bluuebunny/crossref_metadata_2025 huggingface dataset:
The effect of the fraction of inspired oxygen during alveolar recruitment on absorption atelectasis in laparoscopic surgery: A randomized, controlled trial
Authors: Kim Bo Rim , Lee Seohee , Bae Hansu , Lee Minkyoo , Bahk Jae-Hyon , Yoon Susie
Published: May 2020

Background
The intraoperative alveolar recruitment maneuver (ARM) efficiently treats atelectasis, but the effect of Fio2 during ARM on atelectasis is uncertain. Here, we investigated this effect.
Methods
Patients undergoing elective laparoscopic surgery in the Trendelenburg position were randomized to low- (Fio2 0.4; n = 44) and high-Fio2 (Fio2 1.0, n = 46) groups. ARMs were performed 1-min post tracheal intubation and post changes between supine and Trendelenburg positions during surgery. Intraoperative Fio2 was set at 0.4 for both groups. Modified lung ultrasound (LUS) scores were calculated to assess lung aeration after inducing anesthesia and at surgery completion. The primary outcome was modified LUS score at the end of the surgery, and secondary outcomes were the intra- and postoperative Pao2 to Fio2 ratio and postoperative pulmonary complications.
Results
Both groups presented similar modified LUS scores before capnoperitoneum and ARM (P = 0.747). However, the postoperative modified LUS score was significantly lower in the low- than in the high-Fio2 group (7.0 ± 4.1 vs 11.7 ± 4.2, mean difference 4.7, 95% CI 2.96–6.44, P < 0.001). Significant atelectasis postoperatively was more common in the high-Fio2 group (relative risk 1.77, 95% CI 1.27‒2.47, P < 0.001). Intra- and postoperative Pao2 to Fio2 were similar and no postoperative pulmonary complications occurred. Atelectasis occurred more frequently when ARM was performed with high than with low Fio2. High-Fio2 did not benefit oxygenation.
Conclusions
In patients undergoing laparoscopic surgery in the Trendelenburg position, absorption atelectasis occurred more frequently when the ARM was performed with high rather than low Fio2. No oxygenation benefit was observed in the high-Fio2 group.
Trial registration:
ClinicalTrials.gov, NCT03943433. Registered 7 May 2019, https://clinicaltrials.gov/ct2/show/NCT03943433
Quality of sleep and associated factors among people living with HIV/AIDS on follow up at Ethiopian Zewditu Memorial Hospital,2018
Authors: Mengistu Nebiyu , Azale Telake , Yimer Solomon , Fikreyesus Mahilet , Melaku Elsa , Shumye Seid
Published: May 2020

Background
Sleep disturbance is a common complaint in people living with HIV/AIDS. Those individuals with it are less likely to adhere to their antiretroviral therapy regimens, have decreased quality of life, have decreased work productivity as well as it may increase the risk for psychiatric disorders, cardiovascular morbidity and disease progression. However, it is not well studied in Ethiopia.
Methods
An institution based cross-sectional study was utilized among 408 participants selected by systematic sampling technique. The Pittsburgh Sleep Quality Index questionnaire was used to measure sleep quality. Binary and multivariable logistic regression models were fitted. Odds ratios (OR) with the corresponding 95% confidence interval (95%CI)) was computed to assess the strength of association. P-value < 0.05 was considered as statistically significant.
Results
The magnitude of poor sleep quality was 55.6%. Being female [AOR = 3.40, 95% CI: (1.80, 6.41)], depression [AOR = 3.52, 95% CI: (1.95, 6.32)], CD4count ≤ 200 cells/mm3 [AOR = 3.18,95%CI: (1.65,6.13)], duration of HIV/AIDS diagnosis [AOR = 3.43,95% CI: (1.61,7.29)], current use of tobacco [AOR = 5.69, 95% CI: (2.04,15.9)] and chat or caffeinated drinks [AOR = 2.65, 95% CI: (1.06,6.64)] and poor sleep hygiene [AOR = 3.55, 95% CI: (1.85, 6.78)] were significantly associated with poor sleep quality.
Conclusions
More than half of the study participants were found to have poor sleep quality. Routine screening of sleep condition among people living with HIV/AIDS and early intervention based on the findings is suggested.
Effects of enriched environment and probiotics on the intestinal mucosal barrier and the brain-gut axis in rats with colorectal cancer
Authors: Liu Dun , Xian-Yi Wu , Si-Ting Huang
Published: May 2020

Background

Enriched environment is a paradigm where animals are introduced to novel, complex, and stimulating surroundings that can protect the intestinal mucosal barrier and regulate the expression of brain-gut peptides. Probiotics can effectively protect the intestinal mucosal barrier and regulate brain-gut axis activity in colorectal cancer patients. This study assessed the effects of probiotics, enriched environment, and joint intervention on the intestinal mucosal barrier and brain-gut axis in rats with colorectal cancer.
Methods

We used a rat model of 1,2-dimethylhydrazine-induced colorectal cancer. Rats were housed in four different conditions for 2 weeks: enriched environment, probiotic,joint condition and normal condition. Each rat was weighed, and the intestinal mucosa and plasma levels of tumor TNF-α, IL-6, IL-10, ghrelin, CRF, occludin, BT, SIgA and the morphology of the intestinal mucosa were measured.
Results

enriched environment was beneficial regarding bacteria translation, plasma and intestinal mucosa levels of cytokines, plasma CRF levels, villi length and width of intestinal mucosa and hypothalamus ghrelin compared to probiotic (P < 0.05). There were no statistical differences between the enriched environment and the other groups regarding occludin, SIgA, muscle thickness or intestinal mucosa ghrelin (P > 0.05).
Conclusions

