bluuebunny/crossref_metadata_2025 huggingface dataset:
Multicenter evaluation of EIAs and CLIAs in the detection of hepatitis C virus antibody among blood donors in China
Authors: Chang Le , Ji Huimin , Guo Fei , Jiang Xinyi , Wang Lunan
Published: September 2020

Background: Recent data on the evaluation of screening serological assays on anti-HCV among a large sample of blood donors is lacking. The present study aimed to perform a multicenter evaluation of EIAs and CLIAs for detection of anti-HCV among blood donors in 16 different Chinese blood establishments.Methods: A total of 1,309 samples containing 582 anti-HCV screening negatives and 727 positives collected from 15 blood establishments all over China. A total of 10 different anti-HCV assays (8 EIAs and 2 CLIAs) were evaluated in 16 different blood centers/banks. Confirmatory testing was performed using recombinant immunoblot assay and HCV RNA tests.Results: There were 963 true negatives, 261 positives, and 85 indeterminate samples. False positive rate of screening testing was 39.67% (382/963) and the positive prediction value was only 35.76% (260/727). Roche and InTec had the highest sensitivity (98.47%) and KHB and Wantai (indirect EIA) had the highest specificity (99.23%). Ortho/Abbott together with InTec could detect all the true positives. Among samples with discrepant results by different assays, indeterminate samples showed quite different S/CO ratios detected by Roche compared with confirmed positives (4.84 vs 19.36, P<0.0001), and higher signal to cutoff (S/CO) ratios than confirmed negatives (4.84 vs 2.94, P=0.020). However, there was no difference among the three groups when detected by Abbott. When S/CO ratio went to 8.2 on Roche and 4.2 on Abbott, the PPV could achieve more than 95%.Conclusion: False reactive problem of anti-HCV screening should be solved urgently. RIBA indeterminate donations may be a special group, should be further studied.
Development of Fe3O4 core-TiO2 shell nanocomposites and nanoconjugates as a foundation for neuroblastoma radiosensitization
Authors: Liu William , Mirzoeva Salida , Yuan Ye , Deng Junjing , Chen Si , Lai Barry , Vogt Stefan , Shah Karna , Shroff Rahul , Bleher Reiner , Jin Qiaoling , Vo Nghia , Bazak Remon , Ritner Carissa , Gutionov Stanley , Raha Sumita , Sedlmair Julia , Hirschmugl Carol , Jacobsen Chris , Paunesku Tatjana , Kalapurkal John , Woloschak Gayle
Published: September 2020

BackgroundNeuroblastoma is the most common extracranial solid malignancy in childhood which, despite the current progress in radiotherapy and chemotherapy protocols, still has a high mortality rate in high risk tumors. Nanomedicine offers exciting and unexploited opportunities to overcome the shortcomings of conventional medicine. The photocatalytic properties of Fe3O4 core-TiO2 shell nanocomposites and their potential for cell specific targeting suggest that nanoconstructs produced using Fe3O4 core-TiO2 shell nanocomposites could be used to enhance radiation effects in neuroblastoma. In this study, we evaluated bare, metaiodobenzylguanidine (MIBG) and 3,4-Dihydroxyphenylacetic acid (DOPAC) coated Fe3O4@TiO2 as potential radiosensitizers for neuroblastoma in vitro.ResultsThe uptake of bare and MIBG coated nanocomposites modestly sensitized neuroblastoma cells to ionizing radiation. Conversely, cells exposed to DOPAC coated nanocomposites exhibited a five-fold enhanced sensitivity to radiation, increased numbers of radiation induced DNA double-strand breaks, and apoptotic cell death. The addition of a peptide mimic of the epidermal growth factor (EGF) to nanoconjugates coated with MIBG altered their intracellular distribution. Cryo X-ray fluorescence microscopy tomography of frozen hydrated cells treated with these nanoconjugates revealed cytoplasmic as well as nuclear distribution of the nanoconstructs.ConclusionsThe intracellular distribution pattern of different nanoconjugates used in this study was different for different nanoconjugate surface molecules. Cells exposed to DOPAC covered nanoconjugates showed the smallest nanoconjugate uptake, with the most prominent pattern of large intracellular aggregates. Interestingly, cells treated with this nanoconjugate also showed the most pronounced radiosensitization effect in combination with the external beam x-ray irradiation. Further studies are necessary to evaluate mechanistic basis for this increased radiosensitization effect. Preliminary studies with the nanoparticles carrying an EGF mimicking peptide showed that this approach to targeting could perhaps be combined with a different approach to radiosensitization – use of nanoconjugates in combination with the radioactive iodine. Much additional work will be necessary in order to evaluate possible benefits of targeted nanoconjugates carrying radionuclides.
Modelling Cost-Effectiveness Of Syphilis Detection Strategies In Prisoners: Exploratory Exercise In A Chilean Male Prison
Authors: Castillo-Laborde Carla , Gajardo Pedro , Ferrari Manuel Nájera-De , Matute Isabel , Hirmas-Adauy Macarena , Aguirre Pablo , Ramírez Héctor , Rámirez Daniel , Aguilera Ximena
Published: September 2020

