bluuebunny/crossref_metadata_2025 huggingface dataset:
Measuring productivity of healthcare services under environmental constraints: Evidence from China
Authors: Yu Jinna , liu zhen , Zhang Tingting , Hatab Assem Abu , Lan Jing
Published: June 2020

Background: Despite the growing literature on the efficiency and productivity of the Chinese healthcare system, less attention has been given to examining the undesirable outputs linked to healthcare services, including environmental pollution. Taking the atmospheric environmental pollution resulting from the incineration of medical waste as an undesirable output of the healthcare system, this study analyzed the growth and decomposition of Total Factor Productivity (TFP) of healthcare services across 31 Chinese provinces during the period 2005-2016.Methods: The Meta-frontier undesirable super-efficiency slack-based measure (SBM) model and the Global Malmquist-Luenberger (GML) Index were employed to analyze the growth and decomposition of TFP using the Max DEA software. Results: The results revealed that the years 2009 and 2015 marked significant changes in TFP of healthcare services in Chinese provinces. During the study period, the rate of technological change (TC) slowly declined, whereas the rate of efficiency change (EC) steadily increased. With the national average being the benchmark, the results indicated that: the TFP of 17 provinces and cities exceeded the average, the EC changes of 16 provinces and cities exceeded the average, the TC changes of 9 provinces and cities exceeded the average, and the in the Technology Gap Ratio (TGR) changes of 13 provinces and cities were above the national average. Conclusions: (1) The TFP of the healthcare services across China continued to decline slowly during the study period. (2) The effect of technical catch-up in the eastern, central, and western regions of China was significant across the three regions, whereas the effect of technical innovation was negative. (3) The TFP varied considerably among the Chinese provinces. These findings suggest that, under existing environmental constraints, relevant government departments should improve technical innovation in the supply of healthcare services and medical waste treatment, increase technical efficiency in the factor of healthcare production, strengthen regional health planning, and balance the development of regional healthcare.
Degenerative central lumbar spinal stenosis: Is endoscopic decompression through lateral transforaminal approach sufficient?
Authors: Zhang Bin , Kong Qingquan , Yan Yuqing , Feng Pin
Published: June 2020

Background: At present, no percutaneous endoscopic transforaminal decompression surgery has been reported to solve central lumbar spinal stenosis (CLSS). Whether endoscopic decompression through lateral transforaminal approach decompression is sufficient for degenerative CLSS. Methods: This retrospective study included 47 cases of CLSS patients who underwent percutaneous endoscopic decompression through a bilateral transforaminal approach. Clinical outcomes such as ODI, back and leg VAS, the Macnab criteria were evaluated. Surgical results including operative time, postoperative hospital stay, recurrence, and surgical complications were also studied. Radiologically, lumbar stability was assessed and lumbar dural sac dimension was compared preoperatively and postoperatively. Results ： All 47 patients were followed up. The average follow-up period was 24.5 months. The average operation time was 116 minutes. The mean VAS of leg and back pain, and the mean ODI improved from 7.81, 2.53, and 77.03% at baseline to a final 1.94 (P=0.00), 2.47 (P=0.71), and 19.40 % (P=0.00), respectively. According to the Macnab criteria, 97.9% of patients achieved excellent and good results. There were 2 cases of dura tear and 3 cases of transient postoperative dysthesia. The cross sectional area of the dural sac was significantly enlargement at the last fellow up (74.28±13.08 mm 2 vs. 104.91±12.40 mm 2 , P=0.00). Conclusions: Except for the main pathogenic factors on the dorsal side of the dural sac, percutaneous endoscopic decompression through a bilateral transforaminal approach is sufficient for CLSS. It is a feasible, safe, and clinically effective minimally invasive procedure.
Assessment of the efficacy of a fatigue management therapy in schizophrenia: study protocol for a randomized, controlled multi-centric study (ENERGY)
Authors: Raffard Stéphane , Rainteau Nicolas , Bayard Sophie , Laraki Yasmine , Norton Joanna , Capdevielle Delphine
Published: June 2020

Background Fatigue is a well-known common clinical feature of numerous chronic diseases including various forms of cancer, neurological disorders such as multiple sclerosis, and psychiatric disorders. A significant proportion of people with schizophrenia (30-60%) reportedly experience fatigue, which impacts negatively on participation in various activities, including work, study, leisure and social pursuits. Causes of fatigue in schizophrenia are poorly understood and there are no established treatments. Several evidence-based interventions for fatigue syndrome including psychoeducation, cognitive behavioral therapy, and graded exercise therapy have been shown to be effective in other medical conditions and could be adapted to address fatigue in schizophrenia patients. As there are no psychosocial or pharmacological interventions with proved efficacy for fatigue in schizophrenia, there is an urgent need for the development of strategies to improve fatigue management in schizophrenia.The aim of this project is to evaluate in a single blind randomized clinical trial the efficacy of a cognitive-behavioral therapy (CBT) intervention compared to treatment as usual (TAU) on fatigue as the main outcome in schizophrenia patients. Clinical symptoms, physical functioning, major cognitive functions, quality of life and functioning, treatment dosage, daily motor activity, biological markers with inflammatory markers are also considered as secondary outcomes.Methods/design200 patients meeting the inclusion criteria will be randomized to either of the study arms (intervention or TAU). The ENERGY intervention will be delivered according to a standardized treatment manual comprising six modules addressing fatigue and sleep over 14 individual therapy sessions. The treatment encompasses core CBT principles of psycho-education, behavioral activation, behavioral experiments, cognitive restructuring, problem-solving and relapse prevention. Sessions will follow the traditional CBT structure of agenda setting, review of homework tasks, and introduction of a new concept/technique with collaborative discussions on how to implement such strategies in the participant’s day-to-day environment. Our primary endpoint will be the severity of fatigue assessed at baseline and at the 9-month follow-up using the “Multidimensional Fatigue Inventory” (MFI).DiscussionThe trial will provide the first test of CBT intervention for fatigue for patients with schizophrenia. This study will also test to what extent the treatment can be implemented in everyday practice.Trial Registration : ClinicalTrials.gov Identifier: NCT04332601. Registered on April 10, 2020
Impact of DRGS-based Inpatient Service Management on the Performance of Regional Inpatient Services in Shanghai, China: an Interrupted Time Series Study, 2013-2019
Authors: feng lvfan , Tian Yuan , He Mei , Tang Jie , Peng Ying , Dong Chenjie , Xu Wenzhong , Wang Tao , He Jiangjiang
Published: June 2020

