bluuebunny/crossref_metadata_2025 huggingface dataset:
Prehospital Handling of Postpartum Haemorrhage- Healthcare Personnel’s Experiences and Perspectives
Authors: Leonardsen Ann-Chatrin Linqvist , Helgesen Ann Karin , Ulvøy Linn Eik , Grøndahl Vigdis Abrahamsen
Published: December 2020

Background: Postpartum hemorrhage (PPH) is a serious obstetric emergency, and one of the top five causes of maternal mortality globally. The most common causes of PPH include uterine atony, placental disorders, birth trauma and coagulation defects. Timely diagnosis and early management are critical to reduce morbidity, the need for blood transfusion or even mortality. External, manual aortic compression (AC) has been suggested as an intervention that reduce PPH and extend time for control of bleeding or resuscitation. This procedure is not commonly utilized by healthcare personnel. The incidence of home-births is increasing, and competence in PPH handling is essential in prehospital personnel. The objective was to explore prehospital personnel’s competence in PPH and AC, utilizing different tools. Methods: The study was conducted in a county in South-eastern Norway, including five ambulance stations. All prehospital personnel (n=250) were invited to participate in a questionnaire study. The questionnaire included the PPH self-efficacy (PPHSE) and PPH collective efficacy (PPHCE) tools, as well as a developed tool. Descriptive statistics were used to analyse the quantitative data, while quantitative content analysis was used to analyse free-text responses. Results: A total of 87 prehospital personnel responded to the questionnaire, 57.5 percent male, mean age 37.9 years. 80.4 percent were ambulance workers and/or paramedics, and 96.6 and 97.7 percent respectively reported to need more education or training in PPH. Results show that prehospital personnel lack knowledge about what PPH is, how to estimate and handle PPH, and how to perform AC. 82.8 percent reported having experienced PPH, but only 2.9 percent had performed AC. Mean self-efficacy varied from 3.3 to 5.6, while collective efficacy varied from 1.9 to 3.8. Educational background did not seem to have any impact on participants’ responses. Conclusions and implications: This study indicates that prehospital personnel lack knowledge about PPH and AC, and also report to need more education and training. Hence, PPH should be included in educational programs at all levels of the education, as well as in quality improvement initiatives. After the conduction of this study, prehospital personnel attended a digital course in PPH, as well as a practical course in AC.
Regulatory Network Analysis Reveals Prognosis-Related CircRNAs in Pancreatic Cancer Cells
Authors: Zhang Heying , Zeng Juan , Li Yuexian , Sun Cheng , Zhou Yang , Tan Yonggang , Zou Huawei
Published: December 2020

Objective: To construct a key prognosis-related regulatory network and to identify the epigenomic alterations of RNAs that have crucial functions in cancer pathogenesis.Methods: RNA expression profiles of miRNAs, mRNAs and circRNAs were extracted from the NCBI GEO and EBI ArrayExpress databases. The identification of differentially expressed genes was performed by R language. Databases such as starBase and TCGA were used for annotation, visualization, and integrated discovery. GO and KEGG pathway enrichment analyses were performed by DAVID 6.8. The key prognosis-related regulatory network was constructed with Cytoscape software. The involved circRNAs were verified by quantitative real-time PCR (qRT-PCR) in five pancreatic cancer cell lines. Proliferation ability was assessed by the CCK-8 assay, apoptosis was detected by flow cytometry, and migratory and invasive abilities were assessed by Transwell assays.Results: In total, 798 differentially expressed genes, consisting of 85 circRNAs, 19 miRNAs and 694 mRNAs, were obtained. A miRNA interaction network was predicted and used to construct a prognosis-related regulatory network. GO annotation and KEGG pathway analysis revealed important biological processes and pathways in pancreatic cancers. The key regulatory factors in the network were miR-146b-5p and miR-152. Eight circRNAs included in the network were verified, and hsa_circ_0006502 was downregulated in the five tested pancreatic cancer cell lines and functioned as a tumor suppressor, as predicted.Conclusion: In conclusion, a key prognosis-related regulatory network in pancreatic cancers was constructed through bioinformatics analysis of public RNA databases, and miR-146b-5p and miR-152 were the key regulatory factors. Hsa_circ_0006502 was identified as a tumor suppressor that interacted closely with miR-146b-5p and might serve as a potential therapeutic agent.
Mechanical Zonation of Rock Properties and the Development of Hydrothermal Fluid Circulation Pathways: Implications for Enhanced Geothermal Systems
Authors: Kolawole Oladoyin , Ispas Ion , Kolawole Folarin , Germay Christophe , McLennan John D
Published: December 2020

