bluuebunny/crossref_metadata_2025 huggingface dataset:
Association Between Serum Uric Acid And Major Chronic Diseases Among Centenarians In China: Based On The CHCCS Study
Authors: Kou Fuyin , Yang Shanshan , Wang Shengshu , Liu Miao , He Yao
Published: January 2021

Introduction: This study aims to analyze the distribution of SUA level based on more than 1,000 centenarians and to explore the association with three common diseases including hypertension, diabetes and dyslipidemia. Methods: All the 1002 centenarians from the CHCCS were included. Household survey was conducted. Results: The mean SUA level of centenarians was 329.04±97.75μmol/L and the prevalence of hyperuricemia in centenarians was 26.5%. There was no statistical difference in the distribution of SUA levels among centenarians with or without hypertension/diabetes. For dyslipidemia, there was an independent positive association. The risk of dyslipidemia among those with hyperuricemia were 1.646 (95%CI: 1.078-2.298) compared with those who didn’t have hyperuricemia. By comparing different subtypes of dyslipidemia, hyperuricemia was positively associated with hypertriglyceridemia and low-density lipoprotein cholesterolemia, with the corresponding ORs of 2.553 (95%CI: 1.282-5.083) and 1.927 (95%CI: 1.273-2.917) respectively, while there was no statistically significant association with hypercholesterolemia 0.998 (95%CI: 0.574-1.732). Conclusions: There was no relation between SUA with hypertension or diabetes, while there was independently and positively association with hypertriglyceridemia and low-density lipoprotein cholesterolemia. The health benefits of controlling SUA in centenarians still require evidence based on prospective studies.
Intra-database Validation of Case-identifying Algorithms Using Reconstituted Electronic Health Records From Healthcare Claims Data
Authors: Thurin Nicolas Henri , Bosco-Levy Pauline , Blin Patrick , Rouyer Magali , Jové Jérémy , Lamarque Stéphanie , Séverine Lignot , Lassalle Régis , Abouelfath Abdelilah , Emmanuelle Bignon , Pauline Diez , Gross-Goupil Marine , Soulié Michel , Roumiguié Mathieu , Moulec Sylvestre Le , Debouverie Marc , Brochet Bruno , Guillemin Francis , Louapre Céline , Maillart Elisabeth , Heinzlef Olivier , Moore Nicholas , Cécile Droz-Perroteau
Published: January 2021

Background: Diagnosis performances of case-identifying algorithms developed in healthcare database are usually assessed by comparing identified cases with an external data source. When this is not feasible, intra-database validation can present an appropriate alternative.Objectives: To illustrate through two practical examples how to perform intra-database validations of case-identifying algorithms using reconstituted Electronic Health Records (rEHRs).Methods: Patients with 1) multiple sclerosis (MS) relapses and 2) metastatic castration-resistant prostate cancer (mCRPC) were identified in the French nationwide healthcare database (SNDS) using two case-identifying algorithms. A validation study was then conduct to estimate diagnostic performances of these algorithms through the calculation of their positive predictive value (PPV) and negative predictive value (NPV). To that end, anonymized rEHRs were generated based on the overall information captured in the SNDS over time (e.g. procedure, hospital stays, drug dispensing, medical visits) for a random selection of patients identified as cases or non-cases according to the predefined algorithms. For each diseases, an independent validation committee reviewed the rEHRs of 100 cases and 100 non-cases in order to adjudicate on the status of the selected patients (true case/ true non-case), blinded with respect to the result of the corresponding algorithm. Results: Algorithm for relapses identification in MS showed a 95% PPV and 100% NPV and for mCRPC identification, a 97% PPV and 99% NPV. Conclusion: The use of rEHRs to conduct an intra-database validation appears to be a valuable tool to estimate the performances of a case-identifying algorithm and assess its validity, in the absence of alternative.
Effect on 30-day Mortality and Duration of Hospitalization of Empirical Antibiotic Therapy in CRGNB-Infected Pneumonia
Authors: li rongrong , Tang Hao , Xu Huaming , Cui Kunwei , Li Shujin , Shen Jilu
Published: January 2021

PurposeThe objective of this study was to investigate whether unreasonable empirical antibiotic treatment(UEAT) had an impact on 30-day mortality and duration of hospitalization in bacterial pneumonia caused by carbapenem-resistant gram-negative bacteria (CRGNB).MethodsThis was a retrospective study involving CRGNB-infected pneumonia. All patients received empirical and targeted antibiotic treatment. The exposure variable was treated with empirical antibiotic treatment(EAT) within 48 hours of incubation and the outcome was 30-day mortality and duration of hospitalization. Moreover, we also considered other variables that might be relevant and conducted multivariable regression analysis of 30-day mortality and duration of hospitalization.ResultsThe experiment collected 310 cases, the most common bacterium is Acinetobacter baumannii (211/310 [68%]) and the others were Klebsiella pneumoniae(46/310 [15%])、Pseudomonas aeruginosa and others (53/310 [17%]). 76/310 (24.5%) patients received appropriate empirical antibiotic treatment(REAT). In the analysis of risk factors, dementia, unconsciousness were risk factors of 30-day mortality and pulmonary disease, hemodynamic support at culture taken day and recent surgery were risk factors for longer hospital stay. 30-day mortality was 9 of 76(11.84%) with REAT vs 36 of 234 (15.38%) with UEAT (P =0.447), UEAT was not associated with 30-day mortality. On the contrary, there was difference between REAT and UEAT(P=0.023) in the analysis of EAT on hospitalization time.Conclusions﻿UEAT was not associated with 30-day mortality while was related to duration of hospitalization in CRGNB-infected pneumonia, in which Acinetobacter baumanniii accouned for the majority.
Adherence to Standard Treatment Guidelines Among Prescribers in Primary Healthcare Facilities in the Dodoma Region of Tanzania
Authors: Wiedenmayer Karin Anne , Ombaka Eva , Kabudi Baraka , Canavan Robert , Rajkumar Sarah , Chilunda Fiona , Sungi Selemani , Stoermer Manfred
Published: January 2021