Background: The asymmetry of information brings difficulty for government to manage public hospitals. Therefore, Jiading District of Shanghai has been establishing DRGs-based inpatient service management system (ISMS) to effectively compare the output of different hospitals through DRGs, reward desired hospital performance and enhance inpatient service capacity. However, the impact of the implementation of DRGs-based inpatient service management (ISM) policy in Jiading district is still unknow. We therefore conducted this study to evaluate the impact of DRGs-based ISM policy on the performance of inpatient service since its implementation in Jiading District, Shanghai, China in 2017.Methods: Using an interrupted time series design, we analyzed quarterly data of seven DRGs-based performance measures from the ISMS which covered all five public hospitals in Jiading District from 2013 to 2019. We utilized the segmented linear regression model to assess the change of level and trend of performance indicators before and after ISM policy. Durbin-Watson test was performed to check the series autocorrelation of indicators.Results: Significant changes in the following indicators were observed since the implementation of ISM policy. The case-mix index (CMI) level decreased by 0.103 (P < 0.05), the trend increased by 0.008 (P < 0.05). The total weight level decreased by 3719.05 (P < 0.05), and the trend increased by 250.13 (P < 0.05). The time efficiency index (TEI) level increased by 0.12 (P < 0.05), and the trend decreased by 0.01 (P < 0.05). The cost efficiency index (CEI) level increased by 0.31 (P < 0.05), and the trend decreased by 0.02 (P < 0.05). No significant difference was found in the change of DRGs number, inpatient mortality of low-risk group cases (IMLRG) and inpatient mortality of medium-to-low risk group cases (IMMLRG).Conclusions: Findings highlight the role of ISM policy in improving the capacity and efficiency of regional inpatient service. Three prerequisites, including a good information system, high-quality EMR data, and a management team, are needed for other countries to implement their own ISM policy to help government manage public hospitals and improve the performance of regional inpatient service.
Outcomes After Transcatheter Aortic Valve Replacement in Cancer Survivors with Prior Chest Radiation Therapy: A Systematic Review and Meta-Analysis
Authors: Zafar Meer Rabeel , Mustafa Syed Farrukh , Miller Timothy W , Alkhawlani Talal , Sharma Umesh C
Published: June 2020

Background : Cancer survivors with prior chest radiation therapy (C-XRT) frequently present with aortic stenosis (AS) as the first manifestation of radiation-induced heart disease. They are considered high-risk for surgical valve replacement. Transcatheter aortic valve replacement (TAVR) is as an attractive option for this patient population but the outcomes are not well established in major clinical trials. The authors performed a systemic review and meta-analysis of clinical studies for the outcomes after TAVR in cancer survivors with prior C-XRT. Methods: Online databases were searched from inception to April 2020 for studies evaluating the outcomes of TAVR in patients with and without C-XRT. We analyzed the pooled estimates (with their 95% confidence intervals) of the odds ratio (OR) for the all-cause mortality at 30-day and 1-year follow-ups, 4-point safety outcomes (stroke, major bleed, access-related vascular complications and need for a pacemaker), a 2-point efficacy outcome (mean aortic valve gradient and left ventricular ejection fraction) and worsening of congestive heart failure (CHF). Four studies were included following 2054 patients with and without prior C-XRT exposure (164 patients and 1890 patients respectively). Results: The C-XRT group had similar 30-day mortality compared to the control group (OR 1.29, 95% CI 0.64 to 2.58, p=0.48). The 1-year mortality was higher in the C-XRT group (OR 1.97, CI 1.15 to 3.39, p=0.01). Apart from higher congestive heart failure (CHF) exacerbation in the C-XRT group (OR 2.03, CI 1.36 to 3.04, p=0.0006), TAVR resulted in similar safety and efficacy outcomes in both groups. Conclusion: TAVR in the C-XRT group has similar 30-day mortality, safety, and efficacy outcomes compared to the control group; however, they have higher 1-year mortality and CHF exacerbation. Including an oncologist to the cardiology team who considers cancer stage in the decision-making process and applying additional preoperative scores such as frailty indices may refine the risk assessment for these patients. The quality of analyzed data is modest, warranting randomized trials to assess the true benefits of TAVR in these patients.
A new educational method before total knee arthroplasty to be applied in developing countries: a randomized controlled trial
Authors: Andrade Marco Antonio Percope de , Silva Guilherme Moreira Abreu e , Campos Tulio Vinicius Oliveira , Barbosa David Guen Kasuya , Leite Danilo Silva , Rezende Marcus Vinicius Teodoro , Magalhães Tauam Filipe Galo , Santos Felipe Maciel
Published: June 2020

