bluuebunny/crossref_metadata_2025 huggingface dataset:
MiR-7e-5p downregulation promotes malignant transformation of follicular lymphoma by modulating an immunosuppressive stroma through the upregulation of FasL in M1 macrophages
Authors: Lou Xiaoli , Fu Jianhong , Zhao Xin , Zhuansun Xuemei , Rong Chao , Sun Maomin , Niu Hui , Wu Lei , Zhang Yongsheng , An Lu , Wan Shan , Wang Shouli
Published: July 2020

Background
In follicular lymphoma (FL), histologic transformation to high-grade FL and diffuse large B-cell lymphoma (DLBCL) is a critical adverse step in disease progression. Activation of the oncogene c-MYC and tumor microenvironment remodeling account for FL progression. A panel of miroRNA (miRNA) was downregulated in transformed FL.
Methods
Differentially expressed miRNAs were systematically analyzed in tissue samples from patients at different stages of disease. In FL cells, transcriptional regulation of the oncogene c-MYC on its target miR-7e-5p was revealed by Chromatin Immunoprecipitation (ChIP) assay. Exosome, carrying differentially expressed miR-7e-5p was isolated and visualized by transmission electron microscope and fluorescence tracing. The effect of miR-7e-5p on recipient macrophage was determined by target gene quantification, flow cytometry, and TUNEL method in a cocultured system with miR-7e-5p-mimics or inhibitor treatment. Expression of miR-7e-5p targets, macrophage proportions, and clinical parameters were included for correlation analysis.
Results
We determined that downregulation of miR-7e-5p, driven by c-MYC overexpression, was associated with poorer prognosis in FL patients. The decreased expression of miR-7e-5p in lymphoma cells led to a reduced exosomal transfer to surrounding macrophages. As a result, the target gene of miR-7e-5p, Fas ligand (FasL), was upregulated and activated the caspase signaling, which led to the apoptosis of M1 macrophages in tumor stroma. Finally, in transformed FL tissues, overexpression of FasL and activation of caspase proteins was detected in tumor stromal macrophages. Downregulation of miR-7e-5p was associated with poorer clinical outcomes.
Conclusion
Downregulation of exosomal miR-7e-5p induces stromal M1 macrophage apoptosis, which leads to immunosurveillance and transformation of FL.
Dynamic Changes in Plasma Urotensin II and its Correlation with Plaque Stability
Authors: Yin Chunlin , Liu Xue , Wang Hongxia , Yan Mingcong , Guo Lijuan , Li Guonan , Xia Jinggang , Yuan Huihui
Published: July 2020

Background: Urotensin II (UII) is involved in the formation of atherosclerosis, but its role in the stability of atherosclerotic plaque is undetermined. The purpose of this study was to observe the dynamic change of plasma UII and analyze its relationship with the stability of atherosclerotic plaques. Methods: The plasma UII concentration in patients with acute coronary syndrome (ACS) was detected. A vulnerable plaque model was established by local transfection of a recombinant P53 adenovirus into plaques of rabbits fed with a high-cholesterol diet and subjected to balloon injury, to evaluate the stability of the atherosclerotic plaques. ﻿Results: Our results showed that the level of plasma UII was increased in ACS patients compared with healthy subjects. However, it was significantly decreased in ST-segment elevation myocardial infarction patients (STEMI) and increased again in acute myocardial infarction (AMI) patients that were discharged after three months. UII dynamic change and its correlation with plaques stabilities were further verified in rabbit with atherosclerotic vulnerable plaque. The UII level in rabbits was significantly decreased after P53 gene transfection which can lead to of plaque instability. Conclusions: In conclusion, the level of plasma UII was significantly decreased in ACS with STEMI, which may serve as a reliable biological marker to reflect the progression and stability of atherosclerotic plaques.
Efficacy and Safety of Mycophenolate Mofetil Therapy in Neuromyelitis Optica Spectrum Disorders: A Systematic Review and Meta-Analysis
Authors: Songwisit Sakdipat , Kosiyakul Punchika , Jitprapaikulsan Jiraporn , Prayoonwiwat Naraporn , Ungprasert Patompong , siritho sasitorn
Published: July 2020

Background: Neuromyelitis optica spectrum disorders (NMOSD) is an autoimmune demyelinating disease of the central nervous system characterized by severe attacks of optic nerve and spinal cord. Mycophenolate mofetil (MMF) is an immunosuppressive agent (IS) which is widely prescribed for NMOSD patients. This systematic review and meta-analysis aims to assess the efficacy and safety of MMF in controlling relapse and disease severity.Methods: Studies were obtained from the EMBASE and Ovid MEDLINE databases. Eligible studies were the studies of NMOSD patients treated with MMF which reported treatment outcomes as Annualized Relapse Rate (ARR) or Expanded Disability Status Scale (EDSS) before and after treatment. Case reports, case series less than 3 patients, and reviews were excluded.Results: Fifteen studies included 1047 patients, of whom 915 (87.4%) were aquaporin-4 immunoglobulin seropositive. The total number of patients that received MMF was 799. Meta-analysis on ARR and EDSS were conducted in 4 studies with a total of 200 patients and 3 studies with a total of 158 patients, respectively. The result showed a significant improvement with a mean reduction of 1.13 (95% confidence interval (CI), 0.60 to 1.65) in ARR and a mean reduction of 0.85 (95% CI, 0.36 to 1.34) in EDSS after MMF therapy. Adverse drug reactions occurred in 106 (17.8%) of 594 patients that were documented having side effects during MMF therapy.Conclusion: This systematic review and meta-analysis showed that using MMF as a preventive therapy in NMOSD patients can significantly reduce relapse rate and improve disease severity with an acceptable tolerability.
A new method for evaluation of patellar height and the position of the joint line before and after total knee arthroplasty
Authors: Han Hua , Zhang Xiaohui
Published: July 2020