Background: Tanzania’s primary healthcare system suffers from a scarcity of financial and human resources which impedes its effectiveness to deliver dependable and uniform quality healthcare. Adherence to standard treatment guidelines (STG) can help provide more consistent and correct diagnoses and treatments and limit the irrational use of medicines and the negative health consequences that can occur as a result. The purpose of this study was to investigate prescribers’ adherence of their diagnoses and respective treatments to national STG and to identify potential areas for planning interventions.Methods: A cross sectional study on prescribers’ adherence to diagnosis and treatment, according to national STG, was conducted in 2012 in public, primary healthcare facilities (HCF) in the Dodoma region of Tanzania. Information on 2886 patients was collected, prospectively and retrospectively, from 120 HCF across the Dodoma region using a structured questionnaire. Twenty-five, broadly defined, main illness groups were recorded and the nine most prevalent and relevant conditions were statistically analysed in detail. Results: Diagnoses and related treatments were recorded and analysed in 2872 cases. The nine most prevalent conditions were upper respiratory tract infections (25%), malaria (18%), diarrhoea (9.9%), pneumonia (6.1%), skin problems (5.8%), gastrointestinal diagnoses (5%), urinary tract infections (4%), worm infestations (3.6%) and eye problems (2.1%). Only 1.8% of all diagnoses were non-communicable diseases. The proportion of prescribers’ primary diagnoses that completely adhered to national STG was 599 (29.9%), those that partially adhered totalled 775 (38.7%), wrong medication was given in 621 (30.9%) cases and no diagnosis or medication was given in nine cases (0.5%). Sixty-one percent of all patients received an antibiotic regardless of the diagnoses. Complete adherence was highest when worms were diagnosed and lowest for diarrhoea. The proportion of cases that did not adhere to STG was highest with patients with skin problems and lowest for malaria.Conclusion: Prescribers’ general adherence to national STG in primary HCF in the public sector in Dodoma region is sub-optimal. The reasons are multifaceted, and focused attention directed at improving prescribing and pharmacotherapy is required with a view of improving patient care and health outcomes.
High Conversion Rate to Total Hip Arthroplasty after Hemiarthroplasty in Young Patients: Single-center, Retrospective Comparative Cohort Study with a Minimum Follow-up of 10 Years
Authors: Moon Nam Hoon , Shin Won Chul , Do Min Uk , Kang Sang Woo , Lee Sang-Min , Suh Kuen Tak
Published: January 2021

Background: This study aimed to evaluate the long-term results of bipolar hemiarthroplasty (BHA) in patients aged < 60 years and to analyze the risk factors for acetabular erosion after BHA. Methods: This retrospective study included 114 patients who underwent BHA were followed-up for at least 10 years. The mean age was 54.1 years, and the mean follow-up duration was 13.8 years. The patients were divided into two groups according to the presence of acetabular erosion, and the preoperative parameters were compared between the two groups. Moreover, the risk factors related to acetabular erosion after BHA were analyzed using statistical comparisons.Results: Reoperation was performed in 44 of the 114 patients (38.6%). The survival rate when the end point was reoperation related to acetabular erosion was found to be significantly time-dependent: 73.2% at 5 years, 48.8% at 10 years, and 25.9% at 15 years. The acetabular erosion group showed significantly younger age at the time of surgery, higher body mass index (BMI), more avascular necrosis of the femoral head, and smaller prosthetic femoral head. The final multivariate logistic regression analysis showed that young age at the time of surgery were independent risk factors for acetabular erosion after BHA in patients aged < 60 years.Conclusion: The minimum 10-year follow-up outcomes of BHA in patients aged < 60 years showed a relatively high conversion rate to total hip arthroplasty. When considering BHA in younger patients, more careful decisions should be made with respect to patient’s choice, keeping in mind that long-term survival cannot be guaranteed.
Reliability of maternal recall of delivery and immediate newborn care indicators in Sarlahi, Nepal
Authors: Carter Emily D , Chang Karen , Mullany Luke , Khatry Subarna , LeClerq Steven , Munos Melinda , Katz Joanne
Published: January 2021

