bluuebunny/crossref_metadata_2025 huggingface dataset:
Alcohol drinking as a mediator of the influence of smoking prevalence on second-hand smoke exposure in workplaces: A mediation analysis
Authors: LIN Haoxiang , Chang Chun , LIU Zhao
Published: August 2020

Objective: Both alcohol drinking and second-hand smoke (SHS) exposure have shown a strong association with smoking behaviour. This study uses mediation analysis to clarify the process underlying the relationship between smoking prevalence and SHS exposure and the extent to which this relationship is mediated by alcohol use in the workplace.Method: A total of 14195 employees from 81 companies in China participated in this survey. Mediation analysis was used to establish the mediation effect of alcohol drinking. Structural equation modelling（SEM） was used to evaluate the role of alcohol drinking when a smoke-free (SF) workplace policy was imposed.Results: For males, approximately 6.3% of the effects on SHS exposure were mediated through the channel of alcohol use. For females, this channel mediated 14.1% of the total effects. SF policy was negatively associated with smoking prevalence and SHS exposure. The indirect effect of the SF policy on reducing SHS exposure by controlling smoking behaviour was significant. For smokers, worksite smoking bans were negatively associated with the smoking amount and drinking behaviour, and the indirect effect of this policy on promoting smokers’ intention to quit by reducing the smoking amount and controlling drinking behaviour was significant.Conclusion: This study confirmed that alcohol drinking is among the channels that mediate the association between smoking prevalence and SHS exposure in workplaces. Our results also find a spillover effect of SF workplace policy and call for effective interventions for alcohol use, which may influence the outcomes of SF policy implementation.
Resveratrol attenuates cigarette smoke induced endothelial apoptosis by activating Notch1 signaling mediated autophagy
Authors: Zong Dandan , Liu Xiang-ming , Li Jin-hua , Ouyang Ruo-yun , Long Ying-jiao , Chen Ping , Chen Yan
Published: August 2020

Background

Increasing evidences have showed that endothelial apoptosis contributes to cigarette smoke (CS)-induced disease progression, such as chronic obstructive pulmonary disease (COPD). Our previous studies have validated Notch1 as an anti-apoptotic signaling in cigarette smoke (CS)-induced endothelial apoptosis. Resveratrol (RESV) is a naturally occurring polyphenol that exhibits an anti-apoptotic activity in endothelial cells that exposed to many kinds of destructive stimulus. However, the effects of resveratrol on Notch1 signaling in CS-induced endothelial apoptosis have not yet been fully elucidated. Therefore, the aim of this study was to examine whether RESV can protect endothelial cells from cigarette smoke induced apoptosis via regulating Notch1 signaling.

Methods

Human umbilical vein endothelial cells (HUVECs) were pretreated with RESV for 2 h, followed by cotreatment with 2.5%CSE for 24h to explore the role of RESV in CSE induced endothelial apoptosis. 3-methyladenine (3-MA) or rapamycin was used to alter autophagic levels. Lentivirus Notch1 intracellular domain (LV-N1ICD) or γ-secretase inhibitor (DAPT) were used to change Notch1 expression. The expression of Notch1, autophagic and apoptotic markers were examined by Western blot and the apoptosis rate was detected by Flow cytometry analysis.

Results

Our results showed that activating autophagy reduced CSE-induced endothelial apoptosis, while blocking autophagy promoted cell apoptosis in HUVECs. RESV pretreatment attenuated the CSE-induced endothelial apoptosis and activated Notch1 signaling. RESV pretreatment also increased LC3b-II and Beclin1 production, decreased p62 and mTOR expression. 3-MA treatment inhibited autophagy and aggravated CSE induced apoptosis, while rapamycin promoted autophagy, led to a decrease in cell apoptosis. LV-N1ICD transfection upregulated autophagy and reduced apoptosis. However, this protective effect was abolished by 3-MA treatment. In cells treated with DAPT, autophagy was decreased, while apoptosis was increased. RESV partly rescued the DAPT induced apoptosis by activating Notch1 signaling.

Conclusion

In HUVECs, RESV attenuates CSE induced endothelial apoptosis by inducing autophagy in a Notch1-dependent manner.
The Natural Course of Hereditary Angioedema in a Chinese Cohort
Authors: Cao Yang , Liu Shuang , Zhi Yuxiang
Published: August 2020

Background

Hereditary angioedema (HAE) is a rare disease with potential life-threatening risks. To study the natural course of HAE under therapy-free conditions throughout patient life is essential for practitioners and patients to avoid possible risk factors and guide treatment.

Objectives

Describe the natural course of HAE and explore possible risk factors, providing new clues for guiding clinical prevention and treatment.

Methods

A web-based survey was conducted in 103 Chinese patients with type 1 HAE. Disease progression at different age stages was provided by each participant. The data for exploring the natural course of HAE composed of two parts: one came from the participants who had never adopted any prophylactic drug for HAE; the other was from the patients with a history of medication, but only the periods before they got confirmed diagnosis and received medications were analyzed. The demographic characteristics, lifestyles, disease severity, and family history were also collected.

Results

Among 103 patients, 14 (13.6%) had their first HAE attack before ten years old and 51 (49.5%) between 10 and 19. The disease worsened in 83.3% of the patients in their twenties. The proportion of patients with symptoms alleviated increased after the age of 30 years old, but the disease maintained relatively severe in most cases before 50. The participants also reported 233 members shared similar symptoms of angioedema in their family and 30 had died of laryngeal edema with the median death age of 46 years old. The disease severity was not observed to be affected significantly by gender, BMI, alcohol or smoking.

