bluuebunny/crossref_metadata_2025 huggingface dataset:
Emergency department and hospital admissions among people with dementia living at home or in nursing homes: results of the European RightTimePlaceCare project on their frequency, associated factors and costs
Authors: Afonso-Argilés F. Javier , Meyer Gabriele , Stephan Astrid , Comas Mercè , Wübker Ansgar , Leino-Kilpi Helena , Lethin Connie , Saks Kai , Soto-Martin Maria , Sutcliffe Caroline , Verbeek Hilde , Zabalegui Adelaida , Renom-Guiteras Anna
Published: October 2020

Background: Evidence is lacking on the differences between hospitalisation of people with dementia living in nursing homes and those living in the community. The objectives of this study were: 1) to describe the frequency of hospital admission among people with dementia in eight European countries living in nursing homes or in the community, 2) to examine the factors associated with hospitalisation in each setting, and 3) to evaluate the costs associated with it.Methods: The present study is a secondary data analysis of the RightTimePlaceCare European project. A cross-sectional survey was conducted with data collected from people with dementia living at home or who had been admitted to a nursing home in the last three months, as well as from their caregivers. Data on hospital admissions at three months, cognitive and functional status, neuropsychiatric symptoms, comorbidity, polypharmacy, caregiver burden, nutritional status, and falls were assessed using validated instruments. Multivariate regression models were used to investigate the factors associated with hospital admission for each setting. Costs were estimated by multiplying quantities of resources used with the unit cost of each resource and inflated to the year 2019.Results: The study sample comprised 1,700 people with dementia living in the community and nursing homes. Within three months, 13.8% and 18.5% of people living in nursing homes and home care, respectively, experienced ≥1 hospital admission. In the nursing home setting, only polypharmacy was associated with a higher chance of hospital admission, while in the home care setting, unintentional weight loss, polypharmacy, falls, and more severe caregiver burden were associated with hospital admission. Overall, the estimated average costs per person with dementia/year among participants living in a nursing home were lower than those receiving home care.Conclusion: Admission to hospital is frequent among people with dementia, especially among those living in the community, and seems to impose a remarkable economic burden. The identification and establishment of an individualised care plan for those people with dementia with polypharmacy in nursing homes, and those with involuntary weight loss, accidental falls, polypharmacy and higher caregiver burden in the home care setting, might help preventing unnecessary hospital admissions.
Sperm miRNAs— potential mediators of bull age and early embryo development
Authors: Wu Chongyang , Blondin Patrick , Vigneault Christian , Labrecqu Rémi , Sirard Marc-André
Published: October 2020

Background: Sperm miRNAs were reported to regulate spermatogenesis and early embryonic development in some mammals including bovine. The dairy cattle breeding industry now tends to collect semen from younger bulls under high selection pressure at a time when semen quality may be suboptimal compared to adult bulls. Whether the patterns of spermatic miRNAs are affected by paternal age and/or impact early embryogenesis is not clear. Hence, we generated small non-coding RNA libraries of sperm collected from same bulls at 10, 12, and 16 months of age, using 16 months as control for differential expression and functional analysis. Results: We firstly excluded all miRNAs present in measurable quantity in oocytes according to the literature. Of the remaining miRNAs, ten sperm-borne miRNAs were significantly differentially expressed in younger bulls (four in the 10 vs 16 months contrast and six in the 12 vs 16 months contrast). Targets of miRNAs were identified and compared to the transcriptomic database of two-cell embryos, to genes related to two-cell competence, and to the transcriptomic database of blastocysts. Ingenuity pathway analysis of the targets of these miRNAs suggested potential influence on the developmental competence of two-cell embryos and on metabolism and protein synthesis in blastocysts. Conclusions: The results showed that miRNA patterns in sperm are affected by the age of the bull and may mediate the effects of paternal age on early embryonic development.
Effect of Biomechanical Properties on Myopia: a Study of New Corneal Biomechanical Parameters
Authors: Han Fang , Li Mengdi , Wei Pinghui , Ma Jiaonan , Jhanji Vishal , Wang Yan
Published: October 2020

Background: To assess the corneal stress-strain index (SSI), which is a marker for material stiffness and corneal biomechanical parameters, in myopic eyes.Methods: A total of 1054 myopic patients were included in this study. Corneal visualisation Scheimpflug technology was used to measure the SSI. Corneal biomechanics were assessed using the first and second applanation times (A1-and A2-times); maximum deflection amplitude (DefAmax); deflection area (HCDefArea); the highest concavity peak distance (HC-PD), time (HC-time), and deflection amplitude (HC-DefA); integrated radius (IR); whole eye movement (WEM); stiffness parameter (SP-A1;, biomechanically corrected intraocular pressure (BIOP); and Corvis biomechanical index (CBI). Scheimpflug tomography was used to obtain the mean keratometery (Km) and central corneal thickness (CCT). According to the spherical equivalent (SE) (low myopia: SE ≥ -3.00D and high myopia: SE ≤ -6.00D.), the suitable patients were divided into two groupsResults: The mean SSI value was 0.854±0.004. The SSI had a positive correlation with A1-time ((r=0.272), HC-time (r=0.218), WEM (r=0.288), SP-A1 (r=0.316), CBI (r=0.199), CCT (r=0.125), bIOP (r=0.230), and SE (r=0.313) (all p-values＜0.01) . The SSI had a negative correlation with HCDefA (r=-0.721), HCDefArea (r=-0.665), HC-PD(r=-0.597), IR (r=-0.555), DefAmax (r=-0.564), and Km (r=-0.103) (all p-values＜0.01). There were significant differences in SSI (t=8.960, p＜0.01) and IR (t=-3.509, p＜0.01) between the low and high myopia groups.Conclusions: In different grades of myopia, the SSI values were lower in eyes with higher SEs. It indicates that the mechanical strength of the cornea may be compromised in high myopia. The SSI was positively correlated with the spherical equivalent, and it may provide a new way to study the mechanism of myopia.
Perception of the healthcare professionals towards the current trauma and emergency care system in Kabul, Afghanistan: A mixed method study
Authors: Khudadad Umerdad , Aftab Wafa , Ali Asrar , Khan Nadeem Ullah , Razzak Junaid , Siddiqi Sameen
Published: October 2020

