bluuebunny/crossref_metadata_2025 huggingface dataset:
The burden of disease among Brazilian older adults and the challenge for health policies. Results of the Global Burden of Disease Study 2017
Authors: PASSOS VALÉRIA MARIA DE AZEREDO , Champs Ana Paula Silva , Teixeira Renato , Lima-Costa Maria Fernanda Furtado , Kirkwood Renata , Veras Renato , Nascimento Bruno Ramos , Nogales Ana Maria , Schmidt Maria Inês , Duncan Bruce Bartholow , Cousin Ewerton , Naghavi Mohsen , Souza Fatima Marinho
Published: May 2020

Background
Brazil is the world’s fifth most populous nation, and is currently experimenting a fast demographic ageing process in a context of scarce resources and social inequalities. To understand the health profile of older adults in Brazil is fundamental for planning public policies.
Methods
The estimates were derived from data obtained through the collaboration between Brazilian Ministry of Health with the Institute of Health Metrics and Evaluation of the University of Washington. The Brazilian Institute of Geography and Statistics provided the population estimates. Data on causes of death came from the Mortality Information System. To calculate morbidity, population-based studies on the prevalence of diseases in Brazil were comprehensively searched, in addition to information obtained from national databases such as the Hospital Information System, the Outpatient Information System, and the Injury Information System. We presented the Global Burden of Disease (GBD) 2017 estimates among Brazilian older adults (60 + years old) for life expectancy at birth (LE), healthy life expectancy (HALE), cause-specific mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs), from 2000 to 2017.
Results
LE at birth significantly increased from 71.3 years (95%UI to 70.9–71.8) to 75.2 years (95%UI 74.7–75.7). There was a trend of increasing HALE, from 62.2 years (95%UI 59.54–64.5) to 65.5 years (95%UI 62.6–68.0). The proportion of DALYs among older adults increased from 7.3–10.3%. Chronic noncommunicable diseases are the leading cause of death among middle-aged and older adults, while Alzheimer's disease is a leading cause only among older adults. Mood disorders, musculoskeletal pain and hearing or vision losses are among the leading causes of disability.
Conclusions
The increase in LE and the decrease of the DALYs rates are probably results of the improvement of social conditions and health policies. However, the smaller increase of HALE than LE means that despite living more, people spend a substantial time of their old age with disability and illness. Preventable or potentially controllable diseases are responsible for most of the burden of disease among Brazilian older adults. Health investments are necessary to obtain longevity with quality of life in Brazil.
Dietary habits and metabolic response improve in obese children whose mothers received an intervention to promote healthy eating: Randomized clinical trial
Authors: López-Contreras Iris Nallely , Vilchis-Gil Jenny , Klünder-Klünder Miguel , Villalpando-Carrión Salvador , Flores-Huerta Samuel
Published: May 2020

Background: Unhealthy eating habits inside and outside the home lead to developing obesity, leading to clinical and metabolic disorders, such as insulin resistance, metabolic syndrome, and chronic degenerative diseases, which are the leading causes of death in adult life. The present study compared changes in dietary habits, behaviors and metabolic profiles of obese children whose mothers attended at the hospital to group sessions, with those who received the usual nutritional consultation.Methods: Randomized clinical trial, 177 mother/obese child pairs participated, 90 in the intervention group (IG) and 87 in the control group (CG). The intervention group attended six group education sessions to promote healthy eating and 87 received the usual nutritional consultation, both groups were followed up for three months. Frequency of food consumption, behaviors during feeding in the house and metabolic profile was evaluated. Data was compared using Student's t or X2.Results: The GI reduced the filling of their dishes (p = 0.009), forcing the children to finish meals (p = 0.003) and food substitution (p < 0.001), moreover increased the consumption of roasted foods (p = 0.046), fruits (p = 0.002) and vegetables (p < 0.001). In the IG insulin levels (-1.4) and HOMA-IR (-6.2) (p = 0.027 and p = 0.035) decreased with difference between groups.Conclusions: The educational intervention improved some eating habits at home, as well as insulin and HOMA-IR levels; this can be considered as an alternative for managing child obesity.Trial registration: Clinicaltrials.gov, NCT04374292 (Date assigned: May 5, 2020). Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT04374292
Prevalence and Phylogenetic Analysis of Hepatitis E Virus in Pigs in Vietnam
Authors: Lee Hu Suk , Dao Duy Tung , Bui Vuong Nghia , Bui Anh Ngoc , Le Duy Thanh , Nguyen-Viet Hung , Randolph Delia Grace , Thakur Krishna K. , Hagiwara Katsuro
Published: May 2020

Background: Hepatitis E virus (HEV) is one of the important zoonotic diseases with a worldwide distribution. The main objective of this study was to assess the prevalence and phylogenetic analysis of HEV in Vietnam. Pig blood and fecal pooled samples were used to determine for the prevalence of HEV. We evaluated the true prevalence (TP) of HEV from apparent prevalence (AP) by taking into account the sensitivity and specificity of diagnostic tests using a Bayesian approach. For phylogenetic analysis, the data compared with worldwide HEV reference strains illustrating all eight genotypes (G1-G8) which were identified in previous study.Results: A total of 475 sera samples were collected at slaughterhouses from five provinces. The AP of HEV was 58.53% (95% CI: 53.95–62.70) while the TP was slightly higher (59.96%, 95% credible interval: 54.49–65.41). A total of 19 Vietnamese strains were isolated from 1 strain in Hanoi, 5 strains in Dak Lak, 7 strains in An Giang, 4 strains in Son La and 2 strains in Nghe An. The phylogenetic tree demonstrated that 19 Vietnamese strains were clustered into HEV 3 and 4 among 8 genotypes.Conclusions: This study provided evidence that HEV is circulating in domestic pigs in Vietnam. From a public health perspective, it is very important to raise public awareness for high-risk groups (e.g. slaughterhouse workers, pig traders, farmers and market sellers) who may have more opportunities to come in contact with pig and contaminated meats.
High expression of Fibroblast activation protein (FAP) predicts poor outcome in high-grade serous ovarian cancer
Authors: Li Min , Cheng Xue , Rong Rong , Tang Xiuwu , Chen Youguo
Published: May 2020

