bluuebunny/crossref_metadata_2025 huggingface dataset:
Coronavirus Disease 2019 Knowledge Acquisition and Retention: a Flipped Classroom Based on Micro-learning Combined with Case-based Learning in Interns
Authors: Qian Qiaohui , Zhao Jiangxia , Xue Fei , Zhang Fengjiao
Published: July 2020

Background:Since medical school affiliated hospitals suspended the internship rotation during Coronavirus Disease 2019 (COVID-19) pandemic period in China. Determining an effective and available approach for interns learning new disease knowledge becomes an important challenge in affiliated hospitals. We explored a blended learning approach, a flipped classroom based on micro-learning combined with CBL, in interns learning COVID-19 knowledge using prospective randomized study.Methods: During COVID-19pandemic period in China, 74 final-year undergraduate interns who were scheduled to rotatein our affiliated hospital in academicyear 2019-2020were randomized to a flipped classroomor standard classroomwith 37 participants in each classroomgroup during a 120-minute live online COVID-19curriculum utilizing the same Network Teaching Platform provided by our university. The standard classroom group utilized traditional lecture, while the flipped classroom group applied micro-learningcombined with CBL.We compared the effect of both formats on COVID-19knowledge acquisition and the impact onclinical practice attitude.Results: All 74 interns (100%) responded pretest, posttest and retention test, and completed the questionnaire online. Both formats significantlyimproved COVID-19 knowledge acquisitionat the conclusion of online COVID-19 curriculum.Interns’ knowledge test scores including total score and scores of five knowledge dimensions ofCOVID-19were significantly higher in the flipped classroomgroup than those in the standard classroomgroup (P<0.05). Compared with interns in the standard classroom group, interns in theflipped classroomgroup performed better in retention test and hada significantly more positive clinical practice attitude(P<0.05 in all items).Conclusions: A flipped classroom based on micro-learning combined with CBL showed greater effectiveness in COVID-19knowledge gainin final-year undergraduate interns and made their attitude toward clinical practice more positive.
Multiple-Choice Questions in Preclinical and Clinical Phase Examination for Undergraduate Medical Program in a Malaysian Medical School: A 2-Year Analysis
Authors: Adam Siti Khadijah , Idris Faridah , Kassim Puteri Shanaz Jahn , Zakaria Nor Fadhlina , Hod Rafidah
Published: July 2020

Background: Multiple-choice questions (MCQs) are used in measuring the student’s progress and post-examination analysis is usually done to guarantee the item’s appropriateness for question banking. Item analysis is a simple and effective method to determine the quality of MCQs by using three parameters; difficulty or passing index (PI), discrimination index (DI) and distractor efficiency (DE). Methods: This study analysed the MCQs in the preclinical and clinical examinations in Doctor of Medicine program of Universiti Putra Malaysia. Forty MCQs consisted of four options each in the preclinical examination and 80 MCQs with five options from the clinical examination paper in 2017 and 2018 were analysed and compared. Results: The mean DI was similar in all examinations, except a significant reduction in 2018 clinical examination. From 2017 and 2018, preclinical MCQs showed an increment in the number of ‘excellent’ and ‘good’ items. However, clinical papers showed reduction in DI due to high number of ‘poor’ questions. Comparing both years, there was an increase in the number of items with no non-functioning distractors in both examinations. Among all, preclinical MCQs in 2018 showed the highest mean of DE as compared to the others.Conclusion: Our findings suggested that item authors from preclinical phase showed an improvement in constructing good quality MCQs while clinical phase authors may need more training and continuous feedback. Higher number of options did not affect the level of difficulty of a question however the discrimination power and effectiveness of distractors might differ.
Professional Development Arising from Multiple-Site Workplace Learning: Boundary Crossing Between the Education and Clinical Contexts.
Authors: Barry Margot , Kuijer-Siebelink Wietske , Niewenhuis Loek A.F.M. , Scherpbier Nynke
Published: July 2020

Background: This research explores the value of an inter-organisational jurisdiction, on the professional development of faculty members in their roles of researcher and educator. Faculty members from a Dutch university of applied sciences, who work in both the education and clinical practice contexts, participated in this research. Methods: Individual semi-structured interview were conducted with nine faculty members, from various academic health professions, on their experiences of professional development arising from working in both the clinical and education contexts. In this exploratory, post-positive interview study, interview transcripts were analysed thematically.Results: Participants reported that working in two organisational contexts, whilst performing two faculty roles that span both contexts, enhances their ability to broker connections between research, teaching and practice. The boundary crossing activities which participants performed, contributed to professional development in all faculty roles. The broker role was not seen as being a unique role which is distinct from research and practice roles. Broker activities were seen as generic and supportive of the roles that bestow academic status and expertise. Conclusions: The relevance of the broker role in professional development is not as evident as the relevance of roles that enhance specialisation and subject specific expertise. This could be due to the fact that the broker role is not well defined in literature and it is not yet visible as a distinct professionalisable work-package. A better understanding of the broker role could lead to its development in order to harness its professional development potential across academic roles.
How to Restore Rotation Center in Total Hip Arthroplasty for Developmental Dysplasia of the Hip with the Assistance of Three Dimensional Printing Technology? A Pilot Study
Authors: Zhang Heng , Zhang Zheng , Chen Xiaotian , Guan Jianzhong , Dong Qirong , Zhou Jiansheng
Published: July 2020