Background: Trauma and injury contribute to 11% of the all-cause mortality in Afghanistan. The study aimed to explore the perceptions of the healthcare providers (pre and in-hospital), hospital managers and policy makers of the public and private health sectors to identify the challenges in the provision of an effective trauma care in Kabul, Afghanistan.Methods: A concurrent mixed method design was used, including key-informant interviews (healthcare providers, hospital managers and policy makers) of the trauma care system (N=18) and simultaneous structured emergency care system assessment questionnaire (N = 35) from July 15 to September 25, 2019. Interviews were analyzed using thematic analysis and structured questionnaire data were descriptively analyzed. Results: Four themes were identified that describe the challenges: 1) pre-hospital care, 2) cohesive trauma management system, 3) physical and human resources and 4) stewardship. Some key challenges were found related to scene and transportation care, in-hospital care and emergency preparedness within the wider trauma care system. Less than 25% of the population is covered by the pre-hospital ambulance system (n=23, 65.7%) and there is no communication process between health care facilities to facilitate transfer (n=28, 80%). Less than 25% of patients with an injury requiring emergent surgery have access to surgical care in a staffed operating theatre within two hours of injury (n=19, 54.2%) and there is no regular assessment of the ability of the emergency care system to mobilize resources (human and physical) to respond to disasters, and other large-scale emergencies (n=28, 80%). Conclusion: This study highlighted major challenges in the delivery of trauma care services across Kabul, Afghanistan. Systematic improvement in the workforce training, structural organization of the trauma care system and implementing externally validated clinical guidelines for trauma management could possibly enhance the functions of the existing trauma care services. However, an integrated state-run trauma care system will address the current burden of traumatic injury more effectively within the wider healthcare system of Afghanistan.
The Evaluation of Dental English Education in China Based on ‘Guanghua Cup’ International Clinical Skill Exhibition Activity
Authors: Wang Xi , Liu Yangjingwen , Yang Le , Zhou Kai , Cao Yang , Hong Yun , Huang Shuheng , Lin Zhengmei
Published: October 2020

Background: English education in professional areas has become more and more important with the increasing internationalization of health profession education in countries around the world. In this study, we aimed to evaluate current Chinese stomatology English education based on Chinese participants’ ability to apply stomatology English during an international stomatology skill competition called the ‘Guanghua Cup activity’.Methods: The enrollment ratio of English and Chinese volunteers and the answer rate and accuracy of Chinese and international contestants on the English knowledge quiz were statistically described. A 5-point Likert scale questionnaire was delivered to all participants. The data were analyzed using the Spearman test, Kruskal-Wallis rank sum test and Mann-Whitney U test.Results: Among the 194 students, the English and Chinese volunteer enrollment rate was 7.73% and 30.93%, respectively. The answer rate of Chinese contestants and international contestants in the English quiz was 25% and 75%, with an accuracy rate of 50% and 66.70%, respectively. The questionnaire was graded by Likert 5-level classification. There was a positive correlation between the use of English textbooks in classes and the communication with international teachers and students in the competition (Rs=0.348, p=0.016). English volunteers had more preparation in English before the competition, more opportunities to communicate with international peers, and greater improvement in English ability than the contestants and Chinese volunteers(p<0.001). After the competition, all participants paid more attention to stomatology English (p<0.001).Conclusions: Chinese stomatology students have difficulty in stomatology English application. The ‘Guanghua Cup’ helps to improve English proficiency of English volunteers and arouses the interest of stomatology English for all participants. Chinese stomatology scho
The Association between Depressive Symptoms and Self-Rated Health among University Students: A Cross-Sectional Study in France and Japan
Authors: Ishida Mami , Montagni Ilaria , Matsuzaki Keiichi , Shimamoto Tomonari , Cariou Tanguy , Kawamura Takashi , Tzourio Christophe , Iwami Taku
Published: October 2020

