bluuebunny/crossref_metadata_2025 huggingface dataset:
Interferon Inducible Porcine 2′, 5′-oligoadenylate Synthetase-Like Protein Limits Porcine Reproductive and Respiratory Syndrome Virus Infection via the MDA5-Mediated Interferon-Signaling Pathway
Authors: Zhao Mengmeng , Kong Weili , Kang Yinfeng , Li Huawei
Published: November 2020

Porcine reproductive and respiratory syndrome virus (PRRSV) is a constant threat to the swine industry worldwide. Currently approved vaccines against PRRSV are losing effectiveness, as new viral strains are often refractory to conventional treatments. Thus, there is an urgent need to find new therapeutic targets to develop novel antiviral drugs. 2′, 5′-oligoadenylate synthetase-like (OASL) protein has antiviral activity, but this has not been demonstrated for PRRSV and the mechanism is not well elucidated. In this study expression of porcine OASL (pOASL) in porcine alveolar macrophages (PAMs) induced by interferon (IFN) -β stimulation and PRRSV infection was examined by real-time polymerase chain reaction (RT-PCR). Exogenous expression and knockdown of pOASL were used to indicate the role of pOASL in the PRRSV replication cycle. The type I IFN signaling pathway was evaluated after pOASL overexpression. Results showed the expression of pOASL in PAMs was significantly increased by IFN-β stimulation or PRRSV infection. pOASL specific small interfering RNA (siRNA) promoted PRRSV replication, whereas exogenous expression of pOASL inhibited infection of PRRSV. The anti-PRRSV activity was lost after knockdown of the Melanoma differentiation-associated protein 5 (MDA5) RNA sensor. Taken together, pOASL inhibits PRRSV infection via the activation of MDA5.
High Prevalence Of Alphaherpes Virus 2 (HSV-2) Positivity In Prisons From Midwest Brazil: A Cross-Sectional Study
Authors: Almeida Nathália Alves Araujo de , Lima Lyana Rodrigues Pinto , Puga Marco Antonio Moreira , Croda Julio , Horta Marco Aurelio , Motta-Castro Ana Rita Coimbra , Paula Vanessa Salete de
Published: November 2020

Background: The Herpes simplex virus type 2, currently classified as Human alphaherpesvirus 2 (HSV-2) is the main cause of genital herpes, one of the most prevalent sexually transmitted infections (STIs) in the world. STIs are one of the major public health problems in prisons due to the behaviors of prisoners and the factors that increase the risk of transmission. The present study aimed to estimate the prevalence and risk factors associated with HSV-2 infection at 12 prisons in Mato Grosso of Sul, Brazil. Results: We tested 872 serum samples (732 males and 140 females) for anti-HSV-2 IgG and anti-HSV-2 IgM. The overall HSV-2 IgG prevalence was 43.1%, and the prevalence was greater in males than females (32.1% vs. 11%). The prevalence of HSV-2 in females were 3.4 times more than in males in adjusted model. Among the 184 samples HSV-2 IgG tested for IgM anti HSV-2, 46% were positive. The prevalence of HSV-2 positivity was much greater than reported in the general population of Brazil and in other prison populations worldwide. The multivariable model adjusted, indicated significant and independent associations of HSV-2 IgG positivity with female sex, age older than 29 to 39 years, unmarried status, history of STI, no previous incarceration, being incarcerated with more than 26 others, presence of genital discharge, previous homosexual intercourse, HIV-positivity, and no use/occasional use of condoms during sexual intercourse. Conclusions: This is the first study that evaluated HSV-2 in a prison population in Brazil. These data provide important information needed to implement procedures that better prevent and control of STIs in prison populations.
Psychometric Properties of an English Short Version of the Trier Inventory for Chronic Stress
Authors: Petrowski Katja , Braehler Elmaer , Schmalbach Bjarne , Hinz Andreas , Bastianon Christina , Ritz Thomas
Published: November 2020

Background: Although a variety of instruments are available that capture stress experience, the assessment of chronic stress has been hindered by the lack of economical screening instruments. Recently, an English-language version of the Trier Inventory for Chronic Stress (TICS-EN) consisting of 57 items according to a systemic-requirement-resource model of health in nine subdomains of the chronic stress experience has been introduced.Methods: We constructed a new 9-item short version of the TICS covering all nine subdomains and evaluated it in two samples (total N=685). We then used confirmatory factor analysis to check factorial validity.Results: This version showed a highly satisfactory model fit, was invariant across participant gender, demonstrated a very high correlation with the original TICS (r=.94), and showed a moderate correlation (r=.58) with a measure of perceived stress in the past month.Conclusions: Therefore, this theoretically driven instrument can be recommended as a short version of the TICS in English language.
Association between response to triptans and response to erenumab: real-life data
Authors: Frattale Ilaria , Caponnetto Valeria , Casalena Alfonsina , Assetta Maurizio , Maddestra Maurizio , Marzoli Fabio , Affaitati Giannapia , Giamberardino Maria Adele , Viola Stefano , Gabriele Amleto , Pistoia Francesca , Cerone Davide , Marini Carmine , Sacco Simona , Ornello Raffaele
Published: November 2020

