bluuebunny/crossref_metadata_2025 huggingface dataset:
Socio-demographic, environmental and behavioural risk factors of diarrhoea among under-five children in rural Ethiopia: further analysis of the 2016 Ethiopian demographic and health survey
Authors: Ferede Melkamu Molla
Published: May 2020

Background: Diarrhoea is one of the major contributors to death among under-five children in Ethiopia. Studies conducted in different countries showed that rural children are more severely affected by diarrhoea than urban children. Thus, this study was aimed to identify the socio-demographic, environmental and behavioural associated risk factors of the occurrence of diarrhoea among under-five children in rural Ethiopia. Methods: Data for the study was drawn from the 2016 Ethiopian Demographic and Health Survey. A total of 8,041 under-five children were included in the study. Binary logistic regression was used to assess the association of occurrence of diarrhoea with socio-demographic, environmental and behavioural factors among under-five children. Results: Children aged 6-11 months (AOR: 3.5; 95% CI: 2.58-4.87), 12-23 months (AOR: 3.1; 95% CI: 2.33-4.04) and 24-35 months (AOR: 1.7; 95% CI: 1.26-2.34) as compared to >35 months were significantly associated with an increasing prevalence of diarrhoea. Children in Afar region (AOR: 1.92; 95% CI: 1.01-3.64) and Gambela region (AOR: 2.12; 95% CI: 1.18, 3.81) were significantly associated with an increasing prevalence of diarrhoea, but a decreasing prevalence in Somali region (AOR: .42; 95% CI: (.217-.80) as compared to Tigray region. Increasing prevalence of diarrhoea was also significantly associated with male children (AOR: 1.3; 95% CI: 1.05-1.58); households who shared toilet facilities with other households (AOR: 1.4; 95% CI: 1.09-1.77); fourth birth order (AOR: 1.81; 95% CI: 1.17-2.79), and fifth and above birth order (AOR: 1.85; 95% CI: 1.22, 2.81) as compared to first order; and mother’s current age 35-49 years in a household with ≥3 under-five children (AOR: 4.7; 95% CI: 1.64-13.45) as compared to those maternal ages of 15-24 years in a household with ≤2 under-five children.Conclusion: The age of a child, sex of a child, region, birth order, toilet facilities shared with other households and the interaction effect of the number of under-five children with mother’s current age are identified as associated risk factors for diarrhoea occurrence among under-five children in rural Ethiopia. The findings show the need for planning and implementing appropriate prevention strategies considering these risk factors for rural under-five children.
Comparison between transpancreatic sphincterotomy and needle-knife fistulotomy in difficulty biliary access, a retrospective study in Taiwan
Authors: Liang Kai-Shun , Chen Chieh-Chang , Liao Wei-Chih , Kuo Yu-ting , Tseng Liang-Wei , He Wen-Tsung , Wang Hsiu-Po
Published: May 2020

Background Selective deep biliary cannulation is the first and the most important step before further biliary therapy. Transpancreatic sphincterotomy(TPS), and needle knife fistulotomy(NKF) were commonly used in patients with difficult cannulation, but few studies compare the outcome between TPS and NKF.Methods A total of 78 patients who met the criteria of difficult cannulation in the National Taiwan University hospital from October 2015 to October 2017 were retrospectively reviewed. Their baseline demographics, success rate of biliary cannulation, and the rate of adverse events were assessed.Results 31 patients and 47 patients underwent TPS and NKF for difficult biliary access, respectively. The characteristics of the 2 groups were similar, but patients in TPS group had more frequent pancreatic duct cannulation. Bile duct cannulation was successful in 23 patients (74.2 %) in the TPS group and 39 (83.0%) in the NKF group (P=0.34). There was no difference between the TPS and NKF in the rate of adverse events, including post-ERCP pancreatitis (PEP) (16.1% vs. 6.4%, p = 0.17), and hemorrhage (3.2% vs. 8.5%, p = 0.35). No perforation occurred.Conclusions Both TPS and NKF have good biliary access rate in patient with difficult cannulation. TPS has acceptable successful rate and similar complication rate, compared with NKF.
Adverse events in deceased hospitalised cancer patients as a measure of quality and safety in end-of-life cancer care
Authors: Haukland Ellinor Christin , von Plessen Christian , Nieder Carsten , Vonen Barthold
Published: May 2020

Background: Anticancer treatment exposes patients to negative consequences such as increased toxicity and decreased quality of life, and there are clear guidelines recommending limiting use of aggressive anticancer treatments for patients near end of life. The aim of this study is to investigate the association between anticancer treatment given during the last 30 days of life and adverse events contributing to death and elucidate how adverse events can be used as a measure of quality and safety in end-of-life cancer careMethods: Retrospective cohort study of 247 deceased hospitalised cancer patients at three hospitals in Norway in 2012 and 2013. The Global Trigger Tool method were used to identify adverse events. We used Poisson regression and binary logistic regression to compare adverse events and association with use of anticancer treatment given during the last 30 days of life.Results: 30 % of deceased hospitalised cancer patients received some kind of anticancer treatment during the last 30 days of life, mainly systemic anticancer treatment. These patients had 62 % more adverse events compared to patients not being treated last 30 days, 39 vs. 24 adverse events per 1 000 patient days (p<0.001, OR 1.62 (1.23 – 2.15). They also had twice the odds of an adverse event contributing to death compared to patients without such treatment, 33 vs. 18 % (p=0.045, OR 1.85 (1.01 – 3.36)). Receiving follow up by specialist palliative care reduced the rate of AEs per 1 000 patient days in both groups by 29 % (p= 0.02, IRR 0.71, CI 95% 0.53 – 0.96).Conclusions: Anticancer treatment given during the last 30 days of life is associated with a significantly increased rate of adverse events and related mortality. Patients receiving specialist palliative care had significantly fewer adverse events, supporting recommendations of early integration of palliative care in a patient safety perspective.
The effect of problem-based learning after coronary heart disease – A randomised study in primary health care (COR-PRIM)
Authors: Köhler Anita Kärner , Jaarsma Tiny , Tingström Pia , Nilsson Staffan
Published: May 2020