Background: Depressive disorders in University students have risen dramatically in the past few decades to the extent that students’ mental health has become a current global public health priority. Obtaining information from University students about their mental health is challenging because of potential embarrassment of disclosing one’s concerns and fear of stigmatization. Self-rated health might be a good solution to evaluate mental health state by a simple and neutral indicator. The aim of the study is to investigate the association between depressive symptoms and self-rated health by sex among University students in France and Japan. Methods: A cross-sectional study was conducted by using two large cohorts of students aged ≥18 years (n=5,655 in Bordeaux, France and n=17,148 in Kyoto, Japan). Depressive symptoms (PHQ-2 scale), Likert scale of self-rated health, socio-demographic characteristics and health habits were collected through self-administered questionnaires. Multivariate logistic regression models were performed to describe the association between depressive symptoms and other variables including self-rated health, stratified by sex. Results: A high score of PHQ-2 (high depressive symptoms) was associated with poor self-rated health in both cohorts independently of all other variables (OR 2.82, 95%CI 1.99-4.01 in France, OR 7.10, 95%CI 5.76-8.74 in Japan). Although the prevalence of depressive symptoms between sexes was different in French students (males 15.4%, females 25.0%, p<0.001), it was similar in Japanese students (males 3.5%, females 3.3%, p=0.466), who reported less depressive symptoms than French students. The association between depressive symptoms and poor self-rated health was greater in Japanese females (OR 12.40, 95%CI 7.74-20.00) than in males (OR 6.30, 95%CI 4.99-7.95), whereas the strength of the association was almost similar in French students (OR 2.17, 95%CI 0.86-5.47 in males, OR 2.98, 95%CI 2.03-4.38 in females). Conclusions: Depressive symptoms were associated with self-rated health among University students in both countries with slightly differences in sex. Self-rated health would be a simple, reliable and universal indicator for healthcare professionals and University staff to identify students at risk of depression.
A standardized framework to evaluate the quality of studies using TDABC in healthcare: The TDABC in Healthcare Consortium Consensus Statement
Authors: Etges Ana Paula Beck da Silva , Polanczyk Carisi Anne , Urman Richard D.
Published: October 2020

Background: This Consensus Statement introduces a standardized framework, in a checklist format, to support future development and report of TDABC studies in healthcare, and to encourage their reproducibility. Additionally, it establishes the first formal networking of TDABC researchers through the creation of the TDABC for Health Care Consortium.Methods: A consensus group of researchers reviewed the most relevant TDABC studies available in Medline and Scopus databases to identify the initial elements of the checklist. Using a Focus Group process, each element received a recommendation regarding where in the scientific article section it should be placed and whether the element was required or suggested. A questionnaire was circulated with expert researchers in the field to provide additional recommendations regarding the content of the checklist and the strength of recommendation for each included element. Results: The TDABC standardized framework includes 32 elements, provides recommendations where in the scientific article to include each element, and the strength of each recommendation. All 32 elements were validated, with 21 elements classified as mandatory and 11 as suggested but not mandatory. Conclusions: This is the first standardized framework to support the development and reporting of TDABC research in healthcare and to stablish a community of experts in TDABC methodology. We expect that it can contribute to scale strategies that would result in cost-savings outcomes and in value-oriented strategies that can be adopted in healthcare systems and institutions.
Serum SP-A and KL-6 levels can predict the improvement and deterioration of patients with interstitial pneumonia with autoimmune features
Authors: Wang Jingxian , Zheng Peiyan , Huang Zhifeng , Huang Huimin , Xue Mingshan , Liao Chenxi , Zhong Nanshan , Sun Baoqing
Published: October 2020

BackgroundSome patients with interstitial pneumonia with autoimmune features (IPAF) showed a progressive course despite therapy. This study aimed to evaluate whether serial changes in the serum levels of surfactant protein-A (SP-A) and Krebs von den Lungen-6 (KL-6) can predict disease progression. MethodsSixty-four patients with IPAF and 41 patients with non-fibrotic lung disease (non-FLD) were examined. Based on long-term changes in lung function, 36 IPAF patients who were followed up for more than 3 months were divided into a progressive group (n=9), an improvement group (n=13), and a stable group (n=14). Serum KL-6 and SP-A levels were measured. The sensitivity, specificity, cut-off value, and area under the curve (AUC) value for each of the indices were determined using receiver operating characteristic (ROC) curve analysis. The expression differences in these biomarkers and their correlation with disease severity were analyzed. ResultsCompared with non-FLD patients, serum SP-A and KL-6 levels in IPAF patients were increased significantly [SP-A: (p < 0.001); KL-6: (p < 0.001)] and negatively correlated with DLCO (SP-A: rS = -0.323, p = 0.018; KL-6: rS = -0.348, p = 0.0011). In patients with progressive disease, the posttreatment serum SP-A and KL-6 levels were increased significantly compared with pretreatment levels [SP-A: (p = 0.021); KL-6: (p = 0.008)]. In patients showing improvement, the levels were decreased significantly [SP-A (p = 0.007) and KL-6 (p = 0.002)]. Changes in serum biomarkers (Delta SP-A and Delta KL-6) were significantly negatively correlated with changes in lung function (Delta FVC, Delta DLCO and Delta FEV1) (rS = 0.482, p < 0.05). A significant positive correlation was found between Delta SP-A and Delta KL-6 (rS = 0.482, p < 0.001).ConclusionsSerum SP-A and KL-6 offer high sensitivity and specificity for the diagnosis of IPAF. The decrease in serum SP-A and/or KL-6 levels in patients with IPAF is related to the improvement in pulmonary function. SP-A and KL-6 may be important biomarkers for predicting disease progression in patients with IPAF.
Network analysis of firearm movement among US states
Authors: Takada Sae , Choi Kristen , Natsui Shaw , Saadi Altaf , Buchbinder Liza , Easterlin Molly , Zimmerman Frederick
Published: October 2020

