bluuebunny/crossref_metadata_2025 huggingface dataset:
An Investigation of the Intention and Reasons of Senior High School Students in China to Enter into Medical School
Authors: Yang Chaoqun , Jin Xuerui , Yan Ji , Zhang Junkai , Chen Canyu , Cheng Yaqing , You Jialin , Deng Guoying
Published: December 2020

BackgroundShortages of qualified health workers have been a global concern, especially in developing countries. China also faces this dilemma, which hinders the development of public health services. Senior high school students are a group who are considering their college majors and careers after graduation. They are also a potential and basic talent reserve for the health sector. This survey focused on senior high school students’ willingness to learn clinical medicine and explored potential influencing factors. MethodsAn anonymous questionnaire containing 16 items was distributed to 5344 senior high school students. The questions covered the following topics: students’ willingness to learn clinical medicine, personal and family information, understanding of medical education, cognition of doctors’ working conditions, and doctor-patient relationships. Logistic regression and the chi-square test were used to compare students with and without a strong willingness to learn clinical medicine to explore influencing factors. ResultsOnly 5.6% of senior high school students had a strong willingness to learn medicine (SWLCM). Personal and family information had distinct impacts. Interest and anatomy course were also associated with students’ choice. There was a positive correlation between understanding of medical education and students’ willingness. Meanwhile, students’ cognition of doctors, career prospects, and social status had significant impacts. The more optimistic students were about doctors’ working conditions and doctor-patient relationships, the more likely they were to have a SWLCM. ConclusionTo some extent, this survey reflects the shortage of medical talent in China and provides possible clues for solving this problem. In addition, these findings may provide a perspective for understanding the development of health services in developing countries.
Deubiquitinating Enzyme Inhibitor Alleviates Cyclin A1-mediated Proteasome Inhibitor Tolerance in Mixed-lineage Leukemia
Authors: Ge Maolin , Xu Qiongyu , Kang Ting , Li Dan , Wang Ruiheng , Chen Zhihong , Xie Shufeng , Wang Wenbin , Liu Han
Published: December 2020

Background: Drug resistance is a significant obstacle to effective cancer treatment. Drug resistance develops from initially reversible drug-tolerant cancer cells, which offers therapeutic opportunities to impede cancer relapse. The mechanisms of resistance to proteasome inhibitor (PI) therapy have been investigated intensively; however, the ways by which drug-tolerant cancer cells orchestrate their adaptive responses to drug challenges remains largely unknown. Methods: RNA sequencing and bioinformatics analyses were employed to assess dysregulated cell cycle genes. Chromatin immunoprecipitation assays were performed to evaluate the involvement of MLL in cyclin A1 transcriptional activity. Cell cycle assays, cell viability assays, immunoblots, and apoptosis assays were performed to evaluate the dependency of cyclin A1 during tolerance acquisition.Results: Here, we demonstrated that cyclin A1 suppression elicited the development of transient PI tolerance in mixed-lineage leukemia (MLL) cells. This adaptive process involved reversible down-regulation of cyclin A1, which promoted PI resistance through cell cycle arrest. PI-tolerant MLL cells acquired cyclin A1 dependency, regulated directly by MLL protein. Loss of cyclin A1 function resulted in the emergence of drug tolerance, which was associated with patient relapse and reduced survival. Combination treatment with PI and deubiquitinating enzyme (DUB) inhibitors overcame this drug resistance by restoring cyclin A1 expression through chromatin crosstalk between histone H2B monoubiquitination and MLL-mediated histone H3 lysine 4 methylation. Conclusion: These results reveal the importance of cyclin A1-engaged cell cycle regulation in PI resistance in MLL cells, and suggest that cell cycle re-entry by DUB inhibitors may represent a promising epigenetic therapeutic strategy to prevent acquired drug resistance.
Attitudes and Perspectives of Older Adults on Technologies for Assessing Frailty in Home Settings: A Focus Group Study
Authors: Bian Chao , Ye Bing , Hoonakker Anna , Mihailidis Alex
Published: December 2020

Background The rapid development of technology such as sensors and artificial intelligence in recent years enables monitoring frailty criteria to assess frailty early and accurately from a remote location such as a home. However, research shows technologies being abandoned or rejected by users due to a lack of compatibility and consumer involvement with the technologies. This study aims to understand older adult’s perceptions and preferences of technologies that can be potentially used to assess frailty in home settings. Methods This study is a qualitative study in which data were collected through focus group interviews. We recruited 15 older participants. Questions were asked to achieve the goal of understanding their attitudes on the technologies. These questions include 1) the concerns or barriers of installing and using the presented technology in daily life at home, 2) the reasons participants like or dislike a particular technology, 3) what makes a particular technology more acceptable, and 4) participants’ preferences in choosing technologies. Data were transcribed, coded and categorized, and finally synthesized to understand the attitudes towards presented technologies.Results A total of 15 older adults aged 65 and older were recruited. Three focus group sessions were conducted with five participants in each session. In the findings, the attitudes and perspectives of participants on the technologies for assessing frailty were presented in four areas: A) general attitude towards using the technologies, B) concerns about the technologies, C) existing living habits or patterns related to using the technologies, and D) constructive suggestions related to the technologies.Conclusions This study focuses on understanding the attitudes and perceptions of older adults on several technologies that could potentially be used to assess frailty in home settings. Participants generally have positive attitudes towards allowing the technologies to be installed and used at their home. Some technologies were found to be more acceptable if used under certain conditions. However, questions and concerns still remain. The study also found the living habits or patterns of older adults could affect the design and use of technology. Lastly, many valuable suggestions have been made by participants.
Metabolite Profiles of Energy Cane and Sugarcane Reveal Different Strategies During the Axillary Bud Outgrowth
Authors: Abreu Luís Furlan de , Silva Nicholas , Ferrari Allan Ramos , Carvalho Lucas de , Carazzolle Marcelo Falsarella , Fill Taícia Pacheco , Pilau Eduardo , Pereira Gonçalo Guimarães , Grassi Maria de Barros
Published: December 2020