Background Cardiac rehabilitation including patient education is effective after coronary heart disease (CHD). However, risk factors remain, and patients report fear for recurrence during recovery. Problem-based learning is a pedagogical method, where patients work self-directed in small groups with problem solving of real-life situations to manage CHD risk factors and self-care. The aim of the study was to demonstrate the better effectiveness of patient problem-based learning over home-sent patient information for evaluating long-term effects of patient empowerment and self-care in patients with CHD. The hypothesis tested was that one year of problem-based learning improves patients’ empowerment- and self-efficacy, to change self-care compared to one year of standardised home-sent patient information after CHD. Methods We randomly assigned 157 patients (78% male; age 68±8.5 years) with CHD verified by percutaneous coronary intervention (PCI) (70.1%) or coronary artery by-pass surgery (CABG) and CABG+PCI or myocardial infarction (29.9%) to problem-based learning (experimental group; n = 79) or home-sent patient information group (controls; n = 78). The problem-based learning intervention consisted of patient education in primary care by nurses tutoring groups of 6-9 patients on 13 occasions over one year. Controls received home- sent patient information on 11 occasions during the study year. Results At the one-year follow-up, the primary outcome, patient empowerment, did not significantly differ between the experimental group and controls. We found no significant differences between the groups regarding the secondary outcomes e.g. self-efficacy, although we found significant differences for body mass index (BMI) [-0.17 (SD 1.5) vs. 0.50 (SD 1.6), P=0.033 ], body weight [-0.83 (SD) 4.45 vs. 1.14 kg (SD 4.85), P=0.026 ] and HDL cholesterol [0.1 (SD 0.7) vs. 0.0 mmol/L (SD 0.3), P=0.038 ] favouring the experimental group compared to controls. Conclusions The problem-based learning- and the home-sent patient information interventions had similar results regarding patient empowerment. However, problem-based learning exhibited significant effects on weight loss, BMI, and HDL cholesterol levels, indicating that this intervention positively affected risk factors compared to the home-sent patient information intervention. Trial registration : NCT01462799 (February 2020)
The study on knowledge-attitude-practice of primary care physician toward anticoagulant therapy in patients with Non-valvular atrial fibrillation in Shanghai of China
Authors: Ye Shasha , Wang Tianhao , Liu Arthur , Yu Ying , Pan Zhigang , Gu Jie
Published: May 2020

Background: As the large number of Community Health Service (CHS) centers in China face the majority of non-valvular atrial fibrillation (NVAF) patients, primary care physicians (PCPs) play the primary role in the prevention of embolization. Therefore，an awareness of anticoagulant management in NVAF patients must be brought into focus among PCPs in China. This study will investigate PCPs’ Knowledge, Attitude and Practice toward anticoagulant therapy in patients with NVAF and help PCPs increase their awareness of oral anticoagulant (OAC) therapy for NVAF to prevent embolization.Method: This was a cross-sectional observational study of 462 PCPs in CHS centers across Shanghai. We used a self-administered questionnaire to collect data from September to December 2017. A stratified random cluster sampling was adopted in the 90 CHS centers with the family medicine residency program. Result: Among 462 participants, 69.3% (320/462) of females got a medical bachelor’s degree and over 50% participants had more than 10 years of work experience. According to similar study, each section for knowledge, attitude, and practice were categorized as poor (≤39.0%), fair (40.0%–69.0%), and good (≥70.0%)[18]. The level of knowledge of OAC therapy in patients with NVAF among PCPs was insufficient in over half (75.8%) of participants. The majority (89.8%) of PCPs had a positive attitude and 68.0% had modest performance in the anticoagulant management of patients with NVAF. Conclusion: The knowledge and behaviors of PCPs were insufficient in OAC therapy to prevent embolization in patients with NVAF. The study also revealed there is good potential for PCPs’ educational interventions to positively impact on the care of patients with NVAF.
The impact of albumin infusion on the risk of rebleeding and in-hospital mortality in cirrhotic patients admitted for acute gastrointestinal bleeding: a retrospective study of a single institute
Authors: Wang Zhu , Xie Ya-Wen , Lu Qing , Yan Hai-Lin , Liu Xin-Bin , Long Yi , Zhang Xian , Yang Jinlin
Published: May 2020