Background: The movement of firearm across state lines may decrease the effectiveness of state-level firearm laws. Yet how state-level firearm policies affect cross-state movement have not yet been widely explored. This study aims to characterize the interstate movement of firearms and its relationship with state-level firearm policies. Methods: Cross-sectional time series network analysis of interstate firearm movement using Bureau of Alcohol, Tobacco, Firearms, and Explosives firearm trace data (2010 -2017). We constructed the network of firearm movement between 50 states. We used zero-inflated negative binomial regression to estimate the relationship between the number of a state’s firearm laws and number of states for which it was the source of 100 or more firearms, adjusting for state characteristics. We used a similar model to examine the relationship between firearm laws and the number of states for which a given state was the destination of 100 or more firearms.Results: Over the 8-year period, states had an average of 26 (SD 25.2) firearm laws. On average, a state was the source of 100 or more crime-related firearms for 2.2 (SD 2.7) states and was the destination of 100 or more crime-related firearms for 2.2 (SD 3.4) states. Greater number of firearm laws was associated with states being the source of 100 or more firearms to fewer states (IRR0.67 per SD, p<0.001), higher odds of not being a source to any states (aOR1.56 per SD, p<0.001), and states being the destination of 100 or more firearms from more states (IRR1.83 per SD, p<0.001).Conclusions: Restrictive firearm policies are associated with less movement of firearms to other states, but with more movement of firearms from outside states. The effectiveness of state-level firearm-restricting laws is complicated by a network of interstate firearm movement.
Improved prognosis for recurrent epithelial ovarian cancer by early diagnosis and 125I seeds implantation during suboptimal secondary cytoreductive surgery: a case report and literature review
Authors: xiao lin , Tang Junying , Li Wenbo , Xu Xuexun , Zhang Hao
Published: October 2020

Background: Epithelial ovarian cancer (EOC) has the worst prognosis in all of gynecologic malignant tumors because of its high recurrence and eventually chemo-resistance. Early diagnosis of recurrence is crucial to avoid diffuse dissemination. Failure of traditional treatment in recurrent epithelial ovarian cancer remains a challenge for clinicians. On the other hand, 125I brachytherapy has been accepted as a useful and hopeful treatment for multiple advanced cancers in recent years. However, its success in advanced epithelial ovarian cancer is limited. Here we report a case of recurrent ovarian cancer who had been early diagnosis of isolated recurrence and successfully treated with 125I seeds implantation during suboptimal cytoreductive surgery.Case presentation: A 59-year-old woman presented with recurrent epithelial ovarian cancer who have had a history of ovarian cancer stage IIIB and an R0 resection had been achieved nearly two years before presented in our hospital. She underwent suboptimal secondary cytoreductive surgery after four cycles of chemotherapy with little effectiveness and severe chemotherapy-related side effects. Approximately 70% of the cancer-bulk was resected during surgery. For residual lesion which fixed around the right ureter and right external iliac vessel, 125I seeds implantation was performed. Postoperatively, the patient was treated with two cycles of combination chemotherapy with paclitaxel and carboplatin. The patient was free of disease at 26 months’ follow-up period. Conclusion: In recurrent EOC patients with unresectable isolated lesion, salvage 125I seeds implantation are feasible and may contribute to survival.
An evaluation of the effectiveness, facilitators and barriers of HIV Teen Clubs in achieving successful transition from teen to adult care in Blantyre, Malawi using the RE‐AIM Framework.
Authors: Galagade Jerome , Mwapasa Victor
Published: October 2020

Background: High attrition is a major problem for Adolescent Living with HIV (ALHIV) transitioning from pediatric to adult care. Although the HIV Teen Club model has been shown to promote antiretroviral (ARV) adherence and viral suppression among ALHIV, its effect on promoting transitioning ALHIV from pediatric to adult care has not been formally evaluated. We sought to estimate the proportion of ALHIV enrolled in HIV Teen Clubs who successfully transitioned to adult care within six months of the expected transition time and assess health facilities’ fidelity in implementing HIV Teen Clubs’ adult care transition protocols and factors associated with successful transition to adult Care.Methods: From September 2018 to June 2019, we conducted a retrospective descriptive cohort study involving ALHIV attending HIV Teen Clubs in 14 primary health facilities in Blantyre, Malawi who had reached the recommended transition age of 18/19 years between July - December 2017. After obtaining consent, we reviewed their records to assess the proportion who successfully transitioned and also factors associated with transitioning. Checklist was used to ascertain fidelity of implementation of HIV Teen Club transition protocols. In-depth interviews were conducted with service providers (SP) in health facilities providing HIV Teen Club to get their perspectives on reasons for successful or unsuccessful transition.Results: Of the 131 eligible ALHIV enrolled in the study, only 6.9% (n=9) successfully transitioned to adult care within six months of the expected transition time. The overall fidelity in implementing adult care transition protocols in health facilities was medium. There was an association between implementation fidelity and ALHIV successful transition with 2 out of 3 health facilities with high implementation fidelity also successfully transitioning ALHIV into adult care. Successful ALHIV transitioning was associated with urban location of health facilities and ownership of the facilities by NGOs. SPs reported that lack of training in transitioning ALHIV, lack of clear guidelines, inadequate human resource and refusal of ALHIV to transition were some of the health system factors negatively influencing successful transition.Conclusions: Training and mentorship of SP in implementing transitioning protocols and adequately resourcing HIV teen clubs may improve their operations and facilitate successful transitioning.
U-shaped association between serum bilirubin levels and peripheral arterial disease in Chinese males with hypertension
Authors: Shi Yumeng , Hu Lihua , Li Minghui , Huang Xiao , Ding Congcong , Zhou Wei , Wang Tao , Zhu Lin juan , Bao Huihui , Cheng Xiaoshu
Published: October 2020

