bluuebunny/crossref_metadata_2025 huggingface dataset:
4-Hexylresorcinol Inhibits Osteoclastogenesis by Suppressing NF‐κB Signaling Pathway and Reverses Bone Loss in Ovariectomized Mice
Authors: Yi Wenkai , Liu Tao , Gao Xinfeng , Xie Yonghua , Liu Ming
Published: November 2020

Background: 4-Hexylresorcinol is a small organic compound that is widely used as additive antiseptic and antioxidant. In the present study, we investigated its role in osteoclastogenesis. Methods: Bone marrow-derived macrophages were used to test the role of 4-Hexylresorcinol on osteogenesis. Ovariectomy model was created to examine the effect of 4-Hexylresorcinol in vivo. Results: In this study 4-Hexylresorcinol effectively suppressed RANKL‐induced osteoclastogenesis in a dose‐dependent manner. It also significantly suppressed the expression of osteoclast‐specific markers including tartrate‐resistant acid phosphatase, cathepsin K, nuclear factor of activated T‐cells cytoplasmic 1 and c‐Fos. Furthermore, it inhibited osteoclastogenesis by inhibiting activation of NF‐κB signaling pathway. Consistent with in vitro results, 4-Hexylresorcinol effectively ameliorated ovariectomy surgery induced bone loss and profoundly reduced osteoclast number in vivo. Conclusions: Overall, our results suggested that 4-Hexylresorcinol may be a novel therapeutic approach for osteoporosis treatment.
Artificial Neural Networks (ANNs) and Response Surface Methodology (RSM) Approach for Modeling and Optimization of Pectin Extraction from Banana Peel
Authors: AKLILU ERMIAS GIRMA
Published: November 2020

The present study, the influence of three independent variables for extraction of pectin were investigated and optimized using artificial neural network and response surface methodology on the yield and degree of esterification of banana peel pectin obtained using acid extraction method. The results revealed that properly trained artificial neural network model is found to be more accurate in prediction as compared to response surface method model. The optimum conditions were found to be temperature of 82oC, pH of 2 and extraction time of 102 min in the desirable range of the order of 0.977. The yield of pectin and degree of esterification under these optimum conditions was 15.64% and 65.94, respectively. Temperature, extraction time and pH revealed a significant (p < 0.05) effect on the pectin yield and degree of esterification. The extracted banana peel pectin was categorized as high methoxyl pectin, based on the high methoxyl content and degree of esterification. In general, the findings of the study show that banana peel can be explored as a promising alternative for the commercial production of pectin.
Energy Devices Safety and Impact on Video-assisted Thoracoscopic Lung Lobectomy Postoperative Course: Monopolar Electrocautery Versus Ultrasonic Dissector
Authors: Cattoni Maria , Rotolo Nicola , Nardecchia Elisa , De Maio Silvia , Dominioni Lorenzo , Imperatori Andrea
Published: November 2020

Background This study aims to compare safety and impact of monopolar electrocautery and ultrasonic dissector (Harmonic ACE Plus®) on postoperative short-term outcomes after video-assisted thoracoscopic (VATS) lobectomy and lymphadenectomy for lung cancer.Methods We retrospectively analyzed prospectively collected data of 140 consecutive patients [59% male; median age: 71(IQR:62-76) years] undergoing VATS lobectomy and lymphadenectomy in our institution between October 2016 and November 2019. Patients were divided in two groups based on device used: monopolar electric hook in 79 cases (Group A); ultrasonic dissector in 61(Group B). Energy instrument-related intraoperative accidents, hemothorax/chylothorax incidence, total pleural effusion volume at 48 postoperative hours and chest tube duration were compared between groups. Multivariable analysis was performed to test energy device as possible independent risk factor for increased pleural effusion volume or for prolonged chest tube duration.Results No intraoperative accidents due to energy device occurred. No hemothorax was recorded. Chylothorax incidence was slightly higher in Group A (2.5% vs 0%; p-value=0.21). Total pleural effusion volume at 48 hours was significantly higher in Group B: 400 (285-500) vs 255 (150-459) ml (p-value=0.005). Chest tube duration was similar in the two groups: 5 (3-9) vs 5 (3-8) days (p-value=0.77). At multivariable analysis the energy device used was not associated with increased pleural effusion volume (p-value=0.43) nor with prolonged chest tube duration (p-value=0.20).Conclusions Monopolar electrocautery and Harmonic ACE Plus® were safe and had a similar impact on short-term outcomes after VATS lobectomy and lymphadenectomy, suggesting that energy devices choice could be left to surgeon’s preference.
The Effect of Multi-Component Interventions on the Incidence Rate, Severity, and Duration of Post Open Heart Surgery Delirium among Hospitalized Patients
Authors: Tehranineshat Banafsheh , Hosseinpour Nima , Mani Arash , Rakhshan Mahnaz
Published: November 2020