BACKGROUND: Syphilis, together with other sexually transmitted infections, remains a global public health problem that is far from being controlled. People deprived of liberty are one of the vulnerable population. Control activities in prisons rely mostly on passive case detection, despite the existence of affordable alternatives that would allow switching to active case-finding strategies. Our objective was to develop a mathematical modelling framework for cost-effectiveness evaluation, from a health system perspective, of different approaches using rapid tests for the detection of syphilis in inmates' populations and to explore the results based on a Chilean male prison population. Methods: A compartmental model was developed to characterize the transmission dynamics of syphilis inside a prison with the ongoing strategy (passive case detection, with VRDL + FTA-ABS), considering the entrance and exit of inmates over a 40 year period. The model allows simulation of the implementation of a reverse algorithm for the current situation (rapid test + VDRL), different screening strategies (entry point, massive periodically; both with rapid test + VDRL) and treatment of detected cases. The parameters for the exploratory exercise were obtained from systematic searches of indexed and grey literature and field work (EQ-5D questionnaire application and key actors interviews). Probabilistic sensitivity analysis was conducted to account for uncertainty in relevant parameters. RESULTS: The proposed framework allows the evaluation of different detection strategies. In this study, all the strategies were cost-effective in the baseline scenario when considering an ICER threshold of 1 Chilean GDP per capita (US$15,000). The strategies most likely to be cost-effective (over 80% probability) were: current situation with reverse algorithm, entry point screening and mass screening every two years; the latter was the most effective, achieving the lowest prevalence (0.7% and 1.7% over the period versus the 3% prevalence in the current situation).CONCLUSIONS: Mathematical modelling that considers the performance of different test and detection strategies could be a useful tool for decision making. The exploratory results show the efficiency of adopting both the use of the rapid tests and performing active case detection to significantly reduce the burden of syphilis in Chilean prisons in the near future.
Progressive Tricuspid Regurgitation and Elevated Tricuspid Regurgitation Pressure Gradient After Transvenous Permanent Pacemaker Implantation
Authors: Lee Weichieh , Fang Hsiu-Yu , Chen Huang-Chung , Chen Yung-Lung , Tsai Tzu-Hsien , Pan Kuo-Li , Lin Yu-Sheng , Liu Wen-Hao , Chen Mien-Cheng
Published: September 2020

BackgroundThe association of post-implant tricuspid regurgitation (TR) and heart failure (HF) hospitalization in patients without HF and preexisting abnormal TR and TR pressure gradient (PG) remain unclear. This study aimed to explore the clinical outcomes about progressive post-implant TR after permanent pacemaker (PPM) implantation.Methods A total of 1,670 patients who underwent a single ventricular or dual-chamber transvenous PPM implantation at our hospital between January 2003 and December 2017 were included in the study. Patients with prior valvular surgery, heart failure (HF), and baseline abnormal TR and TRPG were excluded. Finally, a total of 1,075 patients were enrolled in this study. Progressive TR was defined as increased TR grade of ≥2 degrees and/or TRPG of >30 mmHg after implant.Results198 (18.4%) patients (group 1) experienced progressive post-implant TR and/or elevated TRPG. Group 1 had l larger changes in post-implant TRPG (group 1 vs. group 2; 12.8 ± 9.6 mmHg vs. 1.1 ± 7.6 mmHg; p < 0.001) than group 2 without progressive post-implant TR. Group 1 had a higher incidence of HF hospitalization compared to group 2 (13.6% vs. 4.7%; p < 0.001). Pre-implant TRPG (HR: 1.075; 95% confidence interval (CI): 1.032-1.121; p = 0.001) and post-implant left atrial dimension (HR: 1.076; 95% CI: 1.038-1.114; p < 0.001) were independent predictors of progressive post-implant TR. ConclusionsAfter a transvenous ventricular-based PPM implantation, 18.4% of patients experienced progressive post-implant TR and/or elevated TRPG. Higher pre-implant TRPG and larger post-implant LA dimension were independent predictors of progressive post-implant TR.
Impact of peer-delivered tuition/feedback on appointment to United Kingdom Higher Surgical Training
Authors: Choong Wen Ling , Joy Melvin , Madurska Marta , Tang Benjie , Ip Brian
Published: September 2020

Background

In the United Kingdom, Core Surgical Trainees (or equivalent) undergo a rigorous National Selection (NS) process to secure a ST3 Training Post in General or Vascular Surgery. Despite a decrease in competition ratio from 3:1 in 2012 to 1.48:1 in 2017, many applicants were unable to secure ST3 Training Posts. We hypothesise that this is due to applicant performance anxiety rather than lack of clinical experience.
Methods

This is a prospective observational study following 27 delegates who have completed a 2-day course consisting of didactic lecture and interactive practice with a 1:1 faculty:delegate ratio. The course was delivered by surgical consultants and trainees. A specific mentor was nominated to oversee the delegate’s progress throughout and post course. Personalised feedback was given by the entire faculty throughout the course. Delegates were asked to complete evaluation forms to track their perceived confidence levels of success at NS at different timeframes, measured by a visual analogue scale. Paired t -test was performed to compare the mean confidence level pre- and post- course.
Results

Evaluation forms were received from all (n = 27) delegates. Delegate self-reported confidence increased significantly for all domains except Professional Communication. 23 (85%) of the participants were successful in the NS post course. There was no statistically significant difference between UK and non-UK graduates; and first time and not-first-time applicants.
Conclusions

Peer-delivered teaching, practice and feedback as a structured interview practice course can significantly improve applicants’ overall confidence levels in preparing for the UK ST3 General and Vascular Surgery NS. Improvement in confidence levels translates to high attrition rate of ST3 Training Posts. Communication skills require longer practice time extending beyond the duration of the 2-day course.
Placing the Patient at the Centre of the Learning Environment: Effect on Agency for the Learner, the Attending Physician and the Patient
Authors: Cheema Bavenjit , Li Meredith , Ho Daniel , Amari Erica , Buckley Heather , Canfield Carolyn , Cuncic Cary , Fritz Daniel , Nimmon Laura , Enk Anneke van , Veerapen Kiran , Wisener Katherine , Holmes Cheryl Lynn
Published: September 2020