Background

In developing countries, the illiteracy index is high in public hospitals. We describe a method in which patients are instructed before total knee arthroplasty (TKA) in a differentiated way without the necessity of reading any self-orientation.
Methods

To improve patient education before TKA we developed a multidisciplinary method in which an orthopedic surgeon, a nurse and a physiotherapist give the patients a differentiated orientation with specific lectures regarding the pre, intra and post-operative issues in a prospective case-control study of 79 consecutive patients undergoing primary TKA. Twenty-nine patients received the standard verbal education (control group) and 38 patients received the differentiated education (intervention group). The patients were evaluated during at least six months.
Results

After a 6-month follow-up period, SF-36 and WOMAC forms, VAS and range of motion improved significantly in both groups. ROM was better in the intervention group (mean and SD − 106.9 ± 5.7 versus 92.5 ± 12.1 degrees, p = 0.02). Moreover, walk ability (more than 400 meters) was improved in the intervention group compared with control group (97.4% versus 72.4%, p = 0.003). In the intervention and control groups, respectively, 10.5% and 31% of patients reported the need of some walking device (p = 0.03).
Conclusions

A differentiated educational program with a multidisciplinary team had a positive impact on functional outcomes, improving ROM and walk ability of patients undergoing TKA in a short-term evaluation.
Treatment Of Ruptured Tiny Intracranial Aneurysms By Electrocoagulation With Guidewire Manipulation:12 Cases Report
Authors: Xia Lixia , Hao Zhongfei , Wang Hongjun , Feng Yan , Zhan Yongxuan , Chen Minghui , Xie Peng , Li Qingbin , Li Ruiyan , Liu Yang , Wang Feng , Fang Yuequn , Li Youxiang , Li Yongli
Published: June 2020

Background: Ruptured tiny intracranial aneurysm (RTIA) is particularly rare seen. Treatment of RTIA is more difficult and not under control.Methods: We hereby present twelve rare cases of RTIA that were diagnosed based on DSA. These patients were found due to spontaneous or traumatic SAH, 11 of whom were treated only by electrocoagulation, and one of whom was treated by stent-assisted coiling and electrocoagulation.Results: There were eight patients with aneurysms located in posterior circulation and four patients with aneurysms located in anterior circulation. 11 patients were cured only by electrocoagulation merely: ten patient’ RTIA disappeared completely and immediately and another patient’s RTIA was thrombosed two months later. The twelfth patient was carried out stent-assisted coiling and electrocoagulation. The twelve patients’ average follow-up time was 12.5 months and the outcomes were all surprisingly excellent. No revascularization of aneurysm was found. Conclusions: Electrocoagulation with guidewire manipulation is a suitable method to treat RTIA. While large-scale studies with long-term follow-up are required to validate these promising results.
Perceptions in a Cohort of Women Exposed to Intimate Partner Violence (IPV)
Authors: Leuenberger Laura , McCall-Hosenfeld Jennifer , Lehman Erik
Published: June 2020

BackgroundAlmost one-half of American women will experience intimate partner violence (IPV), defined as physical, sexual, or psychological harm by a current or former partner. IPV is associated with an increased risk of homicide, with firearms as the most commonly used weapon. We designed this study to better understand the impact of interpersonal trauma exposure and demographic factors on firearm perceptions among a cohort of IPV-exposed women. Methods267 women in central Pennsylvania with exposure to IPV were surveyed about perceptions of gun access, safety, and gun presence in the home. Trauma variables included IPV type, IPV recency, unwanted sexual exposure, and adverse childhood experiences (ACEs). Multivariable analyses examined each of the three firearm perception questions controlling for trauma exposures and demographics. ResultsEase of firearm acquisition: Women who reported physical IPV (aOR2.40, 95%CI 1.20,4.81), women who reported past year unwanted sexual exposure (aOR4.01, 95% CI 1.00,16.03), and women of ages 47-54 (aOR3.57 95%CI 1.49,8.55) reported that guns were easy to acquire, compared to women ages 19-34. Perceived safety in the proximity of a gun: Women with the highest ACE score were less likely to feel safe with a gun nearby (aOR0.41, 95%CI 0.21,0.84). Rural women (aOR4.13, 95%CI 1.55,11.01), and women ages 35-46 had increased odds (aOR2.88, 95%CI 1.35,6.12) of reporting that guns made them feel safer. Odds of guns in the home: Women who were divorced or separated (aOR0.22, 95%CI 0.09,0.54) and women were widowed or single (aOR0.22, 95%CI 0.07,0.68) had lower odds of having a gun in the home, compared to married women. Rural women had higher odds of living in a home with a gun (aOR3.30, 95%CI 1.04,10.49). There was no significant effect of the trauma variables on the odds of having a gun at home. ConclusionsTrauma exposures, including physical IPV and past-year unwanted sexual exposure, were associated with women’s perceptions that it was easier to acquire guns in their community. Women with more severe childhood trauma felt less safe around firearms, but trauma exposures did not predict gun ownership. Instead, demographics of being married and rural residence were associated with gun ownership.
Prevalence of Enterobius Vermicularis Infections and Associated Risk Factors Among Schoolchildren in Nakhon Si Thammarat, Thailand
Authors: Laoraksawong Pokkamol , Pansuwan Pimyada , Krongchon Supakrit , Pongpanitanont Pongphan , Janwan Penchom
Published: June 2020