Background
High-grade serous ovarian cancer (HSOC) is a fatal form of ovarian cancer. Previous studies indicated some potential biomarkers for clinical evaluation of HSOC prognosis. However, there is a lack of systematic analysis of different expression genes (DEGs) to screen and detect significant biomarkers of HSOC.
Method and materials:
TCGA database was conducted to analyze relevant genes expression in HSOC. Outcomes of candidate genes expression, including overall survival (OS) and progression-free survival (PFS), were calculated by Cox regression analysis for hazard rates (HR). Histopathological investigation of the identified genes was carried out in 32 Chinese HSOC patients to validate gene expression in different stages of HSOC.
Results
Of all 57,331 genes that were analyzed, FAP was identified as the only novel gene that significantly contributed to both OS and PFS of HSOC. In addition, FAP had a consistent expression profile between carcinoma-paracarcinoma and early-advanced stages of HSOC. Immunological tests in paraffin section also confirmed that up-regulation of FAP was present in advanced stage HSOC patients. Prediction of FAP network association suggested that FN1 could be a potential downstream gene which further influenced HSOC survival.
Conclusions
High-level expression of FAP was associated with poor prognosis of HSOC via FN1 pathway.
Value of artificial ascites to assist thermal ablation of liver cancer adjacent to the gastrointestinal tract in patients with previous abdominal surgery
Authors: Huang Qiannan , Li Jianguo , Zeng Qingjing , Tan Lei , Zheng Rongqin , He Xuqi , Li Kai
Published: May 2020

BackgroundTo evaluate the feasibility and effectiveness of artificial ascites to assist thermal ablation of liver cancer adjacent to the gastrointestinal tract in patients with previous abdominal surgery.MethodsThirty-nine patients with a total of 40 liver malignant tumors were enrolled between January 2016 and June 2019. All had histories of hepatectomy, splenectomy, cholecystectomy, and intestinal surgery. The distance between the tumor and the gastrointestinal tract was < 5 mm. Normal saline was used as artificial ascites to protect the gastrointestinal tract during thermal ablation. The success rate of the procedure, incidence of major complications, and the technical efficacy of ablation were recorded. Patients were followed for local tumor progression (LTP), and overall survival (OS).ResultsThe use of artificial ascites was successful in 38 of the 40 procedures (95%). Major complications occurred in two of the 39 patients (5.1%) following the procedure. One was an intestinal fistula that occurred in a failed case and was associated with an infection. The other was a liver abscess that occurred in a successful case. The technical efficacy of ablation was 100% (40/40 procedures). The median follow-up was 20 months. The 1-, 2-, and 3-year LTP rates were 2.9%, 5.7% and 5.7%. The 1-, 2-, and 3-year OS rates were 97.1%, 86.8% and 69.5%.ConclusionIn patients with previous abdominal surgery, artificial ascites is feasible and effective for assisting thermal ablation of liver cancer adjacent to the gastrointestinal tract.Co-first authors: Qiannan Huang #, Jianguo Li # contributed equally to this article and should be considered co-first authors.Co-corresponding authors: Xuqi He *, Kai Li * contributed equally to this article and should be considered co-corresponding authors.
Effect of Surgery on The Prognosis of Stage ⅢB non-Small Cell Lung Cancer
Authors: wan jun , Shen Hongchang , wang yadong , chen xiaowei , yan tao , du jiajun
Published: May 2020

For patients with stage IIIB non-small cell lung cancer (NSCLC), the current recommended immunotherapy maintenance treatment after concurrent chemoradiotherapy is not demonstrated whether such patients can be benefit from surgical treatment. We collected clinical data from patients with stage IIIB NSCLC from the surveillance, epidemiological, and final results (SEER) databases. Kaplan-Meier analysis and Cox proportional hazards model were used to analyze the effect of surgical treatment on the survival of stage IIIB NSCLC. We use surgery as a variable to divide into surgical and non-surgical groups. Between the two groups, only age is different (p = 0.017), and there is no significant difference at race (P = 0.531), gender (P = 0.051), tumor primary site (P = 0.385), tumor differentiation grade (P = 0.103), T stage (P = 0.094), and N stage (P = 0.071). Univariate and multivariate analysis showed that gender, tumor differentiation, stage and primary site had an effect on overall survival. Kaplan-Meier analysis showed that the median survival time of stage IIIB NSCLC in the surgical group (13 months, 95% CI (7.400 to 18.600 months)) was higher than that in the non-surgical group (3 months, 95% CI (2.482 to 3.518 months)) was significantly prolonged by 10 months (P < 0.001). The Cox proportional hazard modelled analysis showed that the overall survival of stage IIIB NSCLC was 2.395 times the 95% CI (1.77 to 3.241 months) for the non-surgical group (P < 0.001). We conclude that some patients with stage IIIB NSCLC who can tolerate surgery may benefit from surgery.
CIB1 as a potential diagnosis and prognosis biomarker in uveal melanoma
Authors: Wang Xianwang , Ge Lei , Guo Yu , Zou Zhiming , Wan Xingxia , Lu Yingying , Hu Shujuan
Published: May 2020

