bluuebunny/crossref_metadata_2025 huggingface dataset:
Chinese herbal extract granules combined with 5-aminosalicylic acid for patients with moderately active ulcerative colitis: study protocol for a multicenter randomized double-blind placebo-controlled trial
Authors: Shen Zhaofeng , Zheng Kai , Zou Jiandong , Gu Peiqing , Xing Jing , Zhang Lu , Zhu Lei , Shen Hong
Published: August 2020

Background
Ulcerative colitis (UC) is an intestinal inflammatory disease characterized by inflammation of the colonic mucosa. With unknown pathogenesis, it has become a chronic lifetime disorder worldwide. In patients with moderately active UC, several therapies (e.g. aminosalicylates, corticosteroids, immunosuppressants and biologics) are recommended for induction (or maintenance) of remission. Given the side effects and disease burden, it is difficult for most patients to achieve ideal treatment goals in clinical practice. Chinese herbal medicine (CHM), as a complementary therapy, has been widely used in the management of UC in China. Qing-Chang-Hua-Shi granule (QCHS) is a classical Chinese herbal formula. Our preliminary study suggested that the QCHS decoction has a significant effect on patients with moderately active UC. However, its effectiveness and safety has not been evaluated convincingly. Therefore, we designed this protocol to investigate the efficacy of QCHS granule for moderately active UC.
Methods
This is a multicenter, randomized, double-blind, placebo-controlled, superiority trial. A total of 120 patients with moderately active UC will be recruited from 10 hospitals in China. Each eligible participant will be randomly assigned to receive QCHS granule or placebo twice daily for 12 weeks. Both groups will be given basic treatment with mesalazine (4 g/d). The primary outcomes are the clinical response (remission) rate. The secondary outcomes are health-related quality of life, endoscopic response rate, mucosal healing rate and inflammatory markers (e.g. Fecal calprotectin and CRP). The whole study period will last 36 weeks, including 24 weeks follow-up time. According to the intention-to-treat principle, variables will be assessed at 2, 4, 6, 8, 10 and 12 weeks after study commencement.
Discussion
This is the first prospective, multicenter, randomized, double-blind, placebo-controlled, superiority trial regarding Chinese herbal extract granules in the management of moderately active UC. We aim to investigate the superiority of QCHS granules over placebo in terms of induction of remission. The findings will provide convincing evidence on the efficacy and safety of QCHS granules for moderately active UC, which may help clinical practitioners, UC patients and policymakers make more informed choices in the decision-making.
Trial registration:
Chinese Clinical Trial Registry, ChiCTR-IOR-14005554. Registered on 27 November 2014.
Cancer Patient Management Strategy in a Cancer Center of Zhejiang, China During the COVID-19 Pandemic
Authors: Xu Song-xiao , Cheng Xiang-dong , Pan Zhi-wen , Song Qian , Wang Yi-hong , Xiong Juan , Chen Yong-yi , Fan Fan , Zhu Jing , Wu Wan-ying , Deng Xue-ying , Yu Yan-pin , Xu Xiao-hong , Chen Wen-hu , Zhu Tao , Yu Yang , Liu Kai-zhong , Shao Guo-liang , Chen Ming , Yu En-yan
Published: August 2020

Background: Due to the increased risk of viral infection and the severe shortage of medical resources during the pandemic of COVID-19, most hospitals in the epidemic areas significantly reduced non-emergency admissions and services, if not closed. As a result, it has been difficult to treat cancer patients on time, which adversely affects their prognosis. To address this problem, cancer centers must develop a strategic plan to manage both inpatients and outpatients during the pandemic, provide them with the necessary treatment, and at the same time prevent the spread of the virus among patients, visitors and medical staff. Methods: Based upon the epidemic situation in Zhejiang Province, China, the number of running non-emergency medical wards in the Zhejiang Cancer Hospital was gradually increased in a controlled manner. All staff of the hospital received COVID-19 preventive training and was provided with three different levels of protection according to the risks of their services. Only patients without a known history of SARS-CoV-2 contact were eligible to schedule an appointment. Body temperature was measured on all patients upon their arrival at the hospital. Chest CT image, blood cell counting and travel/contact history were investigated in patients with fever. Respiratory tract samples, such as sputum and throat swabs, from all patients, including those clinically suspected of SARS-CoV-2 infection, were collected for nucleic acid detection of SARS-CoV-2 before treatment.Results: A total of 3697 inpatients and 416 outpatients seeking cancer treatment were enrolled from February 1 to April 3, 2020, in compliance with the hospital’s infection-control interventions. The clinicopathological parameters of the patients were summarized herein. 4237 samples from 4101 patients produced negative RNA testing results. Four clinically suspected patients all presented negative RNA test results and were excluded from the SARS-CoV-2 infection through follow-up retesting and monitoring. Seven patients with only N-gene positive results were retested, followed by CT scan and SARS-CoV-2 contact history investigation. All of them were finally diagnosed as non-infected patients. There was one outpatient who was confirmed positive by virus RNA test and then followed up. She might be an asymptomatic laboratory-confirmed case. During the study period, there was no SARS-CoV-2 infection among staff, patients and escorts of patients in the Zhejiang Cancer Hospital.Conclusion: This study suggested our infection-control interventions, including viral nucleic acid test, could be used as a reliable method to screen cancer patients in the area with moderate COVID-19 prevalence. Cancer may not be a high-risk factor of SARS-CoV-2 infection.
Risk conditions in children hospitalized with influenza in Norway, 2017-2019
Authors: Hauge Siri Helene , Bakken Inger Johanne , de Blasio Birgitte Freiesleben , Håberg Siri Eldevik
Published: August 2020

