bluuebunny/crossref_metadata_2025 huggingface dataset:
Nutritional status and birth outcomes among pregnant teenagers in Ghana
Authors: Gyimah Linda Afriyie , Annan Reginald Adjetey , Apprey Charles , Asamoah-Boakye Odeafo , Azanu Wisdom , Herman Lutterodt E. , Edusei Anthony Kwaku
Published: June 2020

Background: Inadequate nutritional status during pregnancy can lead to adverse birth outcomes but this is more so for pregnant adolescents as they require nutrients to meet their needs for growth and that of the foetus. The study examined the relationship between nutritional status and birth outcomes among Ghanaian teenagers in rural and urban districts of the Ashanti Region, Ghana.Methods In this prospective cohort study, 416 pregnant teenagers recruited at hospitals/health centres during antenatal care were followed until delivery. Data on weight, height (for body mass index), mid-upper arm circumference (MUAC), and nutrients intake using a repeated 24-hour dietary recall were determined. Blood samples were also taken and analysed for haemoglobin (Hb), serum levels of ferritin, prealbumin, vitamin A, total antioxidant capacity (TAC), C-reactive protein (CRP), and zinc protoporphyrin (ZPP). Birth weight, gestational age at birth, type of delivery, and outcome of delivery were collected as each teenager gave birth. Data were analysed using Chi-square (Fisher’s exact) analysis, t-test, two-way ANOVA and multiple linear regression. Results: 15.9% had low birth weight, 12.5% had preterm birth, 11.5% had a postpartum haemorrhage, and 3.1% neonatal deaths. Majority of the participants had inadequate intakes of energy (81.4%), protein (77.2%), vitamins A (97.1%) and E (97.7%), calcium (99.8%), iron (97.6%), folate (93.0%), zinc (83.7%), riboflavin (88.4%), thiamin (74.4%), and fiber (74.4%) intakes. Anaemia and wasting prevalence were 57.1% and 27.8%. Between-subject effects determined using Generalized Linear Modelling indicated MUAC (p=0.058), and gestational age at delivery (p=0.023) significantly affected birth weight. A multiple linear regression analysis indicated MUAC (β=0.283, p=0.002), BMI (β=0.221, p=0.015), gestational age (β=0.285, p<0.001), and ZPP (β=0.131, p=0.057) were significantly associated with birth weight (F(23, 223), P=0.008, R2=1.941).Conclusions: Inadequate nutrients intake, anaemia, and LBW were found in these pregnant teenagers. Maternal MUAC, gestational age, and serum ZPP were associated with birth weight. Interventions for improving the nutritional status of teenagers before and during pregnancy are urgently needed to reduce the risk of adverse birth outcomes.
A GIS based approach: Objectively measured neighbourhood physical environment and walking among adults in Colombo, Sri Lanka
Authors: Weliange Shreenika De Silva , Fernando Dulitha , Withanage Shanthi , Gunatilake Jagath
Published: June 2020

Background: Physical Activity (PA) plays an important role for health. Walking is the easiest way to incorporate activity into everyday life. However, few adults achieve the recommended levels of activity. This study examined the association of the objectively measured neighbourhood physical environment with walking among the adults in Colombo, Sri Lanka through a cross sectional design. Methods : Primary data collection was carried out to assess the minutes walked, socio-demographic characteristics and geo location of residence. Secondary data was obtained to assess neighbourhood environment from existing spatially referenced data. Geographic Information Systems (GIS) was used to calculate density measures (residential density, land use, connectivity and access) and distance measures. Results: A sample consisted of 284 adults aged 29-59 years (mean age 40.6 (SD-10.9) years, Female: 56%). Adults reported a mean of 175.8 (SD214.0) minutes/week of total walking out of which, 158.4 (SD-196.6) minutes/week of walking was for transportation and 17.5 (SD-70.1) minutes/week of walking was for leisure. All residential density measures, building foot print area, length of major roads, number of intersections, number of bus stops, and distance to nearest major roads showed significant moderate degree of correlations with total walking, (p < 0.001). These results were similar with walking for transportation. Conclusion: There is indication that neighbourhood features could be associated with walking in Sri Lankan adults. Understanding the relationship between objectively measured neighbourhood physical environment attributes for walking gives insight for designing effective interventions to promote walking. Therefore, future studies in Sri Lanka, should consider a more comprehensive framework including objective and perceived measures of the built environment to evaluate the neighbourhood physical environment to promote walking.
Alveolar bone loss around mandibular anterior teeth in Class I, II, and III malocclusions: a CBCT evaluation study
Authors: Wang Zixiao , Ma Zhigui , Yang Chi
Published: June 2020

Background: To quantitatively and qualitatively evaluate alveolar defects of mandibular anterior alveolar bone in three different types of malocclusion with cone-beam computed tomography (CBCT).Methods: A total of 542 teeth from 30 skeletal class I malocclusion (mean age: 19.26±5.63), 33 class II malocclusion (mean age: 19.36±4.17), and 28 class III malocclusion (mean age: 21.47±4.53) patients were evaluated with CBCT. Sagittal sectional views were evaluated with regard to labial and lingual alveolar bone thickness and vertical alveolar bone level. Analysis of variance and Tukey’s test were used for statistical comparisons at P<.05 Results: Qualitative analysis: Class II (64.47%) and Class III malocclusions (58.43%) had higher prevalence of dehiscence than Class I malocclusions (32.96%),P<0.05. No significant difference was found in the prevalence of fenestration among the three groups. Quantitative analysis: In general, Class II and III groups had lesser alveolar bone volume than the Class I group. Furthermore, the vertical alveolar height and coronal alveolar bone thickness in Class II malocclusion was significantly lesser than that in the Class III group. Conclusions: The Class II group, followed by the class III group, showed the most severe alveolar bone deficiency For these patients undergoing orthodontic treatment, special care should be taken to avoid aggravated preexisting alveolar bone loss in the mandibular anterior teeth.
Challenges in laboratory diagnosis of Malaria in a low resource country among cases of acute febrile illness at tertiary care hospital in eastern Nepal: Comparative study on Conventional Vs Molecular approach
Authors: Dahal Pragyan , Khanal Basudha , Rai Keshav , Kattel Vivek , Yadav Satish , Bhattarai Narayan Raj
Published: June 2020