Background: Previous studies have indicated that serum total bilirubin might play an important role in peripheral artery disease (PAD). However, the effects of different levels of serum total bilirubin (TBiL) on PAD development remain uncertain, and there are limited data in male participants. We aimed to examine the prevalence of PAD and TBiL among Chinese male adults with hypertension.Methods: A total of 5129 hypertensive male subjects aged 27-93 years were included in the current study. The outcome was peripheral arterial disease (PAD), defined as present when the ABI of either side was ≤ 0.90.Results: Of 5129 hypertensive male participants, 194 (3.78%) had PAD, and the mean serum total bilirubin was 15.67 (7.76) μmol/L. Compared to participants in Q2-Q3 of LgTBiL, there was a significantly increased prevalence of PAD for participants in both Q1 (OR, 1.49; 95% CI: 1.04-2.14) and Q4 (OR, 1.70; 95% CI: 1.16-2.48). After adjusting for potential confounders, a nonlinear U-shaped relationship was detected between TBiL and the prevalence of PAD, and the inflection point was calculated to be 1.08 (LgTBiL = 1.08, TBiL = 12.02 μmol/L). The ORs (95% CIs) were 0.11 (0.02, 0.83) on the left side of the inflection point and 5.26 (1.59, 17.38) on the right side of the inflection point. Similar results were found in various subgroups.Conclusions: This cross-sectional study showed that there was a U-shaped curve for the prevalence of PAD with TBiL concentration in Chinese males with hypertension, with a turning point at 12.02 μmol/L.
Correlation of Next-Generation Sequencing Based Genotypic Profiles with MICM Characteristics in NPM1 Mutated Acute Myeloid Leukemia
Authors: Wang Biao , Yang Bin , Wu Wei , Liu Xuan , Li Haiqian
Published: October 2020

The purpose of this study was to analyze association between next-generation sequencing (NGS) genomic profile and conventional MICM characteristics in patients with acute myeloid leukemia (AML) with NPM1 mutation (NPM1mut). We selected 238 NPM1mut patients with available NGS information on 112 genes related to blood diseases, using χ2 and Mann-Whitney U test to analyze the distribution correlation between genomic alterations and MICM parameters. Compared with NPM1mut/FLT3-ITD(−), the NPM1mut/FLT3-ITD(+) group presented a slightly common M5 [78/143 (54.5%) vs. 64/95 (67.4%); P=0.048], more higher CD34 and CD7 expression rates (CD34: 20.6% vs. 47.9%, P<0.001; CD7: 29.9% vs. 61.5%, P<0.001), and lack of favorable- and adverse-risk karyotypes (6.4% vs. 0%; P=0.031). In entire NPM1mut cohort, totaling 240 NPM1 mutation events were identified, of whom 10 (10/240, 4.2%) were missense types. When confining analysis to the 205 cases with NPM1mut insertions/deletions type and normal karyotype, multivariable logistic analysis showed that FLT3-ITD was positively correlated with CD34 and CD7 expression (HR=5.29 [95% CI 2.64-10.60], P<0.001; HR=3.47 [95% CI 1.79-6.73], P<0.001; respectively). Ras-pathway mutation was positively correlated with HLA-DR expression (HR=4.05 [95% CI 1.70-9.63], P=0.002), and KRAS mutation negatively with MPO expression (HR=0.18 [95% CI 0.05-0.62], P=0.007). DNMT3A-R882 was positively correlated with CD7 and HLA-DR expression (HR=3.59 [95% CI 1.80-7.16], P<0.001; HR=13.41 [95% CI 4.56-39.45], P<0.001; respectively). DNMT3A mutation was negatively correlated with MPO expression (HR=0.35 [95% CI 1.48-8.38], P=0.004). TET2/IDH1 mutations were negatively correlated with CD34 and CD7 expression (HR=0.26 [95% CI 0.11-0.62], P=0.002; HR=0.30 [95% CI 0.14-0.62], P=0.001; respectively), and positively with MPO expression (HR=3.52 [95% CI 1.48-8.38], P=0.004). NPM1mut co-existing mutations in signaling pathways (FLT3-ITD and Ras-pathway) and methylation modifiers (DNMT3A and TET2/IDH1) are linked with the expression of CD34, CD7, HLA-DR and MPO, thereby providing a mechanism explanation for the immunophenotypic heterogeneity of this AML entity.
rTMS modulates precuneus-hippocampal subregion circuit in subjective cognitive decline 
Authors: Chen Jiu , Hu Guanjie , Xue Chen , Qi Wenzhang , Xu Wenwen , Chen Shanshan , Rao Jiang , Liu Wan , Zhang Fuquan , Zhang Xiangrong
Published: October 2020

