bluuebunny/crossref_metadata_2025 huggingface dataset:
Diversity of Immobilized Bacterial Communities and Nitrates Removal by Instantaneous Heterotrophic Denitrification Treating Nitrate-Polluted Water Using 3D-BERs-GAC: Effects of pH and COD/NO3- -N Ratio
Authors: Hassan Mahdi , Zhu Guangcan , Yang Zhonglian , Lu Yongze , Shan Huang
Published: July 2020

In this study, a three-dimensional bioelectrochemical reactor system (3D-BERs) with granular activated carbon (GAC) epitomizes a novel treatment technology for treating nitrate-polluted water. The conventional denitrification process faces many challenges, including the huge demand for organic carbon, long-term accumulation of intermediate products, and the adaptation period. Results shown that under the optimal conditions of the COD/NO3--N ratio was 1.5, the denitrification efficiency reached 98.62%, when compared to 81.12% at COD/ NO3--N ratio of 3.5, and the initial pH of 7.5 ± 0.5, NO3--N was entirely removed at 2.2 h without accumulation of nitrite. The high initial ratio of NO2--N/NO3--N is mainly to accelerate the denitrification rate by accelerating the reduction of nitrite. Denitrification process followed by zero-order kinetics linear model for at different concentrations of inlet NO3--N, and achieved higher denitrification rate at greater inlet NO3--N concentration. High-throughput sequencing shows that the community structure and relative abundance of bacteria changed significantly, especially at the genes and the phyla level in immobilized GAC particles. Microbial composition enhanced the removal of nitrogen at the inner surface (IS) and bottom surface (BS) of immobilized GAC carriers. Therefore, this system is expected to be a more efficient and useful supplement or a cost-effective alternative compared to the traditional low carbon to nitrogen wastewater treatment system.
Advokat dan Hukum Ekonomi di Indonesia
Authors: Naim Abdul Haris
Published: July 2020

The role of law graduates in Indonesia is very important in overcoming problems that exist in society when working as an advocate. But sometimes the profession sometimes gets a slanted view in the middle of society. This is due to the lack of literacy from the general public. Important advocates need to be considered because in addition to providing legal advice by defending the rights of suspects in criminal and civil cases. In criminal cases, the client's interests are subjectively separated from the law, even though the suspect realizes that he made a mistake. Almost never heard of a voluntary criminal willing to be convicted. So the role of advocates in upholding economic law in Indonesia is really needed. Without the role of an advocate, law enforcement, especially those relating to economic law will not be enforced.
Penguatan Sektor Pertanian Melalui Bank Wakaf Tani Berbasis Mudharabah
Authors: Istikomah Istikomah
Published: July 2020

Salah satu filantropi Islam yang berkembang pada saat ini adalah wakaf tunai. Wakaf tunai dinilai memiliki tingkat fleksibilitas yang lebih tinggi dibandingkan dengan wakaf tradisional. Di Indonesia, praktek pemberdayaan wakaf masih belum optimal. Paradigma masyarakat tentang wakaf masih terbatas pada persoalan ibadah. Untuk mendorong giat berwakaf tunai di masyarakat, tidak cukup dilakukan dengan cara sosialisasi dan edukasi. Pemerintah harus memberikan keteladanan berwakaf tunai kepada masyarakat. Dengan menggunakan metode eksploratif, penulis menyajikan konsep keteladanan pemerintah melalui Bank Wakaf Tani untuk menguatkan sektor pertanian di Indonesia. Konsep Bank Wakaf Tani merupakan wakaf tunai dari Kementerian Pertanian yang diperuntukkan bagi petani kurang mampu. Dengan skema mudharabah, Bank Wakaf Tani diharapkan mampu menjadi mitra bagi petani untuk menuju kesejahteraan. Secara keseluruhan makalah ini memiliki misi untuk mendorong model-model pemberdayaan wakaf tunai untuk dapat menjadi acuan pemberdayaan wakaf tunai dalam rangka meningkatkan kesejahteraan bangsa.
Short-term Outcomes of Robotic- versus Laparoscopic-Assisted Total Gastrectomy for Advanced Gastric Cancer: A Propensity Score Matching Study
Authors: Yang Changdong , Shi Yan , Xie Shaohui , Chen Jun , Zhao Yongliang , Qian Feng , Hao Yingxue , Tang Bo , Yu Pei-Wu
Published: July 2020

Background: Few studies have been designed to evaluate the short-term outcomes between robotic-assisted total gastrectomy (RATG) and laparoscopy-assisted total gastrectomy (LATG) for advanced gastric cancer (AGC). The purpose of this study was to assess the short-term outcomes of RATG compared with LATG for AGC. Methods: We retrospectively evaluated 126 and 257 patients who underwent RATG or LATG, respectively. In addition, we performed propensity score matching (PSM) analysis between RATG and LATG for clinicopathological characteristics to reduce bias and compared short-term surgical outcomes. Results: After PSM, the RATG group had a longer mean operation time (291.14±59.18 vs. 270.34±52.22 min, p=0.003), less intraoperative bleeding (154.37±89.68 vs. 183.77±95.39 ml, p=0.004) and more N2 tier RLNs (9.07±5.34 vs. 7.56±4.50, p=0.016) than the LATG group. Additionally, the total RLNs of the RATG group were almost significantly different compared to that of the LATG group (34.90±13.05 vs. 31.91±12.46, p=0.065).Moreover, no significant differences were found between the two groups in terms of the length of incision, proximal resection margin, distal resection margin, residual disease and postoperative hospital stay. There was no significant difference in the overall complication rate between the RATG and LATG groups after PSM (23.8% vs. 28.6%, p=0.390). Grade II complications accounted for most of the complications in the two cohorts after PSM. The conversion rates were 4.55% and 8.54% in the RATG and LATG groups, respectively, with no significant difference (p=0.145), and the ratio of splenectomy were 1.59% and 0.39% (p=0.253). The mortality rates were 0.8% and 0.4% for the RATG and LATG groups, respectively (p=1.000). Conclusion : This study demonstrates that RATG is comparable to LATG in terms of short-term surgical outcomes.
Estimating the number of usability problems affecting medical devices: modelling the discovery matrix
Authors: Vandewalle Vincent , Caron Alexandre , Delettrez Coralie , Périchon Renaud , Pelayo Sylvia , Duhamel Alain , Dervaux Benoit
Published: July 2020

