bluuebunny/crossref_metadata_2025 huggingface dataset:
Conversion from a failed proximal femoral nail anti-rotation to a cemented or uncemented total hip arthroplasty device: A retrospective review of 198 hips with previous intertrochanteric femur fractures
Authors: Yu Weiguang , Han Xiulan , Chen Wenli , Shuai Mao , Zhao Mingdong , Zhang Chao Xin , Han Guowei , Ye Junxing , Chen Meiji , Zhuang Jintao
Published: October 2020

Background: At present, it is unclear which device (uncemented or cemented total hip arthroplasty [UTA or CTA, respectively]) is more suitable for the conversion of a failed proximal femoral nail anti-rotation (PFNA). The aim of this review was to assess the outcomes of failed PFNAs converted to a UTA or CTA device in elderly individuals with intertrochanteric femoral fractures (IFFs).Methods: Two hundred fifty-eight elderly individuals (258 hips) with IFFs who underwent a conversion to a UTA or CTA device following failed PFNAs during 2007-2017 were retrospectively identified from the China Southern Medical Centre (CSMC) database. The primary endpoint was the Harris Hip Score (HHS); secondary endpoint was the key orthopaedic complication rate.Results: The median follow-up was 65 months (60-69 months). Significant distinctions were observed (87.26±16.62 for UTA vs. 89.32±16.08 for CTA, p=0.021; 86.61±12.24 for symptomatic UTA vs. 88.68±13.30 for symptomatic CTA, p=0.026). A significant difference in the overall key orthopaedic complication rate was detected (40.8% [40/98] vs. 19.0% [19/100], p=0.001). Apparent distinctions were detected in terms of the rate of revision, loosening, and periprosthetic fracture (11.2% for UTA vs 3.0% for CTA, p = 0.025; 13.2% for UTA vs 5.0% for CTA, p = 0.043; 10.2% for UTA vs 3.0% for CTA, p = 0.041, respectively).Conclusion: For elderly individuals with IFFs who suffered a failed PFNA, CTA devices seem to have a noteworthy advantage in regard to functional scores and the rate of key orthopaedic complications compared with UTA devices, and CTA revision should be performed as soon as possible, regardless of whether these individuals have symptoms.
Response of phytohormone mediated plant homeodomain (PHD) family to abiotic stress in upland cotton (Gossypium hirsutum spp.)
Authors: Wu Huanhuan , Zheng Lei , Qanmber Ghulam , Guo Mengzhen , Wang Zhi , Yang Zuoren
Published: October 2020

Background: The sequencing and annotations of cotton genomes provide powerful theoretical support to unravel more physiological and functional information. Plant homeodomain (PHD) protein family has been reported to be involved in regulating various biological processes in plants. However, their functional studies have not yet been carried out in cotton.Results: In this study, 108, 55, and 52 PHD genes were identified in G. hirsutum, G. raimondii, and G. arboreum, respectively. A total of 297 PHD genes from three cotton species, Arabidopsis, and rice were divided into five groups. We performed chromosomal location, phylogenetic relationship, gene structure, and conserved domain analysis for GhPHD genes. GhPHD genes were unevenly distributed on each chromosome. However, more GhPHD genes were distributed on At_05, Dt_05, and At_07 chromosomes. GhPHD proteins depicted conserved domains, and GhPHD genes exhibiting similar gene structure were clustered together. Further, whole genome duplication (WGD) analysis indicated that purification selection greatly contributed to the functional maintenance of GhPHD gene family. Expression pattern analysis based on RNA-seq data showed that most GhPHD genes showed clear tissue-specific spatiotemporal expression patterns elucidating the multiple functions of GhPHDs in plant growth and development. Moreover, analysis of cis-acting elements revealed that GhPHDs may respond to a variety of abiotic and phytohormonal stresses. In this regard, some GhPHD genes showed good response against abiotic and phytohormonal stresses. Additionally, co-expression network analysis indicated that GhPHDs are essential for plant growth and development, while GhPHD genes response against abiotic and phytohormonal stresses may help to improve plant tolerance in adverse environmental conditions.Conclusion: This study will provide useful information to facilitate further research related to the vital roles of GhPHD gene family in plant growth and development.
The Epidemiology of Moebius Syndrome in Italy
Authors: carta arturo , Favilla Stefania , Calzetti Giacomo , Casalini Maria Cristina , Ferrari Pier Francesco , Bianchi Berrnardo , Simonelli Maria Beatrice , Farci Roberta , gandolfi Stefano , Mora Paolo
Published: October 2020

