bluuebunny/crossref_metadata_2025 huggingface dataset:
The Prevalence of ACME-arcA and PVL Genes Among Staphylococcus Aureus Isolates in a Student Population from North-West of Iran
Authors: Dehnad Alireza , Rad Rana Khosravi , Rahbarnia Leila , Naghili Behrooz , Golipor Aysan
Published: July 2020

Objectives: Staphylococcus aureus (S. aureus) is the most prevalent cause of skin infections, especially in colonized individuals. Panton–Valentine leukocidin (PVL) and Arginine catabolic mobile element (ACME) are known as the most common virulence factors of S. aureus. This cross-sectional study was conducted to examine the prevalence of ACME-arcA and PVL genes among S.aureus isolates in the student population. Nasal swab samples were randomly collected from 400 healthy students from Tabriz, Iran. The antibiotic resistance pattern of S.aureus isolates was examined by the disk diffusion method. The presence of ACME-arcA, PVL, and mecA genes was detected by PCR reaction.Results: overall, 15% (60/400) students were nasal carriage of S. aureus and 2.75 % (11/400) were MRSA carriage. The frequency of mecA, ACME-arcA, and PVL genes was 54.54% (36/60), 46.66% (28/60), and 16.66% (10/60) respectively. The prevalence of ACME-arcA and PVL genes was independent of gender (P =0.142, P=0.337, respectively). A notable association was observed between the existence of ACME-arcA gene and the frequency of mecA gene (P <0.05), while the incidence of PVL was independent on mecA. These findings highlight the necessity of monitoring nasal carriers in a healthy community to prevent subsequent infections.
Effect of COVID-19 Pandemic on Anxiety Depression And Intention To Go To Hospital in Chronic Patients
Authors: Kaya Yasemin , Bostan Sedat , Kaya Ahmet , Karaman Ömer , Karataş Ahmet , Dereli Seçkin
Published: July 2020

Objective: The aim of this study was to investigate the effects of COVID-19 pandemic on anxiety depression and intention to go to hospital in chronic patients.Methods: The Bostan Intention to Go to Hospital Scale developed by one researcher (SB) as the data collection tool and the Beck Anxiety-Depression Inventories were used.Results: 56.8% of the patients stated that they would go to the hospital in case of emergency and 28.3% expressed that they did not want to go to the hospital even in this case. 50% of the patients said that they did not want to go to the hospital under any circumstances during the pandemic process. As a result of the correlation analysis, there were inverse correlation between the anxiety-depression levels and encountering COVID patient and having a relative with COVID (p=0.001). Inverse correlation was found between intention to go to hospital and encountering COVID patient (p=0.001).Conclusion: It was revealed that chronic patients did not have any intentions to go to hospital during the COVID-19 pandemia and only half of people were willing to go to hospital in case of emergency. Anxiety and depression levels were found to increase when COVID patient was encountered or a relative had COVID.
The Effect of Closed Area on Woody Species Regeneration: A Case study in Loma Bosa Woreda, Dawuro zone, Southern Ethiopia
Authors: Ambushe Assefa Ataro , Gebre Girma Gezimu
Published: July 2020

This study examines the effect of closed area on woody species regeneration by comparing the woody species regeneration among closure, open woodland, and degraded land areas in Loma Bosa district, Dawuro zone in southern Ethiopia. Results show that Simpson's Diversity Index was 7.24 for woody species in closed area, 6.01 in open woodland and 3.40 in open degraded land area. Shannon-Weiner Diversity Index(H') was 2.26 for woody species in closed area, 2.38 in open woodland area and 1.56 in open degraded land area. The results of Sorenson's similarity coefficients indicates woody species composition in closed area are highly correlated with open woodland areas. Wood species density were 2,225 ha-1, 1,642 ha-1, and 297 ha-1 for closed area, open woodland area, and open degraded land area, respectively. The results indicate that closed area development enhanced species composition, richness, diversity, woody vegetation regeneration, inverted J shape Diameter at Breast Height (DBH) and height class and higher woody species density and crown cover class percentage compared to open degraded area. Overall results from this study indicated that area closure is important for improvement of woody species regeneration in the study area.
Working condition and health status of 6,317 front line public health workers during the COVID-19 epidemic across 5 provinces in China: a cross-sectional study
Authors: Li Jinghua , Xu Jingdong , Zhou Huan , You Hua , Wang Xiaohui , Li Yan , Liang Yuan , Li Shan , Ma Lina , Zeng Jing , Cai Huanle , Xie Jinzhao , Pan Chenghao , Hao Chun , Gilmour Stuart , Lau Joseph Tak-fai , Hao Yuantao , Xu Dong Roman , Gu Jing
Published: July 2020