Oil and gas operations in sedimentary basins have revealed significant temperatures at depth, raising the possibility of major geothermal resource potential in the sedimentary sequences. The efficient development of such a resource may require enhancement by hydraulic stimulation. However, effective stimulation relies on an initial assessment of in-situ mechanical properties and a Discrete Fracture Network (DFN) model of the rock response. Here, we examine the distribution of mechanical properties (unconfined compressive strength, UCS ; ultrasonic velocity-derived Poisson ratio, ν; and, scratch-derived fracture toughness, K s ) along the cored interval of a sedimentary formation with a known geothermal anomaly in the Permian Basin, U.S. Our results reveal the mechanical heterogeneity of the rock, demonstrated by four distinct alternating mechanical zones, which include: (1.) mechanically weaker 0.17 m-thick Zone-A and 0.18 m-thick Zone-C with mean UCS = 110 MPa, ν = 0.25, K s = 1.89 MPa·√m; and (2.) mechanically stronger 0.41 m-thick Zone-B and 0.15 m-thick Zone-D which show mean UCS = 166 MPa, ν = 0.22, and K s = 2.87 MPa·√m. Although X-ray Diffraction analyses of the samples suggest that the entire rock matrix is dominated by dolomite, the stronger zones show a higher abundance of quartz (>30%) and relatively lower phyllosilicate mineral content (<2%) than the weaker zones. Further, we observe that the mechanically stronger zones have the greatest occurrences of hydrothermal alterations (anhydrite veins and nodules ), indicating that the cored interval had experienced hydrothermal fluid circulation in the past. We infer that the denser clustering of fractures in the stronger zones which facilitated the hydrothermal vein development was due to the influence of mechanical stratigraphy on the brittle deformation and alteration of the sedimentary-hosted hydrothermal reservoir. Thus, we suggest that the stronger zones represent viable targets for hydraulic stimulation of a geothermal reservoir, both for the emplacement of new fractures and the linkage of pre-existing fractures. Our findings in this study provide an analog for hydraulic stimulation of viable geothermal reservoir targets at higher in-situ temperatures and higher geothermal gradients.
Integration of Dual Stress Transcriptomes and Major QTLs From a Pair of Genotypes Contrasting for Drought and Chronic Nitrogen Starvation Identifies Key Stress Responsive Genes in Rice
Authors: Sevanthi Amitha Mithra , Sinha Subodh Kumar , V Sureshkumar , Manju Rani , Saini Manish Ranjan , Kumari Sapna , Kaushik Megha , Prakash Chandra , Karnam Venkatesh , Singh Gyanendra Pratap , Mohapatra Trilochan , Mandal Pranab Kumar
Published: December 2020

We report here the genome-wide changes resulting from low N (N-W+), low water (N+W-) and dual stresses (N-W-) in root and shoot tissues of two rice genotypes, namely, IR 64 (IR64) and Nagina 22 (N22), and their association with the QTLs for nitrogen use efficiency. For all the root parameters, except for root length under N-W+, N22 performed better than IR64. Chlorophyll a, b and carotenoid content were higher in IR64 under N+W+ treatment and N- and W- stresses; however, under dual stress, N22 had higher chlorophyll b content. While nitrite reductase, glutamate synthase (GS) and citrate synthase assays showed better specific activity in IR64, glutamate dehydrogenase showed better specific activity in N22 under dual stress; the other N and C assimilating enzymes showed similar but low specific activities in both the genotypes. A total of 8926 differentially expressed genes (DEGs) were identified compared to optimal (N+W+) condition from across all treatments. While 1174, 698 and 903 DEGs in IR64 roots and 1197, 187 and 781 in N22 roots were identified, nearly double the number of DEGs were found in the shoot tissues; 3357, 1006 and 4005 in IR64 and 4004, 990 and 2143 in N22, under N-W+, N+W- and N-W- treatments, respectively. IR64 and N22 showed differential expression in 15 and 11 N-transporter genes respectively, under one or more stress treatments, out of which four showed differential expression also in N+W- condition. The negative regulators of N- stress, e.g., NIGT1, OsACTPK1 and OsBT were downregulated in IR64 while in N22, OsBT was not downregulated. Overall, N22 performed better under dual stress conditions owing to its better root architecture, chlorophyll and porphyrin synthesis and oxidative stress management. We identified 12 QTLs for seed and straw N content using 253 recombinant inbred lines derived from IR64 and N22 and a 5K SNP array. Three QTLs co-localized on chromosome 6 spanning 417 Kbp and comprising of 31 genes, of which, five were DEGs including two UDP-glucuronosyl/UDP-glucosyltransferase family proteins. The DEGs, QTLs and candidate genes reported in this study can serve as a major resource for both rice improvement and functional biology.
Association Between Regorafenib Dose and Efficacy Against Metastatic Colorectal Cancer in a Real-world Setting: A Retrospective Study
Authors: Hatori Masahiro , Kawakami Kazuyoshi , Wakatsuki Takeru , Shinozaki Eiji , Kobayashi Kazuo , Aoyama Takeshi , Nakano Yasuhiro , Suzuki Kenichi , Yamaguchi Kensei , Hama Toshihiro
Published: December 2020

Background: The association between regorafenib dosage in the treatment of metastatic colorectal cancer and efficacy is currently not well established. It was previously reported that the regorafenib dose as prescribed is associated with efficacy, but doses in actual clinical settings have not been analyzed. This study was to examine the association between the clinical significance of the cumulative dose of regorafenib in the early cycles and treatment efficacy in patients with metastatic colorectal cancer.Methods: We retrospectively analyzed patients with metastatic colorectal cancer who had received regorafenib as third-line or later chemotherapy between May 2013 and June 2018. Patients who were not treated in the Pharmaceutical Outpatient Clinic for compliance assessment were excluded. Overall survival was calculated using the Kaplan-Meier method. Prognostic factors, including baseline demographics and adverse events, were evaluated using Cox proportional hazard models. Results: A total of 176 patients were enrolled. By multivariate analysis, total dose until the second cycle <3180 mg (HR 1.71, 95% CI, 1.20-2.44, P = 0.003), age <65 years (HR 1.96, 95% CI, 1.36-2.86, P <0.001), PS 2 (HR 1.81, 95% CI, 1.28-2.57, P = 0.001), hepatic metastasis (HR 2.86, 95% CI, 1.90-4.30, P <0.001), and regorafenib initial dose ≤120 mg (HR 1.71, 95% CI, 1.14-2.58, P = 0.01) were independent negative predictors of overall survival. Median survival times of the lower dose group (<3180 mg) and higher dose group (≥3180 mg) were 5.8 and 7.6 months, respectively (P = 0.045).Conclusion: The cumulative dose of regorafenib until the second cycle in patients with metastatic colorectal cancer was associated with survival. It is important to individualize regorafenib dose in metastatic colorectal cancer patients.
Predictors of Undertriage after Major Trauma in a Physician-led Prehospital System: Insights of a French Registry
Authors: BENHAMED Axel , FRATICELLI Laurie , CLAUSTRE Clément , DOUPLAT Marion , MARCOTTE Guillaume , CESAREO Eric , GOSSIOME Amaury , BOURGEOIS Jean-baptiste , HEIDET Matthieu , Emond Marcel , DAVID Jean-Stéphane , KHOURY Carlos EL , TAZAROURTE Karim
Published: December 2020