Background: Delirium is one of the prevalent complications of post open heart surgery. The present research aimed to assess the effect of multi-component interventions on the incidence rate, severity, and duration of post open heart surgery delirium among hospitalized patients.Methods: In this quasi-experimental study, 96 patients under open heart surgery were selected using convenience sampling and were divided into a control and an intervention group. The interventions included patients’ preoperative education, nurses’ education, and intra-ward environmental interventions. The demographic information and Mini-Mental State Examination (MMSE) questionnaires were completed a day before surgery. The patients in both groups were also surveyed after extubation until the fourth day post operation using Delirium Observation Screening (DOS) scale considering the incidence, severity, and duration of delirium. The data were analyzed using the SPSS statistical software, version 20.Results: The incidence rate of delirium was 14.6% and 6.2% in the control and intervention groups, respectively (p>0.05). Besides, the mean severity of delirium was 0.53 in the control group and 0.40 in the intervention group (p>0.05). Finally, the mean duration of delirium was 4.5 and 3.25 hours in the two groups, respectively (p>0.05).Conclusions: Since prevention of delirium can play a considerable role in patients’ recovery after heart surgery, it is necessary to carry out some measures to prevent such complications. Even though the interventions performed in this study did not cause significant changes in this regard, the results suggested that prevention interventions should be performed with stronger and more integrated planning for achieving better outcomes.
The role of nickel-titanium shape memory alloy embracing fixator in determination of the implantation angle of hip tumor prosthesis stem following tumor resection and the analysis of its efficacy ： a retrospective study
Authors: Wang Yang , Zhou Panyu , Xia Demeng , Wang Yunyun , Wang Sheng , Zhang Hongyue , Xu Shuogui
Published: November 2020

Background: To explore the role of nickel-titanium(NiTi) shape memory alloy embracing fixator in determination of implantation angle of hip tumor prosthesis stem and analyze its efficacy. Methods: 36 patients with proximal femur tumor were treated with extended tumor resection and prosthetic replacement. 14 patients received prosthetic replacements with the embracing fixators fixing between the junction of the prosthesis stem and the femur temporarily, while the other 22 patients received the same replacements but without the fixators. Following aspects were compared: occurrence of complications, limb function and active hip ROM.Results: There are fewer cases of hip dislocation in the group received prosthetic replacements with the use of embracing fixators. Occurrence of deep infection presented no difference between the two groups. Better limb function and higher active range of motion (ROM) on abduction or flexion were also found in the group using embracing fixators. Conclusion: Ni-Ti shape memory alloy embracing fixator plays a key part in assisting the accurate implantation angle of the prosthesis stem in the prosthetic replacement. The prosthesis stem can be adjusted to the optimal angle with the help of the embracing fixator. Patients have lower chance of dislocation, better limb function, and higher active hip ROM. Trial registration: retrospectively registered.
Overexpressed Pseudogene MT1L Associated with Tumor Immune Infiltrates and Indicates a Worse Prognosis in BLCA
Authors: Ding Yanpeng , Liu Nuomin , Chen Mengge , Xu Yulian , Fang Sha , Xiang Wenbin , Hua Xinying , Chen Gaili , Zhong Yahua , Yu Haijun
Published: November 2020

Background BLCA is common cancer worldwide, aggressive, and fatal. Immunotherapy (ICT) has achieved an excellent curative effect in BLCA; however, only part of these patients can benefit from ICT treatment. MT1L belongs to pseudogene, and a previous study has suggested that MT1L can be used as an indicator of prognosis in colorectal cancer. However, the role of MT1L in BLCA has not yet been illuminated. Methods Data was collected from TCGA, and logistic regression, Kaplan-Meier Plotter, and multivariate Cox analysis have been performed to demonstrate the correlation between pseudogene MT1L and prognosis in BLCA. To identify the association of MT1L with tumor-infiltrating immune cells, TIMER and TISIDB were utilized. And GSEA was performed to illuminate the potential biologic function. Results The expression of MT1L was decreased in BLCA. And it is positively connected with immune cells, like Tregs(ρ=0.708) and MDSCs(ρ=0.664). We also confirmed that MT1L is related to typical markers of immune cells，like PD-1, CTLA-4. Besides, the high MT1L expression level is related to the high stage of T, N, and the high grade in BLCA and the increased expression of MT1L was significantly associated with the shorter OS of BLCA patients (P<0.05). Multivariate Cox analysis revealed that MT1L expression could be an independent prognostic factor of BLCA. Conclusion Collectively, our findings demonstrated that pseudogene MT1L regulates the immune microenvironment, correlates with poor survival, and serves as an independent prognostic biomarker in BLCA.
MiR-10a-5p regulates proliferation, apoptosis and cell cycle of NPM1-mutated acute myeloid leukemia cells by targeting SHANK3
Authors: Chen Sangsang , Cheng Ling
Published: November 2020

Objective: Although NMP1 mutation plays a crucial role in regulating the occurrence and development of acute myeloid leukemia (AML), there is still a lack of effective means to improve the prognosis of AML. Studies showed that miR-10a-5p is significantly highly expressed in leukemia and other cancers. However, the function and mechanism of miR-10a-5p in NPM1-mutated AML remain unclear. Methods: The differential expression of miRNAs and mRNAs related to AML from GEO database were analyzed by bioinformatics. NPM1-mutated AML cell lines were constructed, while miR-10a-5p and SHANK3 were overexpressed to analyze cell proliferation, apoptosis and cell cycle. The targeting relationship between SHANK3 and miR-10a-5p was predicted by bioinformatics and further validated by dual luciferase assay. Results: Bioinformatics analysis on NPM1-mutated AML samples revealed that miR-10a-5p was highly expressed while SHANK3 was poorly expressed, and miR-10a-5p might target to regulate SHANK3 expression. Overexpression of miR-10a-5p promoted the proliferation, inhibited the apoptosis and regulated the cell cycle of NPM1-mutated AML cells, while opposite results were observed when SHANK3 was overexpressed. Collectively, miR-10a-5p regulated the proliferation, apoptosis and cell cycle of NPM1-mutated AML cells partially by inhibiting SHANK3 expression. Conclusion: These results demonstrate the role of miR-10a-5p/SHANK3 in NPM1-mutated AML, which provides a potential method for prognosis prediction of AML patients.
Instrument Development and Validation of the Comprehensive Ability of Older People Assessment scale
Authors: Li Weitong , Zhu Yuan , Chen Yujing , Pu Yalou , Xu Guihua
Published: November 2020