Background. Triptans and erenumab are both migraine-specific agents acting on the calcitonin gene-related peptide pathway. Therefore, response to triptans might be associated with response to erenumab. Main body. In our study, consecutive patients referring to the Headache Centers of the Abruzzo region from January 2019 to March 2020 and treated with erenumab were interviewed about past use and efficacy of triptans. Triptan users were classified as ‘triptan responders’ if they were headache-free 2 hours after treating ≥3 migraine attacks with ≥1 triptan. We considered patients as ‘erenumab responders’, if they had a ≥50% mean reduction in monthly migraine days between the 4th and the 6th month from treatment start compared with baseline. Of 91 triptan users, 73 (80.2%) were triptan responders and 58 (63.7%) were erenumab responders. The odds ratio of being erenumab responder was 3.64 (95% CI, 1.25-10.64) for triptan users as compared to non-users. (P=0.014). Besides, starting erenumab improved triptan response in both erenumab responders and non-responders. Conclusions. Our data of an association between response to triptans and response to erenumab can be useful for patient advice and to improve the understanding of migraine pathophysiology and treatment.
Magnetism-induced topological transition in EuAs3
Authors: Cheng Erjian , Xia Wei , Xu Jie , Wang Chengwei , Xi Chuanying , Xu Shaowen , Peets Darren , Wang Linshu , Su Hao , Pi Li , Ren Wei , Wang Xia , Yu Na , Chen Yulin , Zhao Weiwei , Liu Zhongkai , Guo Yanfeng , Li Shiyan
Published: November 2020

The nature of the interaction between magnetism and topology in magnetic topological semimetals remains mysterious, but may be expected to lead to a variety of novel physics. We present ab initio band calculations, electrical transport and angle-resolved photoemission spectroscopy (ARPES) measurements on the magnetic semimetal EuAs3, demonstrating a magnetism-induced topological transition from a topological nodal-line semimetal in the paramagnetic or the spin-polarized state to a topological massive Dirac metal in the antiferromagnetic (AFM) ground state at low temperature, featuring a pair of massive Dirac points, inverted bands and topological surface states on the (010) surface. Shubnikov-de Haas (SdH) oscillations in the AFM state identify nonzero Berry phase and a negative longitudinal magnetoresistance (n-LMR) induced by the chiral anomaly, confirming the topological nature predicted by band calculations. When magnetic moments are fully polarized by an external magnetic field, an unsaturated and extremely large magnetoresistance (XMR) of ∼ 2×105 % at 1.8 K and 28.3 T is observed, likely arising from topological protection. Consistent with band calculations for the spin-polarized state, four new bands in quantum oscillations different from those in the AFM state are discerned, of which two are topologically protected. Nodal-line structures at the Y point in the Brillouin zone (BZ) are proposed in both the spin-polarized and paramagnetic states, and the latter is proven by ARPES. Moreover, a temperature-induced Lifshitz transition accompanied by the emergence of a new band below 3 K is revealed. These results indicate that magnetic EuAs3 provides a rich platform to explore exotic physics arising from the interaction of magnetism with topology.
Factors Influencing Post-ICU Psychological Distress in Family Members of Critically Ill Patients: A Linear Mixed-Effects Model
Authors: Naef Rahel , Felten Stefanie van , Ernst Jutta
Published: November 2020

Background: Adverse responses to critical illness, such as symptoms of depression, anxiety or posttraumatic stress, are relatively common among family members. The role of risk factors, however, remains insufficiently understood, but may be important to target those family members most in need for support. We therefore examined the association of patient-, family member- and care-related factors with post-ICU psychological distress in family members in a general population of critical ill patients.Methods: We conducted a prospective, single-centre observational study in a twelve-bed surgical ICU in a 900-bed University Hospital in Switzerland. Participants were family members of patients treated in ICU who completed the Family Satisfaction in ICU-24 Survey, the Hospital Anxiety Depression Scale, Impact of Event Scale-Revised-6, and a demographic form within the first three months of their close other’s ICU stay. Data were analysed using linear mixed-effects models, with depression, anxiety, and posttraumatic stress as outcome measures. Results: A total of 214 family members (53% return rate) returned a completed questionnaire. We found that higher levels of satisfaction were significantly associated with lower levels of depression, anxiety and posttraumatic stress. There was no statistically significant association between family member characteristics and any measure of psychological distress. Among the included patient characteristics, younger patient age was associated with higher levels of depression and anxiety, and patient death was associated with higher levels of depression and posttraumatic stress.Conclusions: Our results suggest that satisfaction with ICU care is strongly associated with family well-being post-ICU. Family members of younger patients and of those who die seem to be most at risk for psychological distress, requiring specific support, whereas family member characteristics may have less relevance.
Pilot study protocol for determining differences in quantitative and functional aspects of dendritic cell subsets in early onset pre-eclampsia patients- a feasibility study for identification of biomarker(s) and immunotherapeutic target(s)
Authors: Sundararajan Aarthi , Vora Kranti , Natesan Senthilkumar
Published: November 2020