Objective: Enterobius vermicularis infection is an important public health problem worldwide, especially among schoolchildren in tropical and subtropical countries. The prevalence of E. vermicularis infections varies in each region of Thailand, but its status remains unknown among children who live in rural areas of southern region. This study aimed to evaluate the current prevalence of E. vermicularis infections and to identify the risk factors for infection among schoolchildren who live in rural communities in Nakhon Si Thammarat, Southern Thailand.Results: The overall prevalence of E. vermicularis infections was 5.79% (23 of 397). According to the multivariate analysis, the following were found to be risk factors associated with E. vermicularis infections (P < 0.05): male sex (AOR = 4.03, 95%CI 1.22-13.29), age group 3-6 years (AOR = 4.85, 95%CI 1.51-15.59), those having mother’s education level of primary school (AOR = 11.22, 95%CI 1.75-71.77), those having older sibling(s) (AOR = 6.25, 95%CI 1.83-21.26), those having younger sibling(s) (AOR = 6.24, 95%CI 2.00-19.44), those sometimes washing hands after using toilet (AOR = 5.25, 95%CI 1.24-22.21), those keeping fingernail long (AOR = 29.97, 95%CI 6.16-145.85), and those sucking their finger (AOR = 3.59, 95%CI 1.21-10.66).
Comparing the Effect of Face-to-Face with Phone Counselling Based on Cognitive-Behavioral Therapy on Vasomotor Symptoms in Postmenopausal Women: A Randomized Controlled Trial
Authors: Joola Nasim Sadeghi , Afshari Pourandokht , Jefreh Maryam Gholamzadeh , Tadayon Mitra , Haghighizadeh Mohammad Hossein
Published: June 2020

Background: Hot flash and night sweat (HF/NS) are the most common complication in menopause that affects the quality of life of women. The present study was conducted with the aim of comparing the effectiveness of the phone with face-to-face counseling based on cognitive-behavioral therapy for vasomotor symptoms of postmenopausal women.Methods: The present study was a randomized clinical trial. In this study, 40 eligible postmenopausal women were randomly assigned to one of face-to-face or phone counseling methods using the block randomization. Six counseling sessions were weekly held for each person and women requested to record their hot flashes and night sweat in a diary. Data were analyzed using chi-square, ANCOVA, and independent t-test.Results: Thirty- six women completed the study. Women in two groups showed a significant improvement in the frequency, severity, and duration of hot flashes and the frequency and severity of night sweats after the intervention (P <0.001). Weekly means of hot flashes and night sweats, decreased after the intervention in both groups (face-to-face group: HF frequency from 31.92±7.98 to 18.83±7.35, HF severity from 2.24±0.28 to 1.21±0.23, HF duration from 4.22±1.17 min to 2.79±0.91min, NS frequency from 2.34±0.31 to 1.21±0.24 and NS severity from 1.70±0.34 to 1.03±0.29 and also in phone counseling group: HF frequency from 33.32±7.77 to 19.53±7.7, HF severity from 2.23±0.24 to 1.20±0.18, HF duration from 4.29±1.23 min to 2.68±0.95min, NS frequency from 2.33±0.31 to 1.14±0.16 and NS severity from 1.59±0.34 to 1.01±0.30). There was no significant difference between groups after the intervention in terms of HF frequency, severity, and duration, as well as NS frequency, and severity (p>0.05). Conclusion: Based on the results of this study, using of face-to-face and phone counseling methods based on cognitive-behavioral therapy had a similar effect on the reducing of frequency, severity and duration of hot flashes as well as the frequency and severity of night sweats. Using phone counseling in women who have difficulty to attend the clinic is recommended.Trial registration number: IRCT20180918041065N1 Website: https://www.irct.ir/login
Genome mining and UHPLC-MS/MS illuminate the specificity of secondary metabolite synthetic gene clusters in Bacillus subtilis NCD-2
Authors: Su Zhenhe , Chen Xiuye , Liu Xiaomeng , Guo Qinggang , Li Shezeng , Lu Xiuyun , Zhang Xiaoyun , Wang PeiPei , Dong Lihong , Zhao Weisong , Ma Ping
Published: June 2020

Background
Bacillus subtilisstrain NCD-2 is anexcellent biocontrol agent against plant soil-borne diseases and shows broad-spectrum antifungal activities. This study aimed to explore all the secondary metabolite synthetic gene clusters and related bioactive compounds in NCD-2. An integrative approach, which coupled genome mining with structural identification technologies using ultra-high-performance liquid chromatography coupled to quadrupole time-of-flight tandem mass spectrometry (UHPLC-MS/MS), was conducted to interpret the chemical origins of the significant biological activities in NCD-2.
Results
Genome mining revealed that NCD-2 contained nine gene clustershaving predicted functionsinvolving secondary metabolites with bioactive abilities. They encoded six known products-fengycin, surfactin, bacillaene, subtilosin, bacillibactin, and bacilysin-as well as three unknown products.Interestingly, the synthetic gene clusters for surfactin and fengycin showed 83% and 92% amino acid sequence similarity levels with the corresponding productsin Bacillus velezensisstrain FZB42. A further comparison of gene clusters encoding fengycin and surfactinrevealed that strain NCD-2 had lost thefenC and fenDgenes in the fengycinbiosynthetic operon, and that the surfactin synthetic enzyme-related gene srfAB was divided into two parts.Abioinformatics analysis showed that fenEAmay function as fenCD in synthesizing fengycinand that the structure of thisfengycin synthetic gene clusteris likely unique to NCD-2.Five kinds of fengycin,with 26 homologs, and surfactin,with 4 homologs,were detectedfrom strain NCD-2, which indicated the non-typical and unique nature of this fengycin biosynthetic gene cluster.To the best of our knowledge, this is the first report of a non-typical gene cluster related to fengycin synthesis.
Conclusions
The data provide the genetic characteristics of secondary metabolite synthetic gene clusters for fengycinand surfactin in B. subtilis NCD-2, including the unique synthetic mechanism for fengycin, and suggest that bioactive secondary metabolites explain the biological activities of NCD-2.
Lived experiences of Tuberculosis patients and their implications for early Tuberculosis case identification and management in Pastoralist community setting: A Qualitative study in Borena Zone, Oromia Region of Ethiopia
Authors: Adlo Abebe Megerso , Deyessa Negusie , Jarso Godana , Worku Alemayehu
Published: June 2020