BackgroundThe proper prehospital triage and transportation of patients suffering major trauma to lever 1 trauma centers is associated with better outcomes. Hence, emergency medical systems (EMS) aim is to avoid undertriage in these patients. The main objective of this study was to assess the rate and predictors of undertriage in a physician-led prehospital system.MethodsWe conducted an observational multicentric, region-wide, retrospective study based on the RESUVal Trauma-System registry, Rhône-Alpes region, France. All adults assessed by physician-led EMS units, from January 2011 to December 2017 with major trauma (Injury Severity Score (ISS) ≥ 16) were included. We defined the correct-triage group as major trauma patients admitted to a level I trauma center. We performed univariate then multivariate logistic regressions with undertriage as outcome.ResultsA total of 7,110 patients were included in the registry, of whom 2,591 patients with an ISS≥ 16. Among these patients, 320 (12.35%) were undertriaged. Median ISS was 25. In-hospital mortality was 16.45% (n=351/2134). Mid-aged patients (51-65 years old) were associated with a higher risk of undertriage than the others (OR=1.62, 95%CI 1.15-2.28, p=0.01). Factors associated with a lower risk of undertriage were: mechanism (fall or gunshot/stabbing wounds, 0.62, [0.45-0.86], p=0.01 and 0.44, [0.22-0.9], p=0.02, respectively), time on-scene (over 60 minutes, 0.61, [0.38-0.95], p=0.03), prehospital need for endotracheal intubation and ultrasound examination (0.53, [0.39-0.72], p<0.001 and 0.15, [0.08-0.29], p<0.001 respectively). After adjusting for severity, undertriage showed a non-significant tendency toward an increased risk of mortality (1.22, [0.8-1.89], p=0.36).ConclusionsIn our region-wide, physician-led prehospital system, undertriage of major trauma was not rare. The typical profile of undertriaged patients was a mid-aged male suffering from a blunt trauma, without respiratory distress or neurologic impairment, not benefiting from prehospital ultrasound examination and located close to a non-trauma center hospital.
Modelling Menstrual Cycle Length in Athletes Using State-space Models
Authors: Oliveira Thiago , Bruinvels Georgie , Pedlar Charles , Newell John
Published: December 2020

The ability to predict menstrual cycle length to a high degree of precision enables female athletes to track their period and tailor their training and nutrition correspondingly knowing when to push harder when to prioritise recovery and how to minimise the impact of menstrual symptoms on performance. Such individualisation is possible if cycle length can be predicted to a high degree of accuracy. To achieve this, a hybrid predictive model was built using data on 16,990 cycles collected from a sample of 2,178women (mean age 33.89 years, range 14.98 - 47.10, number of menstrual cycles ranging from 4 - 53). To capture the within-subject temporal correlation, a mixed-eﬀect state-space model was ﬁtted incorporating a Bayesian approach for process forecasting to predict the duration (in days) of the next menstrual cycle. The modelling procedure was split into three steps(i) a time trend component using a random walk with an overdispersion parameter, (ii) an autocorrelation component using an autoregressive moving-average (ARMA) model, and (iii) a linear predictor to account for covariates (e.g. injury, stomach cramps, training intensity). The inclusion of an overdispersion parameter suggested that 26.81% [24.14%,29.58%] of cycles in the sample were overdispersed where the random walk standard deviation under a non-overdispersed cycle is 1.0530 [1.0060,1.0526] days while under an overdispersed cycle it increased to 4.7386 [4.5379,4.9492] days. To assess the performance and prediction accuracy of the model, each woman’s last observation was used as test data. The Root Mean Square Error (RMSE), Concordance Correlation Coeﬃcient (CCC) and Pearson correlation coeﬃcient (r) between the observed and predicted values were calculated. The model had an RMSE of 1.6126 days, a precision of 0.7501 and overall accuracy of 0.9855. In the absence of hormonal measurements, knowing how aspects of physiology and psychology are changing across the menstrual cycle has the potential to help female athletes personalise their training, nutrition and recovery tailored to their cycle to sustain peak performance at the highest level and gain a competitive edge. In conclusion, the hybrid model presented here is a useful approach for predicting menstrual cycle length which in turn can be used to support female athlete wellness to optimise performance
Mice with Mutations in Trpm1, a Gene within the locus of 15q13.3 Microdeletion Syndrome, Display Pronounced Hyperactivity and Decreased Anxiety-Like Behavior.
Authors: Hori Tesshu , Ikuta Shohei , Hattori Satoko , Takao Keizo , Miyakawa Tsuyoshi , Koike Chieko
Published: December 2020

