bluuebunny/crossref_metadata_2025 huggingface dataset:
Retrospective analysis of pediatric patients with multiple rare-earth magnets ingestion: a single-center experience from China.
Authors: Zheng Yucan , Zhang Zhihua , Yan Kunlong , Guo Hongmei , Li Mei , Lian Min , Liu Zhifeng
Published: October 2020

Background The aim of this study was to characterize patients who ingested multiple rare-earth magnets, reveal the harm of rare-earth magnet foreign bodies in the digestive tract, and develop a clinical management algorithm. Methods This was a retrospective review of patients with rare-earth magnet foreign bodies in the digestive tract admitted to a university-affiliated pediatric medical center in China, between January 2016 and December 2019; the subset of medical data evaluated included clinical symptoms, signs, treatments and outcomes. Results A total of 51 cases were included in this study, including 36(70.6%) males and 15(29.4%) females. The magnets were passed naturally in 24(47.1%) patients and removed by intervention in 27(52.9%) patients, including five (9.8%) cases by endoscopy and 22(43.1%) cases by surgery. Twenty-two (43.1%) patients cases had gastrointestinal obstruction, perforation, and fistula. Compared with the non-surgical group, the proportion of males in the surgical group was higher (21/23 vs 15/28, p=0.004), and the time from ingestion to arriving at the hospital was longer (80(72) vs 26(5), hours, p=0.008). Conclusions Magnets are attractive to children, but lead to catastrophic consequences including gastrointestinal obstruction, perforation, and surgical interventions when ingested multiple magnets. Endoscopic resection should be urgently performed in the presence of multiple magnets as early as possible within 24 hours, even in asymptomatic patients. Trial registration The study will be retrospectively registered.
Acute Encephalopathy in Children with Tuberous Sclerosis Complex
Authors: Numoto Shingo , Kurahashi Hirokazu , Sato Atsushi , Kubota Masaya , Shiihara Takashi , Okanishi Tohru , Tanaka Ryuta , Kuki Ichiro , Fukuyama Tetsuhiro , Kashiwagi Mitsuru , Ikeno Mitsuru , Kubota Kazuo , Akasaka Manami , Mimaki Masakazu , Okumura Akihisa
Published: October 2020

Objective: We examined the clinical manifestations of acute encephalopathy (AE) and identify risk factors for AE in children with tuberous sclerosis complex (TSC).Methods: The clinical data of 11 children with clinically diagnosed TSC associated with AE and 109 children with clinically diagnosed TSC alone aged 4 years or older were collected from 13 hospitals.Results: Of the 11 children with AE, 5 had histories of febrile seizures (FS), and all had histories of febrile status epilepticus (FSE). AE developed within 24 h after fever onset in all children with seizures lasting 30 min or longer. All children developed coma after seizure cessation. Head magnetic resonance imaging (MRI) revealed widespread abnormalities in the cerebral cortex, subcortical white matter, corpus callosum, basal ganglia, and thalamus. One child died; seven had severe neurological sequelae; and the other three, mild sequelae. Logistic regression analysis revealed that a history of FSE was correlated with the development of AE.Significance: AE in children with TSC was characterized by sudden onset after fever, followed by coma, widespread brain edema evident on MRI, and poor outcomes. A history of FSE was a risk factor for the development of AE.
Evaluation of the malaria reporting system supported by the District Health Information System 2 in Solomon Islands
Authors: Wangdi Kinley , Sarma Haribondu , Leaburi John , McBryde Emma , Clements Archie CA
Published: October 2020

Background District Health Information Systems 2 (DHIS2) is used for supporting health information management in 67 countries, including Solomon Islands. However, there have been few published evaluations of the performance of DHIS2-enhanced disease reporting systems, in particular for monitoring infectious diseases such as malaria. The aim of this study was to evaluate DHIS2 supported malaria reporting in Solomon Islands and to develop recommendations for improving the system.Methods The evaluation was conducted in three administrative areas of Solomon Islands: Honoria City Council, and Malaita and Guadalcanal Provinces. Records of nine malaria indicators including report submission date, total malaria cases, Plasmodium falciparum case record, Plasmodium vivax case record, clinical malaria, malaria diagnosed with microscopy, malaria diagnosed with RDT, record of drug stocks and records of RDT from 1st January to 31st December 2016 were extracted from the DHIS2 database. The indicators permitted assessment in four core areas: availability, completeness, timeliness and reliability. To explore perceptions and point of view of the stakeholders on the performance of the malaria case reporting system, focus group discussions were conducted with health centre nurses, whilst in-depth interviews were conducted with stakeholder representatives from government (province and national) staff and World Health Organization officials who were users of DHIS2. Results Data were extracted from nine health centres in Honoria City Council and 64 health centres in Malaita Province. The completeness and timeliness from the two provinces of all nine indicators were 28.2% and 5.1%, respectively. The most reliable indicator in DHIS2 was ‘clinical malaria’ (i.e. numbers of clinically diagnosed malaria cases) with 62.4% reliability. Challenges to completeness were a lack of supervision, limited feedback, high workload, and a lack of training and refresher courses. Health centres located in geographically remote areas, a lack of regular transport, high workload and too many variables in the reporting forms led to delays in timely reporting. Reliability of reports was impacted by a lack of technical professionals such as statisticians and unavailability of tally sheets and reporting forms. Conclusion The availability, completeness, timeliness and reliability of nine malaria indicators collected in DHIS2 were variable within the study area, but generally low. Continued onsite support, supervision, feedback and additional enhancements, such as electronic reporting will be required to further improve the malaria reporting system.
Elucidating the cellular response of silver nanoparticles as a potential combinatorial agent for cisplatin chemotherapy
Authors: Miranda Renata Rank , Fonseca Micaella Pereira da , Korzeniowska Barbara , Skytte Lilian , Rasmussen Kaare Lund , Kjeldsen Frank
Published: October 2020