Background: The intrapartum period is a time of high mortality risk for newborns and mothers. Numerous interventions exist to minimize risk during this period. Data on intervention coverage are needed for health system improvement. Maternal report of intrapartum interventions through surveys is the primary source of coverage data, but they may be invalid or unreliable. Methods: We assessed the reliability of maternal report of delivery and immediate newborn care for a sample of home and health facility births in Sarlahi, Nepal. Mothers were visited as soon as possible following delivery (<72 hours) and asked to report circumstances of labor and delivery. A subset was revisited 1-24 months after delivery and asked to recall interventions received using standard household survey questions. We assessed the reliability of each indicator by comparing what mothers reported immediately after delivery against what they reported at the follow-up survey. We assessed potential variation in reliability of maternal report by characteristics of the mother, birth event, or intervention prevalence.Results: 1502 mother/child pairs were included in the reliability study, with approximately half of births occurring at home. A higher proportion of women who delivered in facilities reported “don’t know” when asked to recall specific interventions both initially and at follow-up. Most indicators had high observed percent agreement, but kappa values were below 0.4, indicating agreement was primarily due to chance. Only “received any injection during delivery” demonstrated high reliability among all births (kappa: 0.737). The reliability of maternal report was typically lower among women who delivered at a facility. There was no difference in reliability based on time since birth of the follow-up interview. We observed over-reporting of interventions at follow-up that were more common in the population and under-reporting of less common interventions.Conclusions: This study reinforces previous findings that mothers are unable to report reliably on many interventions within the peripartum period effectively. Household surveys which rely on maternal report, therefore, may not be an appropriate method for collecting data on coverage of many interventions during the peripartum period. This is particularly true among facility births, where many interventions may occur without the mother’s full knowledge.
Assessment of Local Supply Chains and Stock Management Practices for Trauma Care Resources in Ghana: A Comparative Small Sample Cross-Sectional Study
Authors: Boakye Godfred , Gyedu Adam , Stewart Melissa , Donkor Peter , Mock Charles , Stewart Barclay T
Published: January 2021

Background: Injuries are a major public health problem globally. With sound planning and organization, essential trauma care can be reliably provided with relatively low-cost equipment and supplies. However, availability of these resources requires an effective and efficient supply chain and good stock management practices. Therefore, this study aimed to assess trauma care resource-related supply management structures and processes at health facilities in Ghana. By doing so, the findings may allow us to identify specific structures and processes that could be improved to facilitate higher quality and more timely care. Methods: Ten hospitals were purposively selected using results from a previously performed national trauma care capacity assessment of hospitals of all levels in Ghana. Five hospitals with low resource availability and 5 hospitals with high resource availability were assessed using the United States Agency for International Development (USAID) Logistics Indicators Assessment Tool and stock ledger review. Data were described and stock management practices were correlated with resource availability. Results: There were differences in stock management practices between low and high resource availability hospitals, including frequency of reporting and audit, number of stock-outs on day of assessment (median 9 vs 2 stock-outs, range 3 – 57 vs 0 – 9 stock-outs, respectively; p=0.05), duration of stock-outs (median 171 vs 8 days, range 51 – 1,268 vs 0 – 182 days, respectively; p=0.02), and fewer of up-to-date stock cards (24 vs 31 up-to-date stock cards, respectively; p=0.07). Stock-outs were common even among low-cost, essential resources (e.g., nasal cannulas and oxygen masks, endotracheal tubes, syringes, sutures, sterile gloves). Increased adherence to stock management guidelines and higher percentage of up-to-date stock cards were correlated with higher trauma resource availability scores. However, the variance in trauma resource availability scores was poorly explained by these individual factors or when analyzed in a multivariate regression model (r2=0.72; p value for each covariate between 0.17 – 0.34). Conclusions: Good supply chain and stock management practices are correlated with high trauma care resource availability. The findings from this study demonstrate several opportunities to improve stock management practices, particularly at low resource availability hospitals.
School trajectory disruption among adolescents living with perinatal HIV receiving antiretroviral treatments: a case-control study in Thailand
Authors: Merville Ophélie , Puangmala Patcharee , Suksawas Pranee , Kliangpiboon Woranut , Keawvilai Waraporn , Tunkam Chorkanikar , Yama Suvimon , Sukhaphan Usa , Sathan Somporn , Marasri Siriporn , Rolland-guillard Louise , Sirirungsi Wasna , Coeur Sophie Le
Published: January 2021

Background: Adolescents living with perinatal HIV often experience difficult living circumstances that can impact educational achievement and thus their transition to adult life. We explored their school trajectories and evaluated the contribution of perinatal HIV-infection, in Thailand, where education is free and compulsory until the age of 15.Methods: We used data from the Teens Living with Antiretrovirals (TEEWA) study, a cross-sectional case-control study conducted from 2011 to 2014 in Thailand. Participants were 707 adolescents living with perinatal HIV (ALPHIV, cases) aged 12–19 receiving antiretroviral therapy in 19 hospitals throughout Thailand and 689 HIV-uninfected adolescents (controls) living in the same institutions or, for those living in family settings, randomly selected from the general population and individually matched for sex, age, and place of residence. School trajectory disruption was defined as ≥ 1 year of academic delay or as early school dropout (before 15 years of age). Logistic regression models were used to assess factors independently associated with disrupted school trajectory and to estimate the proportion of school disruption attributable to HIV-infection. We used multivariate imputations by chained equations (MICE) to manage missing data and performed two sensitivity analyses to evaluate the main model’s reliability.Results: The study population’s median age was 14.5 years (58% female). School trajectory disruption was experienced by 37% of ALPHIV and 12% of the controls. After adjusting for sociodemographic factors, ALPHIV were 5 times more likely to experience disruption than controls ( =5.2 [3.7-7.2]). About 50% of school trajectory disruption was attributable to HIV-infection. Males and adolescents living in institutions were more likely to experience school trajectory disruption ( =1.8 [1.3-2.4] and =11.0 [7.7-15.8], respectively). Among ALPHIV, neurocognitive difficulties and growth delay were significantly associated with disruption ( =3.3 [2.1-5.2] and =1.8 [1.3-2.6], respectively). For those living in families, disruption was also associated with having a caregiver who had less than a secondary-level education ( =2.1 [1.1-3.9]) or having experienced stigmatization ( =1.9 [1.2-3.1]). Conclusions: HIV and contextual factors combine to aggravate the educational disadvantage among ALPHIV. The impact of this disadvantage on their life prospects, especially regarding access to higher education and professional achievement, should be further explored.
A comparative study of multimodal magnetic resonance in the differential diagnosis of acquired immune deficiency syndrome related primary central nervous system lymphoma and infection
Authors: Li Jingjing , Xue Ming , Yan Shuo , Guan Chunshuang , Xie Ruming , Chen Budong
Published: January 2021