Background: The epidemiology of Moebius Syndrome (MBS) is actually difficult to assess. In the present study we investigated the epidemiology of MBS in a well-defined population over a precise geographical area. Materials and Methods: Our University Hospital is the only national referral Centre for the diagnosis and treatment of MBS. Participants to this cross-sectional study are patients affected by MBS who have been periodically followed by our medical staff since 1998. Most of the patients were referred to our hospital by the Italian Association of Moebius Syndrome (AISMO). Demographic data necessary for our purposes were made available by AISMO database updated to April 2018. Subjects were assigned to the geographical macro- areas which are the ones conventionally used for surveys and epidemiological investigations by the Italian National Institute of Statistics. Rates and prevalence of the MBS cases were calculated referring to the last survey of the Italian population available. Every study parameter was then calculated by reference to the whole country and to macro-area partition. Gender rate and the corresponding prevalence were calculated with respect to the weighted whole population and to the respective gender population. Chi-square analysis was adopted to investigate possible differences among geographical regions and/or gender. A p value <0.05 was considered statistically significant. Results: One-hundred and sixty-four out of 212 MBS patients fulfilled our inclusion criteria. All cases were Caucasian and sporadic. The median age at diagnosis was 3.6 years, ranging from 0-55; this range was significantly reduced to 0-5 years (median age at diagnosis: 2.2 years) for patients included after 2007. The birth prevalence calculated was 0.06 cases per 10000 live births with an overall prevalence of 0.27/100000 without any gender or geographical predisposition. Conclusions: The rate of MBS prevalence herein observed, rounded for possible underestimation, is 0.3/100000 people without any regional difference in the distribution of the cases. Our data confirm on a national basis the rarity of the disease.
Manuscript title: Prevalence and determinants of undernutrition among under-five children residing in urban slums and rural area, Maharashtra, India: a community-based cross-sectional study
Authors: Murarkar Sujata Kapil , Gothankar Jayashree Sachin , Doke Prakash , Pore Prasad , Lalwani Sanjay , Dhumale Girish , Quraishi Sanjay , Patil Reshma Sudhir , Waghachavare Vivek , Dhobale Randhir , Rasote Kirti , Palkar Sonali , Malshe Nandini
Published: October 2020

BackgroundUndernutrition among under five children in India is a major public health problem.Despite India’s growth in the economy, the child mortality rate due to undernutrition is still high in both urban and rural areas.Studies that focus on urban slums are scarce. Hence the present study was carried out to assess the prevalence and determinants of undernutrition in children under five in Maharashtra, India.Methods A community-based cross-sectional study was conducted in 16 randomly selected clusters in two districts of Maharashtra state, India. Data were collected through house to house survey by interviewing mothers of under five children. Total 2929 mothers and their 3,671 under five children were covered. Multivariate logistic regression analysis was carried out to identify the determinants of child nutritional status seperately in urban and rural areas. ResultsThe mean age of the children was 2.38 years (±SD 1.36) and mean age of mothers was 24.25 years (± SD 6.37).Overall prevalence of stunting among children under five was 45.9 %, wasting was 17.1% and 35.4% children were underweight.Prevalence of wasting, stunting and underweight were more seen in an urban slum than a rural area.In the rural areas exclusive breast feeding(p<0.001) and acute diarrhea (p=0.001) were associated with wasting, children with birth order 2 or less than 2 were associated with stunting and exclusive breast feeding (p<0.05) and low maternal education were associated with underweight. Whereas in the urban slums exclusive breast feeding(p<0.05) was associated with wasting, sex of the child (p<0.05) and type of family(p<0.05)were associated with stunting,and low income of the family(p<0.05) was associated with underweight.ConclusionsFactors like sex of the child, birth order,exclusive breast feeding ,economic status of the family, type of family,acute diarrhea and maternal education have influence on nutritional status of the child. Improvement of maternal education will improve the nutritional status of the child. Strategies are needed to improve the economic status of the community.Trial registration-Trial registration number:CTRI/2017/12/010881;Registration date:14/12/2017. Retrospectively registered.
A Confirmatory Factor Analysis of the knowledge, attitude and practice questionnaire towards prevention of Respiratory tract infections during Hajj and Umrah
Authors: Goni Mohammd Dauda , Naing Nyi Nyi , Hasan Habsah , Wan-Arfah Nadiah , Deris Zakuan Zainy , Arifin Wan Nor , Baaba Aisha Abubakar , Njaka Stanley
Published: October 2020

Background Respiratory tract infections are one of the common infection associated with Hajj pilgrimage that is of great public health and global concern. This study is aimed at determining the factor structure of the knowledge, attitude and practice questionnaire for the prevention of respiratory tract infections during Hajj by confirmatory factor analysis (CFA). Methods A multistage cluster sampling method was conducted on Malaysian Umrah pilgrims during the weekly Umrah orientation course. A total of 200 Umrah pilgrims participated in the study. The knowledge, attitude and practice (KAP) questionnaire was distributed to pilgrims at the beginning of the orientation and retrieved immediately at the end of the orientation. Data analysis was done using R version 3.5.0 after data entry into SPSS 24. The robust maximum likelihood was used for the estimation due to the multivariate normality assumption violation. A two-factor model was tested for measurement model validity and construct validity for each of the attitude and practice domains. Results CFA of a 25-item in total, two-factor model yielded adequate goodness-of-fit values. The measurement model also showed a good convergent and discriminant validity after model re-specification. A two-factor model was tested for measurement model validity and construct validity for each of the attitude and practice domains. The result also showed a statistically significant value (p < 0.001) with χ2 (df) values of 76.8 (43) and 121 (76) for attitude and practice domains respectively. Conclusion The KAP questionnaire was proven to have a valid measurement model and reliable constructs. It was deemed suitable for use to measure the KAP of Hajj and Umrah pilgrims towards the prevention for all respiratory tract infections.
Recent epidemiology of patients with Gastro-Entero-Pancreatic Neuroendocrine Neoplasms (GEP-NEN) in Japan: a population-based study
Authors: Masui Toshihiko , Ito Tetsuhide , Komoto Izumi , Uemoto Shinji , group project study
Published: October 2020