Background: The measurement of patellar height and restoration of the natural position of the joint line are crucial to total knee arthroplasty (TKA). However, there remains a lack of consensus on an optimal measurement method to associate the patellar height with the joint line position. The objective of this study was to introduce a new method and validate the application in TKA both preoperatively and postoperatively.Methods: Instead of taking marginal landmarks as the tibial references, the tibial shaft axis was used to construct the new measurement method, which comprises the axis-patella (AP), joint axis-patella (jAP) indices and joint line height (JLH). Patellar heights were measured using the Insall-Salvati (IS), modified Insall-Salvati (mIS), Blackburne-Peel (BP), Caton-Deschamps (CD) indices, and the new method in 175 knees both preoperatively and postoperatively. Intraclass correlation coefficients and Pearson’s correlation analysis were respectively used to evaluate the reliabilities and correlations.Results: There was good correlation between the proposed method and the mIS, CD, and BP indices. High inter-observer reproducibility was found for AP (preoperative and postoperative 0.83), jAP (preoperative 0.82; postoperative 0.86) indices and JLH (preoperative 0.88; postoperative 0.95). High intra-observer repeatability was also found for AP (preoperative 0.85; postoperative 0.87), jAP (preoperative 0.83; postoperative 0.87) indices and JLH (preoperative 0.80; postoperative 0.92). Conclusions: The new method is reliable for measuring patellar height before and after TKA, providing an alternative to distinguish between true and pseudo patella baja. Furthermore, JLH can be applied to assess and restore the joint line position in TKA.
Effects of Cinnamon on Anthropometry Status and Headache Disability of Migraine Patients: A Randomized Double-blind Placebo-controlled Trial
Authors: Zareie Azadeh , Bagherniya Mohammad , Sharma Manoj , Khorvash Fariborz , Hasanzadeh Akbar , Askari Gholamreza
Published: July 2020

Background: Migraine is a common type of primary headache that is highly disabling and is possibly associated with obesity. Increasing body mass index (BMI) seems to be a risk factor for migraine attacks. Cinnamon has anti-inflammatory, neuroprotective, and anti-obesity effects. Thus, this study aimed to assess the effects of cinnamon on anthropometry status and headache disability of migraine patients.Methods: Fifty patients with migraine were randomized to receive either cinnamon powder, three capsules/day each containing 600 mg of cinnamon or three placebo capsules/day each containing 100 mg of corn starch (control group) for two months. Height, body weight (BW), waist circumference (WC), and hip circumference (HC) were measured at baseline and the end of the study. Furthermore, Minimal or Infrequent Disability (MIDAS) and Headache Daily Result (HDR) Questionnaire were recorded. Results: After follow-up, BW and BMI did not change in the intervention group, however, both of them significantly increased in the placebo group. The differences between the two groups were statistically significant (p=0.001). WC significantly decreased in the cinnamon group and remarkably increased in the control group; the difference between groups was significant (p<0.001). Furthermore, HC and WHR significantly decreased in the intervention group than the placebo group (p=0.001). HDR and the total score of disability in migraine patients were significantly decreased in the intervention versus the control group (p<0.001). Conclusion: Cinnamon seems to have beneficial effects on BW, BMI, WC, and HC and it reduces the headache disability of migraine patients. More randomized controlled trials should be undertaken to confirm these effects.
Can We Safely Reduce the Administration of 131-iodine in Patients With Differentiated Thyroid Cancer? – Experience of the Brugmann Hospital in Brussels
Authors: Iconaru Laura , Baleanu Felicia , Taujan Georgiana , Duttmann Ruth , Spinato Linda , Karmali Rafik , Bergmann Pierre , Hambye Anne-Sophie
Published: July 2020

Background131-iodine administration after surgery remains a standard practice in differentiated thyroid cancer (DTC). In 2014, the American Thyroid Association presented new guidelines for the staging and management of DTC, including no systematic 131I in patients at low-risk of recurrence and a reduced 131I activity in intermediate risk.The present study aims at evaluating the rate of response to treatment following this new therapeutic management compared to our previous treatment strategy in patients with DTC of different risks of recurrence.MethodsPatients treated and followed up for DTC according to the 2014-ATA guidelines (Group 2) were compared to those treated between 2007 and 2014 (Group 1) in terms of general characteristics, risk of recurrence (based on the 2015-ATA recommendations), preparation to iodine administration, cumulative administered 131I activity and response to treatment. ResultsIn total, 136 patients were included: 78 in Group 1 and 58 in Group 2. The two groups were not statistically different in terms of clinical characteristics nor risk stratification: 42.3% in Group 1 and 31% in Group 2 were classified as low risk, 38.5% and 48.3% as intermediate risk and 19.2% and 20.7% as high risk (P=0.38). Preparation to iodine administration consisted in rhTSH stimulation in 23.4% of the patients in Group 1 and 97.4% in Group 2 (p<0.001). 131-iodine was administered to 47/78 patients (60%) in Group 1 (5 at low risk of recurrence) and 39/58 patients (67%) in Group 2 (0 with a low risk). Among the treated patients, median 131I cumulative activity was significantly higher in Group 1 (3.70GBq [100mCi] range 1.11-20.35 GBq [30-550 mCi]) than in Group 2 (1.11 GBq [30 mCi], range 1.11-11.1 GBq [30-300 mCi], P<0.001. Complete response was found in 89.7% in Group 1 vs. 94.8% in Group 2 (P=0.52). ConclusionsUsing the 2015-ATA evidence-based guidelines for the management of DTC, meaning no 131I administration in low-risk patients, a low activity in intermediate and even high risk patients, and an almost systematic use of rhTSH stimulation before radioiodine therapy allowed us to reduce significantly the median administered 131I activity, with a similar rate of complete therapeutic response.
Trends in Out of Pocket Payments and Catastrophic Health Expenditure in the Kyrgyz Republic Post the “Den Sooluk” Health Reform, 2012 - 2018
Authors: Iamschikova Mariia , Mogilevskii Roman , Onah Michael N
Published: July 2020