Background: To identify whether repetitive transcranial magnetic stimulation (rTMS) could ameliorate the HIPsub network connectivity by modulating one node of hippocampal subregions (HIPsub) network in subjective cognitive decline (SCD) subjects.Methods: In the first cohort, we analyzed three HIPsub (HIPe, HIPc, and HIPp) functional connectivity to identify HIPsub network connectivity alterations that relate to SCD. And we further applied a SVM approach using the alterations to identify how well this could distinguish SCD from CN. In the second cohort, rTMS with 5-day of once-daily for 2 weeks was used to modulate the altered HIPsub network connectivity in a sham-controlled design.Results: SCD subjects showed differently altered patterns of HIPsub network connectivity compared to controls. The SVM classifier showed that the abnormalities had a high power to discriminate SCD from CN, with an ACC of 86.0%, an AUC of 92.9%, 83.8% sensitivity, and 89.1% specificity. Restoration of HIPc connectivity with left parahippocampa gyrus and HIPp connectivity with left middle temporal gyrus corresponded to amelioration of episodic memory in SCD patients after 2 weeks of rTMS. Conclusion: rTMS can restore the posterior hippocampus connectivity by modulating the precuneus in SCD subjects. Correction of breakdown in HIPc and HIPp related to cognitive and perceptual processing can simultaneously ameliorate episodic memory in SCD subjects.
Accurate and Objective Determination of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Disease Severity with a Wearable Sensor
Authors: Palombo Turner , Campos Andrea , Vernon Suzanne D. , Roundy Shad
Published: October 2020

Background Approximately 2.5 million people in the U.S. suffer from myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). This disease negatively impacts patients’ ability to function, often resulting in difficulty maintaining employment, sustaining financial independence, engaging socially with others, and in particularly severe cases, consistently and adequately performing activities of daily living. The focus of this research was to develop a sensor-based method to measure upright activity defined as time with feet on the floor and referred to as UpTime, as an indicator of ME/CFS disease severity. Methods A commercially available inertial measurement unit (IMU), the Shimmer, was selected for this research. A Kalman filter was used to convert IMU data collected by the Shimmer to angle estimates. Angle estimate accuracy was confirmed by comparison to a motion capture system. Leg angle estimates were then converted to personalized daily UpTime scores using a critical angle of 39º from vertical to differentiate between upright (feet on the floor) and not upright. A six-day, case-control study with 15 subjects (five healthy controls, five moderate-level ME/CFS, and five severe-level ME/CFS) was conducted to determine the utility of UpTime for assessing disease severity. Results UpTime was found to be a significant measure of ME/CFS disease severity. Severely ill ME/CFS patients spend less than 20% of each day with feet on the floor. Moderately ill ME/CFS patients spend between 20-30% of each day with feet on the floor. Healthy controls have greater than 30% UpTime. IMU-measured UpTime was more precise than self-reported hours of upright activity which were over-estimated by patients. Conclusions UpTime is an accurate and objective measure of upright activity, a measure that can be used to assess disease severity in ME/CFS patients. Due to its ability to accurately monitor upright activity, UpTime can also be used as a reliable endpoint for evaluating ME/CFS treatment efficacy. Future studies with larger samples and extended data collection periods are required to fully confirm the use of UpTime as a measure of disease severity in ME/CFS. With the added perspective of large-scale studies, this sensor-based platform could provide a recovery path for individuals struggling with ME/CFS.
Scale Validation for the identification of falsified hand sanitizer: Public and Regulatory Authorities Perspectives from United Arab Emirates
Authors: Jairoun Ammar Abdulrahman , Al-Hemyari Sabaa Saleh , Shahwan Moyad , El-Dahiyat Faris , Jamshed SHAZIA
Published: October 2020

Background: Since the time of declaration of global pandemic of COVID-19 by World Health Organization (WHO), falsified hand sanitizers surfaced regularly in markets, posing possible harm to public due to unlisted inclusion of methanol. The current research is an attempt to develop and validate a tool to document falsified hand sanitizer in the UAE community.Method: A descriptive cross-sectional community-based study was conducted among 1280 randomly selected participants. Respondents were sent a web-based electronic link to the survey via email. Content validity, factor analyses and known group validity were used to develop and validate a new scale to identify falsified hand sanitizer. Test-retest reliability, internal consistency, item internal consistency (IIC), and intraclass correlation coefficients (ICCs) were used to assess the reliability of the scale. SPSS version 24 was used to conduct data analysis.Results: A total of 1280 participants were enrolled in the study. The content validity index (CVI) was 0.83 with the final scale of 12 items. The Kaiser-Meyer-Olkin (KMO) value was 0.788, with the Bartlett test of sphericity achieving statistical significance (p <0.001). Our factor analysis revealed a 3-component model. The 3-factor solution was confirmed by PCFA analysis and had associations with good fit values. The PCFA for NFI was 0.970, CFI 0.978, and TLI 0.967. All values were in excess of 0.95, with RMSEA values below 0.06 at 0.03; all of these values indicated a good model fit. The Cronbach's alpha was good overall (0.867). All factors had a Cronbach's alpha value in excess of 0.70. The instrument demonstrated that every item met the IIC correlation standard ≥ 0.40. The scale displayed good overall ICC statistics of 0.867 (95% CI 0.856 - 0.877) with statistical significance (p < 0.001). The scale's test-retest reliability was assessed through correlation of the falsified hand sanitizer identification score of respondents at the two time points. The test-retest correlation coefficient was 0.770 (p value <0.01). Participants with post-graduate education were more likely to identify the falsified hand sanitizer compared to those with high school education. (p < 0.001).Conclusions: This study developed and validated a new scale for the measurement of falsified hand sanitizer. This is expected to improve and promote collaboration between the health regulators and the public and hereby encourage customer satisfaction and participation.
Costs and healthcare utilisation of patients with heart failure in Spain
Authors: Escobar Carlos , Varela Luis , Palacios Beatriz , Capel Margarita , Sicras Antoni , Sicras Aram , Hormigo Antonio , Alcazar Roberto , Manito Nicolas , Botana Manuel
Published: October 2020