Background: Public health workers at China CDCs and primary health care institutes (PHI) constitute one of the main workforces for implementing prevention and control measures to contain the COVID-19 epidemic, but their efforts and health status have not been well documented. We aimed to investigate the working conditions and health status of frontline public health workers in China during the epidemic. Methods: Between February 18 to March 1, 2020, we conducted a cross-sectional survey among 2,313 CDC workers and 4,004 PHI workers in five provinces across China experiencing different scales of COVID-19 epidemic. We interviewed all participants about their work conditions, roles, burdens, perceptions, mental health, and self-rated health by self-constructed questionnaire and standardized measurements. To examine the independent associations between working conditions and health outcomes, we used multivariate regression models controlling for potential confounders. Results: The prevalence of depression, anxiety, and poor self-rated health was 21.3%, 19.0%, and 9.8%, respectively, among public health workers (27.1%, 20.6% and 15.0% among CDC workers; and 17.5%, 17.9% and 6.8% among PHI workers). The majority (71.6%) participated in both field and non-field work and gave immense efforts. Nearly 20.0% have worked all night for more than 3 days and 45.3% had worked during the whole period of Chinese New Year. Three risk factors and two protective factors were found independently associated with all three health outcomes in our final multivariate models, including working all night for >3 days (ORm=1.67~1.75, p<0.001), concerns about being infected at work (ORm=1.46~1.89, p<0.001), perceived troubles at work (ORm=1.10~1.28, p<0.001), starting COVID-19 prevention work after January 23 (ORm=0.78~0.82, p=0.002~0.008), and capability to persist for more than 1 month at the current work intensity (ORm=0.44~0.55, p<0.001). Conclusion: Chinese public health workers gave immense efforts and personal sacrifices to curb the COVID-19 epidemic and were exposed to risk of mental health problems. Efforts should be taken to improve the working condition and health status of public health workers to maintain the morale and effectiveness of public health workers in the fight against the epidemic.
Myocardial Injury in Post Mortem Biopsies of Patients with COVID-19
Authors: Hartmann Camila , Miggiolaro Anna Flavia dos Santos , Junior Jarbas da Silva Motta , Carstens Lucas Baena , De Paula Caroline Busatta Vaz , Nunes Larissa Hermann de Souza , Marques Gustavo Lenci , Moura Lidia Zytinsky , Neto Jose Rocha Faria , de Noronha Lucia , Baena Cristina Pellegrino
Published: July 2020

Background: Myocardial injury is significantly and independently associated with mortality in COVID-19 patients. However, the pathogenesis of myocardial injury in COVID-19 is still not clear, and cardiac involvement by SARS-CoV-2 remains a major challenge worldwide.Aim: This histopathological and immunohistochemical study seeks to clarify the pathogenesis of myocardial injury in COVID-19.Methods: Postmortem minimally invasive autopsies were performed in two patients who died from COVID-19, and the myocardium samples were compared to a control patient. Immunohistochemistry (IHC) staining was performed using monoclonal antibodies against the following targets: caspase-1, ICAM-1, TNF-α, IL-4, IL-6, CD163, TGF-β, MMP-9, type 1 and type 3 collagen.Results: The histopathological analysis showed severe pericellular interstitial edema surrounding each of the cardiomyocytes. The IHC analysis showed increased expression of caspase-1, ICAM-1, IL-4, IL-6, CD163, MMP-9 and type 3 collagen in the COVID-19 patients compared to the control. On the other hand, no difference from the control was observed in expression of TNF-α, TGF-β and type 1 collagen. ﻿Conclusion: Our findings point to a pathogenesis related with pyroptosis leading to endothelial disfunction. The subsequent inflammation with associated interstitial edema could explain the myocardial disfunction and arrythmias in COVID-19 patients. The presence of Th2 response, MMP-9 and type-3 collagen suggests progression to myocardial fibrosis in the long term.
Do work ability and well-being matter for return to work? Cut-off points for the Work Ability Index and Life Satisfaction Questionnaire among women with long-term musculoskeletal pain
Authors: Rashid Mamunur , Heiden Marina , Nilsson Annika , Kristofferzon Marja-leena
Published: July 2020

Background
To determine whether work ability and well-being predict return to work (RTW) among women with long-term neck/shoulder and/or back pain at 1-year follow-up, and to assess the ability of the Work Ability Index (WAI) and Life Satisfaction Questionnaire (LiSat-11) to discriminate between those who did RTW and those who did not RTW (NRTW).
Methods
A survey was sent to 600 women receiving sick leave (SL) benefits from the Swedish Social Insurance Agency. In total, 208 women responded at baseline, and 141 at a 1-year follow-up. To identify whether work ability and well-being predicted RTW, multiple logistic regression analyses were performed with and without adjustment for type of work and pain intensity. To assess the discriminative ability of the WAI and LiSat-11 for women who did RTW and those who did NRTW, receiver operating characteristic curves were fitted.
Results
Work ability predicted RTW, and the results remained significant after adjusting for type of work and pain intensity (OR 1.12, 95% CI: 1.04–1.22). Well-being was not significant. The WAI at baseline adequately discriminated between RTW and NRTW after one year (AUC 0.78, 95% CI: 0.70–0.86), but the LiSat-11 did not.
Conclusions
Our results indicate that work ability is an important factor for RTW among women on SL for long-term neck/shoulder and/or back pain. The findings also indicate that the WAI, but not the LiSat-11, is able to discriminate between RTW and NRTW in the population under study. The WAI may be used to identify women at risk of NRTW.
Establishment of a Model for Predicting the Recurrence of Recurrent Acute Pancreatitis in A Short Period of Time
Authors: Yang Bo , Li Peiyun , Liu Honglan , Bai Xuesong , Yu Yijun
Published: August 2020

