sac ( DS )、epidural fat ( EF ) each measured lever on the mid-sagittal MRI and the mean cross-sectional area ± SD of lumbar spinal canal ( SC )、DS of each measured lever on the axial MRI were showed. The mean AP diameters of V and DS are showed obvious significant difference between men and women ( P ＜0.05). The mean AP diameters of EF is showed no significant difference between men and women (P ＞0.05). Also The mean area of lumbar SC (male 316.7 mm2, female 306.4 mm2 ) and DS (male 198.6 mm2, female 189.2 mm2) are showed obvious significant difference between men and women ( P ＜0.05). The growth trend of the thickness of epidural fat in lumbar spinal canal is showed.Conclusion. Our investigation provides insight into the anatomy of epidural fat and gives the relevant parameters of lumbar spinal canal and its contents on MRI. MRI is the most sensitive imaging test to diagnose lumbar epidural lipomatosis
Cross-Cultural Adaptation, Validity and Reliability of The Chinese Version of Miller Behavioral Style Scale
Authors: Zhuo Qiqi , Cui Changsheng , Liang Hongmin , Bai Yangjuan , Hu Qiulan , Hanum Ardani Latifah , Yang MingFang , Wang Yanjiao , Wei Wei , Ding Lan , Ma Fang
Published: October 2020

Background: Health education basing on patients’ information-seeking style can improve the effect of health education and patients’ health outcomes. The Miller Behavioral Style Scale(C-MBSS) is widely used, but the Chinese version is lacking. The study aim was to test the reliability and validity of C-MBSS.Methods: The forward-back-translation procedure was adopted in the translation of the MBSS. Content validity was assessed in a panel of experts. In a sample of 1343 individuals including patients, patients’ caregivers, university students, and medical staff, reliability and construct validity were assessed using Cronbach’s alpha coefficient and factor analysis.Results: The C-MBSS achieved conceptual and semantic equivalence with the original scale. The item-level content validity index (I-CVI) of each item ranged from 0.78 to 1, and the averaging scale-level content validity index (S-CVI/ Ave) was 0.95. Thecronbach`s alpha coefficient for the scale and sub-scales were over 0.6. The exploratory factor analysis resulted in 2-factor assumption for each hypothetical threat-evoking scenario. Confirmatory factor analysis demonstrated a good fit between theoretical model and data, which provided confirmatory evidence for the second-order factor structure of 2-factor solution (Monitoring and Blunting).Conclusions: This study verified the reliability and validity of the C-MBSS and indicated that the C-MBSS can be used to identify individual`s information-seeking style in Chinese population.
An Integrated Primary Care Workforce Planning Toolkit at The Regional Level (Part 2) Quantitative Tools Compiled for Decision-Makers in Toronto, Canada
Authors: Simkin Sarah , Chamberland-Rowe Caroline , Bourgeault Ivy Lynn
Published: October 2020

Background: Health workforce planning capability at a regional level is increasingly necessary to ensure that the healthcare needs of defined local populations can be met by the health workforce. In 2016, a regional health authority in Toronto, Canada identified a need for more robust health workforce planning infrastructure and processes. The goal of this project was to develop an evidence-informed toolkit for integrated, multi-professional, needs-based primary care workforce planning for the region. This article presents the quantitative component of the workforce planning toolkit and describes the process followed to develop this tool.Methods: We first developed a framework for quantitative health workforce planning to assess the alignment of regional service requirements with the service capacity of the workforce. We then conducted an environmental scan to identify datasets addressing population health need and profession-specific health workforce supply that could contribute to quantitative health workforce modeling. We assessed these sources of data for comprehensiveness, quality, and availability.Results: The quantitative model developed as part of the toolkit includes components relating to both population health need and health workforce supply. Different modules were developed to capture the information, including an allocation process for optimizing service delivery. Only data elements meeting criteria for quality, availability, and comprehensiveness were integrated into the model.Conclusions: A quantitative health workforce planning model is a necessary component of any health workforce planning toolkit. In combination with qualitative tools, it supports integrated, multi-professional, needs-based primary care workforce planning.
Altered oligodendroglia and astroglia in chronic traumatic encephalopathy
Authors: Chancellor K. Blake , Chancellor Sarah E. , Duke-Cohan Joseph E. , Huber Bertrand R. , Stein Thor D. , Alvarez Victor E. , Okaty Benjamin W. , Dymecki Susan M. , McKee Ann C.
Published: October 2020

