bluuebunny/crossref_metadata_2025 huggingface dataset:
High frequency jet ventilation through mask contribute to oxygen therapy in patients undergoing bronchoscopic intervention under deep sedation
Authors: Yang Mingyuan , Wang Bin , Hou Qingwu , Zhou Yunzhi , Li Na , Wang Hongwu , Li Lei , Cheng Qinghao
Published: August 2020

Background: High frequency jet ventilation (HFJV) is an open ventilating technique to maintain ventilation for emergency or difficult airway. However, it is unclear whether jet ventilation or conventional oxygen therapy (COT) is more effectively and safely to maintain adequate oxygenation in patients with airway stenosis during bronchoscopic intervention (BI) under deep sedation.Methods: A prospective randomized cohort study was conducted to compare HFJV with normal frequency jet ventilation (NFJV) and COT (high flow oxygen) in oxygen supplementation during BI under deep sedation from March 2020 to August 2020. Patients receiving BI under deep sedation were randomly divided into 3 parallel groups of 50 patients each: the COT group (FiO21.0, 12 L/min), the NFJV Group (FiO2 1.0, driving pressure 0.1MPa, respiratory rate (RR) 15bpm) and HFJV Group (FiO2 1.0, driving pressure 0.1MPa, RR 1200bpm). SpO2, MBP and HR were recorded during the whole procedure. Arterial blood gas was examined and recorded at 15 minutes after initiation of procedure. Procedure duration, dose of anesthetics and adverse events during BI in the three groups were also recorded.Results: A total of 161 patients were enrolled with 11 patients excluded. Clinical characteristics were similar among the three groups. PaO2 of HFJV group was significantly higher than that of COT and NFJV group (P<0.001). PaO2 was significantly correlated with ventilation mode (P<0.001), BMI (P=0.019) and procedure duration (P=0.001). Multiple linear regression showed that only BMI and procedure duration were independent influencing factors of arterial blood gas PaO2 (P=0.040, P=0.002). The location of airway lesions and severity of airway stenosis were no statistical correlation with PaCO2 and PaO2.Conclusions: HFJV can effectively and safely improve intra-operative PaO2 in patients with airway stenosis during BI in deep sedation, and doesn’t increase intra-operative PaCO2 and the risk of hypercapnia. The location of airway lesions and severity of airway stenosis may not affect oxygenation maintain during basic and some advanced BI.Trial registration: Chinese Clinical Trial Registry. Registration number, ChiCTR2000031110, registered on March 22, 2020.
Performance of NT-proBNP as a single biomarker in comparison to SCORE and the recommended ESC/EASD cardiovascular risk stratification model for risk prediction in type 2 diabetes mellitus
Authors: Prausmüller Suriya , Resl Michael , Arfsten Henrike , Spinka Georg , Wurm Raphael , Neuhold Stephanie , Bartko Philipp , Goliasch Georg , Strunk Guido , Pavo Noemi , Clodi Martin , Hülsmann Martin
Published: August 2020

Background. Recently, the European Society of Cardiology (ESC) and European Association for the Society of Diabetes (EASD) introduced a new cardiovascular (CV) risk stratification model to aid further treatment decisions in individuals with diabetes. Our study aimed to investigate the prognostic performance of NT-proBNP and the Systematic COronary Risk Evaluation (SCORE) compared to the ESC/EASD risk model in an unselected cohort of type 2 diabetes mellitus (T2DM).Methods & Results. A total of 1690 T2DM patients with a 10-year follow up for fatal CV and all-cause death and a 5-year follow up for CV and all-cause hospitalizations were analyzed. According to ESC/EASD risk criteria 25 (1.5%) patients were classified as moderate, 252 (14.9%) high, 1125 (66.6%) very high risk and 288 (17.0%) were not classifiable. NT-proBNP, the ESC/EASD and SCORE risk model were all associated with 10-year CV and all-cause death and 5-year CV and all-cause hospitalizations. NT-proBNP showed significantly higher C-indices than the ESC/EASD and SCORE risk model for CV death [0.80 vs 0.53 vs 0.64, p<0.001] and all-cause death [0.73 vs 0.52 vs 0.66, p<0.001]. The performance of SCORE improved in a subgroup without CV disease aged 40-64 years compared to the unselected cohort, whilst performance of NT-proBNP was robust across all groups. Conclusion. NT-proBNP is a high-performing biomarker for CV risk assessment in T2DM. Single NT-proBNP is superior compared to SCORE and the multiparameter ESC/EASD risk stratification model for predicting 10-year CV and all-cause fatal events.
Verification of Bio-Resonance Efficiency Method for Neutralization of Chosen Pathogens
Authors: Krzysztof Patrycja , Strus Magdalena , Nabagło Tomasz
Published: August 2020

Background: The purpose of this study was to verify the effectiveness of the selected bio-resonance method under in- vitro conditions. The question of alternative therapies efficiency is very important in situation when traditional therapies may be not enough effective. In such situations, patients reach for alternative solutions and sometimes even physicians suggest their application.Methods: In the article, the authors present results of a neutralization method efficiency of selected pathogens using selected bio-resonance method. The verification of the method was conducted with usage of a constructed generator. The generator strictly realized a signal described in the literature associated with the bio-resonance topic. The authors carried out tests in in- vitro laboratory conditions on material including both clinical and reference strains of both bacteria and fungi.Results: According analysis of 24 test series of the bacterial and the fungi strains, the samples treated with the generator did not show a significant decrease of the pathogen population in relation to the comparative samples. Generally accepted standards in microbiology, describes a significant reduction of the pathogen population appears when the population size decrease at least about one order of magnitude in relation to the comparative samples.Conclusions: As a result of the tests, the ineffectiveness of the tested method was demonstrated. This is an important result because this method is considered as effective in many environments, and patients based on this fact, often give up conventional treatment.
Do second-line oral antidiabetic drugs have different long-term effects on persons with young-onset type 2 diabetes? ---A nationwide population base cohort study
Authors: Yen Fu-Shun , Wei James Cheng-Chung , Liu Jia-Sin , Hsu Chih-Cheng , Hwu Chii-Min
Published: August 2020