Background. Usability testing of medical devices are mandatory for market access. The testings’ goal is to identify usability problems that could cause harm to the user or limit the device’s effectiveness. In practice, human factor engineers study participants under actual conditions of use and list the problems encountered. This results in a binary discovery matrix in which each row corresponds to a participant, and each column corresponds to a usability problem. One of the main challenges in usability testing is estimating the total number of problems, in order to assess the completeness of the discovery process. Today’s margin-based methods fit the column sums to a binomial model of problem detection. However, the discovery matrix actually observed is truncated because of undiscovered problems, which corresponds to fitting the marginal sums without the zeros. Margin-based methods fail to overcome the bias related to truncation of the matrix. The objective of the present study was to develop and test a matrix-based method for estimating the total number of usability problems.Methods. The matrix-based model was based on the full discovery matrix (including unobserved columns) and not solely on a summary of the data (e.g. the margins). This model also circumvents a drawback of margin-based methods by simultaneously estimating the model’s parameters and the total number of problems. Furthermore, the matrix-based method takes account of a heterogeneous probability of detection, which reflects a real-life setting. As suggested in the usability literature, we assumed that the probability of detection had a logit-normal distribution.Results. We assessed the matrix-based method’s performance in a range of settings reflecting real-life usability testing and with heterogeneous probabilities of problem detection. In our simulations, the matrix-based method improved the estimation of the number of problems (in terms of bias, consistency, and coverage probability) in a wide range of settings. We also applied our method to five real datasets from usability testing.Conclusions. Estimation models (and particularly matrix-based models) are of value in estimating and monitoring the detection process during usability testing. Matrix-based models have a solid mathematical grounding and, with a view to facilitating the decision-making process for both regulators and device manufacturers, should be incorporated into current standards.
Mood, Activity Participation, and Leisure Engagement Satisfaction (MAPLES): A randomised controlled pilot feasibility trial for low mood in acquired brain injury
Authors: Kusec Andrea , Murphy Fionnuala C. , Peers Polly V. , Lawrence Cara , Cameron Emma , Morton Claire , Bateman Andrew , Watson Peter , Manly Tom
Published: July 2020

Background: Acquired brain injury (ABI) affects approximately 79.3 million individuals annually and is linked with elevated rates of depression and low mood. Existing methods for treating depression in ABI have shown mixed efficacy. Behavioural Activation (BA) is a potentially promising intervention. Its premise is that individuals with low mood avoid planning and engaging in activities due to low expectations of a positive outcome. Consequently, their exposure to positive reinforcement is reduced, exacerbating low mood. BA aims to break this cycle by encouraging activity planning and engagement. It is unknown whether cognitive demands of traditional BA may undermine efficacy in ABI. Here we assess the feasibility and acceptability of two groups designed to increase activity engagement. In the Activity Planning Group (traditional BA) the importance of meaningful and positive activity will be discussed and participants encouraged to plan/engage in activities in everyday life. The Activity Engagement Group (experiential BA) instead focuses on engagement in positive experiences (crafts, games, discussion) within the group. The primary aims are to evaluate the feasibility and acceptability of the two groups in ABI. A secondary aim is to explore relative efficacy of the groups compared to an equivalent period of waitlist controls. Method: This study outlines a parallel-arm pilot feasibility trial for individuals with low mood and ABI that compares a traditional vs experiential BA group vs. waitlist controls. Adults (≥18 years) will be recruited from local ABI services and randomised to condition. Feasibility and acceptability will be assessed via recruitment, retention, attendance, and participant feedback. Groups will be compared (pre- and post-intervention and 1 month follow-up) by assessing self-reported activity engagement. Secondary outcomes include self-report measures of depression, anxiety, post-traumatic distress related to the ABI, motivation, participation, and sense of control over one’s life. Ethics and Dissemination: The trial has been approved by the Health Research Authority of the NHS in the UK (East of England – Cambridge Central, REF: 18/EE/0305). Results will inform future research on interventions for mood in ABI and be disseminated broadly via peer-reviewed journals, conference presentations, and social media.
The gut mycobiota of rural and urban individuals is shaped by geography
Authors: Kabwe Mubanga , Vikram Surendra , Mulaudzi Khodani , Jansson Janet , Makhalyane Thulani
Published: July 2020

