bluuebunny/crossref_metadata_2025 huggingface dataset:
Arthroscopic-assisted Fixation of a Nonunited Coronoid Stress Fracture in a Competitive Gymnast
Authors: Kerl Cameron G. , Chassay Charles M. , Gregory James M.
Published: August 2020

Case:

Gymnasts may suffer elbow injuries due to repetitive loading. However, coronoid stress fractures remain uncommon. We report a case of a high-level female competitive gymnast with a nondisplaced coronoid stress fracture that failed to heal with conservative management. Arthroscopic-assisted in situ fixation of the coronoid nonunion was performed, and the gymnast returned to competition after the fracture healed.

Conclusion:

Coronoid stress fractures should be considered in gymnasts presenting with chronic elbow pain. If nonoperative treatment is unsuccessful, arthroscopic fixation can be successful in stimulating healing of the nonunion without the morbidity of an open approach or bone grafting.
Short-Term Tibial Baseplate Fracture After Total Knee Arthroplasty in the Absence of Osteolysis and Implant Loosening
Authors: Sepehri Aresh , Masri Bassam A
Published: August 2020

Case:

The patient is a 62-year-old man with early tibial baseplate failure involving fracture and subsidence of the posteromedial metal implant, only 3 years after primary total knee replacement. Although this mode of failure is frequently observed secondary to polyethylene wear and osteolysis, this case was likely because of suboptimal tibial baseplate size and positioning with lack of cortical support that underwent accelerated fatigue, given the high activity level of the patient.

Conclusion:

This case demonstrates rare sequelae of inadequate tibial coverage and cortical structural support of the baseplate. Tibial coverage is influenced by implant sizing, implant positioning, and variations in patient anthropometrics.
Randomized controlled clinical trial evaluating the efficacy of hyperbaric oxygen therapy in facilitating the healing of chronic foot ulcers in diabetic patients: the study protocol 
Authors: Lopes Jocefabia Reika Alves , Dias Mariza D’Agostino , Correa João Antonio , Batalha Maria Alice Bragagnolo , Guerra Luanda Karla Dantas
Published: August 2020

Background: Diabetic limb ulcers are highly prevalent and contribute to a significant increase in cost for the treatment of these patients in health services. However, healing of these wounds is a major health problem and may even lead to amputation. The primary aim of the current study is to evaluate the efficacy of hyperbaric oxygen therapy (HBOT) in facilitating the healing of diabetic foot ulcers, in addition to secondarily evaluating whether it reduces the number of amputations and improves the quality of life in these patients.Methods: A non-blind randomised clinical study will be conducted in the city of Imperatriz, Maranhão state, Brazil from 2019 to 2020, in diabetic patients with chronic foot ulcers (classified as Wagner grade 2, 3, and 4, persisting for more than one month). The outpatient follow-up for diabetic foot patients will be done at the Unified Health System, with a sample size of 120 patients (the randomisation allocation will be 1:1, being 60 patients for each arm). Half of the patients will receive standard treatment, i.e. dressings, debridement, antibiotics, and load relief, along with HBOT (HBOT group), and the other half will receive only standard treatment (control group). The patients of the HBOT group will be evaluated upon admission, after 10, 20, 30 and 35 HBOT sessions, and after six months and one year. The patients of the control group will also be evaluated at equivalent periods (upon admission, after 2, 4, 6 and 7 weeks, six months and one year). The SF-36 quality of life questionnaire will be filled upon admission and after three months of follow-up in both groups. The primary and secondary endpoints will be assessed with 1 year of follow-up.Discussion: Diabetic foot ulcers are a highly prevalent complication of diabetes with serious consequences. A study to assess the efficacy of HBOT in healing the ulcers and reducing the rate of amputations in diabetic patients is justified, which will eventually aid in the development of guidelines for treating these ulcers. Trial registration: Registration number RBR-7bd3xy. Registered 17 July 2019 – Retrospectively registered, http://www.ensaiosclinicos.gov.br/rg/RBR-7bd3xy
Harmful Cultural Practices in the Consultation Room: Dutch General Practitioners’ Views and Experiences
Authors: Saharso Sawitri , Dekker Carlijn
Published: August 2020

We discuss Dutch general practitioners’ responses to patients, mostly women of migrant background, with needs related to Harmful Cultural Practices. Our aim was to discover whether they encounter these kind of health issues and how they respond. We suspected that the patients concerned would not get the care they needed. We found that there is reason for concern, as based on general practitioners’ own accounts we conclude that notwithstanding their great commitment to these patients they were disinclined to intervene, because they were cautious to judge other cultures and because they may have over- or underestimated the women’s autonomy.
Quantitative proteomics analysis of FFPE tumor samples reveals the influences of NET-1 siRNA nanoparticles and sonodynamic therapy on tetraspanin protein involved in HCC
Authors: Wu Bolin , Shang Haitao , Liang Xitian , Yang Huajing Yang Huajing , Jing Hui , Li Bo , Cheng Wen
Published: August 2020