Background: To investigate the effect of albumin infusion on cirrhotic patients admitted for acute gastrointestinal bleeding.Methods: Medical records of cirrhotic patients who admitted due to acute gastrointestinal bleeding through January 2009 to December 2018 were reviewed. Clinical data and the total amount of albumin and red blood cell used during hospitalization were recorded. For patients with rebleeding, the amount of albumin and red blood cell used before rebleeding was also documented. The primary outcome was the occurrence of rebleeding, and the second outcome was in-hospital mortality. Univariate and multivariate logistic analysis was performed to identify risk factors associated with rebleeding and in-hospital mortality.Results: A total of 1503 cirrhotic patients were included in the analysis. There were 146 episodes of in-patient rebleeding occurred, while 81 patients died. Overall, more red blood cells and albumin were prescribed to patients who suffered rebleeding. In terms of the amount before rebleeding, the red blood cell was higher in patients with rebleeding, but the albumin infusion was similar. In the multivariate model, the albumin infusion was an independent risk factor associated with rebleeding (adjusted OR for ≤40g vs 0g, 0.469 [0.274-0.805], p=0.006; adjusted OR for >40g vs 0g, 0.272 [0.122-0.604], p=0.001). In Child-Pugh C class patients, the use of albumin more than 40g during hospitalization associated with a lower risk of in-patient mortality (adjusted OR for >40g vs 0g, 0.136 [0.019-0.741], p=0.031).Conclusions: Albumin infusion was associated with a lower risk of rebleeding and in-hospital deaths in cirrhosis admitted for acute gastrointestinal bleeding.
Moving a neodymium magnet promotes the migration of a magnetic tracer and increases the monitoring counts on the skin surface of sentinel lymph nodes in breast cancer
Authors: Makita Masujiro , Manabe Eriko , Kurita Tomoko , Takei Hiroyuki , Nakamura Seigo , Kuwahata Akihiro , Sekino Masaki , Kusakabe Moriaki , Ohashi Yasuo
Published: May 2020

Background: We suspected that moving a small neodymium magnet would promote migration of the magnetic tracer to the sentinel lymph node (SLN). Higher monitoring counts on the skin surface before making an incision help us detect SLNs easily and successfully. The present study evaluated the enhancement of the monitoring count on the skin surface in SLN detection based on the magnet movement in a sentinel lymph node biopsy (SNB) using superparamagnetic iron oxide (SPIO) nanoparticles.Methods: After induction of general anesthesia, superparamagnetic iron oxide nanoparticles were injected sub-dermally into the subareolar area or peritumorally. The neodymium magnet was moved over the skin from the injection site to the axilla to promote migration of the magnetic tracer without massage. A total of 62 patients were enrolled from February 2018 to November 2018: 13 cases were subjected to magnet movement 20 times (Group A), 8 were subjected to 1-min magnet movement (Group B), 26 were given a short (about 5 min) interval from injection to 1-min magnet movement (Group C), and 15 were given a long (about 25 min) interval before 1-min magnet movement using the magnetometer’s head (Group D). In all cases, an SNB was conducted using both the radioisotope (RI) and SPIO methods. The monitoring counts on the skin surface were measured by a handheld magnetometer and compared among the four groups. Changes in the monitoring count by the interval and magnet movement were evaluated. Results: The identification rates of the SPIO and RI methods were 100% and 95.2%, respectively. The mean monitoring counts of Group A, B, C, and D were 2.39 μT, 2.73 μT, 3.15 μT, and 3.92 μT, respectively (p<0.0001; Kruskal-Wallis test). The monitoring counts were higher with longer magnet movement and with the insertion of an interval. Although there were no relationships between the monitoring count on the skin surface and clinicopathologic factors, magnet movement strongly influenced the monitoring count on the skin surface.Conclusion: Moving a small neodymium magnet is effective for promoting migration of a magnetic tracer and increasing monitoring counts on the skin surface.Trial registration: UMIN, UMIN000029475. Registered 9 October 2017, https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000033678
Prevalence and risk factors of falls among community-dwelling older people: results from three consecutive waves of the national health interview survey in Taiwan
Authors: Tsai Yih-Jian , Yang Ping-Yen , Yang Yi-Ching , Lin Mau-Roung , Wang Ying-Wei
Published: May 2020

Background: An aging society incurs great losses due to fall-related injuries and mortalities. The foreseeable increased burden of fall-related injury among older people requires a nationwide study on the fall epidemic in Taiwan. Methods: The fall epidemic was examined using data from three consecutive waves of the National Health Interview Survey (2005, 2009, and 2013). Common explanatory variables across these surveys included sociodemographic factors (age, sex, and difficulty in performing activities of daily living (ADL) or instrumental ADL), biological factors (vision, comorbidities, urinary incontinence, and depressive symptoms), and behavioral risk factors (sleeping pill use, and frequency of exercise). After the univariate and bivariate analyses, the prevalence of falls was investigated using multiple linear regression models adjusted for age group, sex, and year of survey. A multivariate logistic regression model for falls with adjustments for these common explanatory variables was established across three waves of surveys. Results: For each survey, there were consecutively 2,722; 2,900; and 3,200 respondents with a mean age of 75.1, 75.6, and 76.4 years, respectively. The multiple linear regression model yielded a negative association between the prevalence of falls and year of survey. Several sociodemographic and biological factors, including female sex, difficulty in performing one basic ADL, difficulty in performing two or more instrumental ADLs, unclear vision, comorbidities, urinary incontinence, and depressive symptoms, were significantly associated with falls.Conclusion: Although information regarding the change in fall prevalence over time supports existing fall intervention strategies in Taiwan, the identification of risk factors in older people may increase the effectiveness of future fall prevention programs.
The stone density does not affect the stone-free rate of kidney pelvic stones (2-3 cm) treated with flexible ureterorenoscopy
Authors: Bai Yao , Hu Sheng , Dai Yuanqing , Chen Xiong , Zhang Xiaobo , Gu Jie
Published: May 2020