Background: Pre-eclampsia (PE) is a pregnancy associated pro-inflammatory disorder. The only known treatment is to deliver the placenta and fetus. PE is clinically identified by hypertension and proteinuria post-20th week of gestation. Early onset pre-eclampsia (EOPE), a severe form of PE is defined as when the clinical symptoms are observed before 34 weeks of gestation. There are no definite biomarkers available for early diagnosis of EOPE. Human dendritic cell (DC) subsets (CD1c+, CD141+ myeloid DCs and plasmacytoid DCs) are intricately involved with the process of inflammation and are significantly altered (quantitatively and functionally) in several proinflammatory disorders. These changes offer value for monitoring DC subsets as potential biomarker(s) and as targets for immunotherapeutic treatment. DC subsets play a critical role in normal pregnancy by mediating efficient migration and invasion of trophoblasts and maintaining anti-inflammatory environment of immunotolerance. In contrast, the status of DC subsets in the proinflammatory microenvironment of EOPE pregnancy requires thorough evaluation. In this direction, the designed study protocol aims to understand how DC subsets are altered (quantitatively and functionally) in EOPE patients, compared to normal pregnant women. Methods: Study protocol is designed to determine changes in the profile of DC subsets in the blood and decidua of EOPE patients by multiparametric flow cytometry approach. Normal pregnant women are included as controls.Discussion: Human DC subsets are altered both quantitatively and functionally in the pro-inflammatory microenvironment. EOPE is a pro-inflammatory disorder and changes in the composition and function of DC subsets in these patients, compared to normal pregnant women is unclear. In this study, the blood sample-based analysis will determine the feasibility for identification of DC subsets associated novel immune biomarkers for early diagnosis of EOPE. In addition, changes in the profile of DC subsets in the decidua of EOPE patients will determine the feasibility for developing novel immunotherapeutic strategies targeting distinct DC subsets or their products for the treatment of EOPE. Overall, the current study protocol and findings will help develop future large scale, prospective design clinical trials focussing on formulating strategies for early diagnosis and treatment of EOPE among pregnant women.
Machine Learning Models for Breast Lesions Based on Ultrasound Imaging Features: A Observational Study
Authors: Tan Yao , Huo Ling , Wang Shu , Geng Cuizhi , Li Yi , Ma XiangJun , Wang Bin , He YingJian , Yao Chen , Ouyang Tao
Published: November 2020

Background: The accuracy of breast cancer (BC) screening based on conventional ultrasound imaging examination largely depends on the experience of clinicians. Further, the effectiveness of BC screening and diagnosis in primary hospitals need to be improved. This study aimed to establish and evaluate the usefulness of a simple, practical, and easy-to-promote machine learning model based on ultrasound imaging features for diagnosing BC.Methods: Logistic regression, random forest, extra trees, support vector, multilayer perceptron, and XG boost models were developed. The modeling data set was divided into a training set and test set in a 75%:25% ratio, and these were used to establish the models and test their performance, respectively. The validation data set of primary hospitals was used for external validation of the model. The area under the receiver operating characteristic curve (AUC) was used as the main evaluation index, and pathological biopsy was used as the gold standard for evaluating each model. Diagnostic capability was also compared with those of clinicians. Results: Among the six models, the logistic model showed superior capability, with an AUC of 0.771 and 0.906 in the test and validation sets, respectively, and Brier scores of 0.18 and 0.165. The AUC of the logistic model in tertiary class A hospitals and primary hospitals was 0.875 and 0.921, respectively. The AUCs of the clinician diagnosis and the logistic model were 0.913 and 0.906. Their AUCs in the tertiary class A hospitals were 0.890 and 0.875, respectively, and were 0.924 and 0.921 in primary hospitals, respectively. Conclusions: The logistic regression model has better overall performance in primary hospitals, and the logistic regression model can be further extended to the basic level. A more balanced clinical prediction model can be further established on the premise of improving accuracy to assist clinicians in decision making and improve diagnosis.Trial Registration: http://www.clinicaltrials.gov. ClinicalTrials.gov ID: NCT03080623.
Food Poisoning and Care-Seeking Behavior - Cases of Students from the City of Mohammedia in Morocco - Prospective Study
Authors: Lamine Hasna , ouanouche Elhassan , Soulaymani Abdelmajid , Khadmaoui Abderrazzak:
Published: November 2020

Background: Food poisoning is a problem that affects public health. It is unveiling opens an opportunity for action to identify and avoid the problem. The main objective of this study is to analyze the environmental factors that influence the obligation to consult a doctor or not following food poisoning.Methods: The study was conducted, following a prospective survey, on a sample of 408 students chosen at random from six schools of urban origin in the city of Mohammedia in Morocco.Results: 33.6% of the students confirmed having consulted the doctor against 66.4% after food poisoning. In the same way, we found that 16.2% (n = 66) of the students who declared poisoning following the consumption of an offending food were hospitalized. In addition, only 13.6% of intoxicated carried out analyzes were requested by the consultant doctor. 59.3% of the drugs prescribed by doctors are anti-infectious followed by gastro-entero-hepatology 15.4% and 12.3% are analgesics.Conclusions: Overall, this study confirms that food poisoning is very frequent among students in Morocco, so parents should be educated about the danger of food poisoning in their children, by presenting them to a doctor immediately after contamination to avoid complications.
Ethyl Acetate Extracts of Bushen-Yizhi Formula Attenuates Aging-Induced Dementia through Suppressing NLRP3 Inflammasome Activation in SAMP8 Mice
Authors: Su Shi-Jie , Cai Wei-Wu , Liu Hao-Fei , Zhang Shi-Jie , Wang Qi , Liu Si-Jun
Published: November 2020