Background Little is known about what factors affect recurrence of recurrent acute pancreatitis (RAP) in a short-term. We performed a retrospective study of patients with RAP, and used non-invasive and quantitative biomarkers to establish a predictive model, so as to provide a basis for effectively predicting and preventing recurrence of RAP. MethodsWe performed a retrospective study of 261 RAP patients admitted to Dazhou Central Hospital from January 2008 through December 2018. The short-term group (n=138) and the long-term group (n=123) were compared. Eight clinical patient characteristics and past medical history were collected from admission records. The prediction model was developed by independent risk factors，and the model to predict the effects were confirmed by the area under the ROC cure．ResultsThe study found that β2-microglobulin (β2-MG) (OR, 0.534; 95% CI, 0.329 to 0.866) and C-reactive protein (CRP) (OR, 1.01; 95% CI, 1.002 to 1.017) were the independent predictors of short-term recurrence. Based on these Independent risk factors，a predicted model for short-term recurrence in RAP patients was constructed．The model was L=β2-MG -0.016BCRP. The AUC for model was 0.651 and the optimal cut-off value was 0.7414, with a sensitivity of 65.9%and a specificity of 63.4%.ConclusionsA new biomarker-based model for predicting risk of short-term recurrence in patients with RAP was satisfactorily developed. The model utilizing β2-MG and CRP may assist physicians in patient education and decision-making when preventing from recurrent attacks with RAP.
Laparoscopic Versus Open Feeding Jejunostomy Insertion in Oesophagogastric Cancer
Authors: Mastoridis Sotiris , Bracalente Giada , Hanganu Bianca , Neccia Michela , Giuliani Antonio , Gillies Richard , Marshall Robert , Maynard Nicholas , Sgromo Bruno
Published: July 2020

Background

Jejunal feeding is an invaluable method by which to improve the nutritional status of patients undergoing neoadjuvant and surgical treatment of oesophageal malignancies. However, the insertion of a feeding jejunostomy can cause significant postoperative morbidity. The aim of this study is to compare the outcomes of patients undergoing placement of feeding jejunostomy by conventional laparotomy with an alternative laparoscopic approach.
Methods

A retrospective review of data prospectively collected at the Oxford Oesophagogastric Centre between August 2017 and July 2019 was performed including consecutive patients undergoing feeding jejunostomy insertion.
Results

In the study period, 157 patients underwent jejunostomy insertion in the context of oesophageal cancer therapy, 126 (80%) by open technique and 31 (20%) laparoscopic. Pre-operative demographic and nutritional characteristics were broadly similar between groups. In the early postoperative period jejunostomy-associated complications were noted in 54 cases (34.4%) and were significantly more common among those undergoing open as compared with laparoscopic insertion (38.1% vs 19.3%, P = 0.049). Furthermore, major complications were more common among those undergoing open insertion, whether as a stand-alone procedure or in conjunction with laparoscopic staging (n = 11/71), as compared with insertion at the time of oesophagectomy (n = 3/86, P = 0.011).
Conclusions

This report represents the largest to our knowledge single-centre comparison of open versus laparoscopic jejunostomy insertion in patients undergoing oesophagectomy in the treatment of gastroesophageal malignancy. We conclude that the laparoscopic jejunostomy insertion technique described represents a safe and effective approach to enteral access which may offer superior outcomes to conventional open procedures.
Association between breakfast skipping and metabolic outcomes with sex, age, and work status stratification
Authors: Heo Jun , Choi Won-Jun , Ham Seunghon , Kang Seong-Kyu , Lee Wanhyung
Published: July 2020

Background
The association between breakfast skipping and abnormal metabolic outcome remains controversial. Large study with stratified data is needed.
Objective
The aim of the current study was to investigate the relationship between abnormal metabolic outcomes and breakfast skipping with sex, age, and work status stratification.
Methods
We used data from the Korea National Health and Nutrition Examination Surveys from 2013–2018. A total of 21,193 (9,022 men and 12,171 women) participants were included in the final analysis. The risk of the increased total number of metabolic outcomes linked to breakfast skipping was estimated using the Poisson regression analysis with sex, work status, and age stratification.
Results
A total of 11,952 (56.4%) participants consumed breakfast regularly. The prevalence of abnormal metabolic outcomes was higher among those with irregular breakfast consumption habits. In the irregular breakfast eating group, young men in the working population demonstrated a higher risk of metabolic syndrome after adjustment (odds ratio, 1.15; 95% confidence interval, 1.06–1.25). We found a similar association among middle-aged men in the working population (odds ratio, 1.11; 95% confidence interval, 1.05–1.19).
Conclusions
The risk of abnormal metabolic outcomes was significant in young men in the working population. Further studies are required to understand the association between specific working conditions (working hours or shift working) and breakfast intake status and the risk of metabolic outcomes
Corrosion Behavior and Failure Mechanism of Rock Bolt(Cable) in Underground Coal Mine
Authors: Wang Qiong , Ren Aiwu , Yin Songyang , Li Mengyi
Published: July 2020

Premature failure of rock bolt (cable) due to stress corrosion cracking (SCC) is a phenomenon that has reported to occur in underground environments. In this study, the corrosion behavior and failure mechanism of rock bolt (cable) samples obtained from underground coal mine were examined and discussed. Macroscopic observation and weight loss test were carried out for the corrosion characteristics of the bolts without failure. It is found the corrosion form is uniform corrosion for the bolts with short service time (S-1, S-2). But for the bolts with longer service time (S-3, S-4 and S-5), experience different degrees of pitting corrosion and the number of corrosion spots on the surface of the sample increases with increase of the service time. The corrosion amount of different parts of the bolts shows the rule of bolt head > bolt end > free section, and the corrosion amount increases year by year with the service time, but the corrosion growth rate is fast in the early stage and slows down in the later stage. At the same time, the failure mechanism of the failure sample S-6, which has been in service for 6 years, was analyzed with macro and micro methods. The results show that S-6 have been in O, Cl and S surrounding rock environment for a long time, resulting serious pitting corrosion and spalling of the surface material of the steel strand, which reduces the outer diameter of the rock cable and its bearing capacity, finally leads to the instantaneous SCC fracture of the sample S-6.
Delirium in older patients undergoing aortic valve replacement Incidence, predictors, and cognitive prognosis
Authors: Humbert Marc , Büla Christophe J , Müller Olivier , Krief Hélène , Monney Pierre
Published: July 2020