Background: At present, many aging assessment instruments have been developed at home and abroad, but the quality of care service in China's pension institutions is uneven, and there is still a lack of a unified tool for assessing the ability of the elderly uesd by evaluators of long-term care institutions.Method: The Comprehensive Ability of Older People Assessment scale was completed by a sample of 971 older people from 4 long-term care facilities in China and the data were collected between April 2018-December 2019. One-way analysis of variance and multiple regression analysis were used to screen scale items, while focus group interviews were used to integrate the subjective and objective items. Confirmative factor analysis and expert judgment were applied to explore construct validity. Reliability was explored through internal consistency estimation using Cronbach’s alpha and homogeneity evaluation using corrected item-total correlations. Cluster analysis and discriminant analysis were used to segment the comprehensive ability assessment scores and discriminant function was established to determine the boundary value of each segment, with correlation analysis used to perform reverse verification.Results: Factor analysis yielded 40 items with six dimensions, including ‘Mentation and cognitive,’ ‘Perception and communication,’ ‘Emotional problems,’ ‘Mental and behavioral problems,’ ‘Daily life and social participation,’ and ‘Skin and oral status’. The Cronbach’s α was 0.951 while the dimensions show a Cronbach’s α 0.760–0.946. The rationality and scientificity of the scale was proved by the correlation analysis of reverse validation.Conclusion: The 4-grade Comprehensive Ability of Older People Assessment Scale had good validity and reliability and should be considered for institutional assessors.
Substitution of Citrate with Tissue Plasminogen Activator (rt-PA) for Catheter Lock Does Not Improve Patency of Tunneled Hemodialysis Catheters in a Randomized Trial
Authors: Richtrova Pavlina , Mares Jan , Kielberger Lukas , Klaboch Jan , Eiselt Jaromir , Reischig Tomas
Published: November 2020

Background: The study aim was to establish if substitution of citrate with rt-PA for catheter lock once weekly can reduce the incidence of catheter-related blood stream infections (CR-BSI) or improve patency of tunneled hemodialysis catheters.Methods: All incident patients undergoing insertion of a tunneled hemodialysis catheter were screened and included except those suffering infection or using oral anticoagulation. Study participants were randomized into two arms according to the solution applied as catheter lock: receiving either trisodium citrate (Citra-LockTM 4%) only or rt-PA (Actilyse® 1mg/ml) on the middle session each week with citrate used on the first and third sessions. The incidence of CR-BSI (confirmed by positive blood culture), catheter non-function (complete obstruction), and malfunction (blood flow <250ml/min) was recorded. Statistical significance was tested with ANOVA, post hoc analysis was performed by means of multiple linear regression.Results: Totally, 18 patients were included and followed during 655 hemodialysis sessions. No episode of CR-BSI was detected while 6 catheter non-functions (0.9% sessions) and 101 malfunctions (15.4% sessions) were recorded. The incidence of both events was equal between the study arms: 4 non-functions and 55 malfunctions in the rt-PA arm and 2 non-functions and 46 malfunctions in the citrate arm (p=0.47 and p=0.24, respectively). Additionally, the mean blood flow achieved did not differ significantly between the arms: 326±1,8 and 326±1,9 ml/min (p=0.95) in rt-PA and citrate arms, respectively. Post hoc analysis identified time elapsed since previous session (β=0.12, p=0.005) and malfunction on previous session (β=0.25, p<0.001) as significant factors affecting the occurrence of malfunction. By contrast, the study arm, rt-PA application on previous session, and catheter vintage did not enter the model.Conclusion: Substitution of citrate with rt-PA for catheter lock does not reduce the incidence of catheter malfunction neither does it affect the blood flow achieved during hemodialysis. Catheter patency is related rather to the time interval between sessions and to previous malfunction (thus probably reflecting undefined individual factors). The incidence of CR-BSI within pre-selected hemodialysis population is sporadic (less than 1 per 4.3 patient years in our sample).Trial registration: The study was registered on the ACTRN 12612000152820
The Impact of COVID-19 quarantine on dietary habits and physical activity in Saudi Arabia: a cross-sectional study
Authors: Bakhsh Manar Abduljalil , Khawandanah Jomana , Naaman Rouba Khalil , Alashmali Shoug
Published: November 2020

Background: The COVID-19 pandemic has forced governments around the world to impose strict hygiene and national lockdown measures, which in turn has changed the dietary and lifestyle habits of the world’s population. Thus, the aim of this study is to evaluate whether dietary and physical activity behaviors of Saudi Arabia’s adult population changed during the COVID-19 quarantine.Methods: An electronic questionnaire was distributed on social media between June and July 2020 and was completed by 2,255 participants (24% aged 30–39 years old, 64% female, 68% university educated).Results: Over 40% and 45% of participants reported eating and snacking more, respectively, which led to weight gain in 38%. Most participants reported that they consumed home-cooked (73%) and healthy meals (47%), while only 7% reported that they consumed foods from restaurants. Feelings of boredom and emptiness (44%) and the availability of time for preparing meals (40%) were the main reasons for changing dietary habits. Honey (43%) and vitamin C (50%) were the most consumed immune-boosting food and dietary supplement, respectively. COVID-19 also had a negative impact on physical activity, lowering the practice in 52% subjects, which was associated with significant weight gain (p <0.001).Conclusion: Assessing the changes to the population’s dietary habits and physical activity during the lockdown will help predict the outcome of the population’s future health and wellbeing after the pandemic.
Mathematical Analysis of a model for Chlamydia and Gonorrhea Codynamics with Optimal Control
Authors: Chukukere Eziaku Chinomso , Inyama Simeon Chioma , Omame Andrew
Published: November 2020

