bluuebunny/crossref_metadata_2025 huggingface dataset:
Implementation and feasibility of inverse-ratio Airway Pressure Release Ventilation (APRV): Switching from Conventional Ventilation to APRV in Two French ICUs.
Authors: Koszutski Matthieu , Pequignot Benjamin , Kimmoun Antoine , Remen Thomas , Guerci Philippe , Levy Bruno
Published: December 2020

Background:To evaluate the switching of patients mechanically ventilated on Pressure Support or Volume Control to inverse-ratio Airway Pressure Release Ventilation (APRV) during the COVID-19 pandemic.Methods:We performed a single-center retrospective observational analysis in two ICUs in a tertiary referral university teaching hospital in France. Were included patients with Covid-19 pneumonia requiring invasive ventilation with a PaO2:FiO2 ratio lower than 200 mmHg who performed a 6-hour trial of inverse-ratio APRV.Results:Seventeen consecutive patients who completed a 6-hour APRV trial in April 2020 were included. Three patients who were unable to be maintained on APRV due to an immediate fall in SpO2 were not included. In 12/17 patients (71%), the increase in PaO2:FiO2 ratio was greater than 20%. Mean (± standard deviation) PaO2:FiO2 ratio increased from 126 (± 28) mmHg to 178 (± 53) mmHg after 6 hours of APRV (p<0.001). Two patients presented a decrease in PaO2:FiO2 ratio after 6 hours of APRV. There was no appearance of significant hemodynamic impairment during APRV and an eventual increase in PaCO2 during the first hour of APRV was managed by increasing the respiratory rate (i.e. shortening T-high) and/or increasing tidal volume (i.e. increasing T-low).Conclusions:Switching from Conventional Ventilation (Pressure Support or Volume Assist Control) to inverse-ratio APRV for a 6-hour period in two ICUs that were not previously familiar with this ventilation technique was well tolerated, and associated with a marked improvement in oxygenation. Further studies evaluating inverse-ratio APRV in acute respiratory failure are warranted.Trial registration:NCT04386369
Determination of MIC, MPC, and MSW of Ilex paraguariensis Against Non-Typhoidal Salmonella with Identification of the Mechanisms of Resistance and Pathogenicity Factors
Authors: Khatib Khaled El , Hadeer Ribal Aby , Saad Anis , Kalaydjian Aline , Fayad Elie , Dougnon Victorien , Daoud Ziad , Abdel-Massih Roula M.
Published: December 2020

Objective: This study investigated the antibacterial activity of Ilex paraguariensis extracts against 32 different strains of non-typhoidal Salmonella (NTS) through the determination of the Minimum Inhibitory Concentration (MIC), Mutant Prevention Concentration (MPC), Mutant Selection Window (MSW), and the detection of virulence genes by multiplex PCR assays. Results: The MIC values of Ilex paraguariensis against Salmonella spp. strains varied between 0.78 mg/ml and 6.25 mg/ml with a MIC 90 of 3.12 mg/ml. The highest MPC in this study was 48 mg/ml yielding a Mutant Selection Window of 41.75 mg/ml. The MSW values of the remaining strains varied between 1.56 and 8.87 mg/ml. Genes of pathogenicity detected in Salmonella spp. isolates were most commonly the stn, sdiA, invA, sopB, invH, and sopE genes. The antibacterial activity of Yerba Mate extracts was not affected by the antimicrobial resistance patterns or pathogenicity genes expressed. More work is needed to identify the active antibacterial compound(s) responsible for the antibacterial activity.
Effects of Compound Probiotics and Aflatoxin-Degradation Enzyme on Alleviating aflatoxin-induced cytotoxicity in chicken embryo primary intestinal epithelium, liver and kidney cells
Authors: Guo Hongwei , Chang Juan , Wang Ping , Yin Qingqiang , Liu Chaoqi , Xu Xiaoxiang , Dang Xiaowei , Hu Xiaofei , Wang Quanliang
Published: December 2020

Aflatoxin B1 (AFB1) is one of the most dangerous mycotoxins for humans and animals. This study aimed to investigate the effects of compound probiotics (CP), CP supernatant (CPS), AFB1-degradation enzyme (ADE) on chicken embryo primary intestinal epithelium, liver and kidney cell viabilities, and to determine the functions of CP + ADE (CPADE) or CPS + ADE (CPSADE) for alleviating cytotoxicity induced by AFB1. The results showed that AFB1 decreased cell viabilities in dose-dependent and time-dependent manner. The optimal AFB1 concentrations and reactive time for establishing cell damage models were 200 µg/L AFB1 and 12 h for intestinal epithelium cells, 40 µg/L and 12 h for liver and kidney cells. Cell viabilities reached 231.58% (P < 0.05) for intestinal epithelium cells with CP addition, 105.29% and 115.84% (P < 0.05) for kidney liver cells with CPS additions. The further results showed that intestinal epithelium, liver and kidney cell viabilities were significantly decreased to 87.12%, 88.7% and 84.19% (P < 0.05) when the cells were exposed to AFB1; however, they were increased to 93.49% by CPADE addition, 102.33% and 94.71% by CPSADE additions (P < 0.05). The relative mRNA abundances of IL-6, IL-8, TNF-α, iNOS, NF-κB, NOD1 (except liver cell) and TLR2 in three kinds of primary cells were significantly down-regulated by CPADE or CPSADE addition, compared with single AFB1 group (P < 0.05), indicating that CPADE or CPSADE addition could alleviate cell cytotoxicity and inflammation induced by AFB1 exposure through suppressing the activations of NF-κB, NOD1 and TLR2 pathways.
Cohort Study of Medical Cannabis Authorization and Motor Vehicle Crash-Related Healthcare Visits in 2014-2017 in Ontario, Canada
Authors: Lee Cerina , Voaklander Don , Minhas-Sandhu Jasjeet K. , Hanlon John G. , Hyshka Elaine , Dyck Jason R.B. , Eurich Dean
Published: December 2020