Background: Combination chemotherapy uses drugs that target different cancer hallmarks, resulting in synergistic or additive toxicity. This strategy enhances therapeutic efficacy as well as minimizes drug resistance and side effects. In this study, we investigated whether silver nanoparticles act as a combinatorial partner to cisplatin. In so doing, we compared post-exposure biological endpoints, intracellular drug accumulation, and changes in the proteome profile of tumoral and normal cell lines. Results: Combinatorial exposure corresponded to cytotoxicity and oxidative stress in both cell lines, yet was substantially more effective against tumoral cells. Proteome analysis revealed that proteins related to energy metabolism pathways were upregulated in both cell lines, suggesting that combinatorial exposure corresponded to energetic modulation. However, proteins and upstream regulators involved in the cell cycle were downregulated, indicating reduced cell proliferation. The response to oxidative stress was markedly different in both cell lines; downregulation of antioxidant proteins in tumoral cells, yet upregulation of the antioxidant defense system in normal cells. These outcomes may have avoided higher cell death rates in normal cells. Conclusions: Taken together, our results indicate that combining silver nanoparticles with cisplatin increases the biological activity of the latter, and the combination warrants further exploration for future therapies.
3D simulation of radiographic projections to test and reduce the effect of pelvic tilt on the accuracy of cross-table lateral radiography
Authors: Xu Jie , Su Baohua , Zhang Wenhui , Sun Hao , Li Deng , Cai Zhiqing , Chen Meiyi , Qiu Meiling , Ma Ruofan
Published: October 2020

Background: Cross-table lateral (CL) radiography is a convenient and feasible method to assess cup version angle (VA) after total hip arthroplasty; However, pelvic tilt (PT) may contribute to its measurement inaccuracy. How PT affects CL radiographic measurements have not been well studied. We sought (1) to determine the effect of the PT on cup version measurement on CL radiography and (2) to develop a method for reducing measurement errors caused by the PT. Methods: We used 3D technique to construct standard model and capture CL radiography simulation. A linear regression model was created to analyze the relationship between PT and VA. CL radiography and computed tomography (CT) were performed for the enrolled patients after surgery. The consistency between CL and CT measurements were verified by intra-class correlation coefficient (ICC). Results: There was a high correlation between the VA and PT. For each 1-degree increased in the PT, the VA decreased by 0.76° (R²=0.995, p<0.001). Based on the data, we created a corrective formula to convert the radiographic measurements into values approximating the actual VA under a natural pelvic position. The VA measurements corrected by our equation was in high agreement with the CT-measured values with reference to the corresponding PT (ICC=0.988, p<0.001), which was in sharp contrast to that without PT control (ICC=0.454, p=0.203). Conclusions: The PT may contribute to cup version measurement inaccuracies on CL radiography. Our mathematical algorithm can serve as a reliable method to improve the accuracy of CL radiography.
Laboratory test ordering in inpatient hospitals: a systematic review on the effects and features of clinical decision support systems
Authors: Zare Sahar , Meidani Zahra , Shirdeli Mohammad , Nabovati Ehsan
Published: October 2020

Background: Studies have revealed inappropriate laboratory testing as a source of waste. This review aimed at evaluating the effects and features of CDSSs on physicians' appropriate laboratory test ordering in inpatient hospitals.Method: Medline through PubMed, SCOPUS, Web of Science, and Cochrane were queried without any time period restriction. The outcomes related to the effect of CDSSs were categorized based on test-related, physician-related, and patient-related. Result: Sixteen studies met the inclusion criteria. Most studies were conducted based on a quasi-experimental design. The results showed improvement in laboratory test-related outcomes (e.g. proportion and cost of tests) and also physician-related outcomes (e.g. guideline adherence and orders cancellation). Patient-related outcomes (e.g. length of stay and mortality rate) were not well investigated in the included studies. Also, the evidence about applying CDSS as a decision aid for interpreting laboratory results was rare.Conclusion: CDSSs increase appropriate test ordering in hospitals through eliminating redundant test orders and enhancing evidence-based practice. Appropriate testing and cost saving were both affected by the CDSSs. However the evidence is limited about the effects of laboratory test CDSSs on patient-related outcomes.
Behavioral factors associated with utilization of healthcare services among elderly in Pakistan: Evidence from a nationally representative survey
Authors: Naz Lubna , Ghimire Umesh , Zainab Abida
Published: October 2020