A model for Chlamydia trachomatis (CT) and Gonorrhea codynamics, with optimal control analysis is studied and analyzed to assess the impact of targetted treatment for each of the diseases on their co-infections in a population. The model exhibits the dynamical feature of backward bifurcation when the associated reproduction number is less than unity. The global asymptotic stability of the disease-free equilibrium of the co-infection model is also proven not to exist, when the associated reproduction number is below unity. The necessary conditions for the existence of optimal control and the optimality system for the co-infection model is established using the Pontryagin's Maximum Principle. Simulations of the optimal control model reveal that the intervention strategy which implements female Chlamydia trachomatis treatment and male gonorrhea treatment is the most effective in combating the co-infections of Chlamydia trachomatis and gonorrhea.
LDH-to-leukocyte ratio predicts COVID-19 diagnosis and CRP-to-lymphocyte ratio predicts prognosis of patients with COVID-19
Authors: Eckel Florian , Eckel Barbara , Müller Malte , Woodvine Christopher , Konert Markus , Schopf Stefan
Published: November 2020

Routine blood parameters are altered in patients with COVID-19 with differences depending on the severity of the disease. Therefore, they may predict diagnosis as well as prognosis of patients with COVID-19 and may be helpful when resources are limited.All patients admitted to our hospital were analyzed for routine blood parameters and SARS-CoV-2 screening results on admission. Primary endpoint was the area under the curve (AUC) of the receiver operating characteristic (ROC) analysis of routine blood parameters with PCR as gold standard.A total of 115 patients were included in the study. Median age was 79 years and male/female ratio was 49%/51%. 77 (67%) patients had PCR confirmed COVID-19. The lactate dehydrogenase (LDH) to leukocyte (WBC) ratio was the best diagnostic predictor (AUC 0.82), markedly better than the single parameters LDH (AUC 0.72) and WBC (AUC 0.75). Optimum cut-off of LDH/WBC ratio was 24.7 nU (sensitivity 87%, specificity 76%). The best single parameter for predicting a severe course of COVID-19 patients were CRP (AUC 0.83) and absolute lymphocyte count (ALC, AUC 0.77). Their ratio CRP/ALC surpassed both with an AUC of 0.88. Optimum cut-off was 77 n*mg (sensitivity 83%, specificity 80%).Our study showed, that on admission the LDH/WBC ratio is a diagnostic predictor of COVID-19 in symptomatic patients. In patients with COVID-19 the CRP/ALC ratio predicts severe course and probability of survival. Both are simple and good tools and may be helpful during pandemic when resources are limited.
A comprehensive multivariate model of biopsychosocial factors associated with opioid misuse and use disorder in a 2017-2018 United States national survey
Authors: Ishino Francisco Alejandro Montiel , McNab Philip R. , Gilreath Tamika , Salmeron Bonita , Williams Faustine
Published: November 2020

Background: Few studies have comprehensively and contextually examined the relationship of variables associated with opioid use. Our purpose was to fill a critical gap in comprehensive risk models of opioid misuse and use disorder in the United States by identifying the most salient predictors.Methods: A multivariate logistic regression was used on the 2017 and 2018 National Survey on Drug Use and Health, which included all 50 states and the District of Columbia of the United States. The sample included all noninstitutionalized civilian adults aged 18 and older (N=85,580; weighted N=248,008,986). The outcome of opioid misuse and/or use disorder was based on reported prescription pain reliever and/or heroin use dependence, abuse, or misuse. Biopsychosocial predictors of opioid misuse and use disorder in addition to sociodemographic characteristics and other substance dependence or abuse were examined in our comprehensive model. Biopsychosocial characteristics included socioecological and health indicators. Criminality was the socioecological indicator. Health indicators included self-reported health, private health insurance, psychological distress, and suicidality. Sociodemographic variables included age, sex/gender, race/ethnicity, sexual identity, education, residence, income, and employment status. Substance dependence or abuse included both licit and illicit substances (i.e., nicotine, alcohol, marijuana, cocaine, inhalants, methamphetamine, tranquilizers, stimulants, sedatives).Results. The comprehensive model found that criminality (adjusted odds ratio [AOR]=2.58, 95% confidence interval [CI]=1.98-3.37, p<0.001), self-reported health (i.e., excellent compared to fair/poor [AOR=3.71, 95%CI=2.19-6.29, p<0.001], good [AOR=3.43, 95%CI=2.20-5.34, p<0.001], and very good [AOR=2.75, 95%CI=1.90-3.98, p<0.001]), no private health insurance (AOR=2.12, 95%CI=1.55-2.89, p<0.001), serious psychological distress (AOR=2.12, 95%CI=1.55-2.89, p<0.001), suicidality (AOR=1.58, 95%CI=1.17-2.14, p=0.004), and other substance dependence or abuse were significant predictors of opioid misuse and/or use disorder. Substances associated were nicotine (AOR=3.01, 95%CI=2.30-3.93, p<0.001), alcohol (AOR=1.40, 95%CI=1.02-1.92, p=0.038), marijuana (AOR=2.24, 95%CI=1.40-3.58, p=0.001), cocaine (AOR=3.92, 95%CI=2.14-7.17, p<0.001), methamphetamine (AOR=3.32, 95%CI=1.96-5.64, p<0.001), tranquilizers (AOR=16.72, 95%CI=9.75-28.65, p<0.001), and stimulants (AOR=2.45, 95%CI=1.03-5.87, p=0.044). Conclusions. Biopsychosocial characteristics such as socioecological and health indicators, as well as other substance dependence or abuse were stronger predictors of opioid misuse and use disorder than sociodemographic characteristics.
Susceptibility of Anopheles gambiae sensu lato from Côte d’Ivoire to insecticides used on insecticide-treated nets: evaluating the additional entomological impact of piperonyl butoxide and chlorfenapyr
Authors: Kouassi Bernard L. , Edi Constant , Tia Emmanuel , Konan Lucien Y. , Akré Maurice A. , Koffi Alphonsine A. , Ouattara Allassane F. , Mea Antoine Tanoh , Zinzindohoue Pascal , Kouadio Blaise , Andre McKenzie , Irish Seth R. , Armistead Jennifer , Dengela Dereje , Cissé Ndombour G. , Flatley Cecilia , Chabi Joseph
Published: November 2020