Background
For ongoing malaria elimination programme, available methods like microscopy and rapid diagnostic test (RDT) are not able to detect all the cases of malaria in acute febrile illness. These methods are entirely dependent on the course of infection, parasite load and skilled technical resources thus the study was carried out to compare performance of microscopy and RDT which are commonly used in a low resource country along with reference to real-time PCR.
Methods
Altogether 52 blood samples collected from patients with acute febrile illness were tested by microscopy, RDT and real-time PCR. The results were compared in terms of sensitivity and specificity.
Results
The test results were as follows: 5.8% positivity by Microscopy, 13.5% positivity by RDT and 27% by real time PCR. Taking into consideration of PCR as a gold standard method microscopy showed 21.4% sensitivity and 100% specificity. Likewise, RDT results revealed 28.6% sensitivity and 92.1% specificity.
Conclusion
Despite of various diagnostic tools available, microscopy stills remains the gold standard for the diagnosis and RDT is the user friendly to execute the test under the tree, but our preliminary results emphasized the need to implement the test with the higher sensitivity and specificity in context of malaria elimination programme which could be another important opportunity to understand the parasite circulation in case of low endemic region. However, these results should be further verified with the large study cohort in order to document the submicroscopic infection.
The effectiveness of patient-centred medical home-based models of care versus standard primary care in chronic disease management: a systematic review and meta-analysis of randomised and non-randomised controlled trials
Authors: John James Rufus , Jani Hir , Peters Kath , Agho Kingsley , Tannous Kathy
Published: June 2020

Background
Patient-centred care by a coordinated primary care team may be more effective than standard care in chronic disease management. We synthesised evidence to determine whether patient-centred medical home (PCMH)-based care models are more effective than standard general practitioner (GP) care in improving clinical, hospital, and economic outcomes.
Methods
MEDLINE, CINAHL, Embase, Cochrane Library, and Scopus were searched to identify randomised (RCTs) and non-randomised controlled trials that evaluated two or more principles of PCMH among primary care patients with chronic diseases. Study selection, data extraction, quality assessment using Joanna Briggs Institute (JBI) appraisal tools, and grading of evidence using Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach were conducted independently. A quantitative synthesis, where possible, was pooled using random effects models and the effect size estimates of standardised mean differences (SMDs) and odds ratios (ORs) with 95% confidence intervals were reported.
Results
Of the 13820 citations, we identified 78 eligible RCTs and 7 quasi trials which included 60617 patients. The findings suggested that PCMH-based care was associated with significant improvements in depression episodes (SMD − 0.24; 95% CI -0.35, -0.14) and increased odds of remission (OR 1.79; 95% CI 1.46, 2.21). There were significant improvements in the health-related quality of life (SMD 0.10; 95% CI 0.04, 0.15); self-management outcomes (SMD 0.24; 95% CI 0.03, 0.44) and hospital admissions (OR 0.83; 95% CI 0.70, 0.98). In terms of clinical outcomes, with exception to total cholesterol, PCMH-based care led to significant improvements in blood pressure, glycated haemoglobin, and low-density lipoprotein cholesterol outcomes. The incremental cost of PCMH care was identified to be small and significantly higher than standard care (SMD 0.17; 95% CI 0.08, 0.26). The quality of individual studies ranged from ‘fair’ to ‘good’ by meeting at least 60% of items on the quality appraisal checklist. Additionally, moderate to high heterogeneity across studies in outcomes resulted in downgrading the included studies as moderate or low grade of evidence.
Conclusion
PCMH-based care has been found to be superior to standard GP care in chronic disease management. Results of the review have important implications that may inform patient, practice, and policy-level changes.
Integrating sexual and reproductive health into health system strengthening in humanitarian settings: designing and evaluating a workshop toolkit to catalyse participatory planning to transition from minimum to comprehensive services in DR Congo, Bangladesh, and Yemen
Authors: Tran Nguyen Toan , Greer Alison , Kini Brigitte , Abdi Hassan , Rajeh Kariman , Cortier Hilde , Boboeva Mohira
Published: June 2020

