bluuebunny/crossref_metadata_2025 huggingface dataset:
Primary Drug-Resistant Tuberculosis in the Elderly in Shandong,China,from 2004 - 2019.
Authors: An Qiqi , Song Wan-mei , Liu Jin-yue , Tao Ning-ning , Liu Yao , Zhang Qian-yun , Xu Ting-ting , Li Shi-jin , Liu Si-Qi , Li Yi-Fan , Yu Chun-Bao , Li Huai-chen
Published: July 2020

Background: With an aging population, China is facing a huge buedern of elderly patients with drug resistant tuberculosisi (DR-TB), which has become an significant obscale for the global TB control targets. There is still few study on DR-TB among China so far.Thus, more researches on the epidemiological characteristics and trend of primary DR-TB among the elderly will be necessary. Methods: A retrospective study was conducted in Shandong, China from 2004-2019, 12661 primary TB and 4368 elderly (≥60 years of age) primary TB cases were involved. Clinical characteristics including age, sex, Cavity, Smoking, drinking, comorbidity and drug susceptibility data were included. Descriptive statistical analysis, Chi-square and linear regression were used for analyzing.Results: Among 4368 elderly patients with primary TB, the DR-TB and MDR-TB accounted for 17.19% and 2.29% respectively. During 2004 to 2019, the proportions of MDR-TB, PDR-TB, RFP-resistance increased by160.00%, 18.18%, 231.82%, and the rate of DR-TB among elderly patients with primary cavitary TB increased by 255%.Among the elderly with primary DR-TB, the proportion of male (from 85.19 to 89.06), cavity (from 7.41 to 46.88), RFP (from 3.70 to 21.88), SM (from 37.04 to 62.5) increased significantly(P<0.05) . And the proportion of female (from 14.81 to 10.94), non-cavity (from 92.59 to 32.81 ), INH (from 66.67 to 57.81 ) decreased significantly. (P<0.05) .Conclusion: Among the elderly, the proportions of MDR-TB, PDR-TB,RFP-resistance and cavitary DR-TB increased significantly. The pattern of DR-TB changed from female, non-cavity and INH-resistant groups to male, cavity and RFP, SM-resistant groups. For a better control on the elderly DR-TB in the future, we should pay more attention to, male, smoking, drinking, COPD and diabetes subgroups.
Development and validation of an immune-related prognostic signature for ovarian cancer based on weighted gene co-expression network analysis
Authors: An Yuanyuan , Yang Qing
Published: July 2020

Background

Ovarian cancer is one of the most lethal diseases of women. The prognosis of ovarian cancer patients was closely correlated with immune cell expression and immune responses. Therefore, it is important to identify a robust prognostic signature, which not only correlates with prognoses but also with immune responses in ovarian cancer, thus, providing immune-related patient therapies.
Methods

Weighted gene co-expression network analysis (WGCNA) was used to identify candidate genes correlated with ovarian cancer prognoses. Univariate and multivariate cox regression analyses were used to construct the prognostic signature. The Kaplan-Meier method was used to predict survival, and the immune-related bioinformatics analysis was performed using R software. The relationship between the signature and clinical parameters was analyzed with GraphPad Prism 7 and SPSS software.
Results

Gene expression from The Cancer Genome Atlas dataset was used to perform the WGCNA analysis, and identified candidate prognostic-related genes in patients with ovarian cancer. According to the Cox regression analysis, the prognostic signature was constructed, which divided patients into two groups. The high-risk group showed the least favorable prognosis. Three independent cohorts from the Gene Expression Omnibus (GEO) database were used for the validation studies. According to the immune analyses, the GEO database signatures were significantly correlated with the immune statuses of ovarian cancer patients. By analyzing the combination of the prognostic signature and total mutational burden (TMB), ovarian cancer patients were divided into four groups. In these groups, memory B cell, resting memory CD4 T cell, M2 macrophage, resting mast cell and neutrophil were found significant distinctions among these groups.
Conclusions

This novel signature predicted the prognosis of ovarian cancer patients precisely and independently and showed significant correlations with immune responses. Therefore, this prognostic signature might could indicate targeted immunotherapies for ovarian cancer patients.
Systemic immune-inflammation index predicts prognosis of sequential therapy with sorafenib and regorafenib in hepatocellular carcinoma
Authors: Hong Young Mi , Cho Mong , Yoon Ki Tae
Published: July 2020

Background

Regorafenib has shown promising results as a second-line therapy for patients with hepatocellular carcinoma (HCC) who progressed on sorafenib. Although several data regarding the efficacy of sequential therapy with sorafenib and that of regorafenib in real-life, specific inflammation markers for predicting the prognosis have not been studied. This study aimed to investigate prognostic value of systemic inflammatory markers in patients with HCC who received sorafenib-regorafenib sequential therapy.
Methods

We retrospectively analyzed medical data of patients who received regorafenib for the treatment of HCC after sorafenib failure. Progression free survival (PFS) and overall survival (OS) were assessed using the Kaplan–Meier survival curves. Univariate and multivariate analyses were performed to analyze the factors associated with survival.
Results