Background: To examine the trends in out- of- pocket health payments (OOPPs) and the incidence of catastrophic health expenditure post the “Den Sooluk” health reform, we used data from the Kyrgyzstan Integrated Household Survey (2012 – 2018). Methods: Population-weighted descriptive statistics were used to examine the trends in OOPPs and catastrophic health expenditure at three thresholds; 10 percent of total household consumption expenditure (Cata10), 25 percent of total household consumption expenditure (Cata25) and 40 percent of total household non-food consumption expenditure (Cata40). Panel and cross-sectional logistic regression with marginal effects were used to examine the predictors of Cata10 and Cata40. Findings: Between 2012 and 2018, OOPPs increased by about US $6 and inpatient costs placed the highest cost burden on users (US $13.6), followed by self-treatment (US $10.7), and outpatient costs (US $9). Medication continues to predominantly drive inpatient, outpatient, and self-treatment OOPPs. About 0.378 to 2.084 million people (6 – 33 percent) of the population incurred catastrophic health expenditure at the three thresholds between 2012 and 2018. Residing in households headed by a widowed or single head, or residing in rural regions, increases the likelihood of incurring catastrophic health expenditure.Conclusions: The initial progress in the reduction of OOPPs and catastrophic health expenditure gained appear to gradually erode since costs continue to increase after an initial decline and catastrophic health expenditure continues to rise unabated. Efforts needs to be made to check the rising out-of-pocket costs to enable a reduction in catastrophic health payments.
Administration of C5a Receptor Antagonist Improves the Efficacy of Human iPSCS-derived NS/PC Transplantation in the Acute Phase Of spinal Cord Injury
Authors: Shibata Reo , Nagoshi Narihito , Kajikawa Keita , Ito Shuhei , Khazaei Mohamad , Nori Satoshi , Kohyama Jun , Fehlings Michael G. , Matsumoto Morio , Nakamura Masaya , Okano Hideyuki
Published: July 2020

Background: We previously reported the efficacy of human-induced pluripotent stem cells derived neural stem/progenitor cells (hiPSC-NS/PCs) transplantation for spinal cord injury (SCI) in the subacute phase. However, this procedure is not effective in the acute phase due to the inflammatory response occurring immediately after SCI, which negatively impacts transplanted cell survival. C5a, which is one of the complement components, is a powerful chemoattractant which recruits inflammatory cells through binding of the C5a receptor. We hypothesized that suppression of the inflammatory response immediately after SCI using a C5a receptor antagonist (C5aRA) as an immunosuppressant would improve the efficacy of hiPSC-NS/PCs transplantation for SCI in the acute phase.Methods: Immunodeficient SCID-Beige mice underwent contusion SCI at T10 and received C5aRA immediately after SCI. Inflammatory cytokines and inflammatory cells in the injured spinal cord tissue during the acute phase were quantified using quantitative PCR and flow-cytometry. Next, we randomly and blindly divided the SCI mice into 4 groups (PBS only, C5aRA only, PBS + transplantation (PBS+TP), C5aRA + transplantation (C5aRA+TP)). Immediately after SCI, C5aRA or PBS was injected intraperitoneally once a day for 4 consecutive days, and then, 5.0 × 105 hiPSC-NS/PCs were transplanted into the lesion epicenter on day 4 in the PBS+TP and C5aRA+TP groups. We evaluated cell survival rate, hindlimb motor function, and the differentiation profile of the graft hiPSC-NS/PCs.Results: C5aRA administration significantly reduced several inflammatory cytokines such as IL-1b, IL-6 and TNFα, as well as inflammatory cells after SCI. Within the transplantation groups, the C5aRA+TP group had better functional improvement as compared to the PBS only group. The C5aRA+TP group also had a significantly higher cell survival rate compared to the PBS+TP group. There were no significant differences in the differentiation profiles of grafted hiPSC-NS/PCs between the C5aRA+TP and PBS+TP groups.Conclusion: This study demonstrates that administration of C5aRA can suppress the inflammatory response during the acute phase of SCI, and also improve the survival rate of transplanted hiPSC-NS/PCs as well as enhance motor functional restoration. hiPSC-NS/PC transplantation with C5aRA is a promising treatment during the acute injury phase for SCI patients.
Evaluation of One-Year Antibiotics Utilization in the Adult Outpatient Pharmacy of a Nigerian Tertiary Health Institution
Authors: OLI Angus N. , ONYEASO Nwanneka , Emencheta Stephen Chijioke , OFOMATA Chijioke M. , KRETCHY James-Paul , OKHAMAFE Augustine
Published: July 2020