The authors have withdrawn this preprint due to author disagreement.
Proximal and distal predictors of self-regulatory change in children aged 4 to 7 years
Authors: Williams Kate E , Howard Steven J.
Published: May 2020

Background Growth in early self-regulation skills has been linked to positive health, wellbeing, and achievement trajectories across the lifespan. While individual studies have documented specific influences on self-regulation competencies in early childhood, few have modelled a comprehensive range of predictors of self-regulation change across health, development, and environment simultaneously. This study aimed to examine the concurrent associations among a range of proximal and distal influences on change in children’s self-regulation skills over 2 years from age 4-5 years.Methods Data from the Longitudinal Study of Australian Children (N= 4983) were used in a structural equation model, predicting a multi-source composite measure of self-regulation at each of 4-5 years and 6-7 years. By controlling for earlier self-regulation and covariates, the model examined the relative contributions of a comprehensive range of variables to self-regulation change including health, development, educational, home environment, time-use, and neighbourhood characteristics. Results The significant predictors of children’s self-regulation growth across 4 to 7 years were fewer behavioural sleep problems, higher gross motor and pre-academic skills, lower levels of maternal and paternal angry parenting, and lower levels of financial hardship. There were also marginal effects for high-quality home learning environments and child-educator relationships.Conclusion Findings suggest that if we are to successfully foster children’s self-regulation skills, interventionists would do well to operate not only on children’s current capacities but also key aspects of their surrounding context.
Research on Robot Boxing Movement Simulation Based on Kinect Sensor
Authors: Li Peicong
Published: May 2020

In the process of continuous development, robot technology has been widely used in aerospace, medical, education and service industries, and the relationship between robots and people is getting closer and closer. The improvement of robot intelligence is a process of continuous learning of external knowledge. Since the introduction of human-computer interaction technology, it has provided more and more technical support for human research robots. This paper firstly takes Tai Chi as an example, analyzes and deconstructs its standard Tai Chi putter movements, and obtains the corresponding movement parameter information. Then, the human body depth image and bone structure are obtained through the Kinect sensor, and the human joint position data is recorded, and then the coordinate data is sent to the brain robot, thereby realizing the imitation learning of the robot's push movements in Tai Chi. The experimental results show that the proposed method can simulate the practice process of inversion of Tai Chi, and can well analyze the shortcomings in the practice process, and then promote the development of the sport.
Factors associated with the burden of family caregivers of elderly patients with femoral neck fracture: a cross-sectional study
Authors: Xiao Peifen , Zhou Yongchun
Published: May 2020

Background: This study aimed to study the factors associated with caregiver burden among caregivers of elderly patients with femoral neck fracture. Methods: This cross-sectional study was based on a non-probabilistic sampling of 183 elderly postoperative patients (aged 65 years or older) with femoral neck fracture who were hospitalized in the orthopaedic centre in our hospital and their family caregivers. Data were collected from January 2016 to June 2019. Patients and family caregivers completed the sociodemographic questionnaire. The Social Support Rating Scale (SSRS), the General Self-Efficacy Scale (GSE) and the Chinese version of the Zarit Burden Interview (ZBI) were used to evaluate social support, self-efficacy and caregiver burden, respectively. By analysing the clinical data of patients and family caregivers and combining the factors that affect the caregiver burden in parallel studies, we selected the factors that affected the caregiver burden in this study and conducted a multivariate analysis of these factors. P <0.05 was considered statistically significant. Results: We observed 176 caregivers aged 69.28 ± 7.19 years old, among whom 52.3% were male, 58.0% lived in the city, 84.0% were spouses of the patients, and 67.0% had a primary school educational background. The ZBI score of the family caregivers was 37.8 ± 8.9, and 82.7% of the caregivers were under a moderate to severe burden. The patient’s functional status, Harris score, and pain score and the caregiver’s SSRS scores, GSE scores, and the ratio of medical expenses to monthly income per capita were factors that affected the caregiver burden. Conclusions: Most family caregivers of elderly patients with femoral neck fracture are subject to a considerable care burden, and social support and self-efficacy intervention are conducive to reducing the caregiver burden.
A modified surgical technique of shortening renal ischemia time in left renal cancer patients with Mayo level II-IV tumor thrombus
Authors: Zhuo Liu , Guodong Zhu , Xun Zhao , Shiying Tang , Peng Hong , Li Zhang , Liwei Li , Shudong Zhang , Guoliang Wang , Xiaojun Tian , Cheng Liu , Hongxian Zhang , Ma Lulin
Published: May 2020