Background Norwegian children are more frequently hospitalized with influenza than adults. Little is known about the characteristics of these children. Our aim was to investigate the presence of pre-existing risk conditions and to determine the duration of influenza hospitalizations in children during two influenza seasons. Methods The Norwegian Patient Registry holds data on all hospitalized patients in Norway. We included all patients younger than 18 years hospitalized with a diagnosis of influenza during the influenza seasons 2017-18 and 2018-19. Pre-existing risk conditions for influenza were identified by ICD-10 diagnoses in the Norwegian Patient Registry. In addition, information on asthma diagnoses were also retrieved from the Norwegian Registry for Primary Health Care. To estimate the prevalence of risk conditions in the child population, we obtained diagnoses on all Norwegian children in a two-year period prior to each influenza season. We calculated age-specific rates for hospitalization and risk for being hospitalized with influenza in children with risk conditions. Results In total, 1013 children were hospitalized with influenza during the two influenza seasons. Children younger than 6 months had the highest rate of hospitalization, accounting for 13.5% of all admissions (137 children). Hospitalization rates decreased with increasing age. Among children hospitalized with influenza, 25% had one or more pre-existing risk conditions for severe influenza, compared to 5% in the general population under 18 years. Having one or more risk conditions significantly increased the risk of hospitalization, (Odds Ratio (OR) 6.1, 95% confidence interval (CI) 5.0-7.4 in the 2017-18 season, and OR 6.8, 95% CI 5.4-8.4 in the 2018-19 season). Immunocompromised children and children with epilepsy had the highest risk of hospitalization with influenza, followed by children with heart disease and lung disease. The average length of stay in hospital were 4.6 days, and this did not differ with age. Conclusion Children with pre-existing risk conditions for influenza had a higher risk of hospitalization for influenza. However, most children (75%) admitted to hospital with influenza in Norway during 2017-2019 did not have pre-existing risk conditions. Influenza vaccination should be promoted in particular for children with risk conditions and pregnant women to protect new-borns.
Refractory Chronic Urticaria in Adults: Clinical Characterization and Predictors of Severity
Authors: Coutinho Iolanda Alen , Regateiro Frederico Soares , Fernandes Rosa Anita , Pita Joana Sofia , Gomes Raquel , Coelho Constança , Todo-Bom Ana
Published: August 2020

Background: Chronic urticaria (CU) is defined as recurrent urticaria lasting for more than 6 weeks. Objectives: We aimed to characterize the phenotypes of patients with CU refractory to standard dose anti-H1 antihistamine treatment and search for clinical predictors of poor disease control.Methods: Retrospective collection of data regarding clinical characteristics, manifestations, comorbidities, treatment, and disease control of all adult refractory CU patients presenting to the Allergy and Immunology Department during one year. Descriptive and inferential analysis was performed to search for factors associated with disease control. Results: Sixty-one adult patients were included, 74% females, average age 44.5 years (18 to 84 years old). Most patients (78.7%) had initiated CU less than 1 year before enrolment. Chronic spontaneous urticaria (CSU) accounted for 55.7% of the patients and chronic inducible urticaria (ClndU) for 44.3%. Angioedema was present in 55.7% of the patients. Evidence for autoimmunity (positive anti-thyroid peroxidase antibodies, anti-nuclear antibodies or autologous serum test) was found in 45.2% (n=19) of 42 tested patients. High C-reactive protein was presenti in 14.3% (n=6) of 42 patients evaluated; half of these also had positive antinuclear antibodies. Forty-six patients (75.4%) had at least one significant exacerbation, requiring medical appointment, emergency room, hospitalization or job absenteeism. The number of exacerbations correlated with the presence of angioedema (p=0.022), with a recent diagnosis (<1 year), and with higher UAS7 severity (p=0.006). ClndU associated with poor symptom control (p=0.022) but had less exacerbations requiring medical observation or hospitalization (p=0.015). Conclusions: About half of the patients with CU presented autoimmunity. UAS7 severity and Angioedema are associated with disease exacebations. UAS7 and UCT presented unequal accuracy, with UAS7 better associating with the occurrence of exacerbations and treatment dosis. Accurate diagnostic tests, namely autoimmune parameters and inflammatory markers, should be recommended in some individual cases.
β-cell function in black South African women: Associations with insulin clearance and ectopic fat
Authors: Smidt Melony Cathlin Fortuin-de , Mendham Amy E , Hauksson Jon , Alhamud Ali , Stefanovski Darko , Hakim Olah , Swart Jeroen , Goff Louise M , Kahn Steven E , Olsson Tommy , Goedecke Julia H
Published: August 2020