Background: Patients with acquired immune deficiency syndrome (AIDS) often suffer from opportunistic infections and related primary central nervous system lymphoma (AR-PCNSL). Both diseases showed multiple ring enhancement lesions in conventional magnetic resonance (MR). It is very difficult to make the differential diagnosis. We aimed to investigate whether multimodal MR (diffusion weighted imaging (DWI)/ apparent diffusion coefficient (ADC), 3D pseudo-continuous arterial spin labeling (3D-pCASL) and susceptibility-weighted imaging (SWI)) combined with conventional MR can differentiate AR-PCNSL from infection. Methods: This was a prospective study. We recruited 19 AIDS patients who were divided into AR-PCNSL group (9 cases) and infection group (10 cases) by pathological results. We analyzed whether there was statistical (Fisher’s method) difference in multimodal MR between the two groups. We analyzed whether multimodal MR combined with conventional MR could improve the diagnosis of AR-PCNSL. Results: The lesions were more likely involved the paraventricular (0.020) and corpus callosum (0.033) in AR-PCNSL group in conventional MR. In multimodal MR, AR-PCNSL group showed low ADC value, with p values of 0.001. Infection group more inclined to high ADC value, with p was 0.003. In multimodal MR, AR-PCNSL group had more low signal intensity(grade 2-3) in the degree of intratumoral susceptibility signal intensity in SWI(SWI-ITSS) ,with p values of 0.001. The sensitivity, specificity of conventional MR in the diagnosis of AR-PCNSL was 88.9%, and 70.0%. The conventional MR sequence combined with DWI/ADC sequence in the diagnosis of AR-PCNSL had a sensitivity of 100.0%, and a specificity of 60.0%. The sensitivity and specificity of the conventional MR sequence combined with the SWI-ITSS sequence in the diagnosis of AR-PCNSL were 100% and 70.0%. The conventional MR combined with ADC or SWI-ITSS improved the diagnosis of AR-PCNSL. Conclusion: Multimodal MR could help distinguish AR-PCNSL from infectious lesions. The multimodal MR (DWI/ADC or SWI-ITSS) combined with conventional MR could improve the diagnosis of AR-PCNSL. The ADC value should be attached importance in clinical work. When distinguishing AR-PCNSL from toxoplasmosis or tuberculoma, SWI should be used to obtain a correct diagnosis.
Immune profiles of male giant panda (Ailuropoda melanoleuca) during breeding season
Authors: shen haibo , Li Caiwu , He Ming , Huang Yan , Wang Jing , Wang Minglei , Yue Bisong , Zhang Xiuyue
Published: January 2021

Background: The giant panda (Ailuropoda melanoleuca) is a threatened endemic Chinese species and a flagship species of national and global conservation concern. Life history theory proposes that reproduction and immunity can be mutually constraining and interrelated. Knowledge of immunity changes of male giant pandas during the breeding season is limited.Results: Here, we researched peripheral blood gene expression profiles associated with immunity. Thirteen captive giant pandas, ranging from 9 to 11 years old, were divided into two groups based on their reproductive status. We identified 318 up-regulated DEGs and 43 down-regulated DEGs, which were enriched in 87 GO terms and 6 KEGG pathways. Additionally, we obtained 45 immune-related genes with altered expression, mostly up-regulated, and identified four hub genes HSPA4, SUGT1, SOD1, and IL1B in PPI analysis. These 45 genes were related to pattern recognition receptors, autophagy, peroxisome, proteasome, natural killer cell, antigen processing and presentation. SUGT1 and IL1B were related to pattern recognition receptors. HSP90AA1 was the most up-regulated gene and is a member of heat shock protein 90 family. HSP90 contributes to the translocation of extracellular antigen. KLRD1 encodes CD94, whose complex is an inhibitor of the cytotoxic activity of NK cells, was down-regulated. IGIP, which has the capability of inducing IgA production by B cells, was down-regulated, suggesting low concentration of IgA in male giant pandas. Our results suggest that most immune-related genes were up-regulated and more related to innate immune than adaptive immune. Conclusions: Our results indicated that breeding male giant pandas presented an immunoenhancement in innate immunity, enhanced antigen presentation and processing in cellular immunity compared to non-breeding males. The humoral immunity of male giant pandas may show a tendency to decrease during the breeding season. This study will provide a foundation for further studies of immunity and reproduction in male giant pandas.
Impact of short-read sequencing on the misassembly of a plant genome
Authors: Wang Peipei , Meng Fanrui , Moore Bethany M. , Shiu Shin-Han
Published: January 2021