Background Understanding the structure and drivers of gut microbiota remains a major ecological endeavour. Recent studies have shown that several factors including diet, lifestyle and geography may substantially shape the human gut microbiota. However, most of these studies have focused on the more abundant bacterial component and comparatively less is known regarding fungi in the human gut. This knowledge deficit is especially true for rural and urban African populations. Therefore, we assessed the structure and drivers of rural and urban gut mycobiota. Results Our participants (n=100) were balanced by geography and sex. The mycobiota of these geographically separated cohorts was characterized using amplicon analysis of the Internal Transcribed Spacer (ITS) gene. We further assessed biomarker species specific to rural and urban cohorts. In addition to phyla which have been shown to be ubiquitous constituents of gut microbiota, Pichia were key constituents of the mycobiota. We found that geographic location was a major driver of gut mycobiota. Other factors such as smoking where also determined gut mycobiota albeit to a lower extent, as explained by the small proportion of total variation. Linear discriminant and the linear discriminant analysis effect size analysis revealed several distinct urban and rural biomarkers. Conclusions Together, our analysis reveals distinct community structure in urban and rural South African individuals. Geography was shown to be a key driver of rural and urban gut mycobiota.
Tea consumption and measures of attention and psychomotor speed in the very old: The Newcastle 85+ Longitudinal Study
Authors: Okello Edward Jonathan , Mendonça Nuno , Stephan Blossom , Muniz-Terrera Graciela , Wesnes Keith , Siervo Mario
Published: July 2020

Background: A number of studies have indicated a beneficial effect of tea consumption on the reduction of risk of cognitive impairment and dementia in older aged populations. However, there is a paucity of data on these associations in the very old, defined as individuals aged 85 years and over. We investigated the relationship between tea consumption in the very old and measures of global cognitive function, memory, attention and psychomotor speed.Method: Longitudinal (5-years), population-based cohort study of individuals aged 85+ years in the North East of England, United Kingdom. Participants were community-dwelling and institutionalized men and women recruited through general medical practices (n=676). Baseline tea consumption and longitudinal measures of global and domain specific (memory, speed and attention) cognitive function were assessed. Linear mixed models, controlling for demographic (e.g. age, sex and education) and health variables were used to determine whether tea consumption was protective against cognitive decline.Results: Tea consumption was not associated with cognitive function at baseline on any measure (unadjusted and adjusted analyses). In the linear mixed effects models adjusted for age, sex, education and disease co-morbidity, higher tea consumption was associated with significantly better attention (focused and sustained attention), and psychomotor speed (complex tasks only) over five-years follow-up. However, there was no association between tea consumption and global cognitive function, memory or performance on simple speed tasks over time.Conclusions: In this cohort study of non-demented very old adults we found that higher (vs. lower) tea consumption was associated with better performance over time on measures of focused and sustained attention and some psychomotor speed tasks. No associations with global cognition, memory or easy speed tasks (simple Reaction Time or Word Recognition) were detected. The results have implications for the development of possible diet-based interventions focused on improving cognitive function in the very old age group. These findings need to be confirmed in a sufficiently powered and well-designed RCT with non-demented very old adults.
Feasibility and Efficacy of Lung Ultrasound to Investigate Pulmonary Complications in Patients Who Developed Postoperative Hypoxaemia-A Prospective Study
Authors: Xie Chen , Sun Kai , You Yueyang , Ming Yue , Yu Xiaoling , Yu Lina , Huang Jiapeng , Yan Min
Published: July 2020

Background: Postoperative pulmonary complications (PPCs) and hypoxaemia are associated with morbidity and mortality. We aimed to evaluate the feasibility and efficacy of lung ultrasound (LUS) to diagnose PPCs in patients suffering from hypoxaemia after general anaesthesia and compare the results to those of thoracic computed tomography (CT). Methods: Adult patients who received general anaesthesia and suffered from hypoxaemia in the postanaesthesia care unit (PACU) were analysed. Hypoxaemia was defined as an oxygen saturation measured by pulse oximetry (SPO2) less than 92% for more than 30 seconds under ambient air conditions. LUS was performed by two trained anaesthesiologists once hypoxaemia occurred. After LUS examination, each patient was transported to the radiology department for thoracic CT scan within 1 hour before returning to the ward. Results: From January 2019 to May 2019, 113 patients (61 men) undergoing abdominal surgery (45 patients, 39.8%), video-assisted thoracic surgery (31 patients, 27.4%), major orthopaedic surgery (17 patients, 15.0%), neurosurgery (10 patients, 8.8%) or other surgery (10 patients, 8.8%) were included. CT diagnosed 327 of 1356 lung zones as atelectasis, while LUS revealed atelectasis in 311 of the CT-confirmed zones. Pneumothorax was detected by CT scan in 75 quadrants, 72 of which were detected by LUS. Pleural effusion was diagnosed in 144 zones on CT scan, and LUS detected 131 of these zones. LUS was reliable in diagnosing atelectasis (sensitivity 98.0%, specificity 96.7% and diagnostic accuracy 97.2%), pneumothorax (sensitivity 90.0%, specificity 98.9% and diagnostic accuracy 96.7%) and pleural effusion (sensitivity 92.9%, specificity 96.0% and diagnostic accuracy 95.1%). Conclusions: Lung ultrasound is feasible, efficient and accurate in diagnosing different aetiologies of postoperative hypoxia in healthy-weight patients in the PACU.
UBR-Box containing protein, UBR5, is over-expressed in human lung adenocarcinoma and is a potential therapeutic target
Authors: Saurabh Kumar , Shah Parag P , Doll Mark , Siskind Leah J , Beverly Levi J.
Published: July 2020