Background: The role of ectopic fat, insulin secretion and clearance in the preservation of β-cell function in black African women with obesity who typically present with hyperinsulinemia is not clear. We aim to examine the associations between disposition index (DI, an estimate of β-cell function), insulin secretion and clearance and ectopic fat deposition.Methods: This is a cross-sectional study of 43 black South African women (age 20-35 years) with obesity (BMI 30-40 kg/m2) and without type 2 diabetes that measured the following: DI, insulin sensitivity (SI), acute insulin response (AIRg), insulin secretion rate (ISR), hepatic insulin extraction and peripheral insulin clearance (frequently-sampled intravenous glucose tolerance test); pancreatic and hepatic fat, visceral adipose tissue (VAT) and abdominal subcutaneous adipose tissue (aSAT) volume (magnetic resonance imaging), intramyocellular (IMCL) and extramyocellular fat content (EMCL) (magnetic resonance spectroscopy). Results: DI correlated positively with peripheral insulin clearance before (β 55.80, p=0.002) and after adjusting for hepatic insulin extraction. Higher DI was associated with lower VAT, pancreatic fat and soleus fat, but VAT explained most of the variance in DI (32%). Additionally, higher first phase ISR (p=0.033) and lower hepatic insulin extraction (p=0.022) associated with lower VAT, independent from SI, rather than with ectopic fat. Conclusion: Peripheral insulin clearance emerged as an important correlate of DI, independent from hepatic insulin extraction. However, VAT was the main determinant of a lower DI above ectopic fat depots. Importantly, VAT, but not ectopic fat, was associated with both lower insulin secretion and higher hepatic insulin extraction, independent from SI, and may provide a novel explanation of these findings in black South African women with obesity.
Evaluating the Efficacy and Safety of the Myrtle (Myrtus Communis) in Treatment and Prognosis of Patients Suspected to Novel Coronavirus (COVID-19) Pneumonia: Study Protocol for a Randomized Controlled Trial
Authors: Azimi Maryam , Hasheminasab Fatemeh Sadat
Published: August 2020

Background: Since December 2019, the outbreak of corona virus pneumonia was observed in China and quickly propagate in all of the world. Nowadays many trials are underway on this disease in which the efficacy of various therapeutic remedies including chemical or natural agents as well as different non pharmacological methods such as acupuncture are evaluated. This study aim at investigating the effect of myrtle fruit for treatment of COVID-19 disease.Methods: We are performing a randomized controlled trial on outpatients clinically suspected to COVID-19 disease in the age range of 18-65 years old with mild to moderate symptoms and without respiratory distress. Patients in both groups (myrtle and control) receive conventional therapy, but those in myrtle group get myrtle preparation in addition to conventional therapy. Intervention will continue for 5 days and the study outcomes including clinical statues as well as mortality rate and adverse effects will be measured up to 14 days.Discussion: The protocol describes the design of an ongoing randomized controlled trial to establish the evidence for the usage of water extract of myrtle fruit in clinically suspected COVID-19 disease and identify any safety concerns.Trial registration: The trial has been registered at the Iranian Registry of Clinical Trials website under the code IRCT20180923041093N3 on March 28th, 2020 (https://www.irct.ir/trial/46721). The results will be disseminated through manuscript publications, and presentations to scientific meetings.
Long noncoding RNA LPP-AS2 promotes glioma tumorigenesis via miR-7-5p/EGFR/PI3K/AKT/c-MYC feedback loop
Authors: Zhang Xiaoming , Niu Wanxiang , Mu Maolin , Hu Shanshan , Niu Chaoshi
Published: August 2020

Background: Glioblastoma is the most common primary malignant intracranial tumor with poor clinical prognosis in adults. Accumulating evidence indicates that long non-coding RNAs (lncRNAs) function as important regulators in cancer progression, including glioblastoma. Here, we identified a new lncRNA LPP antisense RNA-2 (LPP-AS2) and investigated its function and mechanism in the development of glioma.Methods: High-throughput RNA sequencing was performed to discriminate differentially expressed lncRNAs and mRNAs between glioma tissues and normal brain tissues. Expression of LPP-AS2, epidermal growth factor receptor (EGFR) and miR-7-5p in glioma tissues and cell lines was detected by real-time quantitative PCR (RT-qPCR), and the functions of lncRNA LPP-AS2 in glioma were assessed by in vivo and in vitro assays. Insight into the underlying mechanism of competitive endogenous RNAs (ceRNAs) was obtained via bioinformatic analysis, dual luciferase reporter assays, RNA pulldown assays, RNA immunoprecipitation (RIP) and rescue experiments. Results: The results of high-throughput RNA-seq indicated lncRNA LPP-AS2 was upregulated in glioma tissues and further confirmed by RT-qPCR. Higher LPP-AS2 expression was related to a poor prognosis in glioma patients. Based on functional studies, LPP-AS2 depletion inhibited glioma cell proliferation, invasion and promoted apoptosis in vitro and restrained tumor growth in vivo, overexpression of LPP-AS2 resulted in the opposite effects. In addition, LPP-AS2 and EGFR were observed in co-expression networks. LPP-AS2 was found to function as a ceRNA to regulate EGFR expression by sponging miR-7-5p in glioma cells. The result of chromatin immunoprecipitation (ChIP) assays validated that c-MYC binds directly to the promoter region of LPP-AS2. As a downstream protein of EGFR, c-MYC was modulated by LPP-AS2 and in turn enhanced LPP-AS2 expression. Thus, lncRNA LPP-AS2 promoted glioma tumorigenesis via a miR-7-5p/EGFR/PI3K/AKT/c-MYC feedback loop.Conclusions: Our study elucidated that LPP-AS2 acted as an oncogene through a novel molecular pathway in glioma and might be a potential therapeutic approach for glioma diagnosis, therapy and prognosis.
Racial and Ethnic Disparities in Covid-19 Illness Severity Accounting for Concomitant Comorbidities: A Cohort Study
Authors: Ji Hongwei , Achamallah Natalie , Sun Nancy , Botting Patrick , Chen Peter , Cheng Susan , Ebinger Joseph
Published: August 2020

