bluuebunny/crossref_metadata_2025 huggingface dataset:
Increase of non-HBV, non-HCV related hepatocellular carcinoma - Over 20 years single institution study-
Authors: Nagaoki Yuko , Hyogo Hideyuki , Ando Yuwa , Kosaka Yumi , Uchikawa Shinsuke , Nishida Yuno , Teraoka Yuji , Morio Kei , Fujino Hatsue , Ono Atsushi , Nakahara Takashi , Murakami Eisuke , Yamauchi Masami , Okamoto Wataru , Kawaoka Tomokazu , Tsuge Masataka , Hiramatsu Akira , Miki Daiki , Imamura Michio , Takahashi Shoichi , Chayama Kazuaki , Aikata Hiroshi
Published: August 2020

Background
We previously reported the trends of etiologies of hepatocellular carcinoma (HCC) between 1995 and 2009. By updating this study, we aimed to evaluate the incidence of HCC with non- hepatitis B viral and non- hepatitis C viral (NBNC) etiologies and also explore the clinical characteristics.
Methods
Consecutive 2171 HCC patients at our institution were enrolled between 1992 and 2018 in this retrospective cohort study. A comparative study was conducted by dividing into two groups, an early group from 1992 to 2009 and a late group from 2010 to 2018.
Results
NBNC-HCC account for 514 patients (23.6%). The proportion of NBNC-HCC has continued to increase from 26.5% in 2009 to 46.3% in 2018. NBNC-HCC were getting older (median ages, 67 to 73 years). Type 2 diabetes mellitus (48.5–60.3%: P = 0.008), hypertension (48.5–57.4%: P = 0.047), and hyperlipidemia (39.2–53.8%: P = 0.001) has increased significantly in recent years. The median FIB-4 index have decreased (4.37 to 3.61: P = 0.026) and the median platelet counts have increased (15.1 to 17.9: P = 0.013) significantly. Among 514 NBNC-HCC, 194 patients underwent hepatic resection in which 14.9%, 29.3%, and 55.8% were based on nonalcoholic steatohepatitis (NASH), alcoholic liver disease (ALD), and cryptogenic, respectively. Cirrhosis was detected in 72.4%, 38.6%, and 15.5% of NASH, ALD and cryptogenic, respectively. The prevalence of cirrhosis in NASH were significantly higher than other groups (P < 0.001), overall, 70% of the background liver of NBNC-HCC was not cirrhosis. On the other hands, the median FIB-4 index in cryptogenic HCC were 2.56 and significantly lower than other groups, FIB-4 index considered as one of useful screening of HCC.
Conclusions
NBNC-HCC has rapidly been increasing in recent years even in regional university hospital. The presence of metabolic syndrome may be important risk factors. Also, HCC from non-cirrhotic liver needs attention. Accordingly, it is speculated that these patients should receive periodic surveillance for HCC development.
Description of a Palliative Approach to Care to Patients in the Last Year of Life in a Primary Care Setting
Authors: Gallagher Erin , Carter-Ramirez Daniel , Boese Kaitlyn , Winemaker Samantha , MacLennan Amanda , Hansen Nicolle , Hafid Abe , Howard Michelle
Published: August 2020

Background: Most patients nearing the end of life can benefit from a palliative approach in primary care. We currently do not know how to measure a palliative approach in family practice. The objective of this study was to describe the provision of a palliative approach and evaluate their clinicians’ perceptions of the results.Methods: We conducted a descriptive study of deceased patients in an interprofessional team family practice. We integrated conceptual models of a palliative approach to create a chart review tool to capture a palliative approach in the last year of life and assessed a global rating of whether a palliative approach was provided. Clinicians completed a questionnaire before learning the results and after, on perceptions of how often they believed a palliative approach was provided by the team.Results: Among 79 patients (mean age at death 73 years, 54% female) cancer and cardiac diseases were the top conditions responsible for death. One-quarter of patients were assessed as having received a palliative approach. 53% of decedents had a documented discussion about goals of care, 41% had nurse involvement, and 15.2% had a discussion about caregiver well-being. These indicators had the greatest discrimination between a palliative approach or not. Agreement that elements of a palliative approach were provided decreased significantly on the clinician questionnaire from before to after viewing the results. Conclusions: This study identified measurable indicators of a palliative approach in family practice, that can be used as the basis for quality improvement.
Diabetes Mellitus and Incidence of Bladder and Kidney Cancer: An Exposure-Control Matched Study
Authors: Park Jae Won , Kim Dong Kyun , Bang Sung Eun , Lim Hyunsun
Published: August 2020

Background: Diabetes mellitus (DM), one of the most common metabolic diseases worldwide, is associated with malignancies at many sites. The relationship between DM and bladder or kidney cancer is still controversial. We investigated the associations between DM and bladder or kidney cancer in a population-based exposure-control matched study.Method: Using the Korean National Health Insurance System sample cohort database, we identified patients who were diagnosed as having DM between January 2006 and December 2010. A control group was also selected from the database using propensity score matching to adjust for age and sex. An exposure-control matched study was conducted until December 2015. The two groups were compared for baseline characteristics and bladder or kidney cancer incidence. Cox’s proportional hazard regression analyses were performed to investigate associations between bladder or kidney cancer and each clinical variable.Results: In total, 132,570 patients with DM were identified. In addition, 132,570 patients without DM matched by age and sex (control group) were selected. The mean age was 54 years, and the male-to-female ratio was 1:1. During the follow-up period, 619 patients in the DM group and 511 in the control group were diagnosed as having bladder cancer. Of those diagnosed as having kidney cancer, 419 patients were in the DM group and 285 were in the control group. Adjusted Cox’s proportional hazard regression analysis revealed that DM is associated with bladder and kidney cancer.Conclusions: DM is associated with bladder and kidney cancer. Older men are at an increased risk for both cancers.
Mid-term Results of an Anterior Plating Via Combined Anterior Approach for complex Acetabular Fractures: A Retrospective Cohort Study
Authors: Meng Weikun , Ou Yi , Wu Zhaoxiang , Yang Hongchang , Chen Ge , Bi Xin , Gao Liang , Chen Zhong
Published: August 2020