Conclusions

We summarized HAE progression patterns under therapy-free conditions, showing the natural course of HAE development along with aging. Long-term prophylaxis and symptomatic treatment are recommended for all HAE patients, especially young and middle-aged and might be adjusted depending on the disease progression.
The Quality of Primary Care in Community Health Centers: Comparison among Urban, Suburban and Rural Users in Shanghai, China
Authors: Shi Jianwei , Jin Hua , Shi Leiyu , Chen Chen , Ge Xuhua , Lu Yuan , Zhang Hanzhi , Wang Zhaoxin , Yu Dehua
Published: August 2020

Objective: Following World Health Organization’s initiatives to advance primary care, China put forth forceful policies including the Personal Family Doctor Contract to ensure that every family sign up with a qualified doctor in a community health center (CHC) ever since its 2009 New Health Reform. We used the Johns Hopkins-designed Primary Care Assessment Tool (PCAT) to assess primary care quality experienced by the contracted residents and compare this across different socioeconomic regions.Methods: Using a multistage sampling method, four CHCs each were randomly selected from urban, suburban and rural districts of Shanghai, a metropolitan with 24 million residents. ANOVA and Multivariate analyses were used to assess the association between location of CHC and the quality of primary care experience.Findings: A total of 2,404 CHC users completed our survey. Except for the domain of coordination (information systems), users from suburban CHCs reported best primary care experiences in all other domains, followed by users of rural CHCs. After controlling for covariates, suburban CHC users were more likely to report higher total PCAT scores (ß=1.57, P<0.001) compared with those from urban CHCs.Conclusion: That contracted residents from suburban CHCs reporting better primary care experience than those from urban CHCs demonstrates the unique value of CHCs in relatively medical-underserved areas. In particular, urban CHCs could further strengthen first contact (utilization), first contact (accessibility), coordination (referral system), comprehensiveness (available), and community orientation aspects of primary care performance. However, all CHCs could improve coordination (information system).
Impact of viral coinfection and macrolide-resistant mycoplasma infection in children with refractory Mycoplasma pneumoniae pneumonia
Authors: Zhou Yajuan , Wang Jing , Chen Wenjuan , Shen Nan , Tao Yue , Zhao Ruike , Luo Lijuan , Li Biru , Cao Qing
Published: August 2020

Background: Cases of refractory Mycoplasma pneumoniae pneumonia have been increasing recently; however, whether viral coinfection or macrolide-resistant M. infection contribute to the development of refractory M. pneumoniae pneumonia remains unclear. This study aimed to investigate the impacts of viral coinfection and macrolide-resistant M. pneumoniae infection on M. pneumoniae pneumonia in hospitalized children and build a model to predict a severe disease course. Methods: Nasopharyngeal swabs or sputum specimens were collected from patients with community-acquired pneumonia meeting our protocol who were admitted to Shanghai Children’s Medical Center from December 1, 2016, to May 31, 2019. The specimens were tested with the FilmArray Respiratory Panel, a multiplex polymerase chain reaction assay that detects 16 viruses, Bordetella pertussis, M. pneumoniae, and Chlamydophila pneumoniae. Univariate and multivariate logistic regression models were used to identify the risk factors for adenovirus coinfection and macrolide-resistant mycoplasma infection.Results: Among the 107 M. pneumoniae pneumonia patients, the coinfection rate was 56.07%, and 60 (60/107, 56.07%) patients were infected by drug-resistant M. pneumoniae. Adenovirus was the most prevalent coinfecting organism, accounting for 22.43% (24/107). The classification tree confirmed that viral coinfection was more common in patients younger than 3 years old. Adenovirus coinfection and drug-resistant M. pneumoniae infection occurred more commonly in patients with refractory M. pneumoniae pneumonia (P=0.019; P=0.001). A prediction model including wheezing, lung consolidation and extrapulmonary complications was used to predict adenovirus coinfection. The area under the receiver operating characteristic curve of the prediction model was 0.795 (95% CI 0.679-0.893, P<0.001). A prolonged fever duration after the application of macrolides for 48 hours was found more commonly in patients infected by drug-resistant M. pneumoniae (P=0.002). A fever duration longer than 7 days was an independent risk factor for drug-resistant Mycoplasma infection (OR=3.500, 95% CI=1.310-9.353, P=0.012).Conclusions: The occurrence of refractory M. pneumoniae pneumonia is associated with adenovirus coinfection and infection by drug-resistant M. pneumoniae. A prediction model combining wheezing, extrapulmonary complications and lung consolidation can be used to predict adenovirus coinfection in children with M. pneumoniae pneumonia. A prolonged fever duration indicates drug-resistant M. pneumoniae infection, and a reasonable change in antibiotics is necessary.
Myofibroma/myofibromatosis: MDCT and MR imaging findings in 24 patients with radiological-pathological correlation
Authors: Yi Kun-ming , Chen Kang , Ma Qiang , Wang Lu , Li Ran , Wang Yi
Published: August 2020