A total of 58 patients who received at least one dose of regroafenib and fulfilled the eligibility criteria, good performance status (Eastern Cooperative Oncology Group [ECOG] 0–1) and preserved liver function (Child-Pugh-A), were included in the analysis. The median PFS was 3 months (95% confidence interval [CI] = 0.981–5.019) and the median OS was 8 months (95% CI = 5.761–10.239). Elevated systemic immune-inflammation index (SII ≥ 340) was independently associated with poor OS. In multivariate analysis, the SII (hazard ratio [HR] = 2.211, 95% CI = 1.089–4.489, P = 0.028) and alpha-fetoprotein (AFP) (HR = 2.750, 95% CI = 1.259–6.010, P = 0.011) were independent predictors of OS.
Conclusion

Elevated SII is associated with poor OS in patients with HCC who received sequential therapy with sorafenib and regorafenib. In addition, when selecting a treatment strategy, the SII can be used in combination with the AFP level as a promising prognostic tool for HCC.
Development and validation of a novel ten-gene signature predicting prognosis in Hepatocellular carcinoma
Authors: Zhou Guanbao , Lu Genjie , Yang Liang , Lu Yangfang
Published: July 2020

Background: Hepatocellular carcinoma (HCC) is the most common type of liver cancer with relatively poor prognosis. Thus, we aimed to identify novel molecular biomarkers to effectively predict the prognosis of HCC patients and eventually guide treatment. Methods: Prognosis-associated genes were determined by Kaplan-Meier and multivariate Cox regression analyses using the expression and clinical data of 373 HCC patients from The Cancer Genome Atlas (TCGA) database and validated in an independent Gene Expression Omnibus (GEO) dataset. The classification of AML was performed by unsupervised hierarchical clustering of ten gene expression levels. A prognostic risk score was established based on a linear combination of ten gene expression levels using the regression coefficients derived from the multivariate Cox regression models. Results: A total of 183 genes were significantly associated with prognosis in HCC. SLC25A15, RAB8A, GOT2, SORBS2, IL18RAP were top five protective genes, while FHL3, AMD1, DCAF13, UBE2E1, PTDSS2 were top five risk genes in HCC. SLC25A15, GOT2, IL18RAP were significantly down-regulated and DCAF13, PTDSS2 and SORBS2 were significantly up-regulated in the HCC samples and these genes exhibited high accuracy in differentiating HCC tissues from normal liver tissues. Hierarchical clustering analysis of the ten genes discovered three clusters of HCC patients. HCC tumors of cluster1 and 2 were significantly associated with more favourable OS than those of cluster3, cluster2 tumors showed higher pathologic stage than cluster3 tumors. The risk score was predictive of increased mortality rate in HCC patients. Conclusions: The ten-gene signature and the risk score may turn out to be novel molecular biomarkers and stratification of HCC patients to considerably ameliorate the prognostic prediction.
Effect of Autologous Fibrin Glue on Seroma Reduction after Modified Radical Mastectomy for Breast Cancer: A Randomized Controlled Trial
Authors: Faisal Mohammed , Salem Sara , Kamel Noha , Zaher Haidy Abd El- , Bakr Ahmed Abo , fathy hamada
Published: July 2020

Introduction: Breast cancer stands out as the second most common cancer in the world with incidence 35.1% of all malignancies among females in Egypt. Fluid build-up after breast surgery is still the most annoying complication which leads to worse outcome. We aimed to evaluate whether autologous fibrin glue might lessen the formation of seroma following modified radical mastectomy. Methods: This was a randomized controlled trial designed to configure the effect of autologous fibrin glue given in the study group using the drain in comparison to a control group who received the drain only; seroma volume was calculated every 24 hrs. For all of the cases. The drains were removed when the daily drainage was less than 30 ml for 3 consecutive days. Results: We recruited 30 patients to each of the two groups. Age, pathology, breast cancer stage, number of lymph nodes and tumour size did not differ significantly between groups. A comparison of the median days to drain removal showed 8 days reduction in median days to drain removal compared in the intervention group (7 days) than the control (15 days). The patients in the fibrin glue group had a significantly lower cumulative drain output volume (mean ± SD of 505.6 ± 209.3 ml) than those in the control group (1674.1 ± 1373.8 ml). Additionally, the patients treated with fibrin glue had a significantly shorter postoperative length of stay (8.5 (7–10) days) than the controls (15 (10–23) days. Conclusions: Autologous fibrin glue significantly decrease seroma formation post-modified radical mastectomy. Research Registry Unique Identifying Number: researchregistry5372.
Preoperative neoadjuvant targeted therapy for inoperable differentiated thyroid cancer: a case report
Authors: Zhang Yingchao , Deng Xianzhao , Ding Zheng , Niu Yiqi , Hou Jianzhong , Kang Jie , Wu Bo , Yang Zhili , Guo Bomin , Fan Youben
Published: July 2020

Background: The majority of differentiated thyroid cancer (DTC) has good prognosis after a careful standardized therapy according to the current guidelines. However, approximately 13% to 15% of DTC shows surprisingly aggressive behavior and invades the surrounding structures, and then a few is very difficult to remove. In that specific context, preoperative neoadjuvant targeted therapy may improve the clinical stage and create an opportunity for operation.Case presentation: We reported a case of 64-year-old woman with locally advanced papillary thyroid cancer (PTC) who presented with dysphagia due to seemingly unresectable tumor, which severely invaded the left esophagus at the junction of neck and thorax, difficult to undergo a safe and complete removal. With an approvement of institution ethics committee, this patient was treated with neoadjuvant therapy (apatinib 500mg orally qd).Six weeks later, the tumor dramatically shrunk from 56*37mm to 29*26mm with well-controlled mild hypertension. After 10 days interval of apatinib withdrawal, complete tumor excision was accomplished without esophagus fistula. Postoperative inhibition and radioiodine 131I ablation were performed. At one-year follow-up evaluation, no tumor recurrence or metastasis was observed.Conclusion: Preoperative short-termed targeted treatment for locally advanced inoperable DTC may become a promising neoadjuvant therapy, which can reduce the tumor size and decrease stage, thus being convenient for complete and safe removal.
The Phlebotomus Papatasi Transcriptomic Response to Trypanosomatid-contaminated Blood is Robust but non-specific
Authors: Sloan Megan A. , Sadlova Jovana , Lestinova Tereza , Sanders Mandy J. , Cotton James A. , Volf Petr , Ligoxygakis Petros
Published: July 2020