Background: Ethiopia has highly diversified population with notable socioeconomic and cultural differences. Regardless of the differences, short course directly observed treatment is uniformly applied all over the country. Evidences are scarce on how well does this uniform approach fits with the pastoral community setting. The purpose of this study was to explore lived experiences of TB patients in the pastoral community under the uniform approach, and their implications to early case identification and management.Method: Qualitative method with phenomenological study design was undertaken to explore lived experiences of TB patients. Patients from all levels of health care (hospital, health center and health post) were included. Experience of both drug susceptible and drug resistant TB patients were documented. Twenty one patients, who consented to in the study, were selected by a convenient sampling method. In-depth interview was conducted using semi-structured interview guide and the interview ended subsequent to information saturation. The interview was audio recorded; and field notes were also taken. Data analysis was done concurrently with the data collection using word processor designed for qualitative text analysis. Inductive Thematic analysis was undertaken to identify key themes.Results: Twenty one patients (eight from hospitals, nine from health centers and four from health posts) were interviewed. Three of the eight hospital patients were on drug resistant tuberculosis (TB) treatment. Sixty two codes, five code categories and three themes emerged from the interviews. The three themes were health system, stigma and discrimination, and socioeconomic problem related experiences. Inaccessibility to health facilities due to scattered settlement and mobility, delay in care seeking TB symptoms, low index of suspecting TB by care providers, fear of stigma and indirect treatment related costs were some of the codes identified.Conclusion: TB patients in the pastoral setting were experiencing multifaceted challenges with the current application of ‘one-size-fits-all’ approach which implied hampered timely case identification and compromised patient management. Therefore, designing context appropriate intervention approach is required to ensure unprejudiced services.
The effect of sevoflurane anesthesia for dental procedure on neurodevelopment in children: a prospective, equivalence, controlled trial
Authors: Zhou Pinping , Zhang Chao , Huang Guijin , Hu Yuan , Ma Wenzhu , Yu Cong
Published: June 2020

Background

Dental procedures under general anesthesia (DGA) was found to improve the oral health-related quality of children's life. However, some parents and pediatricians expressed concern about the neurotoxicity of general anesthesia. The purpose of this trial was to investigate whether DGA in children has an adverse effect on neurodevelopment.
Methods

In this prospective, assessor-masked, controlled, equivalence trial, we recruited 340 children younger than 7 years who were undergoing caries treatment between Feb 1, 2019, and Aug 31, 2019, without factors affecting neurodevelopment. They received either sevoflurane-based general anesthesia or awake-local anesthesia. The Wechsler Preschool and Primary Scale of Intelligence-Fourth Edition Chinese version was used to evaluate the neurodevelopment of children at six months after surgery, and the Full-Scale IQ (FSIQ) was selected as the primary outcome. Predefine the 95% CI of a difference in means within five (1/3 SD) as the equivalence margin.
Results

The outcome data were obtained from 129 children in the general anesthesia group and 144 in the local anesthesia group. The median length of general anesthesia was 130 min (IQR 110–160). There was equivalence in means of FSIQ score between the general anesthesia group and the local anesthesia group (local minus general anesthesia 0.46, 95% CI -2.35 to 1.61). There was no significant difference in FSIQ scores between different age groups and different anesthesia durations. Just the mother's education could affect the primary outcome.
Conclusions

In this trial, prolonged DGA with a sevoflurane-only anesthetic in preschool children, does not adversely affect neurodevelopment at six months after surgery compared with awake-local anesthesia.
Trial registration:

Chinese Clinical Trial Registry, ChiCTR1800015216. Registered Mar 15 2018, http://www.chictr.org.cn/showproj.aspx?proj=24830.
Assessment of nicotine dependence among tobacco users visiting outreach programs in Dharan, Nepal: a cross-sectional study
Authors: Subedi Krishna , Shrestha Ashish , Bhagat Tarakant
Published: June 2020