Background: The aim of this study was to characterize the radiological features of myofibroma on multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI) and correlate the imaging findings with pathologic features. Methods: The radiological findings of 24 patients with 29 myofibromas were retrospectively reviewed. All images were evaluated with emphasis on density, signal intensity, hypointense area, and enhancement, correlating these with pathologic findings. Results: On plain MDCT scan, 4(26.7%) tumors were homogeneous isodensity, 4(26.7%) tumors were heterogeneous hyperdensity, and 7(46.7%) tumors were heterogeneous hypodensity. On contrast-enhanced MDCT scan, all tumors (9/9) showed heterogeneous enhancement with moderate in 3(33.3%) and marked in 6(66.7%) tumors, and their enhancements were higher compared to adjacent skeletal muscle (P=0.0001). On MRI, heterogeneous slight hyperintensity, homogeneous slight hyperintensity, and heterogeneous hypointensity on T1-weighted imaging (T1WI) were observed in 14(82.3%), 1(5.9%) and 2(11.8%) tumors, respectively. On T2-weighted imaging (T2WI) and fat-suppressed (FS) T2WI, all tumors demonstrated heterogeneous hyperintensity. All tumors showed heterogeneous marked enhancement on FS contrast-enhanced T1WI. On T1WI, T2WI, FS T2WI, and FS contrast-enhanced T1WI, irregular strip or/and patchy hypointensities were found in 16(94.1%), 12(100%), 17(100%) and 17(100%) tumors, respectively, and pseudocapsule was seen in 5(29.4%) tumors. The hypointensities and pseudocapsule on MRI were exactly corresponding to pathological interlacing collagen fibers and fibrosis. The age of the recurrent group was lower than that of the non-recurrent group (P=0.001) and the tumors without pseudocapsule were more likely to recur than those with pseudocapsule (P=0.034). Conclusion: Myofibromas are characterized by heterogeneous density or signal intensity, with moderate or marked enhancement. The hypointensities and pseudocapsule on MRI may be helpful in diagnosis, and the absence of pseudocapsule and younger age may be risk factors for tumor recurrence.
The modules of mental health programs implemented in schools in low- and middle-income countries: Findings from a systematic literature review
Authors: Gimba Solomon Musa , Harris Paul , Saito Amornrat , Udah Hyacinth , Martin Averil , Wheeler Amanda J.
Published: August 2020

Background

Secondary schools in low- and middle-income countries (LMICs) provide promotional, preventive, and early treatment services. But the literature indicates that the components of these services are either adapted or modified from existing mental health programs in developed countries. The literature also highlights the provision of non-comprehensive services (mental health promotion, prevention, and early treatment), in LMICs such as Nigeria. These findings inform the need for undertaking this systematic literature review. The aim of the review was to identify components of school based mental health programs that have been implemented in LMICs to guide the development of a culturally sensitive comprehensive mental health program for adolescents in a LMICs.

Methods

The Preferred Reporting Items for Systematic reviews and Meta-analyses (PRISMA) statement was used to guide this review. The following databases were searched in September 2018, to identify the relevant literature: PubMed, CINAHL, Scopus, Web of Science, PsycINFO, and ERIC. The search was conducted by one of the authors and reviewed by two of the authors.

Results

Following the screening process, a total of 11 papers were identified and reviewed for quality. The systematic review highlighted that the mental health programs provided in schools included: introduction module, communication and relationship module, psychoeducation module, cognitive skills module, behavioral skills module, establishing social networks for recovery and help seeking behavioral activities and a summary/conclusion module.

Conclusion

The review shed light on the characteristics of the programs in LMICs. Two programs were universal in nature. Five programs were directed at key risk factors or at-risk groups and four were early intervention programs. The review also revealed that only one programs out of the 11 programs, included modules for parents. The synthesis indicated that all the identified programs were adapted or modified from existing programs. The dearth of comprehensive programs in LMICs was also revealed. The review also revealed modules that can be useful for developing a school based mental health program in LMICs.
Chronic Loss of STAG2 Leads to Altered Chromatin Structure Contributing to DE-Regulated Transcription in AML.
Authors: Smith James , Lappin Katrina M , Craig Stephanie G , Liberante Fabio G , Crean Clare M , McDade Simon , Thompson Alexander , Mills Kenneth , Savage Kienan
Published: August 2020

Background The cohesin complex plays a major role in folding the human genome into 3D structural domains. Mutations in members of the cohesin complex are known early drivers of myelodysplastic syndromes (MDS) and acute myeloid leukaemia (AML), with STAG2 the most frequently mutated complex member. Methods Here we use functional genomics (RNA-seq, ChIP-seq and HiChIP) to investigate the impact of chronic STAG2 loss on three-dimensional genome structure and transcriptional programming in a clinically relevant model of chronic STAG2 loss. Results The chronic loss of STAG2 led to loss of smaller loop domains and the maintenance/formation of large domains that, in turn, led to altered genome compartmentalisation. These changes in genome structure resulted in altered gene expression, including deregulation of the HOXA locus and the MAPK signalling pathway, resulting in increased sensitivity to MEK inhibition. Conclusions: The altered genomic architecture driven by the chronic loss of STAG2 results in altered gene expression that may contribute to leukaemogenesis and may be therapeutically targeted.
Hematological reference intervals among full-term newborns in Ethiopia: a cross-sectional study
Authors: Tiruneh Tegenaw , Kiros Teklehymanot , Getu Sisay
Published: August 2020

Background: Hematological reference intervals are used for medical decision tools for interpretation of numerical test results. Establishing of hematological interval among newborn babies is very important for the diagnosis of malignancy, anemia, bleeding disorders, and various infections. There is no locally established hematological reference intervals in Ethiopia. Thus, the aim of this study is to established locally determined hematological reference interval among full-term newborns.Methods: A cross sectional study was conducted from February to May 2019 among 151 apparently healthy full-term newborns at Gondar University Hospital. About 3ml of cord blood was obtained for analysis of Hematological parameters and determined by using Sysmex KX-21N (Sysmex Corporation Kobe, Japan) automated analyzer. Median, 2.5th and 97.5th percentiles were computed.Result: Males to female’s ratio was almost equal. All hematological parameter had no statistically significant difference between males and females. The delivery types were not influenced its hematological values. The reference interval of white blood cells, red blood cells, platelets, hemoglobin, hematocrit, mean cell volume, and mean cell hemoglobin were (7.64-22.16) x109/l, (3.69-5.47)x1012/l, (132.74-413.4) x109/l, (13.32-19.64) g/dl and (39.42-58.06)%, (91.6-113.22)fl, and (30.48-38.02)pg, respectively.Conclusion: All hematological reference interval was established from full-term newborns at University of Gondar hospital was different from other studies in Nigeria, Iraq, Pakistan, Nepal, Saudi Arabia and Iran. Therefore, own determined reference value is very important for the clinicians to correctly diagnosis the patients at health facility levels.
Association of whole blood copper, magnesium and zinc levels with metabolic syndrome components in 6–12-year-old rural Chinese children: 2010–2012 China National Nutrition and Health Survey
Authors: Zhang Huidi , Man Qingqing , Song Pengkun , Li Siran , Liu Xiaobing , Wang Lijuan , Li Yuqian , Yang Lichen
Published: August 2020