Background: Similar features indicated common regulators between aging and aging-induced dementia, which demonstrated profound correlations with each other. However, the mechanism remains unclear. Bushen-Yizhi Formula(BSYZ-F) has been used for managing dementia in the clinic for hundreds of years. In this study, we aimed to further explore the mechanism of athyl acetate extracts of BSYZ-F(BSYZ-E) attenuates aging-induced dementia in Senescence-Accelerated Mouse Prone 8 (SAMP8) mice.Methods: As an age-related model, SAMP8 mice have been assigned to receive the corresponding interventions in this study. The Morris water maze was used to evaluate the learning and memory ability in SAMP8 mice. The marker level of oxidative stress(ROS and SOD) and nitrosative stress(NO and iNOS) were measured using commercial kits. The quantification of inflammation-related proteins (NLRP3, ASC, Caspase-1, IL-1β, and IL-18) and related apoptotic proteins (Bax, Bcl-2, Caspase-3, and Cleaved-Caspase-3) in hippocampal tissue were measured using Western blot.Results: In behavioral, the Morris Water Maze test demonstrated BSYZ-E alleviated the cognitive impairments in SAMP8 mice. Mechanism studies indicated that BSYZ-E increased the vitality of SOD, declined the validity of NO, iNOS, and MDA in SAMP8 mice. Besides, BSYZ-E relieved neuronal apoptosis by regulating the expression of related apoptotic proteins (Bax, Bcl-2, Caspase-3, and Cleaved-Caspase-3) and inhibited NLRP3 inflammasome activation by inflammation-related proteins (NLRP3, ASC, Caspase-1, IL-1β, and IL-18) in SAMP8 mice. Conclusions: These results suggested that BSYZ-E attenuates aging-induced dementia by suppressing the activation of NLRP3 inflammasome in SAMP8 mice.
Allogeneic Red Blood Cell Transfusion Rate and Risk Factors in Elderly Patients with Femoral Neck Fracture after Hemiarthroplasty
Authors: Yue Rui , Yang Minghui , Deng Xiaohui , Zhang Ping
Published: November 2020

Objective: To determine the rate and risk factors of allogeneic red blood cell transfusions (ABT) in elderly patients with femoral neck fracture (FNF) after hemiarthroplasty (HA). Methods: We conducted a study on elderly patients (≥65 years old) who were admitted to the geriatric trauma orthopedics ward of Beijing Jishuitan Hospital for HA treatment from March 2018 to February 2019 due to FNF. The perioperative data were collected retrospectively, and univariate and multivariate stepwise logistic regression analysis were performed to determine the postoperative ABT rate and its risk factors. Results: 445 patients were included in the study, of which 177 (39.8%) received ABT after surgery. Multivariate stepwise logistic regression analysis showed that preoperative low hemoglobin (Hb), high intraoperative blood loss (IBL), advanced age, and low body mass index (BMI) are independent risk factors of ABT after HA in elderly FNF patients. Conclusion: ABT after HA is a common phenomenon in elderly patients with FNF. Their postoperative ABT needs are related to preoperative low Hb, high IBL, advanced age, and low BMI. Therefore, ABT can be reduced from the above aspects.
Vitamin D Status in Dupuytren’s Disease: Association with Clinical Status and Vitamin D Receptor Expression
Authors: Park Jin Woo , Kim Sung Taeck , Lee Kyu Sang , Gong Hyun Sik
Published: November 2020

BackgroundDupuytren’s disease(DD) is a progressive fibroproliferative condition involving contractures of the fascia of the palm. Up to now, there are no relevant investigations on patients with DD in case of serum vitamin D deficiency. We hypothesized that transforming growth factor-β1 (TGF-β1) is increased in patients with DD in consequence of vitamin D deficiency, thereby leading to myofibroblast differentiation and subsequent progression of contractures. MethodsThe study’s aim was to analyze serum vitamin D levels and explore possible clinical and immunohistochemical correlates with vitamin D concentrations in a group of patients with DD. Vitamin D levels were measured in all DD patients and healthy controls. In the patient group, clinical characteristics were compared between vitamin D deficient and non-deficient subgroups. Diseased palmar fascia samples were obtained from 14 patients undergoing fasciectomy for DD. Correlations between vitamin D levels and vitamin D receptor(VDR), TGF-β1 expression levels in collected fascia samples were evaluated. ResultsVitamin D concentrations were significantly lower in patients than healthy controls. In addition, total extension deficit of involved fingers was higher in vitamin D deficient patients. Moreover, a positive correlation was found between vitamin D levels and expression of VDR in pathologic fascia in patients undergoing fasciectomy for contracture. Serum vitamin D levels were found to be low in DD patients. Expression of VDR was lower in the vitamin D deficient group.ConclusionsThe results suggest a potential link between vitamin D status and DD but causation is not yet established. The potential role of vitamin D and its interaction with VDR and the TGF-β1 signaling pathway in the pathogenesis of DD needs to be explored further.
Cost-effectiveness of a Hybrid Emergency Room System for Severe Trauma: A health technology assessment from the perspective of the third-party payer in Japan
Authors: Kinoshita Takahiro , Moriwaki Kensuke , Hanaki Nao , Kitamura Tetsuhisa , Yamakawa Kazuma , Fukuda Takashi , Hunink Myriam GM , Fujimi Satoshi
Published: November 2020

Background

Hybrid emergency room (ER) systems, consisting of an angiography-computed tomography (CT) machine in a trauma resuscitation room, are reported to be effective for reducing death from exsanguination in trauma patients. We aimed to investigate the cost-effectiveness of a hybrid ER system in severe trauma patients without severe traumatic brain injury (TBI).

Methods

We conducted a cost-utility analysis comparing the hybrid ER system to the conventional ER system from the perspective of the third-party healthcare payer in Japan. A short-term decision tree and a long-term Markov model using a lifetime time horizon were constructed to estimate quality-adjusted life years (QALYs) and associated lifetime healthcare costs. Short-term mortality and healthcare costs were derived from medical records and claims data in a tertiary care hospital with a hybrid ER. Long-term mortality and utilities were extrapolated from the literature. The willingness-to-pay threshold was set at $47,619 per QALY gained and the discount rate was 2%. Deterministic and probabilistic sensitivity analyses were conducted.