Background: Availability of plant genome sequences has led to significant advances. However, with few exceptions, the great majority of existing genome assemblies are derived from short read sequencing technologies with highly uneven read coverages indicative of sequencing and assembly issues that could significantly impact any downstream analysis of plant genomes. In tomato for example, 0.6% (5.1 Mb) and 9.7% (79.6 Mb) of short-read based assembly had significantly higher and lower coverage compared to background, respectively.Results: To understand what the causes may be for such uneven coverage, we first established machine learning models capable of predicting genomic regions with variable coverages and found that high coverage regions tend to have higher simple sequence repeat and tandem gene densities compared to background regions. To determine if the high coverage regions were misassembled, we examined a recently available tomato long-read based assembly and found that 27.8% (1.41 Mb) of high coverage regions were potentially misassembled of duplicate sequences, compared to 1.4% in background regions. In addition, using a predictive model that can distinguish correctly and incorrectly assembled high coverage regions, we found that misassembled, high coverage regions tend to be flanked by simple sequence repeats, pseudogenes, and transposon elements. Conclusions: Our study provides insights on the causes of variable coverage regions and a quantitative assessment of factors contributing to plant genome misassembly when using short reads and the generality of these causes and factors should be tested further in other species.
Using the Delphi technique to determine objectives and topical outline for a Pharmaceutical Care Course: an experience from the Cuban Higher Education System
Authors: Martínez-Sánchez Alina M.
Published: January 2021

Background: Being pharmaceutical care one of the four areas defined by the International Pharmaceutical Federation's Global Competence Framework, the curriculum redesigned scheme is a priority task to perform a pharmaceutical workforce capable to contribute significantly to the appropriate use of medicines. Therefore, the pharmacy curriculum should be adapted, in order to provide pharmacists with new knowledge and skills to provide pharmaceutical care services. This study used a modified Delphi technique to define objectives and topical outlines for a pharmaceutical care course on a pharmacy curriculum. Methods: A modified Delphi process was used to determine a consensus among proposed courseobjectives and topical outlines. The preliminary phase of the study included a compilation of prospective objectives and outline topics on which to structure informational flow through the Delphi. A two-round modified Delphi process were completed by the participants in the study. The Delphi questionnaire was organized using six domains: the theoretical program foundation; recommended for teaching literature; instructional and educational objectives of the program (course structure); teaching methods; knowledge, skills and professional values considered; and students’ performance assessments. Nineteen items for evaluation within the referred domains were considered.Results: Consensus was achieved among 15 participants regarding 10 objectives, and eleven topical outlines related to pharmaceutical care teaching in an undergraduate pharmacy course. Despite this favorable valuation and considering the qualitative evaluations provided by the participants, it was believed appropriate to analyze the recommendation for the inclusion of literature for the teaching of the course in Spanish language (73%). It resulted in a project proposal for the elaboration of a book by a group of authors from all the faculties of pharmacy in the country.Conclusion: A Delphi expert panel achieved consensus on topical outline and objectives for a pharmaceutical care course. The results of this study can be used to underline the didactic guidance for pharmaceutical care teaching and learning useful for future pharmacy curriculum upgrades.
Comparative short-term outcomes of enhanced recovery after surgery (ERAS) program and none-ERAS traditional care in elderly patients undergoing lumbar arthrodesis: a retrospective study
Authors: Li Zhong-En , Lu Shi-Bao , Kong Chao , Sun Wen-Zhi , Wang Peng , Zhang Si-Tao
Published: January 2021

Background: Enhanced recovery after surgery (ERAS) program is an evidence-based improvement over none-ERAS traditional care. The aim of the present study was to analyze the safety, feasibility, and efficacy of an ERAS program in patients over 70 years undergoing lumbar arthrodesis by comparison with none-ERAS traditional care.Methods: During January 2018 to December 2018, patients enrolled received none-ERAS traditional care, while the ERAS program was implemented from January to December 2019. Demographic characteristics, comorbidities, surgical data and postoperative recovery parameters were collected from all patients. Postoperative pain scores were evaluated by visual analog scales (VAS). The clinical outcomes were length of stay (LOS), postoperative complications and postoperative pain scores. Compliance results were also collected.Result: A total of 127 patients were enrolled, including 67 patients in the none-ERAS traditional care group and 60 patients in the ERAS group. The demographic characteristics and comorbidities of the two groups showed no significant differences. The LOS of patients treated with ERAS program (13.6±4.0 days) was significantly less than that of patients treated with none-ERAS traditional care (15.6±3.9 days) (p = 0.034). Complication rate was 8.3% in the ERAS group versus 20.9% in the none-ERAS traditional care group (p = 0.048). VAS (back) in the ERAS group was significantly lower on postoperative day (POD) 1 and POD2. Postoperative recovery parameters were improved in the ERAS group. The overall compliance with the ERAS program was 94%.Conclusions: Based on our results, ERAS program is safer and more effective for elderly patients over 70 undergoing lumbar arthrodesis than none-ERAS traditional care.
Sequential vs concurrent adjuvant chemotherapy for operable breast cancer: A meta-analysis
Authors: Chen Wanjing , Tu Qian , Shen Yanfei , Tang Kejun , Hong Mengying , shen yong
Published: January 2021