Background: Copper (Cu), magnesium (Mg) and zinc (Zn) are essential elements that participate in a series of oxidative stress and inflammation pathways related to metabolic reactions. Many studies have analyzed the relationship between Cu, Mg and Zn and metabolic syndrome (MetS) in adolescents and adults, but there have been few studies of children. We aimed to investigate the association of whole blood Cu, Mg and Zn with MetS components in 6–12-year-old rural Chinese children. Methods: A total of 911 children (51.2% male, 48.7% female) aged 6–12 years were enrolled from the 2010–2012 China National Nutrition and Health Survey. Basic characteristics, metals and MetS component parameters were collected. Multivariate logistic regression analysis was performed to examine the independent relationship between metals and the incidence of MetS components.Results: Copper was positively associated with elevated waist circumference when analyzed alone (OR=2.00, 1.18–3.28). Combined with Zn, this association approached zero. For elevated triglyceride levels, the combination of low Cu and high Zn showed the opposite association with triglyceride relative to Cu alone (OR=2.21, 1.18–4.13 versus OR=0.33, 0.16–0.65, respectively), but was similar to the analysis of Zn alone (OR=2.12, 1.10–4.10). There was no association between whole blood Mg and waist circumference. However, the presence of both high Cu and high Mg levels significantly increased the risk of waist circumference exceeding the standard value (OR=2.03, 1.26–3.27). In addition, separate analysis of the distribution of Mg and Zn found no association with the risk of reduced high density lipoprotein-cholesterol (HDL-C); but high Zn combined with low Mg negatively associated with the risk of reduced HDL-C levels (OR=0.47, 0.28–0.77). Conclusions: Both the single and combined effects of Cu, Mg and Zn were associated with components of MetS. These results indicate the importance of combined analysis of multiple elements, and also provide new avenues for the early screening of MetS. The current results need to be further investigated in future work and other populations.
Preoperative platelet count predicts posttransplant portal vein complications in orthotopic liver transplantation: a propensity score analysis
Authors: Li Qingshan , Wang Yue , Ma Tao , Ren Fenggang , Mu Fan , Wu Rongqian , Lv Yi , Wang Bo
Published: August 2020

Background: The role of platelets on the prognosis of patients with liver transplantation remains unclear. Thus, we aimed to evaluate the influence of preoperative platelet count on postoperative morbidity after liver transplantation. Methods: Clinical data of the patients who received liver transplantation from January 2015 to September 2018 were evaluated. Results: Of the 329 patients included, the average age was 46.71±0.55 years, and 243 were men (75.2%). The incidence of posttransplant portal vein complication was significantly higher in the high platelet count group (> 49.5×109/L; n=167) than in the low platelet count group (≤ 49.5×109/L, n=162, 12.6% vs. 1.9%). After multivariable regression analysis, high platelet count was independently associated with postoperative portal vein complication (odds ratio [OR]: 8.821, 95% confidence interval [CI]: 2.260 to 34.437). After the inverse probability of treatment weighting analysis, patients in the high platelet count group had significantly higher risk of portal vein complication (OR: 9.210, 95%CI: 1.907 to 44.498, p=0.006) and early allograft dysfunction (OR: 2.087, 95%CI: 1.131 to 3.853, p=0.019). Conclusions: Preoperative platelet count > 49.5×109/L was an independent risk factor for posttransplant portal vein complication and early allograft dysfunction. High preoperative platelet count could be an adverse prognostic predictor for liver transplantation recipients.
Predictive significance of arachidonate 15-lipoxygenase for eosinophilic chronic rhinosinusitis with nasal polyps
Authors: Liang Zhuoping , Yan Bing , Liu Chang , Tan Ruyu , Wang Chengshuo , Zhang Luo
Published: August 2020