Background: Antibiotics are among the most common drugs used worldwide.They kill or prevent the growth of bacterial microorganisms in the body, hence, they are the major agents used in treating bacterial infections. Because they are prone to abuse and misuse, regular evaluation of their utilization is important for optimal healthcare delivery.Objective: This study determined the antibiotics type, utilization, prescriptions and cost patterns in the adult out-patient pharmacy of a public tertiary health facility in Nigeria.Methods: This is a retrospective observational study using medication utilization records (prescriptions) to investigate the study objectives. Prescriptions dispensed in 2018 in adult out-patient pharmacy of Nnamdi Azikiwe University Teaching Hospital, Nnewi were reviewed. Data were evaluated using the World Health Organization-developed prescribing indicators. Descriptive and inferential statistics were used to analyze the results. The percentage and averages of the variable were calculated.Results: The medication utilization records showed that there was a significantly higher proportion (P-value = 0.0038) of females (70%) compared to males (the ratio being 2.44:1.00) that were prescribed antibiotics. The antibiotic utilization profile showed that antibiotic selection by class was significantly different and accounted for 44.02% of the total variance seen in the prescription pattern (P-value is < 0.0001). Also, the age of participants accounted for 19.48% of the total variance seen in the selection practice and so, age significantly affected the selection practice/prescription pattern with P-value < 0.0001. Dosage forms profile showed that the oral dosage forms were significantly more prescribed (P-value < 0.0001) compared with any other dosage form encountered in the study. There was no significant difference in the prescription patterns of parenteral and other dosage forms (P-value > 0.05). A greater percentage (84.22 %) of the prescriptions was from the Essential Drug list of Nigeria. Conclusion: Though the percentage of antibiotics prescribed from essential medicines list was found to be satisfactory, a strict protocol for prescribers is required to promote rational antibiotics use. This would not only prevent antibiotic resistance but also reduce the treatment expenditure and encourage antibiotic stewardship.
Network-based Approach to Identify Prognosis-related Genes in Tamoxifen-treated Patients With Estrogen Receptor-positive Breast Cancer
Authors: Wang Yanyan , Gong Xiaonan , Zhang Yujie
Published: July 2020

Background: The estrogen receptor (ER) antagonist tamoxifen is the most commonly used endocrine therapy for ER-positive breast cancer. However, tamoxifen resistance remains a major cause of cancer recurrence and progression. Here, we aimed to identify hub genes involved in the progression and prognosis of ER-positive breast cancer following tamoxifen treatment.Results: Microarray data (GSE9838) for 155 tamoxifen-treated primary ER-positive breast cancer samples were obtained from the Gene Expression Omnibus database. In total, 1706 differentially expressed genes (DEGs) associated with tamoxifen resistance, including 859 upregulated genes and 847 downregulated genes, were identified. These DEGs were mainly enriched in functions such as protein targeting to the ER and pathways such as ribosome and oxidative phosphorylation.Weighted correlation network analysis (WGCNA) clustered genes into 13 modules, among which the tan and blue modules were the most significantly related to prognosis. From these two modules, we further identified three prognosis-related hub genes (GRSF1, MAPT, and REC8) via survival analysis. High expression ofGRSF1 predicted poor prognosis, whereas MAPT andREC8indicated favorable survival outcomes in all patients with breast cancer and in patients with ER-positive breast cancer based on The Cancer Genome Atlas database. These hub genes were further verified by reverse transcription quantitative polymerase chain reaction.Conclusion: Our findings established novel prognostic biomarkers to predict tamoxifen sensitivity, which may facilitate individualized management of breast cancer.
Covid19 Response in Low-Income Country: The Case of a Lockdown in Zambia
Authors: Muzyamba Choolwe
Published: July 2020

Background The onset of the covid19 pandemic has sparked heated debate among scholars on the relevance of lockdowns. There are those in favor of the lockdown and others who are critical of it. However, despite the increased interest in understanding the relevance of lockdowns, there still has not been much focus on its relevance in low income countries like Zambia. Thus with the help of the SRT, we set out to explore and document the local characterization of the lockdown by residents of Lusaka, Zambia.MethodsA qualitative study in the form of interviews was conducted in Lusaka, Zambia involving a sample of 68 participants. Due to the lockdown measures that were in place during the study, the interviews were conducted via phone calls and the data collected were later analyzed by use of thematic analysis technique. ResultsThe lockdown was on one hand lauded for slowing down the incidence rates, preventing fatalities, and for protecting the healthcare system from collapse. On the other hand, it was criticized for exacerbating poverty levels, unemployment rates, increasing the rate of mental health problems, aiding gender based violence, and intensifying political repression and corruption. The results speak to the complexity in the characterization of the lockdown as a response to covid19 in Zambia. This observation demonstrates the folly of viewing, applying and characterizing the covid19 lockdown as a ‘one-size-fits-all’ approach in Zambia.ConclusionThus rather than definitely establishing the lockdown as an incontestable good, as it is depicted by some scholars or as useless by its critics, our findings instead demonstrate the diversity and complexity in how it is locally viewed by Zambians. The study provides grounds for caution on simplistic and binary characterization of lockdowns. It indicates the need for careful dialog between the designers of lockdowns and citizens in order to tailor such interventions to local realities in context-specific ways. It also shows that though the development of such interventions, all the various and complex elements it embodies must be taken into account in order to realize optimum outcomes.
Association Between Stroke Occurrence and Changes in Atmospheric Circulation
Authors: Vencloviene Jone , Radisauskas Ricardas , Kranciukaite-Butylkiniene Daina , Tamosiunas Abdonas , Vaiciulis Vidmantas , Rastenyte Daiva
Published: July 2020