Hepatocellular carcinoma (HCC) poses a severe threat to human health. The NET-1 protein has been proved to be strongly associated with HCC proliferation and metastasis in our previous study. Here, we established and validated NET-1 siRNA nanoparticles system to conduct targeted gene therapy of HCC xenograft in vivo with the aid of sonodynamic therapy (SDT). Then, a label-free proteome mass spectrometry workflow to analyze formalin-fixed and paraffin-embedded HCC xenograft samples collected in this study. The result showed that 78 proteins were differentially expressed after NET-1 protein inhibited. Among them, the expression of 61 proteins up-regulated and the expression of 17 proteins were significantly down-regulated. Of the differentially expressed proteins, the vast majority of Gene Ontology enrichment terms belong to the biological process. The KEGG pathway enrichment analysis showed that the 78 differentially expressed proteins significantly enriched in 45 pathways. We concluded that the function of the NET-1 gene is not only to regulate HCC but also to participate in a variety of biochemical metabolic pathways in the human body. Furthermore, the protein-protein interaction analysis indicated that the interactions of differentially expressed proteins are incredibly sophisticated. All the protein-protein interactions happened after the NET-1 gene has been silenced. Finally, our study also provides a useful proposal for targeted therapy based on tetraspanin proteins to treat HCC, and further mechanism investigations are needed to reveal a more detailed mechanism of action for NET-1 protein regulation of HCC.
Comparative transcriptomic profiling of myxomatous mitral valve disease in the Cavalier King Charles Spaniel
Authors: Markby Greg , Macrae Vicky , Corcoran Brendan , Summers Kim
Published: August 2020

Background. Almost all elderly dogs develop myxomatous mitral valve disease by the end of their life, but the Cavalier King Charles Spaniel (CKCS) has a heightened susceptibility, frequently resulting in death at a young age and suggesting that there is a genetic component to the condition in this breed. Transcriptional profiling can reveal the impact of genetic variation through differences in gene expression levels. The aim of this study was to determine whether expression patterns were different in mitral valves showing myxomatous degeneration from CKCS dogs compared to valves from non-CKCS dogs. Results. Gene expression patterns in three groups of canine valves resulted in distinct separation of normal valves, diseased valves from CKCS and diseased valves from other breeds; the latter were more similar to the normal valves than were the valves from CKCS. Gene expression patterns in diseased valves from CKCS dogs were quite different from those in the valves from other dogs, both affected and normal. Patterns in all diseased valves (from CKCS and other breeds) were also somewhat different from normal non-diseased samples. Analysis of differentially expressed genes showed enrichment in GO terms relating to cardiac development and function and to calcium signalling canonical pathway in the genes down-regulated in the diseased valves from CKCS, compared to normal valves and to diseased valves from other breeds. F2 (prothrombin) (CKCS diseased valves compared to normal) and MEF2C pathway activation (CKCS diseased valves compared to non-CKCS diseased valves) had the strongest association with the gene changes. A large number of genes that were differentially expressed in the CKCS diseased valves compared with normal valves and diseased valves from other breeds were associated with cardiomyocytes including CASQ2, TNNI3 and RYR2. Conclusion. Transcriptomic profiling identified gene expression changes in CKCS diseased valves that were not present in age and disease severity-matched non-CKCS valves. These genes are associated with cardiomyocytes, coagulation and extra-cellular matrix remodelling. Identification of genes that vary in the CKCS will allow exploration of genetic variation to understand the aetiology of the disease in this breed, and ultimately development of breeding strategies to eliminate this disease from the breed.
The views of health guideline developers on the use of automation in health evidence synthesis
Authors: Arno Anneliese Downey , Elliott Julian , Wallace Byron , Turner Tari , Thomas James
Published: August 2020

Background: The increasingly rapid rate of evidence publication has made it difficult for evidence synthesis – systematic reviews and health guidelines -- to be continually kept up to date. One proposed solution for this is the use of automation in health evidence synthesis. Guideline developers are key gatekeepers in the acceptance and use of evidence, and therefore their opinions on the potential use of automation are crucial. Methods: The objective of this study was to analyze the attitudes of guideline developers towards the use of automation in health evidence synthesis. The Diffusion of Innovations framework was chosen as an initial analytical framework because it encapsulates some of the core issues which are thought to affect the adoption of new innovations in practice. This well-established theory posits five dimensions which affect the adoption of novel technologies: Relative Advantage, Compatibility, Complexity, Trialability, and Observability.Eighteen interviews were conducted with individuals who were currently working, or had previously worked, in guideline development. After transcription, a multiphase mixed deductive and grounded approach was used to analyze the data. First, transcripts were coded with a deductive approach using Rogers’ Diffusion of Innovation as the top-level themes. Second, sub-themes within the framework were identified using a grounded approach.Results: Participants were consistently most concerned with the extent to which an innovation is in line with current values and practices (i.e. Compatibility in the Diffusion of Innovations framework). Participants were also concerned with Relative Advantage and Observability, which were discussed in approximately equal amounts. For the latter, participants expressed a desire for transparency in methodology of automation software. Participants were noticeably less interested in Complexity and Trialability, which were discussed infrequently. These results were reasonably consistent across all participants. Conclusions: If machine learning and other automation technologies are to be used more widely and to their full potential in systematic reviews and guideline development, it is crucial to ensure new technologies are in line with current values and practice. It will also be important to maximize the transparency of the methods of these technologies to address the concerns of guideline developers.
Health literacy in context: struggling to self-manage diabetes. A longitudinal qualitative study
Authors: Debussche Xavier , Balcou-Debussche Maryvette , Ballet Delphine , Caroupin-Soupoutevin Jessica
Published: August 2020