Background: N-end rule ubiquitination pathway is known to be disrupted in many diseases, including cancer. UBR5, an E3 ubiquitin ligase, is mutated and/or overexpressed in human lung cancer cells suggesting its pathological role in cancer. Methods: We determined expression of UBR5 protein in multiple lung cancer cell lines and human patient samples. Using immunoprecipitation followed by mass spectrometry we determined the UBR5 interacting proteins. The impact of loss of UBR5 for lung adenocarcinoma cell lines was analyzed using cell viability, clonogenic assays and in vivo xenograft models in nude mice. Additional Western blot analysis was performed to assess the loss of UBR5 on downstream signaling. Statistical analysis was done by one-way ANOVA for in vitro studies and Wilcoxon paired t-test for tumor volumes in vivo. Results: We show variability of UBR5 expression levels in lung adenocarcinoma cell lines and in primary human patient samples. To gain better insight into the role that UBR5 may play in lung cancer progression we performed unbiased interactome analyses for UBR5. Data indicate that UBR5 has a wide range of interacting protein partners that are known to be involved in critical cellular processes such as DNA damage, proliferation and cell cycle regulation. We have demonstrated that shRNA-mediated loss of UBR5 decreases cell viability and clonogenic potential of lung adenocarcinoma cell lines. In addition, we found decreased levels of activated AKT signaling after the loss of UBR5 in lung adenocarcinoma cell lines using multiple means of UBR5 knockdown/knockout. Furthermore, we demonstrated that loss of UBR5 in lung adenocarcinoma cells results in significant reduction of tumor volume in nude mice. Conclusions: These findings demonstrate that deregulation of the N-end rule ubiquitination pathway plays a crucial role in the etiology of some human cancers, and blocking this pathway via UBR5-specific inhibitors, may represent a unique therapeutic target for human cancers.
Nasopharyngeal Microbiota Profiling of SARS-CoV-2 Infected Patients
Authors: De Maio Flavio , Posteraro Brunella , Ponziani Francesca Romana , Cattani Paola , Gasbarrini Antonio , Sanguinetti Maurizio
Published: July 2020

We analyzed the bacterial communities of the nasopharynx in 40 SARS-CoV-2 infected and uninfected patients. All patients had a mild COVID-19 disease. We did not find statistically significant differences in either bacterial richness and diversity or composition. These findings suggest a nasopharyngeal microbiota at least early resilient to SARS-CoV-2 infection.
Evaluation of risk factors of vertebral fracture in Japanese female patients with glucocorticoid-induced osteoporosis
Authors: Mori Yu , Izumiyama Takuya , Baba Kazuyoshi , Mori Naoko , Fujii Hiroshi , Ishii Tomonori , Itoi Eiji
Published: July 2020

Background Glucocorticoid-induced osteoporosis and vertebral fracture are common complications in patients on glucocorticoid treatment for rheumatological diseases. The present study aimed to identify the risk factors of vertebral fracture in Japanese female patients with glucocorticoid-induced osteoporosis.Methods This study included 225 Japanese women with glucocorticoid-induced osteoporosis and 72 patients with postmenopausal osteoporosis. All participants were treated with bisphosphonate or denosumab for osteoporosis with active form of vitamin D for at least 3 years. The differences of clinical parameters, including age, disease duration, body mass index (BMI), bone mineral density (BMD), and the dose and treatment duration of glucocorticoid were assessed between patients with and without vertebral fracture. Multivariate logistic regression analysis was also performed to evaluate the association of vertebral fracture with clinical parameters.Results The significant differences related to age, BMD of the hip, disease duration, glucocorticoid treatment duration between patients with and without vertebral fractures were demonstrated. The present study indicated that disease duration, BMI, and the total hip BMD were independent risk factors for vertebral fractures in patients with glucocorticoid-induced osteoporosis.Conclusions Prolonged disease duration, low BMI, and low total hip BMD could be risk factors of vertebral fracture in patients on glucocorticoid treatment for rheumatological diseases.
Analysis of key genes and pathways associated with the pathogenesis of intervertebral disc degeneration
Authors: Hu Shiyu , Fu Yucheng , Yan Bin , Shen Zhe , Lan Tao
Published: July 2020

Background: Intervertebral disc degeneration (IDD) is widely known as a main contributor to low back pain which has a negative socioeconomic impact worldwide. However, the underlying mechanism remains unclear. This study aims to analyze the dataset GSE23130 using bioinformatics methods to identify the pivotal genes and pathways associated with IDD.Material/Methods: The gene expression data of GSE23130 was downloaded and differentially expressed genes (DEGs) were extracted from 8 samples and 15 controls. GO and KEGG pathway enrichment analyses were performed. Also, Protein–protein interaction (PPI) network was constructed and visualized, followed by identification of hub genes and key module.Results: A total of 30 downregulated and 79 upregulated genes were identified. The DEGs mainly enriched in regulation of protein catabolic process, extracellular matrix organization, collagen fibril organization, and extracellular structure organization. Meanwhile, we found that most of DEGs were primarily enriched in PI3K-Akt signaling pathway. The top 10 hub genes were FN1, COL1A2, SPARC, COL3A1, CTGF, LUM, TIMP1, THBS2, COL5A2, and TGFB1.Conclusions: In summary, key candidate genes and pathway were identified by using integrated bioinformatics analysis, which may provide insights into underlying mechanisms and offer potential target genes for the treatment of IDD.
Degeneration of structural brain networks is associated with cognitive decline after ischaemic stroke
Authors: Veldsman Michele , Cheng Hsiao-ju , Ji Fang , Werden Emilio , Khlif Mohamed , Ng Kwun Kei , Lim Joseph , Qian Xing , Yu Haoyong , Zhou Juan Helen , Brodtmann Amy
Published: July 2020