Background: The worldwide prevalence and incidence of neuroendocrine neoplasms (NEN) have been increasing recently, although few studies have analyzed data on the current situation of NENs in Japan. Here, the Japan Neuroendocrine Tumor Society (JNETS) planned to investigate the recent incidence and distribution of these tumors using data from the national cancer registry started in 2016. This study examined the incidence and distribution of primary sites as well as rate of advanced disease from this population-based registry.Methods: A retrospective, population-based study using data from the national cancer registry in Japan (NCR) was conducted to evaluate patients with gastro-entero-pancreatic NEN (GEP-NEN) in 2016. Associated population data were used to determine annual age-adjusted incidences.Results: A total of 6735 individuals were diagnosed with GEP-NEN in Japan in 2016. Annual onset incidence was 0.70/100,000 for pancreatic NEN and 2.84/100,000 for gastrointestinal NEN. NEN in the ileum accounted for only 1% of total GEP-NENs in Japan. Most NENs in the esophagus or lungs were neuroendocrine carcinomas (NECs), while the majority of those in the duodenum, ileum, appendix and rectum were grade 1 neuroendocrine tumors (NETs). Median age at initial diagnosis was in between 60 to 65. Tumors in the duodenum, appendix and rectum were mostly limited to local, while those in the esophagus, stomach and colon tended to show distant metastasis. In Japan, initial treatment for GEP-NENs was resection even if the tumor was NEC.Conclusions: This is the first report of a national registry-based incidence and distribution of GEP-NEN in Japan. These data will serve as an important first step to determining the exact etiology and trends for this pathology in Japan.
Digital crowdsourced intervention to promote HIV testing among MSM in China: Study protocol for a cluster randomized controlled trial
Authors: Ren Ci , Tucker Joseph David , Tang Weiming , Tao Xiaorun , Liao Meizhen , Wang Guoyong , Jiao Kedi , Xu Zece , Zhao Zhe , Yan Yu , Lin Yuxi , Li Chuanxi , Wang Lin , Li Yijun , Kang Dianmin , Ma Wei
Published: October 2020

Background: Men who have sex with men (MSM) are an important HIV key population in China. However, HIV testing rates among MSM remain suboptimal. Digital crowdsourced media interventions may be a useful tool to reach this marginalized population. We define digital crowdsourced media as using social media, mobile phone applications, internet, or other digital approaches to disseminate messages developed from crowdsourcing contests. The proposed cluster randomized controlled trial (RCT) study aims to assess the effectiveness of a digital crowdsourced intervention to increase HIV testing uptake and decrease risky sexual behaviors among Chinese MSM.Methods: A two-arm, cluster-randomized controlled trial will be implemented in eleven cities (ten clusters) in Shandong Province, China. Targeted study participants will be 250 MSM per arm and 50 participants per cluster. MSM who are 18 years old or above, live in the study city, have not been tested for HIV in the past 3 months, are not living with HIV or have never been tested for HIV, and are willing to provide informed consent will be enrolled. Participants will be recruited through banner advertisements on Blued, the largest gay dating app in China, and in-person at community-based organizations (CBOs). The intervention includes a series of crowdsourced intervention materials (24 images and four short videos about HIV testing and safe sexual behaviors) and HIV self-test services provided by the study team. The intervention was developed through a series of participatory crowdsourcing contests before this study. The self-test kits will be sent to the participants in the intervention group at the 2nd and 3rd follow-up. Participants will be followed up quarterly during the 12-month period. The primary outcome will be self-reported HIV testing uptake at 12 months. Secondary outcomes will include changes in condomless sex, self-test efficacy, social network engagement, HIV testing social norms, and testing stigma.Discussion: Innovative approaches to HIV testing among marginalized population are urgently needed. Through this cluster randomized controlled trial, we will evaluate the effectiveness of a digital crowdsourced intervention, improving HIV testing uptake among MSM and providing a resource in related public health fields.Trial Registration: ChiCTR1900024350. Registered on 6 July 2019.
Depression and Experience of Incarceration in North Central Nigeria: A Situation Analysis at Makurdi Medium Security Prison 
Authors: NWEFOH EMEKA , aguocha chinyere MIRIAN , RYAN GRACE , ODE PHILIP , Ighagbon FESTUS , Akinjola OYEDELE , OMOI SAMUEL , ABDULMALIK JIBRIL , AGBIR TERKURA , OBEKPA OBEKPA , OGBOLE SAMUEL , EATON JULIAN
Published: October 2020

Background: Human rights watchdogs have described conditions in Nigerian correctional facilities and detention centers as damaging to the physical and mental health of inmates. While the prevalence of mental disorders is high, access to appropriate healthcare is grossly inadequate. Understanding the current state of prison inmates’ mental health and well-being is an essential first step to addressing this important issue. This study aims to document the mental health and experiences of incarceration of inmates of the largest medium security prison in Nigeria’s Benue State.Methods: A cross-sectional survey and descriptive analysis was carried out with a random sample of 381 prison inmates of Benue State Makurdi Medium Security Prison. Survey tools included: (1) a structured questionnaire on participants’ experiences in prison, and (2) the Patient Health Questionnaire (PHQ-9), a screening tool for depression. Results: Most participants were young men (95.5%, mean age 27.95) and had completed secondary school (63.5%). While prison authorities had identified only 27 participants as having a mental disorder, 144 (37.8%) screened positive for depression. Twenty six had received professional counseling while in prison. Of the six participants who were already taking a psychotropic medication at the time of imprisonment, four received medication after being imprisoned. Approximately half, (52%) of participants were dissatisfied with prison health care. Conclusions: Despite the high prevalence of depression among prison inmates, few cases are detected and treated. Prison staff may not recognize depression as a mental disorder, and the mental health care available is generally poor. Inadequate mental health and social care not only affects prison inmates’ well-being, but may also impact recidivism and health outcomes upon release. Prison inmates should be screened routinely for depression and other less-commonly recognized mental health conditions, and appropriate treatment made available.Keywords: depression, prison, Experience of Incarceration
Effect of stellate ganglion block on postoperative recovery of gastrointestinal function in patients undergoing surgery with general anaesthesia: a meta-analysis.
Authors: Wen Bei , Wang Yajie , Zhang Cong , Fu Zhijian
Published: October 2020