BackgroundPyrethroid-treated mosquito nets are currently the mainstay of vector control in Côte d’Ivoire. However, resistance to pyrethroids has been reported across the country, limiting options for insecticide resistance management due to the paucity of alternative insecticides. Two types of insecticide-treated nets (ITNs), ITNs with pyrethroids and the synergist piperonyl butoxide (PBO), and Interceptor®G2 nets, a net treated with a combination of chlorfenapyr and alpha-cypermethrin, are believed to help in the control of pyrethroid-resistant mosquitoes. MethodsThe susceptibility of Anopheles gambiae sensu lato (s.l.) to pyrethroid insecticides with and without pre-exposure to PBO as well as to chlorfenapyr was investigated in fifteen sites across the country. Susceptibility tests were conducted on 2- to 4-day old adult female An. gambiae s.l. reared from larval collections. The resistance status, intensity, and effects of PBO on mortality after exposure to different concentrations of deltamethrin, permethrin and alpha-cypermethrin were determined using WHO susceptibility test kits. In the absence of a WHO-recommended standard protocol for chlorfenapyr, two interim doses (100 and 200 µg/bottle) were used to test the susceptibility of mosquitoes using the CDC bottle assay method. ResultsPre-exposure to PBO did not result in full restoration of susceptibility to any of the three pyrethroids for the An. gambiae s.l. populations from any of the sites surveyed. However, PBO pre-exposure did increase mortality for all three pyrethroids, particularly deltamethrin (from 4.4% to 48.9%). Anopheles gambiae s.l. from only one site (Bettie) were susceptible to chlorfenapyr at the dose of 100 µg active ingredient (a.i.)/bottle. At the dose of 200 µg (a.i.)/bottle, susceptibility was only recorded in 10 of the 15 sites.ConclusionLow mosquito mortality was found for pyrethroids alone, and while PBO increased mortality, it did not restore full susceptibility. The vector was not fully susceptible to chlorfenapyr in one third of the sites tested. However, vector susceptibility to chlorfenapyr seems to be considerably higher than for pyrethroids alone or with PBO. These data should be used cautiously when making ITN procurement decisions, noting that bioassays are conducted in controlled conditions and may not fully represent field efficacy where the host-seeking behaviors which include free-flying activity are known to enhance pro-insecticide chlorfenapyr intoxication to mosquitoes.
Data Cleaning Process for HIV- Indicator Data Extracted from DHIS2 National Reporting System: A Case study of Kenya
Authors: Gesicho Milka , Were Martin , Babic Ankica
Published: November 2020

Background: The District Health Information Software-2 (DHIS2) is widely used by countries for national-level aggregate reporting of health-data. To best leverage DHIS2 data for decision-making, countries need to ensure that data within their systems are of the highest quality. Comprehensive, systematic, and transparent data cleaning approaches form a core component of preparing DHIS2 data for analyses. Unfortunately, there is paucity of exhaustive and systematic descriptions of data cleaning processes employed on DHIS2-based data. The aim of this study was to report on methods and results of a systematic and replicable data cleaning approach applied on HIV-data gathered within DHIS2 from 2011 to 2018 in Kenya, for secondary analyses. Methods: Six programmatic area reports containing HIV-indicators were extracted from DHIS2 for all care facilities in all counties in Kenya from 2011 to 2018. Data variables extracted included reporting rate, reporting timeliness, and HIV-indicator data elements per facility per year. 93,179 facility-records from 11,446 health facilities were extracted from year 2011 to 2018. Van den Broeck et al’s framework, involving repeated cycles of a three-phase process (data screening, data diagnosis and data treatment), was employed semi-automatically within a generic five-step data-cleaning sequence, which was developed and applied in cleaning the extracted data. Various quality issues were identified, and Friedman analysis of variance conducted to examine differences in distribution of records with selected issues across eight years. Results: Facility-records with no data accounted for 50.23% and were removed. Of the remaining, 0.03% had over 100% in reporting rates. Of facility-records with reporting data, 0.66% and 0.46% were retained for voluntary medical male circumcision and blood safety programmatic area reports respectively, given that few facilities submitted data or offered these services. Distribution of facility-records with selected quality issues varied significantly by programmatic area (p<0.001). The final clean dataset obtained was suitable to be used for subsequent secondary analyses. Conclusions: Comprehensive, systematic, and transparent reporting of cleaning-process is important for validity of the research studies as well as data utilization. The semi-automatic procedures used resulted in improved data quality for use in secondary analyses, which could not be secured by automated procedures solemnly.
Hepatic Transcriptome Perturbations in Dairy Cows Fed Different Forage Resources
Authors: Gao Shengtao , Ma Lu , Zhang Yangdong , Wang Jiaqi , Loor JuanJuan , bu dengpan
Published: November 2020