Background: Eosinophilic chronic rhinosinusitis with nasal polyps (ECRSwNP) exhibits a poorer outcome compared with non-eosinophilic chronic rhinosinusitis with nasal polyps (nonECRSwNP), so it is significant to identify effective markers to differentiate ECRSwNP in guiding the treatment strategies of these patients. Although arachidonate 15-lipoxygenase (ALOX15) is positioned as a marker of eosinophilic inflammation, its study in differentiating ECRSwNP has not been reported. The aim of this study is to assess the potential of ALOX15 in distinguishing and predicting ECRSwNP. Methods: Forty-eight patients with chronic rhinosinusitis with nasal polyps (CRSwNP), including 30 ECRSwNP and 18 nonECRSwNP patients, were enrolled. ALOX15 mRNA level was determined in polyps by real-time polymerase chain reaction (RT-PCR). The patients’ baseline characteristics were evaluated and analyzed for correlations with ALOX15. Receiver operating characteristic (ROC) curve was used to assess the predictive significance of the potential predictors for ECRSwNP.Results: ALOX15 mRNA level was significantly higher in ECRSwNP patients than in nonECRSwNP patients (P < 0.001). ALOX15 mRNA was significantly correlated with tissue and blood eosinophil percentages (r = 0.565, P < 0.001 and r = 0.395, P = 0.006), olfaction scores (r = 0.400, P = 0.005), total visual analogue scale (VAS) symptom scores (r = 0.383, P = 0.007), ethmoid/maxillary sinus (E/M) ratio (r = 0.463, P = 0.001), and endoscopy scores (r = 0.409, P = 0.004). Logistic regression analysis showed ALOX15 mRNA level and percentage of blood eosinophils to be predictive factors for ECRSwNP (P = 0.004 and P = 0.036, respectively). ROC curve indicated ALOX15 to have high predictive accuracy for ECRSwNP (area under the curve (AUC) = 0.909), which was further improved by combination of ALOX15 with percentage of blood eosinophils (AUC = 0.933). Conclusions: The relative ALOX15 mRNA level alone or in combination with blood eosinophils might be a reliable biomarker for predicting a diagnosis of ECRSwNP.
Value of CT and three-dimensional reconstruction revealing specific radiological signs for screening causative high jugular bulb in patients with Menière's disease
Authors: Hu Junjiao , Peng Anquan , Deng Kai , Huang Chao , Wang Qin , Pang Xueying , Liu Wei , Zhang Zhiwen , Jiang Wenqi , Chen Yichao
Published: August 2020

BackgroundThe aim of the present study was to investigate the pathological features of vestibular aqueduct (VA) related high jugular bulb (HJB) and explore the possible cause-consequence relation between HJB and endolymphatic hydrops (EH), and the potential specific radiological signs for screening causative HJB in Meniere’s disease (MD).MethodsHigh-resolution computed tomography (HRCT) and three-dimensional reconstruction (3DRC) were used to detect the anatomical variables associated with VA and jugular bulb (JB) in hydropic and non-hydropic ears. The presence or absence of EH in the inner ear was determined by gadopentetate dimeglumine-enhanced magnetic resonance imaging. The presence of different types of HJB, the anatomical variables of the VA and JB and the three types of anatomical relationship between the VA and HJB were compared between the hydropic and non-hydropic ears using the χ2 or Fisher’s exact tests. P<0.05 was considered to indicate a statistically significant difference.ResultsJB was classified as: Type 1, no bulb; type 2, below the inferior margin of the posterior semicircular canal (PSCC); type 3, between the inferior margin of the PSCC and the inferior margin of the internal auditory canal (IAC); type 4, above the inferior margin of the IAC. There were no significant differences in the presence of types 1, 2 and 3 JB between two groups. The presence of type 4 JB, average height of the JB and prevalence of the non-visualization of the VA in CT scans showed significant differences between two groups. The morphological pattern between the JB and VA revealing by 3DRC was classified as: Type I, the JB was not in contact with the VA; type II, the JB was in contact with the VA, but the latter was intact without obstruction; type III, the VA was obliterated by HJB encroachment. There were no significant differences in the presence of type I and II between two groups. Type III was identified in 5 hydropic ears but no non-hydropic ears, with a significant difference observed between the two groups.ConclusionThe present results showed that JB height and non-visualization of the VA on Pöschl's plane could render patients susceptible to the development of EH. A jugular bulb reaching above the inferior margin of the IAC (type 4 JB) could obstruct VA, resulting in EH in a few isolated patients with MD. VA obliteration revealed by 3DRC, as a specific radiological sign, may have the potential for screening causative HJB in MD.
Achilles tendon enthesitis evaluated by MRI assessments in patients with axial spondyloarthritis and psoriatic arthritis: a report of the methodology of the ACHILLES trial
Authors: Baraliakos Xenofon , Sewerin Philipp , de Miguel Eugenio , Pournara Effie , Kleinmond Christine , Wiedon Annette , Behrens Frank
Published: August 2020

Background: The currently available scoring methods for enthesitis are often measures of pain but not of inflammation at entheseal sites. The Outcome Measures in Rheumatology Clinical Trials (OMERACT) psoriatic arthritis (PsA) magnetic resonance imaging (MRI) scoring system (PsAMRIS) assesses inflammation and damage in PsA and was particularly developed for the hands. The ACHILLES trial used clinical measures for heel enthesitis in combination with MRI scoring based on PsAMRIS.Methods: Patients (age ≥ 18 years) with spondyloarthritis (SpA) and PsA were included in the trial if they presented with clinical and MRI-positive heel enthesitis. MRI of the affected heel was performed at three time points: screening, Week 24 and Week 52. Inflammatory MRI findings (tendinitis, bursitis and bone marrow oedema [BME]) in the area of the Achilles tendon and/or plantar aponeurosis, periarticular inflammation of the ankle joint and heel erosion were assessed qualitatively (absent/present). In addition, BME and bone erosion were quantitatively assessed based on PsAMRIS, where their proportion was compared to the volume of the affected bone. Mean scores of BME and bone erosion quantification were calculated, and the mean composite score (based on PsAMRIS) was calculated based on the individual score of each subject for periarticular inflammation, BME and bone erosion and further extended for bursitis and tendinitis. Modifications to PsAMRIS were introduced by categorising oedema length as ≤/> 0.5 cm and locating bone erosion.Conclusions: In ACHILLES, MRI was used to assess and evaluate heel enthesitis. Due to the lack of a validated scoring system for heel enthesitis at the time of ACHILLES initiation, this trial applied quantitative scoring based on PsAMRIS, with specific adaptations for the heel.Trial registration: National Clinical Trial Registry, NCT02771210. Registered 13 May 2016. https://clinicaltrials.gov/ct2/show/NCT02771210
Prognostic role of pre-sarcopenia and body composition with long-term outcomes in obstructive colorectal cancer: a retrospective cohort study
Authors: Lee Chul Seung , Won Daeyoun David , Oh Soon Nam , Lee Yoon Suk , Lee In Kyu , Kim In-Ho , Choi Moon Hyung , Oh Seong Taek
Published: August 2020

