bluuebunny/crossref_metadata_2025 huggingface dataset:
Fast Hypothermia Induced by Continuous Renal Replacement Therapy Alleviates Renal and Intestinal Injury after Cardiac Arrest in Swine
Authors: Xu Jiefeng , Shi Lin , Wang Jiangang , Wu Chunshuang , Chen Qijiang , Jin Xiaohong , Zhang Jungen , Zhang Mao
Published: June 2020

Background: Renal and intestinal damage lead to multiple organ dysfunction and death after cardiopulmonary resuscitation (CPR), and can be partly mitigated by therapeutic hypothermia. Currently, continuous renal replacement therapy (CRRT) was demonstrated to be an effective way to induce hypothermia. In the present study, we aimed to investigate the influence of CRRT cooling on renal and intestinal damage after CPR based on a porcine model.Methods: 32 swine were subjected to ventricular fibrillation for 8 min, while defibrillation was performed at 5 min of CPR. All pigs were randomly allocated to receive CRRT (n = 9), surface cooling (SC, n = 9), normothermia (NT, n = 9) or sham control (Control, n = 5) at 5 min post resuscitation. In the CRRT group, the pigs were cooled by the combination of 8-hr CRRT and 16-hr SC, a rate of 180 ml/min of blood flow was initially set with the infusion line submerged in 4 °C of ice water. In the SC group, pigs were cooled by the 24-hr SC. As to the NT and Control groups, the temperatures were maintained at a normal range. The levels of creatinine (Cr), blood urea nitrogen (BUN), intestinal fatty acid binding protein (IFABP) and diamine oxidase (DAO) in serum were measured at baseline and at 1, 3, 6, 12, 24 and 30h post resuscitation. Additionally, tissues of kidney and intestine were harvested, from which the levels of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), the contents of malondialdehyde (MDA), activities of superoxide dismutase (SOD) and the apoptosis levels were analyzed. Results: After resuscitation, the blood temperature decreased significantly more rapidly in the CRRT group than in the SC group (9.8 ± 1.6 vs. 1.5 ± 0.4 ℃/h, P < 0.01). The levels of Cr, BUN, IFABP and DAO after resuscitation were significantly lower in the two hypothermic groups compared with the NT group. Furthermore, from pathological evidence, cooling induced by CRRT alleviated post-resuscitation renal and intestinal injury compared to SC.Conclusion: Fast hypothermia induced by continuous renal replacement therapy was superior to surface cooling in mitigating renal and intestinal injury post resuscitation.
Measles outbreak in a migrant laborer population in the wake of COVID-19 pandemic: Kathmandu, Nepal, 2020
Authors: Adhikari Biplov , Karki Sauharda Singh , Devkota Amrit , Thakur Rahul , Karki Nabina , Budhathoki Shyam Sundar
Published: June 2020

We describe a measles outbreak in migrant laborers working in a carpet factory in Kathmandu, the capital of Nepal. The outbreak occurred during the nationwide lockdown enforced to contain the COVID-19 pandemic and 2 weeks after the Supplmentary Immunization Activities done for measles elimination. We included all the patients from the factory presenting to Mulpani Primary Health Centre, Kathmandu, Nepal with acute febrile rash illness. Recovered patients with history of fever and rash within the defined outbreak period with a clear epidemiological linkage were also included. Laboratory confirmation was done by detection of immunoglobulin M (IgM) in serum samples against the measles virus via enzyme-linked immunosorbent assay (ELISA). We compared attack rates (ARs) between those less than 5 years and 5 years or older. We identified 11 case patients ranging from 7 months to 27 years of age (3 below 5years of age); rash onsets were from 28 March-20 April 2020. All case-patients were laborers who had immigrated to Kathmandu from rural parts of the country. We sent serum samples of 7 patients for laboratory confirmation; 5 patients tested positive. The remaining four patients had a clear epidemiological linkage. The average attack rate was 30.5% with no significant difference between attack rates among the <5 years and the ≥5 years reported as 37.5 and 28.5 respectively. Migrant population from rural regions with poor outreach of essential health services like vaccination can act as pockets of measles susceptible individuals if not measles reservoirs. The squalid conditions in which the migrant laborers live-in can also compound the risk of outbreak in such populations. It is prudent to address the vaccination status of such population and timely correct their vaccine status if unvaccinated in order to meet the goal of measles elimination by 2023.
Sachet water consumption as a risk factor for cholera in urban settings: findings and implications from a case control study in Kinshasa, Democratic Republic of the Congo during the 2017-2018 outbreak
Authors: Mbala-Kingebeni Placide , Vogt Florian , Miwanda Berthe , Sundika Tresor , Mbula Nancy , Pankwa Isaac , Lubula Leopold , Vanlerberghe Veerle , Magazani Alain , Afoumbom Mildred , Muyembe-Tamfum Jean-Jacques
Published: June 2020