BackgroundUveal melanoma (UVM) is the most common primary intraocular tumor in adults. However, identification of the effective biomarker for the diagnosis and treatment of UVM remain to be explored. Calcium and integrin-binding protein 1 (CIB1) is emerging as an important mediator in carcinogenesis and tumor progression. In the present study, we aim to determine the contribution of CIB1 in the diagnosis of UVM.MethodsImmumohistochemical staining is used to detect the CIB1 expression level, while Gene Expression Profiling Interactive Analysis 2 (GEPIA2) and UALCAN online tools were used to further analyze patient survival and CIB1 correlation genes in UVM. Integrative analysis using STRING and GeneMANIA predicted the correlated genes with CIB1 in UVM.ResultsTo the best of our knowledge the novel observations identified in the present study reveal that CIB1 expression level in UVM was significantly enhanced when compared with that in paracancerous tissues. A higher CIB1 expression level resulted in a significant worse disease free survival as well as overall survival. Moreover, survival probability of patients with UVM was associated with body weight and gender of the the patients. The correlated genes with CIB1 in UVM, and the similarity of the genes in UVM expression and survival heatmap was verified. Furthermore, Gene ontology enrichment analysis revealed that CIB1 and its correlated genes are significantly enriched in ITGA2B-ITGB3-CIB1 complex, regulation of intracellular protein transport and regulation of ion transport.ConclusionsTaken together, our novel findings suggested that CIB1 might be a potential diagnostic predictor for UVM, and might contribute to the potential strategy for UVM treatment by targeting CIB1.# These authors contributed equally to this work
Cost-Effectiveness Analysis of Repeated Self-Sampling for HPV Testing in Primary Cervical Screening: A Randomized Study
Authors: Aarnio Riina , Östensson Ellinor , Olovsson Matts , Gustavsson Inger , Gyllensten Ulf
Published: May 2020

Background Human papillomavirus (HPV) testing is recommended in primary cervical screening to improve cancer prevention. An advantage of HPV testing is that it can be performed on self-samples, which could increase population coverage and result in a more efficient strategy to identify women at risk of developing cervical cancer. Our objective was to assess whether repeated self-sampling for HPV testing is cost-effective in comparison with Pap smear cytology for detection of cervical intraepithelial neoplasia grade 2 or more (CIN2+) in increasing participation rate in primary cervical screening.Methods A cost-effectiveness analysis (CEA) was performed on data from a previously published randomized clinical study including 36 390 women aged 30–49 years. Participants were randomized either to perform repeated self-sampling of vaginal fluid for HPV testing (n = 17 997, HPV self-sampling arm) or to midwife-collected Pap smears for cytological analysis (n = 18 393, Pap smear arm).Results Self-sampling for HPV testing led to 1633 more screened women and 107 more histologically diagnosed CIN2 + at a lower cost vs. midwife-collected Pap smears (€ 229 446 vs. € 782 772).Conclusions This study resulted in that repeated self-sampling for HPV testing increased participation and detection of CIN2 + at a lower cost than midwife-collected Pap smears in primary cervical screening. Offering women a home-based self-sampling may therefore be a more cost-effective alternative than clinic-based screening.Trial registration Not registered since this trial is a secondary analysis of an earlier published study (1).
Rural-Urban Disparities and Factors Associated with Delayed Care Seeking for Fever by Mothers of Under-Five Children, Lgabi LGA, Kaduna Nigeria.
Authors: Babalola Obafemi Joseph , Ajumobi Olufemi , Ajayi IkeOluwapo O.
Published: May 2020

Background Fever in under-five children (U5) is the commonest presenting complaint in general practice and mothers’ recognition is an entry point for fever treatment including malaria. This study describes rural - urban disparity in fever prevalence, mothers’ malaria knowledge, and care seeking for fever in U5 and the associated factors. Methods A cross-sectional survey was conducted among 630 mother-child pairs [rural (300) and urban (330)] selected randomly using a multi-stage sampling from 63 villages in Igabi LGA, Kaduna State, Nigeria. Trained female data collectors administered a pre-tested structured questionnaire to collect information on mother-child demographic profiles, malaria knowledge, fever episodes in birth order last child in two weeks prior to survey, and care - seeking for fever within 48 hours of onset. Care sought for fever > 48 hours of onset was defined as delayed care seeking. Malaria knowledge was categorized into good, average and poor if the final scores is ≥ 75 th , 50 th - 74 th , and < 50 th percentiles, respectively. Frequency, proportions, and odds ratio were calculated. Statistically significant was set at p-value < 0.05. Results The median age (interquartile range) of rural mothers was 30 (IQR, 10) years compared to 27 (IQR, 6) years in urban. Of the 70.0% (441/629) U5 children with fever, 58.5% (258/441) were in rural settlements. A third of the mothers whose child had fever sought care. Mothers in rural settlement were 2.7 (CI: 1.8 – 4.2, p < 0.01) times more likely to delay care seeking for fever, and those with no knowledge of malaria transmission were 70% less likely to seek care (OR: 0.3, CI: 0.2 – 0.7). On the other hand, poor perception of malaria as a major health problem (OR: 2.1, CI: 1.4 – 3.1), and poor knowledge of cause of malaria (OR: 1.7, CI: 1.1 – 2.5) were associated with delayed seeking for fever among urban mothers. Conclusions Disparity existed between fever prevalence in U5 children, care -seeking practices by their mothers, and factors associated with delayed care seeking for fever. Fever treatment for high impact malaria elimination needs a context specific intervention rather than ‘one-size-fits-all’ approach. Also, intensify efforts to educate mothers on malaria.
Association Between Dietary Patterns and Prediabetes Risk in A Middle-Aged Chinese Population
Authors: Shen Xiao-Ming , Huang Yi-Qian , Zhang Xiao-Yan , Tong Xiao-Qing , Zheng Pei-Fen , Shu Long
Published: May 2020