Background
In Pakistan, healthcare system is facing unprecedented challenges to deal with the healthcare demand of the growing ageing population. Using a conceptual framework, this study aims to analyze the factors associated with the utilization of healthcare services in private and public hospitals by the elderly population.
Methods
This study used a sample of 5,319 individuals aged 60 and above extracted from the Pakistan Social and Living Standards Measurement Survey 2014-15. We followed the Anderson’s Behavioral model of healthcare utilization. The behavioral factors, including predisposing, enabling and need factors, associated with the use of healthcare care were analyzed using exploratory data analysis and binary logistic regressions. The utilization of healthcare service in the study refers to the visits to private and government hospitals.
Results
Out of total 5,319 participants around three-fourth or 72.4% of participants visited private hospitals for their healthcare needs. Multivariate analysis showed that older age-group (80 years and above) and participants from urban were 1.35 and 1.53 times more likely to avail healthcare service in private hospitals, respectively. The elderly persons from Khyber Pakhtunkhwa were three times (AOR: 3.29, 95%CI 2.5-4.8) more likely to visit government hospitals than their peers in Punjab. Participants who attended school (AOR: 1.21, 95%CI 0.82-1.31) were more likely to utilize healthcare service in private hospitals. Elders from rich (AOR: 1.04, 95%CI 0.84-1.13) and richest (AOR: 1.29, 95%CI 0.89-1.87) wealth quintiles were more likely to use healthcare in private hospitals. The likelihood of the utilization of healthcare service in private hospitals was 1.7 times higher for three or more consulting visits than the single visit, and 1.5 times higher in the public hospital.
Conclusions
Our findings underscore a dire need for expanding outreach of healthcare services for elderly population. It calls for an effective implementation of policies which aim at improving equitable access to private healthcare services, and upgrading of government hospitals Moreover, the knowledge generated through this research may be employed to make social protection programs more responsive to age-related healthcare needs, and focused on caregiving for elderly living without spouse.
PPARα and PPARβ/δ are negatively correlated with proinflammatory markers in leukocytes of an obese pediatric population
Authors: Vargas-Sánchez Karina , Vargas Laura , Urrutia Yenny , Beltrán Iván , Rossi Ana Beatriz , Lozano Hernán Yupanqui , Guarín Jorge , Losada-Barragán Monica
Published: October 2020

Background: Obesity configures a pathophysiological profile that predisposes the development of metabolic and cardiovascular diseases, critically impacting public health. The chronic dysregulation of immuno-metabolic components triggered by pediatric obesity is a common but scarcely understood aspect of the disease. Peroxisome proliferator-activated receptors (PPARs) are a group of transcription factors essential for energy and immune homeostasis of different tissues. Besides, the glucagon-like peptide-1 receptor (GLP-1R) activation influences insulin secretion, but also regulates the cytokine profile possibly mediated through a PPAR isotype. However, the role of PPARs and GLP-1R in leukocytes from obese pediatric patients remains unclear. Therefore, we examined the expression of PPARs isotypes and GLP-1R in leukocytes, and its correlation with metabolic, hormonal, inflammatory, and anthropometric markers in an obese pediatric population.Results: Obese children and adolescents presented a significant increase in anthropometric and body composition parameters, TG, VLDL, TG/HDL, android fat (%)/gynoid fat (%) (A/G%) index, and HOMA score when compared with the control group. Obese participants exhibited a pro-inflammatory profile with an augment of IL-8 (p=0,0081), IL-6 (p=0,0005), TNF-α (p=0,0004), IFN-γ (p=0,0110), MCP-1 (p=0,0452), and adipsin (p=0,0397), whereas displayed a reduction of adiponectin (p=0,0452). The expression of PPARα and GLP-1R was lower in the leukocytes from obese participants than in lean subjects. Furthermore, PPARα correlates negatively with TNF-α (p=0,0383), while GLP-1R did not show correlation with any inflammatory variable. However, both receptors correlate negatively with the abdominal skinfold. Although PPARβ/δ expression was similar between groups, it was negatively associated with IL-8 levels (p=0,0085).Conclusions: PPARα and PPARβ/δ expression are negatively correlated with the proinflammatory markers TNF-α and IL-8, respectively, suggesting participation in the regulation of inflammation which was observed to be altered in pediatric obesity. Furthermore, PPARα and GLP-1R are downregulated in leukocytes from obese participants. The low expression of both receptors is correlated with an increase in abdominal skinfold, suggesting a role in fat distribution that could indirectly affect cytokine secretion from different immune and adipose cells, likely triggering an inflammatory profile as a consequence of obesity. Altogether, these findings may impact the understanding and implementation of PPARα or GLP-1R agonists in the clinic.
High-dose versus low-dose ergocalciferol for correcting hypovitaminosis D after fragility hip fracture: A randomized controlled trial
Authors: Jarusriwanna Atthakorn , Phusunti Suchat , Chotiyarnwong Pojchong , Unnanuntana Aasis
Published: October 2020

Background: Hypovitaminosis D can be observed in most fragility hip fracture patients. However, measurement of 25-hydroxyvitamin D [25(OH)D] level is costly and may not be available in some centers. Without the baseline 25(OH)D level, the appropriate dose of vitamin D supplementation is not known. The aim of this study was to evaluate the effectiveness and safety of vitamin D supplementation in fragility hip fracture patients compared between high- and low-dose vitamin D supplementation. Methods: A total of 140 patients diagnosed with fragility hip fracture were randomly allocated to either the high-dose (60,000 IU/week) or low-dose (20,000 IU/week) vitamin D2 supplementation group for 12 weeks. The number of patients who achieved optimal vitamin D level [25(OH)D level > 30 ng/mL], the proportion of patients who developed hypercalcemia, and the functional outcome were compared between groups. Results: Of the 140 patients who were enrolled, 21 patients were lost to follow-up during the study period. The remaining 119 patients (58 and 61 in the high- and low-dose group, respectively) were included in the final analysis. The high-dose group had a higher rate of serum 25(OH)D restoration to optimal level than the low-dose group (82.8% vs 52.5%, respectively; p <0.001). Approximately 3.4% and 1.6% of patients in the high- and low-dose groups, respectively, had mild hypercalcemia, but none developed moderate, severe, or symptomatic hypercalcemia. There were no differences in functional outcome scores between groups.Conclusions: In treatment settings where baseline serum 25(OH)D level can’t be evaluated, we recommend high-dose vitamin D2 of approximately 60,000 IU/week for 12 weeks, with subsequent switch to a maintenance dose. This regimen effectively restored serum vitamin D to an optimal level in 82.8% of patients without causing symptomatic hypercalcemia.Trial registration: The protocol of this study was retrospectively registered in the Thai Clinical Trials Registry database no. TCTR20180302007 on 20 February 2018.
Anterior transpedicle screw in lumbosacral spine and radiographic measurements: a retrospective analysis
Authors: Xu Wei-Xing , Ding Wei-Guo , Xu Bin , Sheng Hong-Feng , Lu Di , Hu Tian-Hong
Published: October 2020