Background: Solely anterior plating via the modified Stoppa approach might yield satisfactory outcomes for selected cases of complex acetabular fractures, however, its indications are not practically clear. Methods: Patients with complex acetabular fractures treated with solely anterior plating via the modified Stoppa approach with or without a lateral window at our trauma center between January 2013 and December 2019 were retrospectively reviewed. Fracture type was identified according the newly established three-column classification of acetabular fracture. Perioperative information was recorded, and fracture reduction was evaluated radiographically at 3 days postoperatively. Postoperative hip function was assessed at least 1 year postoperatively. Results: Twenty patients were included with an average 17 months (range, 13-28) follow-up. According to the three-column classification, 2 cases were classified as type B2.2, 8 cases as type B2.3, 3 cases as type C1, and 7 cases as type C3. The mean time from injury and surgery was 7.0 days (range, 3-13 days), operative time was 2.0 hours (range, 1.4-3.2 hours), and intraoperative blood loss was 320 ml (range, 220-450 ml). Fracture reduction was excellent in 15 cases (75%), good in 3 cases (15%), fair in 1 case (5%), and poor in 1 case (5%). Final hip function was excellent in 13 cases (68%), good in 3 cases (16%), fair in 2 cases (11%), and poor in 1 case (5%). Bony healing was achieved in all cases and few complications were reported including recoverable obturator nerve injuries in 2 patients (10%) and controllable osteoarthritis in 1 patient (5%). Conclusions: Solely anterior plating via the combined anterior approach achieved satisfactory mid-term outcomes for complex acetabular fractures with posterior column detachments. Based on the newly established three-column classification of complex acetabular fracture, the type B, C1, and C3 fractures are possibly the appropriate indications for such a simplified procedure.Trial registration informationThe trial was retrospectively registered in https://www.researchregistry.com (No. Researchregistry4862) on July 04, 2019. The first participant was enrolled on March 06, 2017.
Morphometric Study of The Ventricular Indexes in Healthy Ovine Brain Using MRI
Authors: Trovatelli Marco , Spediacci Carlotta , Castellano Antonella , Bernardini Andrea , Dini Daniele , Malfassi Luca , Pieri Valentina , Falini Andrea , Ravasio Giuliano , Riva Marco , Bello Lorenzo , Brizzola Stefano , Zani Davide Danilo
Published: August 2020

BackgroundSheep (Ovis aries) have been largely used as animal models in a multitude of specialties in biomedical research. The similarity to human brain anatomy in terms of brain size, skull features, and gyrification index, gives to ovine as a large animal model a better translational value than small animal models in neuroscience. Despite this evidence and the availability of advanced imaging techniques, morphometric brain studies are lacking. We herein present the morphometric ovine brain indexes and anatomical measures developed by two observers in a double-blinded study and validated via an intra- and inter-observer analysis. ResultsFor this retrospective study, T1-weighted Magnetic Resonance Imaging (MRI) scans were performed at 1.5T on 15 sheep, under general anaesthesia. The animals were female Ovis aries, in the age of 18-24 months. Two observers assessed the scans, twice time each. The statistical analysis of intra-observer and inter-observer agreement was obtained via the Bland-Altman plot and Spearman rank correlation test.The results are as follows (mean±Standard deviation): Indexes: Bifrontal 0,338 ± 0,032 cm; Bicaudate 0,080 ± 0,012 cm; Evans’ 0,218 ± 0,035 cm; Ventricular 0,241 ± 0,039 cm; Huckman 1,693 ± 0,174 cm; Cella Media 0,096 ± 0,037 cm; Third ventricle ratio 0,040 ± 0,007 cm. Anatomical measures: Fourth ventricle length 0,295 ± 0,073 cm; Fourth ventricle width 0,344 ± 0,074 cm; Left lateral ventricle 4,175 ± 0,275 cm; Right lateral ventricle 4,182 ± 0,269 cm; Frontal horn length 1,795 ± 0,303 cm; Interventricular foramen left 1,794 ± 0,301cm; Interventricular foramen right 1,78 ± 0,317 cm.ConclusionsThe present study provides baseline values of linear indexes of the ventricles in the ovine models. The acquisition of these data contributes to filling the knowledge void on important anatomical and morphological features of the sheep brain.
Resilience and vulnerability of maternity services in Zimbabwe: a comparative analysis of the effect of Covid-19 and lockdown control measures on maternal and perinatal outcomes at Mpilo Central Hospital.
Authors: Shakespeare Clare , Dube H , Moyo S , Ngwenya S
Published: August 2020