BackgroundPlanning to transition from the Minimum Initial Service Package for Sexual and Reproductive Health (SRH) toward comprehensive SRH services has been a challenge in humanitarian settings. To bridge this gap, a workshop toolkit for SRH coordinators was designed to support effective planning. This article aims to describe the toolkit design, piloting, and final product. MethodsAnchored in the WHO Health System Building Blocks Framework, the design entailed two complementary strategies. First, a circular approach involved global partners in the initial toolkit conception. Second, a bottom-up approach engaged field stakeholders from three major humanitarian crises to participate in pilot workshops to evaluate and improve the toolkit using qualitative interviews and end-of-workshop evaluations. Pilots occurred in DR Congo for the Kasai region crisis, Bangladesh for the Rohingya humanitarian response in Cox’s Bazar, and Yemen for selected Governorates.ResultsResults suggest that the toolkit enabled facilitators to foster a systematic, participatory, interactive, and inclusive planning process among participants over a two-day workshop. The approach was reportedly effective and time-efficient in producing a joint work plan. The main planning priorities cutting across settings were healthcare workforce strengthening, such as midwifery capacity development, increasing community mobilization and engagement, focusing on adolescent SRH, and enhancing maternal and newborn health services in terms of quality, coverage, and referral pathways. Recommendations for improvement included a dedicated and adequately anticipated pre-workshop preparation to gather relevant data, encouraging participants to undertake preliminary study to equalize knowledge to partake fully in the workshop, and enlisting participants from marginalized and underserved populations. ConclusionCollaborative design and piloting efforts resulted in a workshop toolkit that could support a systematic and efficient identification of priority activities and services related to comprehensive SRH. Such priorities could help meet the SRH needs of communities emerging from acute humanitarian situations while strengthening the overall health system.
Immunogenicity of Two-Dose Booster Immunization with Conventional Inactivated Polio Vaccine in Japanese Adults
Authors: Fukushima Shinji , Nakano Takashi , Shimizu Hiroyuki , Hamada Atsuo
Published: June 2020

Background: Most Japanese adults have been vaccinated twice in childhood with the Sabin oral polio vaccine as part of routine immunization schedules. Booster vaccination is recommended for Japanese travelers to polio-endemic or high-risk countries. This study assessed the immunogenicity of a two-dose booster regimen of conventional inactivated polio vaccine (cIPV) in Japanese adults.Methods: Healthy Japanese adults aged 20 years or older received two doses of standalone cIPV derived from virulent strains (Imovax Polio®). Serum samples were obtained before the booster vaccination and 4–6 weeks after each vaccination. Immunogenicity was evaluated by measuring serum neutralization titers against type 1, 2, and 3 poliovirus strains using a microneutralization assay. Results: The subjects were 61 healthy Japanese adults (26 men and 35 women) with mean ± standard deviation age of 35.8 ± 8.0 years. The seropositivity rates (i.e., percentage of subjects with anti-polio antibody titers ≥1:8 ) before booster vaccination were 88.5%, 95.1%, and 52.5% for Sabin strains (type 1, 2, and 3, respectively); 72.1%, 93.4%, and 31.1% for virulent poliovirus strains (type1: Mahoney strain; type 2: MEF-1 strain; and type 3: Saukett strain, respectively); and 93.4%, 93.4%, 93.4% and 88.5% for type 2 vaccine-derived poliovirus strains (SV3128, SV3130, 11196, and 11198, respectively). After one dose of cIPV, all seropositivity rates increased to 98.4%–100.0%. After two doses of cIPV, seropositivity rates reached 100% for all strains. cIPV was well tolerated, with no safety concerns. Conclusion: Booster vaccination with standalone cIPV induced a robust immune response in Japanese adults. Trial registration: UMIN, UMIN000013551. Registered 28 March 2014 - Retrospectively registered, https://upload.umin.ac.jp/cgi-bin/ctr/ctr_view_reg.cgi?recptno=R000015830
One-step purification and characterization of two novel Thermotolerant β-1,4-glucosidases from a newly isolated strain of Fusarium chlamydosporum HML278
Authors: Qin Yongling , Li Qiqian , Luo Fengfeng , Fu Yue , He Haiyan
Published: June 2020

A newly screened cellulase-producing Fusarium chlamydosporum HML278 was cultivated under solid-state fermentation of sugarcane bagasse, and two new β-glucosides enzymes (BG FH1, BG FH2) from fermentation solution were recovered by modified non-denaturing active gel electrophoresis and gel filtration chromatography. SDS-PAGE analysis showed that the molecular weight of BG FH1and BG FH2 was 93 kDa and 52 kDa, respectively, and the enzyme activity was 5.6 U/mg and 11.5 U/mg, respectively. The optimal reaction temperature of the enzymes was 60 ℃, and the enzymes were stable under 70 ℃. The optimal pH of the purified enzymes was 6.0, and the enzymes were stable between pH 4–10. Km and Vmax values ​​of 2.76 mg/mL, 20.6 U/mg for pNPG. Thin-layer chromatography and high-performance liquid chromatography analysis showed that cellobiose BG FH1and BG FH2 had hydrolysis activity and can hydrolyze cellobiose into glucose. In addition, both enzymes also exhibited transglycoside activity, which can use low molecular weight monosaccharides to synthesize cellobiose and cellotriose, and preferentially synthesize alcohol. In conclusion, our study demonstrated that F. chlamydosporum HML278 can produce heat-resistant β-glucosidase with both hydrolytic activity and transglycosidic activity, and has potential application value in bioethanol and papermaking industries.
Prevalence and Correlates of Psychological Reactions Among Jordanian Nurses During the Coronavirus Disease 2019 Pandemic 
Authors: Al-Amer Rasmieh , Malak Malakeh. Z. , Aburumman Ghaida , Darwish Motasem M. , Nassar Mohammad. S. , Darwish Maram , Randal Sue
Published: June 2020