Background Leishmaniasis, caused by parasites of the genus Leishmania, is a disease that effects up to 8 million people worldwide. Parasites are transmitted to human and animal hosts through the bite of an infected sand fly. Novel strategies for disease control, require a better understanding of the key step for transmission namely, the establishment of infection inside the fly.Methods In this work we wanted to identify fly transcriptomic signatures associated with infected blood meal with non-infected blood meal as our baseline. We used next generation sequencing to describe the transcriptome of the sand fly Phlebotomus papatasi when fed with blood alone or with blood containing one of three trypanosomatids: Leishmania major, Leishmania donovani and Herpetomonas muscarum: a parasite not transmitted to humans.Results Of these, only L. major was able to successfully establish an infection in P. papatasi. However, the transcriptional signatures observed were not specific to success or failure of infection but a generalised response to the blood meal.Conclusions This implies that sand flies perceive Leishmania as just one feature of their microbiome landscape and that any strategy to tackle transmission should focus on the response towards the blood meal rather than parasite establishment. This result will generate new thinking around the concept of stopping transmission by controlling the parasite inside the insect.
Family planning uptake in Kagera and Mara regions in Tanzania: a cross-sectional community survey
Authors: Massenga Joseph Batholomeo , Norohna Ritha , Awadhi Bayoum , Bishanga Dunstan , Safari Oliva , Njonge Lusekelo , Kim Young-Mi , Roosmalen Jos Van , de Akker Thomas Van
Published: July 2020

BackgroundIn Tanzania, 27.1% of all women of reproductive age are currently using modern contraception, and 16.8% have an unmet need for family planning. We therefore examined factors associated with family planning uptake after giving birth in two regions of Tanzania.MethodsSub-analysis of a cross-sectional household survey conducted in April 2016 in Mara and Kagera regions in Tanzania. A total of 1184 women aged 15-49 years, who had given birth less than two years prior to the survey were included. Logistic regression mixed effect modelling was used to examine factors associated with family planning uptake. Univariate analysis was used to present crude effects of covariates, followed by stepwise forward selection to build a multiple logistic regression model. A p-value ≥ 0.20 was applied as the criterion to retain a variable into the model.ResultsAmong 1184 women within two years after giving birth, 393 (33.2%) used family planning methods. After adjusting for (1) age, (2) level of education, (3) living in union, (4) being accompanied to ANC by a partner and (5) being able to mention at least one method, factors independently associated with family planning uptake included: (1) having discussed family planning with the partner (aOR 2.90; 95% CI 1.88-4.49), (2) having been counselled on family planning during ANC (aOR 2.15; 95% CI 1.48-3.13), (3) having discussed family planning with a community health worker (aOR 3.32; 95% CI 1.91-5.77), (4) having discussed family planning with a facility health care worker (aOR 1.79; 95% CI 1.22-2.62), (5) having primary or higher educational level (aOR 1.66; 95% CI 1.01-2.273) and (6) being in union (aOR 1.86; 95% CI 1.02-3.42).ConclusionSupportive constitutes including educational interaction with facility and community health workers, as well as having a supportive partner are facilitators to increased uptake of family planning among women in Tanzania
Validation of Loop Mediated Isothermal Amplification for the Detection of Loa loa Infection in Chrysops sp in Experimental and Natural Field Conditions
Authors: Amambo Glory Ngongeh , Abong Raphael Awah , Fombad Fanny Fri , Njouendou Abdel Jelil , Nietcho Franck , Beng Amuam Andrew , Ritter Manuel , Esum Mathias Eyong , Deribe Kebede , Cho Jerome Fru , Enyong Peter Ivo , Poole Catherine , Hoerauf Achim , Carlow Clotilde , Wanji Samuel
Published: July 2020