Background: The impact of weather on morbidity from stroke was analysed in previous studies. As the risk of stroke was mostly associated with changing weather, the changes in the daily number of strokes may be associated with global changes in atmospheric circulation. The aim of our study was to detect and evaluate the association between daily numbers of ischaemic stroke (IS) and haemorrhagic stroke (HS) and the teleconnection pattern. Methods: The study was conducted in Kaunas city, Lithuania, from 2000 to 2010. The daily numbers of IS, subarachnoid haemorrhages (SAH), and intracerebral haemorrhages (ICH) were obtained from Kaunas Stroke Register. We evaluated the association between these types of stroke and the teleconnection pattern by applying Poisson regression, adjusting for the linear trend, month, and other weather variables. Results: During the study period, we analysed 4,038 cases (2,226 men and 1,812 women) of stroke. Of these, 3,245 (80.4%) cases were IS, 533 (13.2%) cases were ICH, and 260 (6.4%) cases were SAH. A change in mean daily atmospheric pressure of >3.9 hPa was associated with the risk of SAH (RR=1.49, 95% CI 1.14-1.96), and a stronger El Niño event had a protective effect against SAH (RR=0.34, 95% CI 0.16-0.69). The risk of HS was positively associated with East Atlantic/West Russia indices (RR=1.13, 95% CI 1.04-1.23). The risk of IS was negatively associated with Arctic Oscillation indices (RR=0.97, 95% CI 0.94-0.99). During November-March, a positive North Atlantic Oscillation (NAO) was associated with HS (RR=1.29, 95% CI 1.03-1.62), and a negative association between the NAO index and IS (RR=0.92, 95% CI 0.85-0.99) was found. Conclusions: The results of our study provided new evidence that the North Atlantic Oscillation, Arctic Oscillation, East Atlantic/West Russia, and El Niño-Southern Oscillation pattern may affect the risk of stroke. The impact of these teleconnection indices is not identical for different types of stroke. Emergency services should be aware of the fact that specific weather conditions are more likely to prompt calls for more severe strokes.
Factors Influencing Childhood Immunization Uptake in Africa: A Systematic Review
Authors: Galadima Abubakar Nasiru , Zulkefli Nor Afiah Mohd , Md. Salmiah , Ahmad Norliza
Published: July 2020

Background:Vaccine Preventable Diseases are still the most common cause of childhood mortality with an estimated of approximately 3 million death every year mainly in Africa and Asia and about 29% of deaths among children aged 1–59 months were as a result of vaccine preventable.Despite the benefit of childhood immunization uptake, routine vaccination coverage for all recommended Expand Program on Immunization vaccines has remained poor in some African countries such as Nigeria (31%), Ethiopia (43%), Uganda (55%) and Ghana (57%). The aim of this study is to collate evidence on the factors that influences childhood immunization uptake in Africa and also provide evidence for future researchers in developing, implementing and evaluating intervention among African populations that will improve childhood immunization uptake.Methods: We conducted a systematic review of articles on the factors influencing under-five childhood immunization uptake in Africa through using various keywords and we searched multiple databases (Medline, PubMed, CINAHL and Psychology and behavioural data collection) dated from inception to 2019. Results: Of 17,208 records citations retrieved, 240 abstracts were screened leading to 46 included studies: Thefactors that were found to influence the childhood immunization uptake were classified into modifiable and non-modifiable factors and were further classified into different groups based on its relevance. Themodifiable factors include: obstetric factors, maternal knowledge, maternal attitude and self-efficacy and maternal outcome expectation. Whereas non-modifiable factors were sociodemographicfactors of parent and child, logistic factors and administration factors.Conclusion: There were different factors found to be influencing under-five childhood immunization uptake among parents in Africa. Immunization health education intervention should be designed among pregnant women using social cognitive theory SCT which will enable researchers to tackle cognitive factors as well as some environmental factors that could be modifiable which may hopefully improve childhood immunization uptake in a country with poor coverage like Nigeria.
Rational Engineering A Xylanase Hyper-Producing System in Trichoderma Reesei for Efficient Biomass Degradation
Authors: Yan Su , Xu Yan , Yu Xiao-Wei
Published: July 2020