We aimed to assess the prevalence of psychological reactions (depression, anxiety, and stress) and their correlates among Jordanian nurses. This study was conducted using an online survey from March 22, 2020, to March 27, 2020. The Arabic version of Depression, Anxiety, and Stress Scale (DASS) was used. Depression, anxiety, and stress were highly prevalent among nurses (57.8%, 42.4%, and 50.1%, respectively). Those who had close contact with a coronavirus disease 2019 (COVID-19) patient showed stronger psychological reactions than their counterparts (partial = 0.264, part = 0.254). Moreover, female gender and number of children were the main significant predictors of depression [(B = 0.176), (B = 0.232), (B = 0.255)], anxiety [(B = 0.155), (B = 0.232), (B = 0.268)], and stress [(B = 0.148), (B = 0.218), (B = 0.258)]. Hence, the mental health status of nurses should be given priority, especially those who are in contact with COVID-19 patients, female nurses, and those who have children.
Kinetic Analysis of Dominant Intraprostatic Lesion of Prostate Cancer Using Quantitative Dynamic [18F]DCFPyL-PET: Comparison to [18F]fluorocholine-PET
Authors: Yang Dae-Myoung , Li Fiona , Bauman Glenn , Chin Joseph , Pautler Stephen , Moussa Madeleine , Rachinsky Irina , Valliant John , Lee Ting-Yim
Published: June 2020

Purpose
Identification of the dominant intraprostatic lesion(s) (DILs) can faciltiate diagnosis and treatment by targeting biologically significant intra-prostatic foci. [18F]DCFPyL is better than [18F]FCH in detecting and localizing DIL because of higher tumour contrast. However, the optimal imaging time for [18F]DCFPyL is in hours. The goal of this study was to investigate whether the different imaging performance of [18F]FCH and [18F]DCFPyL can be explained by their kinetic behaviour in PCa and to evaluate whether DIL can be accurately detected and localized using a short duration dynamic PET.
Methods
19 and 23 PCa patients were evaluated with dynamic [18F]DCFPyL and [18F]FCH PET, respectively. The dynamic imaging protocol with each tracer had a total imaging time of 22 min and consisted of multiple frames with acquisition times from 10–180 s. Tumour and benign tissue regions identified by sextant biopsy were compared using standardized uptake value (SUV) and tracer kinetic parameters from kinetic analysis of time-activity curves.
Results
For [18F]DCFPyL, logistic regression identified Ki and k4 as the optimal model to discriminate tumour from benign tissue (84.2% sensitivity and 94.7% specificity) while only SUV was predictive for [18F]FCH (82.6% sensitivity and 87.0% specificity) The higher k3 (binding) of [18F]FCH than [18F]DCFPyL explains why [18F]FCH SUV can differentiate tumour from benign tissue within minutes of injection. Superior [18F]DCFPyL tumour contrast was due to the higher k4/k3 (more rapid washout) in benign tissue compared to tumour tissue.
Conclusions
DIL was detected with good sensitivity and specificity using 22-min dynamic [18F]DCFPyL PET and avoids the need for delayed imaging timepoints. The dissimilar in-vivo kinetic behaviour of [18F]DCFPyL and [18F]FCH could explain their different SUV images.
Trial Registration:
ClinicalTrials.gov, NCT04009174. Registered July 5, 2019 – retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT04009174?term=NCT04009174&draw=2&rank=1
Fully Automated Radiosynthesis of [18f]lbt999on Tracerlab Fxfn and Allinonemodules, A Pet Radiopharmaceutical for Imaging the Dopamine Transporter in Human Brain
Authors: Vala Christine , Mothes Céline , Chicheri Gabrielle , Magadur Pauline , Viot Gilles , Deloye Jean-Bernard , Maia Serge , Bouvet Yann , Arlicot Nicolas , Guilloteau Denis , Emond Patrick , Vercoullie Johnny
Published: June 2020

Background:Fluorine labelled 8-((E)-4-fluoro-but-2-enyl)-3b-p-tolyl-8-aza-bicyclo[3.2.1]octane-2b-carboxylic acid methyl ester ([18F]LBT999) is a selective radioligand for in vivoneuroimaging and quantification of the dopamine transporter by Positron Emission Tomography (PET). [18F]LBT999 has been produced on a TRACERlabFXFN for the Phase I study but forPhase III and a potent industrial production transfer, production has been also implemented on AllinOne (AIO)system requiring single use cassette. Both productions methods are reported herein. Results:Automation of [18F]LBT999radiosynthesis on FXFN was carried out in 35% yield (decay-corrected) in 65 min (n=16), with a radiochemical purity higher than 99 %and a molar activity of 158GBq/µmol at the end of synthesis. The transfer on the AIO platform followed by optimizations allowed the production of [18F]LBT999 in 32.7% yield (decay-corrected) within 48 min (n=5), with a radiochemical purity better than 98% and a molar activity in average higher to 154 GBq/µmol at the end of synthesis. Quality controls of both methods met the specification for clinical application.Conclusion:Both modules allow efficient and reproducible radiosynthesis of [18F]LBT999 with good radiochemical yields and a reasonable synthesis time.The developments made on AIO as its ability to meet pharmaceutical criteria and to more easily comply with GMP requirements make this approach as the best for a potent industrial production of the [18F]LBT999 and a future wider use.
The Influential factors of Adherence to Physical Activity and Exercise among Community-Dwelling Stroke Survivors: A Path Analysis
Authors: Lin Beilei , Zhang Zhenxiang , Mei Yongxia , Wang Wenna , Liu Lamei , Xu Hui
Published: June 2020