Background: On 27th March the Zimbabwean government declared the Covid-19 pandemic a ‘national disaster’. Travel restrictions and emergency regulations have had significant impacts on maternity services, including staff shortages, resource stock-outs, and closure of antenatal clinics. Estimates of the indirect impact of Covid-19 on maternal and perinatal mortality expect it to be considerable, but little data is yet available.This study aims to examine the impact of Covid-19 and lockdown control measures on non-Covid outcomes in a government tertiary level maternity unit in Bulawayo, Zimbabwe, by comparing maternal and perinatal morbidity and mortality before and after lockdown was implemented.Methods: This is a retrospective, observational study, using a cross-sectional design to compare routine monthly maternal and perinatal statistics three months before and after Covid-19 emergency measures at Mpilo Central Hospital.Results: Between January-March and April-June 2020, average monthly deliveries fell from 747 to 681 and Caesarean section rates from 29.8% to 26.6%. Women with unbooked pregnancies presenting in labour almost doubled from 4.4% to 8%. There was no substantial change, however, in maternal mortality or severe maternal morbidity (post-partum haemorrhage (PPH), uterine rupture, severe preeclampsia/eclampsia), stillbirth rate or special care baby unit (SCBU) admission. There was a small increase in early neonatal death (ENND) from an average of 18.7 to 24.0 deaths per month.Conclusion: Maternal and perinatal outcomes must continue to be monitored to assess the impact of Covid-19 and lockdown measures as the epidemic in Zimbabwe unfolds. Despite the vulnerability of the healthcare system, the resilience and commitment of maternity units and healthcare workers to providing care in the most difficult circumstances should not be underestimated.
Degradome Sequencing-based Identification of PhasiRNAs Biogenesis Pathways in Oryza Sativa
Authors: Yu Lan , Guo Rongkai , Jiang Yeqin , Ye Xinghuo , Yang Zhihong , Meng Yijun , Shao Chaogang
Published: August 2020

Background: The miRNA-derived secondary phased small interfering RNAs (phasiRNAs) participate in post-transcriptional gene silencing and play important roles in various bio-processes in plants. In rice, two miRNAs, miR2118 and miR2275, were mainly responsible for the triggering of 21-nt and 24-nt phasiRNAs biogenesis, respectively. However, compare to other plant species, relative fewer phasiRNA biogenesis pathways have been discovered in rice, which limits the comprehensive understanding of the mechanism of phasiRNA biogenesis and the miRNA derived regulatory network. Results: In this study, we performed a systematical searching for phasiRNA biogenesis pathways in rice. As a result, five novel 21-nt phasiRNA biogenesis pathways and five novel 24-nt phasiRNA biogenesis pathways were identified. Further exploration of the regulatory function of phasiRNAs revealed eleven novel phasiRNAs with 21-nt length targeting forty-one genes, most of which involving in the growth and development of rice. In addition, five novel phasiRNAs with 24-nt length were found targeting the promoter of an OsCKI1 gene and causing higher methylation status in panicle, implying their regulatory function of the transcription of OsCKI1, and subsequently affect the development of rice. Conclusions: These results substantially extended the information of phasiRNA biogenesis pathways and their regulatory function in rice.
Accessing the Syndemic of COVID-19 and Malaria Intervention in Africa
Authors: Shi Benyun , Zheng Jinxin , Xia Shang , Lin Shan , Wang Xinyi , Liu Yang , Zhou Xiao-Nong , Liu Jiming
Published: August 2020

Background: The COVID-19 pandemic has caused substantial disruptions to health services in the low and middle-income countries with a high burden of other diseases, such as malaria in sub-Saharan Africa. As the COVID-19 pandemic spread to Africa, there is an urgent need to assess the impact of COVID-19 pandemic on malaria transmission potential in malaria-endemic countries in Africa.Methods: We present a data-driven method to quantify the extent to which the COVID-19 pandemic, as well as various non-pharmaceutical interventions (NPIs), could lead to the change of malaria transmission potential in 2020. First, we adopt a particle Markov Chain Monte Carlo method to estimate epidemiological parameters in each country by fitting the time series of the cumulative number of COVID-19 cases. Then, we simulate the epidemic dynamics of COVID-19 under two groups of NPIs: (i) contact restriction and social distancing, and (ii) early identification and isolation of cases. Based on the simulated epidemic curves, we quantify the impact of COVID-19 epidemic and NPIs on the distribution of insecticide-treated nets (ITNs). Finally, by treating the total number of ITNs available in each country in 2020, we evaluate the negative effects of COVID-19 pandemic on malaria transmission potential based on the notion of vectorial capacity.Results: We conduct case studies in four malaria-endemic countries, Ethiopia, Nigeria, Tanzania, and Zambia, in Africa. The epidemiological parameters (i.e., the basic reproduction number R0 and the duration of infection DI ) of COVID-19 in each country are estimated as follows: Ethiopia (R0 = 1:57, DI = 5:32), Nigeria (R0 = 2:18, DI = 6:58), Tanzania (R0 = 2:47, DI = 6:01), and Zambia (R0 = 2:12, DI = 6:96). Based on the estimated epidemiological parameters, the epidemic curves simulated under various NPIs indicated that the earlier the interventions are implemented, the better the epidemic is controlled. Moreover, the effect of combined NPIs is better than contact restriction and social distancing only. By treating the total number of ITNs available in each country in 2020 as a baseline, our results show that even with stringent NPIs, malaria transmission potential will remain higher than expected in the second half of 2020.Conclusions: By quantifying the impact of various NPI response to the COVID-19 pandemic on malaria transmission potential, this study provides a way to jointly address the syndemic between COVID-19 and malaria in malaria-endemic countries in Africa. The results suggest that the early intervention of COVID-19 can effectively reduce the scale of the epidemic and mitigate its impact on malaria transmission potential.
Reference letters for subspecialty medicine residency positions: Are they valuable for decision-making? Results from a Canadian mixed method study.
Authors: Chopra Deepti , Joneja Mala , Sandhu Gurjit , Smith Christopher A. , Spagnuolo Catherine M. , Hookey Lawrence
Published: August 2020