Background: The degradation of lignocellulose needs the synergetic work of cellulase and xylanase. Filamentous fungi Trichoderma reesei has been widely used as a workhorse for cellulase and xylanase fermentation with great producing ability. Previous work for biomass saccharification mainly aims to improve the component and production of cellulase, however the low xylanase activity in T. reesei could not meet the needs of a high saccharification efficiency. Results: In this study, for the first time, a xylanase hyper-producing system in T. reesei was established by tailoring two transcription factors, XYR1 and ACE1, and homologous over-expression of the major xylanase XYNⅡ. The expression of key xylanolytic enzymes was significantly upregulated with an increase of 6.78- and 1.98-fold in the xylanase activity and pNPXase (β-xylosidase) activity compared to that of the parent, Rut-C30, respectively. Besides, 2310-3085 U/mL of xylanase activities were achieved using soluble lactose or glucose as sole carbon source, which was more efficient and economical than the traditional method of xylan induction. Treated with the crude xylanase cocktails as accessory enzymes, an increase of 39.7% in reducing sugar yield (31.3 mg/mL) in saccharification of alkali pretreated corn stover (5% w/v) was achieved compared to that of the parent. Conclusions: An efficient and economical xylanase hyper-producing platform was developed in T. reesei Rut-C30. The novel platform with outstanding ability for crude xylanase cocktails production would greatly fit in biomass degradation and give a new perspective of further engineering in T. reesei for industrial purposes.
Incidence And Risk Factors Of Inguinal Hernia Occurred After Radical Prostatectomy-comparisons of different approaches
Authors: Liu Lijia , Xu Haoxiang , Qi Feng , Wang Shangqian , Shadhu Kamleshsingh , Ramlagun-Mungur Dadhija , Wang Shui
Published: July 2020

Purpose
To observe cumulative morbidity of postoperative inguinal hernia(PIH) and identify risk factors associated with its development in patients who underwent retropubic radical prostatectomy(RRP), laparoscopic prostatectomy(LRP) or robotic assisted laparoscopic prostatectomy (RALP) operation.
Methods
From June 2009 to September 2016, 756 patients diagnosed with localized prostate cancer who had undergone RRP, LRP or RALP in our center were included in this study. Patients with PIH were retrospectively investigated in such factors as age, BMI, previous abdominal operations, diabetes mellitus history, hypertension history, prostate volume, previous hernia, operative methods, operative approach, preoperative Gleason, clinical T-stage, PLND situation, operative time, and estimated blood loss. Univariate and multivariate cox hazard regressions analysis were utilized to identify risk factors predisposing to PIH.
Results
A total of 53 of 751(7.1%) patients developed PIH at a median follow-up period of 43 months. PIH rate in RRP was significantly higher compared to LRP and RALP group (RRP: 15.3%, LRP: 6.7%, RALP:1.9%, P = 0.038). Right side (69.8%) and indirect (88.8%) PIH were dominant type in hernia group. Univariate and multivariate cox hazard regressions analysis indicated that age and RRP approach were identified to be implicated to PIH [adjusted hazard ratio7.39(1.18–46.39), 2.93(95% CI 1.47–5.84)].
Conclusions
RRP technique and older age, especially patients over 80 years, are associated with higher incidence for PIH development. Appropriate prophylaxis during the operation should be evaluated for those in high-risk.
Cultural Adaptation and Validation of the Ghanaian Language (Akan; Asante Twi) Version of the Health Literacy Questionnaire.
Authors: Boateng Millicent Addai , Angel Sanne , Agyei-Baffour Peter , Enemark Ulrika
Published: July 2020

Background In under-resourced settings, patient competences to manage their own health is sometimes a necessity and high health literacy is needed to obtain a good health outcome. Thus, it is relevant to have a comprehensive measurement tool suitable for populations in such settings. The Health Literacy Questionnaire (HLQ) is a tool useful for health literacy assessment covering nine dimensions/scales of health literacy. The HLQ has been translated and validated in diverse contexts but has so far not been assessed in any country in sub-Saharan Africa. We sought to translate this tool into the most common language used in Ghana and assess its validity. Methods We carried out a cross-sectional study using the HLQ concurrently with an assessment of a malaria programme for caregivers with children under five years. The HLQ was translated using a systematic translation procedure. We analysed the psychometric properties of the HLQ based on data collected by face-to-face interview of 1234 caregivers. The analysis covered tests on difficulty level of scales, composite reliability, Cronbach’s alpha and confirmatory factor analysis (CFA). Results Cognitive testing showed that some words were ambiguous, which led to minor rewording of the questionnaire. A nine-factor CFA model was fitted to the 44 question items with no cross-loadings or correlated residuals allowed. Given the very restricted nature of the model, the fit was quite satisfactory: χ2 DWLS (866 df) = 17177.58, p < 0.000, CFI = 0.929, TLI = 0.922, RMSEA = 0.116 and SRMR = 0.099. Composite reliability and Cronbach’s alpha were >0.7 for all scales except Cronbach’s alpha for scale 9, ‘Understanding health information well enough to know what to do’ (0.6). The mean differences between most demographic groups among health literacy scales were statistically significant. Conclusion The Akan-Twi version of HLQ proved relevant in our description of the health literacy levels among the caregivers in our study. This validated tool will be useful to conduct health literacy needs assessments to guide policies addressing such needs. Further work is needed to assess its psychometric properties among other population groups.
Reducing the Smoking-Related Health Burden through Diversion to Electronic Cigarettes: A System Dynamics Simulation Study
Authors: Selya Arielle
Published: July 2020