Background: Regular physical activity and exercise (PAE) after stroke is essential, but the adherence to PAE and its influential factors is rarely studied and unclear in developed countries. The aim of this study was to investigate the status of PAE adherence, and to identify its influential factors among Chinese community-dwelling stroke survivors.Methods: A cross-sectional study was conducted, 208 stroke survivors were randomly selected from three communities (60.10% men, mean age 70.25 ± 9.08 years). Physical Activity and Exercise Adherence Scale (PAEAS) was used as a measure of compliance, knowledge, attitude, self-efficacy and social support were measured using relevant scales. Influential factors of PAE adherence and associations between those variables were explored using multiple linear regression and path analysis.Results: The mean adherence rate was moderate (62.0%), stroke survivors tended to be more adherent to do PAE than monitoring and seeking advices (70.30% > 53.50% > 48.30%). Regression results revealed that seven factors significantly associated with PAE adherence, including knowledge, attitude, self-efficacy, social support, self-care ability, community rehabilitation experience, and times since stroke (R2 = 75.10%, F = 45.593, p < 0.05). Furthermore, path analysis showed that knowledge had a significant indirect positive influence with self-efficacy as a mediator on adherence (β= 0.16, p < 0.05); while attitude and social support impacted both directly and indirectly on adherence with self-efficacy as the mediator; what’s more, self-efficacy was an important predictor that performed the strongest direct effect on community-dwelling stroke survivors’ PAE adherence (β= 0.44, p < 0.01 ). These four variables accounted for a total of 67.00% of the variance of PAE adherence among community-dwelling stroke survivors.Conclusions: Physical activity and exercise adherence of community stroke survivors is needed to be improved. Attitude and social support presented both direct and indirect impacts on PAE adherence through self-efficacy, while knowledge only exhibited an indirect influencing effect on adherence. Health care professionals should administer a more comprehensive and systematic assessment to seek to improve self-efficacy through the development of effective interventions for promoting adherence to PAE in this population.
A plasmid-encoded papB paralogue modulates autoaggregation of Escherichia coli transconjugants
Authors: Monarrez Ruben , Okeke Iruka
Published: June 2020

Objective: Plasmids are key to the transmission of antimicrobial resistance among enteric bacteria. It is becoming increasingly clear that resistance genes alone do not account for the selective advantage of plasmids and bacterial strains that harbor them. Deletion of a 32 Kb fitness-conferring region of pMB2, a conjugative resistance plasmid, produced a hyper­autoaggregation phenotype in laboratory Escherichia coli. This study sought to determine the genetic basis for hyper-autoaggregation conferred by the pMB2-derived mini-plasmid.Results: The 32 Kb fragment deleted from pMB2 included previously characterized nutrient acquisition genes as well as putative transposase and integrase genes, a 272 bp papB/ pefB-like gene, and several open-reading frames of unknown function. We cloned the papB/ pefB paralogue and found it sufficient to temper the hyper-autoaggregation phenotype. Hyper­autoaggregation conferred by the mini-plasmid did not occur in a fim-negative background. This study has identified and characterized a gene capable of down-regulating host adhesins and has shown that trans-acting papB/pefB paralogues can occur outside the context of an adhesin cluster. This plasmid-mediated modification of a bacterial host’s colonization program may optimize horizontal transfer of the mobile element bearing the genes.
Results Following Surgical Resection of Recurrent Chordoma Of the Spine: Experience in a Single Institution
Authors: Chanplakorn Pongsthorn , Lertudomphonwanit Thamrong , Homcharoen Wittawat , Suwanpramote Prakrit , Laohacharoensombat Wichien
Published: June 2020

Background: Chordoma of the spine is a low-grade malignant tumor with vague and indolentsymptoms thus large tumor mass is encountered at the time of diagnosis in almost cases and makes a difficult for En-bloc free-margin resection. Salvage therapyfor recurrent chordoma is very challenging due to its relentless nature and refractory to adjuvant therapies. The aim of this present study was to report the oncologic outcome following surgical resection of chordoma of the spine.Materials and Methods:Retrospective review of 10 consecutive cases of recurrent chordoma patients who underwent surgical treatment between 2003 and 2018atone tertiary-care center was conducted.Results: There were 10 patients, 4 females and 6 males were included in this study. Eight patients had local recurrence. The recurrence was encountered at the muscle, surrounding soft tissue and remaining bony structure. Distant metastaseswere found in 2 patients. The average time of recurrence was 28 months after first surgery. Conclusion:En-bloc free margin resection is mandatory toprevent recurrent. The clinical vigilance and investigation to identify tumor recurrent should be obtained periodically,in the first 28 months. Detection of recurrent in early stage with a small mass may be the best chance to perform an En-Bloc margin free resection to prevent further recurrent.
Semi-Embedded Valve Anastomosis: a New Anti-reflux Anastomotic Method After Proximal Gastrectomy for Adenocarcinoma of Esophagogastric Junction
Authors: Wang Baohua , Wu Yupeng , Wang Haijun , Zhang Haiqiang , Wang Liting , Zhang Zhanxue
Published: June 2020

Background
There is a high probability of gastroesophageal reflux after laparoscopic proximal gastrectomy of SiewertⅡAEG. Various anti-reflux anastomotic methods are emerging in clinical practice, however, none of them is widely accepted. We have innovated a new type of anti-reflux anastomotic method, named semi-embedded valve anastomosis. The aim of this study is to explore the feasibility and anti-reflux effect of the new anastomotic method.
Methods
The clinical data of 28 patients with SiewertⅡAEG were collected in this study, who were treated by semi-embedded valve anastomosis. The key point of operation is to reconstruct a simulated valve and form a similar anti-reflux barrier under physiological mechanism. GerdQ gastroesophageal reflux questionnaire and classification of gastroesophageal reflux under electron microscope were used to evaluate gastroesophageal reflux after operation.
Results
The mean time of operation was 164.3 ± 19.0 min, the median intraoperative hemorrhage was 65 ml, the average number of lymph nodes dissected was 23 ± 2.6, the time of making valve was 15.8 ± 3.2 min, the time of anastomotic reconstruction was 35.4 ± 4.8 min, the median time of first exhaust was 3d, the median time of hospitalization was 12 days, one case with postoperative anastomotic stenosis. GerdQ score, median (range) : 2 (0–6), preoperation; 0 (0–8), 1 months postoperation; 2 (0–12), 3 months postoperation; 3 (0–12), 6 months postoperation. Wilcoxon signed rank sum test was carried out at different time after operation and the day before operation respectively, the differences were not statistically significant, P < 0.05. There was one case of grade B according to LA classification system of gastroesophageal reflux among the gastrofiberscope reexamination reports of 28 cases.
Conclusion
Semi-embedded valve anastomosis is safe and feasible after the proximal gastrectomy of Siewert Ⅱ AEG, and has good anti-reflux effect.
Spie charts for quantifying treatment effectiveness and safety in multiple outcome network meta-analysis: A proof-of-concept study
Authors: Daly Caitlin , Mbuagbaw Lawrence , Thabane Lehana , Straus Sharon E , Hamid Jemila S
Published: June 2020