Background
Nicotine is a highly addictive substance present in tobacco. This study was conducted to assess the prevalence of tobacco use and compare the nicotine dependence among smokers and smokeless tobacco users visiting dental outreach programs of B.P. Koirala Institute of Health Sciences -Dharan, Nepal.
Methods
A cross sectional study was conducted from June 2018 to April 2019. A total of 726 people were selected from participants of dental outreach programs of 6 districts using convenience sampling technique. The data collection was done using semi-structured questionnaire through face to face interview by a single researcher. History of tobacco use and level of nicotine dependency was measured using Nepali translated and validated form of Fagerström Test for Nicotine Dependence for smoking and smokeless. The mean age of the tobacco users was 39.55 ± 15.57 (Range = 19–82 years). Descriptive statistics including the mean, median, percentage, standard deviations and interquartile range were computed. Chi-square test, Fisher’s exact test and odds ratio were calculated where needed.
Results
The overall prevalence of any tobacco use, smoking form, smokeless and both form was found to be 32.8%, 14.9%, 14.3% and 3.6% respectively. Nicotine dependence (moderate and severe) was found in 80% of smokeless tobacco users and 48% of smokers. Among the smokeless tobacco users nicotine dependency was found to be more with female gender (Odds ratio = 4.98, 95%CI = 1.41–17.69, p = 0.01), increase in duration of tobacco use with every 10 years, low socioeconomic status (Odds ratio = 2.75, 95%CI = 1.02–7.40, p = 0.04), married, not using alcohol. Among smokers nicotine dependency was found to be significantly higher with more than 30 years of duration (Odds ratio = 3.35, 95% CI = 1.42–7.92, p = 0.005).
Conclusions
The study concluded that prevalence of tobacco consumption and nicotine dependence was high among the people visiting dental outreach programs. This study incorporated both smoking and smokeless tobacco users. It is high time to develop a policy to control tobacco use along with creating tobacco cessation centers. Tobacco control program are basically focusing on smoking. However, it is very necessary to incorporate in policy level to control smokeless tobacco along with smoking. Tobacco cessation centers will obviously help to quit tobacco among the tobacco users.
Patients with obesity use of activity monitors when attending a weight-loss programme—a qualitative study
Authors: Følling Ingrid Sørdal , Oldervoll Line , Hilmarsen Christina , Ersfjord Ellen M I
Published: June 2020

Background: Obesity is a major health concern in western countries. In Norway, patients with obesity can attend weight-loss programmes, which focus on changes in dietary and physical activity habits. Use of self-monitoring is advocated when changing dietary and physical activity habits for adults with obesity. This study aimed to explore the experiences of patients with obesity who used activity monitors while attending a weight-loss program.Methods: Patients with body mass index (BMI) > 35 kg/m2 with weight related comorbidities or a BMI > 40 kg/m2 referred to an intermittent weight-loss programme were recruited into this study. They were introduced to one of three different activity monitors, Fitbit ZipTM, Mio FuseTM, or Mio SliceTM. Semi-structured interviews were performed with patients six months into the weight-loss programme. Thematic analysis was applied when analysing the data.Results: Of the 29 informants (aged 21 to 66 years) interviewed, 59% were female. Their experience with activity monitors was related to their adherence to the weight-loss programme. Two main themes emerged from the informants stories: 1. “Activity monitors visualize proof of effort or failure to change health habits”. 2. “Activity monitors act as a positive or negative enforcer when incorporating change”.Conclusions: Using activity monitors either strengthens or undermines patients’ attempts to change health habits when attending a weight-loss program. Our findings suggest a need for more individualized weight-loss programmes for patients with obesity.Trial Registration: The study was registered in ClinicalTrials.gov on July 7 2016, with the registration number NCT02826122 and URL: https://clinicaltrials.gov/ct2/show/NCT02826122?term=NCT02826122&draw=2&rank=1.
Understanding the advantages of earth construction in urban housing in the United Kingdom
Authors: Zami Mohammad Sharif
Published: June 2020

Earth building material is beneficial in urban housing in the United Kingdom, particularly with regard to the promotion of environmental sustainability. Due to higher demand to achieve sustainable development around the world, researchers and innovators are increasingly turning their attention to efficient ways to address climate change and excessive CO2 emissions. Contemporary earth construction certainly contributes to reducing current global CO2 emissions and achieving environmental sustainability. Existing literature documents numerous benefits to constructing in earth, yet a critical review of the literature shows that, in many cases, these benefits are empirically unsubstantiated. Moreover, some benefits found in literature seemingly conflict and are often context and/or project specific. This paper aims to address some of these incongruities through an in-depth analysis of the advantages of earth construction in the development of UK urban housing. To achieve this aim, an interpretivist research philosophy was employed, including an up-to-date state of art literature review on the topic, and validation through the Delphi technique and in-depth interviews of construction professionals in the field of earth construction. The results show that earth building is very safe for the environment, it saves energy, promote self-help construction and significantly contribute achieving all aspects of environmental sustainability in the United Kingdom.
Induction of the epithelial-mesenchymal transition in the endometrium by chronic endometritis in infertile patients
Authors: Ishida Mitsuaki , Takebayashi Akie , Kimura Fuminori , Kitazawa Jun , Hanada Tetsuro , Tsuta Koji , murakami Takashi
Published: June 2020