Results

The hybrid ER system was associated with a gain of 1.03 QALYs and an increment of $33,591 lifetime costs compared to the conventional ER system, resulting in an ICER of $32,522 per QALY gained. The ICER was lower than the willingness-to-pay threshold if the odds ratio of 28-day mortality was <0.66. Probabilistic sensitivity analysis indicated that the hybrid ER system was cost-effective with a 79.3% probability.

Conclusion

The present study suggested that the hybrid ER system is a likely cost-effective strategy for treating severe trauma patients without severe TBI.
Evaluation of Indicators for Cyanobacterial Risk in 108 Temperate Lakes Using 23 Years of Environmental Monitoring Data
Authors: LI JING , Person Kenenth M , Pekar Heidi , Jansson Daniel
Published: November 2020

Background: Cyanobacterial blooms are of increasing concern for drinking water supply. Cyanobacterial risk in 108 temperate freshwater lakes were examined for drinking water supply. Results: In Sweden, a survey among drinking water producers showed that the sense of urgency was little. At 60 % of the Swedish drinking water treatment plants, operators lacked monitoring strategies. The study shows that blooms can produce a variety of toxins such as anatoxins, cylindrospermopsins, microcystins and saxitoxins. We confirmed the anthropogenic activities’ impact on cyanobacterial risk and evaluated that total phosphorus (TP) concentration can be used to indicate cyanobacterial risk by applying non-linear quantile regression for 108 Swedish monitoring lakes.Conclusion: We suggest that TP concentration should be investigated thoroughly to provide important knowledge which can be used to set nutrient targets to sustain safe drinking water supply and recreational services.TP should be targeted lower than 15 μg L-1, allowing 10 % exceedance of WHO Drinking Water Alert Level 1.
Pregnant Women’s Well-being and Worry During the COVID-19 Pandemic: A Comparative Study
Authors: Mortazavi Forough , Mehrabadi Maryam , KiaeeTabar Roya
Published: November 2020

Background: COVID-19 caused some worries among pregnant women. Worries during pregnancy can affect women’s well-being. We investigated worry and well-being and associated factors among pregnant women during the COVID-19 epidemic.Methods: This descriptive cross-sectional study was conducted on 484 pregnant women using an online questionnaire. Sampling was performed in a period between May 5 and Aug 5, 2020. Inclusion criteria were having a single healthy fetus and having no significant psychological disorder. We collected the data using the Persian versions of the World Health Organization's well-being Index (WHO-5 well-being index) and the Cambridge worry scale.Results: The mean total scores of the WHO-5 well-being index and the rate of WHO-5 score < 50 were 64.9 ± 29.0 and 24.4%, respectively. Predictors of women’s worry are the increased level of fear of COVID-19, a low family income, employment situation, nulliparity, and having no close family member with chronic disease (p < 0.05). The results of logistic regression analysis on well-being scores showed that the worry about fetus health (OR = 1.081, p = 0.005), women’s own health and relationships (OR = 1.055, p = 0.047), and having an infected person with COVID-19 among relatives (OR = 2.095, p = 0.039) could predict the well-being in pregnant women. The mean score of worry about fetus health in the current study was lower than that of the previous study (p = 0.024). The mean score of socio-economic worry in the current study was higher than that of the previous cross-sectional study (p = 0.025). The result indicates that the percentage of participants with a low level of well-being did not differ by the two periods under study (chi-square = 0.099, p = 0.753) (table 7). Conclusions: The percentage of women experiencing a low well-being state was relatively high. This result is worthy of attention by health care providers and policy makers. To decrease women’s socio economic concerns, governments and charities should expand programs providing financial support to pregnant women in low-income families. Providing care and support to pregnant women should have high priority during the COVID-19 pandemic.
Analysis of Related Influencing Factors of Hysterectomy in Patients With Placenta Accreta Spectrum Disorders After Uterine Artery Embolization
Authors: Zheng Duzhou , Shen Huawei , Liu Mingxing , Huang Shikuan , Liu Weifeng , Zhou Mimi , Cai Mingjin
Published: November 2020

Objective: To estimate the related factors of hysterectomy in patients with Placenta accreta spectrum (PAS) after uterine artery embolization (UAE), and try to evaluate the effectiveness and safety of UAE in patients with PAS.Methods: From January 2012 to July 2020, a retrospective analysis was performed in 85 patients undergoing TAE for PAS. Information regarding clinical data, angiography as well as embolization details, and clinical outcomes was obtained. Univariate and multivariate analyses were performed to determine the factors related to hysterectomy.Results: Bleeding greater than or equal to 500ml during the delivery(p = 0.037), the placenta type by MR or US(placenta increta vs placenta percreta, P = 0.01) and the type of ovarian artery(No vs Bilateral, P = 0.005; Unilateral vs Bilateral, P = 0.01) were independent risk factors of hysterectomy in PAS patients treated with UAE. The area under the curve (AUC) of the predictive model that incorporated the independent risk factors was 0.844. Abnormal collateral vessels communicating with uterine artery were observed on angiography in 24 patients (28.2%) with 31 abnormal collateral vessels. The major abnormal collateral vessel was the abnormal branches of the internal iliac artery(n = 13), followed by the inferior vesical artery (n = 11), internal pudendal artery(n = 3), obturator artery (n = 2), vaginal artery(n = 1) and the abnormal branches of the external iliac artery(n = 1).Conclusions: TAE is safe and effective for patients with PAS. Bleeding greater than or equal to 500ml during the delivery, the placenta type by MR or US and the type of ovarian artery were related to the hysterectomy. For patients with hypertrophic ovarian-uterine artery anastomosis and no fertility requirements, Ovarian artery embolization(OAE) could be a feasible choice.
Usefulness of Shock Index and Delta Shock Index for Management of Postpartum Hemorrhage in Hypertensive Disorder in Pregnancy Cases
Authors: Mori Hiroshi , Shibata Eiji , Kuwazuru Tomoichiro , Kondo Emi , Uchimura Takayuki , Sakuragi Toshihide , Amimoto Shoko , Yoshino Kiyoshi
Published: November 2020