Background To explore the safety and effectiveness of a modified surgical technique which could shorten the time of renal ischemia in left renal cancer and Mayo level II to IV inferior vena cava (IVC) tumor thrombusMethod We retrospectively analyzed the clinical data of 14 cases with left renal cell carcinoma (RCC) and Mayo level II to IV IVC tumor thrombus from February 2015 to July 2019. Preoperative imaging showed that there was no obvious sign of tumor thrombus invading the blood vessel wall. During the surgery, after the right renal artery, the right renal vein and the distal end of IVC were blocked, the balloon catheter was used and the tumor thrombus was removed completely from the IVC. The incision of IVC was closed by Satinsky clamp to make IVC partially blocked. Then the right renal artery and right renal vein were released. The incision of IVC was sutured continuously. At last, the Satinsky clamp and the blocking band at the distal end of the IVC were released.Result There were 8 cases (57.1%) of Mayo level II, 3 cases (21.4%) of Mayo level III and 3 cases (21.4%) of Mayo level IV. The operation was successfully completed in all 14 patients. There were 2 cases (14.3%) operated by complete laparoscopic approach, 8 cases (57.1%) by open approach, and 4 patients (28.6%) by laparoscopic conversion to open approach. The occlusion time of right renal artery and vein (renal ischemia time) was 3 to 15 minutes, with an average of (6.8 ±3.2) minutes. The mean time of IVC occlusion was (19.4 ±4.9) min. Preoperative creatinine was 66 to 130 μmol/L, with an average of (96.6 ±21.2) μmol/L. One week after operation, serum creatinine was 64 to 632 μmol/L, with an average of (132.4 ±144.9) μmol/L. Among the 14 cases, 5 (42.9%) had early postoperative complications. Besides one of the 14 patients died in perioperative period, the median follow-up of other 13 cases was 10 months (range: 4-29 months). The 5 (35.7%) of the 14 cases were died of disease.Conclusion This modified procedure was relatively safe and effective in shortening the time of renal ischemia in left RCC patients with Mayo II to IV IVC tumor thrombus.
Chest CT imaging characteristics of COVID-19 pneumonia in preschool children: a retrospective study
Authors: Li Yang , Cao Jianghui , Zhang Xiaolong , Liu Guangzhi , Wu Xiaxia , Wu Baolin
Published: May 2020

Background: Recently, the World Health Organization has declared the coronavirus disease 2019 (COVID-19) outbreak a public health emergency of international concern. So far, however, limited data are available for children. Therefore, we aimed to investigate the clinical and chest CT imaging characteristics of COVID-19 in preschool children.Methods: From January 26, 2020 to February 20, 2020, the clinical and initial chest CT imaging data of eight preschool children with laboratory-confirmed COVID-19 from two hospitals were retrospectively collected. The chest CT imaging characteristics, including the distribution, shape, and density of lesions, and the pleural effusion, pleural changes, and enlarged lymph nodes were evaluated. Results: Two cases (25%) were classified as mild type, and they showed no obvious abnormal CT findings or minimal pleural thickening on the right side. Five cases (62.5%) were classified as moderate type. Among these patients, one case showed consolidation located in the subpleural region of the right upper lobe, with thickening in the adjacent pleura; one case showed multiple consolidation and ground-glass opacities with blurry margins; one case displayed bronchial pneumonia-like changes in the left upper lobe; and two cases displayed asthmatic bronchitis-like changes. One case (12.5%) was classified as critical type and showed bronchial pneumonia-like changes in the bilateral lungs, presenting blurred and messy bilateral lung markings and multiple patchy shadows scattered along the lung markings with blurry margins.Conclusions: The chest CT findings of COVID-19 in preschool children are atypical and various. Accurate diagnosis requires a comprehensive evaluation of epidemiological, clinical, laboratory and CT imaging data.
Circular RNA profiling of buffalo myoblasts reveals an abundant circPICALM that promotes myoblast differentiation
Authors: Song Mingming , Chen Mengjie , Huang Kongwei , Zhong Dandan , Chen Yaling , Fu Jiayuan , Jiang Mingsheng , Liu Qingyou , Shi Deshun , Li Hui
Published: May 2020

The authors have withdrawn this preprint due to author disagreement.
Synthesis of two-dimensional lamellar porous carbon from fluorene for supercapacitors
Authors: Wang Xiaoting , Huang Fangfang , Zhang Chen , Yu Moxin
Published: May 2020

Lamellar porous carbons (LPCs) were prepared from fluorene with Mg(OH)2 as template precursors coupled with KOH activation. The as-prepared LPCs feature a large flaky structure containing a large number of micropores and mesopores. This unique structure have a big lateral size/thickness aspect ratio and a large specific surface area of 1879 m2 g− 1. As an electrode material, the LPC shows a high capacitance of 231 F g− 1 at 0.05 A g− 1, excellent rate performance of 173 F g− 1 at 100 A g− 1, and good cycle stability with 95.93% capacitance retention after 10,000 cycles in 6 M KOH electrolyte.
An innovative strategy to address shortages of healthcare personnel
Authors: Gumede Dumsani Mandla , Taylor Myra , Kvalsvig Jane
Published: May 2020

Background In order to improve health in low- and middle- income countries the basic health infrastructure needs to be upgraded. Part of the problem is the shortage of skilled healthcare professionals (HCP) particularly in rural areas. The Umthombo Youth Development Foundation (UYDF) is a non-profit organisation (NPO) established in 1999 to assist in addressing shortage of HCPs in rural areas. The aim of this study is to measure the success of the UYDF bursary scheme in achieving this goal by calculating the cost of supporting rural students and estimating the benefits in relieving the shortage in terms of the financial return on investment.Methods The sources of the data were the UYDF organisational records (finance, human resources and procurement), supplemented by the published and unpublished UYDF reports. The return on investment was estimated through the use of an Internal Rate of Return (IRR) calculation.Results The UYDF database of beneficiaries showed that by the year 2017 a total of 337 HCPs had graduated and a further 254 were still studying. An average of R17 million was spent every year on the students or R102 015 per student per year. The IRR was 63% higher than interest rates on commercial loans. These graduates are expected to generate an estimated R15 billion in lifetime earnings, which would be equal to R4 billion at current prices.Conclusion The UYDF scheme relieved the shortage of HCPs in rural hospitals, and the hospitals were able to retain the service of many of the locally sourced HCPs. The costs of implementing the bursary scheme were outweighed by the income generated from salaries, and taxes contributed to the country’s economic development.
Contribution of obesity and cardiometabolic risk factors in patients with cardiovascular disease: A population based cohort study
Authors: Bakhtiyari Mahmood , Kazemian Elham , Kabir Kourosh , Hadaegh Farzad , Mardi Parham , Ghahfarokhi Nooshin Taherzadeh , Ghanbari Ali , Mansournia Mohamad Ali , Azizi Freidoun
Published: May 2020