Background: Cholera is endemic in the Democratic Republic of the Congo. Starting in 2016, a cholera epidemic swept through the country and in November 2017 reached the capital of Kinshasa, which had not experienced a cholera outbreak for nearly a decade. Behavioural risk factors for cholera are well established in rural and semi-urban contexts but not in densely populated mega-cities from Sub-Saharan Africa. Such information is crucial to guide context-specific control measures. We seized the outbreak in Kinshasa as an opportunity to investigate context-specific risk factors for cholera in this urban setting among a mobile population that is not frequently exposed to cholera.

Methods: We recruited 390 participants into a 1:1 age-matched case control study from three affected health zones of Kinshasa between 1 and 28 February 2018. Cases were identified from cholera treatment centre admission records, while controls were recruited from the neighbourhood of the cases’ place of residence. We collected data on socio-demographic and behavioural risk factors using standardized case report forms. We used augmented backward elimination in a conditional logistic regression model to identify risk factors, using a p-values of 0.05 as cut-off to define statistical significance.

Results: The consumption of sachet water was significantly associated with the risk of being a cholera case (p-value 0.019), which increased with increasing frequency of consumption from rarely [OR 2.223, 95% CI 0.944-5.235] to often [OR 4.031, 95% CI 1.642-9.891] to very often [OR 4.144, 95% CI 1.029-16.653]. Overall, more than 80% of all participants reported consumption of this type of drinking water. Funeral attendance and recent contact with someone suffering from diarrhoea were borderline insignificant risk factors (p-value 0.09 and 0.08, respectively). No socio-demographic characteristics were associated with the risk of cholera.

Conclusions: Drinking water consumption from sachets, which are sold informally on the streets in most Sub-Saharan African cities, should be considered as a potential route of infection during future cholera outbreaks in similar urban settings. Outbreak investigation and response need to acknowledge context-specific risk factors to remain a valuable tool in the efforts to achieve national and regional targets to reduce the burden of cholera in Africa.
Quantitative Differences in Levels of Immunohistochemical Biomarkers between Squamous Cell Carcinoma and Adenocarcinoma of the Uterine Cervix: Implications for Treatment Outcomes after Chemoradiotherapy
Authors: Chen RUI-YUN CHEN , LIN YING-CHUN , LIANG JI-AN , Hung Yao-Chin , YEH LIAN-SHUNG , CHANG WEI-CHUN , LIN WU-CHOU , CHANG YIN-YI , Chen Shang-Wen
Published: June 2020

Introduction: This study compared the quantitative differences in immunohistochemical markers between uterine cervical squamous cell carcinoma (SCC) and adenocarcinoma (AC) and assessed the impact of these biomarkers on outcomes in patients treated with chemoradiotherapy (CRT).Method: This retrospective study included 118 patients (SCC in 76, AC in 42) who received definitive CRT. According to the International Federation of Gynecology and Obstetrics staging system, 14, 34, and 70 patients were classified as having stage IB3, II, and III disease, respectively. Baseline immunohistochemical biomarkers, including hypoxia, cell proliferation, cell adhesion, immunogenicity, inflammatory, and evasion of apoptosis biomarkers, were analyzed using tissue microarrays from biopsy specimens. The Mann-Whitney U test was carried out for quantitative analysis between SCC and AC. Cox regression analysis was used to examine the effects of the biomarkers and clinical parameters on treatment outcomes.Results: Using the H-scores of the biomarkers for SCC as a reference, increased expression of E-cadherin, calretinin, CAIX, and c-Myc and decreased levels of HIF-1α, VEGF, tumor necrosis factor-α, galectin-9, chemokine ligand 5, Bax, EGFR, and insulin-like growth factor 1 receptor were found in the patients with AC. A high E-cadherin (P = 0.002) and low Bax (P = 0.001) H-score were associated with inferior pelvic relapse-free survival. Conclusion: Cervical SCC exhibited strong expression of baseline immunohistochemical inflammatory, hypoxic, and angiogenesis biomarkers whereas the intensity of cell adhesion markers was more distinct in cervical AC. A high E-cadherin and a low Bax H-score were associated with a high rate of local relapse.
Contribution to a Mixed Assessment of Patient Safety Culture
Authors: Fourar Youcef Oussama , Djebabra Mebarek , Benhassine Wissal , Boubaker Leila
Published: June 2020