The effect of enriched environment was better than probiotic, especially in the intestinal mucosal immune and biological barrier in rats with colorectal cancer. However, the combination of the two was not as effective as enriched environment. In future studies, we can investigate the role of environment and probiotics in SIgA, intestinal mucosal mechanical barrier and body weight by extending the intervention time and enlarging the sample size.
Examining the effector mechanisms of Xuebijing Injection on COVID-19 based on network pharmacology
Authors: Zheng Wenjiang , Yan Qian , Ni Yongshi , Zhan Shaofeng , Yang Liuliu , Zhuang Hongfa , Liu Xiaohong , Jiang Yong
Published: May 2020

Objective To examine the potential effector mechanisms of Xuebijing (XBJ) on coronavirus disease 2019 (COVID-19) based on network pharmacology.Methods We searched Chinese and international papers to obtain the active ingredients of XBJ. Then, we compiled COVID-19 disease targets from the GeneCards gene database and via literature searches. Next, we used the SwissTargetPrediction database to predict XBJ’s effector targets and map them to the abovementioned COVID-19 disease targets in order to obtain potential therapeutic targets of XBJ. Cytoscape software version 3.7.0 was used to construct a “XBJ active-compound–potential-effector target” network and protein–protein interaction (PPI) network, and then to carry out network topology analysis of potential targets. We used the ClueGO and CluePedia plugins in Cytoscape to conduct gene ontology (GO) Biological Process (BP) analysis and Kyoto Encyclopedia of Genes and Genomes (KEGG) signaling pathway enrichment analysis of XBJ’s effector targets.Results We obtained 147 potential COVID-19 effector targets of XBJ. Fourteen of these targets—glyceraldehyde 3-phosphate dehydrogenase (GAPDH), albumin (ALB), tumor necrosis factor (TNF), epidermal growth factor receptor (EGFR), mitogen-activated protein kinase 1 (MAPK1), Caspase-3 (CASP3), signal transducer and activator of transcription 3 (STAT3), MAPK8, prostaglandin-endoperoxide synthase 2 (PTGS2), JUN, interleukin-2 (IL-2), Estrogen Receptor 1 (ESR1), and MAPK14—had degree values > 40 and therefore could be considered key targets. They participated in extracellular signal–regulated kinase 1 and 2 (ERK1, ERK2) cascade, the T-cell receptor signaling pathway, activation of MAPK activity, cellular response to lipopolysaccharide (LPS), and other inflammation- and immune-related BPs. XBJ exerted its therapeutic effects through the renin–angiotensin system (RAS), nuclear factor κ-light-chain-enhancer of activated B cells (NF-κB), MAPK, phosphatidylinositol-4,5-bisphosphate 3-kinase (PI3K)–protein kinase B (Akt)–vascular endothelial growth factor (VEGF), toll-like receptor (TLR), TNF, and inflammatory-mediator regulation of transient receptor potential (TRP) signaling pathways to ultimately construct a “ingredient–target–pathway” effector network. Conclusion: The active ingredients of XBJ regulated different genes, acted on different pathways, and synergistically produced anti-inflammatory and immune-regulatory effects, which fully demonstrated the synergistic effects of different components on multiple targets and pathways. The results of this study validated current pharmacological mechanistic studies of XBJ in the treatment of sepsis and severe pneumonia and could better explain XBJ’s effector mechanisms in the clinical treatment of COVID-19.
Enhanced therapeutic effects of umbilical cord mesenchymal stem cells after prolonged treatment for HBV- related liver failure and liver cirrhosis
Authors: Jia Yifan , Shu Xin , Yang Xiaoan , sun Haixia , Cao Huijuan , Cao Hong , Zhang Ka , Xu Qihuan , Li Gang , Yang Yang
Published: May 2020

Background: This study aimed to investigate the therapeutic effect of umbilical cord mesenchymal stem cells (UCMSCs) on HBV-related liver failure and liver cirrhosis and to compare the different efficacies of UCMSCs after different treatment courses.Methods: This was an observational study that retrospectively considered a three-year period during which 513 patients who received stem cell infusion met the criteria of hepatic failure and liver cirrhosis were identified from databases of the Third Affiliated Hospital of Sun Yat-sen University. Eligible patients were categorized into the liver failure group and liver cirrhosis group. The two groups were divided into different subgroups according to the times of stem cell therapy. In the liver failure group, group A received more than 4 weeks and group B received less than 4 weeks. In the liver cirrhosis group, patients who received more than 4 weeks of stem cell therapy belonged to group C, and group D received less than 4 weeks. The patients were followed up for 24 weeks. The demographics, clinical characteristics, biochemical factors, and MELD scores were recorded and compared among different groups.Results: A total of 64 patients met the criteria of liver failure, and 59 patients met the criteria of liver cirrhosis. After UCMSC treatments, the levels of ALT, AST, and TBIL at all postbaseline time points were significantly lower than those at baseline in the liver failure group and liver cirrhosis group; the PTA and MELD scores only gradually improved in the liver failure group. Four weeks after UCMSC treatment, patients with prolonged treatment with UCMSCs had higher TBIL decline levels than patients who terminated treatment with UCMSCs. After more than 4 weeks of UCMSC treatment, there was no statistically significant difference in the levels of change for ALT, AST, TBIL, PTA value and the MELD score between patients with liver failure with prolonged treatment with UCMSCs and patients with liver cirrhosis with prolonged treatment with UCMSCs at all observation weeks. However, the median decline and cumulative decline in the TBIL level of patients with liver failure with a standard 4-week treatment course were higher than those of patients with liver cirrhosis with a standard 4-week treatment course.Conclusion: Peripheral infusion of UCMSCs showed good therapeutic effects for HBV-related liver failure and liver cirrhosis. Prolonging the treatment course can increase the curative effect of UCMSCs for end-stage liver disease, especially for patients with cirrhosis.
Quantification of Epicardial Fat using 3D Cine Dixon MRI
Authors: Henningsson Markus , Brundin Martin , Scheffel Tobias , Edin Carl , Viola Federica , Carlhäll Carl-Johan
Published: May 2020