Background: The return of gastrointestinal function is an important sign of postoperative recovery in patients undergoing surgery with general anaesthesia. We aimed to summarize the effects of stellate ganglion block on the recovery of gastrointestinal function as a means of exploring methods through which anaesthesiologists can contribute to postoperative patient recovery. Methods: We performed a quantitative systematic review of randomized controlled trials published between January 1, 1988, and November 11, 2019, in PubMed, the Cochrane Library, China National Knowledge Infrastructure, Chinese VIP Information, and the Wanfang and SinoMed databases. Study quality was assessed using the revised Cochrane risk-of-bias tool for randomized trials. The time to peristaltic sound resumption, flatus, postoperative eating and the incidence of abdominal bloating in the stellate ganglion block and control groups were compared. The control group included patients in whom the stellate ganglion received an injection of normal saline or no treatment. Meta-analysis was performed using Review Manager software. Results: After searching for relevant articles, 281 studies were identified, and five articles with data on 274 patients were eligible. Regarding postoperative flatus time, stellate ganglion block resulted in a mean reduction of 15 hours (P=0.02); then a sensitivity analysis was performed, and the standard mean difference decreased to 6 hours (P=0.007). For gastrointestinal surgery, the mean reduction was approximately an entire day (P=0.0002). Regarding the evaluation of the recovery of peristaltic sounds, stellate ganglion block promoted the recovery of regular peristaltic bowel sounds an average of 14.67 hours earlier than in the control (P=0.0008). With regard to nutrients, stellate ganglion block shortened the total parenteral nutrition time by more than 50 hours in patients who had undergone gastrointestinal surgery (P＜0.00001). Finally, stellate ganglion block prevented the occurrence of postoperative abdominal bloating (P=0.001).) No complications related to stellate ganglion block were reported. Conclusion: Stellate ganglion block may promote postoperative gastrointestinal recovery in patients undergoing various surgeries under general anaesthesia. However, additional trials investigating the use of stellate ganglion block are necessary to confirm our finding. Trial registration: This meta-analysis has been registered at the International Prospective Register of Systematic Reviews (registration number CRD42020157602).
Urban malaria prevalence and its associated risk factors: the case of Batu town, East Shoa, Oromia Regional State, Ethiopia
Authors: Hassen Jifar , Dinka Hunduma
Published: October 2020

Background- Malaria is one of the leading causes of morbidity and mortality particularly in sub-Saharan Africa including Ethiopia. Approximately, 68% of its population is at a risk of malaria infection and nearly three-fourth of the Ethiopia landmass is considered as malarious. Most of the malaria related researches are being conducted in the rural areas; however, urban malaria should be also targeted without which malaria elimination is impossible. Therefore, the aim of this study was to assess the magnitude of malaria, prevalence of P. falciparum and P. vivax and its associated risk factors during low transmission season (April to July, 2018) in Batu town, East Shoa, Oromia Regional state, Ethiopia.Methods – Finger pricked blood samples were collected from 356 febrile individuals visiting health facilities in Batu town from April to July, 2018 supplemented with questionnaire survey to assess socio-demographic and risk factors associated with malaria infection.Results – In the current study an overall prevalence of 17.13% (61/356) malaria infection was observed of which 50.8% (31/61) were positive for P. vivax, 45.95% (28/61) were positive for P. falciparum and 3.3% (2/61) were mixed infections of P. falciparum and P. vivax. Male individuals (32 (9%)) were more infected with malaria than females (29 (8.2%)). Sex had no statistical significance association with malaria (χ2 = 2.026, P = 0.156). Logistic regression analysis revealed that individuals who possessed ITN (OR = 0.38, 95% CI (0.194, 0.743) and P = 0.005) and whose houses were sprayed with insecticides (OR = 0.18, 95% CI (0.097, 0.34) and P < 0.001) were found less likely to get malaria infection. Individuals living closer to stagnant water had more chance (almost three-fold times) of malaria infection than those who were found at a distant from stagnant water (OR= 2.97, 95% CI (1.68, 5.26) and P < 0.001).Conclusion- The current study revealed that malaria is still public health problem in Batu town, which might indicate the same in other urban areas of the country. Therefore, in order to get the national picture about the prevalence of urban malaria and its associated risk factors, we recommend large scale investigation of the situation.
Gene Therapy with Hepatocyte Growth Factor Improves Left Ventricular Systolic Function After Myocardial Infarction: A Systematic Review and Meta-analysis of Pig Models
Authors: Du Chong , Chen Xiao-Wen , Wang Ze-Mu , Meng Hao-Yu , Li Ya-Fei , Wei Tian-Wen , Wang Lian-Sheng
Published: October 2020