Background : Although the SI (Shock index; heart rate / systolic blood pressure) is a useful indicator in the management of PPH (postpartum hemorrhage), there are few reports of SI in pregnant women with complicated with HDP (hypertensive disorder in pregnancy) cases. HDP patients have a high systolic blood pressure and the bleeding volume may not be reflected in SI. The purpose of this study was to examine whether SI and ΔSI (peak SI−baseline SI) would be clinically useful indicators, and to detect the cut-off value for judging abnormal obstetric bleeding. Methods: Retrospective case-control study in 107 patients with HDP in an single perinatal medical center. The values ​​of prepartum SI, postpartum highest SI (peak SI), and the amount of bleeding until peak SI were retrospectively examined. The Kruskal-Wallis test was used to determine the relationship between peak SI, ΔSI and the amount of bleeding until peak SI. ROC(receiver operatorating characteristic) analysis was performed to determine the cut-off value. Results: Both peak SI and ΔSI were significantly related to the amount of bleeding up to peak SI (p <0.001). ROC analysis showed a cut-off values of peak SI where the amount of bleeding exceeded 500ml, 1,000ml, and 1,500ml. The values ​​are 0.77 (sensitivity 64%, specificity 84%; AUC 0.81), 0.76 (sensitivity 87%, specificity 69%; AUC 0.86), 0.99 (sensitivity 100%, specificity 91%; AUC 0.97). And ΔSI, respectively, were 0.25 (sensitivity 66.6%, specificity 88.7%; AUC 0.84), 0.31 (sensitivity 81%, specificity 87.9%; AUC 0.91), and 0.43 (sensitivity 100%, specificity 93.1%; AUC 0.98).Conclusion: In HDP cases, if the peak SI is greater than 0.99, similar to non-HDP pregnancies, or if the ΔSI is greater than 0.43, we need to recognize it as bleeding of 1,500ml or more. In addition, ΔSI may be a more sensitive and specific indicator than conventional peak SI in HDP cases.
Validation of Sonographic Fetal Weight Estimators Among Term Parturients in Uganda
Authors: Sereke Senai Goitom , Omara Richard Okello , Bongomin Felix , Nakubulwa Sarah , Kisembo Harriet Nalubega
Published: November 2020

BackgroundAccuracy of fetal weight estimation by ultrasound is essential in making decisions on the time and mode of delivery. There are many proposed formulas for fetal weight estimation such as Hadlock 1, Hadlock 2, Hadlock 3, Hadlock 4 and Shepard. What best applies to the Ugandan population isn’t known since no validation of any of the formulas has been done before. The primary aim of this study was to determine the accuracy of sonographic estimation of fetal weight using five most commonly used formulas, and analyze formula variations for different weight ranges. MethodsThis was a hospital based prospective cohort study at Mulago National Referral Hospital, Kampala, Uganda. A total of 356 pregnant women who consented and were within three days of birth, prenatal ultrasound fetal weight determined by measuring the biparietal diameter, head circumference, abdominal circumference, femoral length, and then was compared with actual birth weight. ResultsThe overall accuracy of Hadlock 1, Hadlock 2, Hadlock 3, Hadlock 4 and Shepard formula were 66.9%, 73.3%, 77.3%, 78.4% and 69.7% respectively. All Hadlocks showed significant mean difference between weight estimates and actual birth weight (p<0.01) whereas Shepard formula did not [p - 0.2], when no stratification of fetal weights was done. However, all Hadlocks showed a none significant (p-values > 0.05) mean difference between weight estimates and actual birth weight when the actual birth weight was ≥4000.0gms. Shepard weight estimates showed a none significant mean difference when actual birth weight was <4000gms. Bland-Altman graphs also showed a better agreement of weight estimated by Shepard formula and actual birth weights. ConclusionAll the five formulas were accurate at estimating actual birth weights within 10% accuracy. However, this accuracy varied with the fetal birth weight. Shepard was more accurate in estimating actual birth weights <4000grams whereas all Hadlocks were more accurate when the actual birthweight was ≥ 4000grams.
Development and Validation of a questionnaire to describe behaviours and attitudes of physicians towards their own process of falling ill.
Authors: Peña Maria Pilar Astier , Boyero Teresa Martínez , Marco Barbara Gómez , Alvarez Candela Pérez , Royo Alba Gállego , Marroquin Maria Teresa Delgado , Trota Rogelio Altisent
Published: November 2020