Background Multiple reports have highlighted important racial and ethnic differences in the degree to which Americans may be vulnerable to severe forms of Covid-19 illness. Whether or not racial or ethnic disparities are related to variations in the underlying burden of comorbidities or other predisposing factors remains unclear.Methods We identified patients diagnosed with Covid-19, based on a positive PCR for SARS-CoV-2, from the electronic health record of a large multi-hospital system located in Southern California. We developed an illness severity score, based on the level of care each patient required (not admitted to the hospital; required hospital admission but never required intensive care; required intensive level care but never intubation; and, required intubation during hospitalization) and assessed for associations with clinical and demographic factors for each patient using ordinal logistic regression.Results A total of 571 patients with Covid-19 were identified a majority of whom were male (56%), with a mean age of 55±21 years. There were 81 (14%) patient who identified as African American, and 101 (18%) as Hispanic. A total of 202 (36%) patients required hospitalization without need for intensive care, 43 (8%) required intensive care without intubation, and 64 (11%) required intubation while also receiving intensive care. Of the total sample, African American race (OR 2.33, 95% CI 1.44-3.78, P=0.001) and Hispanic ethnicity (OR 1.97, 95% CI 1.14-3.12, P=0.004) were associated with greater illness severity.Conclusions Racial and ethnic disparities in the severity of Covid-19 illness persist, even when controlling for baseline comorbidities. It remains unclear if these differences are related to variations in physiologic response to SARS-CoV-2, differential timing of presentation or disparities in care.
Diagnostic precision and identification of rare diseases is dependent on distance of residence relative to tertiary medical facilities
Authors: Walter Anna-Lena , Baty Florent , Rassouli Frank , Bilz Stefan , Brutsche Martin Hugo
Published: August 2020

Background: Diagnostic precision and the identification of rare diseases (RDs) is a daily challenge, which needs specialized expertise. We hypothesized, that there is a correlation between the distance of residence to the next tertiary medical facility with specialized care and the diagnostic precision, especially for rare diseases.Results: We found a negative association between diagnostic diversity and travel time to the next tertiary hospital when including all cases throughout the overall International Classification of Diseases version 10 German Modification (ICD-10-GM) diagnosis codes. This was paralleled with a negative association of standardized incidence rates in all groups of rare diseases except for rare teratologic and rare allergic diseases.Conclusion: Our findings indicate a higher risk of being mis-, under- or late diagnosed especially in rare diseases when living more distant to a tertiary medical facility. Greater distance to the next tertiary medical facility basically increases the chance for hospitalization in a non-comprehensive regional hospital with less diagnostic capacity, and, thus, impacts on adapted health care access. Therefore, solutions for overcoming the distance to specialized care as an indicator of health care access are a major goal in the future.
Association of the genetic variants in the Endoplasmic reticulum aminopeptidase 2 gene with ankylosing spondylitis susceptibility
Authors: Ebrazeh Mehrdad , Ezzatifar Fatemeh , Torkamandi Shahram , Mohammadi Fatemeh Sadat , Salimifard Sevda , Hemmatzadeh Maryam , Aslani Saeed , Babaie Farhad , Azizi Gholamreza , Jadidi-Niaragh Farhad , Gowhari-Shabgah Arezoo , Mohammadi Hamed
Published: August 2020

Background: Genetic polymorphisms in the Endoplasmic reticulum aminopeptidase (ERAP) 2 gene has been attributed with the Ankylosing spondylitis (AS) etiopathogenesis. Here we assessed the association of ERAP2 gene single nucleotide polymorphisms (SNPs) with AS predisposition in Iranian patients and determined their effect on the inflammatory state of the patients.Methods: For genotyping of rs2548538, rs2287988, and rs17408150 SNPs using Real-time allelic discrimination approach, DNA was extracted from the whole blood of 250 AS patients and 250 healthy subjects. RNA of the peripheral blood mononuclear cells (PBMCs) was separated, cDNA was synthesized, and transcriptional levels of cytokines, including interleukin (IL)-17A, IL-23, IL-10, and transforming growth factor (TGF)-β were measured. Enzyme-linked immunosorbent assay (ELISA) was used to measure the serum concentration on the cytokines.Results: Three ERAP2 gene SNPs were not associated significantly with AS risk. Nonetheless, rs2287988 and rs17408150 SNPs showed statistically significant association with susceptibility to the disease in those AS subjects who were positive to Human leukocyte antigen (HLA)-B27. Transcriptional level and serum concentration of IL-17A and IL-23 were higher, while those of IL-10 were lower in both AS patients and HLA-B27 positive patient group relative to control group. Nevertheless, ERAP2 gene SNPs in the HLA-B27 positive AS patients did not affect the transcriptional level and serum concentration of cytokines.Conclusions: ERAP2 gene rs2287988 and rs17408150 SNP are associated with susceptibility to AS, but they probably are not determining the levels of IL-17A, IL-23, and IL-10 in this disease.
Community Health Nursing Competency and Psychological and Organizational Empowerment of Public Health Nurses in Taiwan: A Cross-Sectional Survey
Authors: Kuo Ching-Pyng , Hsiao Yu-Ling , Chen Hsiao-Mei , Yang Shang-Yu , Hsieh Pei-Lun
Published: August 2020