Background: People with young-onset diabetes (YOD) exhibit a higher risk of morbidity and mortality than those with late-onset diabetes. Few studies have explored the preferred management of diabetes in such patients; therefore, we compared the risks of hospitalization and mortality among people with YOD to whom second-line oral antidiabetic drugs (OADs) were administered.Methods: We conducted a nationwide cohort study using the National Health Insurance Research Database (Taiwan). A total of 7257 people taking second-line OADs after initial metformin therapy were enrolled during 2009–2014. Using add-on sulfonylureas (SUs) as a reference, the multivariable Cox regression model was used to compare the risks of hospitalization and mortality among 5 categories of second-line OADs: alpha-glucosidase inhibitors, meglitinide, dipeptidyl peptidase-4 (DPP-4) inhibitors, SUs, and thiazolidinediones.Results: The mean age of patients, duration of diabetes, and follow-up period were 31.6, 3.3, and 1.9 years, respectively. After baseline characteristics, comorbidities, duration of diabetes, and cardiovascular drug use were controlled, the adjusted hazard ratios and 95% confidence interval for all-cause, cardiovascular, and non-infection hospitalization and all-cause mortality for metformin plus DPP-4 inhibitors were 0.62 (0.52–0.73), 0.49 (0.29–0.85), 0.64 (0.54–0.76), and 0.50 (0.27–0.92), respectively, when compared with the data for metformin plus SUs.Conclusions: We found that among people with YOD, taking add-on DPP-4 inhibitors was associated with lower risks of all-cause hospitalization and mortality than taking add-on SUs. DPP-4 inhibitors thus seem to be a suitable second-line OAD for such patients.Trial registration: retrospectively registered
STAU2 Protein Level is Controlled by Caspases and the CHK1 Pathway and Regulates Cell Cycle Progression in the Non-transformed hTERT-RPE1 Cells
Authors: Conde Lionel , Beaujois Remy , DesGroseillers Luc
Published: August 2020

Background: Staufen2 (STAU2) is an RNA binding protein involved in the posttranscriptional regulation of gene expression. In neurons, STAU2 is required to maintain the balance between differentiation and proliferation of neural stem cells through asymmetric cell division. However, the importance of controlling STAU2 expression for cell cycle progression is not clear in non-neuronal dividing cells. We recently showed that STAU2 transcription is inhibited in response to DNA-damage due to E2F1 displacement from the STAU2 gene promoter. We now study the regulation of STAU2 steady-state levels in unstressed cells and its consequence for cell proliferation. Results: CRISPR/Cas9-mediated and RNAi-dependent STAU2 depletion in the non-transformed hTERT-RPE1 cells both facilitate cell proliferation suggesting that STAU2 expression influences pathway(s) linked to cell cycle controls. Such effects are not observed in the CRISPR STAU2-KO cancer HCT116 cells nor in the STAU2-RNAi-depleted HeLa cells. Interestingly, a physiological decrease in the steady-state level of STAU2 is controlled by caspases. This effect of peptidases is counterbalanced by the activity of the CHK1 pathway suggesting that STAU2 partial degradation/stabilization fines tune cell cycle progression in unstressed cells. A large-scale proteomic analysis using STAU2/biotinylase fusion protein identifies known STAU2 interactors involved in RNA translation, localization, splicing, or decay confirming the role of STAU2 in the posttranscriptional regulation of gene expression. In addition, several proteins found in the nucleolus, including proteins of the ribosome biogenesis pathway and of the DNA damage response, are found in close proximity to STAU2. Strikingly, many of these proteins are linked to the kinase CHK1 pathway, reinforcing the link between STAU2 functions and the CHK1 pathway. Indeed, inhibition of the CHK1 pathway dissociates STAU1 from proteins involved in translation and RNA metabolism. Conclusions: These results indicate that STAU2 is involved in pathway(s) that control(s) cell proliferation, likely via mechanisms of posttranscriptional regulation, ribonucleoprotein complex assembly, genome integrity and/or checkpoint controls. This novel function of STAU2 is regulated by caspases and by the kinase CHK1 pathway.
Clinical Signs Associated With Earlier Diagnosis of Children With Autism Spectrum Disorder
Authors: Sicherman Nachum , Charite Jimmy , Eyal Gil , Janecka Magdalena , Loewenstein George , Law Kiely , Lipkin Paul H. , Marvin Alison R. , Buxbaum Joseph D.
Published: August 2020

Background: The objective of this study is to gain new insights into the relationship between clinical signs and age at diagnosis. Method: We utilize a new, large, online survey of parents of children diagnosed with ASD, and use multiple statistical approaches. Results: We find that clinical signs that most strongly predict early diagnosis are not necessarily specific to autism, but rather those that initiate the process that eventually leads to an ASD diagnosis. Given the high correlations between symptoms, only a few signs are found to be important in predicting early diagnosis. For several clinical signs we find that their presence and intensity are positively correlated with delayed diagnosis (e.g., tantrums and aggression). Even though our data are drawn from parents’ retrospective accounts, we provide evidence that parental recall bias and/or hindsight bias did not play a significant role in shaping our results. Conclusion: In the subset of children without early deficits in communication, diagnosis is delayed, and this might be improved if more attention will be given to clinical signs that are not necessarily considered as ASD symptoms. Our findings also suggest that careful attention should be paid to children showing excessive tantrums or aggression, as these behaviors may interfere with an early ASD diagnoses.
Development and structural characterization of a two-MAb cocktail for delayed treatment of enterovirus D68 infections
Authors: Huang Zhong , Zhang Chao , Xu Cong , Dai Wenlong , Wang Yifan , Liu Zhi , Zhang Xueyang , Wang Xuesong , Gong Sitang , Cong Yao
Published: August 2020