Background: Information regarding dietary patterns associated with prediabetes in the Chinese population is lacking. The objective of the present study was to explore the association between major dietary patterns and risk of prediabetes in a middle-aged Chinese population. Methods: A total of 1761 participants (aged 45 to 59 years) were recruited in Hangzhou city, the capital of Zhejiang Province, China from June 2015 to December 2016. Dietary information was obtained by interview using a 138-item, validated semi-quantitative food frequency questionnaire(SQFFQ). Multivariate logistic regression models were used to analyze the association between dietary patterns and the risk of prediabetes with adjustment of potential confounding variables. Results: Three dietary patterns were ascertained by factor analysis and labeled as traditional southern Chinese, Western, and grains-vegetables patterns. After controlling of the potential confounders, participants in the top quartile of the Western pattern scores had greater odds ratio(OR) for prediabetes (OR=1.54; 95% confidence interval(CI):1.068-2.059; P =0.025) than did those in the bottom quartile. Compared with those in the bottom quartile, participants in the top quartile of the grains-vegetables pattern scores had a lower OR for prediabetes(OR=0.83; 95% CI:0.747-0.965; P =0.03). Besides, no statistically significant association was observed in the association between the traditional southern Chinese pattern and prediabetes risk ( P >0.05). Conclusions: The findings of this study showed that the Western pattern was associated with a higher risk, and the grains-vegetables pattern was associated with a lower risk of prediabetes. Future prospective studies are required to validate our findings.
S100A8 Promotes Inflammation via Toll-Like Receptor 4 After Experimental Traumatic Brain Injury
Authors: He Guoyuan , Han Yan-Ling , Wu Degang , Cheng Hao , Sun Le-An , Di Guangfu , Zhou Meng-Liang , Jiang Xiaochun
Published: May 2020

Background: S100A8 is involved in the pathological processes of a variety of central nervous system(CNS) diseases related to inflammation including traumatic brain injury (TBI). However, the underlying mechanism for the induction of inflammation in the brain by S100A8 after TBI remains unclear, which was investigated in the present study.Methods: The weight-drop TBI model was used in this study. The mice were randomly assigned into 5 groups: the Sham, S100A8, S100A8 + TAK-242, TBI, and TBI + TAK-242 groups. In the S100A8 + TAK-242 and TBI + TAK-242 groups, mice were treated with TAK-242, an inhibitor of Toll-like receptor (TLR) 4, intraperitoneally at half an hour before TBI. In the S100A8 and S100A8 + TAK-242 groups, S100A8 recombinant protein was injected into the lateral ventricle of the brain. To explore the relationship between S100A8 and TLR4, Western Blot (WB), immunofluorescence, enzyme-linked immunosorbent assay (ELISA) and Nissl staining were employed. Neurological score and the brain water content were also assessed. Additionally, BV-2 microglial cells were stimulated with lipopolysaccharide (LPS) or S100A8 recombinant protein with/without TAK-242 in vitro. The expressions of the related proteins were subsequently detected with WB or ELISA.Results: The levels of S100A8 protein and pro-inflammatory cytokines were significantly increased after TBI. After intracerebroventricular administration of S100A8, the neurological scores of non-TBI animals were decreased remarkably with severe brain edema. Furthermore, the levels of TLR4, p-p65 and myeloid differentiation factor 88(MyD88) were all increased after S100A8 administration or TBI, which could be restored by TAK-242. Meanwhile, p-p65 and MyD88 were upregulated after S100A8 or LPS stimulation in vitro, which also could be suppressed by TAK-242.Conclusions: The present study demonstrated that TLR4-MyD88 pathway was activated by S100A8, which was essential to the development of inflammation in the brain after TBI.
A Systematic Review of Patient Prioritization Tools in Non-Emergency Healthcare Services
Authors: Dery Julien , Ruiz Angel , Routhier François , Bélanger Valérie , Côté André , Ait-Kadi Daoud , Gagnon Marie-Pierre , Deslauriers Simon , Pecora Ana Tereza Lopes , Redondo Eduardo , Allaire Anne-Sophie , Lamontagne Marie-Eve
Published: May 2020