Background: This study explored the effect of public health nurses’ current community care nursing competency on the psychological and organizational empowerment of public health services in Taiwan.Method: A cross-sectional survey design and a self-developed structured questionnaire were administered to Taiwanese public health nurses, recruited using a purposive sampling technique, who participated in community health care workshops offered by Ministry of Health and Welfare in 2019.Results: The majority of subjects were aged between 40 and 49 years and reported working in public health for over 10 years. Furthermore, 89.30% of the subjects worked in a Public Health Center. The mean score of Community Care Nursing Competence (CCNC) was 3.92 ± 0.83 (measured using a five-point Likert scale). The mean score in Community Empowerment (CE) was 3.66 ± 0.90, between “Neutral” and “Agree.” The CCNC was positively correlated with the workplace. The CE was positively correlated with age. The CCNC was positively correlated with psychological and organizational empowerment. The stepwise regression revealed that age (B = 0.18, p = .021) and communication competence (B = 0.17, p = .002) positively predicted community empowerment. Conclusions: The study revealed that age and communication competence were crucial factors in public health nurses working in the community. With age and through the accumulation of practical experience, Taiwanese public health nurses’ communication competence may also improve, which can further enhance their psychological and organizational empowerment in the nursing workplace.
ALG3 Contributes to the Malignant Biological Properties of Oral Squamous Cell Carcinoma Cells Through Regulating CDK-Cyclin Pathway
Authors: Shao Peihong , Wei Chengshi , Wang Yun
Published: August 2020

Background: In this study, we planned to investigate the function and potential mechanisms of Alpha-1,3-mannosyltransferase (ALG3) in oral squamous cell carcinoma (OSCC). Methods: Data from The Cancer Genome Atlas (TCGA) was used to analyze ALG3 expression and its effect on the prognosis of patients with OSCC. Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis was applied to explore the signaling pathways related to ALG3. In OSCC cells, ALG3 expression was measured by qPCR and western blot. Cell counting kit-8, colony formation, and transwell assays were implemented to detect the effects of ALG3 on the malignant biological properties OSCC cells. The expression of key proteins related to CDK-Cyclin pathway was detected by western blot. Results: The expression of ALG3 in OSCC samples was higher than that of the control samples, and the increase of ALG3 expression was related to unfavorable prognosis of OSCC patients. Additionally, the elevated expression of ALG3 was associated with pathological stage, lymph node metastasis and primary lesion in OSCC patients. ALG3 depletion blocked the growth, colony formation, invasion and migration of OSCC cells, while over-expression ALG3 reversed these phenomena. Moreover, exhaustion of ALG3 resulted in decreased expression of MCM7, CCNB2, CDK1 and PCNA, while these phenomena were inversed after ALG3 up-regulation. Conclusions: The enhancement of ALG3 expression promoted the aggressive biological behaviors of OSCC cells probably by promoting CDK-Cyclin pathway.
Association between polypharmacy and the persistence of delirium: a retrospective cohort study
Authors: Kurisu Ken , Miyabe Daisuke , Furukawa Yoshiko , Shibayama Osamu , Yoshiuchi Kazuhiro
Published: August 2020

Background: Although the association between polypharmacy and the occurrence of delirium has been well studied, the influence of polypharmacy on the persistence of delirium remains unclear. We aimed to explore the effect of polypharmacy on the persistence of delirium.Methods: This retrospective cohort study was conducted at a tertiary hospital. The medical records of patients diagnosed with delirium who were referred to the Department of Psychosomatic Medicine were reviewed. Presentation with delirium on day 3 was set as the outcome in this study. We counted the number of drugs prescribed on the date of referral, excluding general infusion fluids, nutritional or electrolytic products, and psychotropics. To define polypharmacy, we developed a classification and regression tree (CART) model and drew a receiver operating characteristic (ROC) curve. The odds ratio (OR) of polypharmacy for the persistence of delirium on day 3 was calculated using a logistic regression model with the propensity score as a covariate.Results: We reviewed the data of 113 patients. The CART model and ROC curve indicated an optimal polypharmacy cutoff of six drugs. Polypharmacy was significantly associated with the persistence of delirium both before [OR, 3.02; 95% confidence interval (CI), 1.39–6.81; P = 0.0062] and after (OR, 3.19; 95% CI, 1.32–8.03; P = 0.011) propensity score adjustment.Conclusion: We discovered an association between polypharmacy and worsening courses of delirium and hypothesized that polypharmacy might be a prognostic factor for delirium.
Perspiration During Exercise in Patients With Stable Chronic Obstructive Pulmonary Disease
Authors: Li Zheng , Zhang Yanxin , Wang Jing , Xu Dan , Jing Jing , Jiang Min , Li Fengsen
Published: August 2020