Background

The anterior transpedicle screw technique for L5 and S1 is crucial for proper anterior lumbar interbody fusion. This study aimed to determine the projection, screw trajectory angle, and bone screw passageway length (BSPL) of the anterior transpedicle screw in L5 and S1, as well as the screw’s insertion regularity and the operating area that is safe for its insertion.

Methods

Forty patients with low back pain, all of whom had lumbar computed tomography scans available, were included in a retrospective analysis. Radiographic parameters were measured, including the distances from the projection to the upper endplate, lower endplate, and midline; the transverse and sagittal screws’ angles; and the BSPL. Ten fresh adult cadaveric lumbosacral spine segments were chosen to determine the safe anatomical area at which to operate. Finally, anterior transpedicle screws were inserted in L5 and S1 to determine the regularity of anterior pedicle screw insertion.

Results

We measured the anterior projection parameters, including the distances to the upper endplate (L5:12.5 ± 1.3 mm; S1: 4.54 ± 0.87 mm), lower endplate (L5: 17.3 ± 1.6 mm), and midline (L5: 6.6 ± 0.7 mm; S1: 6.6 ± 0.6 mm); the screw trajectory angle, including the transverse screw angle (L5: 25.3° ± 2.8°; S1: 25.7° ± 2.6°), sagittal screw angle (L5: 17.1° ± 1.7°; S1: 22.4° ± 1.1°); and the BSPL (L5: 48.6 ± 3.5 mm; S1: 48.0 ± 3.5 mm). We then identified the safe operating area and the regularity of L5 and S1 anterior pedicle screw insertions.

Conclusions

We determined the projection, screw trajectory angle, and BSPL of anterior transpedicle screws in L5 and S1, their insertion regularity, and the area in which the operation could be safely performed.
rSodC is a potential antigen to diagnose Corynebacterium pseudotuberculosis by enzyme-linked immunoassay
Authors: de Farias Antonio Pedro Fróes , Filho José Tadeu Raynal Rocha , Marchioro Silvana Beutinger , Moreira Luan Santana , Marques Andressa Souza , de Sá Maria da Conceição Aquino , Oliveira Antonio Anderson dos Santos , Alcântara Maria Emília , Mariutti Ricardos Barros , Arni Raghuvir Krishnaswamy , Trindade Soraya Castro , Meyer Roberto
Published: October 2020

Caseous lymphadenitis (CL) is a chronic infectious disease that affects sheep and goats. Many serological tests have been developed to detect the disease; one of the most widely used is the enzyme-linked immunosorbent assay (ELISA), due to its advantages, which include acceptable cost-effectiveness, applicability, sensitivity and specificity. ELISA formulations using recombinant proteins can exhibit significant sensitivity and specificity when using a single purified antigen. DTxR, Trx, TrxR, LexA, SodC, SpaC, NanH, and PknG recombinant proteins can be considered target proteins for ELISA development due to its extracellular or on the cell surface location, which allows a better recognition by the immune system. Therefore, the objectives of this study were to evaluate the antigenic reactivity of Corynebacterium pseudotuberculosis recombinant proteins in goat and sheep serum. Of eight proteins evaluated, rSodC was selected for validation assays with small ruminant serum samples from the semiarid region of the state of Bahia, Brazil. Validation assays with goat serum samples showed that ELISA-rSodC presented sensitivity and specificity of 96% and 94%, respectively. Validation assays with sheep serum showed that ELISA-rSodC exhibited sensitivity and specificity of 95% and 98%, respectively. Analysis of 756 field serum samples showed that rSodC identified 95 positive samples (23%) in goats and 75 positive samples (21%) in sheep. The ELISA with recombinant SodC protein developed in this study discriminated positive and negative serum samples with high levels of sensitivity and specificity. This formulation is promising for epidemiological surveys and CL control programs.
Adding team-based financial incentives to the Carrot Rewards physical activity app increases daily step count on a population scale: A 24-week matched case control study
Authors: Pearson Emma , Prapavessis Harry , Higgins Christopher , Petrella Robert , White Lauren , Mitchell Marc
Published: October 2020