Background
The purpose of the present study was to evaluate the relationship between chronic endometritis (CE) and the epithelial-mesenchymal transition (EMT) in the eutopic endometrium of infertile patients in the implantation phase.
Methods
Endometrial biopsy specimens from 74 infertility patients were enrolled. The presence of CE was investigated by immunostaining for CD138. Immunohistochemical staining for E-cadherin, N-cadherin, Slug, and Snail was performed, and expression profiles were statistically analyzed according to the presence of CE. When loss of E-cadherin expression and/or positive N-cadherin expression was detected, the specimen was considered EMT-positive. EMT-positive cases were also statistically analyzed according to the presence of CE. Patients’ characteristics were compared between the EMT-positive and EMT-negative groups. Logistic regression analysis was also performed with variables including age, body mass index (BMI), gravidity, parity, and each factor causing infertility to examine the independent effect of each variable on EMT-positive status.
Results
Loss of E-cadherin expression, N-cadherin expression and EMT-positive were significant in CE patients (p = 0.0037, 0.0039 and < 0.0001, respectively). Slug, cytoplasmic Snail, and nuclear Snail expression were significant in CE patients (p = 0.0008, 0.0004 and 0.028, respectively). Differences were detected in unexplained infertility and CE between EMT-positive and EMT-negative cases. Unexplained infertility and CE were identified as variables related to EMT-positive status on logistic analysis.
Conclusion
The EMT was frequent in the eutopic endometrium in infertile patients with CE. Since the EMT is associated with unexplained infertility and CE, the EMT appears to be involved in altered mechanisms of implantation.
Comprehensive at-arrival transcriptomic analysis of post-weaned beef cattle uncovers type I interferon and antiviral mechanisms associated with bovine respiratory disease mortality
Authors: Scott Matthew A. , Woolums Amelia R. , Swiderski Cyprianna E. , Perkins Andy D. , Nanduri Bindu , Smith David R. , Karisch Brandi B. , Epperson William B. , Blanton John R.
Published: June 2020

BackgroundDespite decades of extensive research, bovine respiratory disease (BRD) remains the most devastating disease in beef cattle production. Clinical diagnosis relies upon non-specific signs, which lack sensitivity. Thus, post-weaned beef cattle are often metaphylactically administered antimicrobials at facility arrival, which poses concerns regarding antimicrobial stewardship and resistance. Additionally, there is a lack of high-quality research that addresses the gene-by-environment interactions that underlie why some cattle that develop BRD die while others survive. Therefore, it is necessary to decipher the underlying host genomic factors associated with BRD mortality versus survival to help determine BRD risk and severity. Using transcriptomic analysis of at-arrival whole blood samples from cattle that died of BRD, as compared to those that developed signs of BRD but lived (n = 3 DEAD, n = 3 ALIVE), we identified differentially expressed genes (DEGs) and associated pathways in cattle that died of BRD. Additionally, we evaluated unmapped reads, which are often overlooked within transcriptomic experiments.Results69 DEGs (FDR < 0.10) were identified between ALIVE and DEAD cohorts. Several DEGs possess immunological and proinflammatory function and associations with TLR4 and IL6. Biological processes, pathways, and disease phenotype associations related to type-I interferon production and antiviral defense were enriched in DEAD cattle at arrival. Unmapped reads aligned primarily to various ungulate assemblies, but failed to align to viral assemblies.ConclusionThis study further revealed increased proinflammatory immunological mechanisms in cattle that develop BRD. DEGs upregulated in DEAD cattle were predominantly involved in innate immune pathways typically associated with antiviral defense, although no viral genes were identified within unmapped reads. Our findings provide genomic targets for further analysis in cattle at highest risk of BRD, suggesting that mechanisms related to type I interferons and antiviral defense may be indicative of viral respiratory disease at arrival and contribute to eventual BRD mortality.
Biotransformation of Aromatic Methyl Groups to Aldehyde Groups Using Laccase of Gloephyllum Stratum MTCC-1117
Authors: SAHAY RAM
Published: June 2020

Laccases has been produced by white rot fungi are involved in lignin containing natural substrates wheat-straw, bagasse, saw-dust, corn cob and coir dust particle on the production of laccase enzyme in the aqueous cultivation medium of Gloephyllum stratum MTCC1117. The approach involved concentration of aqueous filtrate by ultrafiltration and anion exchange chromatography on DEAE (diethyl aminoethyl cellulose). From SDS-PAGE analysis the molecular mass of the purified enzyme is 57 kDa. The Km and kcat values of the laccase are found to be 18 μM and 0.34 s-1 using 2,6-dimethoxyphenol as the substrate, giving a kcat/Km value is 1.70 x 103 M-1 s-1. The pH and temperature optimum were 4.5 and 40 °C respectively. The purified enzyme has yellow colour and does not show absorption band around 610 nm found in blue laccases. Moreover the conversion of methylbenzene to benzaldehyde in the lack of mediator molecules, property exhibited by yellow laccases.
Duodenal major papilla morphology can affect biliary cannulation and complications during ERCP, an observational study
Authors: Chen Po-Han , Tung Chun-Fang , Peng Yen-Chung , Yeh Hong-Zen , Chang Chi-Sen , Chen ChiaChang
Published: June 2020

Introduction We investigated whether duodenal major papilla morphology could be a risk factor for failure of selective biliary cannulation (SBC) and post endoscopic retrograde cholangiography and pancreatography (ERCP) complications. Method A prospectively recorded database was reviewed retrospectively. Patients were included if they received therapeutic ERCP and had naïve major duodenal papilla. We used Haraldsson’s classification for papilla morphology, as follows: Regular (Type 1), Small (Type 2), Protruding or Pendulous (Type 3) and Creased or Ridged (Type 4). Risk factors for failing SBC and post-ERCP complications were analyzed by multivariate analysis. Results A total of 286 cases were included. Age, gender, indications and therapeutic procedures were not different among the four types of papillae. The failure rates of SBC with Type 3 papilla and Type 4 papilla were 11.11% and 6.25%, respectively. In the multivariate analysis, Type 2 papilla (odd ratio 7.18, p= 0.045) and Type 3 papilla (odd ratio 7.44, p= 0.016) were associated with greater SBC failure compared with Type 1 papilla. Malignant obstruction compared to stone (odds ratio 4.45, p=0.014) and age (odd ratio=1.06, p=0.010) were also risk factors for cannulation failure. Type 2 papilla was correlated with a higher rate of post-ERCP pancreatitis (20%, p=0.020) compared to the other types of papilla However, papilla morphology was not a significant risk factor for any complications in the multivariate analysis. Conclusion Small papilla and protruding or pendulous papilla are more difficult to cannulate compared to regular papilla. Small papilla is associated with a higher rate of post-ERCP pancreatitis.
Diagnostic Pitfall of Thyroid Fine-needle Aspiration Induced Fibrosis: Follicular Adenoma Mimicking Medullary Thyroid Carcinoma in Frozen Section
Authors: Moon Woo Sung , Kang Myoung Jae , Youn Hyun Jo , Kim Kyoung Min
Published: June 2020