Background: The clinical significance of pre-sarcopenia in colorectal cancer obstruction has not yet been described. The present study aimed to determine the short and long-term oncologic impacts of pre-sarcopenia in obstructive colorectal cancer.Methods: We retrospectively analyzed 214 patients with obstructive colon cancer between January 2004 and December 2013. Initial staging computed tomography (CT) scans identified pre-sarcopenia and visceral obesity by measuring the muscle and visceral fat areas at the third lumbar vertebra level. Both short-term postoperative and long-term oncologic outcomes were analyzed.Results: Among all 214 patients, 71 (33.2%) were diagnosed with pre-sarcopenia. Pre-sarcopenia had a negative oncologic impact in both disease-free survival (DFS) and overall survival (OS), (hazard ratio [HR] = 1.86, 95 % confidence interval [CI] 1.04 – 3.13, p = 0.037, and HR = 1.92, CI 1.02 – 3.60, p = 0.043, respectively). Visceral adiposity, body mass index (BMI) and neutrophil-lymphocyte ratio (NLR) did not significantly impact DFS and OS.Conclusion: Pre-sarcopenia is a clinical factor significantly associated with OS and DFS but not with short-term complications in obstructive colorectal cancer. In future, prospective studies should incorporate body composition data in patient risk assessments and oncologic prediction tools.
An R package for an integrated evaluation of statistical approaches to cancer incidence projection
Authors: Knoll Maximilian , Furkel Jennifer , Debus Jürgen , Abdollahi Amir , Karch André , Stock Christian
Published: August 2020

Background: Projection of future cancer incidence is an important task in cancer epidemiology. The results are of interest also for biomedical research and public health policy. Age-Period-Cohort (APC) models, usually based on long-term cancer registry data (>20yrs), are established for such projections. In many countries (including Germany), however, nationwide long-term data are not yet available. It is unclear which statistical approach should be recommended for projections using rather short-term data. Methods: To enable a comparative analysis of the performance of statistical approaches to cancer incidence projection, we developed an R package (incAnalysis), supporting in particular Bayesian models fitted by Integrated Nested Laplace Approximations (INLA). Its use is demonstrated by an extensive empirical evaluation of operating characteristics (bias, coverage and precision) of potentially applicable models differing by complexity. Observed long-term data from three cancer registries (SEER-9, NORDCAN, Saarland) was used for benchmarking. Results: Overall, coverage was high (mostly >90%) for Bayesian APC models (BAPC), whereas less complex models showed differences in coverage dependent on projection-period. Intercept-only models yielded values below 20% for coverage. Bias increased and precision decreased for longer projection periods (>15 years) for all except intercept-only models. Precision was lowest for complex models such as BAPC models, generalized additive models with multivariate smoothers and generalized linear models with age x period interaction effects. Conclusion: The incAnalysis R package allows a straightforward comparison of cancer incidence rate projection approaches. Further detailed and targeted investigations into model performance in addition to the presented empirical results are recommended to derive guidance on appropriate statistical projection methods in a given setting.
COVID-19 in Northeast Bosnia and Herzegovina and Patient’s Length of Hospitalization
Authors: Trnacevic Alma , Mujkanovic Amer , Al-Salloum Noura , Sakusic Amra , Trnacevic Emir , Jusufovic Emir , Hukic Fatima , Jahic Rahima , Stratton Richard
Published: August 2020

Background Since the outbreak of COVID-19 pandemic clinical data from various parts of the world have been reported; until now, there has been no clinical data with regards to COVID-19 from Bosnia and Herzegovina (B&H). The aim was to report on the first cohort of patients from B&H and to analyze clinical factors of COVID-19 patients that may influence the length of hospitalization (LOH) of COVID-19 infected patients.Methods Retrospective cohort study was conducted at Tuzla University Clinical Center (UKC). It included 25 COVID-19 positive patients that were hospitalized between March 28th and April 27th 2020. The LOH was measured from the time of admission to discharge. Factors analyzed induced age, BMI, presence of comorbidities, serum creatinine and oxygen saturation upon admission.Results The mean age was 52.92±19.15 years and BMI 28.80±4.22. LOH for patients with normal BMI was 9±SE2.646 days (CI 95% 3.814-14.816) vs 14.182 ±SE .937 (CI 95% 12.346-16.018; p<0.05) for ≥25 BMI. Patients without underlying diseases had a LOH of 11.70 ±SE1.075 (CI 95% 9.592-13.808), while those with comorbidities 14.8 ±SE1.303 (CI95% 12.247-17.353; p<0.05). Conclusion LOH varied among COVID-19 patients and was prolonged when clinical characteristics such as elevated BMI, presence of comorbidities, elevated creatinine and low oxygen saturation levels were taken into consideration. Furthermore, risk factors for COVID-19 patients in B&H do not deviate from data reported in other countries.
Effectiveness of intravitreal chemotherapy-assisted endoresection in monocular patients with group D retinoblastoma
Authors: Yu Xiling , Li Xueke , Xing Yue , Lu Siduo , Tanumiharjo Silvia , Ma Jin
Published: August 2020