Background/ObjectiveThe Mass Drug Administration of ivermectin for onchocerciasis control has contributed to a significant drop in Loa loa microfilaria loads in humans that led to reduction of the levels of infection in Chrysops vectors. Accurate parasite detection is essential for the success of any filariasis control program. Although microscopy is the gold standard for detecting the infection, its sensitivity is compromised when the intensity of infection is low. The Loop-mediated isothermal amplification (LAMP) of parasite DNA is an alternative method for detecting infection which offers operational simplicity, rapidity and versatility of visual readout options. This study aimed at validating the Loa loa LAMP assay for the detection of infected Chrysops spp. under experimental and natural field conditions. MethodsTwo sets of 18 flies were fed on volunteers with either a low (<10mf/ml) or high (>30,000mf/ml) microfilarial load. The fed flies were maintained under laboratory conditions for 14 days and then analysed with LAMP for the detection of L. loa infection. In addition, a total of 9,270 flies were collected from the North West, East, and South West regions of Cameroon using sweep nets and subjected to microscopy (7,841 flies) and LAMP (1,291 flies plus 138 nulliparous flies) analyses. FindingsLAMP assay successfully detected parasites in Chrysops fed on both low and high microfilariaemic volunteers. Field validation and surveillance studies phase revealed LAMP-based infection rates ranging from 0,5 % to 31.6 %, with the lowest levels in the South West 2 and highest infection rates in South West 1. LAMP assay detected significantly higher infection rates than microscopy in 4 of 5 study sites. ConclusionThis study demonstrated that LAMP is a simple surveillance tool, and is more sensitive than microscopy for the detection of experimental and natural L. loa infections in Chrysops vectors.
Structure-based Discovery of Potential Inhibitors Targeting Sodium-bile Acid Co-transporter of Carcinogenic Liver Fluke Clonorchis Sinensis
Authors: Yoo Won Gi , Dai Fuhong , Pak Jhang Ho , Hong Sung-Jong
Published: July 2020

Background: Clonorchis sinensis requires bile acid transporters as this fluke inhabits bile juice-filled biliary ducts, which provide an extreme environment. C. sinensis sodium-bile acid co-transporter (CsSBAT) is indispensable for survival in the final host, as it circulates taurocholate and prevents bile toxicity in the fluke; hence, it is recognized as a useful drug target.Results: In the present study, using structure-based drug discovery approach, we presented inhibitor candidates targeting a bile acid-binding pocket of CsSBAT. CsSBAT models were built using comparative tertiary structure modeling based on a bile acid transporter template (PDB ID: 3zuy and 4n7x), and were applied into AutoDock Vina for competitive docking simulation. First, potential compounds were identified from PubChem (holding more than 100,000 compounds) by applying three criteria: i) interacting more favorably with CsSBAT than with a human homolog, ii) intimate interaction to the inward- and outward-facing conformational states, iii) binding with CsSBAT more preferably than natural bile acids. Second, two compounds were identified following Lipinski’s rule of five. Third, another two compounds of molecular weight higher than 500 Da (Mr > 500 Da) were presumed to efficiently block the transporter via a feasible rational screening strategy. These four inhibitor candidates exhibited least toxicity that may enhance drug-likeness properties.Conclusion: It is proposed that four compounds act as potential inhibitors toward CsSBAT, and further studies are warranted for drug development process against clonorchiasis.
Explaining Factors Affecting Help-Seeking Behaviors in Women with Urinary Incontinence for Early Diagnosis by Healthcare Providers: A Qualitative Study
Authors: Fakari Fahimeh Rashidi , Hajian Sepideh , Darvish Soodabeh , Majd Hamid Alavi
Published: July 2020

Background: Urinary incontinence is widely accepted to be among the most important issues in the global health system. However, only a limited number of women refer for treatment as different factors make help-seeking behaviors more complicated than they initially seem to be. The aim of this study was to explain the factors affecting help-seeking behaviors in women suffering from urinary incontinence.Methods: The present study used a qualitative method, the conventional content analysis approach, and in-depth semi-structured interviews. The study was conducted between December 2018 and August 2019 in Tehran, Iran. The participants of the study included 34 women with urinary incontinence selected using purposive sampling method. The content analysis approach was based on the Graneheim and Lundman method, and qualitative data management software was used to analyze data.Results: Data analysis illustrates two facilitating and deterring themes; the categories "not perceiving disease ", "shame", "negative influence of important others", and "the health care system" were among the deterrents and the categories "weakening the quality of life" and "positive effect of important others" were found to be facilitators.Conclusions: The findings of the present study highlight the need for understanding the underlying facilitators and obstacles to help-seeking behaviors in women with urinary incontinence and suggest that healthcare providers consider an open dialogue with patients taking into account their subjective beliefs and life context during routine referrals so as to facilitate early diagnosis of the disease and ultimately lead to an improvement in the woman's quality of life.
A Prospective Case Control Study To Evaluate The CRADLE Vital Signs Alert Device For Detection Of Patients With Clinically Important Malaria In Refugee Settings
Authors: Kuhrt Katy , Seed Paul T , Shennan Andrew H
Published: July 2020

Background: Malaria is a significant threat to refugee populations. Bidibidi Refugee Settlement, Northern Uganda hosts 223 000 of Uganda’s 1.4 million refugees, vulnerable to malaria due to crowded conditions and limited access to preventative measures and health care. Early detection and referral of suspected malaria cases is key to reducing associated morbidity and mortality. We therefore aimed to evaluate shock index (heart rate/ systolic blood pressure), calculated by the CRADLE Vital Signs Alert (VSA) device, an easy-to-use blood pressure and heart rate monitor, for detection of malaria as grounds for whether the device could be used for low cost identification and referral of patients by non-medically trained Village Health Team workers (VHTs).Methods: CRADLE VSA devices and related training were delivered to all health facilities and VHTs in Bidibidi Refugee Settlement from April to August 2018. CRADLE VSA readings was performed as part of routine patient assessment. CRADLE VSA data (blood pressure, heart rate) and assigned diagnoses were collected from health facility data record books and shock index calculated for each case. Cases were grouped into predefined disease categories, including malaria and severe malaria. A control group consisted of refugees undergoing asymptomatic screening using the CRADLE VSA. Average shock index was calculated for cases and controls and prespecified disease categories, and predictive statistics to evaluate shock index for prediction of malaria and severe malaria.Results: Five hundred and eighty-seven CRADLE VSA devices were delivered. Malaria accounted for 26% (915/3577) of cases and had the highest shock index compared to other disease categories. Positive likelihood ratios for shock index using a threshold of greater than or equal to 0.9 were 5 and 11 for malaria and severe malaria respectively.Conclusion: Malaria accounted for over a quarter of cases. Positive likelihood ratios indicated that patients with shock index greater than or equal to 0.9 were 5 and 11 times more likely to be suffering from malaria and severe malaria respectively, indicating that the CRADLE VSA could be used by non-medically trained VHTs to identify patients likely to have malaria, and those most at risk of severe disease needing urgent referral. Trial Registration: This is an observational study and therefore does not have or require a trial registration. Appropriate permissions were granted by UN Refugee Council, Ministry of Health and Office of the Prime Minister.
Impact of Road Fencing on Ungulate-Vehicle Collisions and Hotspot Patterns
Authors: Kučas Andrius , Balčiauskas Linas
Published: July 2020