Enterovirus D68 (EV-D68) is an emerging pathogen associated with respiratory diseases and/or acute flaccid myelitis. Here, two MAbs, 2H12 and 8F12, raised against EV-D68 virus-like particle (VLP), showed distinct preference in binding VLP and virion and in neutralizing different strains. The 2H12/8F12 cocktail exhibited balanced and potent neutralization effects and conferred broader protection in mice than single MAbs when given at onset of symptoms. Cryo-EM structures of EV-D68 virion complexed with 2H12 or 8F12 showed that both antibodies bind to south rim of the canyon and obscure the canyon, blocking virus–cell binding. Additionally, 2H12 binding could partially impair virions and trigger uncoating, resulting in premature viral RNA release. We also captured an uncoating intermediate induced by 2H12 binding, not detected before in picornaviruses. Our study elucidates neutralizing mechanisms of the MAbs and supports further development of the 2H12/8F12 cocktail as a broad-spectrum therapeutic agent against EV-D68 infections in humans.
Incidence, Characteristics and Outcomes of Delirium in Patients With Noninvasive Ventilation: A Prospective Observational Study
Authors: Zhang Rui , Bai Linfu , Han Xiaoli , Huang Shicong , Zhou Lintong , Duan Jun
Published: August 2020

Background: Knowledge of delirium in noninvasive ventilation (NIV) is lacking. We aimed to report the incidence, characteristics and outcomes of delirium in NIV patients. Methods: A prospective observational study was performed in an intensive care unit (ICU) of a teaching hospital. Patients who used NIV as a fist-line intervention were enrolled. During NIV intervention, delirium was screened using Confusion Assessment Method for the ICU every day. Results: We enrolled 1083 patients. Of them, 196 patients (18.1%) experienced delirium during NIV intervention. Patients with delirium had higher NIV failure rates (37.8% vs. 21.0%, p ＜0.01), higher ICU mortality (33.2% vs. 14.3%, p ＜0.01) and higher hospital mortality (37.2% vs. 17.0%, p ＜0.01) than the subjects without delirium. They also spent longer time on NIV (median 6.3 vs. 3.7 days, p ＜0.01), and stayed longer in ICU (median 9.0 vs. 6.0 days, p ＜0.01) and hospital (median 14.5 vs. 11.0 days, p ＜0.01). Furthermore, delirium was independently associated with NIV failure, ICU mortality and hospital mortality (OR =1.97, 2.58 and 2.55, respectively; all p values ＜0.01). These results were confirmed in COPD and non-COPD cohorts. Compared with hyperactive delirium patients, the NIV days was longer in hypoactive delirium patients and much longer in mixed delirium patients (median 3.4 vs. 6.5 vs. 10.1 days, p ＜0.01). Similar outcomes were found in the length of stay in ICU and hospital. However, the NIV failure, ICU mortality and hospital mortality did not differ between three subtypes of delirium.Conclusions: Delirium increases the NIV failure rates, elevates the ICU and hospital mortality, prolongs the NIV days, and lengthens the ICU and hospital stay. Mixed delirium patients use more ICU resources than hypoactive delirium patients and much more than hyperactive delirium patients.
Evaluation of Malaria Preventive Measures Among Adult Patients Attending the Bamendjou and Foumbot District Hospitals of the West Region of Cameroon
Authors: Nlinwe Nfor Omarine , Singong Yengong Clinton , Florentine Tenkam Makamdoum Ruth
Published: August 2020

Background: Although significant decrease in entomological and epidemiological indicators was reported in Cameroon since the introduction of insecticide treated bed nets, malaria prevalence remains high also in some parts of the West Region of Cameroon. Therefore this study was designed to evaluate malaria preventive measures among patients attending the Bamendjou and Foumbot District hospitals of the West Region of Cameroon. Methods: This was a cross sectional study carried out within a period of three months, from January to March 2020. Data was obtained using a structured questionnaire and laboratory analysis. The CareStart ™ Malaria HRP2 (Pf) qualitative rapid diagnostic test was used for malaria diagnosis. The questionnaire was designed to collect information on respondent’s socio demographic characteristics, and use of malaria preventive measures. Data was analyzed using descriptive statistics, regression analysis and Chi-square (and Fisher’s exact) test. Results: A total of 170 study participants were recruited in Foumbot and 197 in Bamendjou. Malaria was significantly (P < 0.0001) more prevalent in Foumbot (47.06%) than in Bamendjou (19.8%). In Foumbot, nonuse of insect repellent spray (P = 0.0214), insect repellent body cream (P = 0.0009), mosquito spray (P = 0.0001) and not draining stagnant water (P = 0.0004) predisposed to higher risk of malaria. But in Bamendjou, nonuse of insect repellent spray (P = 0.0012), long lasting insecticidal bed nets (P = 0.0001), window and door nets (P = 0.0286), predisposed to higher risk of malaria. Conclusions: Malaria prevalence was high among the study participants especially in Foumbot. Adequate follow-up to ensure effective execution of the recently launched third phase of LLINs distribution campaign in Cameroon is recommended. Additionally, Intergrated Vector Management is required to ensure effective control of malaria transmission in Foumbot and Bamendjou.
The Novel Fibrosis Index at Diagnosis May Predict All-cause Mortality in Patients With Antineutrophil Cytoplasmic Antibody-associated Vasculitis Without Substantial Liver Diseases. 
Authors: Pyo Jung Yoon , Ahn Sung Soo , Lee Lucy Eunju , Choi Gwang-mu , Song Jason Jungsik , Park Yong-Beom , Lee Sang-Won
Published: August 2020