Background: Chronic obstructive pulmonary disease (COPD) is a common progressive respiratory condition. Chills in the back region with excessive sweating are common symptoms in COPD patients. The aim of our study was to identify factors associated with increased rates of perspiration in COPD patients.Methods: We performed a prospective cohort study over the course of one year by recruiting 120 COPD patients and 32 healthy controls. All patients underwent pulmonary function testing (PFT) and cardiopulmonary exercise testing (CPET). The rate of perspiration was determined during CPET through sweat collection. The relationship between perspiration rate and multiple clinical and physiologic variables was explored through correlative analyses. Logistic regression analysis was used to reveal the multifactorial influence on the risk of acute COPD exacerbations.Results: Results showed that COPD patients were found to have a higher rate of perspiration during CPET than healthy individuals. We observed a direct relationship between perspiration rate and clinical measures of disease severity such as air flow limitations and the number of acute COPD exacerbations. The rate of perspiration was also found to be correlated with several clinical (i.e. number of hospitalizations) as well as physiologic variables (i.e. PFT and CPET parameters). Lastly, we generated a logistic regression model which predicted the likelihood of acute COPD exacerbations with an accuracy of 87.4%. Thus, elevated perspiration rates during exercise are observed in COPD patients, which is also directly correlated with the degree of dyspnea and disease progression.Conclusions: perspiration may be used as a biomarker for disease state with prognostic value.
Establishment of a Nomogram for Predicting the Surgical Difficulty of Anterior Cervical Spine Surgery
Authors: Ji Chengyue , Rong Yuluo , Wang Jiaxing , Yin Guoyong , Fan Jin , Tang Pengyu , Jiang Dongdong , Liu Wei , Ge Xuhui , Yu Shunzhi , Cai Weihua
Published: August 2020

BackgroundFor a long time, surgical difficulty is mainly evaluated based on subjective perception rather than objective indexes. Moreover, the lack of systematic research regarding the evaluation of surgical difficulty potentially has a negative effect in this field. This study was aimed to evaluate the risk factors for the surgical difficulty of anterior cervical spine surgery (ACSS).MethodsThis was a retrospective cohort study totaling 291 consecutive patients underwent ACSS from 2012.3 to 2017.8. The surgical difficulty of ACSS was defined by operation time longer than 120 min or intraoperative blood loss equal to or greater than 200ml. Evaluation of risk factors was performed by analyzing the patient’s medical records and radiological parameters such as age, sex, BMI, operation level, high signal intensity on T2-weighted images, ossified posterior longitudinal ligament (OPLL), sagittal and coronal cervical circumference, cervical length, spinal canal occupational ratio, coagulation function index and platelet count.ResultsSignificant differences were reported between low-difficulty and high-difficulty ACSS groups in terms of age (p=0.017), sex (p=0.006), operation level (p<0.001), high signal intensity (p<0.001), OPLL (p<0.001) and spinal canal occupational ratio (p<0.001). Multivariate logistic regression analysis revealed that operation level (OR=5.224, 95%CI=2.125-12.843, p<0.001), high signal intensity (OR=4.994, 95%CI=1.636-15.245, p=0.005), OPLL (OR=6.358, 95%CI=1.932-20.931, p=0.002) and the spinal canal occupational ratio>0.45 (OR=3.988, 95%CI=1.343-11.840, p=0.013) were independently associated with surgical difficulty in ACSS. A nomogram was established and ROC curve gave a 0.906 C-index. There was a good calibration curve for difficulty estimation.ConclusionThis study indicated that the operational level, OPLL, high signal intensity, and spinal canal occupational ratio were independently associated with surgical difficulty and a predictive nomogram can be established using the identified risk factors. Optimal performance was achieved for predicting surgical difficulty of ACSS based on preoperative factors.
Harm Reduction Service Utilization Among People Who Inject Drugs in Tajikistan: Prevalence and Precipitating Factors
Authors: Tate Mary M. , Bromberg Daniel J. , Alaei Kamiar , Karimov Saifuddin , Saidi Dilshod , Alaei Arash
Published: August 2020

Tajikistan is in a unique geopolitical location along the global heroin trade route, exacerbating its own opioid use disorder and HIV epidemics. With one of the highest rates of opioid use disorder in the world, and 20,000-30,000 people who inject drugs in the country, Tajikistan’s government and international actors have provided harm reduction measures for people who use drugs, like narcology centers, needle and syringe programs, and methadone maintenance therapy. No implementation science studies have been conducted in Tajikistan and the current implementation gaps in service uptake are unknown. The purpose of this paper is to determine the prevalence of harm reduction service uptake among people who use drugs in Tajikistan, and determine which factors are associated with service uptake.
Methods
This paper uses data from the National AIDS Registry, subset to patients who use drugs (n=11,029) and cross-sectional data from a bio-behavioral survey conducted in 2017 (n=2,390). Univariate and multivariate logistic regression were used to assess associations between study variables and probably of uptake of narcology center registration, uptake of needle and syringe programs, and registration into methadone maintenance therapy.
Results
Fewer than half of all people who inject drugs (42.4%) were registered with the narcology center , most people who inject drugs (88.6%) reported always having access to clean syringes, and only 5.3% of PWID had ever engaged in methadone treatment in Tajikistan. There were ethnic differences in service uptake – with ethnic Russians and Uzbeks less likely to use services than ethnic Tajiks. Men who have sex with men and people living with HIV were also more likely to access services than heterosexual or seronegative individuals.
Conclusion
Narcology center registration and clean needle coverage are high in Tajikistan. Methadone maintenance therapy uptake, however, is low, like in other countries in Eastern Europe and Central Asia. NGO and government initiatives that target risk groups (like LGBTQ+ people and people living with HIV) seem to have been somewhat effective at recruiting their clientele into services. Future research might focus on the “positive deviancy” of these subgroups of people who use drugs to learn how to increase service uptake generally.
The Function of Siberian Fir In The Formation Of Forest Phytocoenoses In The Floodplain Landscapes of North-Eastern European Russia
Authors: Gerling Natalya , Tarasov Sergey
Published: August 2020