Sugarcane (Saccharum spp.) is one of the most well-known plants which possesses a large accumulation of sucrose. Another cultivar, energy cane, is an interspecific hybrid with higher fiber and lower sugar content than sugarcane. Commercial cultivation of sugarcane and energy cane is carried out by vegetative propagation, through the distribution of culm segments (setts) or pre-sprouted seedlings (PSS). In this context, the metabolism of axillary bud outgrowth is crucial for cultures that use vegetative propagation. In this work, we evaluate the metabolic profile of sugarcane and energy cane in the early hours during the axillary bud outgrowth. Sugarcane showed few metabolic changes, except for the significant increase in glutamate levels, which may be associated with root formation in the culm. In contrast, energy cane presented significant changes in amino acid catabolism, increased levels of reducing sugars, lipids, and metabolite activity in the phenylpropanoid pathway. These results together reveal changes in the energy and redox status of the cell, electron transport for the TCA cycle, and an increase in compounds related to cell wall formation and growth in energy cane. Our study provides new insights on the regulation of the axillary bud of species of the Saccharum complex.
The Curious Case of Transient Plasma Generated by ns-laser Ablation of Ag in Ar Gas
Authors: Irimiciuc Stefan , Chertopalov Sergii , Bulíř Jiŕí , Fekete Ladislav , Novotný Michal , Craciun Valentin , Lancok Jan
Published: December 2020

The continuous effort for transitioning pulsed laser deposition technique from an experimental tool into an industrial one is sustained by the use of complex technologies for in situ real-time monitoring of the deposition process. Floating Langmuir Probe (LP) and optical emission spectroscopy (OES) measurements were used for plasma monitoring during the pulsed laser deposition of Ag films under various Ar pressure conditions. The electrical measurements revealed a complex multi-structured distribution of the ions, which was strongly influenced by the increase of Ar pressure. The generation of highly energetic ions with the addition of Ar and the degree of Ar gas ionization was also explored. OES measurements confirmed the presence of highly ionized Ar species in the plasma. A peculiar effect was seen under pressures higher than 10 Pa, where the presence of high electronic charges lead to a perturbative behavior of plasma in the vicinity of the LP. The effect of these complex dynamics on the structure and quality of the deposited thin film was also investigated revealing a strong correlation between the electronic distribution in plasma and thin film thickness profile.
Quantum Deep Learning Functional Similarities on Remdesivir, Drug Synergies to Treat COVID-19 in Practice.
Authors: Grigoriadis Ioannis
Published: December 2020

Νovel SARS coronavirus 2 (SARS-CoV-2) of the family Coronaviridae starting in China and spreading around the world is an enveloped, positive-sense, single-stranded RNA of the genus betacoronavirus encoding the SARS-COV-2 (2019-NCOV, Coronavirus Disease 2019. Remdesivir drug, or GS-5734 lead compound, first described in 2016 as a potential anti-viral agent for Ebola diseade and has also being researched as a potential therapeutic agent against the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the coronavirus that causes coronavirus disease 2019 (COVID-19). Computer-aided drug design (CADD), Structure and Ligand based Drug Repositioning strategies based on parallel docking methodologies have been widely used for both modern drug development and drug repurposing to find effective treatments against this disease. Quantum mechanics, molecular mechanics, molecular dynamics (MD), and combinations have shown superior performance to other drug design approaches providing an unprecedented opportunity in the rational drug development fields and for the developing of innovative drug repositioning methods. We tested 18 phytochemical small molecule libraries and predicted their synergies in COVID-19 (2019- NCOV), to devise therapeutic strategies, repurpose existing ones in order to counteract highly pathogenic SARS-CoV-2 infection and the BRD4- conserved residue associated COVID-19 pathology. We anticipate that our quantum deep learing similarity approaches can be used for the development of anticoronaviral drug combinations in large scale HTS screenings, and to maximize the safety and efficacy of the Remdesivir, Colchicine and Ursolic acid drugs already known to induce synergy with potential therapeutic value or drug repositioning to COVID-19 patients.
The Primary Breaking Pattern of Main Roof Above the First Working Face Based on Main Bending Moment
Authors: Yang Baogui , yang haigang , Lu Xiaofeng
Published: December 2020

Scientific mining is based on breaking regularity of roof above underground working face in coal mine. In order to explore the primary breaking pattern of main roof above the first working face, on account of theory of thin elastic plate, development of the breaking in each region of main roof is analyzed and the breaking sequence of each region is explored in virtue of main bending moment taken as the breaking parameter. The results indicate that the first broken point of main roof is midpoint of the long side. The breaking, which occurs on the top surface of main roof, is caused by the second main bending moment. The fracture in long side region starts from midpoint of the long side and develops along the length direction of the working face. The fracture in middle region starts from the center of main roof and develops along the length direction of the working face. The fracture in short side region starts from midpoint of the short side and develops along advance direction of the working face. There always is an extreme value order of control moment in each region, Mc > Mz > Md, when a single parameter is within a reasonable range. Due to this, the breaking sequence is the long side region, the middle region and the short side region although they end up with the same breaking pattern O-X. Mc, Mz and Md depend on the advance distance of working face and increase linearly with transverse loading. Besides, the short side of main roof becomes stable with the increase of the length of working face. Revealing the primary breaking pattern of main roof above the first working face contributes to learning breaking behavior of main roof and providing theoretical support for design of the working face and roof management.
Burden and Etiology of Moderate and Severe Diarrhea in Chinese Children Less than 5 years of Age: Prospective, Population-based Surveillance
Authors: Zhou Hong-Lu , Bessey Theresa , Wang Song-Mei , Mo Zhao-Jun , Barclay Leslie , Wang Jin-Xia , Zhang Can-Jing , Ma Jing-Chen , Qiu Chao , Zhao Gan , Li Rong-Cheng , Zhao Yu-Liang , Jiang Baoming , Wang Xuan-Yi
Published: December 2020