Objectives: Antineutrophil cytoplasmic antibody associated vasculitis (AAV) is a fatal disease. Currently, predictors of mortality of AAV are based on distribution of organ involvement. Novel fibrosis index (NFI) is an index, which is composed of laboratory results, that reflects the degree of liver fibrosis. The aim of this study is to evaluate whether NFI can predict poor outcomes among patients with AAV without substantial liver diseases. Methods: 210 immunosuppressive drug-naïve AAV patients were retrospectively reviewed. NFI was calculated as follows: NFI= [serum bilirubin x (alkaline phosphatase)2] / [platelet count x (serum albumin)2]. Cut-off of NFI was set at 1.24, and patients were divided into two groups. Poor outcomes were defined as all-cause mortality, relapse, and end-stage renal disease (ESRD). Results: During the median 34.5 months of follow up, twenty-one patients (10%) died, 72 patients (34.3%) relapsed, and 38 patients (18.1%) reached ESRD due to AAV progression. The median calculated NFI was 0.61, and it was higher in AAV patients with all-cause mortality than those without mortality, but it didn’t reach the statistical significance (1.26 vs. 0.59). AAV patients with NFI at diagnosis ≥ 1.24 exhibited a significantly lower cumulative patients’ survival rate than those with NFI at diagnosis < 1.24 (P = 0.002). Multivariate Cox hazard model analysis showed that NFI at diagnosis ≥ 1.24 was an independent predictor of all-cause mortality in AAV (HR 2.850, 95% CI 1.026, 7.910).Conclusions: NFI at diagnosis ≥1.24 may be an independent predictive marker for all-cause mortality in AAV patients without substantial liver diseases.
Exploring the Heterogeneity of Factors that may Influence Implementation of PrEP in Family Planning Clinics: A Latent Profile Analysis
Authors: Piper Kaitlin N , Haardörfer Regine , Escoffery Cam , Sheth Anandi N , Sales Jessica
Published: August 2020

Background: Title X-funded family planning clinics have been identified as optimal sites for delivery of pre-exposure prophylaxis (PrEP) for HIV prevention. However, PrEP has not been widely integrated into family planning services, especially in the Southern U.S., and data suggest there may be significant implementation challenges in this setting. Because Title X clinics vary greatly in provider-, organizational-, and systems-level characteristics, there is likely variation in capacity to implement PrEP across clinics. Methods: We conducted a survey from February-June 2018 among providers and administrators of non-PrEP providing Title X-funded clinics across 18 southern states. Survey items were designed using the Consolidated Framework for Implementation Research (CFIR) to assess constructs relevant to PrEP implementation. To explore the heterogeneity of CFIR-related determinants and identify distinct sub-groups of Title X clinics, a latent profile analysis was conducted using nine CFIR constructs: complexity, relative advantage, cost, attitudes, implementation climate, compatibility, leadership engagement, available resources, and cosmopolitanism. We then conducted a multi-level analysis (accounting for nesting of participants within clinics) to test whether group membership was associated with readiness for implementation of PrEP, controlling for key sociodemographic characteristics. Results: 414 healthcare providers/administrators from 227 non-PrEP providing Title X clinics participated in the study. We identified six sub-groups of clinics that each had distinct patterns of perceptions across the CFIR-related determinants. Clinic sub-groups included: “High Capacity”, “Optimistic”, “Advantageous”, “Moderate”, “Incompatible”, and “Resource Constrained”. Group membership was related to numerous provider-level (i.e., ability to prescribe medication), clinic-level (i.e., provision of primary care), and community-level characteristics (i.e., county-level HIV prevalence). In comparison to the “Moderate” group (which held neutral perceptions across the CFIR constructs), the “High Capacity” and “Optimistic” groups had significantly higher levels of implementation readiness; and the “Resource Constrained group had a significantly lower level of implementation readiness.Conclusions: Latent profile analyses can help researchers understand how context-specific implementation determinants vary across individuals and settings (such as clinics), allowing implementation planning to be tailored to the specific needs of each segment of the population.
Landslide Susceptibility Assessment Based on Geological Data and Remote Sensing Processed Data Using Bi-Variate Statistical Model and GIS: A Case Study on Rangamati District, Bangladesh
Authors: Hafsa Bibi , Chowdhury Md. Sharafat , Rahman Md. Naimur
Published: August 2020