Background

It is technically challenging to restore hip rotation center exactly in total hip arthroplasty (THA) for patients with end-stage osteoarthritis secondary to developmental dysplasia of the hip (DDH) due to the complicated acetabular morphology changes.In this study, we developed a new method to restore hip rotation center exactly and rapidly in THA with the assistance of three dimensional (3-D) printing technology.
Methods

Seventeen patients (21 hips) with end-stage osteoarthritis secondary to DDH who underwent THA were included in this study. Simulated operations were performed on 3-D printed hip models for preoperative planning. The Harris fossa and acetabular notches were recognized and restored to locate acetabular center. The agreement on the size of acetabular cup and bone defect between simulated operations and actual operations were analyzed.Clinical and radiographic outcomes were recorded and evaluated.
Results

The sizes of the acetabular cup of simulated operations on 3-D printing models showed a high rate of coincidence with the actual sizes in the operations(ICC value = 0.930) There was no significant difference statistically between the sizes of bone defect in simulated operations and the actual sizes of bone defect in THA( t value = 0.03,P value = 0.97). The average Harris score of the patients was improved from (38.33 ± 6.07) preoperatively to the last follow-up (88.61 ± 3.44) postoperatively.The mean vertical and horizontal distances of hip rotation center on the pelvic radiographs were restored to (15.12 ± 1.25)mm and ( 32.49 ± 2.83) mm respectively. No case presented dislocation or radiological signs of loosening until last follow-up.
Conclusions

The application of 3-D printing technology facilitates orthopedists to recognize the morphology of Harris fossa and acetabular notches, locate the acetabular center and restore the hip rotation center rapidly and accurately.
Implementation of family psychosocial risk assessment in pediatric cancer with the Psychosocial Assessment Tool (PAT): Study protocol for a cluster randomized comparative effectiveness trial
Authors: Kazak Anne , Deatrick Janet , Scialla Michele , Sandler Eric , Madden Rebecca , Barakat Lamia
Published: July 2020

BackgroundChildhood cancer affects and is affected by multiple levels of the social ecology, including social and relational determinants of health (e.g. economic stability, housing, childcare, healthcare access, child and family problems). The 2015 Standards of Psychosocial Care in Pediatric Cancer outline optimal psychosocial care sensitive to these ecological factors, starting with assessment of psychosocial healthcare needs to promote medical and psychosocial outcomes across all children with cancer. To address the first standard of family psychosocial assessment, the Psychosocial Assessment Tool (PAT) is a validated screener ready for broad implementation.MethodThe PAT will be implemented across a national sample of 18 pediatric cancer programs ranging in size (annual new patients) in a mixed methods, comparative effectiveness study, guided by the Interactive Systems Framework for Dissemination and Implementation, comparing two implementation Strategies. It is hypothesized that implementation will be more successful at the patient/family, provider, and institutional level when Training (Strategy I) is combined with Implementation Expanded Resources (Strategy II). There are three aims: 1) Refine the two implementation strategies using semi-structured qualitative interviews with 19 stakeholders including parent advocates, providers, pediatric oncology organization representatives, healthcare industry leaders; 2) Compare the two theoretically based and empirically informed strategies to implement the PAT in English and Spanish using a cluster randomized controlled trial across 18 sites. Stratified by size, sites will be randomized to cohort (3) and strategy (2). Outcomes include adoption and penetration of screening (patient/family), staff job satisfaction/burnout (provider), and cost effective use of resources consistent with family risk (institution); 3) Based on the results of the trial and feedback from the first and second aim, we will develop and disseminate a web-based PAT Implementation Toolkit.DiscussionUse of the PAT across children’s cancer programs nationally can achieve the assessment Standard and inform equitable delivery of psychosocial care matched to family need for all patients.Trial RegistrationClinicalTrials.gov, NCT04446728, registered 23 June 2020
Mfa5 from Porphyromonas gingivalis: a von Willebrand factor domain and an intramolecular isopeptide bond in a Gram-negative bacterial fimbrial protein
Authors: Heidler Thomas , Claesson Rolf , Persson Karina
Published: July 2020

The Gram-negative bacterium Porphyromonas gingivalis is a secondary colonizer of the oral biofilm and is involved in the onset and progression of periodontitis. Its fimbriae, of type-V, are important for attachment to other microorganisms in the biofilm and for adhesion to host cells. The fimbriae are assembled from five proteins encoded by the mfa1 operon, of which Mfa5 is one of the ancillary tip proteins. Here we report the X-ray structure of the N-terminal half of Mfa5, which reveals a von Willebrand factor domain and two IgG-like domains. One of the IgG-like domains is stabilized by an intramolecular isopeptide bond, which is the first such bond observed in a Gram-negative bacterium. These features make Mfa5 structurally more related to streptococcal adhesins than to the other P. gingivalis Mfa proteins. The structure reported here indicates that horizontal gene transfer has occurred among the bacteria that within the oral biofilm.
Comparison of the effect of regular diet and low-fiber diet on bowel cleansing before colonoscopy
Authors: Liu Dan-Lei , Zhang Han-Xian , Liu Dong-Lian , Peng Tieli
Published: July 2020