Background. Diarrhea remains the leading cause of childhood illness in China. Better understanding of burden and etiology of diarrheal diseases is important for development of effective prevention measures.Methods. Population-based diarrhea surveillance was conducted in Sanjiang (southern China) year-round and Zhengding (northern China) in autumn/winter. Stool specimens were collected from children <5 years of age experiencing diarrhea. The TaqMan Array Card (TAC), based on multiplex real-time PCR, was applied to detect multiple enteric microbial agents simultaneously. Results using these methods were compared to those derived from conventional PCR assays.Results. During the study period, 6,380 children in Zhengding and 3,581 children in Sanjiang <5 years of age participated. Three hundred and forty (31.2%) and 279 (22.9%) diarrhea episodes were identified as moderate-to-severe in the two counties, with incidence of 60.4 and 88.3 cases per 1,000 child-years in Zhengding and Sanjiang, respectively. The five most frequently detected bacterial and viral agents in Sanjiang were adenovirus, enterovirus, enteroaggregative Escherichia coli (EAEC), rotavirus, and sapovirus all the year round, while the most common viral agents in Zhengding were rotavirus, followed by astrovirus and adenovirus during the cool season. Compared to conventional PCR assay, the average incremental detection via the TAC method was 2-fold.Conclusion. Our study demonstrated high diversity and prevalence of multiple major bacterial and viral agents, including rotavirus and calicivirus, among children in China. Further studies are needed to define the public health significance of neglected but frequently detected pathogens such as EAEC, enterotoxigenic E. coli, Campylobacter, adenovirus, and enterovirus.
Selected Lactobacillus Strains Inhibit Inflammation in LPS-induced RAW264.7 Macrophages by Suppressing the TLR4-Mediated NF-κB and MAPKs Activation
Authors: Shi Jialu , Xie Qinggang , Li Huizhen , Yue Yingxue , Evivie Smith , Li Na , Guan Jiaqi , Li Bailiang , Huo Guicheng
Published: December 2020

Pathogenic bacteria, oxidative stress, immunity disorder, and inflammation are involved in inflammatory bowel disease (IBD) development. Lactobacillus acidophilus KLDS 1.0901, Lactobacillus helveticus KLDS 1.8701, and Lactobacillus plantarum KLDS 1.0318 isolated from Chinese fermented dairy food with various functional characteristics, such as antibacterial, antioxidant, and immunomodulatory activity. Therefore, we selected three strains as a potential application for preventing IBD. However, the anti-inflammatory properties of the tested strains are unknown. The current study evaluated the anti-inflammatory potential of the tested strains using the LPS-induced RAW264.7 cells model. The results showed that all tested strains could inhibit iNOS and COX-2 expression, reducing NO and PGE2 production. And all tested strains markedly reduced the production and mRNA expression of proinflammatory cytokines (TNF-α, IL-1β, and IL-6). Moreover, these results may be associated with inhibiting the translocation of NF-κB into nuclear and MAPKs activation. The study can provide evidence for further in vivo studies of Lactobacillus strains to prevent IBD.
Association Between Cardiac Enzyme Elevation and Clinical Prognosis of Neurosurgical and Neurocritically Ill Patients
Authors: Lee Jung Hwa , Lee Yun Im , Ahn Joonghyun , Ryu Jeong-Am
Published: December 2020

Background: To investigate whether cardiac troponin (cTn) elevation is associated with in-hospital mortality and major adverse cardiac events (MACEs) in neurosurgical and neurocritically ill patients. Methods: Among neurosurgical patients admitted to the intensive care unit (ICU) in a tertiary hospital from January 2013 to December 2019, those whose serum cTnI levels were obtained within 7 days after ICU admission were included. Propensity score matching was used. Each patient with cTnI elevation was matched to one of control patients. The primary endpoint was in-hospital mortality and the secondary outcome was MACE. Results: cTnI elevation was shown in 702 (11.7%) of 6,004 patients. After propensity score matching, 617 pairs of data were generated by 1:1 individual matching without replacement. Rates of in-hospital mortality in the overall population and the propensity score-matched population were higher for patients with cTnI elevation than for those without cTnI elevation (p < 0.001 and p = 0.003, respectively). In addition, MACEs were more common in patients with cTnI elevation than in those without cTnI elevation in the overall population and the propensity score-matched population (both p < 0.001). In multivariable analysis of overall and propensity score-matched population, cTnI elevation were associated with in-hospital mortality (adjusted odds ratio [OR]: 2.78, 95% confidence interval [CI]: 1.95 – 3.95 and adjusted OR: 1.77, 95% CI: 1.20 – 2.62, respectively). In addition, cTnI elevation were associated with MACE (adjusted OR: 3.75, 95% CI: 2.43 – 5.78 and adjusted OR: 4.04, 95% CI: 2.24 – 7.29, respectively). In survival analysis, the mortality rate of patients with cTnI elevation was significantly higher than in those without cTnI elevation for the propensity score-matched population (28.8% vs. 19.3%, log-rank test, p < 0.001).Conclusions: In this study, cTnI elevation was associated with in-hospital mortality and MACEs in neurosurgical and neurocritically ill patients.
Clinical Comparative Study of Lower Limb PICC and Deep Venous Catheterization
Authors: Li FengXian , Hao YuFen , Tian MeiJing , Li YanPing , Zhang HongYang , Su peng
Published: December 2020