Background: Mobile health applications (mHealth apps) targeting physical inactivity have increased in popularity yet are usually limited by low engagement. This study examined the impact of adding team-based incentives (Step Together Challenges, STCs) to an existing mHealth app (Carrot Rewards) that rewarded individual physical activity achievements. Methods: A 24-week quasi-experimental study (retrospective matched pairs design) was conducted in three Canadian provinces (pre-intervention: weeks 1-12; intervention: weeks 13-24). Participants who used Carrot Rewards and STCs (experimental group) were matched with those who used Carrot Rewards only (controls) on age, gender, province and baseline mean daily step count (±500 steps/d). Carrot Rewards users earned individual-level incentives (worth $0.04 CAD) each day they reached a personalized daily step goal. With a single partner, STC users could earn team incentives ($0.40 CAD) for collaboratively reaching individual daily step goals 10 times in seven days (e.g., Partner A completes four goals and Partner B completes six goals in a week). Results: The main analysis included 61,170 users (mean age=32yrs; % female=64). Controlling for pre-intervention mean daily step count, a significant difference in intervention mean daily step count favoured the experimental group (p<0.0001; ηp2=0.024). The estimated marginal mean group difference was 537 steps per day, or 3759 steps per week (about 40 walking min/wk). Linear regression suggested a dose-response relationship between the number of STCs completed (app engagement) and intervention mean daily step count (adjusted R2=0.699) with each new STC corresponding to approximately 200 more steps per day. Conclusion: Despite an explosion of physical activity app interest, low engagement leading to small or no effects remains an industry hallmark. In this paper, we found that adding modest team-based incentives to the Carrot Rewards app increased mean daily step count, and importantly, app engagement moderated this effect. Others should consider novel small-teams based approaches to boost engagement and effects.
Integrating Pathology, Chromosomal Instability and Mutations for Risk Stratification in Early-stage Endometrioid Endometrial Carcinoma
Authors: Li Yuan , Li Jiaqi , Guo Ensong , Huang Jia , Fang Guangguang , Chen Shaohua , Yang Bin , Fu Yu , Li Fuxia , Wang Zizhuo , Xiao Rourou , Liu Chen , Huang Yuhan , Wu Xue , Lu Funian , You Lixin , Feng Ling , Xi Ling , Wu Peng , Ma Ding , Sun Chaoyang , Wang Beibei , Chen Gang
Published: October 2020

Background: Risk stratifications for endometrial carcinoma (EC) depend on histopathology and molecular pathology. Histopathological risk stratification lacks reproducibility, neglects heterogeneity and contributes little to surgical procedures. Existing molecular stratification is useless in patients with specific pathological or molecular characteristics and cannot guide postoperative adjuvant radiotherapies. Chromosomal instability (CIN), the numerical and structural alterations of chromosomes resulting from ongoing errors of chromosome segregation, is an intrinsic biological mechanism for the evolution of different prognostic factors of histopathology and molecular pathology and may be applicable to the risk stratification of EC.Results: By analyzing CIN25 and CIN70, two reliable gene expression signatures for CIN, we found that EC with unfavorable prognostic factors of histopathology or molecular pathology had serious CIN. However, the POLE mutant, as a favorable prognostic factor, had elevated CIN signatures, and the CTNNB1 mutant, as an unfavorable prognostic factor, had decreased CIN signatures. Only if these two mutations were excluded were CIN signatures strongly prognostic for outcomes in different adjuvant radiotherapy subgroups. Integrating pathology, CIN signatures and POLE/CTNNB1 mutation stratified stageⅠendometrioid EC into four groups with improved risk prognostication and treatment recommendations. Conclusions: We revealed the possibility of integrating histopathology and molecular pathology by CIN for risk stratification in early-stage EC. Our integrated risk model deserves further improvement and validation.
Student satisfaction with videoconferencing teaching quality during the COVID-19 pandemic
Authors: Fatani Tarah
Published: October 2020

Background: The coronavirus disease 2019 pandemic prompted the pediatric department at King Abdulaziz University to continue students’ educational activities by offering courses online that utilized web video conferencing (WVC). Given the uncertainties of WVC educational quality and the challenge of shifting to an online environment, this study aimed to evaluate student satisfaction with the teaching quality of case-based discussion (CBD) sessions conducted through WVC.Methods: 162 undergraduate medical students in pediatrics completed the reduced Students’ Evaluation of Educational Quality (SEEQ) survey with a five-point Likert scale over 5 weeks. The WVC CBD sessions were facilitated by 50 faculty members.Results: 82% of respondents were highly satisfied with the WVC CBD session’s teaching quality. The majority agreed that the sessions were intellectually challenging, that the instructors were dynamic, and encouraged students to participate. No statistically significant correlation was found between student satisfaction and technical issues (r = 0.037, p = 0.003).Conclusions: WVC teaching had an overall positive outcome on student satisfaction, and teaching quality relied on teaching, cognitive, and social presence rather than technology. However, technology remains an important platform that supports teachers’ educational activities. Thus, implementing a blended pediatric course to augment future course delivery is optimal.
miRNA-126-3p carried by human umbilical cord mesenchymal stem cell enhances endothelial function through exosome-mediated mechanisms in vitro and attenuates vein grafts neointimal formation in vivo
Authors: Qu Qingxi , Wang Limei , Bing Weidong , Bi Yanwen , Zhang Chunmei , Jing Xuanxuan , LIU linghong
Published: October 2020