Background The peculiarity of Siberian fir ( Abies sibirica Ledeb.) growth in the territory of the North-East of the European part of Russia is that its habitats are confined to certain types of landscapes, namely floodplains of streams and rivers, slopes, and watersheds. In the structure of plant communities formed in such areas, fir is generally the predominant species. The purpose of this study is to find out causes why fir tree have been successful in colonizing specific types of landscapes. The study was conducted in the Komi Republic, Russia. The objects of the study were chosen two forest phytocoenoses with fir dominance, one of which grows on a slope and the other — on a floodplain terrace. A comparative analysis of the complex of factors determining the growth and development of these forest communities was made.Results Orographic conditions have been recognized as the main factor determining the species structure of phytocoenoses in the considered landscape types. The relief features of the areas where the forest stands under consideration are located contribute to the development of periodic water flows that have a significant impact on the species structure formation. Comparison of morphological and phenological features of the main forest-forming species of the Komi Republic has shown that the fir has a number of advantages contributing to its success under the conditions of a specific hydrological regime. Conclusions The formation of spatial patterns with Siberian fir dominating on slopes and floodplains is a consequence of fir adaptability to the influence of periodic water flow due to the relief features.
The high climate costs of animal-based foods
Authors: Errickson Frank , Kuruc Kevin , McFadden Jonathan
Published: August 2020

Despite mounting evidence that reductions in agricultural emissions must be part of the global climate agenda, the economic benefits of such reductions have not yet been quantified in a manner appropriate for rigorous cost-benefit analyses. Here we couple the global agricultural and industrial economies in a leading macroeconomic-climate model to quantify the climate costs of animal-based foods along several dimensions. Under representative temperature targets, a transition to veganism alleviates necessary reductions of industrial emissions by 25 percent. Under a business-as-usual pathway, standard diets high in animal protein contribute nearly $100 per person, per year in climate damages; about two-thirds of the damages from the average passenger vehicle in the United States. At the product level, the true cost of a serving of beef is 62% more than producers now face. Disaggregating to the regional level, we highlight where food policy could provide the highest social return.
Plastome Structure and Phylogenetic Relationships of Styracaceae (Ericales)
Authors: Wang Hua-Feng , Cai Xiu-lian , Landis Jacob B. , Wang Hong-Xin , Wang Jian-Hua , Zhu Zhi-Xin
Published: August 2020

Background: The Styracaceae are a woody, dicotyledonous family containing 12 genera and an estimated 160 species. Recent studies have shown that Styrax is monophyletic, Alniphyllum and Bruinsmia cluster into a clade with an approximately 20-kb inversion in the LSC. Halesia and Pterostyrax are not supported as monophyletic, while Melliodendron and Changiostyrax always from a clade sister to the rest of the family. However, the phylogenetic relationship of Styracaceae at the level of genera remains ambiguous. Results: We collected 28 complete plastomes of Styracaceae, including 12 sequences newly reported here and 16 publicly available complete plastome sequences, comprising 11 of the 12 genera of Styracaceae. All species possessed the typical quadripartite structure of angiosperm plastomes, and the sequence difference is small, except for the large 20-kb (14 genes) inversion region found in Alniphyllum and Bruinsmia . Seven coding sequences ( rps4 , rpl23 , accD , rpoC1 , psaA , rpoA and ndhH ) were identified to possess positively selected sites. Phylogenetic reconstructions based on seven data sets (i.e., LSC, SSC, IR, Coding, Non-coding, combination of LSC+SSC and concatenation of LSC+SSC+one IR) produced similar topologies and most relationships are consistent with previous findings. In our study, Pterostyrax was strongly supported as monophyletic; Melliodendron and Changiostyrax as successively sister to the rest of the family. Conclusion: Our results clearly indicate that Pterostyrax is monophyletic, and the establishment of Perkinsiodendron and Changiostyrax are supported. A 20-kb reverse sequence was found in the newly published sequence of Alniphyllum fortunei , which confirmed the existence of large inversion sequence in Alniphyllum and Bruinsmia .
A Novel Essential Protein Identification Method Based on PPI Networks and Gene Expression Data
Authors: Zhong Jiancheng , Tang Chao , Peng Wei , Xie Minzhu , Sun Yusui , Tang Qiang , Xiao Qiu , Yang Jiahong
Published: August 2020