Chronic traumatic encephalopathy (CTE) is a progressive tauopathy found in contact sport athletes, military veterans, and others exposed to repetitive head impacts (RHI)1–6. White matter atrophy and axonal loss have been reported in CTE but have not been characterized on a molecular or cellular level2,7,8. Here, we present RNA sequencing profiles of cell nuclei from postmortem dorsolateral frontal white matter from eight individuals with neuropathologically confirmed CTE and eight age- and sex-matched controls. Analyzing these profiles using unbiased clustering approaches, we identified eighteen transcriptomically distinct cell groups (clusters), reflecting cell types and/or cell states, of which a subset showed differences between CTE and control tissue. Independent in situ methods applied on tissue sections adjacent to that used in the single-nucleus RNA-seq work yielded similar findings. Oligodendrocytes were found to be most severely affected in the CTE white matter samples; they were diminished in number and altered in relative proportions across subtype clusters. Further, the CTE-enriched oligodendrocyte population showed greater abundance of transcripts relevant to iron metabolism and cellular stress response. CTE tissue also demonstrated excessive iron accumulation histologically. Astrocyte alterations were more nuanced; total astrocyte number was indistinguishable between CTE and control samples, but transcripts associated with neuroinflammation were elevated in the CTE astrocyte groups as compared to controls. These results demonstrate specific molecular and cellular differences in CTE oligodendrocytes and astrocytes and may provide a starting point for the development of diagnostics and therapeutic interventions.
Traumatic Brain Injury Accelerates the Onset of Cognitive Dysfunction and Aggravates Alzheimer’s-like Pathology in the Hippocampus by Altering the Phenotype of Microglia in APP/PS1 Mouse Model
Authors: Wu Di , Kumal Jay Prakash Prasad , Lu Xiaodi , Li Yixuan , Mao Dongsheng , Tang Xudong , Nie Meitong , Liu Xin , Sun Liang , Liu Bin , Zhang Yafang
Published: October 2020

Background: There are increasing studies suggest that Traumatic Brain Injury(TBI) might be the cause of some neurodegenerative diseases, including Alzheimer’s Disease(AD). The mechanism of AD induced by TBI has also been elucidated from sorts of aspects. However, there are also researches which opponent to the viewpoint that TBI is the reason of AD. In this study, we investigate whether and how could TBI accelerated the Alzheimer’s-like pathology and cognitive dysfunction in APP/PS1 mice.Method: The traumatic brain injury model was established in adult male APP/PS1 and C57BL/6 mice. At the 29th and 30th day post-TBI, Novel object and novel position recognition test were performed to test the learning and memory function. After cognitive function test, all the mice were sacrificed with PBS perfusion to anatomize the brain for histopathological study. To determine whether the Alzheimer’s-like pathology and the synaptic function decline can be accelerated by TBI, HE staining, IF staining and IHC staining were performed to detect the cell density in the brain, the degree of Aβ-plaques deposition in the brain, and SYP expression in the brain. We also examined the activity and the phenotype of microglia by IF staining and western-blotting the after the 1st, 2nd, 3rd and 4th week of TBI.Result: In current study, we showed that, on the one hand, TBI impaired the hippocampal-dependent learning and memory, decreased the cell density in the brain, disturbed the synaptic function in the brain, aggravated Aβ-plaques deposition in the hippocampus. On the other hand, TBI also quickly activated microglia in the CNS and altered the phenotype of microglia polarizing to a pro-inflammatory direction. The duration of activation of microglia post-TBI can be at least 3 weeks. We also found that microglia activity was related to the deposition of Aβ-plaques in the specific region of hippocampus. Conclusion: Our experiment suggested that TBI accelerate the onset of cognitive dysfunction and Alzheimer’s-like pathology in APP/PS1 mouse model by altering microglia polarizing direction to mostly exhibiting pro-inflammatory phenotype.
Dip Angle Effect on the Main Roof First Fracture and Instability in a Fully-mechanized Workface of Steeply Dipping Coal Seams
Authors: Wei Zhen , Yang Ke , Chi Lou Xiao , Zhao Xin Yuan , Lv Xin
Published: October 2020