Background: The aim of this study was to determine whether the combination of MSC implantation with miRNA-126-3p overexpression would further improve the surgical results after vein grafting.Methods: hucMSCs and HUVECs were isolated from human umbilical cords and characterized by a series of experiments. Lentivirus vector encoding miRNA-126-3p was transfected into hucMSCs and verified by PCR. We analyzed the miRNA-126-3p-hucMSC function in vascular endothelial cells by using a series of co-culture experiments. miRNA-126-3p-hucMSCs-exosomes were separated from cell culture supernatants and identified by WB and TEM. We validated the role of miRNA-126-3p-hucMSCs-exosomes on HUVECs proliferative and migratory and angiogenic activities by using a series of function experiments. We further performed co-culture experiments to detect downstream target genes and signaling pathways of miRNA-126-3p-hucMSCs in HUVECs. We established a rat vein grafting model, CM-Dil-labeled hucMSCs were injected intravenously into rats and the transplanted cells homing to the vein grafts were detected by fluorescent microscopy. We performed historical and immunohistochemical experiments to exam miRNA-126-3p-hucMSC transplantation on vein grafts neointimal formation and reendothelialization in vitro. Results: We successfully isolated and identified primary hucMSCs and HUVECs. Primary hucMSCs were transfected with lentiviral vectors carrying miRNA-126-3p at a MOI 75. Co-culture studies indicated that overexpression of miRNA-126-3p in hucMSCs enhanced HUVECs proliferation, migration and tube formation in vivo. We successfully separated hucMSCs-exosomes and found that miRNA-126-3p-hucMSCs-exosomes can strengthen the proliferative, migratory, and tube formation capacities of HUVECs. Further PCR and WB analysis indicated that, SPRED-1/PIK3R2/AKT/ ERK1/2 pathways are involved in this process. In the rat vein arterialization model, reendothelialization analysis showed that transplantation with hucMSCs modified with miRNA-126-3p had a higher reendothelialization of the vein grafts. The subsequent historical and immunohistochemical examination revealed that delivery with miRNA-126-3p overexpressed hucMSCs significantly reduced vein graft intimal hyperplasia in rats.Conclusion: These results suggest hucMSC-based miRNA-126-3p gene therapy may be a novel option for the treatment of vein graft disease after CABG.
Posterior resection via atlantoaxial lamina space without internal fixation for C1-C2 intraspinal tumors: A novel approach
Authors: Ouyang Beiping , Zou Xiaobao , Ni Ling , Ge Su , Chen Yuyue , Zhang Shuang , Xia Hong , Ma Xiangyang
Published: October 2020

Background: Intraspinal upper cervical C1-C2 tumors pose a challenge in resection. Internal fixation has routinely been used to prevent the occurrence of instability after atlantoaxial laminectomy for resection of C1-C2 intraspinal tumors, that sacrifices the motion of upper cervical spine. We therefore present this report to evaluate the efficacy and safety of one-stage posterior resection of these tumors through the atlantoaxial lamina space without internal fixation. Methods: Ten suitably selected patient with C1-C2 intraspinal tumors were included in this study (period January 2016 to January 2018). All the patients underwent one-stage posterior resection through atlantoaxial lamina space without internal fixation. The efficacy of the procedure was documented by comparing postoperative and preoperative outcome scores [The visual analogue scores (VAS), Japanese Orthopedic Association scores (JOA), neck disability index (NDI)], cervical physiological curvature and range of flexion-extension. Safety was assessed by documenting the complications associated with surgery and subsequent sequale. Results: 6 Male and 4 female patients with mean age 36 years (range 17 years to 50 years) underwent total tumor resection through posterior only approach using the atlantoaxial lamina space for the following tumors: 4 neurofibromas, 3 schwannomas and 3 meningiomas. The mean follow-up was 31.2 months (range 24–36 months). These patients’ pathological types included. Postoperative VAS and NDI were lower than those of pre-operation with statistical significance (p < 0.05) while postoperative JOA was higher than that of pre-operation (p < 0.05). The physiological curvature and activity of cervical spine were maintained at latest follow up. Three patients suffered cerebrospinal fluid leakages that was managed consertaviley with no added intervention required. No patient had local recurrence at latest follow-up. Conclusion: One-stage posterior resection through atlantoaxial lamina space without fixation is an effective and safe treatment for the upper cervical intraspinal tumor. In our experience this technique can remove tumor completely and does not cause instability to C1-C2 joint.
Sex and Gender Determinants of Increased Blood Pressure Among Women With Previous Gestational Diabetes Mellitus in Rural China
Authors: Guo Jia , Lv Wencong , Jiang Shan , Tang Yujia , Long Qing , Yang Jundi , Wiley James , Parry Monica
Published: October 2020

Background: Gestational diabetes mellitus (GDM) increases the long-term risk of hypertension and cardiovascular events for mothers later in life but has not been well recognized by nurses. The aims of the study were to describe the proportion of increased blood pressure in rural women with previous GDM and to explore the sex (biological) and gender (sociocultural) factors that contribute to the increased blood pressure.Methods: A cross-sectional descriptive survey including 397 women with previous GDM was conducted in rural areas of Central South of China between November 2017 and June 2018. The variables of sex (e.g., age, ethnicity, family history of hypertension, time since delivery, 75-g oral glucose tolerance test, body mass index, and waist circumference) and gender (education, occupation, income, physical activity, fruit and vegetable intake, sedentary time, perceived stress, and general self-efficacy) were collected on research site. Increased blood pressure referred to systolic blood pressure of ≥130 mm Hg and/or diastolic blood pressure of ≥85 mm Hg. Logistic regression was performed to recognize the sex and gender factors associated with increased blood pressure. Results: There were nearly 20% (78/397) of participants first found increased blood pressure. Among those participants who had increased blood pressure, advanced age, a family history of hypertension, and abnormal 2-h plasma glucose levels were sex-related factors associating with the increased blood pressure (P < 0.05), while obesity indicators (body mass index and waist circumference) were not associated (P > 0.05). General self-efficacy, a gender factor, had a protective relationship with increased blood pressure (P < 0.05). Conclusions: Increased blood pressure is prevalent in rural Chinese women with previous GDM. Both sex and gender are determinants. Interventions promoting glycemic status and general self-efficacy are promising to improve their cardiovascular health later in life.
Reclassification of classic T cell subsets and identification of novel cell types by single-cell RNA sequencing
Authors: Shen Xiangru , Wang Xuefei , Chen Shan , Liu Hongyi , Hong Ni , Jin Wenfei
Published: October 2020