Background: Patient prioritization is a strategy used to manage access to healthcare services. Patient prioritization tools (PPT) contribute to supporting the prioritization decision process, and to its transparency and fairness. Patient prioritization tools can take various forms and are highly dependent on the particular context of application. Consequently, the sets of criteria change from one context to another, especially when used in non-emergency settings. This paper systematically synthesizes and analyzes the published evidence concerning the development and challenges related to the validation and implementation of PPTs in non-emergency settings. Methods: We conducted a systematic mixed studies review. We searched evidence in five databases to select articles based on eligibility criteria, and information of included articles was extracted using an extraction grid. The methodological quality of the studies was assessed by using the Mixed Methods Appraisal Tool. The article selection process, data extraction, and quality appraisal were performed by at least two reviewers independently. Results: We included 47 studies listing 33 different patient prioritization tools. Most of them are designed for managing access to elective surgeries in hospital settings. Two thirds of the tools were investigated based on reliability or validity. Inconclusive results were found regarding the impact of PPTs on patient waiting times. Advantages associated with PPT use were found mostly in relationship to acceptability of the tools by clinicians and increased transparency and equity for patients. Conclusions: This review describes the development and validation processes of PPTs used in non-urgent healthcare settings. Despite the large number of PPTs studied, implementation into clinical practice seems to be an open challenge. Based on the findings of this review, recommendations are proposed to develop, validate, and implement such tools in clinical settings. Systematic review registration: PROSPERO CRD42018107205
Bio-specific immobilization of enzymes on electrospun PHB nanofibers
Authors: Jang Sun Ah , Park Ji Hyun , Lim Hye Jin , Oh Joon Young , Bae Ki Hyeon , Lee Kyung Jin , Song Jae Kwang , Kim Dong-Myung
Published: May 2020

Background Oriented immobilization of enzymes provides substantial advantages in terms of improving the efficiency of enzymatic process as well as enhancing the reusability of enzymes. Phasins have high binding affinity to PHA, and thus can potentially be used as a fusion partner to immobilize enzymes onto PHA supports. However, presently available PHA supports of granular configuration have low surface-area-to-volume ratio, which limits enzyme loading on the supports. In this study, we explored the use of electrospun PHB nanofibers as an alternative support for high density immobilization of a phasin-fused lipase in directed orientations.Results The electrospun PHB nanofibers were successfully used for selective immobilization of the phasin-fused enzyme, and could anchor 120-fold more enzyme than PHB granules of the same weight. The enzyme immobilized onto the PHB nanofibers exhibited exceptionally high stability. Furthermore, via oriented immobilization of the enzymes, PHB nanofibers loaded with the phasin-fused lipase provided 3- to 10-fold higher enzyme activity than the conventional immobilization supports.Conclusions Our approach combines the advantageous features of nanofibrous materials and the regio-specificity of biomolecular interactions for the efficient immobilization of enzymes, which can be widely adopted in the development of various enzymatic processes.
Diagnostic Performance of a Blood Urea Nitrogen to Creatinine Ratio-Based Nomogram for Predicting in-Hospital Mortality in COVID-19 Patients
Authors: Liu Qingquan , Wang Yiru , Zhao Xuecheng , Wang Lixuan , Liu Feng , Lv Yongman , Wang Tao , Ye Dawei
Published: May 2020

Background: The novel coronavirus disease (COVID-19) is leading to high morbidity and mortality. This study aimed to test whether blood urea nitrogen-to-creatinine ratios (BCR) is a predictor of poor prognosis in patients with COVID-19. Method: From 9,165 generally healthy subjects, we calculated ranges of “normal” BCR values. 416 COVID-19 patients were randomly assigned to training cohort and validation cohort contained 337, 79 patients, respectively. The prognostic ability of abnormal BCR range was assessed using a Logistic regression. Development a nomogram for predicting in-hospital mortality incorporated age, sex and BCR. The model discrimination was assessed using the calibration curves and concordance index in training and validation cohort. The predictive accuracy and clinical values of the nomogram was measured by decision curve analysis (DCA) and clinical impact curve analysis (CICA). Results: Among 337 COVID-19 patients, 13.4% and 11.3% were classified into higher and lower than normal range group, respectively. The BCR was identified as an independent risks factor for death in COVID-19 patients (P<0.0001), with area under the curve (AUC) 0.768; 95%CI: 0.717-0.819). Kaplan-Meier curves for all-cause mortality outcomes showed that patients with above normal range of BCR had worse prognosis (p<0.0001). Logistic regression analysis revealed that BCR above the normal range was independently associated with death in COVID-19 patients (Odds ratio 7.54; 95%CI: 1.55-36.66; P=0.012). ROC curves showed that the nomogram had good discrimination in the training cohort (AUC 0.838; 95%CI 0.795–0.880) and the validation cohort (AUC 0.929; 95%CI 0.869-0.989). Using maximum Youden index, the cutoff values of 59.8 points, the sensitivity and specificity were 75.4% and 81%. The calibration curves showed good agreement between nomogram prediction and actual observation. DCA and CICA indicated the clinical usefulness of the prediction nomogram. Conclusion: BCR was a useful prognostic factor for COVID-19 patients. Development of an individualized prediction nomogram BCR-based, which can effectively predict the risk of mortality, and then, help clinicians to improve individual treatment, make clinical decisions timely and early.
Type of discrepancy between glycosylated hemoglobin and fasting plasma glucose is associated with in-hospital outcomes in patients with acute coronary syndrome and diabetes: findings from the Improving Care for Cardiovascular Disease in China - Acute Coronary Syndrome (CCC-ACS) Project
Authors: Ye Nan , Yang Lijiao , Wang Guoqin , Bian Weijing , Xu Fengbo , Ma Changsheng , Zhao Dong , Liu Jing , Hao Yongchen , Liu Jun , Yang Na , Cheng Hong
Published: May 2020