BACKGROUNDHigh quality bowel preparation is essential for colonoscopy. A low-fiber diet (LFD), changing people’s dietary habit, is recommended for the day before colonoscopy. The aim of this study was to compare the quality of bowel preparation of regular diet (RD) with that of LFD.METHODSPatients undergoing colonoscopy in the morning were randomly to LFD group, which took a LFD the day before the procedure, or RD group. All patients recieved a split dose of 3L PEG regimen. The diet satisfaction and adverse events were recorded by a questionnaire before colonoscopy. The quality of the bowel preparation was ranked according to the Boston Bowel Preparation Scale (BBPS) by the endoscopists. Per-protocol (PP) and intention-to-treat (ITT) analyses were conducted for the clinical outcomes. A non-inferiority analysis was performed to prove the quality of bowel preparation of RD was not inferior to that of LFD.RESULTS400 patients (200 in RD group, 200 in LFD group) were included. In PP analysis (n = 357), no significant difference was found in the quality of the bowel preparation between the RD group and the LFD group (P = 0.440). The diet satisfaction (P = 0.978), polyp detection rate (PDR) (P = 0.763) and adenoma detection rate (ADR) (P = 0.800) were not significantly different between the two groups. Similar results were found in the ITT analysis (n = 400, P = 0.440, 0.778, 0.724, 0.893). Hunger in RD group was significantly lower than that in LFD group (P = 0.010), especially in young patients (P = 0.029) and inpatients (P = 0.036).CONCLUSIONThe quality of the bowel preparation of RD is comparable to that of LFD. RD could reduce hunger, especially in young patients and inpatients. Without changing patients’ eating habits, RD may be more acceptable for patients before undergoing colonoscopy.Trial registration: Current Controlled Trials ChiCTR1900021836 on 12 March 2019.
Association of immunological features with COVID-19 severity: a systematic review and meta-analysis
Authors: Zhang Zhicheng , Ai Guo , Chen Liping , Liu Shunfang , Gong Chen , Zhu Xiaodong , Zhang Chunli , Qin Hua , Huang Jinjin
Published: July 2020

BackgroundWe aim to explore the association of immunological features with COVID-19 severity.MethodsWe conducted a meta-analysis to estimate mean difference (MD) of immune cells and cytokines levels with COVID-19 severity in PubMed and Web of Science.ResultsA total of 16 studies with 1689 COVID-19 patients were included. Compared with mild cases, severe cases showed significantly lower levels of immune cells, CD3+ T cell (× 106, MD, -413.87; 95%CI, -611.39 to -216.34), CD4+ T cell (× 106, MD, -225.89; 95%CI, -306.36 to -145.43), CD8+ T cell (× 106, MD, -138.59; 95%CI, -176.36 to -100.82), B cell (× 106/L; MD, -23.87; 95%CI, -43.97 to -3.78) and NK cell (× 106/L; MD, -57.12; 95%CI, -81.18 to -33.06), and significantly higher levels of cytokines, TNF-α (pg/ml; MD, 0.34; 95%CI, 0.09 to 0.59), IL-5 (pg/ml; MD, 14.2; 95%CI, 3.99 to 24.4), IL-6 (pg/ml; MD, 13.07; 95%CI, 9.80 to 16.35), and IL-10 (pg/ml; MD, 2.04; 95%CI, 1.32 to 2.75). However, no significant differences were found in other indicators, IFN-γ (pg/ml; MD, 0.26; 95%CI, -0.05 to 0.56), IL-2 (pg/ml; MD, 0.05; 95%CI, -0.49 to 0.60), IL-4 (pg/ml; MD, -0.03; 95%CI, -0.68 to 0.62), Treg cell (× 106, MD, -0.13; 95%CI, -1.40 to 1.14), and CD4+/CD8+ ratio (MD, 0.17; 95%CI, -0.14 to 0.49).ConclusionOur meta-analysis revealed significant lower levels in immune cells (CD3+ T, CD4+ T, CD8+ T, B and NK cells) and significant higher levels in cytokines (TNF-α, IL-5, IL-6 and IL-10) in severe cases compared with mild cases of COVID-19. Measurement of immunological features could help to assess disease severity for effective triage of COVID-19 patients.
Population-based Respiratory Syncytial Virus Hospitalization Disease Burden and Cost Effectiveness of Palivizumab Prophylaxis in Infants with Hemodynamically Significant Congenital Heart Diseases
Authors: Chen Robin Hay-son , Chiu Susan Shui-seng , Lee So-lun , Yung Tak-Cheung
Published: July 2020

Background

Infants with hemodynamically significant congenital heart disease (HsCHD) are at risk of respiratory syncytial virus hospitalization (RSVh) and Palivizumab has been shown to be effective in preventing RSVh in regions with a distinct RSV season. However, the incidence of RSVh in HsCHD patients and the cost-effectiveness of Palivizumab in regions with year-round RSV activity is largely unknown.
Methods

All HsCHD patients < 12 months of age referred to the only tertiary pediatric cardiology center in Hong Kong during 1 Jan 2014 to 31 Dec 2016 were included. RSVh rate, Palivizumab efficacy and cost-effectiveness were assessed using a 5 or 6 monthly dose regimen starting from first hospital discharge.
Results

Twenty-six RSVh (11%) were identified out of 236 HsCHD patients. 222 patients were included for further analysis of Palivizumab efficacy and cost-effectiveness. The number needed to treat to prevent RSVh using 5 and 6 dose regimen was 54.9 and 38, respectively, with a wide year-to-year variation from 25 to 166.6. RSVh cost without Palivizumab was $379,436; while palivizumab program cost for 5 and 6 dose were $727,481 and $849,888 respectively. Incremental cost-effective ratio per hospital admission prevented was $85,937 and $80,419 for 5 and 6 dose regimen, respectively, with a wide year-to-year variation from $40,410 to $277,367.
Conclusion