Purpose: The evaluation of patient safety culture is conducted using quantitative methods based on the use of questionnaires and qualitative ones focused on the deployment of cultural maturity models. These methods are known to suffer from certain major limits. This article aims to overcome the difficulties encountered by both methods and to propose a novel approach to the assessment of PSC. Methodology: The approach proposed in this article consists of applying a combined method, based on Principal Component Analysis (PCA) and K-means algorithm, to group together PSC dimensions into macro-dimensions whose exploitation allows to overcome the difficulties encountered with dimensional analysis of PSC and then, serve as a basic support for the development of a patient safety culture maturity model. Findings: The results of the combined method PCA / k-means shows that PSC dimensions can be grouped into three macro-dimensions that were capitalized in a first place using factors related to the development of PSC and in a second place to develop a quantitative maturity matrix that helped in the identification of PSC maturity levels.Originality: The merit of our proposal is to work towards a quali-quantitative evaluation of safety culture recommended by a good number of researchers but, to our knowledge, few or no studies are devoted to this hybrid or systematic evaluation of safety culture. Thus, the results can also be projected to implicate PSC actors and to frame the evaluation pf PSC maturity by international standards.
G6PD deficiency is associated with renal impairment in T2DM
Authors: Basnet Nabin Bahadur , Pradhan Santosh , Kafle Rishi Kumar , Gautam Keyoor
Published: June 2020

Background Diabetes and its complications including renal impairment are the consequences of increased oxidative stress. Glucose-6-phosphate dehydrogenase (G6PD) is responsible for protection from harmful oxidative metabolites. G6PD deficiency hence leaves these individuals at high risk of oxidative stress and at high risk of diabetes and its complications including renal impairment. If any association between G6PD deficiency and damage to kidney exists in diabetic population then screening for G6PD deficiency in this population will help identify the susceptible patient who may be at higher risk of diabetic complications due to G6PD deficiency and can prevent them with early interventions to help decrease patients’ morbidity in the long run. Methods Healthy control volunteers and diabetic with or without renal impairment were selected after counseling. Body Mass Index and blood pressure were recorded. Blood tests to measure the G6PD activity in fresh whole blood, hemoglobin, glycated hemoglobin, uric acid, and creatinine were done. Urine was tested for the presence of proteinuria. The activity of G6PD was measured. Glomerular filtration rate (eGFR) was estimated with the Modification of Diet in Renal Disease Study (MDRD) Equation. Calculations and statistical analysis were done with open software LibreOffice 6.3.3 and SPSS version 22.0.Results The mean G6PD level of healthy control was 84.27 ± 9 and that of diabetic patient without renal impairment and diabetic patients with renal impairment were 65.05 ± 5.35 and 46.64 ± 6.56 respectively. There was only one participant (4.55%) with G6PD deficiency among healthy controls whereas the proportion of participants having normal, mild to moderate, and severe degree of G6PD deficiency were 77.27%, 13.64%, and 9.09%, respectively for diabetic patient without renal impairment while 40.91%, 22.73%, and 36.36% for those with renal impairment. The proportion of participants with renal impairment had more severe degree of G6PD deficiencies than those without renal impairment (p=0.03).Conclusion The prevalence of G6PD deficiency was higher in diabetics with renal impairment than those with diabetes alone suggesting the relation between G6PD activity and diabetes with renal impairment.
An adaptive nonsingular fast terminal sliding mode control for yaw stability control of bus based on STI tire model
Authors: Sun xiaoqiang , Wang Yujun , Cai Yingfeng , Wong PakKin , Chen Long
Published: June 2020