Background
The discrepancy between glycosylated hemoglobin (HbA1c) and fasting plasma glucose (FPG) in clinical practice may be related to factors such as acute stress, renal dysfunction, and anemia, and its relationship with in-hospital outcomes is uncertain. The aim of this study is to investigate the association between the type of discrepancy between HbA1c and FPG and in-hospital outcomes in patients with acute coronary syndrome (ACS) and diabetes.
Methods
The Improving Care for Cardiovascular Disease in China - Acute Coronary Syndrome (CCC-ACS) project is a national, hospital-based quality improvement project with an ongoing database. Patients with ACS, diabetes and complete HbA1c and FBG values at admission were included. The consistent group included patients with HbA1c < 6.5% and FBG < 7.0 mmol/L or HbA1c ≥ 6.5% and FBG ≥ 7.0 mmol/L. The discrepancy group included patients with HbA1c ≥ 6.5% and FBG < 7.0 mmol/L (increased HbA1c group) or HbA1c < 6.5% and FBG ≥ 7.0 mmol/L (increased FBG group).
Results
A total of 7,762 patients were included in this study. The numbers of patients in the consistent group and discrepancy group were 5,490 and 2,272 respectively. In the discrepancy group, increased HbA1c accounted for 77.5% of discrepancies, and increased FPG accounted for 22.5% of discrepancies. After adjusting for confounders, patients in the increased FPG group had a 1.6-fold increased risk of heart failure (OR, 1.62; 95% CI, 1.08–2.44), a 1.6-fold increased risk of composite cardiovascular death and heart failure (OR, 1.63; 95% CI, 1.09–2.43), and a 1.6-fold increased risk of composite major adverse cardiovascular and cerebrovascular events (MACCEs) and heart failure (OR, 1.56; 95% CI, 1.08–2.24).
Conclusions
Patients with an increased FPG but normal HbA1c had a higher risk of in-hospital adverse outcomes than those with increased HbA1c but normal FPG. This result may indicate that when HbA1c and FPG are inconsistent in patients with ACS and diabetes, the increased FPG that may be caused by stress hyperglycemia may have a more substantial adverse effect than increased HbA1c, which may be caused by chronic hyperglycemia. These high-risk patients should be given more attention and closer monitoring in clinical practice.
B-type Natriuretic Peptide Ability to Predict Mortality After Transcatheter Aortic Valve Replacement
Authors: Lehtola Heidi , Piuhola Jarkko , Niemelä Matti , Tauriainen Tuomas , Junttila Juhani , Mäkikallio Timo , Juvonen Tatu , Biancari Fausto
Published: May 2020

Background: Preoperative risk assessment is a cornerstone of patient’s selection for transcatheter aortic valve replacement (TAVR) for severe aortic valve stenosis.Hypothesis: In this study, we evaluated whether B-type natriuretic peptide (BNP) has a prognostic impact in these patients. Methods: Data on baseline BNP was available in 348 patients who underwent TAVR. The outcome measures of this study were 30-day and 3-year mortality.Results: In multivariate analysis, baseline BNP was an independent risk factor for 30-day (logarithmically transformed, OR 2.564, 95%CI 1.288-5.102) and 3-year mortality (logarithmically transformed, HR 1.685, 95%CI 1.280-2.218). According to the Youden’s test, the best cutoff of baseline BNP for 30-day mortality was 690 pg/mL (11.7% vs. 1.7%, adjusted OR 7.156, 1.872-27.358), and for 3-year mortality was 290 pg/mL (30.2% vs. 13.4%, adjusted HR 2.094, 95%CI 1.223-3.585). Harrell’s C and Somer’s D tests showed that baseline BNP improved the predictive ability of the STS score (p=0.040), but not that of the EuroSCORE II (p=0.115), for prediction of 3-year mortality. Conclusions: BNP is an independent predictor of outcome in patients undergoing TAVR and may be useful in guiding patient’s selection and treatment timing. Further studies are needed to assess its potential in increasing the performance of current risk scoring methods. Clinical Trial Registration: ClinicalTrials.gov, identifier NCT03385915 (https://clinicaltrials.gov/ct2/show/NCT03385915)
Cardiac computed tomography improves prediction of long-term cardiovascular events: a retrospective cohort study of type 2 diabetic with higher cardiovascular risk
Authors: Jian Zhijie , Liu Zhe , Zhou Li , Ding Ningning , Zhang Hui , Liu Peining , Li Bolin , Wu Yue , Yan Ge , Zhang Yun , Yu Bolang , Yang Jian
Published: May 2020