ObjectiveConsidering health literacy is a key element for health service responsiveness to self-management needs in diabetes. This qualitative study aimed to provide a detailed analysis of the health literacy of people with type 2 diabetes in relation to their daily self-care practices.MethodsInterviews (n=86) were conducted as part of the qualitative study ERMIES-ethnosocio, at the beginning and at the end of a structured educational care. The interviews focused on food practices, exercise, treatment, relationship to health information and professionals.ResultsThree poles structured into eight themes characterized practices in context: health knowledge, disease management, expertise and social support. The relationships of participants in each of the eight themes were differentiated, ranging from functional to interactive and critical. Treatment and follow-up were essentially functional, while diet and exercise remained more interactive. Social support and relationship to health professionals were important determinants of disease management. Conclusion and Practice implicationsTreatment management and disease monitoring remain primarily the job of health professionals, as opposed to diet, physical activity and social support being part of ordinary practice. Decision-making, as a shared social task, as well as resources for participation in health services, should be considered for relevant interventions in type 2 diabetes.
Analysis of operation procedure and effect for emergency surgery in general hospital during novel coronavirus pneumonia period
Authors: Liu Yuchen , Wang Minggang , Shen Yingmo , Chen Jie
Published: August 2020

Background Novel coronavirus pneumonia(NCP) outbreak in Wuhan, China in early 2020, resulted in over 80 thousand infections in China. At present, NCP has an explosive growth in the world. Surgeons could refuse selective operation during the outbreak, but they must face the emergency operation. We hope to avoid the spread of NCP while ensuring efficient treatment of emergency cases. Methods The data of patients with incarcerated hernia admitted to Beijing Chaoyang Hospital during NCP epidemic were analyzed and compared with those in 2019. All cases were divided into NCP group and 2019 group. The operation data and inpatient protection process of emergency cases were analyzed. Result During the NCP epidemic, 17 cases with incarcerated hernia were treated in our department. A Total of 263 cases of the same disease were admitted in 2019. There was no significant difference in age, gender, BMI and hernia type between two groups. No significant difference was observed between the two groups in operation method and hospital stay. The waiting time for emergency operation of NCP group was significantly longer than that of 2019 group (P=0.002). A buffer ward was set up by administrator of hospital during NCP outbreak. Hospitals were divided into "Red area, Yellow area and Green area" artificially, and strict screening consultation system was implemented. There was no case of SARS-nCoV-2 infection in medical staff. Conclusion It was safe and effective to carry out emergency operation on the premise of screening, protection and isolation during the NCP epidemic. The increased waiting time for operation due to NCP screening did not threaten medical safety of emergency incarcerated hernia patients.
Impact of lockdown on Covid-19 Case Fatality Rate and Viral Mutations Spread in 7 Countries in Europe and North America.
Authors: Pachetti Maria , Marini Bruna , Giudici Fabiola , Benedetti Francesca , Angeletti Silvia , Ciccozzi Massimo , Masciovecchio Claudio , Ipprodrino Rudy , Zella Davide
Published: August 2020

Background: Severe acute respiratory syndrome CoV-2 (SARS-CoV-2) caused the first coronavirus disease 2019 (COVID-19) outbreak in China and has become a public health emergency of international concern. SARS-CoV-2 outbreak has been declared a pandemic by WHO on March 11th, 2020 and the same month several Countries put in place different lockdown restrictions and testing strategies in order to contain the spread of the virus. Methods: The calculation of the Case Fatality Rate of SARS-CoV-2 in the Countries selected was made by using the data available at https://github.com/owid/covi-19-data/tree/master/public/data. Case fatality rate was calculated as the ratio between the death cases due to COVID-19, over the total number of SARS-CoV-2 reported cases 14 days before. Standard Case Fatality Rate values were normalized by the Country-specific ρ factor, i.e. the number of PCR tests/1 million inhabitants over the number of reported cases/1 million inhabitants. Case-fatality rates between Countries were compared using proportion test. Post-hoc analysis in the case of more than two groups was performed using pairwise comparison of proportions and p-value was adjusted using Holm method.We also analyzed 487 genomic sequences from the GISAID database derived from patients infected by SARS-CoV-2 from January 2020 to April 2020 in Italy, Spain, Germany, France, Sweden, UK and USA. SARS-CoV-2 reference genome was obtained from the GenBank database (NC_045512.2). Genomes alignment was performed using Muscle and Jalview software. We, then, calculated the Case Fatality Rate of SARS-CoV-2 in the Countries selected. Results: In this study we analyse how different lockdown strategies and PCR testing capability adopted by Italy, France, Germany, Spain, Sweden, UK and USA have influenced the Case Fatality Rate and the viral mutations spread. We calculated case fatality rates by dividing the death number of a specific day by the number of patients with confirmed COVID-19 infection observed 14 days before and normalized by a ρ factor which takes into account the diagnostic PCR testing capability of each Country and the number of positive cases detected. We notice the stabilization of a clear pattern of mutations at sites nt241, nt3037, nt14408 and nt23403. A novel nonsynonymous SARS-CoV-2 mutation in the spike protein (nt24368) has been found in genomes sequenced in Sweden, which enacted a soft lockdown strategy.Conclusions: Strict lockdown strategies together with a wide diagnostic PCR testing of the population were correlated with a relevant decline of the case fatality rate in different Countries. The emergence of specific patterns of mutations concomitant with the decline in case fatality rate needs further confirmation and their biological significance remains unclear.
The Effect of Atrovastatin on Inflammatory Markers in Sulfur Mustard Gas Induced Bronchitis; A Randomized Double-Blinded, Placebo-Controlled Clinical Trial
Authors: Momeni Behrooz , Nazer Saeed , Masoompour Seyed Masoom , Geramizadeh Bita , Sajadi Seyed Vahid
Published: August 2020