Background: To determine delirium incidence, predictors, and relationship with cognitive performance at 3-month follow-up in older patients undergoing aortic valve replacement (AVR).Methods: Patients (N=93) aged 70 years and older, undergoing transcatheter (TAVR, N=66) or surgical (SAVR, N=27) aortic valve replacement in an academic medical center were enrolled in this prospective cohort study. Delirium was assessed using the Confusion Assessment Method (CAM) on postoperative days 1, 2, 3, and 7. Data on patients’ socio-demographics, functional status (including instrumental activities of daily living (IADL), and surgical risk scores (including Society of Thoracic Surgeons (STS) risk score), were collected at baseline. Cognitive status was assessed with the Mini-Mental Status Exam (MMSE) and the Clock Drawing Test (CDT) at baseline and 3 months after AVR.Results: Delirium occurred in 21 (22.6%) patients, within the first three postoperative days in 95% (20/21) of the cases. Delirium incidence was lower in TAVR (13/66=20%) than SAVR (8/27=30%) patients, but this difference was not statistically significant (p=.298). Patients with delirium had lower baseline cognitive performance (median MMSE score 27.0±3.0 vs 28.0±3.0, p=.029), lower performance in IADL (7.0 vs 8.0, p=.038), and higher STS risk scores (4.7±2.7 vs 2.9±2.3, p=.020). In multivariate analyses, patients with intermediate (score>3 to ≤8) and high (score>8) STS scores had 4.3 (95%CI 1.2-15.1, p=.025) and 16.5 (95%CI 2.0-138.2, p=.010), respectively, higher odds of incident delirium compared to patients with low (score≤3) STS scores. At 3-month follow-up (N=77), patients with delirium still had lower MMSE score (27.0±8.0 vs 28.0±2.0, p=.007) but this difference did not remain significant once adjusting for baseline MMSE (β-coefficient 1.11, 95%CI [-3.03-0.80], p=.248).Conclusions: Delirium occurred in about one in five older patients undergoing AVR, almost essentially within the first three postoperative days. Beside cognitive performance, STS score could enhance the identification of high-risk older patients to better target preventative interventions.
Incidental Retroaortic Innominate Vein in a Patient with Acute Aortic Dissection
Authors: Sasaki Hideki , Harada Takashi , Ishitoya Hiroshi , Sasaki Osamu
Published: July 2020

BackgroundRetroaortic innominate vein is a rare anomaly. It has been reported in patients with congenital anomalies such as Tetralogy of Fallot or right aortic arch. However, isolated retroaortic innominate vein is quite rare.Case presentationA 63-year-old man was transferred to our institution because of Stanford type A acute aortic dissection. Incidentally, we noticed that the left innominate vein coursed under the aortic arch and was directed into the superior vena cava on computed tomography. We performed emergent hemiarch replacement. ConclusionsAttention must be paid to the cannulation site for venous uptake and the method of myocardial protection.
High-Expression of ROCK1 Modulates the Apoptosis of Lens Epithelial Cells in Age-Related Cataracts by Targeting p53 Gene
Authors: Hu Shanshan , Su Dongmei , Sun Lei , Wang Zhongying , Guan Lina , Liu Shanhe , Zhao Baowen , Liu Yong , Shi Cuige , Yu Jianbo , Ma Xu
Published: July 2020

Background: Age-related cataract (ARC) is a serious visual impairment disease, and its pathogenesis is unclear. This article aims to investigate the role of ROCK1 in the apoptosis of lens epithelial cells (LECs) in age-related cataracts. Methods: We collect anterior capsule samples from normal people, patients with age-related cataracts, young mice and naturally aging cataract mice. The Oxidative stress-induced apoptosis model was constructed by cultivating HLE-B3 cells with H2O2. MTT, Hoechst 33342, and TUNEL assay were performed to explore proliferation and apoptosis. HE assay was used to observe cell morphology. The gene and protein expression were assessed by quantitative real-time PCR, western blot, and immunohistochemical staining.Result: The results from the clinic and mice experiments showed that the numbers of lens epithelial cells from cataract individuals were less than the control individuals. In vitro, the apoptotic cells were increased in lens epithelial cells under H2O2 treatment. The ROCK1 protein level increased in the lens epithelial cells from age-related cataract patients and the old mice, respectively. Meanwhile, the up-regulation of the ROCK1 gene was associated with H2O2-induced HLE-B3 cells apoptosis. MTT and apoptosis assay showed ROCK1 was necessary in mediating H2O2-induced lens epithelial cells apoptosis through ROCK1 over-expression and knockdown experiment, respectively. Further investigation showed that p53 protein levels had been increased during ROCK1-mediated apoptosis in response to H2O2. Besides, ROCK1 phosphorylated p53 at ser15 to up-regulate its protein level. Conclusions: This study established the novel association of ROCK1/p53 signaling with lens epithelial cells apoptosis and age-related cataract genesis.
Development of a 38K Single Nucleotide Polymorphism Array and Application in Henomic Selection for Resistance Against Vibrio harveyi in Chinese Tongue sole, Cynoglossus Semilaevis
Authors: Lu Sheng , Zhou Qian , Chen Yadong , Liu Yang , Li Yangzhen , Wang Lei , Yang Yingming , Chen Songlin
Published: August 2020