Background There is an increased interest in quantifying and characterizing epicardial fat which has been linked to various cardiovascular diseases such as coronary artery disease and atrial fibrillation. Recently, three-dimensional single-phase Dixon techniques has been used to depict the heart and to quantify the surrounding fat. The purpose of this study was to investigate the merits of a new high-resolution cine 3D Dixon technique for quantification of epicardial adipose tissue and compare it to single-phase 3D Dixon in patients with cardiovascular disease.Methods Fifteen patients referred for clinical CMR examination of known or suspected heart disease were scanned on a 1.5T scanner using single-phase Dixon and cine Dixon. Epicardial fat was segmented by three readers and intra- and inter-observer variability was calculated per slice. Cine Dixon segmentation was performed in the same cardiac phase as single-phase Dixon. Subjective image quality assessment of water and fat images were performed by three readers using a 4-point Likert scale (1 = severe; 2 = significant; 3 = mild; 4 = no blurring of cardiac structures).Results Intra-observer variability was excellent for cine Dixon images (ICC = 0.96), and higher than single-phase Dixon (ICC = 0.92). Inter-observer variability was good for cine Dixon (ICC = 0.76) and moderate for single-phase Dixon (ICC = 0.63). The intra-observer measurement error (mean ± standard deviation) per slice for cine was − 0.02 ± 0.51 ml (-0.08 ± 0.4%), and for single-phase 0.39 ± 0.72 ml (0.18 ± 0.41%). Inter-observer measurement error for cine was 0.46 ± 0.98 ml (0.11 ± 0.46%) and for single-phase 0.42 ± 1.53 ml (0.17 ± 0.47%). Visual scoring of the water image yielded median of 2 (interquartile range = [Q3-Q1] 2–2) for cine and median of 3 (interquartile range = 3 − 2) for single-phase (P < 0.05) while no significant difference was found for the fat images, both techniques yielding a median of 3 and interquartile range of 3 − 2.Conclusion Cine Dixon can be used to quantify epicardial fat with lower intra- and inter-observer variability compared to standard single-phase Dixon. The time-resolved information provided by the cine acquisition appears to support the delineation of the epicardial adipose tissue depot.
Perceptions of Education Quality and Influence of Language Barrier: Graduation Survey of International Medical Students at Four Universities in China
Authors: Li Wen , Liu Chang , Liu Shenjun , Zhang Xin , Shi Rong-gen , Jiang Hailan , Ling Yi , Sun Hong
Published: May 2020

Background: As an increasing number of Asian and African students are studying medicine in China, it is imperative to assess the training quality of these international medical students (IMSs). The study was to gain insight into the attitudes from China-educated IMSs towards the medical curriculum and the influence of Chinese language abilities on their clinical studies. Methods: A modified Association of American Medical Colleges Graduation Questionnaire was applied among the final-year IMSs during the graduation season from May 2019 to July 2019 at four universities in China. The questionnaire asked IMSs to evaluate medical education quality and assess their Chinese language capacity. One-way ANOVA was used to determine whether participants' Chinese language capacity was associated with their clinical experience and clinical competence. Results: Overall, 209 valid responses were received and 76.1% were satisfied with the quality of the medical education. Genetics, physics, and mathematics were seen as the least helpful basic courses for practice, and 21.5% thought community-oriented medicine was a topic that lacked instruction. 58.9% were positive that discussions surrounding ethical topics were involved during their clerkships, and 71.3% believed they had acquired sufficient clinical skills to begin a residency program. Chinese speaking skill and communication manner were significant factors to influence students' clinical experience and competence. Conclusion: The study demonstrates China-educated IMSs' perceptions of the contemporary education policy from various aspects and language influence on their education experiences. The curriculum for IMSs in China should be more problem-based to enhance course interaction and more community-engaged to meet people's needs for health and medical care. Besides, the oral Chinese teaching and the initiative to speak need to be emphasized to facilitate the clinical training for IMSs. Our findings can be used as a source of evidence to benchmark medical curricular codifications catering for Asian and African students.
Grit protects medical students from burnout: a longitudinal study
Authors: Jumat Raihan , Chow Pierce Kah-Hoe , Allen John , Lai Siang-Hui , Hwang Nian-Chih , Iqbal Jabed , Mok May Un Sam , Rapisarda Attilio , Velkey John Matthew , Engle Deborah , Compton Scott
Published: May 2020