Background:The number of road traffic accidents was decreasing in Lithuania in 2002–2017, while ungulate-vehicle collision (UVC) number was increasing and accounted for about 69% of all wildlife-vehicle collisions (WVC) in the country. Identification of impact of locomotor wildlife behavior and locations where accidents occurs most frequently is important for the effective application of mitigation measures.Methods:We assessed the effect of annual average daily traffic (AADT) and wildlife fencing on UVC using regression analysis of changes in annual UVC and UVC hotspots (KDE+ method based clusters) for different categories of roads.Results:At the greatest rates annual UVC numbers and UVC hotspots increased on lower category (national and regional) roads forming denser network. Lower rates of UVC increase occurred on higher category (main) roads, forming sparser road network and characterised by highest AADT. Before 2011, both UVC occurrence and fenced road sections were most common on higher category roads. However, as of 2011, the majority of UVC occurred on lower category roads where AADT and fencing had no impact on UVC.Conclusions:We conclude that wildlife fencing on roads characterised by higher speed and traffic intensity may decrease UVC numbers, in the same time shifting UVC occurrence towards roads characterised by lower speed and traffic intensity. Wildlife fencing re-allocates wildlife movement pathways towards roads with insufficient or no mitigation measures.
Serum Metabolomic Patterns in Young Patients with Ischemic Stroke
Authors: Liu Jia , Yuan Junliang , Zhao Jingwei , Zhang Lin , Wang Qiu , Wang Guang
Published: July 2020

Background: Ischemic stroke is one of the leading causes of death and adult disability. The incidence of ischemic stroke continues to rise in young adults. This study aimed to provide a comprehensive evaluation of metabolic changes and explore possible mechanisms in young ischemic stroke patients without common risk factors. Methods: This study investigated serum metabolomics in 50 young patients with newly suffered ischemic stroke and 50 age-, sex-, and body mass index–matched healthy controls. The metabolomic data were analyzed by performing a multivariate statistical analysis.Results: The 197 metabolites, including amino acids, bile acids, free fatty acids, and lipids, were identified in all participants. Multivariate models showed significant differences in serum metabolomic patterns between young patients with ischemic stroke and healthy controls. The stroke patients had increased L-methionine, homocysteine, glutamine, uric acid, GCDCA, and PE (18:0/20:4, 16:0/22:5), and decreased levels of L-citrulline, taurine, PC (16:2/22:6, 16:2/20:5, 15:0/18:2), and SM (d18:1/23:0, d20:0/19:1, d18:1/22:0, d16:0/26:1, d16:0/18:0, d16:0/22:1, d18:1/19:1, d16:0/17:1, d16:1/24:1, d18:1/19:0). Based on the identified metabolites, the metabolic pathways of arginine biosynthesis, glycerophospholipid metabolism, and taurine and hypotaurine metabolism were significantly enriched in the young patients with ischemic stroke. Conclusions: Serum metabolomic patterns were significantly different between young patients with ischemic stroke and healthy controls.
Customized Neurotization for Hindlimb Hemiplegia After a Hemorrhagic Stroke
Authors: Qian TengDa , Zheng XiFeng , Shi Jing , Song ZeWu , You WeiYan , Ma Tao , Wu JiaHuan , Huang BaoSheng , Tao Yi , Wang Xi , Li LiXin
Published: July 2020

Background Hemiplegia after hypertensive intracerebral hemorrhage(HICH) is prevalent,devasta-ting,and currently unable to intervene satisfactorily.Established success in neurotization spurs our interest in restoring skilled lower-limb movement.Here,we explored whether contralesional L4 transfer to ipsilesional L4 root,featuring simultaneous invigoration of flexors and extensors,reanimated dexterous locomotion for the hemiplegic hindlimb after HICH.Methods We manufactured eligible rat models by injecting autologous vein blood into the left posterior limb of internal capsule (PLIC) and randomized thirty rats into three groups. We did not transect but expose bilateral L4 in group A (sham operation) after injection of saline,and infused equal blood followed by bilateral L4 transection and contralateral L4 transfer,in group B and group C,respectively.Behavioral,ultrastru-ctural,immunofluorescent,and electromyographic assessments were applied to efficacy analysis.MRI localized the PLIC impact.Results We could see marked reduction in movements and capture a denervated potential in the right hindlimb of model rats (P༞0.05).In the walking tests,group C exhibited an initially high slip,but,later, a larger increment in accuracy on the paretic side, compared to group B and group A(P༜0.001).Also,at Week 17,rats gained ∼58.2% accuracy and actuated ankle motions in group C(P༞0.05). In the retrograde tracing,at Week 9,fluoro-gold labeled motoneurons had been numerously present in the left anterior horn of the spinal cord from the L4-to-L4 root.Histological and ultra-microstructural assessments certified efficient axons regeneration.Electrom-yography and pawprint analysis implied the denervated muscles were reliably reinnervated,and myodynamia improvement(p>0.05).Conclusions Contralateral L4 transfer could render favorable outcomes for major joints,particularly for the ankle,therefore efficaciously repaired the hemiplegic hindlimb after HICH.
Design of A Lightweight Multifunctional Composite Railway Axle Utilising Coaxial Skins
Authors: Mistry Preetum Jayantilal , McRobie Charles Allan , Johnson Michael Sylvester , Jones Ivor Arthur
Published: July 2020