Background

The mechanisms linking adiposity to associated clinical conditions such as type 2 diabetes, cardiovascular disease, and related metabolic and inflammatory disturbances. are poorly understood.This study aimed to identify sex-specific direct and indirect effects of central and general adiposity on cardiovascular disease, mediated by cardiometabolic risk factors and how much is independent of these factors.
Methods

We analyzed data from the TLGS cohort study with 6280 participants aged ≥ 30 years, free of cardiovascular disease at baseline with a median follow-up of 13.9 years. The total effects were broken down into natural direct and indirect effects using a 2-stage regression model in the context of the survival model. We also calculated the proportion mediated by systolic blood pressure, total serum cholesterol, and fasting plasma glucose as mediators.
Results

There was no interaction between BMI and its mediators in the multiplicative scale (P > 0.05 for all). Blood pressure was the most important mediator for general (HRNIE: 1.11, 95% CI:1.17–1.24) and central obesity (HRNIE: 1.11, 95% CI:1.07–1.15) with proportion mediated of 60% and 36% respectively in the total population. The percentage mediated through all three metabolic risk factors together was 46% (95% confidence interval = 31%-75%) for overweight, 66% (45%-100%) for general obesity and 52% (39%-87%) for central obesity. Blood pressure was the most important mediator for overweight and central adiposity in male population with 29% and 36% proportion mediated respectively while in female population percentage mediated through all three metabolic risk factors together was 23% (95% confidence interval = 13%-50%) for overweight, 36% (21%-64%) for general obesity and 52% (39%-87%) for central obesity.
Conclusions

Metabolic mediators explain more than 60% of the adverse effects of high BMI on CVD in the male population. Also, managing these metabolic mediators in women does not effectively contribute to reducing CVD risks without decreasing weight.
A comparison of Attitudes Toward Schizophrenia among Psychiatric Staff, Psychiatrists, Physicians, Medical Students, and Non-medical Workers
Authors: Kataoka Mariko , Ohira Tetsuya , Tsuboi Satoshi , Miura Itaru , Yabe Hirooki
Published: May 2020

Background: Today, schizophrenia remains stigmatized all over the world, and for patients with schizophrenia, the experience of stigma makes improving their lives difficult. Changing of attitudes toward schizophrenia is an important theme not only for medical professionals but also medical students. We therefore invested investigate negative attitudes toward schizophrenia among psychiatric staff, psychiatrists, physicians, medical students, and non-medical workers. Methods: Participants in this study included 490 medical students, 25 psychiatric staff, 13 psychiatrists, 48 physicians, and 222 non-medical workers in Fukushima Medical University, in Japan. We conducted an internet-based questionnaire survey, using a web-based survey tool. We used an 18-item questionnaire on attitudes toward schizophrenia that comprised three factors: stigma, underestimation of patients’ abilities, and skepticism regarding treatment. To compare the scores for each of these factors among the five participant groups, analysis of covariance (ANCOVA) was used to adjust for age and sex. Results: Psychiatrists’ “stigma” and “underestimation of patients’ abilities” scores were significantly lower than those of non-medical workers, physicians, and medical students. The “skepticism regarding treatment” scores were not significantly different among the five groups. For medical students, hoping to become a psychiatrist in the future had the great impact on improving attitudes toward schizophrenia. Conclusion: Medical students had more negative attitudes toward schizophrenia than psychiatrists, but equally negative attitudes compared with physicians and non-medical workers.
Retrospective analysis for the LNM risk factors and effect of chemotherapy for the early colorectal cancer: A Chinese multicenter study
Authors: Zeng Chunyan , Xiong Dandan , Cheng Fei , Luo Qingtian , Wang Qiang , Huang Jun , Lan Guilian , Zhong Huan , Chen Youxiang
Published: May 2020