Background: With increasing numbers of countries/jurisdictions legalizing cannabis, cannabis impaired driving has become a serious public health concern. Despite substantive research linking cannabis use with higher rates of motor vehicle crashes (MVC), there is an absence of conclusive evidence linking MVC risk with medical cannabis use. In fact, there is no clear understanding of the impact of medical cannabis use on short- and long-term motor vehicle-related healthcare visits. This study assesses the impact of medical cannabis authorization on motor vehicle-related health utilization visits (hospitalizations, ambulatory care, emergency room visits, etc) between 2014-2017 in Ontario, Canada. Methods: A matched cohort study was conducted on patients authorized to use medical cannabis and controls who did not receive authorization for medical cannabis – in Ontario, Canada. Overall, 29153 adult patients were identified and subsequently linked to the administrative databases of the Ontario Ministry of Health, providing up to at least 6 months of longitudinal follow-up data following the initial medical cannabis consultation. Interrupted time series analyses was conducted to evaluate the change in rates of healthcare utilization as a result of MVC 6 months before and 6 months after medical cannabis authorization. Results: Over the 6-month follow-up period, MVC-related visits in medical cannabis patients were 0.50 visits/10 000 patients (p=0.61) and -0.31 visits/10 000 patients (p=0.64) for MVC-related visits in controls. Overall, authorization for medical cannabis was associated with an immediate decrease in MVC-related visits of -2.42 visits/10 000 patients (p=0.014) followed by a statistically significant increased rate of MVC-related visits (+0.89 events/10,000 in those authorized medical cannabis) relative to controls in the period following their authorization(p=0.0019). Overall, after accounting for both the immediate and trend effects, authorization for medical cannabis was associated with an increase of 2.92 events/10,000 (95%CI 0.64 to 5.19) over the entire follow-up period. This effect was largely driven by MVC-related emergency department visits (+0.80 events/10,000, p<0.001). Conclusions: Overall, medical cannabis authorization was associated with increased healthcare utilization as a result of a MVC, at the population level, in Ontario, Canada. These findings have public health importance and patients and clinicians should be fully educated on the potential risks. Continued follow-up of medically authorized cannabis patients is warranted to fully comprehend long-term impact on motor vehicle crash risk.
A phase I dose escalation trial using intensity-modulated radiotherapy with simultaneous integrated boost in pelvic chemoradiotherapy for metastatic rectal cancer
Authors: Lizée Thibaut , Seegers Valérie , Blanchecotte Julien , Rio Emmanuel , Capitain Olivier , Véronique Guerin-Meyer , Legouté Florence , Autret Damien , Mahé Marc-Andre , Paumier Amaury
Published: December 2020

BackgroundIn unresectable metastatic rectal cancers, the surgery of the primitive tumor remains highly debated. Chemoradiotherapy (CRT) of the primitive could allow sufficient local control in order to avoid major and sometimes mutilating surgery. Dose escalation during CRT could increase this local control. The aim of this study was to evaluate the feasibility and tolerance of a CRT with radiation dose escalation delivered in intensity modulated radiotherapy (IMRT) with simultaneous integrated boost (SIB), in metastatic low and middle rectal cancers.MethodsThis multicenter phase I study included six patients treated for unresectable synchronous metastatic low and middle rectal adenocarcinoma in two dose levels. Radiotherapy was delivered using IMRT with SIB. The dose escalation was 52.5 Gy (level 1) and 56.25 Gy (level 2) in the primary tumor, in 25 fractions of 2.1 Gy and 2.25 Gy, respectively. High-risk clinical target volume (CTV) and low-risk CTV received respectively 50 Gy and 45 Gy in 25 fractions in the two levels. Concomitant chemotherapy was oral capecitabine and CRT was performed after four cycles of mFOLOX6 chemotherapy. The dose-limiting toxicity (DLT) was defined by a toxicity requiring the interruption of radiotherapy for more than five consecutive fractions.ResultsAll six patients received the full course of treatment at scheduled doses. No patients had acute toxicity requiring interruption of radiotherapy therefore no DLT has been reported. No patients had acute toxicity ≥ 3. Concerning late toxicity, three patients experienced grade 3. After CRT, four patients had a partial response and one patient had a complete clinical response. Two patients were considered in local progression at 9.4 months and 20.4 months of inclusion.ConclusionsDose escalation at 56.25 Gy in the tumor lesion was possible with good acute tolerance. It needs to be evaluated in a larger study. It could allow sufficient local control in order to avoid mutilating surgery in these metastatic patients.Trial registrationNCT03634202. Registered 16 August 2018 – retrospectively registered, https://www.clinicaltrials.gov/ct2/show/NCT03634202
Effect of perfluorosulfonic acid side chains on oxygen permeation in hydrated ionomers of PEMFCs: Molecular dynamics simulation approach
Authors: Kwon Sung Hyun , Kang Haisu , Sohn Young-Jun , Lee Jinhee , Shim Sunbo , Lee Seung Geol
Published: December 2020