Background: This study was conducted to evaluate the anti-inflammatory effect of atorvastatin in patients with chronic bronchitis due to sulfur mustard gas inhalation. Methods: In this randomized double-blinded clinical trial we enrolled patients with chronic bronchitis due to sulfur mustard gas inhalation. Ninety man aged between 45 to 75 years with diagnosed of chronic bronchitis due to exposure to mustard gas during the Iran-Iraq war, were randomly assigned to receive either atorvastatin (40 mg) or placebo, given orally once a day for 3 months. The interleukin 6 (IL-6), tumor necrosis factor α (TNF-α), procalcitonin, highly sensitive CRP, and COPD assessment test (CAT) score in both groups compared with each other and baseline data. Results: After 12 weeks of using atorvastatin (n=40), the level IL-6 decreased significantly (p=0.03) without any significant differences in the level of TNF-α, high sensitive CRP, and procalcitonin (P=0.31, p=0.78, and p=0.08). In placebo group (n=38), both procalcitonin and IL-6 significantly decreased after 12 weeks (P=0.002 and p<0.001), but levels of high sensitive CRP did not differ significantly and the level of TNF-α increased (p=0.006). The mean differences in levels of TNF- α, IL-6, high sensitive CRP, and procalcitonin did not differ statistically significant between the study groups after 12 weeks. Although after 12 weeks of study in both groups the CAT score have had appreciably high magnitude decrease (P<0.001), but its mean differences change wasn't significant between group (P=0.71). Conclusions: Administration of 40 mg atorvastatin for 3 months although could not significantly change systemic inflammatory markers or quality of life in mustard gas induced chronic bronchitis.Trial registration: IRCT, IRCT138904144312N1. Registered 16 August 2014, https://en.irct.ir/trial/4577
The Status and Associated Factors of Early Childhood Caries among 3- to 5-year-old Children in Guangdong, Southern China: A Provincial Cross-sectional Survey
Authors: Li Jianbo , Fan Weihua , Zhou Yueshan , Wu Linmei , Liu Wei , Huang Shaohong
Published: August 2020

Background: Dental caries of deciduous teeth (Early Childhood Caries, ECC) has become a crucial oral health problem over the decades in China. The aim of this study was to examine the prevalence and severity of ECC among preschool children from Guangdong Province, Southern China. In addition, to assess the association of ECC with reported oral health-related behaviors.Methods: A cross-sectional survey of 2592 participants was carried out in Guangdong Province by means of an equal-sized, stratified, multistage random sampling method during December 2015 and April 2016. The participants were divided into three groups according to their ages (3-, 4-, and 5-year-olds). Half of the participants were derived from urban areas, while the other from rural areas. According to the standard for clinical dentition examination of the WHO 2013 criteria, the presence of ECC was determined by the dmft (decayed-missing-filled tooth) index using a CPI (Community Periodontal Index) probe. A questionnaire about caries-related factors was completed by each of the participants’ parents or grandparents through a face-to-face and one-on-one interview. Then, t-test, Chi2 tests, One-Way ANOVA served for statistical analysis, and logistic regression analysis as well as covariance analysis were executed to identify potential associated factors for ECC.Results: The prevalence (% dmft >0) of ECC was 68.3 (95% CI: 66.5-70.1), the mean dmft was 4.36 (95% CI: 4.17-4.55), and the filled rate was 1.2%. In multivariable modeling, associated factors for both prevalence and mean dmft were older age, rural areas, consumption of sweets before sleep, dental visit history, low household income, and low parental education level. Initiating toothbrushing after 3 years of age and being exclusively/ predominantly breastfed indicated only the prevalence; being female and frequently consuming sweetened milk/powdered milk indicated only the mean dmft.Conclusions: Preschool children in Guangdong Province, especially children from rural areas, experienced a significant amount of ECC. Associated factors for ECC included demographics, oral health measures, dietary factors, and socioeconomic factors. More attention should be given to prevention of ECC from early life. The construction of social support for oral health should be strengthened. Oral health education and promotion, especially of rural areas, should be intensified to reduce the inequality between urban and rural areas.
microRNA-214 prevents traits of cutaneous squamous cell carcinoma via VEGFA and Bcl-2
Authors: Ma Xianpeng , Wu Di , Zhang Xiaodong , Shao Xiao , Hu Guangyao
Published: August 2020