Background: Forage plays critical roles in milk performance of dairy. However, domestic high-quality forage such as alfalfa hay is far from being sufficient in China. Thus, more than 1 million tons of alfalfa hay were imported in China annually in recent years. At the same time, more than 10 million tons of corn stover are generated annually in China. Thus, taking full advantage of corn stover to meet the demand of forage and reduce dependence on imported alfalfa hay has been a strategic policy for the Chinese dairy industry. Changes in liver metabolism under different forage resources are not well known. Thus, the objective of the present study was to investigate the effect of different forage resources on liver metabolism using RNAseq and bioinformatics analyses. Results: The results of this study showed that the cows fed a diet with corn stover (CS) as the main forage had lower milk yield, DMI, milk protein content and yield, milk fat yield, and lactose yield than cows fed a mixed forage (MF) diet (P<0.01). KEGG analysis for differently expressed genes (DEG) in liver (81 up-regulated and 423 down-DEG, Padj ≤ 0.05) showed that pathways associated with glycan biosynthesis and metabolism and amino acid metabolism was inhibited by the CS diet. In addition, results from DAVID and ClueGO indicated that biological processes related to cell-cell adhesion, multicellular organism growth, and amino acid and protein metabolism also were downregulated by feeding CS. Co-expression network analysis indicated that FAM210A, SLC26A6, FBXW5, EIF6, ZSCAN10, FPGS, and ARMCX2 played critical roles in the network. Bioinformatics analysis showed that genes within the co-expression network were enriched to “pyruvate metabolic process”, “complement activation, classical pathway”, and “retrograde transport, endosome to Golgi”. Conclusions: Results of the present study indicated that feeding a low-quality forage diet inhibits important biological functions of the liver at least in part due to a reduction in DMI. In addition, the results of the present study provide an insight into the metabolic response in the liver to different-quality forage resources. As such, the data can help develop favorable strategies to improve the utilization of corn stover in China.
Barriers and Facilitators to Implementing Evidence Based Bleeding Management in Australian Cardiac Surgery Units: A Qualitative Interview study analysed with the Theoretical Domains Framework and COM-B model 
Authors: Pearse Bronwyn Louise , Keogh Samantha , Rickard Claire M , Fung Yoke Lin
Published: November 2020

BackgroundBleeding during cardiac surgery is a common complication that often requires the transfusion of blood products. The combination of bleeding and blood product transfusion incrementally increases adverse outcomes including infection and mortality. Following bleeding management guideline recommendations could assist with minimising risk but adherence is not high, and the cause for lack of adherence is not well understood. This study aimed to identify barriers and facilitators to practicing and implementing evidenced-based intra-operative, bleeding management in Australian cardiac surgery units. MethodsWe used a qualitative descriptive design to conduct semi-structured interviews with Australian cardiac surgeons, anaesthetists and perfusionists. The Theoretical Domains Framework (TDF) was utilised to guide interviews and thematically analyse the data. Categorised data were then linked with the three key domains of the COM-B model (capability, opportunity, and motivation) to explore and understand behaviour.ResultsSeventeen interviews were completed. Nine of the 14 TDF domains emerged as significant. Analysis revealed key themes to improving capability included, standardisation, monitoring, auditing, and feedback of data and cross discipline training. Opportunity for change was improved with interpersonal and interdepartmental collaboration through shared goals, and more efficient and supportive processes allowing clinicians to navigate unfamiliar business and financial models of health care. Results suggest as individuals, clinicians had the motivation to make change and healthcare organisations have an obligation and a responsibility to partner with clinicians to support change and improve goal directed best practice. ConclusionUsing a theory-based approach it was possible to identify factors which may be positively or negatively influencing clinicians ability to implement best practice bleeding management in Australian cardiac surgical units.
Imaging analysis of 13 rare cases of renal collecting (Bellini) duct carcinoma patients in northern China: a case series and literature review.
Authors: Lyu Zhehao , Liu Lili , Li Huimin , Wang Haibo , Liu Qi , Chen Tingting , Xu Meiling , Tian Lin , Fu Peng
Published: November 2020

Background: Collective duct carcinoma (CDC) is a highly malignant kidney tumor which is rare in clinical. We report our 12-year experience of Collecting (Bellini) duct carcinoma (CDC) and retrospectively analyzed patients and tumour characteristics, clinical manifestations, different imaging characteristics including CT, MRI and PET/CT. Methods: From January 2007 to December 2019, we retrospectively examined all renal tumors and identifed 13 cases of CDC from 3 medical centers in the northern China. All 13 patients underwent CT scan, 8 of whom underwent dynamic enhanced CT scan, 2 underwent PET/CT scan and 1 underwent MRCP examination. The lesions were divided into nephritis type and mass type according to the morphology of the tumors.Results: The study group included 10 men and 3 women, with an average age of 64.23±10.74 years old. Of these 13 patients, the main clinical manifestations include gross hematuria, flank pain or waist discomfort. The mean tumour size was 8.48 ± 2.48 cm. In this group of cases, 6 (46.2%) cases are cortical-medullary involved type, 7 (53.8%) cases are cortex-medullary-pelvis involved type. 11 (84.6%) cases were nephritis type and 2 (15.4%) cases were mass type. The lesions appeared solid or complex solid and cystic on CT and MRI. The parenchymal part of 13 CDC tumors showed isodensity or slightly higher density on unenhanced CT scan. Two patients with PET/CT showed increased radioactivity intake. Evidence of intra-abdominal metastatic disease was present on CT in 9 ( 69.2% ) cases.Conclusions: The Collecting (Bellini) duct carcinoma has its certain imaging characteristics which were different from the other renal cell carcinoma. A renal tumor should be considered as CDC when it locates in the junction zone of the renal cortex and medulla, with unclear border, slight enhancement and metastases in early stage. PET/CT can greatly enrich the key information of diagnosis, surgery and treatment options, which provide significant help to the clinic.
Repetitive Transcranial Magnetic Stimulation on Chronic Tinnitus: A Systematic Review and Meta-Analysis
Authors: Liang Zhengrong , Yang Haidi , Cheng Gui , Huang Lingfei , Zhang Tao , Jia Haiying
Published: November 2020