In this paper, a novel adaptive nonsingular fast terminal sliding mode (ANFTSM) control scheme for yaw stability control (YSC) is proposed to improve the bus curve driving stability and safety on slippery roads. There are three major contributions in the design process of the bus YSC system. The first contribution is that the STI (Systems Technologies Inc.) tire model, which can effectively reflect the coupling relationship between the tire longitudinal force and lateral force, is established based on experimental data and firstly adopted in the bus YSC system design. The second contribution is a novel YSC strategy based on ANFTSM, which has the merits of fast transient response, finite time convergence and high robustness against uncertainties and external disturbances. The third contribution is that the robust least-squares allocation method is used to solve the optimal allocation problem of the tire forces, whose objective is to achieve the desired direct yaw moment through the effective distribution of the brake force of each tire. To verify the feasibility, effectiveness and practicality of the proposed bus YSC approach, the TruckSim-Simulink co-simulation results are finally provided.
Clinic Correlation and Prognostic Value of P4HB and GRP78 Expression in Gastric Cancer
Authors: Zhang Chenfei , Zhao Wenjing , Zhang Xingsong , Wu Tongyu , Zhang Xunlei , Song Li , Xu Weiwei , Chen Xudong , Yang Lei
Published: June 2020

Background: Prolyl 4-hydroxylase, beta polypeptide (P4HB) and Glucose‑regulated protein 78 (GRP78) are represent for poor prognosis of various cancers. However, rare research investigate the correlation of them in cancer. This study aimed to investigate the correlation and prognostic value of P4HB and GRP78 expression along with clinical features in gastric cancer (GC).Methods: A total of 150 GC tissue samples separately evaluated P4HB and GRP78 protein expression by immunohistochemistry. Association of P4HB and GRP78 expression with clinicopathological features was analyzed. Bioinformatics analyses were performed to find correlation between mRNAs and pathways. Kaplan-Meier analyses were taken to compare survival curves. Univariate and multivariate Cox regression models used to analyze the impact of prognostic factors on overall survival (OS). A prognostic nomogram was constructed based on the multivariate Cox regression model, and compared to TNM stage in discrimination ability and clinical usefulness.Results: P4HB and GRP78 expression were both associated with tumor invasion and lymph node metastasis. P4HB protein positively correlated with GRP78, as well as the same tendency of mRNAs in both GC tissue and cell databases. Bioinformatics analyses indicated that P4HB and GRP78 may be associated with protein folding and response to ER stress, and the protein processing in ER pathway. High single or co-expression of P4HB and GRP78 represented for a shorter OS. When stratified by postoperative adjuvant chemotherapy, the high co-expression was only related to unfavorable prognosis of with chemotherapy group, especially in advanced stage. Multivariate Cox regression analysis identified co-expression of P4HB and GRP78 as an independent prognostic factor for OS. The nomogram including the co-expression was better than TNM stage in discrimination ability and clinical usefulness through the receiver operating characteristic (ROC) and decision curve analysis (DCA) curves.Conclusion: P4HB was positively correlated with GRP78 expression, co-expression of them was an independent prognostic factor, could serve as a predictive marker for GC patients with postoperative adjuvant chemotherapy in advanced stage.
MiR-221-3p-Mediated Downregulation of MDM2 Reverses the Paclitaxel Resistance of Non-Small Cell Lung Cancer in Vitro and in Vivo
Authors: Ni Liwei , Xu Jianhao , Zhao Fenglun , Dai Xiaoxiao , Tao Jialong , Pan Jie , Shi Aiming , Shen Zhu , Su Cunjin , Zhang Yusong
Published: June 2020