Background: Electronic cigarettes (“e-cigarettes”) have altered nicotine use trends, and their impacts are controversial. Given their reduced risk profile relative to conventional cigarettes, e-cigarettes have potential for harm reduction. The current study presents a simulation-based analysis of an e-cigarette harm reduction policy. Methods: A system dynamics simulation model was constructed, with separate aging chains for cigarette smokers and e-cigarette users. These structures work together with a policy module to close the gap between actual (simulated) and a goal number of cigarette smokers, chosen to reduce the nicotine-attributable death rate to the accidental death rate. The policy is two-fold, first removing existing regulations on e-cigarettes (e.g. flavor bans) and second providing an informational campaign promoting e-cigarettes as a lower-risk alternative. Realistic practical implementation challenges are modeled in the policy sector, including time delays, political resistance, and budgetary limitations. Effects of e-cigarettes on conventional smoking occurs through three mechanisms: 1) diversion from ever initiating conventional smoking; 2) reducing smoking behavior and thus progression to established smoking; and 3) increasing smoking cessation. An important unintended effect was included, which increases the nicotine-related mortality accordingly with an increase in nicotine users due to e-cigarettes.Results: The base-case model replicated the historical exponential decline in conventional cigarette smoking and the exponential increase in e-cigarette use since their introduction circa 2010. The ideal-case policy was able to reduce conventional smoking to the goal level approximately 40 years after implementation. Policy scenarios that included realistic, practical obstacles to implementation delayed and weakened the effect of the policy by up to 95% in the worst case, relative to the same time point in the ideal-case scenario; however, these discrepancies substantially decreased over time in dampened oscillations. Conclusions: Current findings demonstrate that the promotion of e-cigarettes as a harm-reduction policy is a viable strategy, given current knowledge of e-cigarettes’ effects on conventional smoking. Given the strong effects of implementation challenges on policy effectiveness in the short term, accurately modeling such obstacles is essential in policy design. Ongoing research is needed with forthcoming data on e-cigarette use prevalence and possible effects on cigarette smoking.
Minimum Clinical Important Difference for Resilience Scale Specific to Cancer: A Prospective Analysis
Authors: YE ZENG JIE , ZHANG ZHANG , TANG YING , LIANG JIAN , ZHANG XIAO YING , HU GUANG YUN , SUN ZHE , LIANG MU ZI , YU YUAN LIANG
Published: July 2020

Background: The minimum clinical important differences (MCIDs) of resilience instruments in patients with cancer have not been comprehensively described. This study was designed to evaluate MCIDs of 10-item and 25-item resilience scales specific to cancer (RS-SC-10 and RS-SC-25).Methods: From June 2015 to December 2018, RS-SCs were longitudinally measured in 765 patients with different cancer diagnoses at baseline (T0) and 3 months later (T1). The EORTC QLQ-C30, Connor-Davidson Resilience Scale, Hospital Anxiety and Depression Scale, and Allostatic Load Index were measured concurrently as anchors. Anchor-based methods (linear regression, within-group), distribution-based methods(within-group), and receiver operating characteristic curves (ROCs, within-subject) were performed to evaluate the MCIDs.Results: 623 of 765 (84.1%) patients had paired RS-SCs scores. Moderate correlations were identified between the change in RS-SCs and change in anchors (r= 0.38-0.44, all p<0.001). Linear regression estimated +8.9 and -6.7 as the MCIDs of RS-SC-25, and +3.4 and -2.5 for RS-SC-10. Distribution-based methods estimated +9.9 and -9.9 as the MCIDs of RS-SC-25, and +4.0 and -4.0 for RS-SC-10. ROC estimated +5.5 and -4.5 as the MCIDs of RS-SC-25, and +2.0 and -1.5 for RS-SC-10.Conclusions: The most reliable MCID is around 5 points for RS-SC-25 and 2 points for RS-SC-10. RS-SCs are more responsive to the worsening status of resilience in patients with cancer and these estimates could be useful in future resilience-based intervention trials.
Development and validation of multiparametric MRI-based nomogram for predicting occult metastasis risk in early tongue squamous cell carcinoma
Authors: Saenthaveesuk Pensiri , Yang Le , Zeng Bin , Xu Meng , Young Simon , Liao Guiqing , Liang Yujie
Published: July 2020

Background
Nomograms are currently used in predicting individualized outcomes in clinical oncology of several cancers. However, nomograms for evaluating occult nodal metastasis of patients with squamous cell carcinoma of lateral tongue (SCCLT) have not been widely investigated for their functionality. This retrospective cohort study was designed to address this question.
Methods
This study was divided into primary and validation cohorts. The primary cohort comprised 120 patients diagnosed between 2012 and 2017, whereas the validation cohort included 41 patients diagnosed thereafter. The diagnostic value of multiparametric MRI, including radiologic tumor thickness threshold (rTTT) in three-dimensions, paralingual distance, and sublingual distance were investigated. A nomogram was developed based on stepwise logistic regression of potential predictors associated with nodal metastasis in the primary cohort and then tested for predictive accuracy in the validation cohort using area under the curve (AUC) and goodness-of-fit tests.
Results
Multivariate analysis, tumor size (odd ratio [OR] 15.175, 95% confidence interval [CI] 1.436-160.329, P = 0.024), rTTT (OR 11.528, 95% CI 2.483–53.530, P = 0.002), paralingual distance (OR 11.976, 95% CI 1.981–72.413, P = 0.005), and tumor location (OR 6.311, 95% CI 1.514–26.304, P = 0.011) were included in the nomogram to predict the likelihood of having cervical metastasis. A nomogram cutoff value of 210 points (sensitivity 93.8%, specificity 87.5%) was significantly different to classify the patients metastasis risk group (P < 0.001). Nomogram showed predictive accuracy with AUC 0.881 (95% CI 0.779–0.983, P < 0.001) and good calibration after the validation.
Conclusions
A preoperative nomogram incorporating multiparametric MRI demonstrated good prediction and performed adequately in our study. Three-dimensional assessment of occult metastasis risk value obtained from this nomogram can assist in preoperative decision making whether to manage with neck surgery for individual patients with early-stage SCCLT. The probability of nodal metastasis tended to be greater than 20% in patients with high metastasis risk or nomogram total score > 210 points.
COVID-19 Induced Economic Uncertainty: A Comparison between the United Kingdom and the United States
Authors: Pata Ugur Korkut
Published: July 2020