Background: Although the clinical efficacy and safety of repetitive transcranial magnetic stimulation (rTMS) in the treatment of chronic tinnitus have been frequently examined, the results remain contradictory. Therefore, we performed a systematic review and meta-analysed clinical trials examining the effects of rTMS to evaluate its clinical efficacy and safety.Methods: Studies of rTMS for chronic tinnitus were retrieved from PubMed, Embase, and Cochrane Library through April 2020. Review Manager 5.3 software was employed for data synthesis, and Stata 13.0 software was used for analyses of publication bias and sensitivity.Results: Twenty-nine randomized studies involving 1,228 chronic tinnitus patients were included. Compared with sham-rTMS, rTMS exhibited significant improvements in the tinnitus handicap inventory (THI) scores at 1 week (mean difference [MD]: -7.92, 95% confidence interval [CI]: -14.18, -1.66), 1 month (MD: -8.52, 95% CI: -12.49, -4.55), and 6 months (MD: -6.53, 95% CI: -11.406, -1.66) post intervention; there were significant mean changes in THI scores at 1 month (MD: -14.86, 95% CI: -21.42, -8.29) and 6 months (MD: -16.37, 95% CI: -20.64, -12.11) post intervention, and the tinnitus questionnaire (TQ) score at 1 week post intervention (MD: -8.54, 95% CI: -15.56, -1.52). Nonsignificant efficacy of rTMS was found regarding the THI score 2 weeks post intervention (MD: -1.51, 95% CI: -13.42, -10.40); the mean change in TQ scores 1 month post intervention (MD: -3.67, 95% CI: -8.56, 1.22); TQ scores 1 (MD: -8.97, 95% CI: -20.41, 2.48) and 6 months (MD: -7.02, 95% CI: -18.18, 4.13) post intervention; and adverse events (odds ratios [OR]: 1.11, 95% CI: 0.51, 2.42). Egger's and Begg's tests indicated no publication bias (P = 0.925).Conclusion: This meta-analysis demonstrated that rTMS is effective for chronic tinnitus; however, its safety needs more validation. Restrained by the insufficient number of included studies and the small sample size, more large randomized double-blind multi-centre trials are needed for further verification.
Preoperative risk grade predicts the long-term prognosis of intrahepatic cholangiocarcinoma: a retrospective cohort analysis
Authors: Zhao Jianping , Chen Yao , Wang Jingjing , Wang Jian , Wang Ying , Chai Songshan , Zhang Yuxin , Chen Xiaoping , zhang wanguang
Published: November 2020

Background: Cumulating evidence indicates that the systemic inflammatory response (SIR) plays a crucial role in the prognosis of various cancers. We aimed to generate a preoperative risk grade (PRG) by integrating SIR markers to preoperatively predict the long-term prognosis of intrahepatic cholangiocarcinoma (ICC).Methods: 468 consecutive ICC patients who underwent hepatectomy between 2010 to 2017 were enrolled. The PRG and a nomogram were generated and their predictive accuracy was evaluated.Results: The PRG consisted of two non-tumor-specific SIR markers platelet-to-lymphocyte ratio (PLR) and albumin (ALB), which were both the independent predictors of overall survival (OS). Multivariate analysis showed that the PRG was significantly associated with OS (PRG =1: Hazard ratio (HR) = 3.800, p < 0.001; PRG = 2: HR = 7.585, p < 0.001). The C-index of the PRG for predicting survival was 0.685 (95% CI: 0.655 to 0.716), which was statistically higher than that of the following systems: American Joint Committee on Cancer (AJCC) 8th edition (C-index 0.645), Liver Cancer Study Group of Japan (LCSGJ) (C-index 0.644) and Okabayashi (C-index 0.633) (p < 0.05). Besides, the C-index of the nomogram only consisting of the tumor-specific factors (serum carcinoembryonic antigen, carbohydrate antigen 19-9, tumor number) could be improved to 0.737 (95% CI: 0.062-0.768) from 0.625 (95% CI: 0.585-0.665) when the PRG was incorporated (p < 0.001).Conclusions: The PRG integrating two non-tumor-specific SIR markers PLR and ALB was a novel method to preoperative predicting the prognosis of ICC.
Dynamic genome-wide association analysis and identification of candidate genes involved in anaerobic germination tolerance in rice
Authors: Su Ling , Yang Jing , Li Dandan , Peng Ziai , Xia Aoyun , Yang Meng , Luo Lixing , Huang Cuihong , Wang Jiafeng , Wang Hui , Chen Zhiqiang , Guo Tao
Published: November 2020