Objective: To compare the clinical application effects of peripherally inserted central catheter (PICC) and deep venous catheters placed through the lower limbs in adults, and to explore the advantages of ultrasound-guided PICC through the lower limbs in adults. Methods: A retrospective study was conducted on 27 bedridden patients with advanced malignant tumor between February 2017 and February 2019. The success rate of one-time catheterization, the length of catheterization puncture time, the number of catheterizations, and the occurrence of catheter-related complications of the two methods were compared. Results: Results of the study showed that ultrasound-guided PICC through the lower limbs has a higher success rate than deep venous catheterization. The average length of puncture time in adults with PICC through the lower limbs under ultrasound guidance was shorter than that in the femoral vein group. There was no significant difference in the incidence of catheter-related complications between the two groups. Conclusion: The indications for PICC through the lower limbs in adults include patients with advanced malignant tumor after bilateral breast cancer lymphadenectomy or superior vena cava obstruction syndrome, and mainly bedridden patients. This technique has certain advantages over deep venous catheterization and is an effective choice for venous access.
The Optimal Duration of Anti-tuberculous Therapy Before Pericardiectomy in Constrictive Tuberculous Pericarditis
Authors: Fang Likui , Yu Guocan , Ye Bo , Zhong Fangming , Chen Gang
Published: December 2020

Background: It is unclear about the duration of anti-tuberculous therapy before pericardiectomy (DATT) in the patients with constrictive tuberculous pericarditis. This study aims to explore the optimal DATT and its impacts in these patients.Methods: We retrospectively enrolled 93 patients with constrictive tuberculous pericarditis undergoing pericardiectomy and divided them into two groups according to the optimal cutoff value of DATT which was determined by the receiver operating characteristic (ROC) curve and Youden Index. Postoperative and survival outcomes were compared between the two groups.Results: The optimal cutoff value of DATT was 1.05 (months). The enrolled patients were divided into the DATT≤1.05 group and the DATT>1.05 group, with 24 (25.8%) and 69 (74.2%) cases, respectively. Comparing with the DATT≤1.05 group, the DATT>1.05 group had shorter postoperative ICU stay (P=0.023), duration of chest drainage (P=0.002), postoperative hospital stay (P=0.001) and lower incidence of postoperative complications (P<0.001). There was no statistical difference between the two groups in recurrence and survival outcomes.Conclusions: It would be of great benefit to enhanced recovery after pericardiectomy in the patients with constrictive tuberculous pericarditis if DATT lasted for at least one month.
Evaluation of Hepatitis B Virus Nucleos(t)ide Analogues Resistance mutations in Treatment-Naïve Patients: A Systematic Review and Meta-Analysis
Authors: Mohebbi Alireza , Shirzad-Aski Hesamaddin , Ebrahimi Mohsen
Published: December 2020

Background: For detection of the nucleus(t)ide analog resistance (NAr) mutants among Hepatitis B virus (HBV) quasispecies, the selection of appropriate methodologies is necessary. Here, we aimed to investigate the role of different methods for the detection of NAr mutations among treatment-naïve patients with chronic HBV (CHB) infection.Methods: In this systematic review and meta-analysis study, five databases were searched. Desired data were extracted from the selected studies. The I2 was used as an indicator of heterogeneity. The NAr mutations rate was investigated with a 95% confidence interval (CI).Results: The overall ratio of occurrence of NAr within treatment-naïve CHB patients (14653) from 128 studies was 0.085 (95% CI, 0.069-0.103, p-value < 0.0001). Direct sequencing was the most prevalent method of DNA sequencing (56.25%). The rates of NAr mutations in the different methodologies, including the direct sequencing, InnoLipa, NGS, and PASS, were 0.079 (0.037-0.160, p < 0.0001), 0.058 (0.021-0.152, p < 0.0001), 0.729 (0.441-0.902, p = 0.114), and 0.448 (0.281-0.628, p = 0.001), respectively.Conclusions: Drug-resistant quasispecies of HBV exist in treatment-naïve patients in relatively high abundance. More sensitive methodologies like NGS should be used for detecting NAr fractions of the viral population. Replacement of current therapy with novel anti-HBV candidates also should be considered.
Metagenomics Unveils Posidonia Oceanica “Banquettes” as a Potential Source of Novel Bioactive Compounds and CAZymes
Authors: Rubio-Portillo Esther , Cuadrado Ana Belén Martin , Ramos-Esplá Alfonso A. , Anton Josefa
Published: December 2020