Landslide is a major hazard all over the world and a very frequent phenomenon in Southeast Asian mountainous terrain. It has become a frequent phenomenon in the hilly regions of Bangladesh and the Rangamati district is the worst victims. This study aims to identify the landslide susceptible area of Rangamati district according to geological and satellite image processed data of the previously occurred landslide. Geological map of Rangamati District, Landsat 8 OLI images of October-2019 and SRTM images were used for landslide factor data mining. In present study Surface geology, Distance from fault line, Slope Angle, Slope Aspect, NDVI, BSI and NDCI are considered as the major factors related to landslide occurrence. Effects of the selected factors were calculated by using bivariate statistical approach (frequency ratio method) to examine the correlation between landslide occurrence and the influencing factors. Results of the landslide susceptibility show that surface geology and fault line has a strong correlation with landslide occurrence in Rangamati district. Analysis also shows that medium to high clay content availability with bare soil surface (no or low vegetation) that have a low slope angle (3 to 16 degree) are closely correlated to landslide occurrence. In the rainy season clay content saturated by heavy rainfall produce mud that flows according to very low slope cause landslide in this region. Due to geological characteristics this landslide can be defined as mud flow. Landslide susceptible map shows that the area near water bodies and lower part of hill slope are more susceptible to landslide occurrence.
Transcriptional Profiling of Leukocytes in Critically Ill COVID19 Patients: Implications for Interferon Response and Coagulation
Authors: Gill Sean , Santos Claudia C. dos , O’Gorman David B. , Carter David E. , Patterson Eric K. , Slessarev Marat , Martin Claudio , Daley Mark , Miller Michael R. , Cepinskas Gediminas , Fraser Douglas D.
Published: August 2020

Background: COVID19 is caused by the SARS-CoV-2 virus and has been associated with severe inflammation leading to organ dysfunction and mortality. Our aim was to profile the transcriptome in leukocytes from critically ill patients positive for COVID19 compared to those negative for COVID19 to better understand the COVID19 associated host response. For these studies, all patients admitted to our tertiary care intensive care unit (ICU) suspected of being infected with SARS-CoV-2, using standardized hospital screening methodologies, had blood samples collected at the time of admission to the ICU. Transcriptome profiling of leukocytes via ribonucleic acid sequencing (RNAseq) was then performed and differentially expressed genes as well as significantly enriched gene sets were identified.Results: We enrolled seven COVID19+ (PCR positive, 2 SARS-CoV-2 genes) and seven age- and sex-matched COVID19- (PCR negative) control ICU patients. Cohorts were well-balanced with the exception that COVID19- patients had significantly higher total white blood cell counts and circulating neutrophils and COVID19+ patients were more likely to suffer bilateral pneumonia. The mortality rate for this cohort of COVID19+ ICU patients was 29%. Transcriptional analysis revealed that when compared to COVID19- patients, the altered transcriptional responses of leukocytes in critically ill COVID19+ ICU patients appeared to be associated with multiple interrelated outcomes, including but not limited to robust interferon (IFN)-associated transcriptional responses, a marked decrease in the transcriptional activity of genes contributing to protein synthesis and the dysregulated expression of genes that contribute to coagulation, platelet activation, Toll-like receptor activation, neurotrophin signalling, and protein SUMOylation/ubiquitination. Conclusions: Our findings demonstrate that critically ill COVID19+ patients on day 1 of admission to the ICU display a unique leukocyte transcriptional profile that distinguishes them from COVID19- patients, providing guidance for future targeted studies exploring novel prognostic and therapeutic aspects of COVID19.
10 Years Follow up of Chondroblastoma Treated with Intralesional Curettage: A Retrospective Study
Authors: Yang Lei , Yang Panyi , Wang Daoxi , Yang Xiaodong , Li Lang , tang xueyang
Published: August 2020

Introduction: Chondroblastoma is a rare benign tumor mainly occurred in epiphyses and apophyses of long bones, and usually affects the young people. The primary treatment for chondroblastoma is intralesional curettage. The aim of this study was to evaluate the clinical and radiologic results of patients suffering chondroblastoma treated with intralesional curettage, electrocauterization of the cavity and bone grafting. Patients and Methods: From January 2000 to January 2010, 15 patients with chondroblastoma were treated with intralesional curettage and electrocauterization of the cavity, among which14 patients received bone grafting. After operation, patients were immobilized with splint for 4 weeks and followed up for at least 10 years. The recurrence was examined by clinical manifestation and X ray. The clinical outcome included complications and the Musculoskeletal Tumor Society Score (MSTS).Results: Totally, 15 patients with chondroblastoma were enrolled in our study, including 9 males and 6 females, with a mean age of 13 years old (range from 8 to 21 years). The most common chief compliant were pain and limited joint motion, others including local swelling and increased skin temperature. The mean duration of symptom was 5 months (range from 2-14 months). Tumors mostly affected the proximal humerus (7/15), distal femur (4/15), proximal femur (1/15), proximal tibia (2/15) and femoral head (1/15). Eight patients were undiagnosed or misdiagnosed before operation, only 7 patients with a consideration of chondroblastoma. With a mean follow up of 12years (range from 10-16 years) , two patients had complications of upper limb shortening and1 patient suffered re-operation due to tumor recurrence. The mean postoperative MSTS score was 28.1 (range, 24 to 30) points, which was significantly higher than the preoperative score of 17.6 (range, 12 to 21) points.Conclusion: Thorough curettage with electrocauterization and bone grafting has a good functional outcome in the treatment of chondroblastoma, but still has a low risk of recurrence and complications.Level of Evidence: Level IV, retrospective case series.
Sustained Acoustic Medicine as a Non-surgical and Non-opioid Knee Osteoarthritis Treatment Option: A Health Economic Cost-effectiveness Analysis for Symptom Management 
Authors: Best Thomas M , Petterson Stephanie , Plancher Kevin
Published: August 2020