Single cell RNA sequencing (scRNA-seq) clusters cells using genome-wide gene expression profiles. The relationship between scRNA-seq Clustered-Populations (scCPops) and cell surface marker-defined classic T cell subsets is unclear. Here, we interrogated 6 bead-enriched T cell subsets with 62,235 single cell transcriptomes and re-grouped them into 9 scCPops. Bead-enriched CD4 Naïve, CD8 Naïve and CD4 memory were mainly clustered into their scCPop counterparts, while the other T cell subsets were clustered into multiple scCPops including unexpected mucosal-associated invariant T cell and natural killer T cell. Most interestingly, we discovered a new T cell type that highly expressed Interferon Signaling Associated Genes (ISAGs), namely IFNhi T. We further enriched IFNhi T for scRNA-seq analyses. IFNhi T cluster disappeared on tSNE after removing ISAGs, and IFNhi T cluster showed up by tSNE analyses of ISAGs alone, indicating ISAGs are the major contributor of IFNhi T cluster. BST2+ cells and BST2- cells showing different efficiencies of T cell activation indicates high ISAGs may contribute to quick immune responses.
CpG Island Methylator Phenotype(CIMP) is An Independent Prognostic Marker with Tumor-Promoting Functions in Colorectal Cancer
Authors: Li Jiante , Hu Kepeng , Wu Chenchen , Cai Mao , Huang Chongjie , Qi Dansi , Li Changjia , Li Long , Hu Wanle , Yu Yaojun
Published: October 2020

Background: The CpG island methylator phenotype(CIMP)with extensive promoter methylation isa distinct epigenotype incolorectal cancer (CRC). Changes in microbiota and epigenetic dysregulation might be the key underlying mechanism.Methods: Tissues with stages I–III cancer were collected after proctocolectomy. The 16S rRNA gene sequencing was carried to determine the differences in microbiota. Subsequently, BRAF mutation, the status of microsatellite instability (MSI, also known as mismatch repair deficiency) and CIMP were also tested. The Chi-square test was carried out to analyze the relationship between molecular changes (MSI and CIMP) and the development of CRC.Results: Patients in the three groups differed in thetumorlocation(P=0.034) and the carcinoembryonic antigen (CEA) level (P=0.036).The positive CIMP and MSI-LOW/MSS were more common in the worse prognosis groups. The Kaplan–Meier and Cox proportional regression analyses indicated that CIMP and MSI were the independent indicators of poor survival since the positive rates of which were significantly higher in the non-survival group. Besides, there were differences in microbiota among tumor tissues of different prognoses, with the Fusobacterium nucleatum and Bacteroides fragilis more abundant in the worse prognosis groups.Conclusion: The persistent epigenetic changes influence the prognosis of patients with CRC and the composition of the gut microbiota might be the cause.
A Study to Evaluate the Accuracy, Usability, and Acceptance of A Blood-Based HIV Self-Test Performed by Observed Intended Users in Canada
Authors: Tian Jason Lo Hog , Galli Richard A. , Sumner-Williams Michelle , McBain Kristin , Stanizai Emal , Tharao Wangari , Aden Muna , Jamieson Heather , Silva Mark Da , Vassal Anne-Fanny , Guilbault Lorie , Ireland Laurie , Witges Kim , King Alexandra , Ametepee Kehinde , Lachowsky Nathan J. , Pant-Pai Nitika , Mazzulli Tony , Rourke Sean B.
Published: October 2020

Background: Self-Testing for HIV (“HIVST”) is an emerging targeted intervention with the potential to increase the access, uptake and frequency of HIV testing and more effectively reach the undiagnosed especially in priority populations. The study objectives of this study were to (1) evaluate the INSTI HIV-Self-Test (HIV-ST) performance compared with laboratory reference testing, (2) document if intended users can perform the steps to use the HIV-ST device, and (3) document if intended users can successfully interpret contrived positive, negative, and invalid results. Study was intended to be submitted to Health Canada for review for license purposes.Methods: The study used a cross-sectional design and recruited consenting adults from four community sites across Ontario, Québec, and Manitoba between August 2019 and March 2020. The results of the observed HIV-ST were compared with results of the Abbott Architect HIV Ag/Ab Combo test.Results: Primary efficacy analysis on 678 completed HIV-ST revealed a positive percent agreement of 100% and a negative percent agreement of 99.5% with the comparator method. The overall percent agreement of results interpretation between participant and observer was 93.5%. Of the 708 participants who took part in the usability study, 92.4% of participants successfully performed the steps determined to be “critical” for successful completion of the test, 96.7% of participants found the instructions easy to follow, and 95% of participants indicated that they would use the test again. Of the 404 participants who interpreted the strong positive, weak positive, negative and invalid contrived results, successful interpretation ranged from 90.6% (for weak positive) to 99.3% (for negative).Conclusions: The addition of this very first self-test into the Canadian HIV testing landscape could significantly increase HIV testing rates. An approved blood-based HIV self-test in Canada can offer an accurate, acceptable and simple alternative to facility-based HIV testing, particularly when impacted by Coronavirus pandemic restrictions.
The Impact of Urine Microbiota in Patients With Lower Urinary Tract Symptoms
Authors: Lee Hsiang ying , Wang Jiunn‐Wei , Juan Yung-Shun , Li Ching-Chia , Liu Chung-Jung , Cho Sung Yong , Yeh Hsin-Chih , Chueh Kuang-Shun , Wu Wen-Jeng , Wu Deng‐Chyang
Published: October 2020