Background Posidonia oceanica is a long-living and very slow-growing marine seagrass endemic to the Mediterranean Sea. It produces large amounts of leaf material and rhizomes, which can reach the shore and build important banks known as “banquettes”. In recent years, interest in the potential uses of these P. oceanica banquettes has increased and it was demonstrated that biomass extracts showed antioxidant, antifungal, and antiviral activities. The discovery of new compounds through the culture of microorganisms is limited, and to overcome this limitation, a metagenomic study was performed to investigate the microbial community associated with P. oceanica banquettes. Results The microbial community associated with P. oceanica banquettes was dominated by Alphaproteobacteria, Gammaproteobacteria, Bacteroidetes and Cyanobacteria. Pseudoalteromonas was the most abundant genus, followed by Alteromonas , Labrencia, and Aquimarina . The metagenome reads were binned and assembled into 23 near-complete metagenome-assembled genomes (MAGs), which belonged to new families of Cyanobacteria, Myxococcota and Granulosicoccaceae and also to the novel genus recently described as Gammaproteobacteria family UBA10353. A comparative analysis with 60 published metagenomes from different environments, including seawater, marine biofilms, soils, corals, sponges and hydrothermal vents, indicated that banquettes have numbers of natural products and Carbohydrate-Active Enzymes (CAZymes) similar to those found for soils and were only surpassed by marine biofilms. New condensation (C) domains in multi-enzymatic non ribosomal peptide synthetases (NRPS) solely found in P. oceanica banquettes were recovered; 90 of the 181 found lacked known homologues. Furthermore, new proteins assigned to cellulosome modules and lignocellulose-degrading enzymes were also found. Conclusions Our results unveiled the diverse microbial composition of P. oceanica banquettes and determined that banquettes are a potential source of bioactive compounds and novel enzymes.
Cell-Derived Hexameric β-Amyloid: A Novel Insight Into Composition, Self-Assembly and Nucleating Properties
Authors: Vadukul Devkee , Vrancx Céline , Burguet Pierre , Contino Sabrina , Suelves Nuria , Serpell Louise , Quinton Loïc , Kienlen-Campard Pascal
Published: December 2020

A key hallmark of Alzheimer’s disease (AD) is the extracellular deposition of amyloid plaques composed primarily of the amyloidogenic amyloid-β (Aβ) peptide. The Aβ peptide is a product of sequential cleavage of the Amyloid Precursor Protein (APP), the first step of which gives rise to a C-terminal Fragment (C99). Cleavage of C99 by γ-secretase activity releases Aβ of several lengths and the Aβ42 isoform in particular has been identified as being neurotoxic. The misfolding of Aβ leads to subsequent amyloid fibril formation by nucleated polymerisation. This requires an initial and critical nucleus for self-assembly. Here, we identify and characterise the composition and self-assembly properties of cell-derived hexameric Aβ42 and show its nucleating properties which are dependent on the Aβ monomer availability. Identification of nucleating assemblies that contribute to self-assembly in this way may serve as therapeutic targets to prevent the formation of toxic oligomers.
Clinical Features and Outcomes of Critically Ill Patients with Coronavirus Disease 2019 (COVID19): A Multicenter Cohort Study
Authors: Sulaiman Khalid Al , Juhani Ohoud A. Al , Eljaaly Khalid , Alharbi Aisha A. , Shabasy Adel M. Al , Alsaeedi Alawi S. , Mutairi Mashael Al , Badreldin Hisham A. , Harbi Shmeylan A. Al , Haji Hussain A. Al , Zumai Omar I. Al , Vishwakarma Ramesh , Alkatheri Abdulmalik
Published: December 2020

BackgroundA novel coronavirus, named Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) causing coronavirus disease-19 (COVID-19) manifested by a broad spectrum of symptoms, ranging from asymptomatic manifestations to severe illness and death. The purpose of the study was to extensively describe the clinical features and outcomes in critically ill patients with COVID19 in Saudi Arabia. MethodA multi-center, non-interventional, observational study for all critically ill patients aged 18 years or older who are admitted to intensive care units (ICUs) between March 1st to August 31st, 2020 with an objectively confirmed diagnosis of COVID19. The diagnosis of COVID19 was confirmed by Reverse Transcriptase – Polymerase Chain Reaction (RT-PCR) on nasopharyngeal and/or throat swabs. Multivariate logistic regression and generalized linear regression were used. We considered a P value of < 0.05 statistically significant. ResultsA total of 560 patients met the inclusion criteria. The overall survival rate was 52.6 % (295 patients). Moreover, the overall ICU mortality rate within 30 days was 42.3 % (237 patients). The median ICU length of stay (LOS), hospital LOS, and mechanical ventilation duration were of 10 days (IQR 6.00-17.50), 17 days (IQR 11-25), and 9 days (IQR 3-17 days), respectively. The rate of ICU readmission for survival within three months was 9.7 %. An extensive list of clinical features was associated with ICU mortality rate within 30 days.ConclusionIn the most comprehensive report to date from Saudi Arabia, among patients with COVID19 who were admitted to the ICU, several variables were associated with increasing the risk of ICU death at 30 days, and the incidence of ICU mortality rate within 30 days 42.3%.
Development and Validation of a Risk Factor-Based Nomogram to Early Predict in-Hospital Mortality in Adult Patients With Suspected Infection Admitted to the Intensive Care Unit: a Retrospective Cohort Study
Authors: Yang Yang , Wang Qiuhe , Liang Shengru , Yang Yuefan , Guo Kai , Gao Fei , Wang Pan , Li Wen , Zhao Yongbo , Li Lihong
Published: December 2020