This is one of the first population-based studies in infants with HsCHD demonstrating a high RSVh burden in a region with round the year circulation of RSV. Palivizumab program was assessed to be not cost-effective in preventing RSVh in such a locality.
Worldwide Trend Analysis and Potential Spread Prediction of SARS-CoV-2
Authors: Jain Arohi , S Aswin , Jose Jais , Nathalia Deepa , Suresh Arjun
Published: July 2020

Covid-19 declared as a pandemic by the World Health Organisation on January 30, 2020, is a major disaster which shook the roots of almost all the economies around the globe. The outbreak began in a city of China, Wuhan majorly due to consumption of bats during December. The symptoms, the ways of spreading of infection are quite similar to that of influenza. The areas with higher pollution levels of particulate matter have reported a higher number of deaths as compared to the number of deaths in the cases from comparatively less polluted areas. The meteorological factors have also played a major role in the extent of spread of disease and the ability of humans living in the area to fight against the disease. Social distancing and lockdown all over the nation have proved to be major weapons to fight against the further spread of disease. The lockdown, on the other hand, has given relief from the high levels of pollution resulting in good air quality and clean rivers. This study focuses on the spread of the novel coronavirus all over the world with the trend in the number of confirmed cases, deaths and the cured from the onset and also highlighting the situations in five countries. The study further gives a prediction of the number of cases for ten days and correlates the values with the actual number of cases reported and throws light on the future aspects of the infection.
Association of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin-receptor blockers (ARBs) with risk of mortality, severity or SARS-CoV-2 test positivity in COVID-19 patients: A systematic review and meta-analysis
Authors: Biswas Mohitosh , Kali Most. Sumaiya Khatun
Published: July 2020

Effects of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) in the treatment of COVID-19 is highly debated. It was aimed to assess aggregated risk by investigating the association of ACEIs/ARBs users against non-users of ACEIs/ARBs with the risk of mortality or severe clinical manifestations or magnitude of SARS-CoV-2 test positivity in COVID-19 patients. Systematic literature search was carried out in different databases for eligible studies. The pooled relative risks (RRs) were measured using RevMan software where P<0.05 was set as statistical significance. In total, 10 studies were included in this analysis. After pooled estimation, it was demonstrated that SARS-CoV-2 positive patients taking ACEIs/ARBs were not associated with increased risk of mortality as compared to those not taking ACEIs/ARBs (RR 0.89; 95% CI 0.64-1.23; P=0.48). Further, the risk of composite severe clinical manifestations was not found significantly different between the positive patients with or without ACEIs/ARBs users (RR 1.29; 95% CI 0.81-2.04; P=0.28). There was no risk difference for SARS-CoV-2 test positivity in patients with or without ACEIs/ARBs users (RR 1.00; 95% CI 0.95-1.05; P=0.91). These findings may augment current professional society guidelines for not discontinuing ACEIs/ARBs in treating COVID-19 patients where it is clinically indicated.
Association between lung injury and cytokine profile in COVID-19 pneumonia
Authors: Chen Li-da , Zhang Zhen-Yu , Wei Xiao-Jie , Cai Yu-Qing , Yao Weng-Zhen , Wang Ming-Hui , Huang Qiu-Fen , Zhang Xiao-Bin
Published: July 2020

Background: Coronavirus disease 2019 (COVID-19) is a systemic disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The purpose of the present study was to investigate the association between lung injury and cytokine profile in COVID-19 pneumonia.Methods: This retrospective study was conducted in COVID-19 patients. Demographic characteristics, symptoms, signs, underlying diseases, and laboratory data were collected. The patients were divided into COVID-19 with pneumonia and without pneumonia. CT severity score and PaO2/FiO2 ratio and were used to assess lung injury.Results: 106 patients with 12 COVID-19 without pneumonia and 94 COVID-19 with pneumonia were included. Compared with COVID-19 without pneumonia, COVID-19 with pneumonia had significant higher serum interleukin (IL)-2R, IL-6, and tumor necrosis factor (TNF)-α. Correlation analysis showed that CT severity score and PaO2/FiO2 were significantly correlated with age, presence of any coexisting disorder, lymphocyte count, procalcitonin, IL-2R, and IL-6. In multivariate analysis, log IL6 was only independent explanatory variables for CT severity score (β=0.397, p<0.001) and PaO2/FiO2 (β=-0.434, p=0.003).Conclusions: Elevation of circulating cytokines was significantly associated with presence of pneumonia in COVID-19 and the severity of lung injury in COVID-19 pneumonia. Circulating IL-6 independently predicted the severity of lung injury in COVID-19 pneumonia.
Assessing SARS-CoV-2 RNA levels and lymphocyte/T cell counts in COVID-19 patients revealed initial immune status as a major determinant of disease severity
Authors: Han Mingfeng , Zhang Yafei , Liu Zhongping , Li Shasha , Xu Mengyuan , He Tengfei , Li Jinsong , Gao Yong , Liu Wanjun , Li Tuantuan , Chen Zixiang , Huang Xin , Cheng Guoling , Wang Jun , Dittmer Ulf , Witzke Oliver , Zou Guizhou , Li Xiuyong , Lu Mengji , Zhang Zhenhua
Published: July 2020