Background: Whether a sequential or concurrent regimen of anthracyclines and taxanes is superior for breast cancer is controversial. We compared the efficacy of two regimens in patients with operable breast cancer based on all relevant published data of phase III randomized controlled trials.Methods: A comprehensive literature search on PubMed, Web of Science, Embase, ScienceDirect, Google Scholar and clinicaltrials.gov databases was performed up to May 2020. Meta-analysis was performed to evaluate the different efficacy on disease free survival (DFS) and overall survival (OS) for the two chemotherapy regimens. Subgroup analyses were further carried out in terms of node status and anthracycline selection.Results: Compared to the concurrent regimen, sequential regimen did not improve the DFS or OS in the population studied. Subgroup analysis showed that in node-positive patients, the sequential regimen had better DFS, but not OS, than the concurrent regimen. In sequential regimen, patients who received doxorubicin and taxanes had improved DFS and OS than patients who were administered epirubicin and taxanes. Furthermore, for patients who received doxorubicin and taxanes, compared to the sequential regimen, fewer cycles (4 cycles) of concurrent treatment resulted in a worse DFS and OS, which can be rescued by more cycles (6 cycles). Conclusions: The sequential regimen of anthracyclines and taxanes for patients with operable breast cancer did not yield a significant benefit in DFS or OS over the concurrent regimen. The sequential regimen, however, provided a better DFS than concurrent regimen for node-positive patients. Interestingly, further subgroup analysis showed that for node-positive patients who were given doxorubicin and taxanes, more cycles (6 cycles) of the concurrent regimen may rescue the efficacy for fewer cycles (4 cycles).
A qualitative study examining transgender people’s attitudes towards having biological children and pursuing fertility treatments in Greece
Authors: Voultsos Polychronis , Zymvragou Christina-Erato , Karakasi M.V. , Pavlidis P.
Published: January 2021

Background: Advances in biomedical technologies permit transgender individuals not only to achieve gender transition but also to experience parenthood. Little is known about this topic in Greece, a traditionally conservative country; however, Greece is changing at the legal level towards a greater recognition of transgender people’s rights. This study aimed to investigate transgender people’s attitudes towards having biological children and pursuing fertility treatments in Greece.Methods: This is a prospective qualitative study conducted with adult individuals who identified as transgender men or transgender women between April 2019 and March 2020. Individual in-depth qualitative interviews were conducted with twelve participants. The interviews were carried out in person and were digitally recorded and transcribed verbatim. We performed an inductive analysis of the data.Results: The inductive data analysis resulted in the identification of themes that represent key barriers to pursuing fertility preservation (FP) or the use of assisted reproductive technology (ART). Six major themes were clearly present in the findings (lack of adequate information and counseling, worsening gender dysphoria, increased discrimination against transgender people due to the rise of extreme far-right populism, low parental self-efficacy, high costs, and a less than perfect legal framework). Moreover, diverse cases were examined, and minor themes, such as the symbolic value of the uterus and pregnancy, the relationship between the type of gender transition and willingness to pursue fertility treatments, and transgender people’s adherence to heteronormative patterns in the context of reproduction, were identified. Various reasons for transgender people’s differing degrees of desire for parenthood were identified.Conclusion: Our findings demonstrated contextual factors as well as factors related to transgender people themselves as barriers to pursuing transgender parenthood. Most aspects of our findings are consistent with those of previous research. However, some aspects of our findings (regarding aggressive behaviors and economic instability) are specific to the context of Greece, which is characterized by the rise of extreme far-right populism due to the decade-long Greek economic crisis and the deeply conservative traditionalist background. In that regard, the participants highlighted the (perceived as) less than perfect Greek legislation on transgender people’s right as barrier to transgender (biological) parenthood.
Dietary Intake, Intestinal Infection, and Safe Drinking Water Among Children with Anemia in Peru: A Cross-Sectional Analysis
Authors: Westgard Christopher M , Orrego-Ferreyros Luis A. , Calderón Liz Franco , Rogers Alexandra M.
Published: January 2021

Anemia is a major public health concern that is present in 41.7% of children under 5 worldwide. The prevalence of anemia in Peru was 43.6% in 2017, a decrease by only 6.8% in 8 years. Despite great efforts made by the government to reduce anemia by distributing free multi-micronutrient supplements and promote the consumption of iron rich foods, progress has been slow. The current study sought to better understand why the prevalence remains high by analyzing the dietary intake, incidence of intestinal infectious disease, and access to safe drinking water by children with anemia in Peru. METHODS A cross-sectional analysis was conducted using data from two national surveys that were combined by child ID. Descriptive statistics was analyzed to understand the experience of children with anemia in comparison to child without anemia. Logistic multivariate regression analyses were conducted to test the associations between anemia and dietary intake, intestinal infection, and access to safe drinking water.RESULTS The sample included 586 children between 6 and 35 months. The prevalence of anemia in this population was 53%. The portion of children that consumed sufficient iron to meet the recommendation for their age was 62%. Of the children with anemia, 52% consumed sufficient iron to meet their recommendation, vs. 72% of children without anemia (p<0.001). The children with anemia were more likely to have an intestinal infection during the previous year (35% vs. 26%, p=0.057) and less likely to have access to safe drinking water (77% vs. 86%, p=0.002) than those without anemia. The logistic analysis revealed that having an intestinal infection increased the odds of having anemia (OR=1.64, CI 95% [1.041-2.584]), and having access to safe drinking waters decreased the odds of having anemia (OR=0.578, [0.334-0.998]). CONCLUSIONS More than half of the children with anemia in Peru already consume sufficient iron to meet their daily requirement. However, they continue to have anemia, likely due to intestinal infection, such as diarrhea and parasites, from a lack of access to safe drinking water and hygienic practices.
Genome-wide identification and function analysis of ERF2 gene family in response to disease resistance against Stemphylium lycopersici in tomato
Authors: Yang Huanhuan , Sun Yaoguang , Wang Hexuan , Zhao Tingting , Xu Xiangyang , Jiang Jingbin , Li Jingfu
Published: January 2021