BackgroundBurnout is a serious issue plaguing the medical profession with potential negative consequences on patient care. Burnout symptoms are observed as early as medical school. Based on a Job Demands-Resources model, this study aims to assess associations between specific job resources measured at the beginning of the first year of medical school with burnout symptoms occurring later in the first year.MethodsThe specific job resources of grit, tolerance for ambiguity, social support and gender were measured in Duke-NUS Medical School students at the start of Year 1. Students were then surveyed for burnout symptoms at approximately quarterly intervals throughout the year. Using high ratings of cynicism and exhaustion as the definition of burnout, we investigated the associations of the occurrence of burnout with student job resources using multivariable logistic regression analysis. ResultsOut of 59 students, 19 (32.2%) indicated evidence of burnout at some point across the first year of medical school. Stepwise multivariable logistic regression analysis identified grit as having a significant protective effect against experiencing burnout (Odds Ratio, 0.84; 95%CI 0.74 to 0.96). Using grit as a single predictor of burnout, area under the ROC curve was 0.76 (95%CI: 0.62 to 0.89).ConclusionsGrit was identified as a protective factor against later burnout, suggesting that less gritty students are more susceptible to burnout. The results indicate that grit is a robust character trait which can prognosticate burnout in medical students. These students would potentially benefit from enhanced efforts to develop grit as a personal job resource.
Knowledge, attitudes, social responsibilities and career plans toward Corona Virus Disease 2019 (Covid-19) among Chinese clinical medical students
Authors: Yang Haojun , Zheng Yue , Yu Fang , Cheng Bohao , Zhu Ziqing , Liao Sheng , Chen Yu , Wang Fang
Published: May 2020

Purpose: To assess knowledge, attitudes and social responsibilities toward Covid-19 among Chinese clinical medical students. Method: Self-administered questionnaires were used to collect data for 889 clinical medical students from 3 well-known Chinese medical universities. The questionnaire was comprised of three domains which consisted of 7 items for knowledge, 5 items for attitudes and social responsibilities and 4 items for career planning. Results: It was found that 47.2%, 46.9% of the clinical medical students were willing to be volunteers in Hubei Province or stick to their own hospitals if they had been back to work, mainly because of responsibilities of doctors(92.7%). About 74.1% of the participants had a clear career plan for the future. 12.5% of the participants preferred several departments with the heaviest workload during the outbreak(Department of infectious disease, 1.2%; Department of respiration, 3.6%; ICU or emergency, 7.7%). Besides, students at clinical learning stage mastered better than basic learning students in the knowledge of Covid-19 especially in clinical manifestations(p < 0.001). There were significant differences between graduated and new-enrolled medical students in the attitudes of becoming a front-line doctor of Wuhan and the professional happiness of doctors(p < 0.001). Conclusions: Students at clinical learning stage mastered better than basic learning students in the knowledge of Covid-19 especially in clinical manifestations. The expectations of professional happiness and social responsibilities in new-enrolled clinical medical students were higher than those in graduated medical students which could be easily influenced and had no relation with different clinical major. Therefore, future strategies for medical education reform in China should focus on keeping the professional identity and sense of belonging of medical students.
Extracellular vesicular Wnt7b mediates HPV E6-induced cervical cancer angiogenesis by activating the β-catenin signaling pathway
Authors: Qiu Jun-Jun , Sun Shu-Gen , Tang Xiao-Yan , Lin Ying-Ying , Hua Keqin
Published: May 2020

Background

The E6 oncoproteins of human papillomavirus (HPV) 16/18 are the critical drivers of cervical cancer (CC) progression. Extracellular vesicles (EVs) are emerging as critical mediators of cancer-tumor microenvironment (TME) communication. However, whether EVs contribute to HPV 16/18 E6-mediated impacts on CC progression remains unclear.

Methods

A series of in vitro and in vivo assays were performed to elucidate the roles and mechanism of EV-Wnt7b in HPV E6-induced CC angiogenesis. The prognostic value of serum EV-Wnt7b was determined and a predictive nomogram model was established.

Results

HPV 16/18 E6 upregulated Wnt7b expression in four HPV 16/18-positive CC cell lines and their EVs. In vitro and in vivo experiments demonstrated that EV-Wnt7b was transferred to and modulated human umbilical vein endothelial cells (HUVECs) toward more proliferative and proangiogenic behaviors by impacting β-catenin signaling. Clinically, serum EV-Wnt7b levels were elevated in CC patients and significantly correlated with an aggressive phenotype. Serum EV-Wnt7b was determined to be an independent prognostic factor for CC overall survival (OS) and recurrence-free survival (RFS). Notably, we successfully established a novel predictive nomogram model using serum EV-Wnt7b, which showed good prediction of 1- and 3-year OS and RFS.

Conclusions

Our results illustrate a potential crosstalk between HPV 16/18-positive CC cells and HUVECs via EVs in the TME and highlight the potential of circulating EV-Wnt7b as a novel predictive biomarker for CC prognosis.
Nelfinavir for COVID19: Summary of basic science data and initial clinical experience
Authors: Lee Paul C
Published: May 2020

Based on in vitro and computational model data that nelfinavir is highly active again SARS-CoV-2, we administered nelfinavir to six COVID-19 outpatients. Three of four acute outpatient COVID-19 patients became afebrile within 48 hours. In contrast, the two subacute COVID-19 patients with predominant GI symptoms responded only partially to nelfinavir.
Comprehensive residency-based point-of-care ultrasound training program increases ultrasound utilization in the emergency department
Authors: Chen Wei-Lung , Hsu Chan-Peng , Wu Po-Han , Chen Jiann-Hwa , Huang Chien-Cheng , Chung Jui-Yuan
Published: May 2020