The magnitude of SARS-CoV-2 infection, the dynamic changes of immune parameters in patients with the novel coronavirus disease (COVID-19) and their correlation with the disease severity remain unclear. The clinical and laboratory results from 154 confirmed COVID-19 patients were collected. The SARS-CoV-2 RNA levels in patients were estimated using the Ct values of specific RT-PCR tests. The lymphocyte subsets and cytokines profiles in the peripheral blood were analyzed by flow cytometry and specific immunoassays. 154 confirmed COVID-19 patients were clinically examined up to 4 weeks after admission. The initial SARS-CoV-2 RNA Ct values at admission varied but were comparable in the patient groups classified according to the age, gender, underlying diseases, and disease severity. Three days after admission significant higher Ct values were found in severe cases. Significantly reduced counts of T cells and T cell subsets were found in patients with old age and underlying diseases at admission and were characteristic for the development of severe COVID-19. Severe COVID-19 developed preferentially in patients with underlying compromised immunity and was not associated with initial virus levels. Higher SARS-CoV-2 RNA levels in severe cases were apparently a result of impaired immune control associated with dysregulation of inflammation.
Savable but lost lives when ICU is overloaded: a model from 733 patients in epicenter Wuhan, China
Authors: Zhu Ziwei , Li Yang , Dan Tingting , Chen Xijie , Quan Wuxiu , Hu Yu , Tao Guihua , Zhu Lei , Zhu Jijin , Jin Yuyan , Li Longgeng , Liang Chaokai , Ou Yangming , Cai Hongmin , Wen Hanchun
Published: July 2020

Background. Coronavirus Disease (COVID-19) causes a sudden turn over to bad at some check-point and thus needs intervention of intensive care unit (ICU). This resulted in urgent and large needs of ICUs posed great risks to the medical system. Estimating the mortality of critical in-patients who were not admitted to the ICU (MI-mortality) will be valuable to optimize the management and assignment of ICU.Methods. Retrospective, of the 733 in-patients diagnosed with COVD-19 at Huangpi Hospital of Traditional Chinese Medicine (Wuhan, China), as of March 18, 2020. This study aims to estimate the MI-mortality and build a model to identify the critical in-patients. Demographic, clinical and laboratory results were collected and analyzed. The mortality rate for the patients who failed to receive ICU and unfortunately died was analyzed. To this end, the key factors for prognostic of patients who may need ICU care were found. A prognostic classification model using machine learning was built to identify the patient who may need ICU. Results. Considering the shortage of ICU beds at the beginning of disease emergence, we defined the mortality for those patients who were predicted to be in needing of ICU treatment yet they did not as MI-mortality. Patients who entered the ICU and died were defined as ICU-mortality. To estimate MI-mortality, a prognostic classification model was built to identify the in-patients who may need ICU care based on the medical factors collected in-hospital. Its predictive accuracies on whole patient set (733 [25 708]), training set (586 [20 566]) and testing set (147 [5 142]) dataset were 0.8513, 0.8935 and 0.8288, with the AUC of 0.8844, 0.8941 and 0.9120, respectively. Our analysis had shown that the MI-mortality is 41% and the ICU-mortality is 32%, implying that enough bed of ICU in treating patients in critical conditions. Conclusions. On our cohort of 733 patients, 25 in-patients were admitted to ICU, among them 8 patients died. 25 in-patients who have been predicted by our model that they should need ICU care, yet they did not enter ICU due to lack of shorting ICU wards. The MI-mortality is 41%.
Genetic Landscapes and Prognostic Implications of Circadian Rhythm in Non-small Cell Lung Cancer
Authors: Li Ming , Chen Zhencong , Jiang Tian , Yang Xiaodong , Du Yajing , Liang Jiaqi , Wang Lin , Xi Junjie , Zhan Cheng , Feng Mingxiang
Published: July 2020

Background: Circadian rhythm plays an influential role in the vast majority of behavior and physiology, even of tumorigenesis and development. In this study, we tried to explore the prognostic implication for non-small cell lung cancer (NSCLC) based on the expression profiles of circadian clock-related genes (CCRGs), and describe the changes of immune infiltration and cell functions of related to the circadian rhythm.Methods: Univariate and multivariate Cox proportional hazard regression were performed to determine and construct a CCRGs risk-score significantly correlated with overall survival (OS) of the training set and validation set. GO, KEGG, and GSVA indicated discrepant changes in cellular processes and signaling pathways associated with these CCRGs. Further, immune cell infiltration, mutation rates, and related drugs and pathways analyses were investigated by the online analysis platform and the algorithm provided by works of literature. Results: The risk-score based on ten-gene signatures could independently predict the OS both in TCGA lung adenocarcinoma (p < 0.0001, HR: 2.117, 95% CI: 1.546 to 2.900) and lung squamous cell carcinoma (p < 0.0001, HR: 2.066, 95% CI: 1.552 to 2.751), respectively. The risk-score also had superior accuracy and predictability (LUAD: AUC 0.788; LUSC: AUC 0.738). The prognostic performance of the ten-gene signature was finally validated in validation set based on GEO cohorts. The circadian oscillations driven by CCRGs could disturb the metabolism and cellular functions of cancer cells. We also found that the infiltration level of critical cells in specific anti-tumor immunity process was suppressed apparently. In contrast, the infiltrating of inflammatory cells and immune cells with negative regulatory effects were promoted in the high-risk group. CCRGs were evolutionarily conserved with low mutation rates, which brought difficulties to explore therapeutic targets. Conclusions: We described the landscapes and prognostic implications of CCRGs. The risk-score based on CCRGs was an independent predictor of prognosis and could significantly stratify patient outcomes and immune cell infiltration levels. CCRGs were evolutionarily conserved with low mutation rates, which brought difficulties to explore therapeutic targets.Our study revealed that circadian rhythms might play an influential role in the NSCLC.
Effectiveness of a group functional power training program for frail older adults implemented through neighbourhood senior centres – a randomised controlled study
Authors: Tou Nien Xiang , Wee Shiou-Liang , Seah Wei Ting , Ng Daniella Hui Min , Pang Benedict Wei Jun , Lau Lay Khoon , Ng Tze Pin
Published: July 2020