Background: Increasing the knowledge about heart failure (HF) costs and their determinants is important to ascertain how HF management can be optimized, leading to a significant decrease of HF costs. This study evaluated the cumulative costs and healthcare utilisation in HF patients in Spain. Methods: Observational, retrospective, population-based study using BIG-PAC database, which included data from specialized and primary care of people ≥18 years, from seven autonomous communities in Spain, who received care for HF between 2015 and 2019. The healthcare and medication costs were summarized on a yearly basis starting from the index date (1st January 2015), and then cumulatively until 2019.Results: We identified 17,163 patients with HF (year 2015: mean age 77.3±11.8 years, 53.5% men, 51.7% systolic HF, 43.6% on NYHA functional class II). During the 2015-2019 period, total HF associated costs reached 15,373 Euros per person, being cardiovascular disease hospitalizations the most important determinant (75.8%), particularly HF hospitalizations (51.0%). Total medication cost accounted for 7.0% of the total cost. During this period, there was a progressive decrease of cardiovascular disease hospital costs per year (from 2,834 Euros in 2015 to 2,146 Euros in 2019, P<0.001), as well as cardiovascular and diabetic medication costs. Conclusions: During the 2015-2019 period, costs of HF patients in Spain were substantial, being HF hospitalizations the most important determinant. Medication costs represented only a small proportion of total costs. Improving HF management, particularly through the use of drugs that reduce HF hospitalization may be helpful to reduce HF burden.
Agnostic Evaluation of Ipilimumab and Nivolumab Association: a Metanalysis.
Authors: Marchetti Paolo , Botticelli Andrea , Ascierto Antonio Paolo , Curigliano Giuseppe , Giannarelli Diana
Published: October 2020

Background. Ipilimumab and Nivolumab, targeting the molecules CTLA-4, PD-1, respectively,have shown efficacy against several types of cancer. Despite these results, only a small percentage of patients maintains a long-lasting effect. Even Ipilimumab, in combination with nivolumab, has demonstrated a significant clinical benefit in multiple tumor types. However, no trial has been designed with the primary endpoint to compare the efficacy of nivolumab plus ipilimumab combined, compared to nivolumab alone. Hence, the added value of ipilimumab in the combination has not clearly been established yet. The aim of this study was to demonstrate the superiority of the combination strategy compared to the single agent therapy.Materials and methods. We performed a meta-analysis of Phase I-II-III Clinical Trials, published from 2010 up to 2020, in which the combination of ipilimumab plus nivolumab was compared to nivolumab alone. We extracted ORR, OS and PFS HR on the basis of treatment from the subgroup analysis of each trial. Results. A total of 7 trials were included in the present meta-analysis. Overall, 1313 patients were treated with the nivolumab plus ipilimumab combination compared to 1110 patients treated with nivolumabalone. All trials reported the Objective response rate(ORR), no heterogeneity was found among studies and the pooled Odds Ratio was highly in favor of the nivolumab plus ipilimumab combination with respect to nivolumab alone (1.683; 95% CI: 1.407-2.012; P<0.0001). Three studies were considered for Progression free survival (PFS) analysis, and the pooled Hazard Ratio favored the combination of nivolumab plus ipilimumab with respect to nivolumab alone (0.807; 95% CI: 0.719-0.907; P<0.0001). The Overall survival(OS) endpoint was considered only in 2 trials, and the pooled HR favored, also in this case, the combination of nivolumab plus ipilimumab with respect to nivolumab alone (0.87; 95% CI: 0.763-0.997; P=0.045).Conclusions. The combination of ipilimumab plus nivolumab seems to be superior to nivolumab alone in cancer patients, regardless of histology.
Association between electronic cigarette use and tobacco cigarette smoking initiation in adolescents: A systematic review and meta-analysis
Authors: O'Brien Doireann , Long Jean , Quigley Joan , Lee Caitriona , McCarthy Anne , Kavanagh Paul
Published: October 2020