Background: Physicians have not learned their role as patients. Medical associations focused mainly on mental health programs for doctors in different countries. Nevertheless, the anomalous behaviours of ill doctors exist independently of their health problem. We described the development and validation of a questionnaire to describe Behaviours and Attitudes of Doctors towards their Own Illness (BADOI).Methods: Development of the questionnaire and appearance and content validation (ACV) by experts’ debriefings; construct validation by exploratory (EFA) and confirmatory factor analysis (CFA); reliability by Cronbach's alpha index (CAI) and feasibility by completion time (CT), accessibility to questionnaire platform and % of not answer items.Results: A Questionnaire with 56 items was developed with 3 sections: 1) socio-demographic, professional and work-related data. 2) Activities for self-care and work impact (sick leaves and presenteeism) and physicians’ healthcare pathways (Self-management and use of healthcare services). 3) Doctors of ill doctors and the role of medical associations. The validation sample size was of 4308 physicians’ answers. The factorial model presented 5 factors explaining 78.08% variance, a high value. Factor 1 explained 26.75% of the model describing the relationship between illness and work; Factor 2 explained 16.68%, with items regarding the negative impact of mental issues, toxic habits and the use of healthcare services; Factor 3 explained 15.06%, with items considering presenteeism and sick leaves; Factor 4 explained 9.95% regarding the handling of an ill colleague and medical associations. Finally, Factor 5 explained 9.64%, with items describing healthcare given to ill physicians and the revalidation of medical profession. Discussion: The factors grouped together items relating to self-care, impact on work and physicians’ healthcare pathways (F1-F2-F3) and the role of doctors of ill doctors and of the professional associations (F4-F5), being consistent with the 2 main perspectives: personal experience and caring for ill colleagues.Conclusion: A reliable Multidimensional Questionnaire on the process of physicians becoming ill has been validated in a large sample of registered doctors. It will help to identify and quantify physicians’ healthcare pathways allowing healthcare managers to set evidence-based interventions and formulate policies and ethical recommendations regarding the management of sick doctors.
Disentangling Depression in Belgian Higher Education Students Amidst a COVID-19 Lockdown
Authors: Man Jeroen De , Buffel Veerle , Velde Sarah van de , Bracke Piet , Hal Guido F Van , Wouters Edwin
Published: November 2020

BackgroundThe surge of COVID-19 infections has prompted many countries to take unprecedented policy measures. In Belgium, the authorities implemented a nation-wide stay-at-home order for several months. Evidence of the mental health effect of such measures is scarce. A recent review by Brooks et al. has compiled a defined list of stressors affecting people's mental health under quarantine during previous epidemic settings. This study aims to test the association between these stressors and the mental health of students attending higher education during the stay-at-home order in Belgium. MethodsIn this cross-sectional study, 18,301 students from 13 higher education institutions (HEI) participated in an online survey between 26 April and 11 May 2020. Structural equation modeling was used to assess associations between potential stressors and depressive symptoms severity scores and to assess the mediation effect of stressors between duration of exposure and depressive symptoms severity. ResultsThe stressors proposed by Brooks et al. were found to be associated with depressive symptoms severity. The stressors 'perceived academic stress', 'institutional dissatisfaction' and 'fear of being infected' were associated with substantially higher depressive symptoms severity scores. The association between duration of exposure and depressive symptoms severity was mediated by 'academic stress'. Being in a steady relationship and living together with others were both associated with a lower depressive symptoms severity.ConclusionFindings underline the need for a student-centered approach and mental health prevention. Authorities and HEIs should consider whether and if so, how a stay-at-home order should be implemented.
Macrolide and fluoroquinolone associated mutations in Mycoplasma genitalium in a retrospective study of male and female patients seeking care at an STI Clinic in Guangzhou, China, 2016-2018.
Authors: Ke Wujian , Li Dongling , Tso Lai Sze , Wei Ran , Lan Yinyuan , Chen Zhengyu , Zhang Xiaohui , Wang Liuyuan , Liang Chunmei , Liao Yuying , Chen Huiru , Liu Yahui , Zheng Heping , Yang Ligang
Published: November 2020

Background Antimicrobial resistance in M. genitalium is a growing clinical problem. We investigated the mutations associated with macrolide and fluoroquinolone resistance, two commonly used medical regimens for treatment in China. Our aim is to analyze the prevalence and diversity of mutations among M. genitalium-positive clinical specimens in Guangzhou, south China.Methods A total of 154 stored M. genitalium positive specimens from men and women attending a STI clinic were tested for macrolide and fluoroquinolone mutations. M. genitalium was detected via TaqMan MGB real-time PCR. Mutations associated with macrolide resistance were detected using primers targeting region V of the 23S rRNA gene. Fluoroquinolone resistant mutations were screened via primers targeting topoisomerase IV (parC) and DNA gyrase (gyrA).Results 98.7% (152/154), 95.5% (147/154) and 90.3% (139/154) of M. genitalium positive samples produced sufficient amplicon for detecting resistance mutations in 23S rRNA, gyrA and parC genes, respectively. 66.4% (101/152), 0.7% (1/147) and 77.7% (108/139) samples manifested mutations in 23S rRNA, gyrA and parC genes, respectively. A2072G (59/101, 58.4%) and S83I (79/108, 73.1%) were highly predominating in 23S rRNA and parC genes, respectively. Two samples had amino acid substitutions in gyrA (M95I and A96T, respectively). Two samples had two amino acid substitutions in parC (S83I + D87Y). 48.6% (67/138) of samples harbored both macrolide and fluoroquinolone resistance-associated mutations. The most common combination of mutations was A2072G (23S rRNA) and S83I (parC) (40/67, 59.7%). One sample had three amino acid changes in 23S rRNA, gyrA and parC genes (A2072G + A96T + S83I).Conclusions The high antimicrobial resistance rate of M. genitalium in Guangzhou is a very worrying problem and suggests that antimicrobial resistance testing and the development of new antibiotic regimens are crucially needed.
The role of Nrf2 in acute and chronic muscle injury
Authors: Bronisz-Budzyńska Iwona , Kozakowska Magdalena , Podkalicka Paulina , Kachamakova-Trojanowska Neli , Łoboda Agnieszka , Dulak Józef
Published: November 2020