We prepared two types of perfluorosulfonic acid (PFSA) ionomers with Aquivion (short side chain) and Nafion (long side chain) on a Pt surface and varied their water contents (2.92 ≤ λ ≤ 13.83) to calculate the solubility and permeability of O2 in hydrated PFSA ionomers on a Pt surface using full atomistic molecular dynamics (MD) simulations. The solubility and permeability of O2 molecules in hydrated Nafion ionomers were greater than those of O2 molecules in hydrated Aquivion ionomers at the same water content, indicating that the permeation of O2 molecules in the ionomers is affected not only by the diffusion coefficient of O2 but also by the solubility of O2. Notably, O2 molecules are more densely distributed in regions where water and hydronium ions have a lower density in hydrated Pt/PFSA ionomers. Radial distribution function (RDF) analysis was performed to investigate where O2 molecules preferentially dissolve in PFSA ionomers on a Pt surface. The results showed that O2 molecules preferentially dissolved between hydrophilic and hydrophobic regions in a hydrated ionomer. The RDF analysis was performed to provide details of the O2 location in hydrated PFSA ionomers on a Pt surface to evaluate the influence of O2 solubility in ionomers with side chains of different lengths. The coordination number of C(center)–O(O2) and O(side chain)–O(O2) pairs in hydrated Nafion ionomers was higher than that of the same pairs in hydrated Aquivion ionomers with the same water content. Our investigation provides detailed information about the properties of O2 molecules in different PFSA ionomers on a Pt surface and with various water contents, potentially enabling the design of better-performing PFSA ionomers for use in polymer electrolyte membrane fuel cells.
Dynamic QTL analysis for developmental behavior of cell wall components and forage digestibility in maize (Zea mays L.)
Authors: Li Kun , Yang Xue , Liu Xiaogang , Hu Xiaojiao , Wu Yujin , Wang Qi , Ma Feiqian , Li Shuqiang , Wang Hongwu , Liu Zhifang , Huang Changling
Published: December 2020

Background

Cell wall architecture plays a key role in stalk strength and forage digestibility. Lignin, cellulose and hemicellulose are the three main components of the plant cell wall and can impact stalk quality by affecting cell wall structure and strength. To explore cell wall development during secondary cell wall lignification in maize stalks, conventional and conditional genetic mappings was used to identify the dynamic quantitative trait locus (QTL) for cell wall components and digestibility traits in five growth stages after silking.
Results

Acid detergent lignin (ADL), cellulose (CEL), Acid detergent fiber (ADF), neutral detergent fiber (NDF), and in vitro dry matter digestibility (IVDMD) of stalk were evaluated in a maize recombinant inbred line (RIL) population. The cell wall components gradually increased in the 10–40 days after silking (DAS), reached a maximum at 30–40 DAS, and then steadily decreased. IVDMD decreased over the initial 40 DAS and then increased slightly. Seventy-two QTL were identified for five traits and each accounted for 3.48–24.04% of the phenotypic resistance variation. Twenty-six conditional QTL were detected using conditional QTL mapping. 22 out of 24 conditional QTL were found for stages III|II and V|IV. Six QTL hotspots were found localized in bins 1.08, 2.04, 2.07, 7.03, 8.05, and 9.03 in the maize genome.
Conclusion

The unconditional pleiotropic QTL in bins 1.08 and 8.05 were also associated with stalk strength. Furthermore, several pleiotropic QTL for cell wall and digestibility were found not associated with stalk strength. A simultaneous improvement in forage digestibility and lodging resistance can be achieved by pyramiding multiple effective QTL identified in the present study.
Super Bolus – A Remedy for A High Glycemic Index Meal in Children With Type 1 Diabetes on Insulin Pump Therapy?: Study Protocol for a Randomised Controlled Trial.
Authors: Kowalczyk Emilia , Dżygało Katarzyna , Szypowska Agnieszka
Published: December 2020

Background: Postprandial hyperglycemia (PPH) is common clinical problem among patients with type 1 diabetes (T1D), especially in relation to high glycemic index (h-GI) meals. The main problem are high, sharp glycemic spikes with following hypoglycemia after h-GI meal consumption. There is lack of effective and satisfactory solutions concerning insulin dose adjustment to cover the h-GI meal. The goal of this research is to find out whether a Super Bolus is an effective strategy to prevent postprandial hyperglycemia and late hypoglycemia after h-GI meal in comparison to the normal bolus.Methods: A total of 72 children aged 10-18 years with T1D for at least 1 year, treated with continuous subcutaneous insulin infusion for more than 3 months will be enrolled in a double-blind, randomized, cross-over clinical trial. Participants will receive the prandial insulin bolus for h-GI breakfast in the form of Super Bolus and as Normal Bolus another day. The primary outcome measure will be the glucose level 90 minutes after administration the prandial bolus. The secondary endpoints will refer to glucose level 30, 60, 120, 150, 180 minutes postprandially; the area under the blood glucose curve within 180 min postprandially; the peak glucose and time to peak glucose level; the glycemic rise, mean amplitude of glycemic excursion, time in postprandial glucose range and the number of hypoglycemia episodes.Discussion: There is a lack of clinical studies concerning this kind of bolus. Available literature refers only to in-silico studies and case reports. The Super Bolus was defined as a prandial insulin dose increased by 50% in comparison to the dose calculated based on individualized patient’s Insulin-Carbohydrate Ratio (ICR) and simultaneous suspension of the basal insulin for 2 hours. The comprehensive and effective solution to this frequent clinical difficulty of PPH after h-GI meals has not been found yet. The problem is known and important but the presented solution innovatory and easy to apply in every-day life.Trial registration: The trial was registered at the ClinicalTrials.gov prior to the inclusion of the first patient, 15 July 2019 on registration number: NCT04019821.
Crystal and Electronic Structure Engineering of Tin Monoxide by External Pressure
Authors: Li Kun , Wang Junjie , Blatov Vladislav A. , Gong Yutong , Umezawa Naoto , Tada Tomofumi , Hosono Hideo , Oganov Artem R.
Published: December 2020