One third of ischemic stroke patients develop cognitive impairment. It is not known whether topographical secondary neurodegeneration within distributed brain structural covariance networks (SCNs) underlies this cognitive decline. We examined longitudinal changes in SCNs and their relationship to domain-specific cognitive decline in 73 ischemic stroke patients. Patients were scanned with magnetic resonance imaging (MRI) and assessed on five cognitive domains at subacute (3-months) and chronic (1-year) timepoints. Individual-level SCN scores of major cognitive networks were derived from MRI data at each timepoint. We found that distributed degeneration in higher-order cognitive networks was associated with cognitive impairment in subacute stroke. Importantly, faster degradation in these major cognitive SCNs over time was associated with greater decline in attention, memory, and language domains. Our findings suggest that subacute ischemic stroke is associated with degeneration of higher-order structural brain networks and degradation of these networks contribute to individual trajectories of longitudinal domain-specific cognitive dysfunction.
A Hybrid Metaheuristic For Solving Asymmetric Distance-Constrained Vehicle Routing Problem
Authors: Ban Bang Ha , Nguyen Phuong Khanh
Published: July 2020

The Asymmetric Distance-Constrained Vehicle Routing Problem (ADVRP) is an NP-hard problems. In ADVRP problem, each customer is visited once by one vehicle; every tour starts and ends at a depot; and the travelled distance by each vehicle is required to be less than or equal to the given maximum value. The problem is a natural extension of Vehicle Routing Problem case. In our work, we propose a hybrid metaheuristic algorithm combining the Randomized Variable Neighborhood Search (RVNS) and the Tabu Search (TS) to solve the problem. The combination of multiple neighborhoods and tabu mechanism is used for their capacity to escape local optima while exploring the solution space. Furthermore, the intensification and diversification phases are also included to deliver optimized and diversified solutions for the search. Extensive numerical experiments on benchmark instances show that our algorithm can be comparable with the state-of-the-art previous algorithms in terms of solution quality and computation time. In many cases our proposed method is able to improve the best-known solution available from the literature.
Prognostic factors in patients admitted to an urban teaching hospital with COVID-19 infection
Authors: Maguire Donogh , Woods Marylynne , Richards Conor , Dolan Ross , Veitch Jesse Wilson , Sim Wei MJ , Kemmett Olivia EH , Milton David C , Randall Sophie LW , Bui Ly D , Goldmann Nicola , Cameron Allan , Laird Barry , Talwar Dinesh , Godber Ian , Davidson Alan , McMillan Donald C
Published: July 2020

BackgroundSevere COVID-19 infection results in a systemic inflammatory response (SIRS). This SIRS response shares similarities to the changes observed during the peri-operative period that are recognised to be associated with the development of multiple organ failure. MethodsElectronic patient records for patients who were admitted to an urban teaching hospital during the initial 7-week period of the COVID-19 pandemic in Glasgow, U.K. (17th March 2020 - 1st May 2020) were examined for routine clinical, laboratory and clinical outcome data. Age, sex, BMI and documented evidence of COVID-19 infection at time of discharge or death certification were considered minimal criteria for inclusion.ResultsOf the 224 patients who fulfilled the criteria for inclusion, 52 (23%) had died at 30-days following admission. COVID-19 related respiratory failure (75%) and multiorgan failure (12%) were the commonest causes of death recorded. Age>70 years (p<0.001), past medical history of cognitive impairment (p<0.001), previous delirium (p<0.001), clinical frailty score>3 (p<0.001), hypertension (p<0.05), heart failure (p<0.01), national early warning score (NEWS) >4 (p<0.01), positive CXR (p<0.01), and subsequent positive COVID-19 swab (p<0.001) were associated with 30-day mortality. CRP>80 mg/L (p<0.05), albumin <35g/L (p<0.05), peri-operative Glasgow Prognostic Score (poGPS) (p<0.05), lymphocytes <1.5 109/l (p<0.05), neutrophil lymphocyte ratio (p<0.001), haematocrit (<0.40 L/L (male) / <0.37 L/L (female)) (p<0.01), urea>7.5 mmol/L (p<0.001), creatinine >130 mmol/L (p<0.05) and elevated urea: albumin ratio (<0.001) were also associated with 30-day mortality.On analysis, age >70 years (O.R. 3.9, 95% C.I. 1.4 – 8.2, p<0.001), past medical history of heart failure (O.R. 3.3, 95% C.I. 1.2 – 19.3, p<0.05), NEWS >4 (O.R. 2.4, 95% C.I. 1.1 – 4.4, p<0.05), positive initial CXR (O.R. 0.4, 95% C.I. 0.2-0.9, p<0.05) and poGPS (O.R. 2.3, 95% C.I. 1.1 – 4.4, p<0.05) remained independently associated with 30-day mortality. Among those patients who tested PCR COVID-19 positive (n=122), age >70 years (O.R. 4.7, 95% C.I. 2.0 - 11.3, p<0.001), past medical history of heart failure (O.R. 4.4, 95% C.I. 1.2 – 20.5, p<0.05) and poGPS (O.R. 2.4, 95% C.I. 1.1- 5.1, p<0.05) remained independently associated with 30-days mortality.ConclusionAge > 70 years and severe systemic inflammation as measured by the peri-operative Glasgow Prognostic Score are independently associated with 30-day mortality among patients admitted to hospital with COVID-19 infection.
Sequential Vs Concurrent Adjuvant Chemotherapy for Operable Breast Cancer: A Meta-analysis
Authors: Chen Wanjing , Tu Qian , Shen Yanfei , Tang Kejun , Hong Mengying , shen yong
Published: July 2020