Background

Several trials have demonstrated the efficacy of resistance training to reduce frailty and improve function of older adults. To narrow the research-practice gap, we designed and evaluated the implementation of a community-delivered group-based functional power training (FPT) program for frail older adults within their neighbourhoods.
Methods

Two-arm, multicentre assessor-blind stratified randomised controlled trial at four local senior activity centres. Older adults (n = 61) with low handgrip strength (HGS) were randomised to intervention (IG) or control (CG) group. The IG underwent the FPT program (power and balance exercises using simple equipments) delivered by a community provider. The 12-week program comprised 2 × 60 mins sessions/wk. CG continued usual activities at the centres. Functional performance (SPPB and TUG), HGS, knee extensor strength (KES), and frailty status were assessed at baseline and 3-month. Program implementation was evaluated using RE-AIM framework.
Results

The program was halted due to Coronavirus Disease 2019 related suspension of senior centre activities. Results are reported from four centres (n = 61), which completed the program. IG showed significant improvement of moderate effect sizes in frailty status (0.36 points, 95CI [0.09, 0.64], p = 0.011) and SPPB (0.51 points, 95CI [0.13, 0.89], p = 0.010). IG improvement in TUG (0.57 s, 95CI [-0.07, 1.20], p = 0.080) did not achieve significance and there were no effects for HGS and KES. Only SPPB showed greater improvement in IG than CG (p = 0.047). The community program exhibited good reach, effectiveness, adoption, and implementation.
Conclusions

FPT is superior to regular activities at local senior centres in improving physical function and can be successfully implemented for frail older adults in their neighbourhoods.
Trial registration:

ClinicalTrials.gov, NCT04438876. Registered 19 June 2020 – Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT04438876?term=NCT04438876
The Segment IV Approach: A Useful Method for Achieving the Critical View of Safety During Laparoscopic Cholecystectomy in Patients With Anomalous Bile Duct
Authors: Fujioka Shuichi , Nakashima Keigo , Kitamura Hiroaki , Takano Yuki , Misawa Takeyuki , Kumagai Yu , Hata Taigo , Akiba Tadashi , Ikegami Toru , Yanaga Katsuhiko
Published: July 2020

Background
The critical view of safety (CVS) method can be achieved by avoiding vasculo-biliary injury resulting from misidentification during laparoscopic cholecystectomy (LC). Although achieving the CVS has become popular worldwide, there is no established standardized technique to achieve the CVS in patients with an anomalous bile duct (ABD). We recently reported our original approach for securing the CVS using a new landmark, the diagonal line of the segment IV of the liver (D-line). The D-line is an imaginary line that lies on the right border of the hilar plate. The cystic structure can be securely isolated along the D-line without any misidentification, regardless of the existence of an ABD. We named this approach the segment IV approach in LC.
Methods
In this study, we adopted the segment IV approach in patients with an ABD. From October 2015 to June 2020, 209 patients underwent LC using the segment IV approach. Among them, three (1.4%) were preoperatively diagnosed with an ABD.
Results
The branching point of the cystic duct was the posterior sectional duct, anterior sectional duct, or left hepatic duct in each patient. The CVS was achieved in all cases without any complications.
Conclusion
The segment IV approach is useful for achieving CVS, especially even for patients with an ABD during LC.
“If you are on Duty, you may be Afraid to Come out to Attend to a Person”: Fear of Crime and Security Challenges in Maternal Acute Care in Nigeria from a Realist Perspective.
Authors: Etiaba Enyi , Manzano Ana , Agbawodikeizu Uju , Ogu Udochukwu , Ebenso Bassey , Uzochukwu Benjamin , Onwujekwe Obinna , Ezumah Nkoli , Mirzoev Tolib
Published: July 2020