Background: This study aimed to determine the efficacy and complications of intravitreal chemotherapy-assisted endoresection for refractory International Classification of Retinoblastoma (ICRB) group D retinoblastoma in monocular patients.Methods: In this retrospective case series, intravitreal chemotherapy-assisted endoresection by pars plana vitrectomy was performed in 11 eyes with refractory ICRB group D retinoblastoma unresponsive to standard therapies in monocular patients.Results: Across a mean follow-up period of 42.7 months, globe salvage was attained in all 11 eyes (100%). There were no cases of extra-ocular tumour seeding or remote metastasis. In 9 eyes (81.8%), tumour control was achieved with one pars plana vitrectomy; in 2 cases (18.2%), repeated treatment, such as laser therapy, intravitreal chemotherapy or a second pars plana vitrectomy, was needed. Retinal reattachment was achieved in all 4 eyes (100%) with previous retinal detachment. Four eyes (36.4%) required subsequent cataract surgery due to secondary cataract. Ten eyes (90.9%) had improvement in best-corrected visual acuity at the last follow-up.Conclusion: Intravitreal chemotherapy-assisted endoresection appears to be a safe and effective globe-salvaging method for refractory group D retinoblastoma. It is a promising alternative to enucleation and a supplementary therapeutic strategy for those unresponsive to standard therapies, especially for the monocular retinoblastoma patients.
Alcohol Consumption and Associated Risk Factors in Burkina Faso: Results of a Population-based Cross-sectional Survey
Authors: Bonnechère Bruno , Samadoulougou Sékou , Cissé Kadari , Tassembedo Souleymane , Kouanda Séni , Kirakoya-Samadoulougou Fati
Published: August 2020

Background: Lifestyle modifiable risk factors are a leading preventable cause of non-communicable diseases (NCDs). Amongst them, alcohol and tobacco consumption are the most important. Studies characterizing the prevalence of alcohol consumption in low-income countries are lacking. This study describes the prevalence of alcohol use in Burkina Faso and its associated factors separately for urban and rural residents.Methods: Data from the 2013 Burkina Faso World Health Organization (WHO) Step wise approach to Surveillance (STEPS) were analyzed. The prevalence of alcohol consumption over the last 30 days were recorded and recoded into categories according to WHO recommendations: low alcohol consumption (<40g alcohol/day for men, <20g for women), mid alcohol consumption (between 40 and 59.9g/day for men and between 20 and 39.9g for women) and a heavy consumption (>60g/day for men and 40g for women). Logistic regression analyses identified factors associated with alcohol consumption use.Results: In the whole population 3,559 (75.8% [72.5 – 78.7]) were not consuming any alcohol, 614 (12.9% [10.9 – 15.3]) had a low alcohol consumption, 399 (8.5% [7.1 – 10.1]) a mid alcohol consumption and 120 (2.7% [2.0 – 3.7]) a high consumption. Sex was significantly associated with increased risk of alcohol consumption (AOR = 1.28 [1.00 – 1.63]). Age was associated with alcohol intake with a gradient effect, older people having a higher risk (AOR = 2.40 [1.74 – 3.72] for the 55 – 64 years old compared to 25 – 34 group). Tobacco consumption was also significantly associated with alcohol intake with a gradient effect, those with higher tobacco consumption being at higher risk of abusive alcohol intake. When analyzing the risk of having abusive consumption in those consuming alcohol we found a highly significant effect of gender with male having an increased risk (AOR = 2.53 [1.38 – 4.68]).Conclusion: Our data showed an important burden of alcohol consumption in Burkina Faso with a strong relationship with age, gender and tobacco consumption and disparities across the different regions of Burkina Faso. To effectively reduce alcohol consumption in Burkina Faso, a comprehensive control program should consider these associated factors.
Smartphone and medical application use among dentists in China
Authors: Zhang Chao , Fan Lin , Chai Zhaowu , Yu Cong , Song Jinlin
Published: August 2020

Background: With the development of information technology, more and more healthcare professionals are using smartphones and mobile medical applications (apps) in their clinical practice. The objective of this study was to survey the use of smartphone based medical apps among dentists in China and their perceptions on such apps.Methods: All data were collected using anonymous questionnaires. The questionnaires for this cross-sectional study were randomly sent to dentists by email, and 379 dentists completed the questionnaires. Dentists’ demographics and their perceptions on Wechat, QQ (the most popular social media apps in China) and other medical apps were assessed, including questions on the purpose, frequency, daily use, and opinion of these apps they used. Questions were answered using a Likert scale (1 = strongly agree, 2 = agree, 3 = not sure, 4 = disagree, and 5 = strongly disagree).Results:A total of 379 valid responses were received with a median age of 33.6 years old (63.3% female). All subjects (100%) owned a smartphone, and all of them installed and used WeChat or QQ in their clinical practice. Only 76% subjects installed medical apps (except Wechat and QQ) on their smartphones. Male dentists would like to install medical apps than female dentists (p < 0.05). With the increasing of age, the percentage of dentists to install medical apps was decreasing ( p < 0.001). The frequency and daily use of WeChat or QQ were more often than medical apps. Medical apps were positively perceived, with dentists reporting to recommend these medical apps to other peers (Likert score: 1.67 ± 0.68).Conclusion: Medical apps were perceived to provide positive impact on clinical practice, education and patient care in dentistry by providing relevant medical information. But there will be still much room for improvement in the future.
High HbA1c is associated with decreased 6-month survival and poor outcomes after out-of-hospital cardiac arrest: a retrospective cohort study
Authors: Lee Junhaeng , Oh Joo Suk , Zuh Jong Ho , Hong Sungyoup , Park Sang Hyun , Kim Ji Hoon , Kim Hyungsoo , Seo Mingu , Kim Kiwook , Lee Doo Hyo , Jung Hyun Ho , Park Jungtaek , Oh Young Min , Choi Semini , Choi Kyoung Ho
Published: August 2020