The authors have withdrawn this preprint due to erroneous posting.
Prevalence of temporomandibular disorder in children and adolescents with juvenile idiopathic arthritis – a Norwegian cross-sectional multicentre study
Authors: Fischer Johannes , Skeie Marit Slåttelid , Rosendahl Karen , Tylleskär Karin , Lie Stein Atle , Shi Xieqi , Gil Elisabeth Grut , Cetrelli Lena , Halbig Josefine , Marti Larissa von Wangenheim , Rygg Marite , Frid Paula , Stoustrup Peter , Rosén Annika
Published: August 2020

Background. Children and adolescents with juvenile idiopathic arthritis (JIA) may suffer pain from temporomandibular disorder (TMD). Still, routines for the assessment of temporomandibular joint (TMJ) pain in health and dental care are lacking. The aims of this study were to examine the prevalence of TMD in children and adolescents with JIA compared to their healthy peers and to investigate potential associations between JIA and TMD. Methods. This comparative cross-sectional study is part of a longitudinal multicentre study performed during 2015–2020, including 228 children and adolescents aged 4–16 years with a diagnosis of JIA according to the ILAR criteria. This particular substudy draws on a subset of data from the first study visit, including assessments of TMD as part of a broader oral health examination. Children and adolescents with JIA were matched with healthy controls according to gender, age, and centre site. Five calibrated examiners performed the clinical oral examinations according to a standardised protocol, including shortened versions of the diagnostic criteria for TMD (DC/TMD) and the former EuroTMJoint Recommendations for Clinical TMJ Assessment in Patients Diagnosed with JIA. Symptoms were recorded and followed by a clinical examination assessing the masticatory muscles and TMJs. Results. In our cohort of 221 participants with JIA and 221 healthy controls, 88 (39.8%) participants with JIA and 25 (11.3%) healthycontrols presented with TMD based on symptoms and clinical signs. Painful TMD during the last 30 days was reported in 59 (26.7%) participants with JIA vs. 10 (5.0%) of the healthy controls (p < 0.001). Vertical unassisted jaw movement was lower in participants with JIA than in controls, with means of 46.2 mm vs. 49.0 mm, respectively (p < 0.001). Among participants with JIA, a higher proportion of those using synthetic disease-modifying antirheumatic-drugs and biologic disease-modifying antirheumatic-drugs presented with painful masticatory muscles and TMJs at palpation.Conclusion. Symptoms and clinical signs of TMD were seen in approximately half of the JIA patients compared to about one fourth of their healthy peers. Painful palpation to masticatory muscles and decreased vertical unassisted jaw movement were more frequent in participants with JIA than among healthy controls and should be part of both medical and dental routine examinations in patients with JIA.
Right Atrial Aneurysm with Supraventricular Tachycardia and Frequent Atrial Premature: A Case Report
Authors: Chen Yuyuan , Wang Bin , Fang Ling-yun , Yang Si , Yi Aijiao
Published: August 2020

Background: Right atrial aneurysm (RAA) is a rare form of congenital heart disease with a wide range of clinical presentation varying from asymptomatic patients to those with refractory atrial arrhythmias. Diagnosis is often confused with other causes of right atrial dilation such as Ebstein disease or idiopathic right atrial enlargement. Case presentation: We present the case of right atrial aneurysm with supraventricular tachycardia and frequent atrial premature in our institution and discuss the diagnostic challenges, the research progress of right atrial aneurysm and follow-up situation. Conclusion: RAA should be considered in the differential diagnosis of RA enlargement. Accurate diagnosis can be achieved by echocardiograph, and our report also highlights the importance of longitudinal follow-up of RAA over 5 years and the long-term regular conservative treatment for patients with supraventricular tachycardia and frequent atrial premature could be useful.
Predicting COVID-19 Disease Progression and Patient Outcomes based on Temporal Deep Learning
Authors: Sun Chenxi , Hong Shenda , Song Moxian , Wang Zhenjie , Li Hongyan
Published: August 2020

Background: The coronavirus disease 2019 (COVID-19) pandemic has caused health concerns worldwide since December 2019. From the beginning of infection, patients will progress through different symptom stages, such as fever, dyspnea or even death. Identifying disease progression and predicting patient outcome at an early stage helps target treatment and resource allocation. However, there is no clear COVID-19 stage definition, and few studies have addressed characterizing COVID-19 progression, making the need for this study evident.Methods: We proposed a temporal deep learning method, based on a time-aware long short-term memory (T-LSTM) neural network and used an online open dataset, including blood samples of 485 patients from Wuhan, China, to train the model. Specifically, our method predicted the outcome of COVID-19 patients by T-LSTM, considering both the biomarkers and the irregular time intervals. Then, we used the patient representations, extracted from T-LSTM units, to subtype the patient stages and describe the disease progression of COVID-19.Results: Using our method, the accuracy of the outcome of prediction results was more than 90% at 12 days and 98%, 95% and 93% at 3, 6, and 9 days, respectively. Most importantly, we found 4 stages of COVID-19 progression, with different patient statuses and risks, such as mortality and length of illness. Predicting which of the 4 stages the patient is currently in can help doctors better assess and cure the patient. Conclusions: To combat the COVID-19 epidemic, this paper aims to help clinicians better assess and treat infected patients, provide relevant researchers with potential disease progression patterns, and enable more effective use of medical resources. Our method predicted patient outcomes with high accuracy and identified a four-stage disease progression. We hope that the obtained results and patterns will aid in fighting the disease.
Differences of tensile strength in knot tying technique between orthopaedic surgical instructors and trainees
Authors: Harato Kengo , Yagi Mitsuru , Kaneda Kazuya , Iwama Yu , Masuda Akihiko , Kaneko Yosuke , Oya Akihito , Matsumura Noboru , Suzuki Taku , Nakayama Robert , Kobayashi Shu
Published: August 2020