Background
Network meta-analysis (NMA) simultaneously synthesises direct and indirect evidence on the relative efficacy and safety of at least three treatments. A decision maker may use the coherent results of an NMA to determine which treatment is best for a given outcome. However, this evidence must be balanced across multiple outcomes. This study aims to provide a framework that permits the objective integration of the comparative effectiveness and safety of treatments across multiple outcomes.
Methods
In the proposed framework, measures of each treatment’s performance are plotted on its own pie chart, superimposed on another pie chart representing the performance of a hypothetical treatment that is the best across all outcomes. This creates a spie chart for each treatment, where the coverage area represents the probability a treatment ranks best overall. The angles of each sector may be adjusted to reflect the importance of each outcome to a decision maker. The framework is illustrated using two published NMA datasets comparing dietary oils and fats and psoriasis treatments. Outcome measures are plotted in terms of the surface under the cumulative ranking curve. The use of the spie chart was contrasted with that of the radar plot.
Results
In the NMA comparing the effects of dietary oils and fats on four lipid biomarkers, the ease of incorporating the lipids’ relative importance on spie charts was demonstrated using coefficients from a published risk prediction model on coronary heart disease. Radar plots produced two sets of areas based on the ordering of the lipids on the axes, while the spie chart only produced one set. In the NMA comparing psoriasis treatments, the areas inside spie charts containing both efficacy and safety outcomes masked critical information on the treatments’ comparative safety. Plotting the areas inside spie charts of the efficacy outcomes against measures of the safety outcome facilitated simultaneous comparisons of the treatments’ benefits and harms.
Conclusions
The spie chart is more optimal than a radar plot for integrating the comparative effectiveness or safety of a treatment across multiple outcomes. Formal validation in the decision-making context, along with statistical comparisons with other recent approaches are required.
Design and Optimization for Uav-enabled Two-way Relaying System With Swipt
Authors: Wang Jinlong , Wang Gang , Chen Guanyi , Li Bo , Zhou Ruofei , Zhang Ruoyu
Published: June 2020

In this paper, we investigate the resource allocation scheme for an unmanned-aerial-vehicle-enable (UAV-enabled) two-way relaying system with simultaneous wireless information and power transfer (SWIPT), where two user equipments (UEs) exchange information with the help of UAV relay and harvest energy through power splitting (PS) scheme. Under the transmission power constraints at UEs and UAV relay, a non-convex intractable optimization problem is formulated which maximizes the sum retained energy of two UEs while satisfying the minimum signal-to-noise ratio requirement. We decouple the complicated beamforming and PS factors optimization problem into three solvable subproblems and propose an efficient alternating optimization scheme. Subsequently, in order to reduce the complexity, a robust scheme based on generalized singular value decomposition (GSVD) is designed. Finally, numerical results verify the robustness and effectiveness of two proposed schemes.
Compensation Models for Community Health Workers: Comparison of Legal Frameworks across Five Countries
Authors: Ballard Madeleine , Westgate Carey , Alban Rebecca , Choudhury Nandini , Adamjee Rehan , Schwarz Ryan , Bishop Julia , McLaughlin Meg , Flood David , Finnegan Karen , Rogers Ash , Olsen Helen , Johnson Ari , Palazuelos Daniel , Schechter Jennifer
Published: June 2020

Background
Despite the life-saving work they perform, community health workers (CHWs) have long been subject to global debate about their remuneration. There is now, however, an emerging consensus that CHWs should be paid. As the discussion evolves from whether to financially remunerate CHWs to how to do so, there is an urgent need to better understand the types of CHW payment models and their implications.
Methods
This study examines the legal framework on CHW compensation in five countries: Brazil, Ghana, Nigeria, Rwanda, and South Africa. In order to map the characteristics of each approach, a standardized questionnaire was developed and targeted at local law firms. The questionnaire covered legal structures and requirements for compensation of CHWs, CHW compensation mechanisms, CHW legal protections and benefits, and alignment of national CHW policies with global guidelines.
Results
The five countries profiled represent possible archetypes for CHW compensation: Brazil (public), Ghana (volunteer-based), Nigeria (private), Rwanda (cooperatives with performance based incentives) and South Africa (hybrid public/private). Advantages and disadvantages of each model with respect to (i) CHWs, in terms of financial protection, and (ii) the public sector, in terms of ease of implementation, are outlined.
Conclusions
While a strong legal framework does not necessarily translate into high-quality implementation, it is the first necessary step. While certain approaches to CHW compensation - particularly public-sector or hybrid models with public sector wage floors - best institutionalize recommended CHW protections, political will and long-term financing often remain obstacles. Removing ecosystem barriers - such as multilateral and bilateral restrictions on the payment of salaries - can help governments institutionalize CHW payment.
Pre-existing liver disease is associated with poor outcome in patients with SARS CoV2 infection; The APCOLIS Study (APASL COVID-19 Liver Injury Spectrum Study)
Authors: Sarin Shiv Kumar , Choudhury Ashok , Lau George K , Zheng Ming-Hua , Ji Dong , Abd-Elsalam Sherief , Hwang Jaeseok , Qi Xiaolong , Cua Ian Homer , Suh Jeong Ill , Park Jun Gi , Putcharoen Opass , Kaewdech Apichat , Piratvisuth Teerha , Treeprasertsuk Sombat , Park Sooyoung , Wejnaruemarn Salisa , Payawal Diana A. , Baatarkhuu Oidov , Ahn Sang Hoon , Yeo Chang Dong , Alonzo Uzziel Romar , Chinbayar Tserendorj , Loho Imelda M. , Yokosuka Osamu , Jafri Wasim , Tan Soeksiam , Soo Lau Ing , Tanwandee Tawesak , Gani Rino , Anand Lovkesh , Esmail Eslam Saber , Khalaf Mai , Alam Shahinul , Lin Chun-Yu , Chuang Wan-Long , Soin A S , Garg Hitendra K , Kalista Kemal , Batsukh Badamnachin , Purnomo Hery Djagat , Dara Vijay Pal , Rathi Pravin , Mahtab Mamun Al , Shukla Akash , Sharma Manoj K , Omata Masao
Published: June 2020