Background: Hepatocyte growth factor (HGF) is an angiogenic cytokine which can promote angiogenesis and inhibit fibrosis. Previous studies have shown that HGF may have significant therapeutic effects on ischaemic diseases, such as ischaemic heart disease and peripheral arterial occlusive disease. Due to insufficient clinical study evidence, we conducted a quantitative meta-analysis of HGF therapy in pigs with myocardial infarction (MI) to provide more reliable evidence for the feasibility and effectiveness of HGF therapy for MI patients. We also analysed the efficacy and characteristics of different gene therapy vectors and drug delivery routes.Methods: PubMed, EMBASE, and the China National Knowledge Infrastructure were searched for randomised studies that corresponded to our subject. The search terms included (hepatocyte growth factor OR HGF) AND (heart failure OR HF OR myocardial infarction OR MI OR AMI OR coronary heart disease OR CHD). The retrieved articles were screened strictly according to the inclusion criteria. The endpoints were the left ventricular ejection fraction (LVEF) and capillary density in the ischaemic regions in the model pigs.Results: A total of nine studies were eventually included in this meta-analysis. Our analysis showed that LVEF (with mean difference [MD]:9.73, 95%CI :8.70, 10.76, P < 0.00001) and capillary density (MD:79.98, 95%CI :24.58,135.39, P=0.005) in the HGF group were significantly higher than those in the control group several weeks after HGF treatment. Further analysis showed that there was no statistically significant difference in the improvement of LVEF caused by intracoronary adenovirus5-mediated HGF (Ad5-HGF) gene transfer and intramyocardial plasmid HGF injection (12.63±3.2 vs 9.4±1.09, P=0.06), while intramyocardial injection of plasmid HGF had a stronger angiogenic capacity than intramyocardial administration of Ad5-HGF and HGF in hydrogel (117.34±27.82 vs 26.45±22.11 vs 11.50±5.28, P＜0.00001).Conclusions: HGF therapy can effectively promote angiogenesis and recovery of cardiac function and is a promising cardiac repair method. Intracoronary Ad5 vector transfer and intramyocardial injection of plasmid vectors can be used as effective means of gene therapy, and hydrogel as a vector also has potential applications.
Effects of texture properties of semi-solid food on the sensory test for pharyngeal swallowing effort in the elderly
Authors: Park Jin-Woo , Lee Seul , Yoo Byoungseung , Nam Kiyeon
Published: October 2020

Background: Increasing viscosity can reduce the risk of aspiration into the airway, but conversely, very thick solid food may require greater strength and effort. We assumed that semi-solid foods with similar viscosities will behave differently in the oropharynx and there might exist the possibility that properties other than viscosity may have clinical relevance. This study aimed to find out the texture of semi-solid foods that affects the effort of pharyngeal swallow in the elderly. Methods: Nine kinds of semi-solid foods not requiring mastication were selected for texture profile analysis (TPA), and included whipped cream, mayonnaise, soft tofu, mango pudding, boiled mashed pumpkin, boiled mashed potatoes, boiled mashed sweet potatoes, red bean paste, and peanut butter. Hardness, adhesiveness and cohesiveness of each food were measured three times by using the rheometer. A blinded sensory test using a 9-point hedonic scale was also conducted in eighteen elderly people to investigate how much effort was required to swallow food, and how much of the food remained in the pharynx after swallowing. The correlation between texture and sensory outcome was statistically analyzed.Results: Foods that belonged to the same viscosity category showed different texture values, and the participants also rated different scores respectively. Only adhesiveness among three properties was significantly correlated with the sensory test. (r= 0.882, p=0.002 for difficult to swallow, r=0.879, p=0.002 for sense of residue).Conclusions: Adhesiveness was the most important property of the semi-solid foods, requiring most efforts in pharyngeal swallow in the elderly. If we select and provide food having low adhesiveness value in the same viscosity category, there might be the possibility to make it easier to swallow in older adults.
Serum interleukin-6 is an indicator for severity in 901 patients with SARS-CoV-2 infection: A cohort study
Authors: Zhang Jing , Hao Yiqun , Ou Wuling , Ming Fei , Liang Gai , Qian Yu , Cai Qian , Dong Shuang , Hu Sheng , Wang Weida , Wei Shaozhong
Published: October 2020

Background: Interleukin-6 (IL-6) was proposed to be associated with the severity of coronavirus disease 2019 (COVID-19). The present study aimed to explore the kinetics of IL-6 levels, validate this association in COVID-19 patients, and report preliminary data on the efficacy of IL-6 receptor blockade. Methods: We conducted a retrospective single-institutional study of 901 consecutive confirmed cases. Serum IL-6 concentrations were tested on admission and/or during hospital stay. Tocilizumab was given to 16 patients with elevated IL-6 concentration. Results: 366 patients were defined as common cases, 411 patients as severe, and 124 patients as critical according to the Chinese guideline on diagnosis and treatment of COVID-19. The median concentration of IL-6 was <1.5 pg/ml (IQR <1.50-2.15), 1.85 pg/ml (IQR <1.50-5.21), and 21.55 pg/ml (IQR 6.47-94.66) for the common, severe, and critical groups respectively (P＜0.001). The follow-up kinetics revealed serum IL-6 remained high in critical patients even when cured. An IL-6 concentration higher than 37.65 pg/ml was predictive of in-hospital death (AUC 0.97 [95%CI 0.95-0.99], P<0.001) with a sensitivity of 91.7% and a specificity of 95.7%. In the 16 patients who received tocilizumab, IL-6 concentrations were significantly increased after administration, and survival outcome was not significantly different from that of propensity-score matched counterparts (n=53, P=0.12). Conclusion: Serum IL-6 should be included in diagnostic work-up to stratify disease severity, but the benefit of tocilizumab needs further confirmation.Trial registration: retrospectively registered.
Correlation Between the Thyroid Hormone Levels and Nonalcoholic Fatty Liver Disease in Type 2 Diabetic Patients with Normal Thyroid Function
Authors: Zhang Yuanyuan , Liu Huaizhen , Li Juyi , Li Ling , Zhang Jinjun , Wang Yan , Zhang Zhimian
Published: October 2020