The study of fracture and instability mechanism of the main roof in steeply dipping coal seams (SDCS) workface is crucial to the proper choice of support type and control of stability of surrounding rock, as well as the safe and effective mining in the coal seam. Based on the established SDCS main roof model, this study derived the stress distribution in the main roof under linear load, analyzed the dip angle effect associated with the evolving stress of SDCS workface, and elaborated the sequential characteristics of the ground pressure mechanism. Besides, an inclined unstable structure model of the main roof based on deformation, fracturing, and rotating of the main roof in the SDCS workface was also proposed here, which explained the impacts of overburden rock's key parameters on sliding and rotatory instability of rock mass. In light of the analysis of the movement rule of overburden rock and loading condition of support, it is found that, when the roof and floor in the workface are stable, the critical support resistance with the absence of sliding and rotating increases as the dip angle of coal seam increases, the roof is in the state of discontinuous movement due to its self-weight and overburden pressure. Support is affected by the discontinuous movement and moved along with the roof. The results of this study can be of theoretical reference to the control of SDCS.
Comparing Neoadjuvant Long-Course Chemoradiotherapy With Short-Course Radiotherapy in Rectal Cancer
Authors: Wang Jian , Long Yiwen , Liu Kun , Pei Qian , Zhu Hong
Published: October 2020

BackgroundThe purpose of this study was to compare short-course radiotherapy (SC) or neoadjuvant long-course chemoradiotherapy (LC) treatment for locally advanced rectal cancer patients.MethodsPatients with a diagnosis of locally advanced rectal cancer (LARC) who had undergone neoadjuvant radiotherapy before surgery between 2013 and 2018 at the medical center in China were included in this study. All patients’ MRI confirmed T2N+M0 or T3-4N0-3M0 clinical stages. Patients in the SC group received pelvic radiotherapy with a dose of 5×5 Gy (with or without chemotherapy at any time), followed by immediate or delayed surgery. Patients in the LC group received a dose of 50-50.4 Gy in 25-28 fractions, concomitantly with FOLFOX or capecitabine-based chemotherapy, followed by surgery 4-6 weeks later. All clinical data were retrospectively collected, and long-term follow-up was completed and recorded at the same time.ResultsA total of 170 were eligible to participate in this study, 32 patients in the SC group, and 138 in the LC group. The median follow-up time of living patients was 39 months. The disease-free survival (DFS) and overall survival (OS) rates in the SC group and LC group at 3 years, were, 84.9% versus 72.4% (P= 0.273) and 96.2% versus 87.2% (P= 0.510), respectively. The complete pathological response (pCR) rates in the SC group and LC group were, 25% versus 18.1% (the difference was not statistically significant, P=0.375), respectively. However, the SC group had better node(N) downstaging compared to the LC group (P=0.011).ConclusionsThere were no differences observed in DFS and OS between short-course radiotherapy and long-course chemoradiation, and both can be used as treatment options for patients with locally advanced rectal cancer.
Skin RT-QuIC Assays are More Sensitive than CSF RT-QuIC in Prion Detection for Chinese Probable Sporadic Creutzfeldt-Jakob Disease
Authors: Xiao Kang , Yang Xue-Hua , Zhou Wei , Chen Cao , Appleby Brian S , Zou Wen-Quan , Dong XiaoPing , Shi Qi
Published: October 2020