Although tin monoxide (SnO) is an interesting compound due to its p-type conductivity, a widespread application of SnO has been limited by its narrow band gap of 0.7 eV. In this work, we theoretically investigate the structural and electronic properties of several SnO phases under high pressure through employing van der Waals (vdW) functionals. Our calculations reveal that a metastable SnO (A-SnO), which possesses space group P21/c and a wide band gap of 1.9 eV, is more stable than l-SnO at pressures higher than 80 GPa. Moreover, a stable (space group P2/c) and a metastable (space group Pnma) phases of SnO appear at pressures higher than 120 GPa. Energy and topological analyses show that P2/c-SnO has a high possibility to directly transform to t-SnO at around 120 GPa. Our work also reveals that h-SnO is a necessary intermediate state between high-pressure phase Pnma-SnO and low-pressure phase o-SnO for the phase transition path Pnma-SnO ®u-SnO ® g-SnO. Two phase transition analyses indicate that there is a high possibility to synthesize h-SnO under high-pressure conditions and have it remain stable under normal pressure. Finally, our study reveals that the conductive property of -SnO can be engineered in a low-pressure range (0-9 GPa) through a semiconductor-to-metal transition, while maintaining transparency in the visible light range.
The Effectiveness and Safety of Heat Sensitive Moxibustion for Anaphylactic Rhinitis: A PRISMA Compliance Systematic Review and Meta-Analysis of Randomized Clinical Trials
Authors: Yang Jun , Xiong Jun , Yuan Ting , Wang Xue , Yunfeng Yun Feng , Zhou Xiao hong , Kai Liao , Xu Ling Ling
Published: December 2020

BackgroundAnaphylactic rhinitis (AR) is an IgE antibody-mediated, inflammatory disorder. Heat- sensitive moxibustion (HSM) has been accepted for AR in clinically. Our study was conducted to evaluate the effectiveness and safety of HSM for AR. MethodsWe conducted a comprehensive literature review of the PubMed, Cochrane Library, EMBASE, China National Knowledge Infrastructure (CNKI), Wanfang, Chinese Science and Technology Periodical Database (VIP) and Chinese Biomedical Literature Database (CBM) from their inception to April 2020 for RCTs that compared HSM with other active intervention for AR. The primary outcome measure was the total nasal symptom and sign score, and secondary outcomes include total effective rate, Rhinoconjunctivitis quality of life questionnaire (RQLQ) and adverse events. More than two authors independently conducted the process of data collection and analysis by Review Manager (Version 5.3). ResultsA total of 15 RCTs of 1087 participants were included in our study. The overall meta-analysis demonstrated that HSM were superior in relieving the symptoms and signs of AR in treatment (SMD = -1.46, 95%CI (-1.81, -1.10); P < 0.00001) or during the follow-up period (SMD = -2.87, 95%CI (-5.11, -0.63); P < 0.0001). The results also applied to the total effective rate (OR = 2.96, 95%CI (2.19, 4.00); P < 0.00001) and RQLQ (SMD = -7.80, 95%CI (-13.92, -1.68); P < 0.00001) in treatment. Subgroup analysis indicated that there was a significant difference between the HSM group and control group. There were two studies referred to the adverse effects. The overall level of evidence was low with low methodology quality. ConclusionThis meta-analysis suggests that the effectiveness of HSM on AR were statistically significant in treatment or during the follow-up period. However, the included studies have relatively poor quality; further high-quality trials should be conducted to confirm our finding.Systematic review registrationPROSPERO CRD42019140723
The Effect of An mLearning Application on Nurses’ and Midwives’ Knowledge and Skills for The Management of Postpartum Hemorrhage and Neonatal Resuscitation: Quasi-Experimental Study.
Authors: Nishimwe Aurore , Ibisomi Latifat , Nyssen Marc , Conco Daphney Nozizwe
Published: December 2020

Background: Globally, mobile learning (mLearning) tools have attracted considerable attention as a means of continuous training for healthcare workers. Rwanda like other low-resource settings with scarce in-service training opportunities requires innovative approaches that adapt technology to context to improve healthcare workers’ knowledge and skills. One such innovation is the safe delivery application (SDA), a smartphone mLearning application for Basic Emergency Obstetric and Neonatal Care (BEmONC) content. This study assessed the effect of the SDA intervention on nurses’ and midwives’ knowledge and skills for the management of postpartum hemorrhage (PPH) and neonatal resuscitation (NR).Methods: The study used a pre-post, quasi-experimental design to compare knowledge and skills of nurses and midwives in the management of PPH and NR at two measurement points: immediately prior SDA intervention and after 6 months SDA intervention. The intervention took place in two district hospitals in Rwanda and included 54 participants. A paired-sample t-test was used to measure the pre-post intervention, mean knowledge and skills scores differences. Confidence intervals (CIs) and effect size were calculated. A t-test and a one-way Anova was used to test for potential confounders. Results: The analysis included 54 participants. Knowledge scores and skills scores on PPH management and NR increased significantly from baseline to endline measurements. The mean difference for PPH knowledge is 17.1 out of 100; 95% CI = 14.69 to 19.49 and 2.6% for PPH skills; 95% CI = 1.01 to 4.25. The mean difference for NR knowledge is 19.1 out of 100; 95% CI = 16.31 to 21,76 and 5.5% for NR skills; 95% CI = 3.66 to 7.41. Increases were unaffected by participants’ attendance to in-service training six months prior and during SDA intervention and previous smartphone use. However, pre- and post-intervention skills scores were significantly different by years of experience in obstetric care.Conclusion: The SDA intervention improved the knowledge and skills of nurses and midwives on the management of PPH and NR as long as 6 months after SDA introduction. The results are highly relevant in low-income countries like Rwanda, where quality of delivery care is challenged by a lack of in-service continuous training for healthcare providers.
Clinical Outcomes of Severe Sepsis and Septic Shock Patients with Left Ventricular Dysfunction Undergoing Continuous Renal Replacement Therapy: A Multicenter Retrospective Study
Authors: Yu Guangwei , Cheng Kun , Liu Qing , Zhu Zhenhao , Lin Fenghui , Lin Xiaohong , Wu Wenwei
Published: December 2020