BackgroundThe over-consumption of time for data collection in the Sequential Organ Failure Assessment (SOFA) score and the poor performance of the quickSOFA (qSOFA) score in predicting poor prognosis among patients with suspected infection in intensive care unit (ICU) may delay the treatment towards sepsis. The aim of this study is to develop a prediction model to early identify patients with suspected infection who are under a high risk of in-hospital mortality in ICU.MethodsPatients with suspected infection were retrospectively retrieved from the Medical Information Mart for Intensive Care (MIMIC III) database. Objective variables whose results can be obtained within a short period of time were integrated into the uni- and multi-variate logistic regression to screen the independent predictors for the in-hospital mortality in ICU patients with suspected infection. Then, the prediction nomogram was constructed by these independent predictors in the training set, and undergone internal validation and sensitivity analysis.ResultsA total of 7000 patients with suspected infection were included into the final analysis. In the training set, multivariate logistic regression revealed that patient’s age, elixhauser index, the first result of lactate, red blood cell distribution width (RDW), white blood cell (WBC), lymphocyte, PH value and bicarbonate as well as the first hour’s mean value of respiratory rate, temperature and SpO2 since ICU admission were the independent predictors for the in-hospital mortality. Then, a nomogram for predicting the in-hospital mortality in ICU patients with suspected infection was developed in the training set and exhibited strong discrimination and calibration as well as great clinical usefulness in both of the training and validation sets as well as the sensitivity analysis.ConclusionsThe nomogram shows good predictive performance in ICU to identify adult patients with suspected infection who are likely to die in hospital, which may facilitate clinicians to initiate necessary treatment towards sepsis timely and finally improve the prognosis of septic patients.
Patient-Ventilator Asynchrony in Critically-Ill Adult Patients Undergoing Invasive Mechanical Ventilation: Incidence, Risk Factors and Outcomes
Authors: Zhou Yongfang , Holets Steven R , Li Man , Puentes Gustavo A Cortes , Meyer Todd J , Hanson Andrew C , Schulte Phillip J , Oeckler Richard A
Published: December 2020

Background: Patient-ventilator asynchrony (PVA) is commonly encountered during mechanical ventilation of critically ill patients. Estimates of PVA incidence vary widely. Type, risk factors, and consequences of PVA remain unclear. We aimed to measure the incidence and identify types of PVA, characterize risk factors for development, and explore the relationship between PVA and outcome among critically ill, mechanically ventilated adult patients admitted to medical, surgical, and medical-surgical intensive care units in a large academic institution staffed with varying provider training background.Methods: A single center, retrospective cohort study of all adult critically ill patients undergoing invasive mechanical ventilation for ≥12 hours.Results: A total of 676 patients who underwent 696 episodes of mechanical ventilation were included. Overall PVA occurred in 170 (24%) episodes. Double triggering 92(13%) was most common, followed by flow starvation 73(10%). A history of smoking, and pneumonia, sepsis, or ARDS were risk factors for overall PVA and double triggering (all P<0.05). Compared with volume targeted ventilation, pressure targeted ventilation decreased the occurrence of events (all P<0.01). During volume controlled synchronized intermittent mandatory ventilation and pressure targeted ventilation, ventilator settings were associated with the incidence of overall PVA. The number of overall PVA, as well as double triggering and flow starvation specifically, were associated with worse outcomes and fewer hospital-free days (all P<0.01).Conclusion: Double triggering and flow starvation are the most common PVA among critically ill, mechanically ventilated patients. Overall incidence as well as double triggering and flow starvation PVA specifically, portend worse outcome.
A Strategy for Identifying the Risk of Developing Alzheimer's Disease From Healthy Controls: Distance to Novelty Detection Boundary
Authors: Mao Jiangbing , Ye Qinyong , Yang Hongqing , Bucholc Magda , Liu Shuo , Gao Wenzhao , Wang Yingqing , Xin Jiawei , Ding Xuemei
Published: December 2020

Background:Machine learning (ML) techniques are expected to tackle the problem of the high prevalence of Alzheimer’s disease (AD) we are facing worldwide. However, few studies of novelty detection (ND), a typical ML technique for safety-critical systems especially in healthcare, were engaged for identifying the risk of developing cognitive impairment from healthy controls (HC) population.Materials and Methods: Two independent datasets were used for this study, including the Australian Imaging Biomarkers and Lifestyle Study of Ageing (AIBL) and the Fujian Medical University Union Hospital (FMUUH), China datasets. Multiple feature selection methods were applied to identify the most relevant features for predicting the severity of AD. Four easily interpretable ND algorithms, including k nearest neighbor, Mixture of Gaussian (MoG), KMEANS, and support vector data description were used to construct predictive models. The models were visualized by drawing their decision boundaries tightly surrounding the HC data. A distance to boundary (DtB) strategy was proposed to differentiate individuals with mild cognitive impairment (MCI) and AD from HC. Results: The best overall MCI&AD detection performance in both AIBL and FMUUH was obtained on the cognitive and functional assessments (CFA) modality only using MoG-based ND with AUC of 0.8757 and 0.9443, respectively. The highest sensitivity of MCI was presented by using a combination of CFA and brain imaging modality. The DTB value reflects the risk of developing cognitive impairment for HC and the dementia severity of MCI/AD.Conclusions: Our findings suggest that applying some non-invasive and cost-effective features can significantly detect cognitive decline in an early stage. The visualized decision boundary and the proposed DtB strategy illustrated the severity of cognitive decline of potential MCI&AD patients in an early stage. The results would help inform future guidelines for developing a clinical decision-making support system aiming at an early diagnosis and prognosis of MCI&AD.
Chitin Matrix and Ultrastructure of Phosphate-Shelled Brachiopods
Authors: Agbaje Oluwatoosin , Brock Glenn , Zhang Zhifei , Liang Yue , George Simon , Holmer Lars
Published: December 2020