The authors have requested that this preprint be removed from Research Square.
Comparison of qSOFA Score, SOFA Score, and SIRS Criteria for the Prediction of Infection and Mortality Among Surgical Intermediate and Intensive Care Patients
Authors: Koch Christian , Edinger Fabian , Fischer Tobias , Brenck Florian , Hecker Andreas , Katzer Christian , Markmann Melanie , Sander Michael , Schneck Emmanuel
Published: September 2020

Background It is crucial to rapidly identify sepsis so that adequate treatment may be initiated. Accordingly, the Sequential Organ Failure Assessment (SOFA) and the quick SOFA (qSOFA) score are used to evaluate intensive care unit (ICU) and non-ICU patients, respectively. As demand for ICU beds rises, the intermediate care unit (IMCU) carries greater importance as a bridge between the ICU and the regular ward. This study aimed to examine the ability of SOFA and qSOFA scores to predict sepsis and mortality in IMCU patients. Methods Retrospective data analysis included 13,780 surgical patients treated at the IMCU, ICU, or both between 01/01/2012 and 09/30/2018. Patients were screened for suspected infection (i.e., the commencement of broad-spectrum antibiotics) and then evaluated for the SOFA score, qSOFA score, and the 1992 defined systemic inflammatory response syndrome (SIRS) criteria. Results Suspected infection was detected in 1,306 (18.3%) of IMCU, 1,365 (35.5%) of ICU, and 1,734 (62.0%) of IMCU/ICU encounters. Overall, 458 (3.3%) patients died (IMCU: 45 [0.6%]; ICU: 250 [6.5%]; IMCU/ICU: 163 [5.8%]). All investigated scores failed to predict sepsis independently of the analyzed subgroup. Regarding mortality prediction, the qSOFA score performed sufficiently within the IMCU cohort (AUCROC SIRS: 0.72 [0.71-0.72]; SOFA: 0.52 [0.51-0.53]; qSOFA: 0.82 [0.79-0.84]), while the SOFA score was predictive in patients of the IMCU/ICU cohort (AUCROC SIRS 0.54 [0.53-0.54]; SOFA 0.73 [0.70-0.77]; qSOFA 0.59 [0.58-0.59]). Conclusions None of the assessed scores was sufficiently able to predict sepsis in surgical ICU or IMCU patients with suspected infection. While the qSOFA score is appropriate for mortality prediction in IMCU patients, SOFA score prediction quality is increased in critically ill patients.
The Continuing Evolution of Community-Associated MRSA ST93-IV in Australia
Authors: Pang Stanley , Daley Denise A , Sahibzada Shafi , Mowlaboccus Shakeel , Stegger Marc , Coombs Geoffrey W
Published: September 2020

BackgroundThe global emergence of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) has seen the dominance of specific clones in different regions around the world with the PVL-positive ST93-IV as the predominant CA-MRSA clone in Australia. In this study we applied a genome-wide association study (GWAS) approach on a collection of Australian ST93-IV MRSA genomes to identify genetic traits that may have assisted the ongoing transmission of ST93-IV in Australia. We also compared the genomes of ST93-IV bacteraemia and non-bacteraemia isolates to identify potential virulence factors associated with bacteraemia.ResultsBased on single nucleotide polymorphism phylogenetics we identified two distinct ST93-IV clades circulating concurrently in Australia. One of the clades contained isolates primarily isolated in the northern regions of Australia whilst isolates in the second clade were distributed across the country. Analyses of the ST93-IV genome plasticity over a 15-year period (2002-2017) revealed an observed gain in accessory genes amongst the clone’s population. The GWAS analysis on the bacteraemia identified two genes that have also previously been associated to this kind of infection. ConclusionsThe emergence of a ST93-IV clade containing additional virulence genes may explain the high prevalence of ST93-IV infections amongst the indigenous population living in the northern regions of Australia. In summary, this study has shown ST93-IV is evolving with multiple additional genes possibly contributing to its dominance in the Australian community.
Evaluation of Lymphocytic Infiltration in the Bronchial Glands of Sjögren's Syndrome in Transbronchial Lung Cryobiopsy
Authors: Okabayashi Hiroko , Baba Tomohisa , Ootoshi Ryota , Shintani Ryota , Tabata Erina , Ikeda Satoshi , Niwa Takashi , Oda Tsuneyuki , Okuda Ryo , Sekine Akimasa , Kitamura Hideya , Komatsu Shigeru , Hagiwara Eri , Takemura Tamiko , Sakagami Takuro , Ogura Takashi
Published: September 2020