15q13.3 microdeletion syndrome is a genetic disorder caused by a deletion of a region containing seven genes on chromosome 15, MTMR10, FAN1, TRPM1, MIR211, KLF13, OTUD7A, and CHRNA7, and characterized by a wide spectrum of psychiatric disorders. The contribution of each gene in this syndrome has been studied using mutant mouse models, but the phenotypes of these mice do not account for human phenotypes and the results are still controversial. The behavior of Trpm1−/− mice with relation to 15q13.3 microdeletion syndrome has not been investigated due to the visual impairment in these mice, which may confound the results of behavior tests that involve vision. We have now applied a comprehensive behavioral test battery to examine the relationship of TRPM1 and 15q13.3 microdeletion syndrome by using Trpm1 null mutant mice. Our data indicate abnormal behavior of Trpm1−/− mice which may explain some phenotypes of 15q13.3 microdeletion syndrome, including reduction of anxiety behavior, abnormality of social interaction, attenuation in fear memory, and hyperactivity, which is the most prominent phenotype of Trpm1 mutant mice. While the ON visual transduction pathway is impared in Trpm1−/− mice, we did not detect compensatory high sensitivities for other sensory modalities. Although Trpm1−/− mice share the same pathway for visual impairment with mGluR6−/− mice, hyperlocomotion activity has not been reported in mGluR6−/− mice. These data suggest that the phenotype of Trpm1−/− mice extends beyond that expected from visual impairment alone. This is the first evidence to associate TRPM1 with impairment of cognitive function similar to that found in the phenotypes of 15q13.3 microdeletion syndrome.
Desflurane and Sevoflurane Induce Prolonged Motor Learning Deficits in aged AppNL-G-F/ NL-G-F Mice.
Authors: Niikura Ryo , Miyazaki Tomoyuki , Takase Kenkichi , Sasaguri Hiroki , Saito Takashi , Saido Takaomi C , Goto Takahisa
Published: December 2020

As the proportion of elderly in society increases, so does the number undergoing surgical procedures. The potential for anesthetics to facilitate Alzheimer’s disease (AD) is an important issue. The causal relationship between clinical AD development and anesthesia remains conjectural, but preclinical studies have demonstrated that anesthesia, such as halothane, isoflurane and sevoflurane, but not desflurane, induce AD-like pathophysiological changes and cognitive impairments in transgenic mice AD models. Although it is expected desflurane will have more opportunities for use on elderly patients, little is known of its effects especially on non-cognitive functions such as motor and emotional functions. Thus, we examined the postanesthetic effect of desflurane and another common general anesthetic sevoflurane on motor and emotional function of aged AppNL-G-F/ NL-G-F (App-KI) mice. This is a recently developed transgenic mouse model of AD exhibiting amyloid b peptide (Ab) amyloidosis and neuroinflammatory response in age dependent manner without non-physiological amyloid precursor protein overexpression. Mice applied to a short test battery consisting of elevated plus maze, balance beam test, and tail suspension seven days after exposure to 8.0% desflurane for 6 hours or 2.8% sevoflurane for 2 h. App-KI mice showed significant increments in percentage of entry and time spent in open arms in elevated plus maze. Further, the number of slips and latency to traverse in balance beam test were also increased in App-KI mice. In tail suspension test, App-KI mice increased limb clasping score and immobile duration, but decreased the latency to first immobile episode compare to age-matched WT control. Desflurane and sevoflurane induced motor learning deficits in balance beam tests specifically in App-KI mice, while not affecting other behavioral performance. These results suggest high validity of App-KI mice as an animal model of AD. Use of anesthetics in AD patients and those at-risk requires careful and subsequent follow-up.
Treadmill Running Regulates Adult Neurogenesis, Spatial and Non-Spatial Learning by ErbB4 Signaling
Authors: Yi Yandong , Song Yuanlong , Liu Bo , Lu Yisheng
Published: December 2020

Recent studies have shown exercise is effective for adult hippocampus neurogenesis and memory. However, the molecular mechanism of exercise is unclear. In this study, AG1478, an ErbB4 inhibitor, was used to explore the involvement of ErbB4 receptors. Four weeks post-running, cognitive impairment was analyzed using T-maze, Morris water maze (MWM) and contextual fear discrimination learning tests, followed by histological assessment of the proliferation and survival of hippocampal neurons using Ki67, NeuN and BrdU immunostaining respectively. Expression of total and phosphate ErbB4 protein level was evaluated by Western blotting. The results showed that AG1478 significantly impaired the performances in T-maze and MWM (spatial learning and memory), contextual fear conditioning and discrimination learning paradigm (non-spatial working and reference memory), enhanced neurogenesis loss, downregulated the expression of p-ErbB4 and total ErbB4 protein, which could be reversed by running. Taken together, our study suggested that running ameliorates cognitive impairment and neurogenesis via ErbB4 signaling.
The Congenital Sternoclavicular Sinus: a Single-institution Retrospective Study of 88 Patients
Authors: Yang Gang , He Taozhen
Published: December 2020