Background: Knot tying technique is an extremely important basic skill for all surgeons. Clinically, knot slippage or suture breakage will lead to wound complications. Although some previous studies described the knot-tying technique of medical students or trainees, little information had been reported on the knot-tying technique of instructors. The objective of the preset study was to assess surgeons’ manual knot tying techniques and to investigate the differences of tensile strength in knot tying technique between surgical instructors and trainees. Methods: A total of 48 orthopaedic surgeons (postgraduate year: PGY 2-18) participated. Surgeons were requested to tie surgical knots manually using same suture material. They were divided into two groups based on each career; instructors and trainees.　Although 4 open conventional knots with 4 throws were chosen and done with self-selected methods, knot tying practice to have the appropriate square knots was done as education only for trainees before the actual trial. The knots were placed over a 30 cm long custom made smooth polished surface with 2 cylindrical rods. All knots were tested for tensile strength using a tensiometer. The surgical loops were loaded until the knot slipped or the suture broke. The tensile strength of each individual knot was defined as the force (N) required to result in knot failure. Simultaneously, knot failure was evaluated based on knot slippage or suture rupture. In terms of tensile strength or knot failure, statistical comparison was performed between groups using two-tailed Mann-Whitney U test or Fisher exact probability test, respectively. Results: Twenty-four instructors (PGY6- PGY18) and 24 trainees (PGY2-PGY5) were enrolled. Tensile strength was significantly greater in trainees (83.0 ± 27.7N) than in instructors (49.9 ± 34.4N, P=0.0246). The ratio of slippage was significantly larger in instructors than in trainees (P<0.001). Knot slippage (31.8 ± 17.7N) was significantly worse than suture rupture (89.9 ± 22.2N, P<0.001) in tensile strength. Conclusions: Mean tensile strength of knots done by trainees after practice was judged to be greater than that done by instructors in the present study. Clinically, knot slippage can lead to wound dehiscence, compared to suture rupture.
Visual outcomes and complications following One-way Air-fluid exchange technique for vitreous hemorrhage post vitrectomy in proliferative diabetic retinopathy patients
Authors: Wang Qun , Zhao Jie , Xu Qing , Han Cui , Hou Baojie , Huang Yifei
Published: August 2020

Background
To evaluate the efficacy and outcomes following one-way surgical technique for the treatment of vitreous hemorrhage post vitrectomy in proliferative diabetic retinopathy (PDR) patients.
Methods
Those PDR patients who had vitrectomy with balance saline tamponade and then developed vitreous hemorrhage post vitrectomy were included in this study. 47 patients underwent the one-way air-fluid exchange surgical procedure with a 10 ml syringe used to exchange between 4.5–5.5 ml of fluid in the treatment room. After the air-fluid surgical exchange procedure, additional treatments were administered when needed. Best corrected visual acuity (BCVA) and occurrence of intra-procedural and post-procedural complications were collected and analyzed.
Results
A total of 47 eyes of 47 PDR patients with a mean age of 50.8 ± 12.0 years were reviewed. All 47 eyes had undergone vitrectomy with balance saline tamponade because of PDR. 4 of them were diagnosed with type 1 diabetes mellitus (T1DM), and 43 of them were diagnosed with type 2 diabetes mellitus (T2DM). All the 47 eyes were given the one-way air-fluid exchange procedure in the treatment room. In 4 cases the procedure was administered twice, and in 1 case the procedure was administered three times, followed by additional retinal photocoagulation and one intravitreal injection of Conbercept. The BCVA at the final follow-up was significantly improved from the initial acuity baseline in all cases. No complications were observed during the follow-ups.
Conclusion
This one-way air-fluid exchange procedure could effectively exchange the vitreous hemorrhage and improve visual acuity without obvious complications in treating vitreous hemorrhage post vitrectomy.
Morphological Characterization and Genetic Diversity Analysis of a Tunisian Durum Wheat (Triticum Turgidum Var. Durum) Collection
Authors: Ouaja Maroua , Bahri Bochra Amina , Aouini Lamia , Ferjaoui Sahbi , Medini Maher , Marcel Thierry , Hamza Sonia Mihed
Published: August 2020