Background
The letter of recommendation is currently an integral part of applicant selection for residency programs. Internal medicine residents will spend much time and expense completing sub-specialty away electives to obtain a letter of recommendation. The purpose of this study was 1) to examine a large sample of reference letters in order to define essential components of a high-quality letter, and 2) to elucidate the relationship between quality of reference letter and the letter writer.
Methods
We conducted a two-phase mixed methods study. In phase one, a large sample of letters of recommendation was examined using an audit tool as a coding framework. A 5-point composite endpoint of high-quality letter components was subsequently developed. In phase two, program director letters were compared to non-program director home institution and elective letters based on inclusion of components of the 5-point composite endpoint using Chi square testing.
Results
715 letters were examined (398 non-program director home institution letters, 201 program director letters, and 116 elective letters). High-quality letter components were: nature of relationship, duration of relationship, In Training Evaluation Report information, research involvement and comments on areas for improvement. Program director letters had a significantly higher proportion (10.4%) of all 5 high-quality components, compared to 0% in both non-program director home institution letters and elective letters (p < 0.001). A significantly higher proportion of program director letters had 4–5 high-quality components (62.5%) compared to 2% of non-program director home institution letters and 0% of elective letters (p < 0.0001).
Conclusions
Letters of recommendation from elective rotations are of the poorest quality and such rotations should not be pursued for the sole purpose of obtaining a letter. The low quality of elective letters leads to the recommendation that writers should decline to write them, programs should not require them and trainees should not request them. Program directors write the highest quality letters and should be a resource for faculty development. Clinical supervisors can use the 5-point composite endpoint as a guide when writing letters for applicants.
AKR1B10 promotes breast cancer cell proliferation and migration via the PI3K/AKT/NF-κB signaling pathway
Authors: Qu Jiayao , Li Jia , He Rongzhang , Liu Xiangting , Gong Ke , Duan Lili , Luo Weihao , Hu Zheng , luo dixian
Published: August 2020

BackgroudAberrant expression of Aldo-Keto reductase family 1 member B10 (AKR1B10) has been observed during the progression of some human carcinomas. However, the expression pattern and clinical relevance of AKR1B10 in breast cancer (BC) need clarification.MethodsThe relationship between the high expression of AKR1B10 and the overall prognosis and disease-free survival of breast cancer patients was analyzed by Kaplan-Meier Plotter database. Breast cancer cell lines MCF-7/AKR1B10 stably overexpressing AKR1B10 and breast cancer cell lines BT-20/shAKR1B10 that knock down AKR1B10 were constructed, respectively. RT-qPCR, Western blot and immunohistochemistry were used to detect the expression of AKR1B10 in breast cancer and its normal tissues. CCK8 cell proliferation assay and cell scratch test were used to detect the proliferation and migration of breast cancer cells. Western blot was used to detect the expression of proliferation-related proteins cyclinD1, c-myc, survivin and EMT-related proteins twist, snail, slug, ZEB1, E-cadherin, PI3K, p-PI3K, AKT, p-AKT, IKBα, p-IKBα, NF-κB p65, and p-NF-κB p65 proteins in breast cancer cells. The PI3K inhibitor LY94002 was used to treat MCF-7 cells to detect PI3K/AKT/NF-κB signal cascade protein Expression, and expression of NF-κB p65 in nucleoproteins and plasma proteins.ResultsIn this study, we found that AKR1B10 expression was higher in BC tissue compared to paired non-cancerous tissue. The expression of AKR1B10 positively correlated with lymph node metastasis, tumor size, Ki67 expression, and p53 expression, but inversely correlated with overall and disease-free survival rates. Gene Ontology (GO) analysis showed that AKR1B10 was closely related to cell proliferation. Overexpression of AKR1B10 facilitated proliferation and migration of BC cells in vitro in association with induction of epithelial-mesenchymal transition. Conversely, knockdown of AKR1B10 inhibited these effects. Mechanistically, silencing AKR1B10 reduced the phosphorylation of PI3K, AKT, and NF-κB p65, whereas AKR1B10 overexpression activated these signaling molecules. Indeed, PI3K inhibition attenuated NF-κB p65 nuclear localization.ConclusionsOur results demonstrate that AKR1B10 promotes proliferation and migration of BC cells and represents a novel prognostic indicator as well as a potential therapeutic target in BC.
Using the WHO Safe Childbirth Checklist to Improve Essential Care Delivery as Part of the District -Wide Maternal and Newborn Health Quality Improvement Initiative, a Time Series Study
Authors: Bitewulign Befikadu , Abdissa Dereje , Mulissa Zewdie , Kiflie Abiyou , Abate Mehiret , Biadgo Abera , Alemu Haregeweyni , Zelalem Meseret , Kassa Munir , Parry Gareth , Magge Hema
Published: August 2020