Background: Baseline left ventricular (LV) dysfunction is associated with subsequent risks of acute kidney injury (AKI) and mortality in patients with sepsis. This study investigated the therapeutic effects of continuous renal replacement therapy (CRRT) in hemodynamically unstable patients with severe sepsis and septic shock combined with LV dysfunction.Methods: In this multicenter retrospective study, severe sepsis and septic shock patients with LV dysfunction were classified into one of two groups according to the timing of CRRT: the early group (before AKI was detected) or the control group (patients with AKI). All-cause intensive care unit (ICU) mortality and ICU stay were compared between the groups. Patients were weighted by stabilized inverse probability of treatment weights (sIPTW) to overcome differences in baseline characteristics.Results: After sIPTW analysis, the ICU mortality was significantly lower in the early group than the control group (25.9% vs 59.0%, p < 0.001). Weighted multivariable analysis showed that early CRRT initiation was a protective factor for the risk of ICU mortality. Early CRRT initiation significantly improved the ICU mortality compared to the control group (OR, 0.322; 95% CI, 0.125-0.834; p = 0.020).Conclusions: Early CRRT in the absence of AKI is suggested for hemodynamically unstable patients with severe sepsis and septic shock combined with LV dysfunction since it benefits survival outcomes.Trial registration: The study was preregistered in the Chinese Clinical Trial Registry (number, ChiCTR2000033083).
A Novel Longshi Scale Measured Activity of Daily Living Disability in Elderly Patients Affected by Neurological Diseases: a Multi-center Cohort Study in China
Authors: Zhao Jingpu , Wan Li , Gao Yan , Huang Meiling , Liu Xiangxiang , Zha Fubing , Long Jianjun , Li Dongxia , Wang Yulong
Published: December 2020

Background: The activity of daily life (ADL) ability is often impaired in the elderly patients with neurological diseases. Barthel index (BI) is a global disability scale which can assess the performance of ADL for old people. The Longshi scale is a novel pictorial-based scale for evaluating a patient’s disability, but few studies assess the elderly patients. Hence, the aim of this study was to determine whether Longshi scale can distinguish the ADL level of the elderly people and investigate the relationship between the Longshi scale and BI in measuring ADL among the elderly disabled. Methods: This was a multi-center cross-sectional study of elderly disabled patients (more than 65 years old). The ADL levels of all patients were evaluated by both Longshi scale and BI. Patients were divided into three groups (Bedridden group, Domestic group, Community group) based on the Longshi scale, while there were four groups (slight dependence, moderate dependence, severe dependence, total dependence) according to different BI scores. The relationship between the scores of Longshi scale and BI at different level were analysed. Results: A total of 2438 consecutive patients were recruited into the study from 9 centers during a period of 6 months (from 1 Oct 2019 to 1 April 2020). There was a significant difference of the total BI scores between the three groups of Longshi scale (p<0.001). Moreover, the Longshi scale scores showed significant differences between the four BI groups in the bedridden group, domestic group and community group of Longshi scale (p<0.001), respectively. Furthermore, the Spearman correlation coefficients between the LS scores of three groups (bedridden, domestic and community group) and BI scores were 0.869, 0.848 and 0.828 (P<0.001, respectively). Conclusions: Longshi scale can efficiently distinguish the degree of ability of daily living activities among the elderly disabled and has positive correlations with the BI.
Performance comparison of public hospitals between 2014 and 2018 in different regions of Guangdong province, China, following 2017 medical service price reforms
Authors: Weng Kaiyuan , Xia Feng , Wang Yibao
Published: December 2020

BackgroundThis study analyzed performance of public hospitals and regional differences in performance following reform of medical service prices in Guangdong province, China. From three cities in four regions, we randomly selected a total of 12 traditional Chinese medicine hospitals and 12 general tertiary hospitals.MethodsSix questionnaires were completed by the hospitals, using 2014–2018 internal data. Principal components analysis was used to compare performances of the hospitals and regions following price reform. The extent to which medical service prices were adjusted varied considerable for different procedures in the same region and for the same category of procedures among regions.ResultsAfter reform, compensation for medical services in public hospitals reached the target of 80%, except in the Western region. However, annual growth of costs to patients was generally above 4%; the burden on patients was not alleviated by fee control. Reforms were more effective for comprehensive than Chinese traditional medicine hospitals. Performance scores of general hospitals in the Pearl River Delta, Eastern, Western, and Northern regions were 1.24, 1.16, -0.22, and -1.01, respectively. This is consistent with ranking by level of economic development of each region.ConclusionsThe government should implement a regional medical service pricing mechanism. Additionally, comprehensive and traditional Chinese medicine hospitals should each have appropriate pricing policies. Future policies should focus on controlling costs incurred by patients.
Impact of the HLA-DRB1 shared epitope on responses to treatment with tofacitinib or abatacept in patients with rheumatoid arthritis
Authors: Hirose Wataru , Harigai Masayoshi , Amano Koichi , Hidaka Toshihiko , Itoh Kenji , Aoki Kazutoshi , Nakashima Masahiro , Nagasawa Hayato , Komano Yukiko , Nanki Toshihiro
Published: December 2020