Background:Fine-needle aspiration (FNA) is a frequently utilized method for the diagnosis of thyroid nodules. Although the technique has clear advantages, the injury caused by the aspiration needle can induce various histological alterations. Herein, we report a case of follicular adenoma showing histological alterations possibly caused by FNA biopsy. Furthermore, the histological appearance of the lesion mimicked those of medullary thyroid carcinoma, particularly in the frozen section. Case presentation: Ultrasonography of a thyroid nodule in a 39-year-old man revealed a mass (2.2cm in diameter) in the right thyroid lobe. FNA was performed three times on the mass, and the results of the cytology were atypia of undetermined significance. Thereafter, the patient underwent right hemithyroidectomy. The histological findings of the operative frozen section analysis indicated medullary thyroid carcinoma. However, after evaluation and immunohistochemical staining of the permanent section, the mass was diagnosed as follicular adenoma with extensive fibrosis.Conclusion:The histological alterations observed in the follicular adenoma are believed to have been caused by injury during the repeated FNA procedures.
Low Arterial Oxygen Partial Pressure Induces Pulmonary Thrombocytopenia in Patients and a Mouse Model
Authors: Wu Limeng , Guo Ninghong , Xu Zhenyan , Wang Wei , Xiong Qinmei , Hu Jinzhu , Wan Rong , Hong Kui
Published: June 2020

Background
Recent basic studies demonstrate that the lung is a primary organ of platelet biogenesis. However, whether the pathophysiological state of the lung affect the platelets is little known. We aim to investigate the incidence of thrombocytopenia in patients with pulmonary infection (PIN) and risk factors associated with pulmonary thrombocytopenia.
Methods
In total, 11941 patients with pulmonary infection (PIN) were enrolled, and patients with three other infectious diseases were collected as controls. The incidence of thrombocytopenia was compared, and the risk factors associated with thrombocytopenia in PIN patients were investigated by multivariate analysis. To explore the mechanism of thrombocytopenia, hypoxic model were constructed. Blood platelet counts from the angular vein (PLTs), left ventricle (PLTpost) and right ventricle (PLTpre) were determined. Megakaryocyte staining with a CD41-specific antibody in the lungs was detected by flow cytometry and immunofluorescence.
Results
The incidence of thrombocytopenia in PIN patients was higher than that in the other three types of infectious disease patients(9.8% vs 6.4%~5.0%, P < 0.001). Relatively low arterial oxygen partial pressure (PaO2) was an important risk factor for thrombocytopenia (OR = 0.88; P < 0.001). In a hypoxic mouse model, PLTs were decreased (518.38 ± 127.92 vs 840.75 ± 77.30, P < 0.05), which showed that the low PaO2 could induce thrombocytopenia. The difference between the PLTpost and PLTpre (△PLTpost−pre) represented the production of platelets in the lungs, which was significantly attenuated in hypoxic mice compared with normoxic mice (F = 25.47, P < 0.05). Additionally, CD41-positive megakaryocyte numbers in the lungs were decreased in hypoxic mice.
Conclusion
PIN is a susceptibility factor for thrombocytopenia. Low PaO2-induced thrombocytopenia is associated with impaired platelet generation in the lungs.
Povidone-iodine demonstrates rapid in-vitro virucidal activity against SARS-CoV-2, the virus causing COVID-19 disease
Authors: Anderson Danielle E. , Sivalingam Velraj , Kang Adrian Eng Zheng , Ananthanarayanan Abhishek , Arumugam Harsha , Jenkins Timothy M. , Hadjiat Yacine , Eggers Maren
Published: June 2020

Introduction: Within six months of its emergence, SARS‑CoV‑2 has infected 5.5 million people worldwide, causing >345,000 deaths. The virus is transmitted through respiratory droplets and physical contact from contaminated surfaces to the mucosa. Hand hygiene and oral decontamination among other measures are key to preventing the spread of the virus. We report the in-vitro virucidal activity of topical and oral povidone-iodine (PVP‑I) products against SARS‑CoV‑2.Methods: Suspension assays were used to assess the virucidal activity of PVP‑I against SARS‑CoV‑2. Products were tested at a contact time of 30 seconds for virucidal activity. Viral titres were calculated using the Spearman-Kärber method and reported as TCID50/mL.Results: All four products (antiseptic solution [PVP-I 10%], skin cleanser [PVP-I 7.5%], gargle and mouth wash [PVP-I 1%] and throat spray [PVP-I 0.45%] achieved ≥99.99% virucidal activity against SARS-CoV-2, corresponding to ≥4 log10 reduction of virus titre, within 30 seconds of contact.Conclusion: This study provides evidence of rapid and effective virucidal activity of PVP-I against SARS-CoV-2. PVP-I-based products are widely available for medical and personal use for hand hygiene and oral decontamination and could be readily integrated into COVID-19 infection control measures in hospital and community settings.