Background: Patients diagnosed with osteoarthritis (OA) and presenting with symptoms are seeking conservative treatment options to reduce pain, improve function, and avoid surgery. Sustained acoustic medicine (SAM), a multi-hour treatment has demonstrated improved clinical outcomes for patients with knee OA. The purpose of this analysis was to compare the costs and effectiveness of multi-hour SAM treatment versus the standard of care (SOC) over a 6-month timeframe for OA symptom management.Methods: A decision tree analysis was used to compare the costs and effectiveness of SAM treatment versus SOC in patients with OA. Probabilities of success for OA treatment and effectiveness were derived from the literature using systematic reviews and meta-analyses. Costs were derived from Medicare payment rates and manufacturer prices. Functional effectiveness was measured as the effect size of a therapy and treatment pathways compared to a SOC treatment pathway. A sensitivity analysis was performed to determine which cost variables had the greatest effect on deciding which option was the least costly. An incremental cost effectiveness plot comparing SAM treatment vs. SOC was also generated using 1,000 iterations of the model. Lastly, the incremental cost effectiveness ratio (ICER) was calculated as the (cost of SAM minus cost of SOC) divided by (functional effectiveness of SAM minus functional effectiveness of SOC). Results: Base case demonstrated that over 6 months, the cost and functional effectiveness of SAM was $8,641 and 0.52 versus SOC at: $6,281 and 0.39, respectively. Sensitivity analysis demonstrated that in order for SAM to be the less expensive option, the cost per 15-minute session of PT would need to be greater than $88, or SAM would need to be priced at less than or equal to $2,276. Incremental cost effectiveness demonstrated that most of the time (84%), SAM treatment resulted in improved functional effectiveness but at a higher cost than SOC.Conclusion: In patients with osteoarthritis, SAM treatment demonstrated improved pain and functional gains compared to SOC but at an increased cost. Based on the SAM treatment ICER score being ≤$50,000, it appears that SAM is a cost-effective treatment for knee OA.
Clinical Utility of Procalcitonin in Febrile Infants Younger Than 3 Months of Age Visiting a Pediatric Emergency Room: A Retrospective Single Center Study.
Authors: park Jun Sung , Byun Young-Hoon , Lee Jeong-Yong , Lee Jong Seung , Ryu Jeong-Min , Choi Seung Jun
Published: August 2020

BackgroundFever in infants under 90 days of age is highly likely to be caused by a severe bacterial infection (SBI) and it accounts for a large number of patients visiting the pediatric emergency room. In order to predict the presence of a bacterial infection and reduce unnecessary inpatient treatment, the classic classification system is based on crude white blood cell (WBC) count, urinalysis, and x-ray, and it is modified and applied at each center including recently appeared biomarkers such as c-reactive protein (CRP) or procalcitonin (PCT). This study analyzed the usefulness of PCT in predicting SBI when applied along with the existing classification system, including CRP, among infants less than 90 days old who visited the hospital with a fever in a single institution pediatric emergency center.MethodsWe retrospectively reviewed the medical records of patients younger than 3 months of age who presented with fever at the Seoul Asan Medical Center pediatric emergency room between July 2017 and October 2018. ResultsA total of 317 patients were analyzed, and 61 were diagnosed with SBI, of which urinary tract infection (UTI) accounted for the largest proportion (55/61, 90.2%). There were differences in WBC, neutrophil proportion, CRP, and PCT between the SBI group and the non-SBI group, and the AUC values of WBC, CRP, and PCT were 0.651, 0.804, and 0.746, respectively. When using cutoff values of CRP and PCTs as 2.0 mg/dL and 0.3 ng/mL, respectively, sensitivity and specificity for SBI were 49.2/89.5, and 54.1/87.5, respectively. WBC, CRP, and PCT were statistically significant for predicting SBI in multivariate analysis (odds ratios 1.066, 1.377, 1.291 respectively). When the subjects were classified using the existing classification criteria, WBC and CRP, the positive predictive value (PPV) and negative predictive value (NPV) were 29.3% and 88.7%, respectively, and when PCT was added, PPV and NPV were 30.7% and 92%, respectively, both increased.ConclusionPCT is useful for predicting SBI in children aged 3 months or less who visit the emergency room with a fever, and it is helpful for improving the diagnostic accuracy even when combined with WBC and CRP.
Clinical decision support improves the appropriateness of laboratory test ordering in primary care without increasing diagnostic error: the ELMO cluster randomized trial
Authors: Delvaux Nicolas , Piessens Veerle , De Burghgraeve Tine , Mamouris Pavlos , Vaes Bert , Stichele Robert Vander , Cloetens Hanne , Thomas Josse , Ramaekers Dirk , De Sutter An , Aertgeerts Bert
Published: August 2020

BackgroundInappropriate laboratory test ordering poses an important burden for healthcare. Clinical decision support systems (CDSS) have been cited as promising tools to improve laboratory test ordering behavior. The objectives of this study were to evaluate the effects of an intervention that integrated a clinical decision support service into a computerized physician order entry (CPOE) on the appropriateness and volume of laboratory test ordering, and on diagnostic error in primary care.MethodsThis study was a pragmatic, cluster randomized, open label, controlled clinical trial.Setting280 general practitioners (GPs) from 72 primary care practices in Belgium.PatientsPatients aged 18 years with a laboratory test order for at least one of 17 indications; cardiovascular disease management, hypertension, check-up, chronic kidney disease (CKD), thyroid disease, type 2 diabetes mellitus, fatigue, anemia, liver disease, gout, suspicion of acute coronary syndrome (ACS), suspicion of lung embolism, rheumatoid arthritis, sexually transmitted infections (STI), acute diarrhea, chronic diarrhea, and follow-up of medication.InterventionsThe CDSS was integrated into a computerized physician order entry (CPOE) in the form of evidence-based order sets that suggested appropriate tests based on the indication provided by the general physician.MeasurementsThe primary outcome of the ELMO study was the proportion of appropriate tests over the total number of ordered tests and inappropriately not-requested tests. Secondary outcomes of the ELMO study included diagnostic error, test volume and cascade activities.ResultsCDSS increased the proportion of appropriate tests by 0.21 (95% CI 0.16 - 0.26, p<.0001) for all tests included in the study. GPs in the CDSS arm ordered 7 (7.15 (95% CI 3.37 - 10.93, p=.0002)) tests fewer per panel. CDSS did not increase diagnostic error. The absolute difference in proportions was a decrease of 0.66% (95% CI 1.4% decrease - 0.05% increase) in possible diagnostic error.ConclusionsA CDSS in the form of order sets, integrated within the CPOE improved appropriateness and decreased volume of laboratory test ordering without increasing diagnostic error. Trial RegistrationClinicaltrials.gov Identifier: NCT02950142
Assessment of genetic purity in rice using polymorphic SSR markers
Authors: Kumar S.P. Jeevan , Susmita C , Agarwal Dinesh K. , Pal Govind , Rai Abhishek Kumar , Simal-Gandara Jesus
Published: August 2020