Background: Sjögren's syndrome (SS) is a systemic autoimmune disease characterized by deteriorated exocrine gland function with associated lymphocytic infiltration. However, there are few pathological studies on bronchial glands in SS. In this study, we aimed to clarify pathological features of bronchial glands in SS. Methods: We retrospectively evaluated infiltration of lymphocytes in the bronchial glands incidentally collected by transbronchial lung cryobiopsy (TBLC), which were performed for the diagnosis of diffuse lung diseases. The degrees of lymphocyte infiltration in the bronchial glands were classified into four grades (grade 0-3). We compared the degrees of infiltration of SS with those of other diffuse lung diseases. Results: TBLC for diagnosis of diffuse lung diseases were performed on 432 cases during the study period. The samples of 50 cases included bronchial glands. Of those, 20 cases were excluded due to insufficient size or influence of therapy. The remaining 30 cases included 17 of idiopathic interstitial pneumonias, 5 of chronic hypersensitivity pneumonia, 6 of connective tissue disease (SS; n=4, systemic sclerosis; n=1, dermatomyositis; n=1) and 2 of other diseases. In SS, infiltration of lymphocytes was observed in all cases; grade 1 in one, grade 2 in one, and grade 3 in two cases. In contrast, 11 of 26 in other diseases showed no lymphocytes infiltration, with the remaining 15 of grade 1 infiltration. Grade 2 or more infiltration were found only in SS but not in other diseases. Conclusion: Our results suggested that high-grade lymphocytic infiltration of bronchial glands is a distinct characteristics in SS.
Effect of Daily Chlorhexidine Bathing on Reducing Infections Caused by Multidrug-Resistant Organisms in Intensive Care Unit Patients: A Semi-Experimental Study with Parallel Controls
Authors: Huang Wenzhi , Qiao Fu , Cai Lin , Zong Zhiyong , Zhang Wei
Published: September 2020

Background: A number of studies have shown that daily bathing by chlorhexidine (CHG) wipes in ICU can reduce healthcare-associated infections (HAIs) caused by methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococci (VRE). However, the impact of CHG bathing on carbapenem-resistant Acinetobacter baumannii (CRAB), carbapenem-resistant Pseudomonas aeruginosa (CRPA), and carbapenem-resistant Enterobacteriaceae (CRE) is not clear and remains controversial. Methods: A semi-experimental study which employs both pre-controls and a parallel control was conducted. In the intervention period (from July 1 to December 31, 2016), strengthened infection control measures and daily bathing with 2% CHG-impregnated wipes once daily was performed in the ICU. Fifty-seven non-ICU wards with the occurrence of multidrug-resistant organisms (MDRO) infections during the same time period were selected as parallel control group (only CHG bathing was not performed). The net effect of the 2% CHG daily bathing was evaluated by the difference in difference (DID) model.Results: The incidence of HAIs caused by CRPA in ICU was significantly decreased between the intervention and pre-intervention period (2.5, 95% confidence interval (CI) 1.6–3.8 vs. 4.6, 95% CI 3.3–6.3 cases /1,000 patient days, P = 0.02). Similarly, the incidence of HAIs caused by CRAB in intervention group was 19.75% lower than that in pre-intervention group (6.0, 95% CI 4.4–7.6 vs. 7.5, 95% CI 5.7–9.3 cases / 1,000 patient days, P = 0.24). The DID model analysis showed that CHG bathing reduced the incidence of CRAB- and CRPA-caused infections in ICU by 1.56 and 2.15 cases/1,000 patient days, respectively, P <0.01, and bathing of every 38 patients (95% CI, 21–268) and 39 patients (95% CI, 24–110) were able to prevent one case of HAIs of CRAB and CRPA, respectively. However, CHG bathing showed no effect on MRSA, VRE and CRE (P>0.05).Conclusion: Daily bathing with 2% CHG-impregnated wipes can reduce HAIs caused by CRAB and CRPA, while it is not effective for the prevalence of infections caused by MRSA, VRE, and CRE.
An Innovative Pharmacology Curriculum for Medical Students: Promoting Higher Order Cognition, Learner-Centered Coaching, and Constructive Feedback Through A Social Pedagogy Framework
Authors: McHugh Douglas , Yanik Andrew J , Mancini Michael R
Published: September 2020

BackgroundOngoing developments in medical education recognize the move to curricula that support self-regulated learning processes, skills of thinking, and the ability to adapt and navigate uncertain situations as much as the knowledge base of learners. Difficulties encountered in pursuing this reform, especially for pharmacology, include the tendency of beginner learners not to ask higher-order questions and the potential incongruency between creating authentic spaces for self-directed learning and providing external expert guidance. We tested the feasibility of developing, implementing, and sustaining an innovative model of social pedagogy as a strategy to address these challenges.MethodsConstructivism, communities of practice, and networked learning theory were selected as lenses for development of the model. 365 first-year medical students participated between 2014-2018; they were introduced to pharmacodynamics and pharmacokinetics via 15 online modules that each included: learning objectives, a clinical vignette, teaching video, cumulative concept map, and small group wiki assignment. Five-person communities organized around the 15 wiki assignments were a key component where learners answered asynchronous, case-based questions that touched iteratively on Bloom’s cognitive taxonomy levels. The social pedagogy model’s wiki assignments were explored using abductive qualitative data analysis.ResultsQualitative analysis revealed that learners acquired and applied a conceptual framework for approaching pharmacology as a discipline, and demonstrated adaptive mastery by evaluating and interacting competently with unfamiliar drug information. Learners and faculty acquired habits of self-directed assessment seeking and learner-centered coaching, respectively; specifically, the model taught learners to look outward to peers, faculty, and external sources of information for credible and constructive feedback, and that this feedback could be trusted as a basis to direct performance improvement. ConclusionsThis social pedagogy model is agnostic with regard to pharmacology and type of health professional learner; therefore, we anticipate its benefits to be transferable to other disciplines.
Challenges in Diagnosis of Food Allergies via Oral Food Challenges: A Qualitative Analysis of the Caregiver Perspective
Authors: Correa Natasha , Protudjer Jennifer LP , Hsu Elaine , Soller Lianne , Chan Edmond S , Kim Harold , Jeimy Samira
Published: September 2020