Background: Point-of-care ultrasonography (POCUS) is a prompt and simple tool for the urgent diagnosis and treatment of patients in the emergency department (ED). It has contributed to improvements in patient treatment quality, procedural safety, timeliness of care, diagnostic accuracy, and cost reduction. We developed a comprehensive residency-based POCUS training program for ED residents and determined its effect on ultrasound utilization in the ED.Methods: We conducted a retrospective cohort study in the ED of a university-affiliated medical center, evaluating a centralized residency-based POCUS training course from July 2017 to June 2018 for ED residents that included 12 core ultrasound applications: trauma, intrauterine pregnancy, abdominal aortic aneurysm, echocardiography and hemodynamic assessment, hepatobiliary system, urinary tract, deep vein thrombosis, soft tissue and musculoskeletal, thoracic-airway, ocular, bowel, and procedural guidance. Each application comprised a combined lecture and hands-on practice session that lasted for 2 hours. Pre-tests and post-tests, including still image and video interpretation, were performed. Utilization of POCUS among ED residents before and after the POCUS training course (July 2016–June 2017 and July 2018–June 2019) was calculated and analyzed using the Wilcoxon signed-rank test.Results: In total, 16 residents participated and completed the entire training course. The post-test score improved significantly compared to the pre-test score by a median of 12 points (p = 0.04). Utilization of POCUS among the ED residents increased significantly from 0.15 ultrasound studies per patient per year to 0.41 ultrasound studies per patient per year (p < 0.01) after completion of the entire training course. Increased POCUS scanning percentages over the cardiac, soft tissue, abdominal region, vascular system, procedural guidance, and ocular regions were also noted after providing the curriculum.Conclusions: There was a significant increase in POCUS utilization among ED residents after a comprehensive residency-based POCUS training program.
Factors Affecting the Acceptance of Blended Learning in Medical Education: Application of UTAUT2 Model
Authors: Azizi Seyyed Mohsen , Roozbahani Nasrin , Khatony Alireza
Published: May 2020

Background: Blended learning is a new approach toward improving the quality of medical education. Acceptance of blended learning plays an important role in its effective implementation. Therefore, the purpose of this study was to investigate and determine the factors that may influence the behavioral intention to use of blended learning in medical education.Methods: In this cross-sectional, correlational study, the sample consisted of 225 Iranian medical sciences students. The theoretical framework for designing the conceptual model was UTAUT2. Data were analyzed using SPSS-18 and AMOS-23 software. Structural equation modeling technique was used to test the hypothesis.Results: The validity and reliability of the model constructs were acceptable. Performance expectance, effort expectance, social influence, facilitating conditions, hedonic motivation, price value and habit had a significant effect on students’ behavioral intention to use of blended learning. Additionally, Behavioral intention to use of blended learning also had a significant effect on students’ actual usage of blended learning (β=0.645, P≤0.01).Conclusion: The study revealed that the proposed framework based on UTAUT2 has good potential to identify factors influencing students' behavioral intention to using of blended learning. Universities can use the results of this study to design and implementation successful blended learning courses in medical education.
Limited effects from professional identity formation-oriented education on self-regulated learning in a hybrid problem-based learning curriculum: a mixed-method study in Japan
Authors: Matsuyama Yasushi , Nakaya Motoyuki , Leppink Jimmie , Vleuten Cees van der , Asada Yoshikazu , Lebowitz Adam Jon , Sasahara Teppei , Yamamoto Yu , Matsumura Masami , Gomi Akira , Ishikawa Shizukiyo , Okazaki Hitoaki
Published: May 2020

Background: Developing self-regulated learning (SRL) in a teacher-centered curriculum is challenging. Previous studies indicate professional identity formation (PIF), or the formation of self-identity with internalized values and norms of professionalism, might improve SRL．We designed a PIF-oriented education format for hybrid problem-based learning (PBL) and tested its effectiveness on SRL in a mixed research method.Methods: A randomized controlled crossover trial was conducted using 112 pre-clinical year students at Jichi Medical University. In the six one-day PBL sessions, Groups A (n = 56, female 18, mean age 21.5y ± 0.7) and B (n = 56, female 11, mean age 21.7y ± 1.0) experienced PIF-oriented pre-PBL learning: Group A had three sessions in the first half, B in the second half. Between-group PIF and SRL levels were compared using Professional Identity Essay (PIE) and Motivated Strategies for Learning Questionnaire (MSLQ). A qualitative thematic analysis of potential reasons for PIF improvement was performed using the PIE description.Results: Two-level regression analyses showed moderate improvement of PIF stages over time (R2 = 0.069), regardless of intervention. PIF-oriented pre-PBL learning alone did not significantly improve PIE stages or MSLQ scores. Thematic analysis indicated that PIF-oriented pre-PBL learning helped students recognize realistic difficulties in clinical practice, and articulate professional image and values. However, encounters in extracurricular clinical settings had diverse and meaningful impacts on PIF.Conclusions: Limited effect of PIF-oriented pre-PBL learning on PIF and SRL indicate challenges in SRL-oriented education for pre-clinical year students within a teacher-centered hybrid PBL curriculum.
Prognostic factors affecting the short-term efficacy of non-surgical treatment of chronic periodontitis: a multilevel modelling analysis
Authors: Liu Hui-Jie , Wang Bo , Wang Ao-Chen , Zhang Dan-Hong , Mao Cui , Li Qiu-Hong
Published: May 2020