Background: Care bundles are a set of three to five evidence-informed practices which, when performed collectively and reliably, may improve health system performance and patient care. To date, many studies conducted to improve the quality of essential birth care practices (EBPs) have focused primarily on provider- level and have fallen short of the predicted impact on care quality, indicating that a systems approach is needed to improve the delivery of reliable quality care. This study evaluates the effectiveness of integrating the use of the World Health Organization Safe Childbirth Checklist (WHO-SCC) into a district-wide system improvement collaborative program designed to improve and sustain the delivery of EBPs as measured by "clinical bundle" adherence over-time.Methods: The WHO-SCC was introduced in the context of a district-wide Maternal and Newborn Health (MNH) collaborative quality of care improvement program in four agrarian Ethiopia regions. Three "clinical bundles" were created from the WHO-SCC: On Admission, Before Pushing, and Soon After Birth bundles. The outcome of each bundle was measured using all- or- none adherence. Adherence was assessed monthly by reviewing charts of live births.A time-series analysis was employed to assess the effectiveness of system-level interventions on clinical bundle adherence. STATA version 13.1 was used to analyze the trend of each bundle adherence overtime. Autocorrelation was checked to assess if the assumption of independence in observations collected overtime was valid. Prais-Winsten was used to minimize the effect of autocorrelation.Findings: Quality improvement interventions targeting the three clinical bundles resulted in improved adherence over time across the four regions. In Tigray region, adherence to “On Admission” bundle was increased monthly on average by B =1.39 (95% CI; 0.47 - 2.32; P<0.005).Similarly, adherence to the “Before Pushing” bundle in Southern Nations, Nationalities and People’s (SNNP) region increased monthly on average by B = 2.3 (95% CI; 0.89 - 3.74; P<0.005). Conclusion: Use of the WHO-SCC paired with a system-wide quality improvement approach improved and sustained quality of EBPs delivery. Further studies should be conducted to evaluate the impact on patient-level outcomes.
A Novel Nomogram for Predicting Liver Metastasis in Patients with Gastrointestinal Stromal Tumor: A SEER-based Study
Authors: Zhou Guowei , Xiao Keshuai , Gong Guanwen , Wu Jiabao , Zhang Ya , Liu Xinxin , Jiang Zhiwei , Ma Chaoqun
Published: August 2020

Background: Liver metastasis (LIM) of gastrointestinal stromal tumor (GIST) is associated with poor prognosis. The present study aimed at developing and validating nomogram to predict LIM in patients with GIST, thus helping clinical diagnosis and treatment.Methods: The data of GIST patients derived from Surveillance, Epidemiology, and End Results (SEER) database from 2010 to 2016, which were then screened by univariate and multivariate logistic regression for the construction of LIM nomogram. The model discrimination of LIM nomogram was evaluated by concordance index (C-index) and calibration plots, while the predictive accuracy and clinical values were measured by decision curve analysis (DCA) and clinical impact plot. Furthermore, we validated predictive nomogram in the internal testing set.Results: A total of 3797 patients were enrolled and divided randomly into training and validating groups in a 3-to-1 ratio. After logistic regression, the significant variables were sex, tumor location, tumor size, N stage and mitotic rate. The calibration curves showed the perfect agreement between nomogram predictions and actual observations, while the DCA and clinical impact plot showed the clinical utility of LIM nomogram. C-index of the nomogram was 0.812. What’s more, receiver operating characteristic curves (ROC) also showed good discrimination and calibration in the training set (AUC=0.794, 95% CI: 0.778 to 0.808) and the testing set (AUC=0.775, 95% CI: 0.748 to 0.802).Conclusion: The nomogram for patients with GIST can effectively predict the individualized risk of liver metastasis and provide insightful information to clinicians to optimize therapeutic regimens.
Microhardness of Two Composite Resins with Different Curing Sources
Authors: Alagha Ebaa Ibrahim , Alagha Mustafa Ibrahim
Published: August 2020

Background This study evaluated the influence of two light sources on the microhardness of two recent composite resins.Methods A total of one hundred and twenty specimens were prepared and divided into two groups according to the composite resin restoration used (Tetric EvoCeram Bulkfill) and (Universal Nanohybrid Mosaic). Each group was subdivided into four subgroups according to the light source used with different curing intervals: laser curing system (SIROLaser) for 10,15, and 20 seconds and conventional blue light system (LED) for 20 seconds. Microhardness testing machine was used to assess the microhardness. Two-way ANOVA was done for comparing resin composite and curing energy effect on different variable studied. One-way ANOVA followed by pair-wise Tukey’s post-hoc tests were performed to detect significance between each composite subgroups and t-test for subgroups. P values ≤ 0.05 are considered statistically significant in all tests.Results LED cured Tetric EvoCeram Bulkfill composite resin recorded higher B/T ratio than laser cured one and the difference in B/T ratio between both energies was statistically non-significant. LED cured Mosaic composite resin recorded higher B/T ratio than laser cured one. The difference in B/T ratio between both energies was statistically significant.Conclusion SIROLaser Blue laser device has been promoted for composite resin curing with different curing intervals, but the high cost and technique sensitivity result in their limited use. Clinical Significance: Different types of curing systems are present in the dental practice. The use of SIROLaser Blue laser to photopolymerize composite resin will offers proper polymerization properties.
Pulp volume changes after piezocision-assisted tooth movement: a randomized clinical trial
Authors: Hatrom Abdulkarim A. , Howait Mohamad S. , Zawawi Khalid H. , Al-Turki Ghassan A. , Alansari Reem A. , Hassan Ali Habib
Published: August 2020