The potential for lightweighting of railway axles was investigated to primarily reduce the unsprung mass of rail vehicles. The reduction of unsprung mass equates to an overall lighter train which will help to reduce: track damage, energy consumption and total operating costs. This paper presents the design of a lightweight multifunctional hybrid metallic-composite railway axle utilising coaxial skins. The lightweight axle assembly comprises a carbon fibre reinforced polymer composite tube with steel stub axles bonded into either end. The structural hybrid metallic-composite railway axle is surrounded by coaxial skins each performing a specific function to meet secondary requirements. These include fire and ballast skins to protect the axle core. An outer pigmented layer provides visual identification of the axle class, along with protection against environmental agents. Integrated into the railway axle is a structural health monitoring layer to provide feedback on the integrity of the composite tube and adhesive bonds during the operating life. A tether assembly acts as a failsafe against wheel detachment resulting from catastrophic axle damage. The optimised hybrid metallic-composite railway axle design concept has a mass of 200 kg representing a reduction of 50% over the solid steel version.
Predictive value of prognostic nutritional index and systemic immune‐inflammation index on tumor progression in bladder cancer patients with after radical cystectomy
Authors: Zhou Jiatong , Xu Xitong , Liu RanLu
Published: July 2020

OBJECTIVES: The purpose of this study was to explore the predictive value of preoperative prognostic nutritional index(PNI) and systemic immune‐inflammation index(SII) for local tumor stage in bladder cancer(BC) after radical cystectomy(RC).METHODS: We researched our database between April 2011 and October 2019. There were 195 BC patients who underwent RC. The PNI and SII were calculated using preoperative blood sample results. The predictive value of SII and PNI was analysed with univariate and multivariate Cox regression models. Receiver operating characteristic (ROC) was used to determine the optimum PNI. Signifcant P was P<0.05.RESULTS: Of patients, all patients were males with a mean age of 67.94±8.97years. Mean serum albumin was 42.13±4.28(g/L), mean PNI score was 51.29±6.09 and mean SII was 661.67±506.22. Multivariable Cox regression analysis demonstrated that PNI scores and SII could not play a significantly predictive factor between muscle invasive bladder cancer(MIBC) and non-muscle-invasive bladder cancer(NMIBC). While we also found PNI was an independent risk factors for predicting tumor stagep(pT＜3a and pT≥3a).CONCLUSIONS: Our research revealed that preoperative low PNI but not SII could be used as an independent factor to predict worse pathologically stage(pT≥3a). But preoperative PNI and SII might not were significantly related with the incidence risk of muscle invasive. We still need future studies with large cohorts to identify our results.
Categorisation of Sit-To-Stand Motion Pattern. Human vs Automated Quantitative Assessments.
Authors: Job Mirko , Battista Simone , Stanzani Ronny , Signori Alessio , Testa Marco
Published: July 2020

BACKGROUND: The Sit-to-Stand (STS) test is widely used in clinical practice as an indicator of lower-limb functionality decline, especially for older adults. Hitherto, due to its high variability, there is no standard approach for categorising the STS motion pattern, and the vision-based evaluation remains the most reliable method to evaluate people’ performance. This paper presents a comparative analysis between visual assessments and an automated-software approach for the categorisation of STS, relying on registrations from a force plate. METHODS: A group of 5 participants (30 ± 6 years) took part in 2 different sessions of visual inspections on 200 STS movements randomly extracted from a dataset of 742 acquisitions under self-paced and controlled speed conditions. Assessors were asked to identify three specific STS events from the Ground Reaction Force, simultaneously with the software analysis: the start of the trunk movement (Initiation), the beginning of the stable upright stance (Standing) and the sitting movement (Sitting). The Test-Retest Reliability between first and second visual evaluations was compared with the Inter-Rater Agreement between visual and software assessments, as indexes of human and software performance, respectively.RESULTS: No statistical differences between methods were found for the identification of the Initiation and the Sitting events at self-paced speed and for only the Sitting event at controlled speed. The estimated significant values of maximum discrepancy between visual and automated assessments were 0.200 s [0,039; 0.361] in unconstrained conditions and 0,340 s [0,014; 0,666] for standardised movements.CONCLUSIONS: The software assessments displayed an overall good agreement against visual evaluations of the Ground Reaction Force, relying, at the same time, on objective measures. In this sense, the proposed approach can provide robust and consistent data in the field of Big Data analytics, augmenting the performance of artificial intelligence methods for Human Activity Recognition tasks.
Novel instellation calculations for close-in exoplanets
Authors: Sadh Mradumay
Published: July 2020