BackgroundThe definite diagnosis of human sporadic Creutzfeldt-Jakob disease (sCJD) largely depends on postmortem neuropathology and PrPSc detection in the brain. The development of prion RT-QuIC of cerebrospinal fluid (CSF) samples makes it possible for premortem diagnosis for sCJD. However the diagnostic potential of RT-QuIC of skin specimen for probable sCJD is not well researched. This study is to evaluate the diagnostic potential of RT-QuIC of skin specimen in human prion diseases.MethodsWe collected the paired skin and CSF samples from 29 recruited alive patients referred to Chinese CJD surveillance center, including 12 probable sCJD, 9 non-CJD, 3 genetic prion disease (gPrD) and 5 cases whose diagnoses still pending. The samples were subjected to RT-QuIC assays using recombinant hamster PrP protein rHaPrP90-231 as the substrate.ResultsAll 12 probable sCJD patients, 4 pending, and 1 T188K genetic CJD (gCJD) cases showed positive prion-seeding activity, while all 9 non-CJD patients were negative. CSF RT-QuIC positive seeding activity was only observed in 5 probable sCJD patients.ConclusionsOur preliminary data indicate high sensitivity and specificity of skin RT-QuIC in prion detection for Chinese probable sCJD and highlight that skin prion-seeding activity is a reliable biomarker for premortem diagnosis of human prion disease.
Spatio-Temporal Impacts of Aerial Adulticide Applications on Populations of West Nile Virus Vector Mosquitoes
Authors: Holcomb Karen M. , Reiner Robert C. , Barker Christopher M
Published: October 2020

Background: Aerial applications of insecticides that target adult mosquitoes are widely used to reduce transmission of West Nile virus to humans during periods of epidemic risk. However, estimates of the reduction in abundance following these treatments typically focus on single events and can vary widely due to stochastic variation in population dynamics and trapping success unrelated to the treatment.Methods: To overcome these limitations and assess real-world efficacy using observational data from 12 years of vector control operations, we fitted generalized additive models to mosquito surveillance data from CO2-baited traps in Sacramento and Yolo counties, California from 2006-2017. The models accounted for the expected spatial and temporal trends in the abundance of adult female Culex tarsalis and Culex pipiens in the absence of aerial spraying. Estimates for the magnitude of deviation from baseline abundance following aerial spray events were obtained from the models.Results: One-week post-treatment with pyrethroid or pyrethrin products, Cx. pipiens abundance was reduced by a mean of 52.4% (95% CI: -65.6, -36.5%) while the use of at least one organophosphate pesticide resulted in a 76.2% (95% CI: -82.8, -67.9%) reduction. For Cx. tarsalis one-week post-treatment resulted in a 30.7% (95% CI: -54.5, 2.5%) reduction; pesticide class was not a significant factor for this species. Repetition of spraying over three to four consecutive weeks resulted in similar estimates for Cx. pipiens and a somewhat smaller magnitude for Cx. tarsalis.Conclusions: Aerial adulticides are effective for rapid short-term reduction of the abundance of the primary West Nile virus vectors, Cx. tarsalis and Cx. pipiens. A larger magnitude of reduction is estimated for Cx. pipiens, possibly due to the species’ focal distribution. Effects of aerial sprays on Cx. tarsalis populations are likely moderated by the species’ large dispersal ability, population sizes, and vast productive larval habitat present in the study area. Our modeling approach provides a way to estimate effects of public-health pesticides on vector populations using real-world observational data and accounting for contextual factors like spatio-temporal relationships, weather, and habitat and expands upon past studies that have focused on effects of individual aerial treatment events.
Merozoites of Theileria Orientalis Buffeli Reduce Parasitosis Following Challenge by Ticks Infested with T.Orientalis Ikeda
Authors: Emery David , Burgh Susan de , Dinh Therese Hoang Hieu Hanh , Rolls Peter , Carter Phillip
Published: October 2020

Background: An investigation aimed to confirm whether immunisation with the “benign” buffeli genotype of Theileria orientalis could reduce the parasitosis of the virulent ikeda genotype. Methods: Calves were inoculated intravenously or subcutaneously with bovine blood containing merozoites of T.orientalis buffeli. When recipients became positive, they and control animals were challenged with unfed nymphs of Haemaphysalis longicornis ticks infested as larvae with T.orientalis ikeda. Results: All calves became positive for the challenge within 12 days after tick application. In the immunised calves, the first wave of parasitosis with T.orientalis ikeda from 4-6 weeks was reduced significantly by >80% before the infestation declined into the carrier state by 9 weeks. Conclusions: The results confirm the field experience with theileriosis in endemic zones where the carrier state appears to prevent clinical disease despite repeated, seasonal tick infestations with virulent genotypes of the parasite. This method offers a means to reduce the severity of the first wave of theilerial parasitosis after tick challenge and recover associated production losses.