Background: The objective of this study is to retrospectively analyze the correlation between the thyroid hormones and nonalcoholic fatty liver disease (NAFLD) in type 2 diabetes mellitus (T2DM) patients with normal thyroid function. Methods: Totally 586 T2DM patients with normal thyroid function participated in this research and were divided into T2DM without NAFLD (240 cases) group and T2DM with NAFLD (346 cases) group. The NAFLD fibrosis score (NFS) >0.676 was defined as progressive liver fibrosis and used to categorize the patients into T2DM without progressive liver fibrosis group (493 cases) and T2DM with progressive liver fibrosis group (93 cases). Results: The results indicated that the levels of free triiodothyronine (FT3) and total triiodomethylamine (TT3) were significantly higher while the free thyroxine (FT4) level was lower in T2DM with NAFLD group than that in T2DM2 without NAFLD group (p<0.05). The levels of FT3, FT4 and TT3 in patients with progressive liver fibrosis were significantly lower in patients with progressive liver fibrosis than that in patients without progressive liver fibrosis (p<0.05). Logistic regression analysis showed a negative relationship between FT4 level and NAFLD (p=0.026), between the levels of FT4,TT3 and total thyroxine (TT4) and the risk of progressive hepatic fibrosis (p=0.022, p=0.007,p=0.046).Conclusion: There is a certain correlation between thyroid hormone levels and NAFLD in T2DM patients, suggesting that the assessment of thyroid hormone levels in T2DM patients with normal thyroid function is of great significance in the prevention and treatment of NAFLD.
The transverse diameter of right common femoral vein by ultrasound in the supine position for predicting post-spinal hypotension during cesarean delivery.
Authors: Yao Shi-Fa , Zhao Yan-Hong , Zheng Jing , Qian Jie-Yan , Zhang Chen , Xu Zifeng , Xu Tao
Published: October 2020

Background: Post-spinal anesthesia hypotension during cesarean delivery is caused by decreased systemic vascular resistance due to the blockage of autonomic nerves, which is further worsened by inferior vena cava (IVC) compression by the gravid uterus. The aim of this study was to assess whether peak velocity and diameter of IVC below the xiphoid or the right common femoral vein (RCFV) in the inguinal region, as measured on ultrasound, could reflect the degree of IVC compression and further identify parturients at risk of post-spinal hypotension.
Methods: After ultrasound measurement of peak velocities and anteroposterior diameters of the IVC and peak velocities and transverse diameters of the RCFV before anesthesia, 56 parturients undergoing elective cesarean section with spinal anesthesia were enrolled in this study. Hypotension was defined as having a drop of systolic arterial pressure >20% from the baseline. The primary outcome was ultrasound measurements of IVC and RCFV, and their association with post-spinal hypotension during cesarean delivery. Multinomial logistic regression analysis was used to identify the association between the measurements of ICV, RCFV and post-spinal hypotension during cesarean delivery. Receiver operating characteristic curves were used to test the abilities of the identified parameters to predict post-spinal hypotension, and the areas under the curve and the optimum cut-off values for the predictive parameters were calculated.
Results: Longer transverse diameter of the RCFV was associated with the occurrence of post-spinal hypotension (odds ratio = 2.022, 95% confidence interval [CI] 1.261–3.243). The area under the receiver operating characteristics curve for the prediction of post-spinal hypotension was 0.759 (0.628–0.890; P = 0.001). A transverse diameter of the RCFV >12.2 mm could predict post-spinal hypotension during cesarean delivery.
Conclusions: We demonstrated a longer transverse diameter of RCFV was associated with hypotension and it could predict parturients at major risk of hypotension before anesthesia.
Does Patient Gender Influence Medical Care Among Students? Evaluation During an Objective Structured Clinical Examination
Authors: Boudec Joana Le , Félix Sylvie , Gachoud David , Monti Matteo , Barazzoni Mirjam Schuler , Clair Carole
Published: October 2020

Background: Gender bias induces gender inequality in health. In this study, we evaluated gender bias during a local objective structured clinical examination (OSCE). Methods: We assessed gender bias by using two clinical cases—generalized anxiety disorder (GAD) and ascending aorta dissection (AAD)—during an OSCE performed among fifth-year medical students. For each situation, half of the students encountered male and half encountered female standardized patients (SPs). Except for gender, variables were identical in each clinical case. Patients, students, and examiners were blinded to the purpose of the study. Medical history, clinical examination, diagnosis, and management were compared between male and female SPs. The interaction between student and SP gender was analyzed. Results: A total of 110 medical students were observed (55% women). For GAD, students arrived at the correct diagnosis more often for female SPs than for male SPs (diagnosis completed, partially completed, and not completed in 47%, 16%, and 36%, respectively, of female SPs vs. 22%, 20%, and 58%, respectively, of male SPs, p = 0.02). The nature of their symptoms was more often asked of male SPs (completed, partially completed, and not completed in 51%, 4%, and 0% of male SPs, respectively, vs. 38%, 17%, and 0% of female SPs, respectively, p = 0.002), and associated physical symptoms were more often explored in female SPs (completed and not completed in 84% and 16% of female SPs, respectively, vs. 65% and 35% of male SPs, respectively, p = 0.03). For AAD, an emergency was better identified in female SPs (95% identified in female SPs vs. 76% in male SPs, p = 0.005) and examination of femoral pulses was more often performed in female SPs (88% completed in female SPs vs. 54% in male SPs, p < 0.0001). The interaction between SP and student gender was not significant. Conclusion: The gender bias observed supports the need to address unconscious biases and to raise student awareness of gender stereotypes likely to lead to underrecognition or subtreatment of disease in patients of both genders.
Pulmonary cavitation – an under-recognized late complication of severe COVID-19 lung disease
Authors: Zoumot Zaid , Bonilla Maria-Fernanda , Wahla Ali S. , Shafiq Irfan , Uzbeck Mateen , El-Lababidi Rania M. , Hamed Fadi , Abuzakouk Mohamed , ElKaissi Mahmoud
Published: October 2020