Background: Food allergy disproportionately affects children and contributes to poor quality of life for families. As a result, accurate diagnosis of food allergy is important. Oral food challenges (OFC) are the gold standard test for diagnosis of food allergy. Yet, many children do not undergo OFCs. The purpose of this study was to understand the barriers to OFCs faced by parents of children with food allergies in Ontario, as well as solutions to increase their utilization.Methods: Three focus group discussions were carried out with a total of 24 parents of children with food allergies in Kitchener-Waterloo, Ontario. Focus group data were analyzed using constant comparative analysis.Results: Parents misperceived OFCs as management of food allergies. They were also unsure about whether OFCs take place in hospitals, clinics or in the home. Parents reported several barriers to OFCs including not being referred by their primary care physicians, wait times, and fear and anxiety. Additionally, parents with older children, children with multiple allergies and children who could only tolerate allergens in its baked form felt that OFCs would not improve their quality of life. Solutions offered by parents to increase uptake of OFCs included education of the public, physicians and policy makers to improve knowledge and training, and ensure timely access to OFCs. Parents also suggested a need for improved counselling about the risk of OFCs, psychological support, and sharing of patient success stories. Long-term follow-up after an OFC as well as support and guidance around food reintroduction was also suggested to ensure OFCs resulted in an improvement in quality of life.Conclusion: Interventions aimed at addressing barriers to OFCs identified by parents have the potential to increase utilization of OFCs, and thereby reduce the burden of food allergies in children and improve quality of life.
Association of 25 Hydroxyvitamin D Concentration with Risk of COVID-19: A Mendelian Randomization Study
Authors: Liu Di , Tian Qiuyue , Zhang Jie , Hou Haifeng , Wang Wei , Meng Qun , Wang Youxin
Published: September 2020

Background: Coronavirus disease 2019 (COVID-19) has caused a large global pandemic. In observational studies, 25 hydroxyvitamin D (25OHD) concentration has been associated with an increased risk of Coronavirus disease 2019 (COVID-19). However, it remains unclear whether this association is causal.Methods: We performed a two-sample Mendelian randomization (MR) to explore the causal relationship between 25OHD concentration and COVID-19, using summary data from the genome-wide association studies (GWASs) and using 25OHD concentration-related SNPs as instrumental variables (IVs). Results: MR analysis did not show any evidence of a causal association of 25OHD concentration with COVID-19 susceptibility and severity (odds ratio [OR]=1.136, 95% confidence interval [CI] 0.988-1.306, P=0.074; OR=0.889, 95% CI 0.549-1.439, P=0.632). Sensitivity analyses using different instruments and statistical models yielded similar findings, suggesting the robustness of the causal association. No obvious pleiotropy bias and heterogeneity were observed.Conclusions: The MR analysis showed that there might be no linear causal relationship of 25OHD concentration with COVID-19 susceptibility and severity.
A Multi-Parametric Prognostic Model Based on Clinical Features and Serological Markers Predicts Overall Survival in Non-Small Cell Lung Cancer Patients with Chronic Hepatitis B Viral Infection
Authors: Chen Shulin , Huang Hanqing , Liu Yijun , Lai Changchun , Peng Songguo , Zhou Lei , Chen Hao , Xu Yiwei , He Xia
Published: September 2020

features and serological markers to estimate overall survival (OS) in non-small cell lung cancer (NSCLC) patients with chronic hepatitis B viral (HBV) infection.Methods: The prognostic model was generated by using Lasso regression in training cohort. The incremental predictive value of the model to traditional TNM staging and clinical treatment for individualized survival was evaluated by concordance index (C-index), time-dependent ROC (tdROC), and decision curve analysis (DCA). A model risk score nomogram for OS was built by combining TNM staging and clinical treatment. Then we stratified patients into high and low risk subgroups according to the model risk score. Difference in survival between subgroups was analyzed using Kaplan–Meier survival analysis. Furthermore, correlations between the prognostic model and TNM staging or treatment were analysed.Results: The C-index values of the model for predicting OS were 0.769 and 0.676 in the training and validation cohorts, respectively, which were higher than that of TNM staging, and treatment, the tdROC curve and DCA also showed the model had good predictive accuracy and discriminatory power than TNM staging and treatment. And the nomogram shown some clinical net benefit. According to the model risk score, we divided the patients into low risk and high risk subgroups. The differences of OS rates were significant in the subgroups. Furthermore, the model was positive correlation with TNM staging and treatment. Conclusions: The proposed prognostic model showed favorable performance than traditional TNM staging and clinical treatment for estimating OS in NSCLC (HBV+) patients.
Reliability, Validity, and Cutoff Point of the Chinese Version of the Chelsea Critical Care Physical Assessment Tool in Critically Ill Patients
Authors: Wu Yuchen , Wang Guoqiang , Ding Nannan , Jiang Biantong , Zhang Zhigang , Wei Huaping , Li Bin , Yue Weigang , Tian Jinhui
Published: September 2020