Background: Orthodontic treatment may result in undesirable side effects, such as root resorption and a decrease in the size of the pulp tissue which could be associated with the duration of the orthodontic treatment. Piezocision-assisted tooth movement was introduced as a minimally invasive surgical procedure to shorten orthodontic treatment time. This prospective randomized clinical trial was aimed to compare the pulp volume changes of maxillary anterior teeth after en-masse retraction with or without piezocision-assisted orthodontics.Methods: Patients who required orthodontic treatment with bilateral maxillary first premolar extractions and en-masse retraction were recruited. Patients were randomly divided into extraction with piezocision, or only extraction, serving as controls. Pulp volume and root length changes of the maxillary six anterior teeth were measured and compared between the two groups using a 3-Dimensional analytical software. Paired and independent sample t-tests were used to compare within and between groups. Bivariate correlation was done between the mean change in pulp volume and its corresponding root length. The significance level was set at α = 0.05.Results: A total of 23 patients were included, 12 in the piezocision, and 11 in the control group. At the end of the en-masse retraction phase, (mean = 122.74 ±3.06 days) pulp volume was significantly decreased in all six anterior teeth in both groups (P < 0.01). The decrease in pulp volume was not statistically different between both groups, (P > 0.05). There was a statistically significant but moderate correlation only between the pulp volume change of the right canine and its root length, r = 0.44, P = 0.034.Conclusions: The effect of piezocision-assisted orthodontic tooth movement on the pulp volume was comparable to the conventional orthodontic treatment. The degree of change in pulp volume does not appear to be related to the amount of root resorption.Trial registration: NCT03180151. Registered December 25,2016, retrospectively registered, https://clinicaltrials.gov/ct2/show/record/NCT03180151
Infrared spectroscopic study of hydrogen bonding topologies in the water octamer: The smallest ice cube
Authors: Li Gang , Zhang Yang-Yang , Li Qinming , Wang Chong , Yu Yong , Zhang Bingbing , Hu Hanshi , Zhang Weiqing , Dai Dongxu , Wu Guorong , Zhang Donghui , Jiang Ling , Li Jun , Yang Xueming
Published: August 2020

The water octamer, with its cubic structure consisting of six four-membered rings, presents an excellent system in which to unravel the cooperative interactions driven by subtle changes in the hydrogen-bonding topology. Although many distinct structures are calculated to exist, it has not been possible to extract the structural information encoded in their vibrational spectra because this requires size-selectivity of the neutral clusters with sufficient resolution to identify the contributions of the different isomeric forms. Here we report the size-specific infrared spectra of the isolated cold, neutral water octamer using a scheme based on threshold photoionization using a tunable vacuum ultraviolet free electron laser. A plethora of sharp vibrational bands features are observed for the first time. Theoretical analysis of these patterns reveals the coexistence of five cubic isomers, including two with chirality. The relative energies of these structures are found to reflect topology-dependent, delocalized multi-center hydrogen-bonding interactions. These results demonstrate that even with a common structural motif, the degree of cooperativity among the hydrogen-bonding network creates a hierarchy of distinct species. The implications of these results on possible metastable forms of ice are considered.
A Comparative Case Control Study between Innovations Team Malta and Innovations Project UK Working with Hard to Reach Young People with Complex Mental Disorders
Authors: Saliba Andrea , Camilleri Nigel
Published: August 2020

BackgroundHard-to-reach young people (HTRYP) can be defined as YP at risk, disadvantaged, marginalised, who slip through the healthcare system and are unwilling to engage with services. MethodThis case control study compared the outcomes from two HTRYP services, Innovations Team Malta (IT Malta) and Innovations Project UK (IP UK) and a matched control from a UK based Community Mental Health Team (CMHT) over a 12 month period. IT Malta included HTRYP 13-25 years and IP UK 15-25 years. An in-depth MDT assessment was carried out together with the Health of the Nation Outcome Scales for Child and Adolescent Mental Health (HoNOSCA) and Children’s Global Assessment Scale (CGAS) at assessment and discharge. HTRYP meeting criteria were offered intensive individual tailored therapy. Results38 YP were referred to IT Malta, 34 (89.5%) assessed and 22 (57.9%) treated in 2018. 40 referrals to IP UK, 36 (90%) assessed, 31 (86%) met criteria and 15(48%) were treated. The HoNOSCA for IT Malta and IP UK were similar, at baseline (20.65, 19.32) and discharge (16.65, 16.53) respectively, but higher when compared to CMHT (11.19, 8.03) (p <0.001). The mean baseline CGAS for IT Malta (46.0) elucidates more impairment compared to IP UK (51.1) and CMHT (58.9). The total mean contact time (hours) per YP were; IT Malta (24.5), IP UK (18.2) and CMHT (8.6). ConclusionIT Malta and IP UK identified, engaged and treated YP with multiple complex mental disorders whose needs were not being met by other mental health services. HTRYP may benefit from a flexible YP oriented service, including outreach capability and a focus on engagement. Despite improvement, HTRYP’s mental and social functioning remained clinically worse than CMHT.
Congenital Myasthenic Syndrome Due to Compound Heterozygous Mutations in the GFPT1 Gene
Authors: Jiang Yanfang , Liu Siwen , Wang Chunyan , Yu Yan , Zhang Peng , Yu Xuefan
Published: August 2020