Background: APETALA2/ethylene responsive factor (AP2/ERF) transcription factors are a plant-specific family of transcription factors and one of the largest families of transcription factors. Ethylene response factors (ERF) regulate plant growth, development, and responses to biotic and abiotic stress. In a previous study, the ERF2 gene was significantly upregulated in both resistant and susceptible tomato cultivars in response to Stemphylium lycopersici. The main purpose of this study was to systematically analyze the ERF family and to explore the mechanism of ERF2 in tomato plants resisting pathogen infection by the Virus-induced Gene Silencing technique.Results: In this experiment, 134 ERF genes were explored and subjected to bioinformatic analysis and divided into twelve groups. The spatiotemporal expression characteristics of ERF transcription factor gene family in tomato were diverse. Combined with RNA-seq, we found that the expression of 18 ERF transcription factors increased after inoculation with S. lycopersici. In ERF2-silenced plants, the susceptible phenotype was observed after inoculation with S. lycopersici. The hypersensitive response and ROS production were decreased in the ERF2-silenced plants. Physiological analyses showed that the superoxide dismutase, peroxidase and catalase activities were lower in ERF2-silenced plants than in control plants, and the SA and JA contents were lower in ERF2-silenced plants than in control plants after inoculation with S. lycopersici. Furthermore, the results indicated that ERF2 may directly or indirectly regulate Pto, PR1b1 and PR-P2 expression and enhance tomato resistance.Conclusions: In this study, we identified and analyzed members of the tomato ERF family by bioinformatics methods and classified, described and analyzed these genes. Subsequently, we used VIGS technology to significantly reduce the expression of ERF2 in tomatoes. The results showed that ERF2 had a positive effect on tomato resistance to S. lycopersici. Interestingly, ERF2 played a key role in multiple SA, JA and ROS signaling pathways to confer resistance to invasion by S. lycopersici. In addition, ERF2 may directly or indirectly regulate Pto, PR1b1 and PR-P2 expression and enhance tomato resistance to S. lycopersici. In summary, this study provides gene resources for breeding for disease resistance in tomato.
The need for additional mental health support for women in the postpartum period in the times of epidemic crisis
Authors: Chrzan-Dętkoś Magdalena , Walczak-Kozłowska Tamara Zofia , Lipowska Małgorzata
Published: January 2021

Background: This retrospective study aimed to identify possible intensification of mental health difficulties among women seeking support in the postpartum period during the epidemic state in Poland. We assumed that the epidemic crisis, social isolation, and restrictions in hospitals which affect pregnant and postpartum women - lack of family labors, lack of the possibility to be with the newborn when he/she is hospitalized, may increase fear and reduce psychosocial resources of women, hinder their normal process of transition to motherhood and thus contribute to the intensified severity of depressive symptoms.Methods: The study participants were women seeking support at the on-line platform of the project ‘Next Stop: Mum’, which is a part of the postpartum depression prevention’s program implemented by the Ministry of Health in Poland, and enables remote self-screening for the severity of the postpartum depression symptoms with the Edinburgh Postpartum Depression Scale developed by Cox and collaborators. The analyzed data in this study were obtained from 139 women: 61 filled forms from October 1 - November 10, 2019 (non-epidemic period), and 78 filled forms from February 20 - March 30 (beginning of the COVID-19 epidemic), 2020.Results: A statistically significant difference in the severity of postpartum depression symptoms were observed among women making a self-assessment with EPDS scale at the beginning of the COVID-19 epidemic in Poland (M = 15.71; SD = 6.23), compared to the pre-epidemic neutral period (M = 13.56; SD = 6.46).Conclusions: The results of this study indicate that the epidemic crisis may be associated with an increased need for additional caution and support of women's mental health in the postpartum period. We believe that recommendations for medical staff, policy, and families of women struggling with postpartum depression symptoms during crisis should be widespread as the second wave of COVID-19 disease may develop in the autumn-winter 2020 and spring 2021.
Mitotic arrest affects clustering of tumor cells
Authors: Bonnet Julia , Rigal Lise , Mondesert Odile , Morin Renaud , Corsaut Gaelle , Vigneau Mathieu , Ducommun Bernard , Lobjois Valerie
Published: January 2021