Background Maternal and Child Health (MCH) is global priority. Access and utilization of facility MCH services remain challenges in low and middle-income countries (LMICs). Evidence on barriers to providing and accessing services omits information on role of security within facilities. This paper explores the role of security in provision and use of MCH services in primary healthcare (PHC) facilities in Nigeria. Methods Study was carried out in Anambra state, Nigeria. Qualitative data was collected from 35 in-depth interviews (IDIs) and 16 focus group discussions (FGDs) with purposively identified key informants. Information gathered was used to build a program theory that was tested with another round of IDIs and FGDs and the literature. Data analysis and reporting were based on the Context-Mechanism-Outcome heuristic of Realist Evaluation methodology.Results Security elements (presence or lack of security guards, fencing, lighting and staff accommodation) facilitated or constrained provision and uptake of services respectively, by impacting behaviour of staff and patients. Security concerns of facility staff who did not feel safe to let in people into unguarded facilities, mirrored those of pregnant women who did not utilize health facilities because of fear of not being let in and attended to by facility staff.Conclusion Health facility security needs to be key consideration in program planning, to avert staff and women’s fear of crime which currently constrains provision and use of MCH care at health facilities. This, in turn, should contribute to improved MCH outcomes and facilitate achievement of Universal Health Coverage.
Transcriptomic analysis reveals that bromodomain containing 9 controls signaling pathways in gastric cancer
Authors: Wang Yuan , Wang Chen , Mo Yu-Ting , Tan Wen Yi , Yu Xi-Yong
Published: July 2020

Background

According to the Cancer Genome Atlas, gastric cancers involve 30% BRD9 changes. Studying the signaling net controlled by BRD9 is important and provides useful information for the treatment of patients with gastric cancer and BRD9 alteration.
Objective

We performed this study to find the signaling pathways controlled by BRD9 in gastric cancer cells.
Methods

MGC-803 and AGS cells were selected as BRD9 overexpression and normal expression models, respectively, and added with BRD9 inhibitors BI9564 and BI7273, respectively. RNA-seq and limma R language were used to obtain differentially expressed genes (DEGs), and heatmap R language was employed for cluster analysis. Database for Annotation, Visualization and Integrated Discovery (DAVID) was applied to identify the gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichments, and STRING database was utilized to construct the protein–protein interaction (PPI) networks. Analysis was performed through Cytoscape software to determine the possible signaling pathway and target genes.
Results

Group MGC-803: 1204 and 1338 DEGs were found in MGC-803 cells added with BI9564 and BI7273, respectively, and 425 DEGs were found in the intersection of these two sets. AGS group: 974 and 1006 DEGs were found in AGS cells added with BI9564 and BI7273, respectively, and 382 DEGs were found in the intersection of these two sets. The DEG number in the intersection of groups MGC-803 and AGS was only 12, and only 3 of which showed the same regulation direction. Hence, these two types of gastric cancers are greatly altered in the signaling network. GO enrichment and KEGG signaling pathway analyses showed that in group MGC-803, BRD9 mainly controls cell adhesion molecule (CAM) pathway, and genes SPP1 and GNAO1 may play important an important role in the BRD9 controlling network. In group AGS, BRD9 mainly controls protein digestion and absorption pathway, and genes AR and GNGT2 have an important function in the BRD9 controlling network.
Conclusion

Comprehensive bioinformatics analyses were conducted to screen the DEGs and signaling pathways controlled by BRD9 in different gastric cancer cells. The findings provide a theoretical basis in curing patients with clinical gastric cancer.
Geographic Monitoring for Early Disease Detection (GeoMEDD)
Authors: Curtis Andrew , Ajayakumar Jayakrishnan , Curtis Jacqueline , Mihalik Sarah , Purohit Maulik , Scott Zachary , Muisyo James , Labadorf James , Vijitakula Sorapat , Yax Justin , Goldberg Daniel W.
Published: July 2020

Identifying emergent patterns of coronavirus disease 2019 (COVID-19) at the local level presents a geographic challenge that is not ideally addressed using traditional spatial clustering approaches. The need is not only to identify statistically significant spatial patterns, but also develop a surveillance system to identify small numbers of cases emerging in vulnerable settings. This paper presents an approach that has been used to provide near-real time assessments of emergent disease to guide a hospital system’s intervention strategy: Geographic Monitoring for Early Disease Detection (GeoMEDD). Through integration of a spatial database and two types of clustering algorithms, GeoMEDD has the flexibility to scale in terms of required minimum members, connecting distance between cases, and time frame under consideration. GeoMEDD, has proven effective in revealing different cluster influencers and accelerators that give insight as to why the cluster exists where it does, and why it expands.
Physical distancing and risk of COVID-19 in small-scale fisheries: A remote sensing assessment in coastal Ghana
Authors: Okyere Isaac , Chuku Ernest Obeng , Ekumah Bernard , Angnuureng Donatus Bapentire , Boakye-Appiah Justice K. , Mills David Jonathan , Babanawo Raymond , Aheto Denis Worlanyo , Crawford Brian
Published: July 2020

The novel coronavirus is predicted to have dire implications on global food systems including fisheries value chains due to restrictions imposed on human movements in many countries. In Ghana, food production, both agriculture and fisheries, is exempted from restrictions as an essential service. The enforcement of COVID-19 prevention protocols, particularly social distancing, has been widely reported in Ghana’s agricultural markets whereas casual observations and media reports on fish landing sites suggest no such enforcements are in place. This study aimed to provide sound scientific evidence as a basis for informed policy direction and intervention for the artisanal fishing sector in these challenging times. We employed an Unmanned Aerial Vehicle (UAV) in assessing the risk of artisanal fishers to the pandemic using physical distancing as a proxy. From analysis of cumulative distribution function (G-function) of the nearest-neighbour distances (NND), this study underscored crowding at all surveyed fish landing beaches, and identified potential “hotspots” for disease transmission. Aerial measurements taken at times of peak landing beach activity indicated that the highest proportion of people, representing 56%, 48%, 39% and 78% in Elmina, Winneba, Apam and Mumford respectively, were located at distances of less than one metre from their nearest neighbour. Risk of crowding was independent of the population at the landing beaches, suggesting that all categories of fish landing sites along the coast would require equal urgency and measured attention towards preventing and mitigating the spread of the diseases.
Does Twitter affect Stock Market Decisions?Financial Sentiment Analysis in Pandemic Seasons: A Comparative Study of H1N1 and COVID-19
Authors: Valle-Cruz David , Fernandez-Cortez Vanessa , López-Chau Asdrúbal , Sandoval-Almazan Rodrigo
Published: July 2020