Background: The value of cardiac computed tomography (CT) for screening and risk stratification in patients with type 2 diabetes mellitus (DM) who are at a higher cardiovascular risk is unclear. Thus, this study aim s to investigate the efficacy of cardiac CT in predicting long-term cardiovascular events (CVEVs) in this subset of patients. Methods: Type 2 diabetic with a higher cardiovascular risk who underwent cardiac CT between 2012 and 2014 were included in this study. Cardiac CT was performed, and coronary artery calcium score, location and extent of lesion, stenosis severity, plaque composition, and epicardial adipose tissue (EAT) volume were assessed. The endpoints were a composite of CVEVs (cardiac death, non-fatal myocardial infarction, or coronary revascularization,non-fatal stroke, hospitalization for unstable angina, and hospitalization for congestive heart failure). Potential predictors of CVEVs were identified. Predictive models were created and compared. Results: CVEVs occurred in 26.8% of the patients. Independent predictors of CVEVs included diabetes duration (odds ratio [OR]=10.003), mean creatinine level (OR=3.845), hypertension (OR=3.844), atheroma burden obstructive score (OR=14.060), segment stenosis score (OR=7.912), and EAT volume (OR=7.947). The model including cardiac CT data and clinical parameters improved the prediction of CVEVs, with an area under the receiver operating characteristic curve of 0.912 (95% confidence interval 0.829–0.963; p<0.05) for the prediction of the study endpoints. Conclusion: Cardiac CT showed a great value in risk stratification for patients with diabetes with higher cardiovascular risk. Cardiac CT data may help predict CVEVs and potentially improve outcomes.
Patterns of Pesticides Usage in Agriculture in Rural Tanzania Call for Integrating Agricultural and Public Health Practices in Managing Insecticide-resistance in Malaria Vectors
Authors: Matowo Nancy S. , Tanner Marcel , Munhenga Givemore , Mapua Salum A. , Finda Marceline , Utzinger Jürg , Ngowi Vera , Okumu Fredros O.
Published: May 2020

Background: Unrestricted use of pesticides inagricultureis likely toincreaseinsecticide resistance in malaria mosquitoes. Unfortunately, strategies for managing insecticide resistance in agriculture and public health sectors lack integration. This study explored types of agricultural pesticides, the usage, awareness and management practicesamong retailers and farmers in Ulanga and Kilombero districts in south-eastern Tanzania, where malaria mosquitoes are resistant to pyrethroids.Methods: An exploratory sequential mixed-methods approach was used. First, a survey to characterise pesticide stockswas conducted in agricultural and veterinary (agrovet) retail stores. Interviews to assess general knowledge and practices regarding agricultural pesticideswere done with 17 retailers and 30 farmers followed by an in-depth survey involving 427 farmers.Concurrently, field observations were done to validate the results.Results: Lambda-cyhalothrin, cypermethrin and neonicotinoid imidacloprids were the most common agricultural insecticides sold to farmers. The herbicide glyphosate (amino-phosphonates)(59%) and the fungicides dithiocarbamate and acylalanine (54.5%) and organochlorine (27.3%) were also readily available in the agrovet shops and widely used by farmers. Although both retailers and farmers had at least primary-level education and recognized pesticides by their trade names,they lacked knowledge on pest control orproper usage of these pesticides. Mostof the farmers (n=316, 54.4%) relied on instructions from pesticides dealers. Overall, 93.7% (n = 400)farmers practiced pesticides mixing in their farms, often nearby water sources. One-third of the farmers disposedof their pesticide leftovers (n=128, 30.0%), and most of them discarded empty pesticide containers into rivers or nearby bushes (n = 238, 55.7%).Conclusion: Similarities of active ingredients used in agriculture and malaria vector control, poor pesticides management practices and low-levels of awareness among farmers and pesticides retailers might enhance the selection of insecticide resistance in malaria vectors. This study emphasises the need forimproving awareness among retailers and farmers on usage and management of pesticides, and highlights the needfor an integrated approach in the management of insecticide resistance inagricultural and public health sectors.
Online Readability of COVID-19 Health Information
Authors: Worrall Amy P , Connolly Mary J , O'Neill Aine , O'Doherty Murray , Thornton Kenneth P , McNally Cora , McConkey Samuel J , de Barra Eoghan
Published: May 2020

Introduction: The internet is now the first line source of health information for many people worldwide. In the current Coronavirus Disease 2019 (COVID-19) global pandemic, health information is being produced, revised, updated and disseminated at an increasingly rapid rate. The general public are faced with a plethora of misinformation regarding COVID-19 and the readability of online information has an impact on their understanding of the disease. The accessibility of online healthcare information relating to COVID-19 is unknown.Methods: The Google® search engine was used to collate the first twenty webpage URLs for three individual searches for ‘COVID’, ‘COVID-19’, and ‘coronavirus’ from Ireland, the United Kingdom, Canada and the United States. The Gunning Fog Index (GFI), Flesch-Kincaid Grade (FKG) Score, Flesch Reading Ease Score (FRES), Simple Measure of Gobbledygook (SMOG) score were calculated to assess the readability.Results: There were poor levels of readability webpages reviewed, with only 17.2% of webpages at a universally readable level. There was a significant difference in readability between the different webpages based on their information source (p <0.01). Public Health organisations and Government organisations provided the most readable COVID-19 material, while digital media sources were significantly less readable. There were no significant differences in readability between regions.Conclusion: Much of the general public have relied on online information during the pandemic. Information on COVID-19 should be made more readable, and those writing webpages and information tools should ensure universal accessibility is considered in their production. Governments and healthcare practitioners should have an awareness of the online sources of information available, and ensure that readability of our own productions is at a universally readable level which will increase understanding and adherence to health guidelines.
Comparison of Gray Values of Cone-beam Computed Tomography With Hounsfield Units of Multislice Computed Tomography Using a U-net Based Network
Authors: Wang Jingbo , Xiaofeng Tao , Liang Zhao , Jing Yuan , Chang Liu , Shuaining Xie , Xin Dou , Ling Zhu
Published: May 2020