Background: In recent years, the disease outbreak caused by Vibrio harveyi upset the booming development of the Chinese tongue sole (Cynoglossus semilaevis) farming industry. Genomic selection (GS) is a powerful method to improve the traits of interest, which has been proved in livestock and some fishes. Besides, the single nucleotide polymorphism (SNP) array is an efficient genotyping platform that can be used for genetic studies. To improve V. harveyi resistance in C. semilaevis, we firstly constructed a reference group of 1,572 individuals and investigated accuracies of four genomic methods (genomic best linear unbiased prediction (GBLUP), weighted GBLUP, BayesB, and BayesC) at predicting the genomic estimated breeding value (GEBV) using five-fold cross-validation and SNPs varying from 0.5 k to 500 k. Then, an SNP array was developed using the Affymetrix Axiom technology, and its accuracy in genotyping was evaluated by comparing SNPs generated by the array and by the re-sequencing technology. Finally, we selected 44 candidates as the parents of 23 families of C. semilaevis to evaluate the feasibility of the SNP array for GS.Results: all genomic methods outperformed the pedigree-based BLUP (ABLUP) when at least 50 k SNPs used for prediction, of which GBLUP resulted in better estimation than ABLUP when more than 1 k SNPs used. A 38 k SNP array, “Solechip No.1”, was developed with an average of 10.5 kb inter-spacing between two adjacent SNPs. The SNPs generated by the array and by the re-sequencing reached an average consistency of 94.8 %, of which 79.3 % of loci had a more than 90 % of the consistency. The survival rates of these 23 offspring families had a correlation of 0.706 with the family GEBVs (mid-parental GEBVs), and the average survival rate of the top five families in GEBVs (79.1 %) is higher than the bottom five families (58.1 %).Conclusion: GS is an efficient method to improve the V. harveyi resistance in C. semilaevis, and the SNP array “Solechip No.1” is a convenient and reliable tool for the Chinses tongue sole selective breeding practice.
Duodenal Perforation Caused Septic Shock: a Rare Case Combined With Coronavirus Disease 2019
Authors: Guo Huanhuan , Hu Jing , Li Yunxiang , Xiang Wei , Gan Quan
Published: July 2020

Background: Duodenal perforation is one of the rarer causes of acute abdomen in pregnancy, which is especially easy to be overlooked during the outbreak of 2019 novel coronavirus (2019-nCoV) after delivery.Case presentation: Here, we report a case of duodenal perforation-induced septic shock with coronavirus disease 2019 (COVID-19), and the patient underwent emergency laparotomy after reporting to the hospital management department under strict protection. Her recovery in postoperative period in Medical Intensive Care Unit (MICU) was uneventful and she was transferred to a designated hospital for treatment of COVID-19 5 days later.Conclusions: The establishment of emergency green channel for maternal health care, and timely and comprehensive multidisciplinary cooperation during the epidemic period, strengthen the standardized management of high-risk pregnancy, and better guarantee the safety of mothers and infants.
Hypophosphataemia in Critically Ill Adults and Children – A Systematic Review
Authors: Blaser Annika Reintam , Gunst Jan , Ichai Carole , Casaer Michael , Benstoem Carina , Besch Guillaume , Dauger Stephane , Fruhwald Sonja M , Hiesmayr Michael , Joannes-Boyau Olivier , Malbrain Manu LNG , Perez Maria-Helena , Schaller Stefan J , Man Angelique de , Starkopf Joel , Tamme Kadri , Wernerman Jan , Berger Mette M
Published: July 2020

Background: Phosphate is the main intracellular anion essential for numerous biological processes. Symptoms of hypophosphataemia are non-specific, yet potentially life-threatening. This systematic review process was initiated to gain a global insight into hypophosphataemia, associated morbidity and treatments. Methods: A systematic review was conducted (PROSPERO CRD42020163191). Nine clinically relevant questions were generated, seven for adult and two for paediatric critically ill patients, and prevalence of hypophosphataemia was assessed in both of these groups. We identified trials through systematic searches of Medline, EMBASE, Scopus, Cochrane Central Register of Controlled Trials, CINAHL, and Web of Science. Quality assessment was performed using the Cochrane risk of bias tool for randomized controlled trials and the Newcastle-Ottawa Scale for observational studies.Results: For all research questions, we identified 2727 titles in total, assessed 399 full texts, and retained 82 full texts for evidence synthesis, with 20 of them identified for several research questions. Only 3 randomized controlled trials were identified with two of them published only in abstract form, as well as 28 prospective and 31 retrospective studies, and 20 case reports. Relevant risk of bias regarding selection and comparability was identified for most of the studies. No meta-analysis could be performed. The prevalence of hypophosphataemia varied substantially in critically ill adults and children, but no study assessed consecutive admissions to intensive care.In both critically ill adults and children, several studies report that hypophosphataemia is associated with worse outcome (prolonged length of stay and the need for respiratory support, and higher mortality). However, there was insufficient evidence regarding the optimal threshold upon which hypophosphataemia becomes critical and requires treatment. We found no studies regarding the optimal frequency of phosphate measurements, and regarding the time window to correct hypophosphataemia. In adults, nutrient restriction on top of phosphate repletion in patients with refeeding syndrome may improve survival, although evidence is weak. Conclusion: Evidence on the definition, outcome and treatment of clinically relevant hypophosphataemia in critically ill adults and children is scarce and does not allow answering clinically relevant questions. High quality clinical research is crucial for the development of respective guidelines.
Divergent enhancement of in vitro induced coagulopathy by microparticle subtypes
Authors: Boehm Julia , Schäfer Nadine , Maegele Marc , Stümpges Birgit , Bauerfeind Ursula , Caspers Michael
Published: July 2020