Background Estimating the risk of lymph node metastasis (LNM) is crucial for determining subsequent treatments following curative resection of early colorectal cancer (ECC). This multicenter study analyzed the risk factors for LNM and the effectiveness of postoperative chemotherapy in patients with ECC.MethodsWe retrospectively analyzed the data of 473 patients with ECC who underwent general surgery in five hospitals between January, 2007 and October, 2018. The correlations between LNM and gender, age, tumor size, tumor location, endoscopic morphology, Pathology, depth of invasion and tumor budding (TB), were estimated directly based on postoperative pathology results. We also observed the overall survivals (OS) and recurrences between ECC patients with and without LNM after the base-line being matched.Results There were 473 ECC patients observed, 288 patients of them were enrolled, 17 patients had LNM (5.90%). Univariate analysis revealed that tumor size, pathology, lympho-vascular invasion were associated with LNM in ECC (P = 0.026, 0.000, 0.000, respectively), and multivariate logistic regression confirmed that tumor size, pathology, lympho-vascular invasion were risk factors for LNM (P = 0.021, 0.023, 0.001, respectively). There were no significant differences for the OS and recurrence between the ECC patients with and without LNM whose base-lines were matched (P = 0.158,0.346, respectively), neither no significant difference between chemotherapy and no chemotherapy ECC patients without LNM after surgery (P = 0.729,0.052).Conclusion Tumor size, pathology, lympho-vascular invasion were risk factors for predicting LNM in ECC patients. Adjuvant chemotherapy could improve the overall survival and recurrence in patients with LNM, but no necessary for the ECC patients without LNM.
Association of the plasma xanthine oxidoreductase activity with the metabolic parameters and vascular complications in patients with type 2 diabetes: a cross-sectional study in a hospital setting
Authors: Okuyama Tomoko , Shirakawa Jun , Nakamura Takashi , Murase Takayo , Miyashita Daisuke , Inoue Ryota , Kyohara Mayu , Togashi Yu , Terauchi Yasuo
Published: May 2020

Background

Xanthine oxidoreductase (XOR) is a rate-limiting enzyme that catalyzes the oxidation of hypoxanthine to xanthine, and of xanthine to uric acid. XOR also enhances the production of reactive oxygen species (ROS) and causes endothelial dysfunction. To explore the association of XOR and its substrate with the vascular complications in patients with type 2 diabetes mellitus (hereafter simply, diabetes), we measured the plasma XOR activity and plasma levels of xanthine and hypoxanthine in patients with type 2 diabetes.
Materials and Methods

Plasma XOR activity and the plasma levels of xanthine and hypoxanthine were measured, and their associations with the clinical parameters and vascular complications were investigated in 94 Japanese inpatients with type 2 diabetes.
Results

Both the plasma XOR activity and plasma xanthine levels were correlated with the serum uric acid level. The plasma XOR activity was correlated with the plasma xanthine level, but not the plasma hypoxanthine level. The plasma XOR activity and plasma xanthine levels were positively correlated with the body mass index (BMI), serum levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), serum γ-GTP, fasting plasma insulin, and the homeostasis model of assessment of insulin resistance (HOMA-IR), and negatively correlated with the serum high density lipoprotein cholesterol levels (HDL-C). The plasma XOR activity also showed a positive correlation with the serum triglyceride (TG) levels. Plasma xanthine was positively correlated with the Fib4-index. Multivariate analyses identified AST, ALT, fasting plasma insulin and HOMA-IR as being independently associated with the plasma XOR activity. In addition, a negative correlation was observed between the plasma XOR activity and the duration of diabetes, and positive correlations were observed between the plasma XOR activity and the coefficient of variation of the R-R interval (CVR-R) and sensory nerve conduction velocity (SCV). Furthermore, the plasma XOR activity was found to be significantly decreased in patients with coronary artery disease.
Conclusions

The plasma XOR activity might be a surrogate marker for the development of vascular complications, as well as liver dysfunction and insulin resistance, in patients with type 2 diabetes
C1q/TNF–Related Protein-3 attenuates endothelial dysfunction in diabetic retinopathy via the Nitric Oxide signaling pathway
Authors: Yan Zheyi , Cao Xiaoming , Wang Chunfang , Liu Sha , Gan Lu , Yan Wenjun , Guo Rui , Zhao Dajun , Liu Jing , Gao Jia , Xu Yong
Published: May 2020

The authors have requested that this preprint be removed from Research Square.
Clinical characteristics and predictors of pneumonia in patients presenting fever or respiratory symptoms with normal or low leukocyte counts: a retrospective study
Authors: Wang Chunting , Liu Jihai , Li Yan , Wang Jiangshan , Xu Shengyong , Xu Jun , Li Yi , Yu Xuezhong , Zhu Huadong
Published: May 2020

Background

Many patients went to the hospital presenting with acute fever, or respiratory symptoms, most of whom have a normal or low leukocyte counts. The aim of this study was to investigate the clinical characteristics and predictors of pneumonia in those patients.
Methods

In this retrospective study, adult patients (≥ 18 years old) presenting with acute fever or respiratory symptoms with normal or low leukocyte counts (≤ 9.5 × 109/L) in Peking Union Medical College Hospital between 26 January 2020 and 10 March 2020 were included. Patients were categorized into groups with pneumonia or upper respiratory tract infection (URTI) according to chest CT scans. Logistic regression was used to explore predictors of pneumonia.
Results

A total of 195 patients were included, 63 of whom were diagnosed with pneumonia. The median maximum body temperature was 38.5 °C (38.0-38.8 °C) in patients with pneumonia and 37.5 °C (37.4–37.8 °C) in the other group. There was a significant difference in high-sensitivity C-reactive protein (hsCRP) levels between the two groups (0.21 (0-3.74) versus 33.4 (15.5–75.5) mg/L, p < 0.001). Multivariable regression showed that the predictive values of pneumonia were older age (OR 1.06, 95% CI 1.02–1.10, p = 0.004), cough (OR 0.18, 95%CI 0.06–0.56; p = 0.003), higher temperature (OR 3.36, 95%CI 1.16–9.71; p = 0.025) and higher hsCRP level (OR 1.05, 95%CI 1.02–1.09; p = 0.003). The optimal cutoff values based on the ROC curve analysis were a temperature of 37.8 °C and a hsCRP level of 1.64 mg/L.
Conclusions