Background: Tunisia is a center of genetic diversity of durum wheat and has a large number of abandoned old local landraces. An accurate investigation and characterization of the morphological and genetic features of these landraces would allow their rehabilitation and use for practical and beneficial purposes. In this context, a collection of 304 local accessions of durum wheat, collected from five regions and three climatic zones of central and southern Tunisia, was studied. Results: Morphological characterization was carried out using 12 spike-related traits and rendered a mean Shannon-Weaver Index (H') of 0.80 indicating the presence of a high level of polymorphism among accessions. Based on these traits 11 local landraces, namely Mahmoudi, Azizi, Jneh Khotifa, Mekki, Biskri, Taganrog, Biada, Badri, Richi, Roussia and Souri were identified. Spike length (H’=0.98) and shape (H’=0.86) with grains size (H’=0.94), form (H’=0.87) and color (H’=0.86) were the most polymorphic morphological traits. The genetic diversity was assessed using 10 SSR markers, with a polymorphic information content (PIC) of 0.69. Levels of genetic diversity were generally high, with a Shannon's Information Index (I) of 0.62 and a gene diversity (He) of 0.35. In addition, population structure analysis distinguished 11 genetic groups resulted from STRUCTURE and Mantel test showed a significant correlation between genetic and morphological distances. Analysis of molecular variance (AMOVA) showed high genetic variations within regions (81%) and wheat subpopulations (41%) showing a considerable amount of admixture between landraces realized by farmers; as well as a moderate (19%) and high (59%) genetic variations among regions and wheat subpopulations, indicating practices of selection pressure conducted by farmers. The Mahmoudi landrace showed spike densities significantly different between the center to the south of Tunisia; notably loose spikes with open glumes in the south and compact ones in the center, which may represent an adaptation form for tolerance to high temperature. Conclusion: Overall, this study highlights the genetic richness of local resources for better in situ or ex situ conservation and for their subsequent use in plant breeding programs.
The first biological choice in patients with rheumatoid arthritis: data from the Moroccan register of biotherapies
Authors: Eddaoudi Meryem , Rostom Samira , Hmamouchi Ihsane , Binoune Imane El , Amine Bouchra , Abouqal Redouane , Achemlal Lahcen , Allali Fadoua , Bouchti Imane El , Maghraoui Abdellah El , Ghozlani Imad , Hassikou Hasna , Harzy Taoufik , Ichchou Linda , Mkinsi Ouafa , Niamane Redouane , Bahiri Rachid
Published: August 2020

Background: The aim of our study is to determine, from data of the Moroccan register of biotherapies, the factors influencing the choice of the first prescribed biological treatment.Methods: Cross-sectional multicenter study including rheumatoid arthritis patients who were initiated the first biological treatment either: Rituximab, an anti-TNF, or Tocilizumab. The determinants related to the patient and disease have been gathered. A univariate and then multivariate analysis to determine the factors associated with the choice of the first bDMARDs was realized.Results: A total of 225 rheumatoid arthritis patients were included in the Moroccan registry. The mean age was 52 ± 11 years, with female predominance 88% (n = 197). The first prescribed biological treatment was Rituximab 74% (n = 166), the second one was Tocilizumab, 13.6% (n = 31) then comes the anti-TNF in 3rd position with 12.4% (n = 28). The factors associated with the choice of Rituximab as the first line bDMARDs prescribed in univariate analysis were: the insurance type, the positivity of the rheumatoid factor. In multivariate analysis, only the insurance type that remains associated with the choice of Rituximab as the first biological drugs. The Tocilizumab was associated with shorter disease duration and was more prescribed as mono-therapy compared to non Tocilizumab group. TNFi was associated with the insurance type.Conclusion: Our study suggests that Rituximab and TNFi are associated with the type of insurance and Tocilizumab is the most prescribed biologic mono-therapy in RA patients. Further studies are needed to confirm these results.
Correlation of pain with Substance P and neurokinin-1 receptor in the L5-S2 spinal cord in rats with chronic nonbacterial prostatitis
Authors: Hao Liya , Zhang Junfeng , Bai Xianguang , Liu Li , Qi Jinxu , Wang Zhonglin , Zhang Wanjie , Zuo Yubin , Zheng Xinhua
Published: August 2020