Objectives The aim of this study was to compare the clinical effectiveness of tofacitinib and abatacept and clarify the impact of the HLA-DRB1 shared epitope (SE) on responses to these treatments in patients with rheumatoid arthritis (RA).MethodsAfter adjustments by propensity score matching, 70 out of 161 patients receiving tofacitinib and 70 out of 131 patients receiving abatacept were extracted. The clinical effectiveness of both drugs over 24 weeks and the impact of the copy numbers of SE on effectiveness outcomes were investigated.ResultsThe percentage of patients in remission in the 28-joint count disease activity score using the erythrocyte sedimentation rate (DAS28-ESR) did not significantly differ between patients receiving tofacitinib and abatacept at week 24 (32% vs 37%, p=0.359). The mean change at week 4 in DAS28-ESR from baseline was significantly greater in patients receiving tofacitinib than in those receiving abatacept (-1.516 vs -0.827, p=0.0003). The percentage of patients in remission at week 4 was 30% with tofacitinib and 15% with abatacept (p=0.016). When patients were stratified by the copy numbers of SE alleles, differences in these numbers did not affect DAS28-ESR scores of patients receiving tofacitinib. However, among patients receiving abatacept, DAS28-ESR scores were significantly lower in patients carrying 2 copies of SE alleles than in those carrying 0 copies at each time point throughout the 24-week period. Furthermore, the percentage of patients in remission with DAS28-ESR at week 24 was not affected by the copy numbers of SE alleles in patients receiving tofacitinib (p=0.947), whereas it significantly increased as the copy numbers became higher in patients receiving abatacept (p=0.00309). Multivariable logistic regression analyses showed a correlation between the presence SE and DAS28-ESR remission in patients receiving abatacept (OR=25.881, 95%CI=3.140−213.351, p=0.0025), but not in those receiving tofacitinib (OR=1.473, 95%CI=0.291−7.446, p=0.639).ConclusionsAlthough the clinical effectiveness of tofacitinib and abatacept was similar at week 24, tofacitinib was superior to abatacept for changes from baseline in DAS28-ESR and the achievement of remission at week 4. SE positivity was associated with the achievement of DAS28-ESR remission by week 24 in patients receiving abatacept, but not in those receiving tofacitinib.
Psychometric Properties of the Critical Thinking Disposition Assessment Test Amongst Medical Students in China: A Cross-Sectional Study
Authors: Cui Liyuan , Zhu Yaxin , Qu Jinglou , Tie Liming , Wang Ziqi , Qu Bo
Published: December 2020

Background: Critical thinking disposition helps medical students and professionals overcome the effects of personal values and beliefs when exercising clinical judgment. The lack of effective instruments to measure critical thinking disposition in medical students has become an obstacle for training and evaluating students in undergraduate programs in China. The aim of this study was to evaluate the psychometric properties of the CTDA test.Methods: A total of 278 students participated in this study and responded to the CTDA test. Cronbach’s a coefficient, internal consistency, test-retest reliability, floor effects and ceiling effects were measured to assess the reliability of the questionnaire. Construct validity of the pre-specified three-domain structure of the CTDA was evaluated by explanatory factor analysis (EFA) and confirmatory factor analysis (CFA). The convergent validity and discriminant validity were also analyzed.Results: Cronbach’s alpha coefficient for the entire questionnaire was calculated to be 0.92, all of the domains showed acceptable internal consistency (0.81-0.86), and the test-retest reliability indicated acceptable intra-class correlation coefficients (ICCs) (0.93, p<0.01). The EFA and the CFA demonstrated that the three-domain model fitted the data adequately. The test showed satisfactory convergent and discriminant validity.Conclusions: The CTDA is a reliable and valid questionnaire to evaluate the disposition of medical students towards critical thinking in China and can reasonably be applied in critical thinking programs and medical education research.
Risk factors and clinical features of deterioration in COVID-19 patients in Zhejiang, China: a single- centre, retrospective study
Authors: Yi Ping , Yang Xiang , Ding Cheng , Chen Yanfei , Xu Kaijin , Ni Qing , Zhao Hong , Li Yongtao , Zhang Xuan , Liu Jun , Sheng Jifang , Li Lanjuan
Published: December 2020

BackgroundSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection swept through Wuhan and spread across China and overseas beginning in December 2019. To identify predictors associated with disease progression, we evaluated clinical risk factors for exacerbation of SARS-CoV-2 infection.MethodsA retrospective analysis was used for PCR-confirmed COVID-19 (coronavirus disease 2019)-diagnosed hospitalized cases between January 19, 2020, and February 19, 2020, in Zhejiang, China. We systematically analysed the clinical characteristics of the patients and predictors of clinical deterioration.ResultsOne hundred patients with COVID-19, with a median age of 54 years, were included. Among them, 49 patients (49%) had severe and critical disease. Age ([36-58] vs [51-70], P=0.0001); sex (49% vs 77.6%, P=0.0031); Body Mass Index (BMI ) ([21.53-25.51] vs [23.28-27.01], P=0.0339); hypertension (17.6% vs 57.1%, P<0.0001); IL-6 ([6.42-30.46] vs [16.2-81.71], P=0.0001); IL-10 ([2.16-5.82] vs [4.35-9.63], P<0.0001); T lymphocyte count ([305- 1178] vs [167.5-440], P=0.0001); B lymphocyte count ([91-213] vs [54.5-163.5], P=0.0001); white blood cell count ([3.9-7.6] vs [5.5-13.6], P=0.0002); D2 dimer ([172-836] vs [408-953], P=0.005), PCT ([0.03-0.07] vs [0.04-0.15], P=0.0039); CRP ([3.8-27.9] vs [17.3-58.9], P<0.0001); AST ([16, 29] vs [18, 42], P=0.0484); artificial liver therapy (2% vs 16.3%, P=0.0148); and glucocorticoid therapy (64.7% vs 98%, P<0.0001) were associated with the severity of the disease. Age and weight were independent risk factors for disease severity.ConclusionDeterioration among COVID-19-infected patients occurred rapidly after hospital admission. In our cohort, we found that multiple factors were associated with the severity of COVID19. Early detection and monitoring of these indicators may reduce the progression of the disease. Removing these factors may halt the progression of the disease. In addition, Oxygen support, early treatment with low doses of glucocorticoids and liver therapy, when necessary, may help reduce mortality in critically ill patients.
Homocysteine promotes migration of adventitial fibroblasts via Angiotensin II type 1 receptor activation to aggravate atherosclerosis
Authors: Zhu Zhibo , Hao Xiangyu , Li Tianxiang , Guo Jianqiang
Published: December 2020

BackgroundHyperhomocysteinemia (HHcy) is an independent risk factor for atherosclerosis. However, the mechanisms of HHcy-induced arteriosclerosis are largely unknown. Objective: To clarify the effect of Hcy on adventitial fibroblasts (AFs) and its relation with angiotensin II type 1 receptor (AT1R).Method:The apolipoprotein E gene-deficient mice (ApoE−/−) were used as the murine model for atherosclerosis. HHcy was induced and treated by feeding them 1.5% methionine and telmisartan (gavage 10 mg/kg/d) for 12 weeks, respectively. The AFs and HEK293A cells transfected with the AT1R plasmid were used to investigate the interaction between Hcy and AT1R. All data were expressed as mean ± SEM. The data were analyzed by one-way ANOVA or repeated measurement ANOVA.Results:HHcy aggravated the plaque area of the aortic root and increased the expression of IL-6, MCP-1, and the macrophage marker Mac3 in the plaque and adventitia of the aorta, whereas telmisartan improved this effect. HHcy induced the occurrence of the AFs marker protein ER-TR7 in the plaque and the entire layer of the aorta, whereas telmisartan also improved this effect, indicating that HHcy induced AFs migration and that AT1R mediated this process. Hcy increased the production of AFs H2O2, ROS, and IL-6 of AFs, indicating that Hcy activated the oxidative stress and inflammatory reactions, which may induce cell migration. The subsequent scratch and transwell experiments confirmed that Hcy induced the AFs migration and that telmisartan inhibited this effect. Hcy increased the expression of AFs AT1R and the phosphorylation levels of PKC and ERK1/2 in the AF and HEK293A cells transfected with the AT1R plasmid, whereas telmisartan inhibited this effect, indicating that Hcy activated AT1R intracellular signaling pathway.Conclusion:Hcy promoted adventitial inflammation, induced AFs migration, and aggravated atherosclerosis by activating AT1R.
Sulfur content at sulfide saturation of peridotitic melt at upper mantle conditions
Authors: Blanchard Ingrid , Abeykoon Sumith , Frost Daniel J. , Rubie David C.
Published: December 2020

The concentration of sulfur that can be dissolved in a silicate liquid is of fundamental importance because it is closely associated with several major Earth-related processes. Considerable effort has been made to understand the interplay between the effects of silicate melt composition and its capacity to retain sulfur, but the dependence on pressure and temperature is mostly based on experiments performed at pressures and temperatures below 6 GPa and 2073 K. Here we present a study of the effects of pressure and temperature on sulfur content at sulfide saturation of a peridotitic liquid. We performed 14 multi-anvil experiments using a peridotitic starting composition, and we produced 25 new measurements at conditions ranging from 7 to 23 GPa and 2173 to 2623 K. We analyzed the recovered samples using both electron microprobe and laser ablation ICP-MS. We compiled our data together with previously published data that were obtained at lower P-T conditions and with various silicate melt compositions. We present a new model based on this combined data set that encompasses the entire range of upper mantle pressure-temperature conditions, along with the effect of a wide range of silicate melt compositions. Our findings are consistent with earlier work based on extrapolation from lower-pressure and lower-temperature experiments and show a decrease of sulfur content at sulfide saturation (SCSS) with increasing pressure and an increase of SCSS with increasing temperature. We have extrapolated our results to pressure-temperature conditions of the Earth’s primitive magma ocean, and show that FeS will exsolve from the molten silicate and can effectively be extracted to the core by a process that has been termed the “Hadean Matte.” We also discuss briefly the implications of our results for the lunar magma ocean.
Fractal distribution of mineral species among the crystallographic point groups
Authors: Hummer Daniel R.
Published: December 2020