Background: Pulmonary radiological findings of the novel coronavirus disease 2019 (COVID-19) have been well documented and range from scattered ground-glass infiltrates in milder cases to confluent ground-glass change, dense consolidation, and crazy paving in the critically ill. However, lung cavitation has not been commonly described in these patients. The objective of this study was to assess the incidence of pulmonary cavitation in patients with COVID-19 and describe its characteristics and evolution.Methods: We conducted a retrospective review of all patients admitted to our institution with COVID-19 and reviewed electronic medical records and imaging to identify patients who developed pulmonary cavitation.Results: Twelve out of 689 (1.7%) patients admitted to our institution with COVID-19 developed pulmonary cavitation, comprising 3.3% (n=12/359) of patients who developed COVID-19 pneumonia, and 11% (n=12/110) of those admitted to the intensive care unit. We describe the imaging characteristics of the cavitation and present the clinical, pharmacological, laboratory, and microbiological parameters for these patients. In this cohort six patients have died, two are recovering in hospital and four have been discharged home. Conclusion: Cavitary lung disease in patients with severe COVID-19 disease is not uncommon, and is associated with a high level of morbidity and mortality.
RNA-Sequencing Profiling Analysis of Pericyte-Derived Extracellular Vesicle-Mimetic Nanovesicles-Regulated Genes in Primary Cultured Fibroblasts From Normal and Peyronie’s Disease Penile Tunica Albuginea
Authors: Yin Guo Nan , Piao Shuguang , Liu Zhiyong , Wang Lei , Ock Jiyeon , Kwon Mi-Hye , Kim Do-Kyun , Gho Yong Song , Suh Jun-Kyu , Ryu Ji-Kan
Published: October 2020

BackgroundPeyronie’s disease (PD) is a severe fibrotic disease of the tunica albuginea that causes penis curvature and leads to penile pain, deformity, and erectile dysfunction. The role of pericytes in the pathogenesis of fibrosis has recently been determined. Extracellular vesicle (EV)-mimetic nanovesicles (NVs) have attracted attention regarding intercellular communication between cells in the field of fibrosis. However, the global gene expression of pericyte-derived EV-mimetic NVs (PC-NVs) in regulating fibrosis remains unknown. Here, we used RNA-sequencing technology to investigate the potential target genes regulated by PC-NVs in primary fibroblasts derived from human PD plaque. MethodsHuman primary fibroblasts derived from normal and PD patients was cultured and treated with cavernosum pericytes isolated extracellular vesicle (EV)-mimetic nanovesicles (NVs). A global gene expression RNA-sequencing assay was performed on normal fibroblasts, PD fibroblasts, and PD fibroblasts treated with PC-NVs. Reverse transcription polymerase chain reaction (RT-PCR) was used for sequencing data validation. ResultsA total of 4135 genes showed significantly differential expression in the normal fibroblasts, PD fibroblasts, and PD fibroblasts treated with PC-NVs. However, only 91 contra-regulated genes were detected among the three libraries. Furthermore, 20 contra-regulated genes were selected and 11 showed consistent changes in the RNA-sequencing assay, which were validated by RT-PCR. ConclusionThe gene expression profiling results suggested that these validated genes may be good targets for understanding potential mechanisms and conducting molecular studies into PD.
Preoperative Anemia and Thrombocytosis Predict Adverse Prognosis in Non-Metastatic Renal Cell Carcinoma With Tumor Thrombus
Authors: Ma Lulin , Ruotao Xiao , Chuxiao Xu , Wei He , Lei Liu , Hongxian Zhang , Cheng Liu
Published: October 2020

Objection: The aim of the study was to determine the prognostic value of preoperative blood parameters in patients with renal cell carcinoma (RCC) and tumor thrombus (TT) treated surgically.Method: we retrospectively analyzed 152 patients diagnosis with RCC and TT and treated surgically. Clinicopathologic data and blood parameter were obtained. Univariable and multivariable analysis using the Cox regression model were performed to determine risk factors that were associated with progression-free survival (PFS) and overall survival (OS). Kaplan-Meier curve and logistic regression were performed to analyze the risk factors.Results: Preoperative Hgb＜120g/L (HR=2.48, P=0.024) and lymph node metastasis (HR=3.98, P=0.032) were an independent prognostic factors associated with OS. Preoperative PLT≥300×109/L (HR=2.10, P=0.014) and lymph node metastasis (HR=3.42, P=0.021) were an independent prognostic factors associated with PFS. In Kaplan–Meier survival analysis, preoperative anemia had worse OS than without anemia (P=0.003) and thrombocytosis had worse PFS than without thrombocytosis (P=0.001). Preoperative anemia were associated with more symptomatic (P=0.009), surgical time≥6h (P=0.016), Blood loss≥1000ml (P=0.014), transfusion(P=0.012), higher thrombus level (III-IV) (P=0.004) and higher nuclear grade (III-IV) (P=0.002) while thrombocytosis were associated with more symptomatic (P=0.008) and higher nuclear grade (III-IV) (P=0.042)Conclusions: Preoperative anemia and thrombocytosis was associated with adverse prognosis in patients with non-metastatic RCC with TT. Both preoperative hemoglobin level and platelet count may be clinical useful for risk stratifying patients receiving operation for non-metastatic RCC with TT.
Is Tocilizumab an effective therapy for Severe COVID-19: a retrospective cohort study
Authors: Sarfaraz Samreen , Shaikh Quratulain , Iftikhar Sundus , Herekar Fivzia Farooq , Saleem Syed Ghazanfar , Kanani Fatima
Published: October 2020