Objective This current study is aimed to analyze the prognostic factors affecting the short-term efficacy of non-surgical treatment of patients in periodontitis from stage II to stage IV by the multilevel modelling analysis. Materials and Methods A total of 58 patients of chronic periodontitis were included in this study. Patients were clinically explored before and 3 months after the treatment, with the data of Δ probing depth (PD) [Δ PD = baseline PD – finial probing depth (FPD)] as the outcome variables. All the data were divided into site level, tooth level and patient level to construct a multi-layer linear model. Results Compared with the mesial sites and distal sites of the multi-rooted teeth, the number of PD ≥ 5mm or PD < 5mm after the treatment was significantly different ( P < 0.05), and the proportion of PD < 5mm was higher in mesial sites. The null model showed that Δ PD varied greatly between groups at various levels ( P <0.001), with prediction variable of site level, tooth level, and patient level accounted for 66%, 18%, and 16% of the overall difference, respectively. The complete model showed that the Δ PD of smokers was significantly lower than that of non-smokers ( P < 0.001). The Δ PD of the mesial and distal sites was larger than that of the buccolingual central site ( P < 0.001). The Δ PD of single-rooted teeth was larger than that of multi-rooted teeth ( P < 0.001). The baseline PD, tooth mobility (TM), bleeding index (BI), clinical attachment loss (CAL) were significantly negatively correlated with Δ PD ( P < 0.001). Conclusions Patients with periodontitis from stage II to stage IV, who are non-smoking, have good compliance, good awareness of oral health, and low percentage sites with PD ≥ 5mm at baseline, single rooted teeth with hypomobility, less CAL and lower BI and sites of mesial or distal can obtain an ideal short-term efficacy of non-surgical treatment.
Are registered nurses ready to take care at the end-of-life: crossectional survey
Authors: Blazeviciene Aurelija , Laurs Lina , Newland Jamesetta A
Published: May 2020

Background: End-of-life care is provided in a variety of healthcare settings, not just palliative care hospitals. This is one reason it is very important to assess all the obstacles to end-of-life care and to provide safe and quality services to patients. The main purpose of this study was to examine attitudes faced by registered nurses in providing end-of-life care and to explore obstacles and supportive behaviors for nurses. Methods: A descriptive, correlational design was applied in this study. Cross‐sectional survey of 1320 registered nurses within 7 hospitals in Lithuania. Results: Registered nurses working in the three different profiles emphasized safe and effective care andthe importance of meeting the patient's spiritual needs at the end of life. The main obstacles assigned by nurses caring for patients at the end of life were angry family membersthe inadequate understanding of nursing care by the patient's relatives; family members' inadequate knowledge about the situation and lack of time to talk to patients about their wishes, lack of nursing knowledge to deal with the bereaved patient's family, lack of evaluation of nurses' opinions, and the evasion by physicians to talk about the diagnosis and their over-optimistic view of the situation. Conclusions: Spiritual needs were identified by nurses as the primary needs of patients at the end of life. Family-related obstacles remain one of the main obstacles to end-of-life care. Also, the behavior of physicians and their relationship with nurses remains one of the most sensitive issues in end-of-life care.
Comparing the Efficacy of Syngeneic Iliac and Femoral Allografts with Iliac Crest Autograft in a Rat Model of Lumbar Spinal Fusion
Authors: Holmes Christina , Elder Benjamin D. , Ishida Wataru , Pantoja Alexander Perdomo , Locke John , Cottrill Ethan , Lo Sheng-Fu L. , Witham Timothy F.
Published: May 2020

Background: Despite widespread use of femoral-sourced allografts in clinical spinal fusion procedures and the increasing interest in using femoral reamer–irrigator–aspirator (RIA) autograft in clinical bone grafting, few studies have examined the efficacy of femoral grafts compared to iliac crest grafts in spinal fusion. The objective of this study was to directly compare the use of autologous iliac crest with syngeneic femoral and iliac allograft bone in the rat model of lumbar spinal fusion.Methods: Single-level bilateral posterolateral intertransverse process lumbar spinal fusion surgery was performed on Lewis rats divided into three experimental groups: iliac crest autograft; syngeneic iliac crest allograft; and syngeneic femoral allograft bone. Eight weeks postoperatively, fusion was evaluated via microCT analysis, manual palpation and histology. In vitro analysis of the colony-forming and osteogenic capacity of bone marrow cells derived from rat femurs and hips was also performed to determine whether there was a correlation with the fusion efficacy of these graft sources.Results: Although no differences were observed between groups in CT fusion rates or fusion mass volumes, iliac allografts displayed a higher rate of bilateral fusion via manual palpation. Histologically, hip-derived grafts showed better integration with host bone than femur derived ones, likely associated with the higher concentration of osteogenic progenitor cells observed in hip-derived bone marrow.Conclusions: This study demonstrates the feasibility of using syngeneic allograft bone in place of autograft bone within inbred rat fusion models and highlights the need for further study of femoral-derived grafts in fusion.
Comparative chromosomal localization of 45S and 5S rDNAs in 76 purple-fleshed sweet potato cultivars
Authors: Su Dan , Chen Lei , Sun Jianying , Zhang Luyue , Gao Runfei , Li Qiang , Han Yonghua , Li Zongyun
Published: May 2020