Purpose: Translation and cross-cultural adaptation of the Chelsea Critical Care Physical Assessment Tool (CPAx) into a Chinese version of CPAx (“CPAx-Chi”), test the reliability and validity of CPAx-Chi, and verify the cutoff point for the diagnosis of intensive care unit-acquired weakness (ICU-AW) Material and methods: Translation and cross-cultural adaptation of CPAx into CPAx-Chi was based on the Brislin model. Participants were recruited from the general ICU of five third-grade class-A hospitals in western China. Adult patients (n = 200) 48 h after receiving intensive care were included (median age, 53 years; 64% males). Patients were assessed by two assessment scales: Medical Research Council Muscle Score (MRC-Score) and CPAx-Chi.Results: The item-level content validity was 0.889. The scale-level content validity was 0.955. Taking the MRC-Score scale as standard, the criterion validity of CPAx-Chi was r = 0.758 (p < 0.001) for Researcher A, and r = 0.65 (p < 0.001) for Researcher B. Cronbach’s ɑ was 0.939. The inter-rater reliability was 0.902 (p < 0.001). The AUC of CPAx-Chi for diagnosing ICU-AW based on MRC-Score ≤48 was 0.899 (95%CI 0.862–1.025) and 0.874 (0.824–0.925) for Researcher B. The maximum value of the Youden Index was 0.643, and the best cutoff point for CPAx-Chi for the diagnosis of ICU-AW was 31.5. The sensitivity was 87% and specificity was 77% for Researcher A, whereas it was 0.621, 31.5, 75%, and 87% for Researcher B, respectively. The consistency was high when taking CPAx-Chi ≤31 and MRC-Score ≤48 as the cutoff points for the diagnosis of ICU-AW. Also, kappa = 0.845 (p = 0.02) in Researcher A and 0.839 (p = 0.04) for Researcher B. Conclusions: CPAx-Chi had good content validity, criterion-related validity and reliability. CPAx-Chi showed the best accuracy in assessment of patients at risk for ICU-AW with good sensitivity and specificity at a recommended cutoff of 31.
Prolonged Dark Time Within A 24-h Light Regime Improves Eggshell Quality by Enhancing Calcium Deposition in Laying Hens
Authors: Xin Qian , Zhao Jingpeng , Jiao Hongchao , Li Haifang , Wang Xiaojuan , Lin Hai
Published: September 2020

Background: The absorption and transportation of calcium and phosphorus is mainly relied on their corresponding transporters. Eggshell is mainly formed during dark time in one egg cycle. The aim of this study was to determine the effect of different light regime on eggshell quality and the expression of the relevant calcium and phosphorus transporters in laying hens. Seventy two 56-week-old laying hens were randomly divided into two groups and subjected to the following treatments: 16 h light: 8 h dark (control) and 9 h light: 15 h dark (LDP). The expression of phosphorus transporters type IIb Na/Pi co-transporter NaPi-IIa (NPt2a) and NaPi-IIb (NPt2b), calcium transporter calbindin-D28k (CaBP-D28k), and plasma membrane Ca ATPase 1b (PMCA1b) were measured in small intestine, kidney, and eggshell gland. Results: The results showed that the feed intake (P < 0.001) and egg weight (P = 0.05) was decreased by LDP treatment, while laying rate, egg production, and feed efficiency were not significantly influenced (P > 0.05). Compared to control, eggshell hardness was increased (P < 0.05) by LDP treatment whereas eggshell thickness and eggshell percentage were not significant changed. Eggshell calcium (Ca) and phosphorus (P) contents were elevated in LDP-hens, compared to control birds. Compared to control birds, serum Ca (P < 0.01) and P levels (P = 0.079) at dark time were increased in LDP-hens while and alkaline phosphatase (ALP) activity was lowered (P < 0.05). The protein expression levels of CaBP-D28k and PMCA1b were not influenced in duodenum but were decreased at light time in jejunum of LDP hens. In kidney, the expression of CaBP-D28k, PMCA1b and NPt2a were not changed by LDP treatment. In eggshell gland, however, the expression of CaBP-D28k and osteopontin (OPN) were relative higher in LDP hens compared to control birds, whereas the PMCA1b expression was not altered. Conclusions: The result indicates that the increased circulating Ca and P concentrations in dark time are favorable for the deposition of calcium and phosphorus in eggshell. The result offers an alternative strategy for the laying hen with a worse eggshell problem.
Enterobacter Ludwigii Protects Experimental Colitis Through CD103+DC and Treg Cells
Authors: Li Qianqian , Sun Xuan , Yu Kaiyuan , Lv Junqiang , Miao Chunhui , Yang Jianming , Wang Song , Fu Zheng , Zhang Hong , Zhang Zhi-Song , Yao Zhi , Wang Quan
Published: September 2020

Background: Intestinal bacteria are closely related with inflammatory bowel disease (IBD), and regulatory cell-mediated immune tolerance is important to inhibit IBD. Commensal intestinal bacteria play key roles in regulating immune tolerance cell, however, bacterial strains directly involved in this regulation remain to be identified.Results: In the present study, metronidazole, among nine antibiotics, was found to have the best effect on protecting mice against DSS-induced colitis. Enterobacter ludwigi, abundant in mouse feces after metronidazole treatment, was identified to decrease mice susceptibility to DSS-induced colitis with or without the presence of complex intestinal bacteria. E. ludwigii gavage increased CD103+DCs and Foxp3+Treg cells in intestinal microenvironment, and effects of E. ludwigii on diminishing colitis were lost in DC or Treg depletion mice. CD103+DCs isolated from E. ludwigii-treated mice showed enhanced ability to promote the Treg differentiation from naive T cells. DCs, directly stimulated by live E. ludwigii strain or its culture supernatant, had increased immune tolerance ability for Treg differentiation in vitro. Conclusions: Overall, our findings identify a facultative anaerobe bacterial strain E. ludwigii, which directly enhances CD103+DC and Treg-mediated immune tolerance, resulting in protecting mice against DSS-induced colitis.
Technique for Arthroscopic Resection of the Distal Clavicle in Patients with Symptomatic Acromioclavicular Joint Osteoarthritis: A Retrospective Study
Authors: Minamikawa Tomohiko , Shibata Yozo , Minokawa So
Published: September 2020