The distribution of instellation at the top of a planet's atmosphere or surface is usually calculated using the inverse-square law of radiation. This is based on the assumption that the host star is far enough to be considered a point-sized Lambertian source. This assumption, which works well for the solar system planets and most exoplanets, must be revised for close-in exoplanets.
Spatial analysis of perceived health system capability and actual health system capacity for COVID-19 in South Africa
Authors: Mokhele Tholang , Sewpaul Ronel , Sifunda Sibusiso , Weir-Smith Gina , Dlamini Simangele , Manyaapelo Thabang , Naidoo Inbarani , Parker Whadi-Ah , Dukhi Natisha , Jooste Sean , Parker Saahier , Zuma Khangelani , Moshabela Mosa , Mabaso Musawenkosi , Reddy Sasiragha Priscilla
Published: July 2020

People’s confidence on the health system capability in managing COVID-19 outbreak can determine public support, risk perceptions and compliance behaviours during the pandemic. Therefore, this paper investigated people’s perception on health system capability using online survey data and current state of health system capacity to deal with COVID-19 pandemic at different spatial areas across the country. Simple and multiple logistic regression models were used to examine the factors associated with perception of the health system’s capability to manage the COVID-19 pandemic at a national level and within each province. Spatial comparative analysis was conducted on perception of health system capability and density indicators of health system capacity. Findings showed South Africans had low confidence on health system capability with only two in five (40.7%) reporting that they thought that the country’s health system was able to manage the COVID-19 pandemic. Sex and knowledge on COVID-19 were significantly associated with the perception of the health system’s capability to manage the pandemic at the national level and in four of the nine provinces. Overall, the findings of this study clearly highlights the challenges on the country’s health system both perceived or real that needed to be addressed as part of the preparation for the COVID-19 pandemic. Timeous implementation of a countrywide National Health Insurance (NHI) system is now more critical than ever in improving health care outcomes of the South African population even beyond the existence of the COVID-19 epidemic.
The Impact of the lockdown on ENT services during the COVID-19 Pandemic, a report from the developing world.
Authors: Hari Kapila , Maharaj Shivesh
Published: July 2020

The novel coronavirus and accompanying lockdown measures have resulted in the disruption of specialist clinic services. There have been reports of a decrease in the number of clinic attendees and surgical procedures performed in clinics throughout the worldThe study period was from the 2 January 2020 until 19 June 2020 which was divided by the lockdown date of the 26 March 2020, into two periods of 85 days for comparative review.During the pre-lockdown phase (2 January 2020 to 25 March 2020), 2160 patients were booked for the outpatient clinics and 1911 attended in this period (88.5%). In contrast during the post-lockdown period (26 March 2020 to 19 June 2020), 1220 visits were scheduled. Of these, 937 (76.8%) visits were completed. The number of patient visits booked (p=0.01) and completed (0.0001) after lockdown declined significantly. The total number of outpatient procedures performed pre-lockdown was 1892 (0.99/ patient) compared to 937 (1.04/ patient) post-lockdown. This represents an approximate decrease of 50% in the number of procedures completed post-lockdown but the change in the number of procedures/ patient was not significant (p=0.4).During the pre-lockdown phase 228 theatre cases were completed, including 66 emergencies and post-lockdown there were 188 cases together with 48 emergencies. There were no elective cases post-lockdown. The study illustrates that even during a stringent lockdown period there is an ongoing need for specialist ENT services and health care systems need to be tailored to manage all patients such that care is not shifted away from vulnerable groups and solely focused on Covid19 patients.
Telemedicine: A cornerstone of healthcare assistance during the recent pandemic outbreak of COVID-19 but also a great opportunity for the future. A pilot experience in the largest Teaching Hospital in Southern Italy.
Authors: Edoardo MD; Tartaglia , Anna Vozzella Emilia , Anna LLD Iervolino , Rosanna Egidio , Gaetano Buonocore , Antonietta EngD Perrone , Gugliemo EngD Toscano , Raffaele EngD Tremante , Francesca EngD Cesaro , Vincenzo Sommella , Paola Magri , Lanfranco Iodice
Published: July 2020

Background: At the end of 2019, Wuhan, China, experienced an outbreak of a novel coronavirus. The epidemiologic burden of COVID-19 is constantly evolving, with numbers of infected persons, hospital admissions and deaths growing near exponentially. The recent pandemic outbreak of COVID-19 worldwide caught the health care systems in every country around the world by storm and without a proper defense mechanism to cope and control such a pandemic. In fact, this outbreak is causing an overwhelming burden of illnesses that stresses health system capacity and adverse effects on healthcare workers including the risk of infection. In this context, telemedicine has been promoted and scaled up to reduce the risk of transmission. In this paper the Authors reports their own experience with Telemedicine. Methods: During the “lockdown”, the AOU“Federico II” was forced to create peculiar pathways to ensure the safety of the patients and medical staff, and to keep an appropriate medical assistance, therefore it was introduced the telemedicine, wherever possible, by modifying the Information Technology (IT) related to the waiting times, rescheduling all booked visits and identifying several outpatient’s clinics suitable for telemedicine activities. Besides, safe pathways were properly studied to screening all patients who had a medical consult in person.Results: Since the introduction of telemedicine service, 953 consultations were provided in this way, about 13 % of all medical consults delivered by AOU “Federico II” in this period; 97,38% of them were follow-up visits, that otherwise would have been missed during the current pandemic, so an economic loss has been avoided. In addition, it has been calculated that, using Telemedicine visits vs a face-to-face consultation, about 65-70% of direct costs were spared by our Healthcare Company.Conclusions: Telemedicine has been the keystone that has allowed a rapid, appropriate response of whole overloaded healthcare systems to current Pandemic, and, as reported by Ohannessian et al., all stakeholders are encouraged to address the challenges and collaborate to promote the safe and evidence-based use of telemedicine during the current pandemic and future outbreaks, and the COVID-19 pandemic is a call to adopt the necessary regulatory changes supporting wide adoption of telemedicine.
Toll-like Receptor 2 Polymorphisms Impose Considerable Impacts On Acute Myelocytic Leukemi Occurrence
Authors: Qu Hong , Chen Yongfang , Zeng Wenjing , Huang Xiaohua , Cheng Shuqin
Published: July 2020