IntroductionInflammation and infection are causative factors of benign prostatic hyperplasia (BPH). Urine is not sterile, and urine microbiota identified by DNA sequencing can play an important role in the development of BPH and can influence the severity of lower urinary tract symptoms (LUTS).Materials and methodsWe collected mid-stream voided urine samples from BPH patients and control participants and stored them in a freezer at -80 °C. All enrolled participants were requested to provide information about their clinical characteristics and complete the International Prostate Symptom Score (IPSS) questionnaire. Each step of the procedure, including the extraction of the genomic DNA from the urine samples; the amplification by polymerase chain reaction (PCR); PCR product quantification, mixing, and purification; DNA library preparation; and sequencing was performed with quality control (QC) measures. Alpha diversity was indicative of the species complexity within individual urine samples, and beta diversity analysis was used to evaluate the differences among the samples in terms of species complexity. Pearson’s correlation analysis was performed to calculate the relationship between the clinical characteristics of the participants and the microbiota species in the urine samples.ResultsWe enrolled 77 BPH patients and 30 control participants who reported no recent antibiotic usage. Old age, high IPSS and poor quality of life were observed in the participants of the BPH group. No significant differences were observed in the alpha diversity of the samples. In the beta diversity analysis, there was a significant difference between the microbiota in the samples of the BPH and control groups according to ANOSIM statistical analysis. On comparing the groups, the ten bacterial genera present in the samples of the BPH group in descending order of abundance were: Sphingomonas, Bacteroides, Lactobacillus, Streptococcus, Alcaligenes, Prevotella, Ruminococcaceae UCG-014, Escherichia_Shigella, Akkermansia, and Parabacteroides. Spearman’s correlation analysis revealed that urine samples showing the presence of the bacterial genera Haemophilus, Staphylococcus, Dolosigranulum, Listeria, Phascolarctobacterium, Enhydrobacter, Bacillus, [Ruminococcus]torques, Faecalibacterium, and Finegoldia correlated with a high IPSS, and severe storage and voiding symptoms (P<0.05).ConclusionOur current study shows that dysbiosis of urine microbiota may be related to the development of BPH and the severity of LUTS. Further research targeting specific microbes to identify their role in the development of diseases is necessary and might provide novel diagnostic biomarkers and therapeutic options.
Exosomes from Gastric Cancer Suppressed Adipo-differentiation of Adipose Mesenchymal Stem Cells to Promote Cancer-associated Cachexia via miR-155/ C/EPBβ pathway
Authors: Liu Ying , Lin Dan , Zhang Haiyang , Wang Huiya , Deng Ting , Liu Rui , Ning Tao , Bai Ming , Ying Guoguang , Ba Yi
Published: October 2020

BACKGROUNDCancer-associated cachexia (CAC) is defined as a multifactorial syndrome including depletion of adipose tissue and skeletal muscle. Adipose tissue wasting, as a key characteristic of CAC, occurs early and is related with poor survival. However, the influence of exosomes on adipo-differentiation in CAC remained be mysterious.METHODSOil-red staining, western blotting, and real-time polymerase chain reaction (RT-PCR) were used to investigate the adipo-differentiation capacity of A-MSCs from GC patients and healthy donors. Adipo-differentiation capacity of A-MSCs treated with exosomes from GES-1 or GC cell lines was also detected. To further explore the effects of exosomal miR-155 on adipo-differentiation in vitro, we carried out luciferase reporter assay. Finally, to evaluate the function of exosomal miR-155 in vivo, BALB/c mice were subcutaneously transplanted with SGC7901 cells transfected with lentivirus containing a miR-155 overexpressing (miR-155 OE) sequence or miR-155 shRNA (miR-155 KO) or control lentivirus(NC) to observe the change of adipo-differentiation of A-MSCs.RESULTSWe showed that miR-155 was high expressed in adipose mesenchymal stem cells (A-MSCs) isolated from GC patients, which exhibited significantly suppressed adipo-differentiation. Mechanistically, targeting C/EPBβ and suppressing C/EPBα and PPARγ by GC exosomal miR-155 was demonstrated to be involved in impairing the differentiation of A-MSCs into adipocytes. The expression of C/EPBβ C/EPBα and PPARγ were rescued through downregulating miR-155 in GC exosomes. Moreover, overexpression of miR-155 improved cancer cachexia in tumor-implanted mice, charactered by weight loss, tumor progression and low expression of C/EPBβ, C/EPBα, and PPARγ in A-MSCs as well as FABP4 in tumor-related adipose tissue. Decreasing level of miR-155 in implanted tumor blocked the anti-adipogenic effects of GC. CONCLUSIONGC exosomsal miR-155 suppressed adipo-differentiation of A-MSCs via targeting C/EPBβ of A-MSCs plays a crucial role in CAC.