Background: Arthroscopic resection of the distal clavicle has the potential risk of inadequate resection that may be associated with residual postoperative pain. We propose a new arthroscopic technique to excise the distal clavicle precisely and reproducibly without causing impingement or instability of the acromioclavicular (AC) joint. The purpose of this study was to evaluate the clinical and radiological results of arthroscopic distal clavicle resection in patients with symptomatic AC joint osteoarthritis.Methods: We retrospectively evaluated 26 patients (mean age, 55.3 ± 16.0 years) who underwent arthroscopic distal clavicle resection between April 2010 and September 2017 with a minimum 1-year follow-up (mean follow-up, 25.3 ± 11.1 months). Nine of these patients also underwent rotator cuff repair. Clinical evaluations performed preoperatively and at final follow-up included subjective pain scores according to a visual analogue scale (VAS), range-of-motion examinations, UCLA scores, and Shoulder-36 scores. Shoulder muscle strengths were measured with a handheld dynamometer. The amount of distal clavicle resection was measured on plain radiographs. Results: No patients had AC joint tenderness. There were significant differences between the preoperative and postoperative VAS, UCLA, and Shoulder-36 scores (P < 0.05). Muscle strengths were measured preoperatively and at final follow-up in 14 patients. Elevation and internal rotation strengths were significantly greater postoperatively, but there was no significant difference in external rotation strength. The mean amount of distal clavicle resection was 14.1 ± 2.1 mm. The mean coracoclavicular distance was 8.4 ± 1.6 mm preoperatively and 8.6 ± 1.8 mm at final follow-up, with no significant difference. Conclusions: Our arthroscopic technique of distal clavicle resection for AC joint osteoarthritis resulted in successful clinical outcomes at final follow-up. Bone resection was performed according to the amount planned, as confirmed on postoperative radiographs. The technique allows resection of the distal clavicle with accurate shape and amount as planned preoperatively with no postoperative instability of the AC joint.
A Modified Method to Treat Severe Asymptomatic Pre-existing Degeneration of Adjacent Segment: A Retrospective Case-Control Study
Authors: Zhang Xinliang , Zhu Jinwen , Li Yibing , Hao Dingjun , Gao Wenjie
Published: September 2020

Background: Pre-existing degeneration of adjacent segment is an important risk factor for adjacent segment degeneration (ASD), but limited and controversial studies have addressed its management.Methods: Patients with symptomatic degeneration of the L5/S1 segment warranting surgical interference and severe asymptomatic degeneration of the L4/5 segment were retrospectively analyzed. Among them, those who underwent interbody fusion in the causative (L5/S1) segment and distraction of the intervertebral space and facet fusion in the adjacent L4/5 segment were included as Group A (n=103). Patients who underwent interbody fusion in both L5/S1 and L4/5 segments were included as Group B (n=81). Clinical and radiographic outcomes were evaluated.Results: Mean follow-up was 58.5 months (range, 48-75 m). No significant difference in clinical outcomes or the incidence of adjacent segment degeneration in L3/4 segment was found between Groups A and B. Compared with Group B, less bleeding (315±84 vs. 532±105 ml), shorter operation time (107±34 vs. 158±55 min) and lower costs (13,830±2640 vs. 16,020±3380 US$) were found in Group A (P<0.05). In Group A, disc height ratio (DHR) of L4/5 segment was significantly increased from preoperative value of 0.40±0.13 to last follow-up value of 0.53±0.18 (P<0.05), while the degree of canal stenosis (DCS) was decreased from preoperative value of 34.3±11.2% to last follow-up value of 15.9±9.3% (P<0.05). Conclusions: This modified method could be effective in treating severe asymptomatic pre-existing degeneration of adjacent segment in lumbar spine.
WITHDRAWN: Are Intravertebral Clefts Kümmell’s Disease?
Authors: Chen Zhenzhong , Lou Chao , Yu Weiyang , He Dengwei
Published: September 2020

Purpose: Intravertebral clefts (IVC) used to be considered as the unique characteristic of Kümmell’s disease (KD). However, accumulating literatures and our clinical findings identified the presence of IVC in acute osteoporotic vertebral compression fractures (OVCF) as well. Since the exact time for incidence of OVCF is usually difficult to recall for old people, it leads to challenging to differentiate IVC from KD and acute OVCF and begs for further investigation. Moreover, the treatment scheme of the two is not exactly the same. In order to identify the differences between IVC of KD and OVCF, we performed this study of radiological features.Materials and Methods: Seventy-nine patients with IVC were included in our study, with 44 cases in the KD group and 35 cases in the acute OVCF group. Radiological images, including X-ray, CT, and MRI, were collected for each group. Results: Consistent with previous reports, IVC was present in both groups. Intriguingly, we found several unique features that were only present in the KD group, including sclerosis of the cleft margin (95.5%, 42/44), ossification of the fractured vertebrae (100%, 44/44), ossification of the pedicle (31.8%, 14/44), double-line sign (27.3%, 12/44), tress fracture of the spinous process (13.6%, 6/44) and even formation of paravertebral callus (18.2%, 8/44).Conclusion: IVC could present in patients with both KD and acute OVCF, which leads to the challenges in the differentiation of clinical diagnosis. Due to the differences in the treatment, it is essential for surgeons to identify the differences among radiological features between the two. We found that marginal cleft sclerosis, vertebral and pedicle ossification, double-line sign, spinous process fracture, and formation of paravertebral callus are unique radiological features of KD and could be used for differentiation of KD from acute OVCF with IVC.
LncRNA FAM83A-AS1 Dives ESCC Progression by Regulating miR-214/CDC25B Axis
Authors: Li Hongle , Jia Jinlin , Chu Jie , Sheng Jinxiu , Wang Chang , He Fucheng , Yin Huiqing , Wan Junhu
Published: September 2020