Background Sinus near the sternoclavicular joint was considered as a rare congenital neck abnormality. Though it was reported as a dermoid sinus in some literatures, the embryological origin of the sinus was unclear. This study aimed at reviewing the clinical and histological characteristics and analyzing the possible embryological origin of this malformation in children.Methods The medical records of all patients with congenital sternoclavicular sinus who underwent surgical resection between March 2018 through June 2020 were reviewed retrospectively. The clinical presentations, complications, histological examination, and treatment were analyzed.Results Of the 88 patients with congenital sternoclavicular sinus included, the mean age of surgery was 2.73 ± 1.71 years old. The sinuses occurred on the left side in 73 (83.0%) cases. Sixty-three patients experienced sinus infection and 44 patients underwent incision and drainage before excision. All patients received surgical resection with one patient recurred after surgery. Histopathological examination showed that the sinuses were lined by squamous epithelium in most patients. However, ciliated epithelium was observed in one patient and salivary gland was detected in two patients.Conclusions The congenital sternoclavicular sinus should be excised promptly to prevent recurrent infection. According to the ciliated epithelium and salivary gland were found in the wall of sinus, it should be viewed as the skin side remnant of the fourth branchial cleft rather than a dermoid cyst/sinus.
How to Design a Registry for Undiagnosed Patients in the Framework of Rare Disease Diagnosis – Suggestions on Software, Data Set and Coding System
Authors: Berger Alexandra , Rustemeier Anne-Kathrin , Göbel Jens , Kadioglu Dennis , Britz Vanessa , Schubert Katharina , Mohnike Klaus , Storf Holger , Wagner Thomas OF
Published: December 2020

Background: About 30 million people in the EU and USA, respectively, suffer from a rare disease. Driven by European legislative requirements, national strategies for the improvement of care in rare diseases are being developed. To improve timely and correct diagnosis for patients with rare diseases, the development of a registry for undiagnosed patients was recommended by the German National Action Plan. In this paper we focus on the question on how such a registry for undiagnosed patients can be built and which information it should contain.Results: To develop a registry for undiagnosed patients, a software for data acquisition and storage, an appropriate data set and an applicable terminology/classification system for the data collected is needed. We used the open source software OSSE (Open Source Registry System for Rare Diseases) to build the registry for undiagnosed patients. Our data set is based on the minimal data set for rare disease patient registries recommended for European Rare Disease Registries Platform. We extended this Common Data Set to also include symptoms, clinical findings and other diagnoses. In order to ensure findability, comparability and statistical analysis, symptoms, clinical findings and diagnoses have to be encoded. We evaluated three medical ontologies (SNOMED – CT, HPO and LOINC) for their usefulness. With exact matches of 98% of tested medical terms, a mean number of five deposited synonyms, SNOMED CT seemed to fit our needs best. HPO and LOINC provided 73% and 31% of exacts matches of clinical terms respectively. Allowing more generic codes for a defined symptom, with SNOMED-CT 99%, with HPO 89% and with LOINC 39% of terms could be encoded.Conclusions: With the use of the OSSE software and a data set, which, in addition to the Common Data Set, focuses on symptoms and clinical findings, a functioning and meaningful registry for undiagnosed patients can be implemented. The next step is the implementation of the registry in centres for rare diseases. With the help of medical informatics and big data analysis, case similarity analyses could be realized and aid as a decision-support tool enabling diagnosis of some patients.
Hyperpigmented Spots at Fundus Examination: A New Ocular Sign in Neurofibromatosis Type I
Authors: Moramarco Antonietta , Mallone Fabiana , Sacchetti Marta , Lucchino Luca , Miraglia Emanuele , Roberti Vincenzo , Lambiase Alessandro , Giustini Sandra
Published: December 2020

Background: Neurofibromatosis Type I (NF1), also termed von Recklinghausen disease, is a rare genetic disorder that is transmitted by autosomal dominant inheritance, with complete penetrance and variable expressivity. It is caused by mutation in the NF1 gene on chromosome 17 encoding for neurofibromin, a protein with oncosuppressive activity, and it is 50 % sporadic or inherited.The disease is characterized by a broad spectrum of clinical manifestations, mainly involving the nervous system, the eye and skin, and a predisposition to develop multiple benign and malignant neoplasms. Ocular diagnostic hallmarks of NF1 include optic gliomas, iris Lisch nodules, orbital and eyelid neurofibromas, eyelid café-au-lait spots. Choroidal nodules and microvascular abnormalities have recently been identified as additional NF1-related ocular manifestations. The present study was designed to describe the features and clinical significance of a new sign related to the visual apparatus in NF-1, represented by hyperpigmented spots (HSs) of the fundus oculi.Results: HSs were detected in 60 (24.1%) out of 249 patients with NF1, with a positive predictive value of 100% and a negative predictive value of 44.2%. None of the healthy subjects showed the presence of HSs. HSs were visible under indirect ophthalmoscopy and infrared light, but not appreciable on green reflectance. The location and features of pigmentary lesions matched with the already studied NF1-related choroidal nodules. No significant difference was found between the group of patients (n=60) with ocular HSs and the group of patients (n=189) without ocular pigmented spots in terms of age, gender or severity grading of the disease. A statistically significant association was demonstrated between the presence of HSs and neurofibromas (p=0.047), and between the presence of HSs and NF1-related retinal microvascular abnormalities (p=0.017).Conclusions: we described a new ocular sign represented by HSs of the fundus in NF1. The presence of HSs was not a negative prognostic factor of the disease. Following an in-depth instrumental investigation, we demonstrated that HSs and choroidal nodules were consistent with the same type of lesion, and simple indirect ophthalmoscopy allowed for screening of HSs in NF1.
The Prevalence and Stressors of Job Burnout Among Medical Staff in Liaoning, China: a Cross-section Study
Authors: Guo YouQi , Hu Shu , Liang Fei
Published: December 2020