Background
Aggressive fluid therapy of patients following a major trauma may result in hypothermia, acidosis and haemodilution that deteriorates even further towards a trauma-induced coagulopathy. The combination of these three factors is referred as lethal triad (LT) and a progressive course of LT is associated with a worsening or complete failure of haemodynamics and coagulative function. Within the process of coagulation, microparticles (MP) are crucial players at the interface of cellular and plasmatic coagulation. This study aimed at the characterization of coagulative effects originating from MP with different cellular origin and concentration under in vitro simulated traumatic conditions of haemodilution (HD) and LT.
Methods
HD was induced by replacing a blood volume of 33% by crystalloids and for LT, samples were further processed by reducing the temperature to 32 °C and lowering the pH to 6.8. MP were obtained either from platelet concentrates (platelet-derived MP, PDMP) or from cell culture (ECV304 cells for endothelial-derived MP, EDMP) by targeted stimulation. Effects of MP on coagulation depending on concentrations (1.000, 10.000 and 15.000 MP/µl blood) were characterized by flow cytometric platelet activation and by quantification of fibrin clot propagation and spontaneous clotting using Thrombodynamics® technology.
Results
MP originated from platelets and endothelial cell culture affected blood coagulation in a concentration-dependent manner. Particularly, high PDMP quantities significantly induced platelet activation and fibrin clot growth and size in HD conditions. In LT conditions, the highest PDMP concentration enhanced platelet activation, clot growth and size. In contrast, EDMP supplementation did not affect platelet activation, but resulted in enhanced formation of spontaneous clots, irrespective of simulated condition. With increasing EDMP concentration, the time until the onset of spontaneous clotting decreased in both HD and LT conditions.
Discussion
The study demonstrates the essential role of MP within the coagulation process in the simulated traumatic conditions. While PDMP affected platelets promoting clot formation likely by providing a surface enlargement, EDMP presumably affected clotting factors of the plasmatic coagulation resulting in an increased formation of spontaneous fibrin clots.
Conclusion
The diverse effects of in vitro generated MP from different cellular origin indicate a divergent mechanism of action exhibiting distinct functions within the coagulation process.
Giant Left Atrial Myxoma Misdiagnosed As Schizophrenia: A Case Report
Authors: Xu Hongfei , Si Wei , Zhang Yiran , Ni Yiming , Li Weidong
Published: July 2020

Background: Primary cardiac tumors are rare. Myxoma is the most common cardiac tumor and presents in the left atrium. Improvements tend to occur with early diagnosis, and with the help of high-resolution imaging technology, such as transesophageal echocardiography (TEE). Patients typically present with tightness of the chest, fatigue and lassitude. There are also cases of misdiagnosis and missed diagnosis. Case presentation: A 59-year-old Chinese woman complained of tightness in her chest, fatigue and lassitude for eight years. She had been misdiagnosed with schizophrenia by the local rural hospital. Computed tomography (CT) confirmed a giant mass in the left atrium, and transthoracic echocardiography (TTE) revealed left atrial enlargement with an occupying lesion. For this patient, we performed tumor resection surgery with a cardiopulmonary bypass. The giant tumor was partially detached during the operation, and the thrombus was removed successfully. After the operation, the mental health department of our hospital thought that the patient's diagnosis of schizophrenia was misdiagnosed. The patient recovered well and appeared rejuvenated after the operation. A two-year follow-up found no adverse events since the operation. Conclusions: When making a diagnosis for a patient who presented with tightness of the chest, we need to administer a cardiac physical examination and echocardiography. The physician diagnosing schizophrenia needs to first rule out any organic diseases. A careful and complete resection of the cardiac myxoma is a vital operation, due to the risk of thromboembolism.
Algorithm for Program of the Vertical Thermo-siphon Re-boiler
Authors: Ketin Sonja , JOVICIC Aleksandar , ANDREJIC Marko
Published: August 2020

The authors have withdrawn this preprint due to author disagreement.
Prevalence and Prognostic Value of Elevated Troponins in Patients Hospitalised for Coronavirus Disease 2019: A Systematic Review and Meta-Analysis
Authors: Zhao Bing-Cheng , Liu Wei-Feng , Lei Shao-Hui , Zhou Bo-Wei , Yang Xiao , Huang Tong-Yi , Deng Qi-Wen , Xu Miao , Li Cai , Liu Ke-Xuan
Published: July 2020

Background: The clinical significance of cardiac troponin measurement in patients hospitalised for coronavirus disease-2019 (covid-19) is uncertain. We investigated the prevalence of elevated troponins in these patients and its prognostic value for predicting mortality.Methods: Studies were identified by searching electronic databases and preprint servers. We included studies of hospitalised covid-19 patients that reported the frequency of troponin elevations above the upper reference limit and/or the association between troponins and mortality. Meta-analyses were performed using random-effects models.Results: Forty-four studies were included. Elevated troponins were found in 21.3% (95% confidence interval [CI] 18.0-24.9 %) of patients who received troponin test on hospital admission. Elevated troponins on admission were associated with a higher risk of subsequent death (risk ratio 2.81, 95% CI 2.01-3.93) after adjusting for confounders in multivariable analysis. The pooled sensitivity of elevated admission troponins for predicting death was 0.64 (95% CI 0.58-0.70), and the specificity was 0.88 (0.82-0.92). The post-test probability of death was about 50% for patients with elevated admission troponins, and was about 7% for those with non-elevated troponins on admission. There were significant heterogeneity and publication bias in the analyses, and many included studies were at risk of selection bias due to the lack of systematic troponin measurement and inadequate follow-up.Conclusion: Elevated troponins were relatively common in patients hospitalised for covid-19. Troponin measurement on admission might help in risk stratification, especially in identifying patients at high risk of death when troponin levels are elevated. High-quality prospective studies are needed to validate these findings.Systematic Review Registration: PROSPERO (CRD42020176747).
“Students in public and private schools—which are at higher risk of drug abuse?”: A survey from Iran
Authors: Bahramnejad Ali , Iranpour Abedin , Nakhaee Nouzar
Published: July 2020