Background Cancer cell aggregation is a key process involved in the formation of tumor cell clusters. It has recently been shown that clusters of circulating tumor cells (CTCs) have an increased metastatic potential compared to isolated circulating tumor cells. Several widely used chemotherapeutic agents that target the cytoskeleton microtubules and cause cell cycle arrest at mitosis have been reported to modulate CTC number or the size of CTC clusters. Results In this study, we investigated in vitro the impact of mitotic arrest on the ability of breast tumor cells to form clusters. By using live imaging and quantitative image analysis, we found that MCF-7 cancer cell aggregation is compromised upon incubation with paclitaxel or vinorelbine, two chemotherapeutic drugs that target microtubules. In line with these results, we observed that MCF-7 breast cancer cells experimentally synchronized and blocked in metaphase aggregated poorly and formed loose clusters. To monitor clustering at the single-cell scale, we next developed and validated an in vitro assay based on live video-microscopy and custom-designed micro-devices. The study of cluster formation from MCF-7 cells that express the fluorescent marker LifeAct-mCherry using this new assay allowed showing that substrate anchorage-independent clustering of MCF-7 cells was associated with the formation of actin-dependent highly dynamic cell protrusions. Metaphase-synchronized and blocked cells did not display such protrusions, and formed very loose clusters that failed to compact. Conclusions Altogether, our results suggest that mitotic arrest induced by microtubule-targeting anticancer drugs prevents cancer cell clustering and therefore, could reduce the metastatic potential of circulating tumor cells.
Serum levels of bone formation and resorption markers in relation to vitamin D status in professional gymnastics and physically active men during upper and lower body high-intensity exercise
Authors: Mieszkowski Jan , Kochanowicz Andrzej , Piskorska Elżbieta , Niespodziński Bartłomiej , Siódmiak Joanna , Buśko Krzysztof , Olszewska-Słonina Dorota , Antosiewicz Jedrzej
Published: January 2021

Purpose/Introduction: To compare serum levels of bone turnover markers in athletes and non-athletes, and to evaluate the relationship between serum levels of vitamin D metabolites and exercise-induced changes in biomarker levels. Methods: Sixteen elite male artistic gymnasts (EG; 21.4 ± 0.8 years-old) and 16 physically active men (the control group, PAM; 20.9 ± 1.2 years-old) performed lower and upper body 30-s Wingate anaerobic tests (LBWT and UBWT, respectively). For biomarker analysis, blood samples were collected before, and 5 and 30 min after exercise. Samples for vitamin D levels were collected before exercise. N-terminal propeptide of type I collagen (PINP) was analysed as a marker of bone formation. C-terminal telopeptide of type I collagen (CTX) was analysed as a marker of bone resorption.Results: UBWT fitness readings were better in the EG group than in the PAM group, with no difference in LBWT readings between the groups. UBWT mean power was 8.8% higher in subjects with 25(OH)D3 levels over 22.50 ng/ml and in those with 24,25(OH)2D3 levels over 1.27 ng/ml. Serum CTX levels increased after both tests in the PAM group, with no change in the EG group. PINP levels did not change in either group; however, in PAM subjects with 25(OH)D3 levels above the median, they were higher than those in EG subjects. Conclusion: Vitamin D metabolites affect the anaerobic performance and bone turnover markers at rest and after exercise. Further, adaptation to physical activity modulates the effect of anaerobic exercise on bone metabolism markers.
Clinical features of anti-synthetase syndrome associated interstitial lung disease: a retrospective cohort in China
Authors: Zhan Xi , Wei YAN , Ying WANG , Qing LI , Xuhua SHI , Yanli GAO , Qiao YE
Published: January 2021

BackgroundAnti-synthetase syndrome (ASSD) is a chronic autoimmune condition characterized by antibodies directed against an aminoacycl transfer RNA synthetase (ARS) along with a group of clinical features including the classical clinical triad: inflammatory myopathy, arthritis, and interstitial lung disease (ILD). ASSD is highly heterogenous due to different organ involvement, and ILD is the main cause of mortality and function loss, which presents as different patterns when diagnosed. We designed this retrospective cohort to describe the clinical features and disease behaviour of ASSD associated ILD. MethodsData of 108 cases of ASSD associated ILD were retrospectively collected in Beijing Chaoyang Hospital from 2017.12 to 2019.3. Data were obtained from the Electronic Medical Record (EMR) system. Patients were divided into 5 groups according to distinct aminoacyl tRNA synthetase (ARS) antibodies. Results:Overall, 108 consecutive patients were recruited. 33 were JO-1 positive,30 were PL-7 positive,23 were EJ positive, 13 were PL12 positive and 9were OJ positive. The JO-1 group had a significant higher rate of mechanic’s hand (57.6%) than other 4 groups. Polymyositis/ dermatomyositis (PM/DM) was diagnosed in 25 (23.1%) patients and no difference was observed among the 5 groups. The anti-PL7 positive group had a higher frequency of UIP pattern (13.3%) than the other 4 groups but the difference was not significant, and the EJ group had the most frequent OP pattern(78.2%), which was significantly higher than the PL-7 (P<0.001) and PL-12 groups (P=0.025). The median follow-up time was 10.7 months, during which no patients died. All received prednisone treatment, with or without immunosuppressants. At the 6-month-follow up, 96.3% of all patients (104/108) had a positive response to therapy, the JO-1 and EJ groups had a significantly higher improvement of forced vital capacity than the other 3 groups (P<0.05), and the PL-7 group had the lowest FVC improvement (P<0.05). The anti-JO1-positive group and anti-EJ-positive group had significantly higher anti-RO52-positive occurrence than the other 3 groups (P<0.05).ConclusionAnti PL-7 antibody had the same frequency as anti-JO1 in ASSD-ILD, in which the ILD pattern was different with distinct anti-ARS antibodies. Most ASSD-ILD had a positive response to steroid therapies, with or without immunosuppressants. The PL-7 group had the highest occurrence of UIP pattern, and a significantly lower response to therapy.