BackgroundTo investigate the correlation of the pain with the expression of SP and NK-1R in the posterior horn of the L5-S2 spinal cord in a rat model of chronic nonbacterial prostatitis (CNP) at different time points of modeling. MethodsForty adult male SD rats were randomly divided into four equal groups: control group, 45 day (d) group, 60 d group, and 90 d group, and proteins were obtained from the prostatic tissue of another 30 rats. The CNP model was established by intraperitoneal injection of 0.5 mL diazepam vaccine and intradermal injection of a mixed solution of 1 mL prostatein extract and complete adjuvant at a 1:1 ratio. The control group rats were injected with the same volume of normal saline. At 45, 60, and 90 days after modeling, we measured the paw withdrawal threshold (PWT) of the rats, detected the level of TNF-α, IL-1ß, IL-2, and IL-10 in the prostate tissues by ELISA, observed the histomorphological changes in the prostate by transmission electron and light microscopy, and detected the expression of SP and NK1-R in the L5-S2 spinal cord by immunohistochemistry. ResultsThe levels of TNF-α, IL-1ß, IL-2, and IL-10 in the prostate tissue were markedly higher in the CNP models than those in the control group(all P<0.05); this difference was Most significant at 90 days (all P<0.05). Immunohistochemistry showed that the expressions of SP and NK-1R were remarkably higher in the CNP model groups than in the control (all P<0.05), with the highest expression found at 90 days. Light microscopy revealed no inflammatory cell infiltration in the prostate tissue of the control rats, and obvious edema and increased lymphocyte count were observed as the duration of modeling increased. Transmission electron microscopy showed inflammatory changes in the prostate tissue of the model rats; peritubular interstitial edema was most obvious at 90 days, with widened gaps between the peritubular cells and epithelial base and increased numbers of fibroblasts and collagen fibrils. ConclusionThere was a correlation between the pain and the expressions of SP and the NK-1R in the L5-S2 spinal cord of the rats.
Effects of Sevoflurane and Propofol on the Optic Nerve Sheath Diameter in Patients Undergoing Laparoscopic Gynecological Surgery: A Randomized Controlled Clinical Studies 
Authors: Geng Weilian , Chen Changxing , Sun Xingfeng , Huang Shaoqiang
Published: August 2020

Background The results of studies on changes in intracranial pressure in patients undergoing laparoscopic surgery are inconsistent. Meanwhile, previous neurosurgery studies have suggested that propofol and sevoflurane have inconsistent effects on cerebral blood flow and cerebrovascular self-regulation. The purpose of this study is to compare changes in the optic nerve sheath diameter in patients undergoing laparoscopic gynecological surgery under anesthetic maintenance with propofol versus sevoflurane. Methods This study included 110 patients undergoing laparoscopic gynecological surgery with an estimated operative time of more than 2 hours under general anesthesia. The study was a randomized controlled study. The ONSD at various time points was measured by ultrasound, including when the patients entered the operating room (Tawake), after successful anesthesia induction and endotracheal intubation (Tinduction), when the body position was adjusted to the Trendelenburg position and the CO2 pneumoperitoneum pressure reached 14 mmHg, which was recorded as T0. Then, measurements were conducted every 15 minutes for first 1 hour and then once every hour until the end of the surgery（T15,T30,T45 ,T1h ,T2h…）, after end of surgery and the tracheal tube was removed (Tend), and before the patients were transferred to the ward (Tpacu).Results A significant difference in optic nerve sheath diameter was found between two groups at T15, T30, T45 (4.64±0.48mm and 4.50±0.29mm, respectively, p =0.031; 4.77±0.45mm and 4.62±0.28mm, respectively, p =0.036; 4.84±0.46mm and 4.65±0.30mm, respectively, p =0.012), while no significant difference at Tawake and other time points. Conclusion During laparoscopic gynecological surgery lasting more than 2 hours, the optic nerve sheath diameter gradually increased with establishment of the CO2 pneumoperitoneum and patient placement in the Trendelenburg position in both sevoflurane group and propofol group and returned to baseline 1 hour after surgery. No significant difference was observed between the two groups 1 hour after surgery. Trial registration clinicaltrials.gov，NCT03498235. Retrospectively registered 1 March2018,https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S0007UMM&selectaction=Edit&uid=U00040C5&ts=39&cx=c7i8icThe manuscript adheres to CONSORT guidelines.
Testing Attitudes, Social Desirability and Behavioral Regulations as Moderators of Implicit-Explicit Exercise Cognition Discrepancies in Iranian Students
Authors: Berry Tanya , Taymoori Parvaneh , Shirzadi Kohestan , Pashaei Tahereh , Bahamani Afshin
Published: August 2020

The authors have withdrawn this preprint due to author disagreement.
Supporting Women With Mild to Moderate Anxiety in Pregnancy: a Feasibility Study of a Midwife Facilitated Intervention
Authors: Evans Kerry , Morrell Jane , Spiby Helen
Published: August 2020

Aim: The aim of the study was to determine the acceptability and feasibility of an intervention to support women with mild to moderate anxiety in pregnancy.Design: The intervention development and feasibility testing followed the MRC guidelines for complex interventions. A feasibility study was conducted between April - May 2016.Methods: Qualitative and quantitative data were collected to assess the acceptability and feasibility of the intervention. The intervention was delivered in three components: pre-group individual meeting with the midwife; group sessions; guided self-help resources. The intervention was facilitated by midwives and co-facilitated by midwifery support workersResults: Eight women with self-reported symptoms of mild to moderate anxiety participated in the study. Women reported an improvement in anxiety symptoms and felt they had benefitted from participation. Accessing social support from other women in similar circumstances had helped women to feel less isolated and facilitated open and honest discussions. Women valued the involvement of the midwife facilitator to support their wellbeing and provide specific advice about their pregnancies.Conclusions: The intervention design appeared to be acceptable and beneficial for this group of women. This study highlights the potential for midwives to facilitate supportive interventions to enhance the current provision of emotional support for women with anxiety symptoms in pregnancy and address the current gap in services. The intervention is potentially feasible for introduction into current clinical practice with minimal additional resources.