Background Recently, extensive researches have established that long non-coding RNA (lncRNA) was an important factor that is strongly related to carcinogenesis. However, the function of lncRNAs in esophageal cell squamous carcinoma (ESCC) remains to be explored. In the current study, we assessed the expression pattern and the biological function of FAM83A-AS1 in ESCC. Methods qRT-PCR was used to detect the expression of FAM83A-AS1,miR-214, and CDC25B expression in ESCCtissues and cell lines. Cell counting kit 8 (CCK-8, Transwell, apoptosis, and cell cycle assays were performed to define the function of FAM83A-AS1 in ESCC cell. Furthermore, the regulation of miR-214 by FAM83A-AS1 was defined by qRT- PCR and rescue assays.In addition, the association between CDC25B,miR-214,CDC25B were performed with qRT-PCR.Results: Here we discovered that FAM83A-AS1 was strongly expressed in ESCC tissues. FAM83A-AS1 abundance was associated with TNM stages and the differentiation grade of ESCC patients. The receiver operating characteristic curve (ROC) analysis indicated the high accuracy of FAM83A-AS1 in ESCC diagnosis. Functionally, inhibiting FAM83A-AS1 repressed cell proliferation, migration, and invasion in ESCC. In addition, we found that FAM83A-AS1 accelerated cell cycle and inhibited cell apoptosis. Mechanistically, we found that FAM83A-AS1 regulated miR-214 expression and there was a negative correlation between miR-214 and FAM83A-AS1 in ESCC. Rescue assay indicated that miR-214 could impair the suppressing effect of cell migration induced by FAM83A-AS1 depletion. Furthermore, CDC25B was a direct target of miR-214 and FAM83A-AS1 enhanced CDC25B expression while miR-214 positively CDC25B expression in ESCC. Conclusions Collectively, we concluded that FAM83A-AS1 facilitated ESCC progression by regulating the miR-214/CDC25B axis. Our study showed FAM83A-AS1 may act as a target for ESCC diagnosis and therapy.
Death After Discharge: Prognostic Model of 1-year Mortality in Traumatic Brain Injury Patients Undergoing Decompressive Craniectomy
Authors: Cui Wenxing , Ge Shunnan , Shi Yingwu , Wu Xun , Luo Jianing , Lui Haixiao , Zhu Gang , Guo Hao , Feng Dayun , Qu Yan
Published: September 2020

OBJECTIVE: Despite advances in decompressive craniectomy (DC) for the treatment of traumatic brain injury (TBI), a high risk of poor long-term prognosis exists in these patients. The aim of this study is to predict 1-year mortality in TBI patients undergoing DC using the logistic regression and random tree models.METHODS: This was a retrospective analysis of TBI patients undergoing DC from January 1, 2015 to April 25, 2019. Patient demographic characteristics, biochemical tests and intraoperative factors were collected. 1-year mortality prognostic models were developed using multivariate logistic regression and random tree algorithms. Overall accuracy, sensitivity, specificity and area under the receiver operating characteristic curves (AUC) were used to evaluate model performance.RESULTS: Of the 230 patients, 70 (30.4%) died within 1 year. Older age (OR, 1.066; 95% CI, 1.045-1.087; P < 0.001), higher Glasgow coma score (GCS) (OR, 0.737; 95% CI, 0.660-0.824; P < 0.001), higher d-dimer (OR, 1.005; 95% CI, 1.001-1.009; P = 0.015), coagulopathy (OR, 2.965; 95% CI, 1.808-4.864; P < 0.001), hypotension (OR, 3.862; 95% CI, 2.176-6.855; P < 0.001) and completely effaced basal cisterns (OR, 3.766; 95% CI, 2.255-6.290; P < 0.001) were independent predictors of 1-year mortality. Random forest demonstrated better performance for 1-year mortality prediction, which achieved overall accuracy of 0.810, sensitivity of 0.833, specificity of 0.800, and AUC of 0.830 on the testing data, compared to logistic regression model.CONCLUSIONS: Random forest model showed relatively good predictive performance for 1-year mortality in TBI patients undergoing DC. Further external test is required to verify our prognostic model.
The impact of COVID-19 lockdown on social network sites use, body image disturbances and self-esteem among adolescents and young women
Authors: Vall-Roqué Helena , Andrés Ana , Saldaña Carmina
Published: September 2020

This study aimed to determine the impact of COVID-19 lockdown on social network sites (SNS) use and to explore whether SNS use is associated with body image disturbances and low self-esteem. A total of 2601 women living in Spain aged 14-35 years completed questionnaire measures of SNS use, self-esteem, body dissatisfaction and drive for thinness. In the survey, participants were asked about their use of SNS at the moment of answering the survey and before lockdown. A statistically significant increase was found in the frequency of use of all studied SNS (Instagram, YouTube, TikTok, Twitter and Facebook) during lockdown, as well as in the number of women following appearance-focused Instagram accounts. Moreover, significant relationships were found between the frequency of Instagram use and body dissatisfaction, drive for thinness and low self-esteem in the younger age group (14-24), and between the frequency of Instagram use and drive for thinness in the older age group (25-35). Following appearance-focused accounts on Instagram was related to body dissatisfaction and drive for thinness in the younger group, and only to drive for thinness in the older group (25-35). Following appearance-focused accounts on Instagram and a higher frequency of use of Instagram significantly predicted higher levels of drive for thinness. These results suggest that lockdown has had an impact on SNS use, and this might be linked to increased drive for thinness and eating disorder risk among adolescents and young women.