Background: In recent years, purple-fleshed sweet potato has been paid more and more attention because of its high nutritional value. However, the current studies on purple-fleshed sweet potato were still focused on the research and production of the related products. The research on its cytogenetics is relatively lagging behind, which cannot satisfy the study of genetic diversity of purple-fleshed sweet potato. Therefore, we carried out cytogenetic analysis on 76 purple-fleshed sweet potato cultivars, aim to analyze the chromosome structure and distribution of 45S rDNA and 5S rDNA in 76 purple-fleshed sweet potato cultivars.Results: We have found that only 62 purple-fleshed sweet potato cultivars with 90 chromosomes, and the others were aneuploid with 88, 89, 91, 92 chromosomes. The number of 45S rDNA in 76 purple-fleshed sweet potato cultivars varies from 16 to 21, with different signal sizes and intendities, and localized at the terminal or satellite of chromosomes. The number of 5S rDNA were relatively stable, 74 of the varieties investigated contained 6 sites, located at the terminal of chromosomes and near centromere. Only the Quanzishu 96 has 7 5S rDNA sites, and Yuzixiang 10 has 5 5S rDNA sites. In addition, rDNA analysis was also performed on two parents of Quanzishu 96. Both the two parents had 18 45S rDNA sites and 6 5S rDNA sites, which were different from the results of Quanzishu 96.Conclusions: For hexaploid sweet potato cultivars, there is genetic instability between purple-fleshed sweet potato cultivars. The 45S rDNA sites showed numerical variation, whereas conserved number of 5S rDNA sites were observed.
The affordability of a healthy and sustainable diet: An Australian case study.
Authors: Goulding Tara , Lindberg Rebecca , Russell Catherine Georgina
Published: May 2020

BACKGROUND/AIMS : EAT– Lancet Commission’s Planetary Health Diet proposed a diet that integrates nutrition and sustainability considerations, however its affordability is unknown in many country-specific contexts, including Australia. The aim of this study is to develop a healthy and sustainable food basket modelled on the Planetary Health Diet to determine the affordability of the Planetary Health Diet basket across various socio-economic groups, and compare this affordability with a food basket modelled on the typical current diet, in an Australian setting.METHODS : An Australian-specific Planetary Health Diet basket was developed for a reference household (2 adults and 2 children) modelled on the Planetary Health Diet reference diet, and compared to a previously-developed Typical Australian Diet basket. The cost of each food basket was determined by online supermarket shopping surveys in low, medium and high socio-economic areas in each Australian state. Basket affordability was determined for the reference household by comparing the basket cost to disposable income in each socio-economic group in each state. Mann-Whitney U tests then determined if there were significant differences between the median costs and the median affordability of both baskets.RESULTS : The Planetary Health Diet basket was shown to be less expensive and more affordable than the Typical Australian Diet basket nationally, in all metropolitan areas, in all socio-economic groups across Australia (median cost: Planetary Health Diet=AUD$188.21, Typical Australian Diet=AUD$224.36; median affordability: Planetary Health Diet=13%, Typical Australian Diet=16%; p =<0.05).CONCLUSIONS : This study showed the Planetary Health Diet to be more affordable than the Typical Australian Diet for metropolitan-dwelling Australians.IMPLICATIONS : These results can help to inform public health and food policy aimed at achieving a healthy and sustainable future for all Australians, including reductions in overweight/obesity rates and increased food security.
Identification of saquinavir as a potent inhibitor of dimeric SARS-CoV2 main protease through MM/GBSA
Authors: Martiniano Bello , Alberto Martínez-Muñoz , Irving Balbuena-Rebolledo
Published: May 2020

Among targets selected for studies aimed to identify potential inhibitors against COVID-19, SARS-CoV2 main proteinase (Mpro) is highlighted. Mpro is indispensable for virus replication, and is a promising target of potential inhibitors of COVID-19. Recently, monomeric SARS-CoV2 Mpro, drug repurposing and docking methods have facilitated the identification of several potential inhibitors. Results were refined through the assessment of dimeric SARS-CoV2 Mpro, which represents the functional state of enzyme. Docking and molecular dynamics (MD) simulations combined with molecular mechanics/generalized Born surface area (MM/GBSA) studies indicated that dimeric Mpro most significantly impacts binding affinity tendency compared with the monomeric state, which suggesting that dimeric state is most useful when performing studies aimed to identify drugs targeting Mpro. In this study, we extend previous research by performing docking and MD simulation studies coupled with an MM/GBSA approach to assess binding of dimeric SARS-CoV2 Mpro to 12 FDA-approved drugs (darunavir, indinavir, saquinavir, tipranavir, diosmin, hesperidin, rutin, raltegravir, velpatasvir, ledipasvir, rosuvastatin and bortezomib), which were identified as the best candidates for treatment of COVID-19 in some previous dockings studies involving monomeric SARS-CoV2 Mpro. This analysis identified saquinavir as a potent inhibitor of dimeric SARS-CoV2 Mpro, therefore, the compound may have clinical utility against COVID-19.
The Rises of Coronavirus Disease (COVID-19) death rate in Japan with high PM2.5
Authors: Nawahda Amin
Published: May 2020