Background

Recent evidence from Western countries suggests that private school students are more prone to drug use. Such an evidence is lacking in Muslim countries. The aim of this study was to examine whether the risk of drug use is higher in private schools than public schools.
Methods

This cross sectional study was conducted on 630 randomly selected 10th grade students of Kerman city, the center of largest province of Iran. Well-validated questionnaires regarding current, lifetime substance use, and perceived use by classmates were utilized. Substances included in the questionnaire were waterpipe, cigarette, alcohol, marijuana, opium, methamphetamine, and Naas. Drug Abuse Tendency Scale was used to measure the attitudes of students towards drug use.
Results

More than 82% of sample were public school students (n = 504). Ever use of cigarette, alcohol and marijuana was higher in private schools (27.6%, 39.0%, and 5.7%, respectively) than public schools (15.3%, 25.8%, 2.2%, respectively) (P < 0.05). The drug abuse tendency score was nearly higher in public school students (10.4 ± 9.4) than private schools (12.1 ± 9.9) (P = 0.090). Perceived prevalence of cigarette and marijuana use by classmates was higher among private school students.
Conclusion

Despite the popular belief that private schools are better than public schools regarding the risk of substance use, students who attend private schools are at a higher risk of turning to some drugs comparing to public schools in Iran.
Gastrointestinal Anastomosis (GIA) Stapler as a safe and efficacious damage control tool for High-Grade Liver Injury in Hemodynamically Unstable Patient- A Case Report
Authors: Saqib Sabah uddin , Iftekhar Wafa , Zafar Hasnain
Published: July 2020

Background: Liver injury occurs in approximately 5% of all trauma admissions. The large size of the liver and its location makes it more susceptible to injuries. Nowadays, the majority of isolated liver injuries are successfully managed with non-operative methods, however, operative management is still the mainstay of treatment for hemodynamically unstable patients. There are many traditional ways of controlling hemorrhage from the liver and here we report a case in which a GIA 75 stapler was successfully used to manage Grade IV liver injury in a hemodynamically unstable patient.Case presentation: 45 years old policeman presented in the emergency, within 20 minutes after sustaining a gunshot injury to his abdomen. At presentation, he was hemodynamically unstable with a heart rate of 100 beats/min and blood pressures of 70/35 mm Hg. On examination, he had a single entry wound in the epigastrium with no exit wound and had generalized peritonitis. He was paraplegic and had a sensory level. He was rushed to the operating room (OR) for exploratory laparotomy which revealed a shattered left lobe of the liver. Gastrointestinal anastomosis 75 stapler device was used for non-anatomical left segmentectomy (segments I and II). Active bleeding from tributaries of left hepatic vein and small branches opening into retrohepatic inferior vena cava (IVC) was identified and the vessels were suture ligated. Perihepatic packing was done and the patient shifted to the surgical intensive care unit(SICU). His improved hemodynamically and was re-explored within 24 hours. No active bleeding was seen after the packs were removed and the abdomen was closed. The next day he was moved out of SICU and the rehabilitation program was initiated for his spine injury. He was discharged on the 10th day of admission.Discussion: Grade IV liver injuries are often very complex and challenging to manage in a hemodynamically unstable patient. The role of GIA staplers for hepatic resection is quite common and safe in elective settings but their similar use in the context of trauma is less described. The concept of damage control surgery rests on quick control of life-threatening bleeding and a GIA stapler can be effectively used for rapid non-anatomical resection of the liver in trauma. This can prevent the depletion of physiological reserves and the life-threatening death triad. Conclusion: GIA stapler device is an effective, safe, and rapidly deployable tool for managing high grade live injury in a hemodynamically unstable patient. It controls bleeding without any concomitant chances of bile leak and also resection of the shattered liver gives good access for inspecting the rest of the bleeding sites.
Cerebrospinal Fluid Microglial Activation Markers in Patients With Neuromyelitis Optica
Authors: Chen Jinyu , He Yan , Luo Ying , Guan Hongbin , An Hongwei , Wang Honghao
Published: July 2020

Aim: Microglia, the resident immune cells in the brain can activated by inflammation in the central nervous system (CNS), then become significant sources of inflammatory mediators. However, little is known about that whether microglia activation in neuromyelitis optica (NMO). The aims of this pilot study were to investigate the levels of the biomarkers of microglia activation, YKL-40, sCD163 and sCD14 in patients with NMO，and the possible associations between those and Expanded Disability Status Scale EDSS scores. ﻿Methods: We found significantly higher CSF YKL-40, sCD163 and sCD14 levels in NMO patients. The level of neurological disability was assessed by the EDSS scores.Results: The levels of microglia biomarkers in NMO patients were positively correlated with Expanded Disability Status Scale (EDSS) scores, but not in MS and GFAP groups. Finally, we showed levels of CSF YKL-40, sCD163 and sCD14 were higher in NMO patients and positive relationship with disease severity of NMO. Conclusion: These finding suggesting that microglial activation, may be implicated in the pathogenesis of NMO.
Peripheral Nerve Activity Potential Difference Among TaiYang, TaiYin, ShaoYang and ShaoYin
Authors: JIN Li-yan , JIN Chun-yu , JIANG Jin-long , ZHENG Dao-xuan
Published: July 2020