Congenital myasthenic syndrome (CMS) is a heterogeneous group of hereditary neuromuscular disorders associated with neuromuscular junction (NMJ) dysfunction. Here, we report the genetic variants and clinical follow-up of one individual suffering from CMS. The proband presented with limb weakness, and symptoms worsened after limb activities. In addition, decreases in muscle action potential were observed with repetitive nerve stimulation. Thus, myasthenia gravis was initially suspected, but the patient did not experience drooping eyelids or blurred vision. Trio whole exome sequencing was performed for the proband and his parents. We found two different heterozygous missense variants (c.331C>T; p.Arg111Cys and c.1428G>C; p.Lys476Asn) in the gene encoding glutamine-fructose-6-phosphate transaminase 1 (GFPT1) in this patient with autosomal recessive CMS, of which one was novel. The new c.1428G>C; p.Lys476Asn variant has not been previously reported, and has not been recorded in the ClinVar dataset or the gnomAD global population dataset. The phenotypes （proximal muscle weakness and fatigue while ocular and facial involvement is only minimal，limb-girdle weakness and fatigue.，beneficial and sustained response to acetylcholinesterase inhibitor treatment）of the proband were consistent with those previously reported for CMS. Our study provides important information for the diagnosis and treatment of patients with CMS.
Melatonin Dependent Modulation in microRNAs Relative Expression Pattern and Levels of cfDNA in Mature Oocytes of Unexplained Infertile Patients.
Authors: Khan Haroon Latif , bhatti Shahzad , abbas Sana , Kaloglu Celal , Qurat-ul-ain Syeda , Khan Yousaf Latif , Hassan Zahira , Aydin Hikmet Hakan , Turhan Nilgün Öztürk , Bousnane Nour El Houda , Yildiz Aysegul , Saruhashi Isadora
Published: August 2020

The authors have withdrawn this preprint due to author disagreement.
An Improved BM25 for Clinical Decision Support in Precision Medicine Based on Co-word Analysis and Cuckoo Search
Authors: zhang zicheng
Published: August 2020

Background: Retrieving gene and disease information from massive biomedical articles to provide doctors with clinical decision support is one of the important research directions of precision medicine . Methods: we present a new method for biomedical article retrieval based on co-word analysis and cuckoo search. The specific goal is to retrieve biomedical articles, in the form of article abstracts, addressing relevant treatments for a given patient. The method in this paper first uses the BM25 algorithm to calculate the score of the abstract, and we designed a method based on BM25 to calculate the score of expanded words. Second, when a disease and a gene both appear in the same biomedical article, the score of the biomedical article will be increased. Finally, the cuckoo algorithm is used to optimize the parameters of the retrieval algorithm. The paper discusses the influence of different parameters on the retrieval algorithm, and summarizes the parameters to meet different retrieval needs. Results: all data were taken from medical articles provided in the TREC (Text Retrieval Conference) Clinical Decision Support Track 2017、2018 and 2019 in precision medicine. 120 standard topics were tested. we chose 3 test indicators and many kinds of algorithms for experimental comparison. For the fairness of the experiment, all these selected algorithms all used the BM25 algorithm or an improved BM25 algorithm. Experimental results showed that our algorithm has achieved good results and ranking Conclusions: we designed an improved BM25 algorithm based on co-word analysis and cuckoo search and verified the superiority of our algorithm on a large number of experimental sets. In this paper, the query expansion method is relatively simple, the next step is to consider the ontology and semantic network to expand the query vocabulary.
Validation of a simplified risk prediction model using a cloud based critical care registry in a lower-middle income country
Authors: Kumar Bharath , Gamage Dilanthi , Rashan Aasiyah , Beane Abi , Venkataraman Ramesh , Ramakrishnan Nagarajan , Haniffa Rashan
Published: August 2020

Background:The use of severity of illness scoring systems such as the Acute Physiology and Chronic Health Evaluation in lower-middle income settings comes with important limitations, primarily due to data burden, missingness of key variables and lack of resources. To overcome these challenges, in Asia, a simplified model, designated as e-TropICS was previously developed. We sought to externally validate this model using data from a multi-centre critical care registry in India. Methods:Seven ICUs from the Indian Registry of IntenSive care(IRIS) contributed data to this study. Patients > 18 years of age with an ICU length of stay > 6 hours were included. Data including age, gender, co-morbidity, diagnostic category, type of admission, vital signs, laboratory measurements and outcomes were collected for all admissions. e-TropICS was calculated as per original methods. The area under the receiver operator characteristic curve was used to express the model’s power to discriminate between survivors and non-survivors. For all tests of significance, a 2-sided P less than or equal to 0.05 was considered to be significant. AUROC values were considered poor when ≤ to 0.70, adequate between 0.71 to 0.80, good between 0.81 to 0.90, and excellent at 0.91 or higher. Calibration was assessed using Hosmer-Lemeshow C -statistic. Results: We included data from 2094 consecutive patient episodes. The median age of the cohort was 60 and predominantly male (n=1350, 65.47%). Mechanical Ventilation and vasopressors were administered at admission in 504 (24.44%) and 423 (20.51%) patients respectively. Overall, mortality at ICU discharge was 10.28% (n=212). Discrimination (AUC) for the e-TropICS model was 0.81 (95% CI 0.78-0.84) with an HL C statistic p value of < 0.05. Brier score, used to evaluate overall model accuracy for prediction of mortality was 0.15 (0-14-0.16). The best sensitivity and specificity (72% and 74% respectively) were achieved with the model at an optimal cut-off for probability of 0.37. Conclusion:e-TropICS has utility in the care of critically unwell patients in the South Asia region with good discriminative capacity. Further refinement of calibration in larger datasets from India and across the South-East Asia region will help in improving model performance.
Recommendations for hemodynamic Monitoring for Critically Ill Children – Expert Consensus Statement issued by the Cardiovascular Dynamics Section of the European Society of Paediatric and Neonatal Intensive Care (ESPNIC)
Authors: Singh Yogen , Villaescusa Javier Urbano , Cruz Eduardo M. da , Tibby Shane M , Bottari Gabriella , Saxena Rohit , Guillén Marga , Herce Jesus Lopez , Nardo Matteo Di , Cecchetti Corrado , Brierley Joe , de Boode Willem , Lemson Joris
Published: August 2020