Background：Dental departments generally employ cone-beam computed tomography (CBCT) instead of conventional computed tomography (CT), due to its lower price, smaller dosage, and high spatial resolution. During the corona virus disease 2019 (COVID-19) outbreak, CBCT is highly recommended to replace intraoral radiography because it greatly reduces the risk of exposure to salivary droplets. However, CBCT's inability to quantitatively measure tissue attenuation limits its application in differential diagnosis. Methods:We employed a U-Net based network to generate synthetic CT from dental CBCT. The deep neural network can be trained end-to-end to learn the complex mapping between CBCT and CT values. By the U-Net architecture, low-level and high-level features are both utilized to get fine detailed synthetic CT. We applied our method on the collected dataset contains 62 patients. Results:Experimental results on four metrics -- mean absolute error (MAE), root-mean-square error (RMSE), structural similarity index (SSIM), and peak-signal-to-noise ratio (PSNR) -- showed significant improvement of the synthetic CT compared to the original CBCT data. The MAE and RMSE improvement percentages are 64.44% and 66.44%.The MAE level of synthetic CT for most of the tissues are small enough to separate most important tissues,including dentin and cancellous bone, dentin and root canal，implants and cortical bone.Conclusions:CBCT and synthetic CT values can be used to distinguish different high-attenuation structures that are of interest to dentists. The application of CBCT assisted by this U-net based network in medical imaging of other parts of the body is promising.
Coincidence Analysis: A New Method for Causal Inference in Implementation Science
Authors: Whitaker Rebecca Garr , Sperber Nina , Baumgartner Michael , Thiem Alrik , Cragun Deborah , Damschroder Laura , Miech Edward J. , Slade Alecia , Birken Sarah A.
Published: May 2020

Background: Implementation of multifaceted interventions typically involves many diverse elements working together in interrelated ways, including intervention components, implementation strategies, and features of local context. Given this real-world complexity, implementation researchers may be interested in a new mathematical, cross-case method called Coincidence Analysis (CNA) that has been designed explicitly to support causal inference, answer research questions about combinations of conditions that are minimally necessary or sufficient for an outcome, and identify the possible presence of multiple causal paths to an outcome. CNA can be applied as a standalone method or in conjunction with other approaches, and can reveal new empirical findings related to implementation that might otherwise have gone undetected. Methods: We applied CNA to a publicly available dataset from Sweden with county-level data on human papillomavirus (HPV) vaccination campaigns and vaccination uptake in 2012 and 2014 and then compared CNA results to the published regression findings. Results: The original regression analysis found vaccination uptake was positively associated only with the availability of vaccines in schools. CNA produced different findings and uncovered an additional solution path: high vaccination rates were achieved by either (1) offering the vaccine in all schools or (2) a combination of offering the vaccine in some schools and media coverage. Conclusions: CNA offers a new comparative approach for researchers seeking to understand how implementation conditions work together and link to outcomes.Contributions to the literature· Coincidence Analysis (CNA) represents a new mathematical, cross-case method for researchers evaluating the implementation of complex interventions in dynamic settings.· CNA can address multiple dimensions of real-world complexity, including conjunctivity (where several conditions must be jointly present to bring about an outcome) and equifinality (where different paths can lead to the same outcome). CNA can also detect causal chains, where conditions lead to an intermediary outcome, which then leads to the final outcome. · Intentionally designed to investigate different hypotheses and uncover different properties of causal structures than more traditional approaches, CNA can identify implementation-related findings that might otherwise go undetected.
FTO alleviates Aβ1-40 induced retinal pigment epithelium degeneration via PKA/CREB signaling pathway
Authors: Hu YiFan , Chen JieQiong , Sun JunRan , Wang YuWei , Huang PeiRong , Feng JingYang , Liu Te , Sun XiaoDong
Published: May 2020

Background

Amyloid-β (Aβ), a component of age-related macular degeneration (AMD) hallmark drusen, induces retinal pigment epithelium (RPE) cell degeneration and promotes the progress of AMD. Evidence shows that epigenetics mechanism is involved in the regulation of AMD. In this study, we aimed to investigate the roles of N6-methyladenosine (m6A) and its demethylase the fat mass and obesity-associated gene (FTO) in Aβ-mediated degeneration.
Methods

The molecular characteristics and morphology of FTO were examined by quantitative Real-Time PCR (qRT-PCR), Western blot and immunofluorescence. Inhibition of FTO was conducted to analyze its function on cell survival. Ocular Coherence Tomography and Fundus Photography was performed to evaluate the fundus of animal models. m6A-mRNA Epi-transcriptomic microarray, bioinformatics analysis and experimental verification were used to explore the potential molecular mechanism and signaling pathway.
Results

We found overexpression of FTO in Aβ model and demonstrated that inhibition of FTO by the sodium form of Meclofenamic acid (MA1) aggravated RPE impairment. Mechanistically, we identified protein kinase A (PKA) as FTO’s mediating target and found that FTO epigenetically demethylated PKA mRNA and decreased PKA expression, leading to suppressed PKA/ cyclin AMP-responsive element binding (CREB) signaling pathway. Moreover, inhibition of FTO promoted PKA/CREB signaling pathway inducing greater RPE degeneration and death.
Conclusions

These data demonstrated the functional significance of FTO in Aβ-induced RPE degeneration and the regulatory mechanism of PKA/CREB signaling pathway, implying FTO as a potentially therapeutic target for AMD.