Genetic purity is conventionally performed through Grow-Out-Test (GOT) with morphological characters. Simple sequence repeat (SSR) markers are independent of G X E interaction. Herewith, 16 high yielding varieties of rice were analyzed using 55 SSR markers for DNA fingerprinting and identification of genetic impurities: 14 were found to be polypmorphic and amplified 48 alleles with an average of 3.43 alleles per each primer pair. The number of alleles amplified ranged from 2 to 6 and the size of the PCR products amplified from these 14 primer pairs ranged from 80–450 bp with polymorphic information content (PIC) from 0.14 (RM 346) to 0.99 (RM 5900). PICs at 0.5 or higher are highly informative SSR markers for genetic studies, DNA fingerprinting and scoring polymorphism rate of SSR markers pertinent to specific locus. The 14 polymorphic SSR markers can be used for DUS testing, genetic purity and DNA finger printing of rice varieties.
Interaction Between Genetic Variants and Serum Levels of Organochlorine Pesticides Contributes to Parkinson’s Disease
Authors: Xu Shaoqing , Yang Xiaodong , Qian Yiwei , Wan Dayong , Sun Fenghua , Luo Qian , Song Yanyan , Xiao Qin
Published: August 2020

Background: There is evidence that genetic and environmental factors contribute to the onset and progression of Parkinson’s disease (PD). Pesticides are a class of environmental toxins that are linked to increased risk of PD. However, few studies have investigated the interaction between specific pesticides and genetic variants related to PD in the Chinese population.Methods: In this cross-sectional study, 19 serum levels of pesticides were measured. In addition, we also analyzed the interaction between specific pesticides and candidate genetic variants for PD. Finally, we investigated the mechanistic basis for the association between pesticides and increased risk of PD.Results: Serum levels of organochlorine pesticides including α-hexachlorocyclohexane (α-HCH), β-HCH, γ-HCH, δ-HCH, propanil, heptachlor, dieldrin, hexachlorobenzene, p,p’-dichlorodiphenyltrichloroethane (p,p’-DDE) and o,p’-dichloro-diphenyl-trichloroethane (o,p’-DDT) were higher in PD patients than in controls. α-HCH and propanil levels were associated with increased PD risk. Serum levels of dieldrin were associated with Hamilton Depression Scale and Montreal Cognitive Assessment scores in PD patients. The interaction between rs11931074 in α-synuclein (SNCA) and α-HCH or β-HCH, respectively, as well as rs16940758 in the microtubule-associated protein tau (MAPT) gene and δ-HCH were related to increased risk of PD. In addition, α-HCH and propanil enhanced the production of reactive oxygen species and decreased of mitochondrial membrane potential. Propanil but not α-HCH induced the aggregation of α-synuclein.Conclusions: Elevated serum levels of α-HCH and propanil are associated with increased risk of PD. Serum levels of dieldrin were associated with depression and cognitive function in PD patients. The interaction between genetic variants and pesticides also increased the risk of PD. Effects of genetic variants and pesticides on the risk of PD should be studied in more detail with a larger sample size to further understand the mechanisms involved.
Residents' Performance of Single-Incision Pediatric Endo-Surgery Appendectomy (SIPESA) Versus Conventional Laparoscopic Appendectomy (CLA) in Two Centers
Authors: Raboei Enaam , Owiwi Yazeed , Ghallab Alaa , Alsaggaf Ameen , Alofi Turki , Zidan Mazen , Alawi Ahmed , Fayez Mohamed , Shalaby Hanin , Onazi Mohamed Al , Mohaidly Mohammed Al- , Babker Mohammed , Kamel Saleh , Al-Hindi Jawad , Batniji Khalil Al- , Omar Ihab
Published: August 2020

Background: The outcome of SIPESA performed by surgical residents is explored once in the literature. To the best of our knowledge, there are no published studies comparing the outcome of SIPESA versus CLA performed by the surgical residents.Aim: To assess the outcome of SIPESA at King Fahd Armed Forces Hospital (KFAFH), Jeddah versus CLA at Prince Sultan Military Medical City (PSMMC), Riyadh performed by surgical residents. Material & Methods: A retrospective comparative study of the outcome of SIPESA versus CLA conducted in two centers from January 2011 to July 2018. The two groups were compared for age, seniority of operating surgeon, mean operative time (MOT), perioperative complications and length of hospital stay (LOS).Results: 136 appendectomies (83(61%) SIPESA & 53(39%) CLA) were performed by residents between January 2011 and July 2018 in both centers. Postoperative complications were reported in 3.8% of CLA and 3.6% of SIPESA. There was no significant difference in postoperative complications between the two groups. The MOT of SIPESA and CLA was 92.25 minutes & 87.85 minutes respectively. Conclusion: SIPESA and CLA performed by residents are equally safe and feasible with no added morbidity. We believe that this good outcome is related to the adequate supervision of residents by experienced surgeons in conjunction with a properly structured training program. There was no significant difference in the outcome of both groups.
COVID-19: Needs assessment of the pharmacy profession and contributions so far across the Commonwealth
Authors: Ashiru-Oredope Diane , Chan Amy , Olaoye Omotayo , Rutter Victoria , Babar Zaheer-Ud-Din , Anderson Claire , Matuluko Ayodeji , Tuck Chloe , Halai Manjula , Wickens Hayley , Nambatya Winnie , Vadlamudi Rao , Anderson Raymond
Published: August 2020