Aim: This systematic review of longitudinal cohort studies aimed to explore whether electronic cigarette (e-cigarette) use by adolescents who had never smoked conventional tobacco cigarettes (tobacco cigarettes) at baseline was associated with subsequent initiation of tobacco cigarette smoking. The analysis included studies based in Europe and North America. Methods: This study followed all the principles of a systematic review and meta-analysis. A key word search identified peer-reviewed literature published between 1 January 2005 and 2 October 2019 from seven bibliographic databases and one search engine. Using a predefined inclusion/exclusion criteria two authors independently screened abstracts, and subsequently, full text papers. Eligible papers were quality assessed and scored by two authors. Included papers had data on population characteristics, exposure and outcome measures extracted into an adapted Cochrane Data Extraction Form. Statistical analysis was preceded by a feasibility assessment, and included a pairwise random effects meta-analysis, and sensitivity and subgroup analyses. Findings: From an initial 6,619 studies, 14 unique studies in 21 papers were identified. Overall, the studies populations were between 13 and 19 years at baseline. Nine of the 14 unique longitudinal studies with follow-up periods between 4 and 24 months were eligible for inclusion in a meta-analysis of the association between ever use of e-cigarettes and subsequent initiation of tobacco cigarette use. Based on primary study adjusted odds ratios, our meta-analysis calculated a 4.06 (95% confidence interval (CI): 3.00-5.48) times higher odds of initiating tobacco cigarette smoking for those who had ever used e-cigarettes at baseline, although the odds ratio was reduced slightly (to 3.71 times odds, 95%CI: 2.83-4. 86) when only the four high-quality studies were included. The initial meta-analysis model had a moderate to high statistical heterogeneity, sensitivity analysis restricted to high-quality studies had a low to moderate statistical heterogeneity.Conclusion: The systematic review found that e-cigarette use was associated with initiation of tobacco cigarette smoking among adolescents in Europe and North America, identifying a potentially serious public health harm. Given the widespread availability and use of e-cigarettes, this study further supports urgent action by policymakers to prevent their use by adolescents to reduce direct harms in this vulnerable population group, as well as to protect gains in reducing tobacco cigarette initiation.
Higher expression of monocyte chemotactic protein 1 in mild COVID-19 patients may be correlated with the inhibition of IFN signaling
Authors: Xi Xueyan , Guo Yang , Zhu Min , Wei Yuhui , Li Gang , Du Boyu , Wang Yunfu
Published: October 2020

Background: The level of chemokines was markedly elevated in severe COVID-19 patients. But the role of chemokines in mild COVID-19 has not yet been established. However, most of the COVID-19 patients in Shiyan City, China, had mild cases. The purpose of this study is to evaluate the level of chemokines in mild COVID-19 patients and explore the correlation between chemokines and host immune response.Methods: In this study, the level of chemokines in the serum for COVID-19 patients in Shiyan City was detected by ELISA. The expression of chemokine receptors and other signal molecules was measured by real-time PCR.Results: We first demonstrated that COVID-19 patients are characterized by higher level of chemokines. Meanwhile, monocyte chemotactic protein 1 (MCP-1) has also shown higher expression in patients with mild cases of COVID-19. The receptor of MCP-1, CCR2, was also found to be expressed at higher level in the same mild COVID-19 patients. Finally, we found the downregulation of interferon regulatory factor 3 (IRF3) was significantly negative correlated with the concentration of MCP-1 in mild COVID-19 patients.Conclusion: Higher expression of MCP-1 in mild COVID-19 patients may be correlated with the inhibition of IFN signaling. The finding adds our understanding to the immune-pathologic mechanisms of SARS-CoV-2 infection, and provides potential therapeutic targets and strategies.
Microorganisms associated with intraamniotic infection among women with preterm birth at Ruhengeri Referral Hospital, Rwanda: A case-control study
Authors: Yadufashije Callixte , Umugwaneza Jasmine , Izere Cedrick , Munyeshyaka Emmanuel , Mala Albert Onyango , Niyonzima François , Mucumbitsi Joseph , Sangano Georges Bahati , Ndayambaje Martin , Mwanzia Lydia , Habyarimana Thierry
Published: October 2020

Background

Preterm birth could be a worldwide open well-being danger. It was assessed that each year 15 million neonates are born prematurely around the world, and 40% brought about from intrauterine infections.
Methods

A total of 40 women were selected. Of the 40 women, 20 had a premature birth, and the remaining 20 had a full-term birth. 120 Swab samples were collected from the placenta, amniotic fluids, and fetal membrane immediately after birth. The sterile cotton swab was used to collect samples and put into swabs Stuart plastic to avoid sample contamination. Samples were transported to the clinical microbiology laboratory at INES Ruhengeri for microbiological investigation. Gram staining, culture, and biochemical tests were performed. The independent t-test was used to test for significant difference between means of the two groups, while the chi-square test (x2) was used to test for significant association with microorganisms and intraamniotic infections.
Results

The findings revealed that half of the participants were in the age range of 24–29 years. Non- Albicans Candida (32.7%) and mold (27.9%) were the foremost overwhelming confined microorganisms. Some microorganisms were common to the placenta, amniotic fluid, and fetal membrane. Only Non-Albicans Candida and mold were common to samples of both preterm and full-term women, Staphylococcus species was observed in placental and fetal membrane samples and absented in amniotic fluid. Escherichia coli, Klebsiella species, Streptococcus species, and Candida Albicans were only observed among women with preterm birth. To compare isolated microorganisms between both preterm and full-term birth, the significance test of mean was performed. There was a statistically significant difference between the two means in the amniotic fluid isolates (t = 4.023, P = 0.006522), placental membrane isolates (t = 7.17, P = 0.000372), and fetal membrane isolates (t = 6.7, P = 0.000537). Association with microorganisms and intraamniotic infection was statistically significant with Escherichia coli (x2 = 3.98, P = 0.046044), Streptococcus species (x2 = 5.53, P = 0.018693), Yeast (x2 = 8.37, P = 0.003815) and Candida Albicans (x2 = 3.98, P = 0.046044).
Conclusion

Invasion of the amniotic fluid, placenta, and fetal membranes by pathogenic microorganisms may be associated with the incidence of preterm labor and birth. Early diagnosis is recommended to avoid both maternal and fetal complications.