Background: This research aimed to explore the genetic association of Toll-like receptor 2 (TLR2) gene polymorphisms with acute myelocytic leukemia (AML) susceptibility in Chinese population.Methods: Firstly, the genotypes of TLR2 polymorphism were detected in 148 AML patients and 126 healthy controls by polymerase chain reaction (PCR). The genotype distribution of every polymorphism in the control group was detected whether conformed to Hardy-Weinberg equilibrium (HWE). The genotype frequency difference of TLR2 polymorphism between the case and control groups was compared by chi-square test and odds ratio (OR) with 95% confidence interval (95%CI) was calculated to express the risk of AML resulted from genetic variant of TLR2.Results: For TLR2 rs3804099 polymorphism, the heterozygous genotype TC was detected the significantly lower frequency in AML patients than that in the controls (P=0.031), so was C allele (P=0.021), which showed that rs3804099 was associated with the decreased the risk of AML (OR=0.580, 95%CI=0.354-0.953; OR=0.641, 95%CI=0.438-0.938). Similarly, GG genotype and G allele of rs1898830 also showed the obviously association with the risk reduction of AML (GG vs. AA: OR=0.430, 95%CI=0.200-0.924, G vs. A: OR=0.644, 95%CI=0.451-0.919). However, no significant association was found in rs7656411 with AML.Conclusions: TLR2 rs3804099 and rs1898830 polymorphisms may be the protective factors for AML, but not rs7656411.
Remote clinician-based home management of COVID-19 associated pneumonia in a resource limited setting
Authors: Kana Nadir , Maharaj Shivesh
Published: July 2020

The coronavirus disease (COVID-19) pandemic has resulted in an increased number of patients that require respiratory support in terms of oxygen and ventilation. Due to the burden on the healthcare system there has been a shortage of hospitals beds in both the public and private sector. This has led to many patients being managed at home. Currently there is no consensus regarding best practice guidelines in terms of treatment of this subset of patients.We hereby present a case of a patient who was treated using appropriate respiratory support (a combination of low flow oxygen therapy via nasal prongs or face mask as high flow oxygen was not available), oral corticosteroids and anti-coagulants managed by remote clinician intervention. We also include our home management protocol.
Percutaneous Screw Fixation for Acute Scaphoid Fractures Through K-wire-assisted Reduction and Maintenance
Authors: Bai Jiangbo , Kong Lingde , Tian Siyu , Yu Kunlun , Lu Jian , Liu Chunjie , Tian Dehu
Published: July 2020

Background: Percutaneous screw fixation was introduced for acute scaphoid fractures through K-wire-assisted reduction and maintenance, and the effectiveness of the methods was evaluated.Methods: Ten patients with acute scaphoid fractures were consecutively treated with the proposed technique from January 2015 to December 2018. With the wrist placed in ulnar deviation, one K-wire was introduced perpendicularly through the styloid process of radius into the proximal pole of scaphoid under fluoroscopic guidance. The scaphoid fragment was reduced by dorsiflexing the wrist and translating the distal pole into an extended position. A headless compression screw was then inserted in a standardised manner. Operation time, time to union, time to return to previous activity and complication were recorded. Function outcomes including pain, work status, range of motion (ROM) and grip strength were assessed according to the modified Mayo wrist scoring system.Results: Final follow-up examination was performed on an average of 12 months (range, 10–15 months) after surgery. No immediate postoperative complication occurred. All scaphoid fractures united at an average of 9.2 weeks (range, 7–11.4 weeks). The following average values were achieved: operation time was 48.2 minutes (range, 38–65 minutes), the time that patients returned to previous activity levels was 9.4 weeks (range, 7–11 weeks) and function scores were 92.5 (range, 80–100). At 3 months post-operation, the wrist range of motion was generally 62.5° wrist extension (range, 50°–70°) and 68.2° wrist flexion (range, 55°–75°). Grip strength was approximately 40.1 kg (range, 28–45 kg) and 83.5% (range, 85%–100%) of the contralateral sides. The mean post-operative height-to-length ratio was 0.61.Conclusions: Our novel percutaneous screw fixation method is beneficial to minimise injury to the blood supply of the scaphoid. Primary percutaneous screw fixation for acute scaphoid fractures is a superior method with reduced time to bony union, early return to daily activity or employment and predictably lessened complications of wrist stiffness, diminished grip strength, delayed union, non-union and osteonecrosis.Trial registration: Clinicaltrials.gov; NCT04482868; Registered 19 July 2020-Retrospectively registered.