BackgroundThe declaration of COVID-19 a pandemic by the World Health Organisation on the 11March 2020 marked the beginning of a global health crisis of an unprecedented natureand scale. The approach taken by countries across the world varied widely, however,the delivery of frontline healthcare was consistently recognised as being central to thepandemic response. This study aimed to identify and explore the issues currentlyfacing pharmacy teams across Commonwealth countries during the COVID-19pandemic. The study also evaluates pharmacy professionals’ understanding of keyknowledge areas from the COVID-19 webinar hosted by the CommonwealthPharmacists’ Association ( CPA) on 5 th June 2020.MethodA quantitative survey-based approach was adopted, using a 32-item questionnairedeveloped from the literature on pharmacy and pandemic response. The survey washosted on Survey Monkey and pilot tested. The final survey was disseminated by CPAmember organisations. A 6-item online questionnaire was sent via email to allattendees of CPA's COVID-19 webinar. Descriptive statistics on frequency distributionsand percentages were used to analyse the responses. Data were analysed usingMicrosoft® Excel (2010).ResultsThere were 545 responses from pharmacy professionals across 31/54 commonwealthcountries in Africa, Asia, the Americas, Europe and the Pacific. Majority of therespondents reported being at least somewhat worried (90%) and more than 65% werevery worried or extremely about the impact of COVID-19 on them personally andprofessionally. Nearly two-thirds of respondents stated finding it somewhat difficult orvery difficult to work effectively during the pandemic. Challenges mostly faced bypharmacy professionals working remotely included; general anxiety about the impact ofCOVID-19 on their lives (12%), and difficulties in communicating with their co-workers(12%). Most pharmacy professionals had not previously been actively involved in aglobal health emergency (82%) nor obtained training on global/public healthemergency preparedness (62%). Between 45% to 97% of the COVID-19 webinarattendees provided the correct answers to post-webinar questions, suggesting someimprovement in knowledge.ConclusionOur study confirms pharmacy professional’s concerns about practice during apandemic and provides preliminary data on the challenges and learning needs of theprofession. The CPA has since acted on these findings, providing on-goingopportunities to develop and refine resources for the profession as the pandemicevolves. Pharmacy professionals have also demonstrated improved knowledge on themanagement of COVID-19 and resources available for professionals.
Isolation and Identification of Nuc Nuclease Gene and Sea Enterotoxin Gene in Staphylococcus Aureus Isolates From Nasal Mucosa of Burn Hospital Staff
Authors: Karimzadeh Roxana , Ghassab Romina Karimzadeh
Published: August 2020

Objectives: Staphylococcus aureus is one of the main causes of nosocomial infections. The hospital staff as carriers of Staphylococcus aureus have an important role in spreading it among patients. This study aimed to investigate nuc gene, as S. aureus marker and sea gene, enterotoxin A gene nasal mucosa of sari burn hospital staff. In this cross-sectional study, a nasal swab of 40 staff of Burnt hospital of Sari was collected and isolated. The S. aureus was detected by biochemical tests such as Gram stain, catalase, coagulase. Then nuc and sea genes were identified after the extraction of DNA, by PCR technique and gel electrophoresis with specific primer.Results: From the 40 strains obtained from nasal of carriers, 20 S. aureus strains were isolated, and all of them included nuc gene, while 6 samples included sea gene. Given that every 20 samples had nuc gene, therefore this gene is a strong marker for S. aureus. Also, the presence of sea genes in some samples suggested the presence of enterotoxin A in hospital staff as a healthy carrier. Also, given that hospital staffs can be carriers of Staphylococcus aureus and spreading nosocomial infections, therefore identification of the carriers to prevent the spread of infection is essential.
Maternal perception of breastfeeding in children with unilateral cleft lip and palate: a qualitative research work
Authors: Cerón-Zapata Ana María María , Martínez-Delgado Cecilia María , Calderón-Higuita Gloria Emilia
Published: August 2020

BackgroundUnilateral cleft lip and / or palate (UCLP) is one of the most common congenital craniofacial abnormalities. The objective of this study was to describe maternal perception of breastfeeding in children with unilateral cleft lip and palate and to assess the role of breastfeeding counseling. MethodsQualitative descriptive method and phenomenological analysis were used to analyze the narratives. 28 mothers of patients with nonsyndromic UCLP treated with Nasoalveolar molding (NAM) between April 2015 and April 2017 were strategically selected and interviewed. Framework analysis was conducted for qualitative data. The CES University ethical committee approved the study. ResultsThe findings resulted in six main categories. First, contact with the CLP program, access to early diagnosis and timely treatment, perceptions of parents about health personnel on breastfeeding of CLP patients, perceptions of mothers toward breastfeeding, perception of advantages and disadvantages of the NAM technique regarding breastfeeding and assessment of the CLP program. ConclusionThe participants related difficulties with breastfeeding. Mothers acknowledged the clinical results when using the NAM obturator, as well as the support provided by the breastfeeding consultant.