Phosphate-shelled brachiopods differ in filter-feeding lifestyle, with Lingula anatina an active infaunal burrower, and Discinisca tenuis a shallow marine epibenthic animal. The shells of these biomineralized organisms are built of organophosphatic constituents, the organic fibres/sheets reinforced with calcium phosphate (Ca-phosphate) to provide a sophisticated ultrastructural robustness. This investigation studied the nature of organic fibres in order to improve our understanding of how design principles are relevant to biominerals. Unlike the powdered samples that were commonly used in previous studies, for the first time organic fibres were isolated and the shell fractions were purified, in order to study the content and nature of the biopolymer fibres. Ultrastructural analysis, thermal gravimetric analysis and spectroscopic analyses reveal that the core polysaccharide framework is composed of layers of β-chitin sheets that are coated with a fibrous protein matrix. The chitin matrix in Lingula shells, 26.6 wt.%, is about two-fold higher wt.% compared to Discinisca shells,12.9 wt.%. After thermal gravimetric analysis, skeletal imaging of these shells shows important differences. Discinisca contains just a single layer that is ~21.0 µm thick. In contrast, Lingula exhibits two separate layers: the thicknesses of the primary- and secondary-layers are ~20.3 µm and ~8.1 µm, respectively. Taken together, the data shows that the chitin matrix contributes to increased skeletal strength, making Lingula highly adapted for life as an active burrower. In comparison, Discinisca contains less chitin and lives as attached epibenthos in a shallow marine environment.
Prognostic value of Neutrophil-to-lymphocyte ratio in COVID-19 compared with Influenza and respiratory syncytial virus infection
Authors: Prozan Lior , Shusterman Eden , Ablin Jacob , Mitelpunkt Alexis , Weiss-Meilik Ahuva , Adler Amos , Choshen Guy , Kehat Orli
Published: December 2020

Background: A high Neutrophil to Lymphocyte Ratio (NLR) is considered an unfavorable prognostic factor in various diseases, including COVID-19. The prognostic value of NLR in other respiratory viral infections, such as Influenza, has not hitherto been extensively studied. We aimed to compare the prognostic value of NLR in COVID-19, Influenza and Respiratory Syncytial Virus infection (RSV).Method: A retrospective cohort of COVID-19, Influenza and RSV patients admitted to the Tel Aviv Medical Center from January 2010 to October 2020 was analyzed. Laboratory, demographic, and clinical parameters were collected. Two way analyses of variance (ANOVA) was used to compare the association between NLR values and poor outcomes among the three groups. ROC curve analyses for each virus was applied to test the discrimination ability of NLR. Results: 722 COVID-19, 2213 influenza and 482 RSV patients were included. Above the age of 50, NLR at admission was significantly lower among COVID-19 patients (P<0.001). NLR was associated with poor clinical outcome only in the COVID-19 group. ROC curve analysis was performed; the area under curve of poor outcomes for COVID-19 was 0.643, compared with 0.497 and 0.537 for Influenza and RSV respectively. In the COVID-19 group, multivariate logistic regression identified a high NLR (defined as a value above 4.7) to be a prognostic factor for poor clinical outcome, after adjusting for age, sex and Charlson comorbidity score (odds ratio of 1.6, P=0.005). Conclusions: NLR at admission is lower and has more prognostic value in COVID-19 patients, when compared to Influenza and RSV.
Isolation, Serotyping and Molecular Detection of Bovine FMD Virus from Outbreak Cases in Aba'ala District of Afar Region
Authors: Tegegne Teshager Dubie , Mengiste Tsedale Amare
Published: December 2020

Background: Among the top listed economically important transboundary livestock diseases of cattle, foot and mouth disease (FMD) is the leading bottleneck in livestock production and productivity in Ethiopia. On the basis of FMDV active outbreak cases, a cross sectional study was undertaken to collect samples from January, 2019 to March, 2020 intended for isolation, serotyping and molecular detection of FMDV in the study district. Purposive sampling method was applied to select the study area for the reason that the presence of current active FMD outbreak case report during the study period. Totally, 27 FMD suspected clinical samples were collected from clinically affected study population during field outbreak. Out of 27 samples, 18 of them were inoculated on cultured Baby hamster kidney (BHK-21) monolayer cells and all 27 samples were tested using conventional RT-PCR and sets of specific universal primers. Finally, the PCR products were visualized with UV illumination and imaged with gel documentation system. Results: The current study result revealed that out of 18 clinical samples subjected to virus isolation, 72.2%(n=13) of these cultures exhibited FMDV induced cytopathic effect (CPE) and the identified serotype was SAT-2 FMD virus. Out of 27 clinical samples tested by conventional RT-PCR, only 12 FMDV samples were found to be FMDV positive by universal primers. Out of 27 clinical samples detected by conventional reverse transcription polymerase chain reaction (RT-PCR), only 12 FMDV samples were found to be FMDV positive by universal primers.Conclusions: Our study finding indicated FMDV is prevalent in the study area and FMDV serotype SAT-2 was the causality for the outbreaks of the disease in the study area. Hence, region wise regular FMD outbreaks investigation, further phylogenetic analysis and vaccine matching field isolates should be carried out to know in depth data about FMDV serotypes and topotypes involving in afar region of Ethiopia for effective vaccine development and control of the disease.
The Prevalence of Behavioral Risk Factors in People with HIV/AIDS and Its Effect on Adherence to Treatment
Authors: Soofi Moslem , Shakiba Ebrahim , Moradinazar Mehdi , Moradi Atefeh
Published: December 2020