Backgroud: Controversy still remains in that whether sequential or concurrent regimen of anthracyclines and taxanes benefits more for breast cancer. Here we aimed to compare these two regimens in patients with operable breast cancer based on all published data of phase III randomized controlled trials in this topic.Methods: A literature search on PubMed, Web of science, Embase, ScienceDirect, Google scholar and clinicaltrials.gov databases was conducted up to May 2020. Meta-analysis was performed to evaluate the different efficacy on disease free survival (DFS) and overall survival (OS)for these two regimens. Subgroup analyses were further carried out in terms of node status and anthracycline selection.Results: Compared to concurrent regimen, sequential regimen did not improve the DFS or OS in the whole population included. Subgroup analysis showed that in node-positive patients, however, sequential regimen has better DFS, but not OS, than concurrent regimen.In sequential regimen, patients received doxorubicin and taxanes had improved DFS and OS than those were given epirubicin and taxanes. Futhermore, for patients receiving doxorubicin and taxanes,compared to sequential regimen,less cycles (4 cycles) of concurrent treatment showed worse DFS and OS, whereas more cycles(6 cycles) may rescue the loss.In addition,high grade toxicity response in both groups exhibited no difference except for neuropathy, which occured more frequently in the sequential regimen.Conclusions:Sequential regimen of anthracyclines and taxanes for patients with breast cancer did not promise a significant benefit in neither DFS nor OS over concurrent regimen. However, sequential regimen did provide a better DFS than that in concurrent regimen for node-positive patients. Interestingly, further subgroup analysis showed that for patients with node-positive and were given doxorubicin and taxanes, more cycles (6 cycles) of concurrent reigmen was not inferior to sequential regimen.
Prediction of Glycated Haemoglobin Based on Routine Blood Count Tests to Support the Diagnosis of Diabetes Mellitus
Authors: Cardozo Glauco , Andreis Guilherme Rettore , Cossul Sandra , Lopes Annelise Correa Wengerkievicz , Nassar Silvia Modesto , Marques Jefferson Luis Brum
Published: July 2020

Background

Currently 8.8% of the World's population aged from 20 to 79 have diabetes mellitus (DM); of this total is estimated that 50% have not been diagnosed and do not know they have the disease. The most common laboratory tests used for diagnosis include blood glucose (FPG) and glycated haemoglobin (HbA1c). The HbA1c test has advantages over FPG, therefore being recommended in diagnoses of DM. Early diagnoses are essential to prevent complications caused by DM; however, the symptoms of the initial stage are present in only 40% of the carriers, symptomless carriers oddly pursue the DM test. In a lifetime patients performs a series of laboratory exams for health analysis which is stored as laboratory data, the computational approach offers enormous potential in health data analysis discovering relevant results overlooked by physicians. Use machine learn approach on data stored of routine blood count laboratory tests to predict HbA1c diagnosis.
Method:

Using laboratory results from data stored of HbA1c, was formed six data groups composed of individuals: healthy and pre-diabetic (HP); healthy and diabetic (HD); pre-diabetic and diabetic (PD); healthy and non-healthy (HN); non-diabetic and diabetic (ND); and healthy, pre-diabetic and diabetic (HPD) patients. For each data group, was tested the K nearest neighbours (KNN), support vector machines (SVM), random forests (RF), naive Bayes (NB) and artificial neural network (ANN) models. Assessment of model performance was carried out using sensitivity, specificity, precision and negative prediction.
Results

The KNN model applied to the ND group had the best performance in the diagnosis of diabetes, resulting in a sensitivity value of 53.6% and an accuracy of 90.1%. The classification after regression with the neural network model (ANNr) and the ND group had a more general result, with a sensitivity of 74.3% and an accuracy of 77.2%. Analysing only the values for the regression, the neural network model presented a mean square error of 0.36 for the final test base with a correlation of 0.85.
Conclusions

We conclude that machine learning-based computational models can predict HbA1c values from other routine laboratory tests. Thus, they can assist in the detection of diabetes and act as a warning for undiagnosed cases.
Actuation system of the ankle exoskeleton T-FLEX: first use experimental validation in people with stroke
Authors: Gomez-Vargas Daniel , Ballen-Moreno Felipe , Barria Patricio , Aguilar Rolando , Azorín José M. , Munera Marcela , Cifuentes Carlos A.
Published: July 2020