Background and Aims: COVID-19 is a dominant pulmonary disease, with multisystem involvement, depending upon co morbidities. Its profile in patients with pre-existing chronic liver disease (CLD) is largely unknown. We studied the liver injury patterns of SARS-Cov-2 in CLD patients, with or without cirrhosis. Methods: Data was collected from 13 Asian countries on patients with CLD, known or newly diagnosed, with confirmed COVID-19. Result: Altogether, 228 patients [185 CLD without cirrhosis and 43 with cirrhosis] were enrolled, with comorbidities in nearly 80%. Metabolism associated fatty liver disease (113, 61%) and viral etiology (26, 60%) were common. In CLD without cirrhosis, diabetes [57.7% vs 39.7%, OR=2.1(1.1-3.7), p=0.01] and in cirrhotics, obesity, [64.3% vs. 17.2%, OR=8.1(1.9-38.8), p=0.002) predisposed more to liver injury than those without these. Forty three percent of CLD without cirrhosis presented as acute liver injury and 20% cirrhotics presented with either acute-on-chronic liver failure [5(11.6%)] or acute decompensation [4(9%)]. Liver related complications increased (p<0.05) with stage of liver disease; a Child-Turcotte Pugh score of 9 or more at presentation predicted high mortality [AUROC-0.94, HR=19.2(95CI 2.3-163.3), p<0.001, sensitivity 85.7% and specificity 94.4%). In decompensated cirrhotics, the liver injury was progressive in 57% patients, with 43% mortality. Rising bilirubin and AST/ALT ratio predicted mortality among cirrhosis. Conclusions: SARS-Cov-2 infection causes significant liver injury in CLD patients, decompensating one fifth of cirrhosis, and worsening the clinical status of the already decompensated. The CLD patients with diabetes and obesity are more vulnerable and should be closely monitored.
Accelerated Partial Breast Irradiation in the Elderly:8-year Oncological Outcome and Prognostic Factors
Authors: Sumodhee Shakeel , PUJALTE-MARTIN Marc , Gal Jocelyn , Kee Daniel Lam Cham , Gautier Mathieu , Schiappa Renaud , Chand Marie-Eve , Hannoun-Levi Jean-Michel
Published: June 2020

Introduction: To evaluate long term clinical outcome and prognostic factors after accelerated partial breast irradiation (APBI) in the elderly using high-dose-rate interstitial multi-catheter brachytherapy (HIBT).Material and methods: Between 2005 and 2018, 109 patients underwent APBI using HIBT (34 Gy/10f/5d or 32 Gy/8f/4d). Based on a prospective database, outcomes were retrospectively analyzed (local relapse-free survival (LRFS), metastatic-free survival (MFS), specific survival (SS) and overall survival (OS). Prognostic factors were investigated. Late toxicity and cosmetic evaluation were reported.Results: With a median follow-up of 97 months [7–159], median age was 81.7 years [58-89]. According to the GEC-ESTRO APBI classification, 72.5%, 11.9% and 15.6% were classified as low, intermediate and high-risk respectively. The histological type was mainly invasive ductal carcinoma (87.1%). The median tumor size was 10 mm [range 1-35]. Eight-year LRFS, SS and OS were 96.7% [95% CI [0.923; 1]), 96.7% [95% CI [0.924; 1] and 72%[95% CI [0.616; 0.837] respectively. In univariate analysis, APBI classification was not cosidered as prognostic factor, whilemolecular classification was prognostic factor for OS (p<0.0001), SS (p=0.007) and MFS (p=0.009) but not for LR (p=0.586). No Grade ³3 late toxicity was observed while 61 patients (88.4%) and 8 patients (11.6%) presented grade 1 and 2 toxicities respectively. Cosmetic outcome was excellent/good for 96.4%.Conclusion: Long-term follow-up confirms that HIBT is safe and effective for elderly early breast cancer. Our results suggest that selected elderly women presenting with high-risk breast cancer could be also considered for APBI.
Potential research ethics violations against an indigenous tribe in Ecuador: a mixed methods approach
Authors: Ortiz-Prado Esteban , Simbana-Rivera Katherine , Gomez-Barreno Lenin , Tamariz Leonardo , Lister Alex , Baca Juan Carlos , Norris Alegria , Adana-Diaz Lila
Published: June 2020