Background
Cardiovascular instability is common in critically-ill children. There is scarcity of published high-quality studies to develop meaningful evidence-based hemodynamic monitoring guidelines and hence, with the exception of management of shock, currently there are no published guidelines for hemodynamic monitoring in children. The European Society of Paediatric and Neonatal Intensive Care (ESPNIC) Cardiovascular Dynamics section aimed to provide expert consensus recommendations on hemodynamic monitoring in critically ill children.
Methods
Creation of a panel of experts in cardiovascular hemodynamic assessment and hemodynamic monitoring and review of relevant literature - a literature search was performed, and recommendations were developed through discussions managed following a Quaker-based consensus technique and evaluating appropriateness using a modified blind RAND/UCLA voting method. The AGREE statement was followed to prepare this document.
Results
Of 100 suggested recommendations across 12 subgroups concerning hemodynamic monitoring in critically ill children, 72 reached “strong agreement”, 20 “weak agreement” and 2 had “no agreement”. Six statements were considered as redundant after rephrasing of statements following first round of voting. Due to lack of published evidence to develop evidence-based guidelines, most of the recommendations are based upon expert consensus.
Conclusions
These expert consensus-based recommendation may be used to guide clinical practice for hemodynamic monitoring in critically-ill children and they may serve as a basis for highlighting gaps in the knowledge base to guide further research in hemodynamic monitoring.
Effect of Different Sintering Additives on the Microstructure, Phase Compositions and Mechanical Properties of Si3N4/SiC Ceramics
Authors: Qin Ying , Yang Hailing , Li Qinggang , Wang Zhi , Wu Hao , Wu Junyan , Cheng Xin
Published: August 2020

Y2O3 and CeO2 were chosen as additives to investigate the effect of different additives on the microstructure, composition of phases and mechanical properties of Si3N4/SiC ceramics using pressureless sintering. Si3N4/SiC ceramic without additives had a high density, while after adding Y2O3 and CeO2, the density and flexural strength of Si3N4/SiC ceramics were significantly decreased due to the increase of porosity. The main phase compositions of samples were β-Si3N4 and SiC. Moreover, the liquid phases Y-Si-O-N and Ce-Si-O-N were observed after adding Y2O3 and CeO2 respectively. It also indicated that for Si3N4/SiC composite ceramics, the high aspect ratio β-Si3N4 overlapped with each other and closely bonded with glass phase could improve flexure strength effectively. Besides, the SiC crystal grains mainly existed in grain boundary, which could inhibit the secondary recrystallization to avoid that the decrease of flexural strength caused by the overgrowth of β-Si3N4 grains.
Knowledge and attitude of dentists, dental auxiliaries and students regarding the COVID-19 pandemic in Saudi Arabia: A Cross-Sectional Survey
Authors: Shahin Suliman , Bugshan Amr , Almulhim Khalid , AlSharief Mishali , Al-Dulaijan Yousif , al-Qarni Faisal
Published: August 2020

Background: This study aimed to assess the knowledge and attitude of dental professionals in Saudi Arabia regarding severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease 2019 (COVID-19).Methods: A questionnaire was developed to assess various dental professionals from both governmental and private sectors through online and social media outlets. Results: A total of 1,033 responses were collected. Moreover, 63.4% of respondents (63.4%) were working in hospitals. Of all respondents, 44.9%, 33.4%, and 21.7% were in governmental clinics, academia, and private sector, respectively. Overall knowledge on incubation period and route of transmission of SARS-CoV-2 was satisfactory across all dental professions. All dental professionals except for dental assistants demonstrated adequate knowledge on the recommended hand-soap cleaning time (p < 0.001). Most dental professionals displayed unsatisfactory knowledge and disagreement on the survival of SARS-CoV-2 outside the host (p < 0.001). Furthermore, 75.1% of respondents were reluctant to treat a suspected COVID-19 patient, and 92% participants believed that the mode of transmission was droplet inhalation. Fever, coughing, and shortness of breath were identified as the most common symptoms of COVID-19. Most standard methods of prevention in the dental office were selected by at least 50% of participants. Conclusions: An appropriate level of knowledge on SARS-CoV-2 incubation period and signs and symptoms of COVID-19 was noted among all dental professionals in Saudi Arabia. Perceived survival outside the host was modest. A certain level of apprehension toward suspected SARS-CoV-2 patients existed among most professionals. Pandemic-awareness campaigns are essential among healthcare providers.