Background: Robotic devices can provide physical assistance to people who have suffered neurological impairments such as stroke. Neurological disorders related to this condition induce abnormal gait patterns, which harm the independence to execute different Activities of Daily Living (ADL). From the fundamental role of the ankle in walking, Active Ankle-Foot Orthoses (AAFOs) have been developed to enhance the users' gait patterns, and hence, their quality of life.Methods: Ten patients who suffered stroke used the actuation system of the T-FLEX orthosis triggered by an inertial sensor on the foot tip. The VICON motion capture system recorded the users' kinematics for unassisted and assisted gait modalities. Biomechanical analysis and usability assessment measured the performance of the system actuation for the participants in overground walking. Results: The biomechanical assessment exhibited changes in the range of motion of the lower joints for $70\%$ of the subjects. Moreover, the ankle kinematics showed a correlation with the variation of other movements analyzed. This variation had positive effects on 70\% of the participants in at least one joint. The Gait Deviation Index (GDI) presented significant changes for 30\% of the paretic limbs, where one volunteer increased this index in 14\%. The spatiotemporal parameters did not show significant variations between modalities, although users' cadence had a decrease. Lastly, the satisfaction with the device was positive, being the comfort the most users-selected aspect.Conclusions: This article presented the assessment of the T-FLEX actuation system in people who suffered stroke. Biomechanical results showed improvement in the ankle kinematic and variation in the other joints. In general terms, GDI did not exhibit significant changes, and Movement Analysis Profile (MAP) registered the main movements altered by the device. Future works should focus on assessing the full T-FLEX orthosis in a larger sample of patients that includes a stage of training.Trial registration: This study was registered as Preliminary Biomechanical and Usability Study of an Active Ankle-Foot Orthosis for Stroke Survivors on 30 January 2020 in Clinical Trials with the identi er No NCT04249349 (available at https://clinicaltrials.gov/ct2/show/NCT04249349).
Risk Areas for Tuberculosis Among Children and Their Inequalities in a City from Southeast Brazil.
Authors: Alves Yan Mathias , Berra Thais Zamboni , Alves Luana Seles , de Assis Ivaneliza Simionato , Arcoverde Marcos Augusto Moraes , Ramos Antônio Carlos Vieira , Arroyo Luiz Henrique , Campoy Laura Terenciani , Bruce Alexandre Tadashi Inomata , Santos Felipe Lima dos , Souza Ludmilla Leideanne Limírio , Crispim Juliane de Almeida , Arcêncio Ricardo Alexandre
Published: July 2020

BACKGROUNDAccording to the World Health Organization, there are approximately one million cases of tuberculosis in the world's child population, and the disease is responsible for 130.000 deaths per year, which makes tuberculosis one of the top 10 causes of death in children in the world. The objective of the study was to identify areas of risk for the appearance of tuberculosis in children and their association with social inequalities in a municipality in southeastern Brazil.METHODSEcological study conducted in Ribeirão Preto, Brazil. To identify areas of spatial risk for tuberculosis in children, we use the technique of spatial scanning statistics. To analyze the association of cases of childhood tuberculosis with social vulnerability, the Social Vulnerability Index of São Paulo was used and four explanatory statistical models were listed.RESULTS96 cases of childhood tuberculosis were reported, of which 90 were geocoded. A risk area was identified in the municipality, where children under 15 years old have 3.14 times more risk of contracting tuberculosis than outside this area. Of the models tested, the Zero-Inflated Poisson probability distribution was the one that best suited the nature of the variables. The variables identified as risk factors were: number of private and collective households; Proportion of children aged 0 to 5 in the population; Proportion of households without per capita income; Proportion of private households with monthly nominal incomes of up to 1/4 minimum wages. The variables identified as possible protection factors, there was a proportion of women responsible for the household under 30 and an average income of women responsible for the household.CONCLUSIONThe study showed areas of risk for the occurrence of tuberculosis in children. Although the study was conducted in a city with satisfactory social indicators, income distribution is quite uneven, as the findings reveal. The study is in line with the End TB Strategy and the 2030 agenda, which aims to support strategic actions and, therefore, save the lives of children through the systematic, intensified and comprehensive search of children with tuberculosis respiratory symptoms in the community.
Combination of Biomarker with Clinical Risk Factors for Prediction of Severe Acute Kidney Injury in Critically ill Patients
Authors: Jia Lan , Sheng Xiaohua , Zamperetti Anna , Xie Yun , Corradi Valentina , Chandel Shikha , De Cal Massimo , Montin Diego Pomarè , Caprara Carlotta , Ronco Claudio
Published: July 2020

Background: Acute kidney injury (AKI) occur commonly in the intensive care unit (ICU). Insulin-like growth factor-binding protein 7 (IGFBP7) and tissue inhibitor of metalloproteinase-2 (TIMP-2), known as [TIMP-2] x [IGFBP7] (NephroCheck), have been identified as novel biomarkers for the prediction of AKI risk. However, disease biomarkers require appropriate clinical context to be used effectively. We conducted a cohort study to find risk factors and assess the performance of the combination of NephroCheck with risk factors would provide feasible information for AKI prediction.Methods: All patients who admitted in the ICU (June 2016 to July 2017) participated in the study. The primary outcome was severe AKI within the first 7 days of the ICU. The predictors were separated into 3 categories: chronic risk factors, acute risk factors and biochemical indicators. Results: The study included 577 patients. 96 patients developed to severe AKI (16.6%) within 7 days. In addition to NephroCheck (+) (OR=2.139, 95% CI (1.260-3.630), P =0.005), age >65 years (OR=1.961, 95% CI (1.153-3.336), P=0.013), CKD (OR=2.573, 95% CI (1.319-5.018), P=0.006) and PCT (+)(OR=3.223, 95% CI (1.643-6.321), P=0.001) were also the independent predictor of severe AKI within 7 days. Compared to NephroCheck (+) only (AUC=0.66, 95% CI:0.60-0.72), the combination of NephroCheck (+) and risk factors (age>65years, CKD and PCT positive) (AUC=0.75, 95% CI:0.70-0.81) led to a significant increase in the area under ROC curve for severe AKI prediction within 7 days.Conclusions: Although NephroCheck is an effective screening tool for recognizing patients at high risk, we found that combination with biomarker and risk factors (age>65years, CKD, procalcitonin positive) for risk assessment of AKI has the greatest significance for patients with uncertain disease trajectories.
The Reliability of Maternal Audit Instruments to Assign Cause of Death in Maternal Deaths Review Process: A Systematic Review and Meta-Analysis
Authors: Cahyanti Ratnasari Dwi , Widyawati Widyawati , Hakimi Mohammad
Published: July 2020