Backgroud:Investors are always playing with the fears and desires of buyers and sellers. Stock exchange markets are not the exception. Financial sentiment analysis allows us to understand the effect of reactions and emotions on social media in the stock market. In this research, we analyze Twitter data and financial indices to answer the question: How do polarity generated by the posts on Twitter influence financial indices behavior in pandemic seasons? Methods:The study is based on the sentiment analysis of influential Twitter accounts in this field and its relationship with the behavior of important financial indices. To achieve this, we tested four lexicons to detect polarity on Twitter. Results:Our findings shows that the period in which the markets reacted was 6 to 13 days after the information was shared and disseminated on Twitter in the COVID-19 season, and 1 to 2 day for H1N1 season. Furthermore, in our analysis, we found that the lexicons that got the best results for sentiment analysis on Twitter were S140 and Affin.Conclusions:Financial sentiment analysis is an important technique to forecasting stock market and polarity is the most widely used technique in the financial area. There is a relationship between the polarity in Twitter and the financial indexes behavior. The most influential Twitter accounts during the pandemic season were The New York Times, Bloomberg, CNN News, and Investing, presenting a very high relation between sentiments on Twitter and the stock market behavior.
Predicting the early depleting transmission dynamics of COVID-19: A time-varying SIR model
Authors: Law Kian Boon , Peariasamy Kalaiarasu M , Gill Balvinder Singh , Singh Sarbhan Singh Lakha , Sundram Bala Murali , Rajendran Kamesh , Dass Sarat Chandra , Lee Yi Lin , Goh Pik Pin , Ibrahim Hishamshah Mohd , Abdullah Noor Hisham
Published: July 2020

The susceptible-infectious-removed (SIR) model offers the simplest framework to study transmission dynamics of COVID-19, however, it does not factor in its early depleting trend observed during a lockdown. We modified the SIR model to specifically simulate the early depleting transmission dynamics of COVID-19 to better predict its temporal trend in Malaysia. The classical SIR model was fitted to observed total (I total), active (I), and removed (R) cases of COVID-19 before lockdown to estimate the basic reproduction number. Next, the model was modified with a partial time-varying force of infection, given by a proportionally depleting transmission coefficient, βt, and a fractional term, z. The modified SIR model was then fitted to observed data over 6 weeks during the lockdown. Model fitting and projection were validated using the mean absolute percent error (MAPE). The transmission dynamics of COVID-19 was interrupted immediately by the lockdown. The modified SIR model projected the depleting temporal trends with lowest MAPE for I total, followed by I, I daily, and R. During lockdown, the dynamics of COVID-19 depleted at a rate of 4·7% each day with a decreased capacity of 40%. For 7–day and 14–day projections, the modified SIR model accurately predicted I total, I, and R. The depleting transmission dynamics for COVID-19 during lockdown can be accurately captured by time-varying SIR model. Projection generated based on observed data is useful for future planning and control of COVID-19.
Recombinant interleukin-2 stimulates lymphocyte recovery in severe patients with COVID-19
Authors: Zhu Meng‘en , Wang Qian , Zhou Shaoqiong , Wang Bin , Ke Li , He Ping
Published: July 2020

Object: A recently developing pneumonia called COVID-19 which caused by SARS-CoV-2 has quickly spread across the world. Lymphopenia and a proinflammatory cytokine storm frequently happened in severe COVID-19 patients. But no specific immunomodulate therapy on COVID-19 had been reported. In this retrospect case control study, we observed the potential therapeutic effect of recombinant human interleukin-2 (rIL-2) on severe COVID-19 patients in a hospital in Wuhan, China. Methods: Fifty nine severe cases with COVID-19 admitted in hospital from January 29, 2020 to February 29, 2020 were included in this study. Twenty patients received a one-week to 10 days subcutaneous injection of the recombinant human interleulin-2 1 million IU per day other than regular treatment were classified as rIL-2 group. Twenty from thirty nine patients with regular treatment without intervention of rIL-2 were matched as the control group. Clinical characteristic such as age, gender, symptoms, signs, laboratory data and comorbidities were paired in these two groups. Changes of lymphocytes counts, IL-6 and C- reactive protein (CRP) before and after rIL-2 treatment and differences between rIL-2 group and non-rIL-2 group were analyzed.Results: There were a clearly visible increasing in lymphocyte counts and a decreasing in CRP level in non rIL-2 group and rIL-2 group. The difference of the change of lymphocyte counts were significant in rIL-2 group and non-rIL-2 group (p<0.01). Though CRP decreased more in rIL-2 group, it did not show a significant difference between the two groups (p>0.05).Conclusion: RIL-2 might be a prospective adjuvant therapy for severe COVID-19 patients by increasing lymphocytes number.