Background: Behavioral risk factors, in addition to increasing the risk of HIV/AIDS transmission, can affect the antiretroviral therapy (ART) pattern of people with the condition. The aim of this study was to determine the prevalence of behavioral risk factors and its effect on adherence to antiretroviral drugs (ARV) treatment in patients with HIV/AIDS in western Iran.Methods: This study was performed on all patients who were diagnosed with HIV/AIDS in Kermanshah province during the years 1995-2019 (25 years). Adherence to treatment in these patients was divided into three categories according to the WHO definition: Non-adherence, cessation and adherence to treatment. Using single-variable and multi-variable logistic regression, the effect of important variables in four models was modified and the effect of each of the behavioral risk factors was studied in patients who had non-adherence or experienced cessation compared to those who adhered to ARV.Results: Of the 2,867 patients with HIV/AIDS, 2,449 (85.42%) were men. The mean age of HIV infection was 33.36 ± 11.8 years. In 1995, less than 10 percent of people received treatment, which is 2019 it reached to more than 67 percent. All behavioral risk factors increased the non-adherence to medication and cessation of ARV. In general, after controlling confounding variables except needle sharing, all behavioral variables affected ARV treatment; The greatest impact on non-adherence to medication was History of drug abuse, History of the prison, History of injection drug use and Sex with non-spouse with a chance of 10.87 (7.21-16.39), 3.94 (2.84-5.46), 3.86 (2.47-6.03) and 3.38(2.19-5.23) times more than patients without these risk factors, respectively.Conclusion: Although the process of receiving treatment has been increasing since 2005, the non-adherence to medication is still high in high-risk groups, so it is important to focus more on reducing non-adherence and eventually cessation of treatment. In particular, more focus is necessary for health education and raising the level of awareness of these groups.
FİZİKSEL ENGELLİ BİREYLER İÇİN TOPLU TAŞIMAYA YÖNELİK ERİŞİLEBİLİRLİK STRATEJİLERİ
Authors: ÖZİSPA Nergis , ARABELEN Gamze
Published: December 2020

Avrupa’da 18. ve 19. yüzyıllarda başlayan 1. sanayi devrimi ile üretim artmış, köylerden kentlere göç başlamış ve şehirlerin büyümesi hızlanmıştır. 2011 yılında ilk olarak Almanya’da ortaya çıkan ve robot teknolojilerini hayatlarımıza entegre eden 4. sanayi devrimini yaşadığımız bu günlerde ise, şehirlerin büyümesi muazzam bir hıza ulaşmıştır. Şüphesiz ki, şehirlerin hızlı büyümesi kentsel planlama ve teknik altyapı oluşturma hizmetlerinin (planlı yapılaşma, eğitim, sağlık ve ulaşım hizmetleri, vb.) aynı hızda sağlanamaması, sağlanamadığında ise yetersiz kalması gibi sorunlara sebep olmuştur. Tüm bu hızlı şehirleşme sürecinde köylerden şehirlere göç faaliyetlerinin artması ile çalışan nüfus şehirlerde yoğunlaşmış ve şehir içi mobilite (hareketlilik) ihtiyacı sebebiyle ulaştırma altyapısına duyulan talep artmıştır. Günümüzde belediyeler tarafından sağlanan şehir içi toplu taşıma hizmetleri bu talebi karşılamaktadır. Dezavantajlı gruplardan engelli bireyler ise, bu toplu taşıma hizmetlerinden yararlanabilmek için engelleri doğrultusunda ek hizmet ya da ekipmana ihtiyaç duymaktadırlar. Amacı, engelli bireylerin toplu taşıma hizmetlerinden aldıkları verimi iyileştirecek stratejiler önermek olan bu çalışmada, dünyanın çeşitli ülkelerinde engelli bireyler için tasarlanmış ulaştırma tasarımları ve devlet politikaları incelenmiştir. Çalışma sonucunda, dünya üzerinde uygulanan ulaştırmaya yönelik erişilebilirlik stratejilerinin, engelli bireylerin ihtiyaçlarını karşılama konusunda yetersiz kaldığı tespit edilmiştir. Engelli bireylerin ulaşım ihtiyaçlarının iyileştirilmesine yönelik başarılı projeleri olan Türkiye Cumhuriyeti Devleti’nin, gelişen teknolojiler sayesinde, söz konusu stratejilere yönelik hedefler oluşturmasının ülkeyi, engelli ulaşım hizmetleri konusunda örnek ülke haline getirebileceği düşünülmektedir. Çalışma gelecek araştırmalar için öneriler bölümüyle sona ermektedir.
Los Sistemas Normativos Indígenas en tiempos del Gobierno Abierto. Perspectiva municipal en Oaxaca.
Authors: Cruz Meléndez Christian Arturo , Martínez Lauro Domingo Santiago
Published: December 2020

El Gobierno Abierto tomo auge a partir del memorando de Barack Obama en 2009, y se convirtió en una tendencia, filosofía y/o paradigma de la Administración Pública, sustenta en tres pilares: Transparencia, Participación y Colaboración, y posteriormente se agregó la Rendición de Cuentas. México se unió al auge del Gobierno Abierto, con un liderazgo del ámbito nacional y subnacional, pero más rezagado a nivel municipal. Este rezago es más visible en los municipios de Sistemas Normativos Indígenas, como lo son 417 de los 570 del estado de Oaxaca, los cuales tienen un régimen jurídico, político y administrativo, reconocido desde la constitución, que les permite auto determinarse de acuerdo a usos y costumbres con muchos años de existencia. Por sus características su incursión al Gobierno Abierto, es por un lado un camino complicado por limitaciones y costumbres contrarias a los principios del paradigma moderno; y por otro lado tienen un camino recorrido por los usos y costumbres que hacen que el Gobierno Abierto, no les sea del todo ajeno y les facilite transitar hacia este objetivo.