Background
Biomedical and ethnographic studies among indigenous people are common practice in health and geographical research. Prior health research misconduct has been documented, particularly when obtaining genetic material. The objective of this study was to crossmatch previously published data with the perceptions of the Waorani peoples about the trading of their genetic material and other biological samples.
Methods
We conducted a mixed methods study design using a tailored 15-item questionnaire and in-depth interviews with 72 participants belonging to 20 Waorani communities about their experiences and perceptions of participating in biomedical research projects. Additionally, we conducted a systematic review of the literature in order to crossmatch the published results of studies stating the approval of an ethics committee and individual consent within their work.
Results
A total of 40 men (60%) and 32 women (40%), with a mean age of 57 ± 15 years agreed to be interviewed for inclusion. Five main categories around the violation of good clinical practices were identified, concerning the obtention of blood samples from a recently contacted Waorani native community within the Amazonian region of Ecuador. These themes are related to the lack of adequate communication between community members and researchers as well as the voluntariness to participate in health research. Additionally, over 40 years, a total of 38 manuscripts related to the use of biological samples in Waorani indigenous people were published. The majority of the studies (68%) did not state within their article obtaining research ethics board approval, and 71% did not report obtaining the informed consent of the participants prior to the execution of the project.
Conclusion
Clinical Research on the Waorani community in the Ecuadorian Amazon basin has been performed on several occasions. Unfortunately, the majority of these projects did not follow the appropriate ethical and professional standards in either reporting the results or fulfilling them. The results of our investigation suggest that biological material, including genetic material, has been used by researchers globally, with some omitting the minimum information required to guarantee transparency and good clinical practices. We highlight the importance of stating ethics within research to avoid breaches in research transparency.
Urinary sediments could differentiate the endocapillary proliferative lupus nephritis and endocapillary proliferative IgA nephrology
Authors: Yuan Mo , Li Jing-zi , Yu Xiao-juan , Zhang Hong , Tan Ying
Published: June 2020

Background: The role of manual urine sediment examination in the diagnosis and prognostication of endocapillary proliferative glomerulonephritis remains to be elucidated. This study aims to investigated the differences of urinary sediment findings between lupus nephritis and IgA nephropathy with endocapillary proliferative glomerulonephritis and further evaluated associations of leukocyturia with disease activity, pathological features and prognosis.Methods: The urinary sediment of 126 patients, including 92 patients with lupus nephritis and 34 patients with IgA nephropathy, with a renal biopsy-proven endocapillary proliferative glomerulonephritis were examined in the morning before renal biopsy according to a standardized method. The urinary elements investigated including various cells, casts and crystals. The associations of the level of leukocyturia and disease activity, pathological features and prognosis were further analyzed.Results: In the patients with endocapillary proliferative glomerulonephritis, normal to mild leukocyturia (≤12/HPF), and moderate to severe leukocyturia (>12/HPF) were found in 52(41.27%) and 74 (58.73%) patients, respectively. The proportion of moderate to severe leukocyturia, the frequency of urinary white blood cells casts and waxy casts were significantly higher in endocapillary proliferative lupus nephritis patients compared with endocapillary proliferative IgA nephropathy patients (P<0.001, P=0.020, P=0.010, respectively). In the proliferative lupus nephritis group, the levels of leukocyturia was significantly correlated with serum creatinine (r=0.288, P=0.005), eGFR (r=-0.284, P= 0.006), serum C3 (r=-0.275, P= 0.009) , SLEDAI scores (r=0.383, P=＜0.001) and glomerular leukocyte infiltration (r=0.285, P= 0.002). A multivariate analysis showed that leukocyturia was identified as an independent risk factor for renal outcome in proliferative lupus nephritis (HR: 1.456, 95% CI: 1.083-1.957, P=0.013) but not in IgA nephropathy (HR: 1.069, 95% CI: 0.494-2.312, P=0.866).Conclusions: Urinary sediments of the endocapillary proliferative lupus nephritis and endocapillary proliferative IgA nephrology differed in many aspects. Leukocyturia could reflect the disease activity and prognosis of endocapillary proliferative glomerulonephritis, especially in lupus nephritis.
ProfKin: A Comprehensive Web Server for Structure-based Kinase Selectivity Profiling
Authors: Shen Zihao , Yan Yu-Hang , Yang Shuo , Zhu Sang , Yuan Yuan , Qiu Zhiqiang , Jia Huan , Wang Ruiqiong , Li Guo-Bo , Li Honglin
Published: June 2020

Protein kinases are central mediators of signal-transduction cascades and attractive drug targets for therapeutic intervention. Since kinases are structurally and mechanistically related to each other, kinase inhibitor selectivity is often investigated by kinase profiling and considered as an important index for drug discovery. We here describe a versatile web server termed ProfKin for structure-based kinase selectivity profiling, which is based on a kinase-ligand focused database (KinLigDB). It provides all ready-to-use 3D structure coordinates of 4,219 kinase-ligand complex structures covering 297 human kinases and the associated information, particularly including binding site type, binding ligand type, interaction fingerprints, downstream molecules and related human diseases. The web server works via predicting possible binding modes for the query molecule, prioritizing the binding modes guided by an interaction fingerprint analysis method, and giving a list of ranked kinases by a comprehensive index. Users can freely select entire or part of the KinLigDB database, e.g. via subfamily and binding site type, to customize the profiling contents. The superimpositions of the predicted binding poses of the query molecule with reference binding modes can be visually inspected on the website. For each top-ranked kinase, the additional classification attributes and the phylogenetic tree are given simultaneously.