Background: Sustained attention to the prevalence and associated factors of burnout in China is important for the health care service quality and related reform. In this study, we investigated the prevalence of job burnout among medical staff in Liaoning province, China; performed a survey of subjective perception ranking for the main stressors among respondents; estimated the effect of stresses from work tasks and the relationship with patients on job burnout in order to provide improved strategy and suggestion for hospital administrators.Methods: The respondents were from 8 hospitals in 3 cities in Liaoning province, China. Data were collected and analyzed including the following sections: (1) demographic characteristics; (2)work situations; (3) ranking of six stressors; (4) job burnout scale; (5) effort-reward imbalance scale; (6) work violence scale; (7) Fear of malpractice scale. A total of 1056 individuals became the study objects. A statistical analysis and hierarchical linear regression analysis were performed to explore the prevalence of burnout and the effects of stressors.Results: The prevalence of job burnout was 20.5%, and 72.9% of all respondents reported a least one symptom of burnout. The respondents who were male, 30-39 years old, had master's degree or high and working hour >60 hr per week prone to job burnout. The relationship with patients and work tasks are the top two ranking stressors in the subjective perception survey. Regression analysis showed that the relationship with patients explained 19.4%, 16.9% and 2.0% of variance in burnout subscales EE, DP and PA, respectively and work tasks explained 23.9%, 16.3% and 5.2% of variance in burnout subscales EE, DP and PA, respectively.Conclusion: The Chinese medical staff had high prevalence of job burnout. Some factors of demographic and work situations were associated with job burnout. The medical staff considered the relationship with patients and work tasks are the two major stressors. These two stressors are also the major indicators associated with job burnout. The hospital administrators should be aware of the risk of burnout. Efforts should be made to ameliorate the status of job burnout.
Proteomics Analysis of the Protective Effects of Hesperetin on Coronary Artery injury in Streptozotocin-Induced Type 1 Diabetic Rats
Authors: Xing Guofang , Huo Pingting , Zhang Xinyi , Chen Zhaoyang , Wang Lei , Liu Yu
Published: December 2020

Background: Type 1 and type 2 diabetes both cause damage to the cardiovascular system. Hesperetin, a medicinal product found in foods, has been shown to have various cardioprotective effects. However, the effects of this compound on diabetes-related cardiovascular damage have not been evaluated.Methods: In this study, we aimed to investigate the protective effects of hesperetin on the coronary artery in diabetic rats and to explore its effects on the changes in critical proteins in the coronary artery using proteomics analysis. Results: Hesperetin alleviated coronary artery injury and modulated the expression of various proteins, including S100A8 and S100A9, which functioned in Toll-like receptor 4 binding, Toll-like receptor binding, and RAGE receptor binding. Pathways altered by hesperetin included type I diabetes mellitus, cell adhesion molecules, antigen processing and presentation, and interleukin-17 signaling pathway. Conclusions: In this study, we constructed a protein map of SD rats with type 1 diabetes treated with hesperetin, and found significant changes in three important proteins, S100A8, S100A9 and KNG1.Our findings provided important insights into further studies of the cardiovascular protective effects of hesperetin.
Comparison of Preoperative Trans-thoracic Echocardiography with Intraoperative Findings in Patients with Congenital Heart Disease Undergoing Surgery; A Prospective Observational Study.
Authors: Njem Josiah Miner , Edwin Frank , Tettey Mark
Published: December 2020

OBJECTIVE: To determine the diagnostic accuracy and safety of trans-thoracic echocardiography alone for indicating surgery by correlating preoperative trans-thoracic echocardiography with intra-operative findings in patients with congenital heart disease (CHD) in a low resource, low volume center. METHODOLOGY: The pre-operative trans-thoracic echocardiography and intra-operative findings of two hundred and fifty patients with CHD, undergoing surgery at the National Cardiothoracic Centre (NCTC), Korle Bu Teaching Hospital, from 2012 to 2017 were prospectively compared. Included in this prospective study, were all patients with CHD who had trans-thoracic echocardiography alone at the NCTC. Excluded were patients who were operated at the NCTC based on echocardiography done elsewhere , those who had echocardiography at the NCTC but were operated elsewhere, as well as those whose operative decision were based on cardiac catheterization or CT angiography and patients with acquired heart defects. The analysis included profiling of patients on different demographic and clinical parameters. SPSS software was used for analysis. RESULTS: Of the 250 patients ages ranged from two months to sixty years. The mean was 4 years 95 days, median 1 year 180 days. The female sex accounted for 152 (60.6%). The preoperative trans-thoracic echocardiography correlated with intra-operative findings completely in 228 (91.2%) of patients, affirming the accuracy of this imaging modality. There were however, 19 (7.6%) false negatives and 3 (1.2%) false positive. Neither the false positive nor false negative errors resulted in complications or adversely affected the surgical outcome.CONCLUSION: Based on the results of this study, preoperative transthoracic echocardiography done by cardiologists at the National Cardiothoracic Center, Korle Bu Teaching Hospital Accra, demonstrated a high correlation with intraoperative findings. Echocardiography also proved to be sensitive, accurate and safe for indicating surgery in patients with congenital heart disease.
Integrated effects of bacteria and fungi biofertilizers on morphological traits, antioxidants indices, and polyphenol compounds of quinoa (Chenopodium quinoa Willd.) under salinity condition
Authors: Karimi Giti , Pourakbar Latifeh , Moghaddam Sina Siavash , Popović-Djordjević Jelena
Published: December 2020