Background: To evaluate the associations between glycated hemoglobin (HbA1c) at admission and 6-month mortality and outcomes after out-of-hospital cardiac arrest (OHCA) treated by hypothermic targeted temperature management (TTM).Methods: This single-center retrospective cohort study included adult OHCA survivors who underwent hypothermic TTM from December 2011 to December 2019. High HbA1c at admission was defined as a level higher than 6%. Poor neurological outcomes were defined as cerebral performance category scores of 3-5. The primary outcome was 6-month mortality. The secondary outcome was the 6-month neurological outcome. Descriptive statistics, log-rank tests, and multivariable regression modeling were used for data analysis.Results: Of the 302 patients included in the final analysis, 102 patients (33.8%) had HbA1c levels higher than 6%. The high HbA1c group had significantly worse 6-month survival (12.7% vs. 37.5%, p < 0.001) and 6-month outcomes (89.2% vs. 73.0%, p = 0.001) than the non-high HbA1c group. Kaplan-Meier analysis and the log-rank test showed that the survival time was significantly shorter in the patients with HbA1c >6% than in those with HbA1c ≤6%. In the multivariable logistic regression analysis, HbA1c >6% was independently associated with 6-month mortality (OR 5.85, 95% CI 2.26-15.12, p < 0.001) and poor outcomes (OR 4.18, 95% CI 1.41-12.40, p < 0.001).Conclusions: This study showed that HbA1c higher than 6% at admission was associated with increased 6-month mortality and poor outcomes in OHCA survivors treated with hypothermic TTM. Poor long-term glycemic management may have prognostic significance after cardiac arrest.
Risk factors of lymph node metastasis in the splenic hilum of gastric cancer patients: A meta-analysis
Authors: Du Jun , Shen Yangchao , Yan Wenwu , Wang Jinguo
Published: August 2020

BackgroundThe issue of whether or not splenic hilum lymph nodes (SHLN) should be excised in radical gastrectomy with D2 lymph node dissection remains controversial. In this study, we identified the clinicopathological features in patients with gastric cancer that could serve as predictive risk factors of SHLN metastasis. MethodsWe searched Medline, Embase, PubMed and Web of Science databases from inception to May 2020 and consulted the related references. Overall, 15 articles evaluating a total of 4377 patients were included for study. The odds ratios (OR) of each risk factor and corresponding 95% confidence intervals (CI) were determined using Revman 5.3 software.ResultsOur meta-analysis revealed tumor size greater than 5 cm (p < 0.01), tumor localization in the greater curvature (p < 0.01), diffuse type (Lauren’s classification) (p < 0.01), Borrmann type 3–4 (p < 0.01), poor differentiation and undifferentiation (p < 0.01), depth of invasion T3–T4 (p < 0.01), number of lymph node metastases N2–N3 (p < 0.01), distant metastasis M1 (p < 0.01), TNM stage 3–4 (p < 0.01), vascular invasion (p = 0.01), and lymphatic invasion (p < 0.01) as potential risk factors of SHLN metastasis. Moreover, positivity of Nos. 1, 2, 3, 4sa, 4sb, 4d, 6, 7, 9, 11, and 16 lymph nodes for metastasis was strongly associated with SHLN metastasis.ConclusionsTumor size, tumor location, Lauren’s diffuse type, Borrmann type, degree of differentiation, T stage, N stage, M stage, TNM stage, vascular invasion, lymphatic infiltration, and other positive lymph nodes are risk factors for SHLN metastasis.
Prenatal Diagnosis of Fetal Skeletal Dysplasia Using 3-Dimensional Computed Tomography: A Prospective Study
Authors: Waratani Miyoko , Ito Fumitake , Tanaka Yukiko , Mabuchi Aki , Mori Taisuke , Kitawaki Jo
Published: August 2020

Background: Fetal skeletal dysplasia (FSD) comprises a complex group of systemic bone and cartilage disorders. Many FSD phenotypes have indistinct definitions, making definitive prenatal diagnosis difficult. The condition is typically diagnosed using sonography; however, three-dimensional computed tomography (3D-CT) also aids in making a prenatal diagnosis. This study aimed to examine the efficacy of 3D-CT in the prenatal diagnosis of FSD by comparing the diagnostic accuracy of fetal sonography and 3D-CT.Methods: On suspicion of FSD based on ultrasound examination, we performed 3D-CT prenatally to confirm this diagnosis. To minimize exposure of the fetuses to radiation without compromising image quality, we used predetermined 3D-CT settings for volume acquisition.Results: Sixteen fetuses were suspected of having skeletal dysplasia based on ultrasonography findings. Of these, 15 were diagnosed with FSD using 3D-CT. All 15 fetuses diagnosed with skeletal dysplasia prenatally were confirmed postnatally to have the condition. The definitive postnatal diagnosis (campomelic dysplasia) differed from the prenatal diagnosis (osteogenesis imperfecta) in only one infant. Fourteen cases (93.3%) were diagnosed with an accurate classification. Five infants had lethal skeletal dysplasia; one died in utero, and four died as neonates. We determined the appropriate delivery method for each infant based on the prenatal diagnosis.Conclusions: 3D-CT is a valuable tool for augmenting ultrasound examinations in the diagnosis of FSD. While improving the diagnostic tool of sonography is essential in cases of suspected FSD, 3D-CT imaging is indispensable for diagnosis and classification, enabling better planning for resuscitation of the infant after birth.Trial registration: University Hospital Medical Information Network (UMIN) Center trial registration number is UMIN000034744. Registered 1 October, 2018 – Retrospectively registered, https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=Roooo39610.