Patients with older age, cough, higher temperature and higher hsCRP level were more inclined to have pneumonia. Temperatures higher than 37.8 °C were a potential predictor of pneumonia in patients with normal or low leukocyte counts in the early stage. However, a hsCRP level less than 1.64 mg/L could rule out most cases of pneumonia.
Lotus Leaf Extract Inhibits the Cell Migration and Metastasis of ER- Breast Cancer
Authors: Tong Yuelin , Li Zhongwei , Wu Yikuan , Zhu Shenglong , Lu Keke , He Zhao
Published: May 2020

Background: Patients with estrogen receptor negative (ER-) breast cancer have poor prognosis because of their high rates of metastasis. However, there is no effective treatment and drugs for ER− breast cancer metastasis. Our purpose of this study was to evaluate the effect and mechanism of lotus leaf alcohol extract (LAE) on the cell migration and metastasis of ER- breast cancer.Methods: The anti-migratory effect and mechanism of LAE were analysed in ER- breast cancer cells including SK-BR-3, MDA-MB-231 and HCC1806. Cell viability assay, wound-healing assay, RNA-sequence analysis and immunoblotting assay were applied in examining the cytotoxicity, anti-migratory effect and its possible pathways of LAE. To further investigate the inhibitory effect of LAE on metastasis in vivo, subcutaneous xenograft nude mice model and intravenous injection nude mice model were established. Lung and liver tissues were analysed by the Hematoxylin & eosin staining and immunoblotting assay.Results: We found that lotus leaf alcohol extract (LAE), not nuciferine, inhibited cell migration significantly in SK-BR-3, MDA-MB-231 and HCC1806 breast cancer cells, and did not change viability of breast cancer cells. The anti-migratory effect of LAE was dependent on TGF-β1 signaling, while independent of Wnt signaling and autophagy influx. Intracellular H2O2 participated in the TGF-β1-related inhibition of cell migration. LAE inhibited significantly the breast cancer cells metastasis in mice models. RNA-sequence analysis showed that extracellular matrix signaling pathways are associated with LAE-suppressed cell migration.Conclusions: Our findings demonstrated that lotus leaf alcohol extract inhibits the cell migration and metastasis of ER- breast cancer via TGF-β1/Erk1/2 and TGF-β1/SMAD3 signaling, which provides a potential therapeutic strategy for ER- breast cancer.
Distinct Microbial Assemblages Associated with Genetic Selection for High- and Low- Muscle Yield in Rainbow Trout
Authors: Chapagain Pratima , Walker Donald , Leeds Tim , Cleveland Beth M , Salem Mohamed
Published: May 2020

Background Fish gut microbial assemblages play a crucial role in the growth rate, metabolism, and immunity of the host. We hypothesized that the gut microbiota of rainbow trout was correlated with breeding program based genetic selection for muscle yield. To test this hypothesis, fecal samples from 19 fish representing an F2 high-muscle genetic line (ARS-FY-H) and 20 fish representing an F1 low-muscle yield genetic line (ARS-FY-L) were chosen for microbiota profiling using the 16srRNA gene. Significant differences in microbial population between these two genetic lines might represent the effect of host genetic selection in structuring the gut microbiota of the host.Results Tukey’s transformed inverse Simpson indices indicated that ARS-FY-H samples have higher microbial diversity compared to those of the ARS-FY-L (LMM, χ2(1) = 14.11, p < 0.05). The fecal samples showed distinct clusters with significant differences in microbial assemblages between the genetic lines (F1,36= 4.7, p < 0.05, R2 = 11.9%). Further, Tax4Fun analyses predicted characteristic functional capabilities of the microbial communities in the ARS-FY-H and ARS-FY-L samples.Conclusion The significant differences of the microbial assemblages between ARS-FY-H and ARS-FY-L indicate an effect of genetic selection on the microbial diversity of the host. The functional composition of taxa demonstrates correlation of the function in improving the muscle accretion in the host, probably, by producing various metabolites and enzymes that might aid in digestion. Further research is required to elucidate the mechanisms involved in shaping the microbial community through host genetic selection.
Identification of circular RNA hsa_circ_0044556 and its effect on the development and progression of colorectal cancer
Authors: Jing Liang , Wu Junhui , Tang Xiaocheng , Ma Min , Long Fei , Tian Buning , Lin Changwei
Published: May 2020

Background
Circular RNAs (circRNAs) are a novel class of noncoding RNAs. Increasing evidence indicates that circRNAs play an important role in the occurrence and development of tumors. However, the role of circRNAs in the development and progression of colorectal cancer (CRC) remains unclear.
Methods
First, we searched for differentially expressed circRNAs using a circRNA microarray in paired CRC and adjacent normal tissues. The circRNA hsa_circ_0044556 was screened out from the existing CRC circRNA microarray in the Gene Expression Omnibus database and our microarray. The clinical significance of hsa_circ_0044556 expression level in CRC patients was then investigated. Finally, the functions of the targets of this circRNA were determined in CRC cell lines.
Results
hsa_circ_0044556 was highly expressed in CRC patients and was positively correlated with tumor stage and lymph node metastasis. In CRC cell lines, the proliferation, migration, and invasion of cancer cells were inhibited by knocking down hsa_circ_0044556 expression.
Conclusion
hsa_circ_0044556 promoted the development and progression of CRC. It is possible that hsa_circ_0044556 will become a novel biomarker or therapeutic target for CRC.