It is imperative to assess the potential of halophyte plant species, such as quinoa, in resisting high salinity levels in arid and semi-arid regions where the productivity of crops is dramatically affected. A factorial experiment based on a completely randomized design with three replications was conducted to explore the effect of integrated biofertilizer, on morphological traits, antioxidants, and polyphenol compounds of quinoa under salinity stress. The studied factors included NaCl salinity stress at three levels of 0, 150, and 300 mM (S0, S150, and S300, respectively), Trichoderma (T) fungus at two levels (its use and non-use), and biofertilizer at three levels (control, nitrogen (FN), and phosphorus (FP). The means of the studied traits showed that the highest shoot length and dry weight was related to S0T0FN, the highest root length to S150TFN, the highest root dry weight to S0T0FN, and the highest phenol and flavonoid contents to S300TFP and S0TFN treatments. Among polyphenols, the highest caffeic acid, rutin, coumaric acid, and quercetin were observed in S0TFP, and the highest levels of chlorogenic, rosmarinic, cinnamic acids, and apigenin (mg/kg) were observed in S0TFN. To sum up, Bacteria and fungi biofertilizers were effective on the studied traits at the three salinity levels.
Soil Moisture Remote Sensing Using SIW Cavity Based Metamaterial Perfect Absorber
Authors: Amiri Majid , Abolhasan Mehran , Shariati Negin , Lipman Justin
Published: December 2020

Continuous and accurate sensing of water content in soil is an essential and useful measure in the agriculture industry. Traditional sensors developed to perform this task suffer from limited lifetime and also need to be calibrated regularly. Further, maintenance, support, and deployment of these sensors in remote environments provide additional challenges to the useof conventional soil moisture sensors. In this paper, a metamaterial perfect absorber (MPA) based soil moisture sensor isintroduced. The ability of MPAs to absorb electromagnetic signals with near 100% efficiency facilitates the design of highlyaccurate and low-profile radio frequency (RF) passive sensors. MPA based sensor can be fabricated from highly durablematerials and can therefore be made more resilient than traditional sensors. The creation of channels in the SIW cavity MPA’s substrate to accommodate the soil contact leads to high-resolution sensing. The proposed sensor does not require connectionfor both electromagnetic signals or for adding a testing sample. Importantly, an external power supply is not needed, makingthe MPA based sensor the perfect solution for remote and passive sensing in modern agriculture. The proposed MPA based sensor has three absorption bands due to the various resonance modes of the SIW cavity. By changing the soil moisture level,the absorption peak shifts by 10 MHz, 23.3 MHz, and 60 MHz, which is correlated with the water content percentage at the first, second and third absorption bands, respectively. Finally, a 6×6 cell array with a total size of 312 mm × 312 mm has been fabricated and tested. A strong correlation between measurement and simulation results validates the design procedure.
An R2R3-MYB Transcription Factor PgFLP Directly Activates PgPIN10 to Regulate the GSA of Adventitious Root in Pomegranate
Authors: Wang Zenghui , Li Jialin , Yang Xuemei , Tang Haixia , Feng Lijuan , Wang Fei , Tao Jihan , Yin Yanlei
Published: December 2020

Background: The self-rooted seedling is widely used in pomegranate planting industry currently; However, the root system of self-rooted seedling is shallow and poor cold resistance. Therefore, the study of the molecular mechanisms of pomegranate adventitious root gravitropism is very important for developing deep-rooted pomegranate cultivars.Results: We report the pomegranate FOUR LIPS (PgFLP) that play an key role in regulating the gravitropic set-point angle of pomegranate adventitious root in response to gravity signal. In our study, PgFLP directly regulates the transcriptional expression of PgPIN10 by binding to its promoter, thus regulating the GSA of adventitious root in pomegranate. Additionally, the 35S::PgFLP show stronger gravitational response than wild-type, leading to a smaller GSA in Arabidopsis lateral roots, indicating that PgFLP participates in regulating the GSA of adventitious root via PgPIN10 in pomegranate. Conclusion: Our results confirm that the transcriptional regulation of PgPIN10 by R2R3-MYB transcription factor PgFLP in setting the gravitropic set-point angle of pomegranate adventitious root in response to gravity signal.
Determinants of Patient Satisfaction in The United Arab Emirates Health Care Industry
Authors: Sayani Hameedah , Moonesar Immanuel Azaad , Zakzak Lama , Elsholkamy Mona Mostafa
Published: December 2020

Background: The United Arab Emirates is aiming to provide 'world-class healthcare' to its citizens. This study aims to determine the association between overall satisfaction and various aspects of health care services in the United Arab Emirates on a country level. Methods: The data was collected from 5,855 respondents on the affordability, quality, accessibility, and responsiveness dimensions of health care. Besides frequency tables and descriptive statistics, statistical methods, such as Principal Component Analysis and Multiple Regression, were used to reduce and model the association between dependent (overall satisfaction) and independent (affordability, quality, accessibility, and responsiveness) variables. Results: The findings indicated higher satisfaction levels with quality and accessibility and lower satisfaction levels with affordability and responsiveness. Recommendations are provided to address the latter two factors. Conclusion: The study identifies issues in health care service provision in the United Arab Emirates and offers recommendations about enhancing affordability and responsiveness.
A novel Swollenin from Talaromyces leycettanus JCM12802 enhances cellulase hydrolysis towards various substrates
Authors: Zhang Honghai , Wang Yuan , Brunecky Roman , Yao Bin , Xie Xiangming , Zheng Fei , Luo Huiying
Published: December 2020