Background: In Asian rice production, an increasing number of countries now choose the direct seeding mode because of rising costs, labour shortages and water shortages. The ability of rice seeds to undergo anaerobic germination (AG) plays an important role in the success of direct seeding.Results: In this study, we used 2,123,725 single nucleotide polymorphism (SNP) markers based on resequencing to conduct a dynamic genome-wide association study (GWAS) of coleoptile length (CL) and coleoptile diameter (CD) in 209 natural rice populations. A total of 26 SNP loci were detected in these two phenotypes, of which 5 overlapped with previously reported loci (S1_ 39674301, S6_ 20797781, S7_ 18722403, S8_ 9946213, S11_ 19165397), and two sites were detected repeatedly at different time points (S3_ 24689629 and S5_ 27918754). We suggest that these 7 loci (−log10 (P) value > 7.3271) are the key sites that affect AG tolerance. To screen the candidate genes more effectively, we sequenced the transcriptome of the flooding-tolerant variety R151 in six key stages, including anaerobic (AN) and the oxygen conversion point (AN-A), and obtained high-quality differential expression profiles. Four reliable candidate genes were identified: Os01g0911700 (OsVP1), Os05g0560900 (OsGA2ox8), Os05g0562200 (OsDi19-1) and Os06g0548200. Then qRT-PCR and LC-MS/ MS targeting metabolite detection technology were used to further verify that the up-regulated expression of these four candidate genes was closely related to AG.Conclusion: The four novel candidate genes were associated with gibberellin (GA) and abscisic acid (ABA) regulation and cell wall metabolism under oxygen-deficiency conditions and promoted coleoptile elongation while avoiding adverse effects, allowing the coleoptile to obtain oxygen, escape the low-oxygen environment and germinate rapidly. The results of this study improve our understanding of the genetic basis of AG in rice seeds, which is conducive to the selection of flooding-tolerant varieties suitable for direct seeding.
Leaders' Perspectives on Learning Health Systems: a qualitative study 
Authors: Enticott Joanne , Braaf Sandy , Johnson Alison , Jones Angela , Teede Helena
Published: November 2020

Background: Integrated utilisation of digital health data has the power to transform healthcare to deliver more efficient and effective services, and the learning health system (LHS) is emerging as a model to achieve this. The LHS uses routine data from service delivery and patient care to generate knowledge to continuously improve healthcare. The aim of this project was to explore key features of a successful and sustainable LHS to inform implementation in an Academic Health Science Centre context.Methods: We purposively identified and conducted semi-structured qualitative interviews with leaders, experienced in supporting or developing data driven innovations in healthcare. A thematic analysis using NVivo was undertaken.Results: Analysis of 26 interviews revealed five themes thought to be integral in an effective, sustainable LHS: (1) Systematic approaches and iterative, continuous learning with implementation into healthcare contributing to new best-practice care; (2) Broad stakeholder, clinician and academic engagement, with collective vision, leadership, governance and a culture of trust, transparency and co-design; (3) Skilled workforce, capability and capacity building; (4) Resources with sustained investment over time and; (5) Data access, systems and processes being integral to a sustainable LHS. Conclusions: This qualitative study provides insights into the elements of a sustainable LHS across a range of leaders in data-driven healthcare improvement. Fundamentally, an LHS requires continuous learning with implementation of new evidence back into frontline care to improve outcomes. Structure, governance, trust, culture, vision and leadership were all seen as important along with a skilled workforce and sustained investment. Processes and systems to optimise access to quality data were also seen as vital in an effective, sustainable LHS. These findings will inform a co-designed framework for implementing a sustainable LHS within the Australian healthcare and Academic Health Science Centre context. It is anticipated that application of these findings will assist to embed and accelerate the use of routine health data to continuously generate new knowledge and ongoing improvement in healthcare delivery and health outcomes.
A new method for functional analysis of plastid EMBRYO-DEFECTIVE PPR genes by efficiently constructing cosuppression lines in Arabidopsis
Authors: Chen Jingli , Zhu Haojie , Huang Jirong , Huang Weihua
Published: November 2020

Background: Pentatricopeptide-repeat proteins (PPRs) characterized by tandem arrays of a degenerate 35-amino-acid repeat (PPR motif) can bind a single strand RNA and regulate organelle gene expression at the post-transcriptional level, including RNA cleavage, splicing, editing and stability etc. PPRs are conserved in all eukaryotes and extremely expanded in higher plants. Many knockout mutants of PPR genes are embryonically lethal. These genes are named EMB PPRs and functional analysis of them is hindered by the difficulty in obtaining their knockout mutants. Results: Here, we report a new method for functional analysis of plastid EMB PPRs by efficiently constructing their cosuppression lines in Arabidopsis. When we overexpressed a mutated full length or truncated coding sequence (CDS) of EMB PPRs, such as EMB2279, EMB2654 and EMB976 (all belong to the P family PPRs) in the wild-type (WT) background, a large portion of T1 plants displayed chlorosis phenotypes, which are similar to those of the weak allele mutants, knockdown lines or partially complementary lines. RT-PCR analysis showed that overexpression of the truncated EMB PPRs led to significant and specific downregulation of their corresponding endogenous mRNAs. However, when these EMB PPRs were overexpressed in the PTGS (Post transcriptional Gene Silencing) deficient mutant, rdr6 (RNA-dependent RNA polymerase 6), none of the T1 plants displayed chlorosis phenotypes. These results indicate that the chlorosis phenotype results from post transcriptional silencing of the corresponding endogenous gene (also known as sense cosuppression). Conclusions: Overexpression of an appropriately truncated EMB PPR CDS in WT leads to gene silencing in a RDR6-dependent manner, and this method can be employed to study the unknown function of EMB PPR genes. By this method, we showed that EMB976 is required for splicing of chloroplast clpP1 intron 2 and ycf3 intron 1.