ObjectivesTo compare the outcome of severe COVID-19 patients treated with Tocilizumab (TCZ). Methods: A retrospective cohort study comparing the clinical characteristics and outcomes of patients who received TCZ with those who did not, was conducted at The Indus Hospital, Karachi. A sub-group analysis was conducted on the TCZ group to identify predictors of mortality. Results 88 patients including 41 patients in the TCZ group and 47 in non-TCZ group were recruited. Baseline characteristics were comparable. TCZ group patients presented with worse clinical features including median SpO2 82% vs 88%, p<0.05 and CRP 193 vs 133.9 mg/L, p<0.05. TCZ group showed severe bilateral chest x-ray findings (92% vs 31%, p<0.05) compared to non-TCZ. In the TCZ group 85.4% were admitted in ICU compared to 69.8% in non-TCZ group, p>0.05. Mortality was not different among the groups (46% in TCZ group vs 51.1% in non-TCZ group, p>0.05). Median length of hospital stay, days of intubation, use of inotropic agents, use of invasive ventilation or in-hospital complications were not different between the groups. Sub-group analysis revealed that mortality within TCZ group was associated with high IL-6 levels (173 vs 69.66 pg/ml, p<0.05), ICU admission (100% vs 72%, p<0.05), need for mechanical ventilation (100% vs 13.6%, p<0.05) and higher incidence of in-hospital complications, p<0.05. ConclusionTCZ group had more critical patients and TCZ failed to demonstrate any mortality benefit in these patients. Non-survivors within the TCZ group were more critical compared to survivors and developed higher proportion of in hospital complications
Clinical and radiological outcome after Anterior Cruciate Ligament Reconstruction using the T-Lock Osteotrans resorbable Tendon Anchor: Early Experience and Midterm Follow-up
Authors: Bangert Yannic , Jaber Ayham , Wünnemann Felix , Berrsche Gregor , Streich Nikolaus , Rehnitz Christoph , Ott Henning , Barié Alexander
Published: October 2020

Purpose
Reonstruction of the Anterior cruciate ligament (ACL) using tendon grafting is an established method for restoring knee function and stability. Multiple methods are established for graft fixation. Several involve anchoring the autograft distant to the joint with hardware that remains implanted. This study reports the first early to midterm results in patients who received ACL reconstruction (ACLR) using the T-Lock Osteotrans femoral near joint fixation method with a tibial fixation using the BioactIF Osteotrans interference screw.
Methods
This consecutive prospective series included 20 Patients (14 Male, 6 Female) with a primary ACL rupture. All patients were treated with an ACLR using the semitendinosus autograft fixated with the T-Lock Osteotrans and were followed-up postoperatively. The following parameters were assessed: Side-to-side difference of the posterior-anterior translation measured using the KT-1000 arthrometer, Tegner activity score, Lysholm score, IKDC subjective knee evaluation form. Magnetic resonance imaging (MRI) was done to assess tunnel enlargement and integrity of the anchoring device.
Results
The average follow-up duration was 2.15 years (range 1–4.2 years). One patient was lost to follow-up. Two Patients suffered a traumatic ACL re-rupture 2 years postoperatively and received 2-stage revision ACLR. Difference in the posterior-anterior translation was 1.8 mm (range 0–5). The median Tegner score was 6 (range 4–10) and 9 patients (45%) returned to their preinjury level of activity. The mean IKDC subjective knee evaluation form scored 91.2 points (range 77–100). The mean Lysholm score was 86.1 points (74–96). All mentioned scores showed were significantly better compared to preoperative values. No relevant tunnel enlargement was seen on MRI. The anchoring device was evaluated to be intact in all patients.
Conclusion
ACLR with the aforementioned procedure leads to good clinical and radiological outcome.
Computational Modeling Indicates A Decreased Affinity of SARS-CoV-2 to ACE2 by Steroids
Authors: Mansouri Alireza , Kowsar Rasoul , Sadeghi Khaled , Miyamoto Akio
Published: October 2020

The novel coronavirus disease (COVID-19) presently poses significant concerns around the world. Latest reports show that the degree of disease and mortality of COVID-19 infected patients may vary from gender to gender with a very high risk of death for seniors. It was hypothesized that sex steroid hormones estradiol (E2), progesterone (P4), testosterone (T), and dexamethasone (DEX) may change the interaction of coronavirus spike protein (CSP) with angiotensin converting enzyme-2 (ACE2). Data showed that E2 was more strongly to interact with the main protease of the coronavirus, while T had the lowest affinity for CSP. The binding energy of the CSP to ACE2 was increased in the presence of steroids; the greatest increase was observed by DEX and E2. The binding free energy of the CSP to ACE2 was the highest in the presence of E2 and DEX. Together, the interaction between CSP and ACE2 can be disrupted by E2 and to a greater extent by DEX, in part explaining the lower incidence of COVID-19 infection in women than men. The potential use of E2 and DEX to reduce coronavirus attachment to ACE2 in the early phase of the coronavirus invasion needs to be clinically investigated.