Background: Swollenins exist within some fungal species such as Trichoderma reesei and Aspergillus niger, and are candidate accessory enzymes for the biodegradation of cellulosic substrates. Swollenins theorized role in biological processes is as promoters in the rearrangement of non-covalent interaction networks formed by cell wall polysaccharides. Such network rearrangements though to be responsible for expanding accessibility for hydrolytic enzyme degradation processes. We hereby report in detail the characterization of a recombinant swollenin and its disruptive activity on cellulosic substrates and its synergistic effects while interacting with cellulases.Results: We have expressed a novel swollenin gene Tlswo consists of an open reading frame encoding 503 amino acids to be identified from Talaromyces leycettanus JCM12802 and successfully expressed it in both Trichoderma reesei and Pichia pastoris. Similar to other fungal swollenins, TlSWO is composed of a N-terminal family 1 carbohydrate binding module (CBM1) followed by a Ser/Thr rich linker connected to an expansin-like domain, followed by a family of 45 endoglucanase-like domains and a group-2 grass pollen allergen domain. From our experimental results, TlSWO demonstrated disruptive activity on Avicel and displayed a synergistic effect with cellobiohydrolases, enhancing its hydrolytic performance up to 132%. We also explored the activity of TlSWO on several model substrates as well as pretreated biomass. Our results indicate that TlSWO is capable of releasing reducing sugars from lichenan, barley β-glucan, carboxymethyl cellulose sodium (CMC-Na) and laminarin. The specific activity of TlSWO towards the substates mentioned above is 9.0 ± 0.100 U/mg, 8.9 ± 0.100U/mg, 2.3 ± 0.002 U/mg and 0.79 ± 0.002 U/mg, respectively. Moreover, further experimentation confirms the fungal swollenin TlSWO exhibits maximum activity at pH 4.0 and 50 ℃.Conclusion: This study reports on a novel swollenin protein capable of enhancing biomass conversion. Experimental data reveals the functional diversity of this swollenin with considerable activity on various substrates. Although the exact catalytic mechanism of swollenin’s remains unknown, the functional diversity of TlSWO broadens its applicability under experimental settings, and suggests it may be a promising candidate for future industrial applications.
Unmet contraceptives needs among Female Sex Workers (FSWs) in semi urban Blantyre, Malawi
Authors: Twizelimana Donatien , Muula Adamson S
Published: December 2020

Background: Research has paid limited attention to understanding factors that are associated with unmet contraceptive needs among female sex workers. In order to fill this knowledge gap, we estimated the prevalence of unmet contraceptive needs and examined associated factors among FSWs in semi urban Blantyre, Malawi. Methods: We used systematic sampling to recruit 290 female sex workers in semi urban Blantyre between February and March 2019. In this cross sectional study, we used questionnaire interviews to collect quantitative data. We calculated the mean and standard deviation for continuous variables and proportions for categorical variables to describe the data. Logistic regression analysis was used to investigate the association between unmet needs (the outcome variable) and explanatory variables such as: having a steady partner, fear of contraceptives’ side effects and having a history of sexually transmitted infections. Results: Out of the 290 study participants 102 (35.2%) reported unmet contraceptive needs. The following factors were significantly associated with unmet contraceptive needs in multivariate analysis: female sex workers’ history of physical and sexual violence by clients [OR 3.38, 95% CI (1.10, 10.43)], p<0.03, participants with a steady partner [OR 3.28, 95% CI (1.89, 5.68)], p<0.001, and participants who feared side effects of contraceptives [OR 2.99, 95% CI (1.73, 5.20)], p<0.001. Conclusion: Reproductive Health services should address barriers to contraceptives use for instance: violence by female sex workers’ clients, fear and misinformation on contraceptives. There is need to improve awareness of contraceptives. Specific health promotion interventions on female sex workers engaged in a steady partnership are recommended. It is important to enhance the knowledge, attitudes, and counseling skills of health care providers in order to address unmet contraceptive needs among female sex workers in semi-urban Blantyre.
Comprehensive analysis of NAC transcription factor family uncovers drought and salinity stress response in pearl millet (Pennisetum glaucum) 
Authors: Dudhate Ambika , Shinde Harshraj , Yu Pei , Tsugama Daisuke , Gupta Shashi Kumar , Liu Shenkui , Takano Tetsuo
Published: December 2020

Background: Pearl millet (Pennisetum glaucum) is a cereal crop that possesses the ability to withstand drought, salinity and high temperature stresses. The NAC [NAM (No Apical Meristem), ATAF1 (Arabidopsis thaliana Activation Factor 1), and CUC2 (Cup-shaped Cotyledon)] transcription factor family is one of the largest transcription factor families in plants. NAC family members are known to regulate plant growth and abiotic stress response. Currently, no reports are available on the functions of the NAC family in pearl millet. Results: Our genome-wide analysis found 151 NAC transcription factor genes (PgNACs) in the pearl millet genome. Thirty-eight and 76 PgNACs were found to be segmental and dispersed duplicated respectively. Phylogenetic analysis divided these NAC transcription factors into 11 groups (A-K). Three PgNACs (-073, -29, and -151) were found to be membrane-associated transcription factors. Seventeen other conserved motifs were found in PgNACs. Based on the similarity of PgNACs to NAC proteins in other species, the functions of PgNACs were predicted. In total, 88 microRNA target sites were predicted in 59 PgNACs. A previously performed transcriptome analysis suggests that the expression of 30 and 42 PgNACs are affected by salinity stress and drought stress, respectively. The expression of 36 randomly selected PgNACs were examined by quantitative reverse transcription-PCR. Many of these genes showed diverse salt- and drought-responsive expression patterns in roots and leaves. These results confirm that PgNACs are potentially involved in regulating abiotic stress tolerance in pearl millet.Conclusion: The pearl millet genome contains 151 NAC transcription factor genes that can be classified into 11 groups. Many of these genes are either upregulated or downregulated by either salinity or drought stress and may therefore contribute to establishing stress tolerance in pearl millet.