The nuclear factor erythroid 2-related factor 2 (Nrf2) is considered as a master cytoprotective factor regulating the expression of genes encoding anti-oxidant, anti-inflammatory, and detoxifying proteins. The role of Nrf2 in the pathophysiology of skeletal muscles has been evaluated in different experimental models, however, due to inconsistent data, we aimed to investigate how Nrf2 transcriptional deficiency (Nrf2tKO) affects muscle functions both in an acute and chronic injury. The acute muscle damage was induced in mice of two genotypes – WT and Nrf2tKO mice by cardiotoxin (CTX) injection. To investigate the role of Nrf2 in chronic muscle pathology, mdx mice that share genetic, biochemical, and histopathological features with Duchenne muscular dystrophy (DMD) were crossed with mice lacking transcriptionally active Nrf2 and double knockouts (mdx/Nrf2tKO) were generated. To worsen the dystrophic phenotype, the analysis of disease pathology was also performed in aggravated conditions, by applying a long-term treadmill test. We have observed slightly increased muscle degeneration in Nrf2tKO mice after CTX treatment. Nevertheless, transcriptional ablation of Nrf2 in mdx mice did not significantly aggravate the most deleterious, pathological hallmarks of DMD related to degeneration, inflammation, fibrotic scar formation, angiogenesis, and the number and proliferation of satellite cells in non-exercised conditions. On the other hand, upon chronic exercises, the degeneration and inflammatory infiltration of the gastrocnemius muscle, but not diaphragm, turned to be increased in Nrf2tKOmdx in comparison to mdx mice. In conclusion, the lack of transcriptionally active Nrf2 influences moderately muscle pathology in acute CTX-induced muscle injury and chronic DMD mouse model, without affecting muscle functionality. Hence, in general, we demonstrated that the deficiency of Nrf2 transcriptional activity has no profound impact on muscle pathology in various models of muscle injury.
Rural context, single institution prospective outcomes after Enhanced Recovery colorectal surgery protocol implementation
Authors: Smucker Levi , Victory Jennifer , Scribani Melissa , Oceguera Luis , Monzon Raul
Published: November 2020

Background: Rural hospitals face unique challenges to adopting Enhanced Recovery protocols after colorectal surgical procedures. There are few examples of successful implementation in the United States, and fewer yet of prospective, outcomes-based trials. Methods: This study drew data from elective bowel resection prospectively collected, retrospectively analyzed cases 2 years prior (n=214) and 3 years after (n=224) implementing an ERAS protocol at a small, rural health network in upstate New York. Primary outcomes were cost, length-of-stay, readmission rate, and complications.Results: The implementation required changes and buy-in at multiple levels of the institution. There was a statistically significant reduction in mean length of stay (6.9 versus 5.1 days) and per-patient savings to hospital ($3000) after implementation of ERAS protocol. There was no significant change in rate of 30-day readmissions or complications. Conclusions: The authors conclude that for rural-specific barriers to implementation of Enhanced Recovery protocols there are specific organizational strategies that can ultimately yield sustainable endpoints.Trial Registration: The research trial data was retrospectively registered in the following fashion: Original IRB approval was granted 01/25/2016. Study has been reviewed & approved yearly. Request to waive consent was submitted to the IRB & granted with the initial review/approval.
Generation of Dyskeratosis Congenita-like Hematopoietic Stem Cells through the Stable Inhibition of DKC1
Authors: Carrascoso-Rubio Carlos , Zittersteijn Hidde A. , Pintado-Berninches Laura , Fernández-Varas Beatriz , Lozano M. Luz , Manguan-Garcia Cristina , Sastre Leandro , Bueren Juan A. , Perona Rosario , Guenechea Guillermo
Published: November 2020

Dyskeratosis congenita (DC) is a rare telomere biology disorder, which results in different clinical manifestations, including severe bone marrow failure. To date, the only curative treatment for bone marrow failure in DC patients is allogeneic hematopoietic stem cell transplantation. However due to the toxicity associated to this treatment, improved therapies are recommended for DC patients. Here we aimed at generating DC-like human hematopoietic stem cells in which the efficacy of innovative therapies could be investigated. Because X-linked DC is the most frequent form of the disease and is associated with an impaired expression of DKC1, we have generated DC-like hematopoietic stem cells based on the stable knock-down of DKC1 in human CD34+ cells with lentiviral vectors encoding for DKC1 short hairpin RNAs. At a molecular level, DKC1-interfered CD34+ cells showed a decreased expression of TERC, as well as a diminished telomerase activity and increased DNA damage, cell senescence and apoptosis. Moreover, DKC1-interfered human CD34+ cells showed defective clonogenic ability and were incapable of repopulating the hematopoiesis of immunodeficient NSG mice. The development of DC-like hematopoietic stem cells will facilitate the understanding of the molecular and cellular basis of this inherited bone marrow failure syndrome, and will serve as a platform to evaluate the efficacy of new hematopoietic therapies for DC.