Objects Explain the mechanism of PNAP Characteristic changes for each Korean Medicine Sasang typology. Methods By ways of question form and expert’s deliberation, 1000 healthy volunteers are distinguished into corresponding Sasang types, then detect median, ulnar, peroneal, tibial nerves’ CMAP and F-Wave, to analyze nerve conduction’s characteristic changes between groups or within group. Results ① Within group, TaiYin: Median nerve’s right side MCV is declined than left side; Ulnar and Peroneal and tibial nerve’s left side MCV is declined than right side. ShaoYang: Ulnar and tibial nerve’s left side MCV is declined than right side. ( P <0.05 ). ② Between groups, TaiYin & ShaoYang: About median and tibial nerve’s Distal Amlitude ( DA ), MCV, TaiYin is declined than that of ShaoYang; TaiYin & ShaoYin: About tibial nerve’s DA, MCV, The shortest latency of F-wave ( FL ), TaiYin is declined or extended than that of ShaoYin; ShaoYang & ShaoYin: For median nerve’s MCV, FL, ShaoYin is declined or extended than that of ShaoYang ( P < 0.05 ). ③ Nerve amount rate of FL ≥ 2SD ( ShaoYang as standard), for peroneal and tibial nerves, TaiYin is greater than ShaoYang and ShaoYin ( P < 0.01). ④ Nerve amount rate which conduction is under-activity, for tibial nerve, TaiYin is greater than ShaoYin ( right ) and ShaoYang ( left ) ( P < 0.01). ⑤ AMP. / DUR. rate of median nerve: ShaoYin > ShaoYang > TaiYin ( P < 0.05 ). Conclusions Median nerve’s left side has advantage than right side, however the ulnar and tibial nerve’s right side is well than left side, this characteristic is much more obvious in TaiYin; PNAP of ShaoYang is well than TaiYin and ShaoYin; AMP. / DUR. rate of median nerve shows sensitively about constitutional differences. Significance Provide foundation of clinical diagnosis and treatment on a constitutional basis.
Serum S100B protein as a marker of severity in Covid-19 patients
Authors: Aceti Antonio , Margarucci Lory Marika , Scaramucci Elena , Orsini Massimiliano , Salerno Gerardo , Sante Gabriele Di , Gianfranceschi Gianluca , Liddo Rosa Di , Valeriani Federica , Ria Francesco , Simmaco Maurizio , Parnigotto Pier Paolo , Vitali Matteo , Spica Vincenzo Romano , Michetti Fabrizio
Published: July 2020

SARS-CoV-2 infection shows a wide-ranging clinical severity, requiring prognostic markers. We focused on S100B, a calcium-binding protein present in biological fluids, being a reliable biomarker in disorders having inflammatory processes as common basis and RAGE as main receptor. Since Covid-19 is characterized by a potent inflammatory response also involving RAGE, we tested if S100B serum levels were related to disease severity.Serum samples (n=74) were collected from hospitalized SARS-CoV-2 positive patients admitted to Covid center. Illness severity was established by admission clinical criteria and Covid risk score. Treatment protocols followed WHO guidelines available at the time. Circulating S100B was determined by ELISA assay. Statistical analysis used Pearson’s χ2 test, t-Test, and ANOVA, ANCOVA, Linear Regression.S100B was detected in serum from Covid-19 patients, significantly correlating with disease severity as shown both by the level of intensity of care (p<0.006) as well by the value of Covid score (Multiple R-squared: 0.3751); the correlation between Covid-Score and S100B was 0.61 (p<0.01). S100B concentration was associated with inflammation markers (Ferritin, C-Reactive Protein, Procalcitonin), and organ damage markers (Alanine Aminotransferase, Creatinine). Serum S100B plays a role in Covid-19 and can represent a prognostic marker in Sars-CoV-2 infected patients.
Unmet Need for Healthcare Among People with Hypertension in Indonesia
Authors: Ainy Asmaripa , Rosyada Amrina , Idris Haerawati , Maharani Asri
Published: August 2020

Background: Hypertension is a leading global public health problem in both developed and developing countries including Indonesia, mainly due to its high frequency and risks of cardiovascular diseases. Prevalence of hypertension in the Indonesian population aged> 18 years in 2018 was 34.11%. Unmet need for healthcare generally has been explored, but limited empirical study explores it among people with hypertension. The objective of this study is to investigate the determinants of unmet need for healthcare among people with hypertension. Methods: The design of this study is cross-sectional, using the data from the Indonesia Family Life Survey wave 5 (IFLS-5). The sample of the survey was 6,302 adults age >40 years old, stratified by rural/urban status. Three-level multilevel analysis was performed to estimate the individual level, household level, and community-level determinants of unmet needs for hypertension care. Results: The data shows that 78.4% of respondents with hypertension reported an unmet need for healthcare. Age, female, single, income, having insurance, living in the urban area, and the number of health posts for elderly (Posyandu Lansia) are significantly associated with meet needs for health care utilization among hypertension, while education and employment status shows no association with them. Conclusion: Improving access to healthcare and reducing health inequality are required to address this problem.