Background: Maternal Death Reviews (MDR) can assist in formulating prevention strategies to reduce maternal mortality. To support MDR, an adequate MDR instrument is required to accurately identify the underlying causes of maternal deaths. We conducted a systematic review and meta-analysis to determine the reliability of maternal death instruments for conducting the MDR process.Method: Three databases: PubMed, ProQuest and EBSCO were systematically searched to identify related research articles published between January 2005 and July 2019. The review and meta-analysis involved identification of measurement tools to conduct MDR in all or part of maternal audit. Eligibiliy and quality of studies were evaluated using the Modified Quality Appraisal of Diagnostic Reliability (QAREL) Checklist: Reliability Studies.Results: Overall, 242 articles were retrieved and 17 articles were selected for full-text review. Six articles examined the instrument used for MDR in 4 countries consisting of 4 articles on verbal autopsy (VA) and 2 articles on facility-based MDR. None of studies identified reliability in evaluation instruments assessing maternal audit cycle as a comprehensive approach. The pooled kappa for the MDR instruments was 0.72 (95%CI:0.43-0.99; p<0.001) with considerable heterogeneity (I²=96.19%; p<0.001). Subgroup analysis of MDR instruments showed pooled kappa in VA of 0.89 (95%CI:0.52-1.25) and facility-based MDR of 0.48 (95%CI:0.15-0.82). Meta-regression analysis tended to show the high heterogeneity was likely associated with sample sizes, regions, and year of publications.Conclusions: The MDR instruments appear feasible. Variation of the instruments suggest the need for judicious selection of MDR instruments by considering the study population and assessment during the target periods.
Cardiac radiation dose predicts survival in esophageal cancer treated by definitive concurrent chemoradiotherapy
Authors: Pao Tzu-Hui , Chang Wei-Lun , Chiang Nai-Jung , Chang Jeffrey Shu-Ming , Lin Chia-Ying , Lai Wu-Wei , Tseng Yau‐Lin , Yen Yi‐Ting , Chung Ta-Jung , Lin Forn-Chia
Published: July 2020

Background
The prognostic significance of cardiac radiation dose in esophageal cancer after definitive concurrent chemoradiotherapy (CCRT) without surgery remains largely unknown. This study aimed to investigate the association between cardiac dose-volume parameters and overall survival (OS) in esophageal cancer after definitive CCRT.
Methods
A total of 121 consecutive esophageal cancer patients undergoing definitive CCRT between 2008 and 2018 were reviewed. Dose-volume parameters of the heart were calculated. Survival of patients and cumulative incidence of adverse events were estimated by the Kaplan–Meier method and compared between groups by the log-rank test. The prognostic significance of cardiac dose-volume parameters was determined with multivariate Cox proportional hazards regression analysis.
Results
Median follow-up was 16.2 months (range, 4.3-109.3). Median OS was 18.4 months. Heart V5, V10, and V20 were independent prognostic factors of OS. The median heart V5, V10, and V20 were 94.3%, 86.4%, and 76.9%, respectively. Median OS was longer for patients with heart V5 ≤ 94.3% (24.7 vs. 16.3 months, p = 0.0025), heart V10 ≤ 86.4% (24.8 vs. 16.9 months, p = 0.0041), and heart V20 ≤ 76.9% (20.0 vs. 17.2 months, p = 0.047). Moreover, lower cumulative incidence of symptomatic cardiac adverse events was observed among patients with heart V5 ≤ 94.3% (p = 0.017), heart V10 ≤ 86.4% (p = 0.02), and heart V20 ≤ 76.9% (p = 0.0057). The patients without symptomatic cardiac adverse events had a higher 3-year OS rate (33.8% vs. 0%, p = 0.03).
Conclusions
Cardiac radiation dose was inversely correlated with survival in esophageal cancer treated by definitive CCRT. Radiation dose to the heart should be minimized.
More Active Internet-Search on Google and Twitter Posting for COVID-19 Corresponds with Lower Infection Rate in the 50 U.S. States
Authors: Sun Jiachen , Gloor Peter
Published: July 2020

As the novel coronavirus disease 2019 (COVID-19) continues to rage worldwide, the United States has become the most affected country with more than 2.5 million total confirmed cases up to now (June 2, 2020). In this work, we investigate the predictive power of online social media and Internet search for the COVID-19 pandemic among 50 U.S. states. By collecting the state-level daily trends through both Twitter and Google Trends, we observe a high but state-different lag correlation with the number of daily confirmed cases. We further find that the predictive accuracy measured by the correlation coefficient is positively correlated to a state’s demographic, air traffic volume and GDP development. Most importantly, we show that a state’s early infection rate is negatively correlated with the lag to the previous peak in Internet search and tweeting about COVID-19, indicating that the earlier the collective awareness on Twitter/Google in a state, the lower is the infection rate.
Genetic factors of hereditary phenotypes of vesicoureteral reflux and reflux nephropathy
Authors: Yuryeva E. A. , Dlin V. V. , Vozdvizhenskaya E. S.
Published: July 2020

The article reviews publications on genetically determined vesicoureteral reflux and reflux nephropathy, accompanying certain phenotypes of systemic or local forms of hereditary connective tissue dysplasia (Ehlers–Danlo, Marfan, Williams syndromes, sluggish skin). The authors determined the role of mutations of the genes of fibrillar collagen, elastin, transforming growth factor β1, tenascin, lysyl peroxidase, metalloproteinases and other components of connective tissue, as well as their possible combination in the development of pathology. The authors call the specialists to continue research on genetic mutations in vesicoureteral reflux and reflux nephropathy.