The purpose of this study is to investigate the effects of the COVID-19 pandemic on economic policy uncertainty in the US and the UK. The impact of the increase in COVID-19 cases and deaths in the country, and the increase in the number of cases and deaths outside the country may vary. To examine this, the study employs bootstrap ARDL cointegration approach from March 8, 2020 to May 24, 2020. According to the bootstrap ARDL results, a long-run equilibrium relationship is confirmed for five out of the 10 models. The long-term coefficients obtained from the ARDL models suggest that an increase in COVID-19 cases and deaths outside of the UK and the US has a significant effect on economic policy uncertainty. The US is more affected by the increase in the number of COVID-19 cases. The UK, on the other hand, is more negatively affected by the increase in the number of COVID-19 deaths outside the country than the increase in the number of cases. Moreover, another important finding from the study demonstrates that COVID-19 is a factor of great uncertainty for both countries in the short-term.
Cause-specific death in hospitalized individuals infected with SARS-CoV-2: More than just acute respiratory failure or thromboembolic events.
Authors: Marta Cobos-Siles , Cubero-Morais Pablo , Arroyo-Jiménez Irene , Hernández-Gómez Laura , Vargas-Parra Derly Judith , González-Fernández María , Cazorla-González Marina , Gabella-Martín Miriam , Ruíz-Albi Tomás , Berezo-García José Angel , García-Cruces-Méndez Jesús Fernando , Miramontes-González Pablo , Corral-Gudino Luis
Published: July 2020

Background: Infection with SARS-CoV-2 is becoming the leading cause of death in most countries during the 2020 pandemic.Objective: to assess the association between COVID-19 and cause-specific death.Design: Retrospective cohort study.Setting and Participants: We included data from inpatients diagnosed with COVID-19 between March 18 and April 21, 2020, who died during their hospital stay. Demographic, clinical and management data were collected. Causes of death were ascertained by review of medical records.Results: The sample included 100 individuals. The median age was 85 (IQR 15), 59% were men. Fifteen patients (15%) died from complications unrelated to COVID-19. In univariate analysis, these patients compared to those who died from COVID-19 complications had a greater likelihood of dementia (47% vs 20%) and dependency in activities of daily living (93% vs 48%), higher Charlson comorbidity index scores (6 vs 5), a lower likelihood of fever at diagnosis (47% vs 77%), and higher lymphocyte counts (1,000 vs 660). In multivariate analysis, patients were older (OR 1.10, 95% CI 1.00–1.23) and more often had heart failure (OR 5.58, 95% CI 1.09–28.66). The presence of X-ray infiltrates was uncommon (OR 0.03, 95% CI 0.01–0.17). A higher percentage of patient deaths from causes unrelated to COVID-19 complications occurred during the two first weeks of the pandemic.Conclusions: Fifteen percent of patients with COVID-19 died from causes unrelated to COVID-19 complications. Most of these patients had more comorbidities and were frail and elderly. These findings can partially explain the excess mortality in older people.
Failure Risk Factor For Non-Operative Treatment of Splenic Trauma
Authors: Maubert Alexandre , Douissard Jonathan , Tokoto Pierre-Alain , Massalou Damien
Published: July 2020

Background: Splenic trauma is a common pattern for admission in blunt abdominal trauma. The objective of this study is to identify risk factors for failure of non-operative management (NOM) in splenic trauma.Methods: This is a retrospective monocentric analysis of a prospectively collected database. All patients admitted in the university hospital of Nice [Centre Hospitalier Universitaire (CHU) de Nice, France] for a splenic trauma from January 1st 2006 to January 6th 2018 were included. Primary outcome was the need for delayed splenectomy as an indicator of NOM failure.Results: Two-hundred-eighty patients were included in this study. Most splenic lesions were severe grades (grade 3 or higher). In total, 83 splenectomies were performed urgently, i.e. 29% of patients; 88 angio-embolizations, i.e., 31% of patients with a success rate greater than 80%; 14.7% of 136 patients who had no previous angio-embolization required secondary splenectomy; 19.7% of the 61 patients who had anterior angio-embolization required secondary splenectomy. Age was not found associated with a higher failure rate (44 years in successful embolization vs 37.5 years in NOM-failure group, p = 0.15). Higher drop in hemoglobin levels between admission and 6 hours after admission was detected in the embolization failure group (-1.44 g/dl) as compared with the successful group (-0.68 g/dl), which approached statistical significance (p = 0.064).Conclusions: Hemoglobin monitoring in the hours following the admission of a patient with splenic trauma might be an important factor during the medical supervision of hemodynamically stable patients. Early identification of patients at high risk of NOM failure by hemoglobin monitoring may prevent late splenectomy.Level of evidence: IV (retrospective study)