Background: Some proposed methods for identifying essential proteins have better results by using biological information. Gene expression data is generally used to identify essential proteins. However, gene expression data is prone to fluctuations, which may affect the accuracy of essential protein identification. Therefore, we propose an essential protein identification method to calculate the similarity of "active" and "inactive" state of gene expression in a cluster of the PPI network based on gene expression and the PPI network data. Our experiments show that our method can improve the accuracy in predicting essential proteins. Results: In this paper, we propose a new measure, named JDC, based on the PPI network data and gene expression data. The JDC method offers a dynamic threshold method to binarize gene expression data. After that, it combines the degree centrality and Jaccard similarity index to calculate the JDC score for each protein in the PPI network. We respectively perform experiments on Yeast data and E.coli data and evaluate our method by using ROC analysis, modular analysis, jackknife analysis, overlapping analysis, top analysis, and accuracy analysis. The results show that the performance of JDC is better than DC, IC, EC, SC, BC, CC, NC, PeC, and WDC. We compare JDC with both NF-PIN and TS-PIN methods, which predict essential proteins from active PPI networks constructed with dynamic gene expression. Conclusions: We demonstrate that the new centrality measure, JDC, is more efficient than state-of-the-art prediction methods. The main ideas behind JDC are as follows: (1) Essential proteins are generally densely connected clusters in the PPI network . (2) Binarizing gene expression data can screen out fluctuations in gene expression profiles. (3) The essentiality of the protein depends on the similarity of "active" and "inactive" state of gene expression in a cluster of the PPI network.
Hospital resilience after the 2015 earthquake in Nepal: results from semi-structured interviews with hospital staff
Authors: Almeida Maria Moitinho de , Loenhout Joris Adriaan Frank van , Thapa Sunil Singh , Kumar KC , Mahara Deepak Prakash , Guha-Sapir Debarati , Aujoulat Isabelle
Published: August 2020

Background “Safe and resilient hospitals” are increasingly recognized as a cornerstone of disaster reduction in global policies such as the Sendai Framework for Action. However, current hospital resilience frameworks emerged from pre-disaster conceptualizations, and have not been verified in real-life disaster contexts nor in the frontlines. Our aim was to study a tertiary hospital’s resilience after the 2015 earthquake in Nepal, as experienced by its staff. Methods We undertook a qualitative study in the Tribhuvan University Teaching Hospital (TUTH), where we conducted 18 semi-structured interviews with hospital staff. We inductively created themes to describe the earthquake burden to the hospital, and to analyze individual resilience of hospital staff. In addition, we deductively documented the resilience of the hospital as a system, according to the system resilience dimensions: means of resilience (redundancy and resourcefulness), and ends of resilience (robustness and rapidity).Results TUTH faced material challenges, as well as challenges to healthcare provision, to management and coordination, and to hospital staff. In terms of robustness, TUTH increased its capacity for earthquake victims as elective activities were temporarily interrupted and quality of care was not a priority. Three stages of rapidity were identified: critical rapidity to address immediate needs, stabilizing rapidity until the hospital re-started routine activities, and recovery rapidity. In addition to the disaster plan, emerging adaptations played a major role in redundancy and resourcefulness. We found that individual resilience depended on three determinants: safety, meaningfulness, and sense of belonging.Conclusions Hospital resilience results from a complexity of emerging and planned adaptations, as well as from interdependencies with individual resilience. Ensuring workforce safety and sense of meaning directly contributes to hospital systems-level resilience. Hospitals should establish and test disaster plans and strategies to alter standards of care, while being flexible to emerging adaptations.
Rapid Epidemiological Appraisal of Spatial Distribution of Animal Bite Injury Cases and Rabies Post Exposure Prophylaxis in Kisumu County, Kenya
Authors: Peter Omemo , Wasonga Job , Omollo Morvan , Adhiambo Joy , Yeda Redemptah
Published: August 2020

Background Animal bites in humans provide an important source of epidemiological information which is crucial in enhancing rabies surveillance in humans and animals. Rabies post exposure prophylaxis consumes substantial resources and exerts a lot of financial burden on animal bite injury victims and consumes resources and time. The overall objective of this study was to conduct a rapid epidemiological appraisal of animal bite injury and rabies post exposure prophylaxis in Kisumu County, Kenya.Methods A retrospective cross-sectional study was conducted in 32 administrative units (Sub-locations or wards) in Kisumu County, Kenya. Data was collected from outpatient department (OPD) registers in four peri-urban health centres in Kisumu East Sub County, Kenya. An integration of epidemiological tools for disease mapping was applied in the study. Quantum Geographic Information System was used to create a thematic map and spatial distribution of the animal bite injuries in Kisumu County.Results There were 133 (63%) males and 78(37%) female cases. The range in age was 11 – 40 years. The cases were highest among 11-17 years age group. Among the cases were 14( 6.6% ) children less than 10 years , 63(29.9% ) were of age group between 11-17 years, 49(23.2%) were in the age group between 18-24 years, 41(19.4%) were in the age bracket between 25-31 years, 24 (11.4%) were between 32 and 38 years, while 20(9.5%) were 38 years and above. Majority, (87.2 %) of the animal bite injuries were inflicted by domestic dogs. Wild dogs/stray dogs contributed 8.1% of the total number of animal bite injury cases. Cats and unknown animals contributed 1.4% and 3.3 respectively. The epidemiological curve shows that more than one case of animal bite injury occurred daily in Kisumu County between June and December, 2019 with the highest daily figure being 7. The study revealed the need to strengthen animal bite injury and rabies prevention and control strategies in Kisumu County.Conclusion