Currently vulnerable age groups in most countries are affected by the respiratory -coronavirus disease 2019 (COVID-19). Long-term-exposure to high levels of PM2.5 (particulate matter with aerodynamic diameter ≤ 2.5μm) is also associated positively with repository deaths. The aim of this study is to find if high PM2.5 levels affect COVID-19 caused deaths in Japan. COVID-19 caused death and tested positive cases in all prefectures during the study period from Feb. 18 up to Apr. 16, 2020 are analyzed. PM2.5 caused deaths from 2010 to 2017 are calculated based on PM2.5-relative risk (RR) of 1.04 (95% CI: 1.01 – 1.08) from the World Health Organization-Air Quality Guidelines (WHO–AQG). The findings of this study show that old people who are living in prefectures with high levels of PM2.5 are the most vulnerable to COVID-19. The estimated death cases from 2010 to 2017 are about 115,532 (95% CI: 28,883 - 231,064) cases. Thus; policy decision makers could consider PM2.5 data to support their efforts not only to minimize the spread of COVID-19, but also to improve air quality.
Metabolic engineering of phosphite metabolism in Synechococcus elongatus as an effective measure to control biological contaminants in outdoor raceway ponds
Authors: González-Morales Sandra Isabel , Pacheco-Gutiérrez Navid , Rodríguez-Sierra Carlos A. , Brito-Bello Alethia A. , Estrella-Hernández Priscila , Herrera-Estrella Luis , ARREDONDO DAMAR LOPEZ
Published: May 2020

Background The use of cyanobacteria and microalgae as cell factories to produce biofuels and added-value bioproducts has received great attention during the last two decades. Important investment has been made by public and private sectors to develop this field. However, it has been a challenge to develop a viable and cost-effective platform for cultivation of cyanobacteria and microalgae under outdoor conditions. Dealing with contamination caused by bacteria, weedy algae/cyanobacteria and other organisms is a major constraint to establish effective cultivation processes.Results Here we describe the implementation in the cyanobacteria Synechococcus elongatus of a phosphorus selective nutrition system to control biological contamination during cultivation. The system is based on the metabolic engineering of S. elongatus to metabolize phosphite, a phosphorus source normally not metabolized by most organisms, by expressing a bacterial phosphite oxidoreductase (PTXD). Conversion of phosphite into phosphate supports normal growth of S. elongatus. The engineered S. elongatus expressing PTXD grows on media supplemented with phosphite at a similar rate as the non-transformed control supplemented with phosphate. We show that when grown in media containing phosphite as sole phosphorus source in glass flasks, the engineered strain was able to grow and outcompete biological contaminants even when the system was intentionally inoculated with natural competitors isolated from an irrigation canal. We also show that the PTXD/phosphite system can be successfully used for outdoor cultivation of engineered S. elongatus in 100 L cylindrical reactors and 1,000 L raceway ponds, under non-axenic conditions and without the need of sterilizing containers or media and the implementation of any other chemical agent or additional measure to control contamination.Conclusions Our results suggest that the PTXD/phosphite system is a stable and a sufficiently robust strategy to control biological contaminants without the need of sterilizing and other complex aseptic procedures. Our data shows that the PTXD/phosphite system allows the production of cyanobacteria in non-sterile outdoor reactors at lower cost, which in principle should be applicable to other cyanobacteria and microalgae engineered to metabolize phosphite.
A simple and fast Agrobacterium-mediated transformation system for hybrid passion fruit (Passiflora edulis f. edulis × Passiflora edulis f. flavicarpa)
Authors: Asande Lydia K. , Omwoyo Richard O. , Oduor Richard O. , Nyaboga Evans
Published: May 2020

The authors have removed this preprint from Research Square.
Identifying the know-do gap in evidence-based neonatal care practices among informal health care providers—A cross-sectional study from Ujjain, India
Authors: Mungai Isaac Gikandi , Baghel Sumit Singh , Soni Suchi , Vagela Shailja , Sharma Megha , Diwan Vishal , Tamhankar Ashok J. , Lundborg Cecilia Stålsby , Pathak Ashish
Published: May 2020

Background
More than a quarter of global neonatal deaths are reported from India, and a large proportion of these deaths are preventable. However, in the absence of robust public health care systems in several states in India, informal health care providers (IHCPs) with no formal medical education are the first contact service providers. The aim of this study was to assess the knowledge of IHCPs in basic evidence-based practices in neonatal care in Ujjain district and investigated factors associated with differences in levels of knowledge.
Methods
A cross-sectional survey was conducted using a questionnaire with multiple-choice questions covering the basic elements of neonatal care. The collective score per question among the respondents was calculated. The score achieved by each respondent was calculated, grouped into either “fair” or “low”, and then checked for association with the practitioners’ age and years of experience, number of patients examined per day, and whether they attended children in their practice.
Results
Of the 945 IHCPs approached, 830 (88%) participated in the study. Of the potential 39,840 points, only an average of 18,483 (46%) were achieved, indicating a knowledge gap. Although these providers could identify key tenets of enhancing survival chances of neonates, they scored low on the specifics of cord care, breastfeeding, vitamin K use to prevent neonatal hemorrhage, and identification and care of low-birth-weight babies. The practitioners particularly lacked knowledge about neonatal resuscitation, and only a small proportion reported following up on immunizations in children they attended. Fair knowledge of IHCPs was significantly associated with attending more than 10 but less than 50 patients per day and of being aged between 35 and 45 years. Offering pediatric consultations was not significantly associated with achieving a fair score.
Conclusions
The present study highlighted that know-do gap exists in evidence-based practices for all key areas of neonatal care tested among the IHCPs. The study provides the evidence that educational interventions targeting IHCPs can improve neonatal care services and is an innovative way to reach a large rural population in the study setting.