Crystallographic data from 5289 IMA-approved mineral species in the RRUFF database were used to examine the distribution of species among the 32 crystallographic point groups. It is found that within each crystal system, minerals strongly prefer point groups with higher group orders. Within a crystal system, the abundance of minerals belonging to each point group approximately obeys a power law with respect to group order, the same mathematical formalism that describes objects with fractal geometry. In this framework, each crystal system has its own fractal dimension; crystal systems possessing threefold (or sixfold) symmetry elements (i.e., trigonal, hexagonal, isometric) have significantly lower fractal dimension (<2), while those with only one-, two-, or fourfold symmetry elements (triclinic, monoclinic, orthorhombic, tetragonal) have higher fractal dimension (>2). While higher symmetry is preferred within a crystal system, the opposite trend is observed when comparing between crystal systems, with more species preferring crystals systems with lower order symmetry elements than those with higher order symmetry elements at constant group order. The combination of these two competing trends leads to a complex distribution of minerals among the crystal systems, and to the monoclinic group 2/m, the orthorhombic group 2/m2/m2/m, and the triclinic group 1 being the three most popular point groups, respectively. The fractal behavior of symmetry distribution among minerals points toward universal scaling patterns not just in physical, geometric objects but also in the way that symmetry is incorporated into natural periodic structures.
Problems of collective transport management – obstacles for the mobility of elderly and mobility-impaired
Authors: Szewczyk Irena
Published: December 2020

The key assumption of public transport is the overall accessibility for all its users. Lack of adjustments or only partial adjustments of the touristic transport infrastructure to the needs of elderly and disabled persons constitutes a barrier for their free mobility. The study aims to formalize measures to improve public transport activities by identifying the problems of the disabled and the elderly while traveling. The article presents an assessment of the current state and recognizing the most important problems of the physically disabled and elderly persons in the mobility in the city using public transport. The research part of the article attempts to assess the availability of solutions in public transport for the physically disabled and elderly persons. For practical simplification, the article focuses on the mass transport implemented by the only possible means of this type of transport for the research is a bus.In line with the predefined criterion, one city from the region of Bielsko-Biała was included into the research – city Szczyrk. In the article, the diagnostic survey was used as the best research method. The basic technique for collecting the empirical data was the open participating observation using the observation sheet. The basic research was complemented by the direct survey of disabled persons with various levels of disabilities to achieve intended results.The research concluded that the mobility of disabled persons in the transport processes was assessed positively despite multiple difficulties and obstacles caused by their limited mobility and the lack of transport infrastructure adjustments (bus stops or information systems).
O ENSINO JURÍDICO E A PERSPECTIVA UNIVERSITÁRIA HUMANÍSTICA
Authors: Berwig Aldemir
Published: December 2020

Este artigo é uma reflexão sobre a formação humana em cursos jurídicos, orientada a partir da ideia de que uma formação sólida pode contribuir para o fortalecimento das relações humanas e da sociabilidade. Trata-se de pesquisa qualitativa com reflexão a partir de estudo teórico que tematiza a ideia de que a educação tem o papel fundamental de desenvolver a humanidade do homem e que formação jurídica não pode pretender apenas ter um viés operatório-instrumental. Nesse contexto propõe a necessidade de um debate sobre a linguagem, o simbólico e o desenvolvimento do pensamento crítico-reflexivo nos cursos jurídicos. No seu desenvolvimento analisa a necessidade de uma abordagem de viés humanista como preocupação com as futuras gerações, que o ensino jurídico universitário não deve ser apenas um instrumento de conservação da tradição ou de leitura da legalidade, mas deve desenvolver a capacidade crítico-reflexiva. Por fim, defende a ideia de que uma formação sólida pode contribuir para o fortalecimento das relações humanas e da sociabilidade, de modo que esteja comprometida com a justiça social e que seja entendida como uma ampliação dos horizontes para uma atuação comprometida na sociedade, o que somente é possível com uma formação integral do ser humano.
DESENVOLVIMENTO, DIREITOS HUMANOS E CORRUPÇÃO: CORRELAÇÕES ENTRE IDH E IPC NO CASO BRASILEIRO
Authors: Pinheiro Analissa Barros , De Oliveira Franco Fernanda Cristina
Published: December 2020

O exercício do desenvolvimento como um direito é plataforma política e normativa que vem sendo discutida há décadas em âmbito internacional. O irromper global de medidas anti-corrupção não deixou de entrar em diálogo com esse debate. O resultado é o reconhecimento, em vários instrumentos internacionais, dos efeitos adversos da corrupção ao desenvolvimento bem como do advento das abordagens dos direitos humanos à corrupção, que a caracterizam como prática que viola direitos humanos e obstaculiza o exercício do direito ao desenvolvimento. O presente estudo ressalta as relações entre desenvolvimento, direitos humanos e corrupção esmiuçando esta correlação a partir da análise conjunta entre o IDH e o IPC. O contexto brasileiro de anos recentes serve como parâmetro para investigar em que medida ações anti-corrupção garantem melhores nos índices de desenvolvimento e de efetivação dos direitos humanos e vice-versa.
RELEVÂNCIA PROVISÓRIA E URGÊNCIA SOB MEDIDA: PARADOXOS CONCEITUAIS NA MODERNA CONJUNTURA JURÍDICO-POLÍTICA BRASILEIRA
Authors: Silva Delano David , Fernandez Everaldo Luiz Bonfim
Published: December 2020

O presente ensaio visa a observar a definição de pressupostos constitucionais de relevância e urgência nas medidas provisórias sob uma perspectiva sociopolítica. Previstas no artigo 62 da Constituição da República Federativa do Brasil de 1988, são instrumentos de caráter excepcional e de emprego pelo Chefe do Poder Executivo para editar normas com força de lei para situações de manifesta relevância que exijam urgência. A aferição do cumprimento desses requisitos na realidade, e, consequentemente, o uso adequado deste instrumento normativo, considerado o diagnóstico contumaz de que a competência legislativa do Poder Executivo revela-se desvirtuada nesta seara, traduz o núcleo de discussão deste artigo.

Palavras-chave: Constituição. Sociedade. Medidas Provisórias. Relevância. Urgência.