Background: MicroRNAs (miRNAs) are involved in the initiation and development of cancer, and participate in drug resistance. Paclitaxel (PTX) is first-line chemotherapy drug for advanced non-small cell lung cancer (NSCLC). The abnormal miRNA expression in NSCLC and its association with chemotherapy drug resistance remains largely unknown. The study aimed to investigate the aberrant expression of miR-221-3p in NSCLC and to elucidate its molecular mechanisms in relation to PTX resistance.Methods: Quantitative polymerase chain reaction (qPCR) was used to examine miRNA and messenger RNA (mRNA) in NSCLC tissues and cell lines. The roles of miR-221-3p in NSCLC progression and drug resistance were assessed by Western blot analysis, colony formation assay, and CCK-8. Dual-luciferase reporter assay was conducted to evaluate the interaction between miR-221-3p and MDM2. Xenograft tumor models were established by subcutaneously injecting PTX-resistant A549 cells (A549/Taxol) to assess the effect of miR-221-3p on tumor growth. Data regarding miRNAs and target proteins from 20 NSCLC tissues and paired non-cancerous matched tissues were also obtained for correlation analysis. Results: PTX increased miR-221-3p expression, which regulated MDM2/P53 expression in the PTX-sensitive NSCLC strain (A549). Meanwhile, miR-221-3p was rarely expressed and not interfered by PTX in A549/Taxol. Dual luciferase reporter assay confirmed that miR-221-3p specifically binds to MDM2 mRNA. MiR-221-3p down-regulation reduced the sensitivity of A549 cells to PTX, whereas its up-regulation partially reversed the A549/Taxol cells resistance to PTX and increased the chemosensitivity of A549/Taxol cells to PTX in xenograft models. QPCR analysis revealed that miR-221-3p expression increased, whereas the MDM2 level decreased in NSCLC tumor tissues. Furthermore, the result of Western bolt analysis showed that P53 was lowly expressed in tumor tissues with MDM2 overexpression.Conclusions: MiR-221-3p overexpression could regulate MDM2/p53 signaling pathway to reverse the PTX resistance of NSCLC and induce apoptosis in vitro and vivo.
WITHDRAWN: The LncRNA XIST Promotes Colorectal Cancer Cell Growth Through Regulating miR-497-5p/FOXK1 Axis
Authors: Wang Nan , He Jia-Xing , Jia Guo-Zhan , Wang Ke , Zhou Shuai , Wu Tao , He Xian-Li
Published: June 2020

Background: Recently, accumulated numbers of studies have reported that long noncoding RNAs (lncRNAs) process an important role in tumorigenesis. As a new member found in lncRNAs, the role of lncRNA XIST (XIST) in colorectal cancer (CRC) was still elusive. The objective of this study was conducted to characterize a novel regulatory network involving XIST in CRC cells. Methods: The mRNAs of XIST, miR-497-5p, and forkhead box k1 (FOXK1) in CRC cells and tissues were detected using quantitative real-time polymerase chain reaction (qRT-PCR). And the proliferation and apoptosis of CRC cells were determined using cell counting kit-8 assay and flow cytometry. Moreover, we also detected the cell migration and invasion using Transwell assays. The relationships between XIST, miR-497-5p, and FOXK1 were predicted and then the dual-luciferase reporter assay was used to their relationships. The protein level of FOXK1 was quantitated using western blot. Results: In CRC tissues and cell lines, XIST expression was up-regulated, in which also existed miR-497-5p down-regulation and FOXK1 up-regulation. XIST knockdown suppressed CRC cell proliferation and migration as well as its invasion. Moreover, blocking the XIST expression could inhibit CRC tumor growth in vivo and the effects were antagonized by loss of miR-497-5p. miR-497-5p was identified as a sponge of XIST and also targeted FOXK1 in CRC cells. Besides, XIST silencing-mediated inhibitory activity against CRC progression reversed miR-497-5p down-regulation or FOXK1 up-regulation. Conclusion: In conclusion, XIST promotes the malignancy of colon cancer cells partly by competitively binding to miR-497-5p, which then led to increased FOXK1 expression. We conclude that targeting XIST may be a possible treatment for colon cancer.
Eight-Gene Metabolic Signature Related with Tumor-Associated Macrophages Predicting Overall Survival for Hepatocellular Carcinoma
Authors: Huo Junyu , Zang Yunjin , Dong Hongjing , Liu Xiaoqiang , He Fu , Zhang Xiao , Wu Liqun
Published: June 2020

Background: In recent years, the relationship between tumor associated macrophages (TAMs) and solid tumors has become a research hotspot. The study aims at exploring the close relationship of TAMs with metabolic reprogramming genes in hepatocellular carcinoma(HCC), in order to provide a new way of treatment for HCC.Materials and methods: The study selected 343 HCC patients with complete survival information(survival time >= 1month) in the Cancer Genome Atlas (TCGA) as the study objects. Kaplan-Meier survival analysis assisted in figuring out the relationship between macrophage infiltration level and overall survival (OS), and Pearson correlation test to identify metabolic reprogramming genes(MRGs) related to tumor macrophage abundance. Lasso regression algorithm were conducted on prognosis related MRGs screened by Univariate Cox regression analysis and Kaplan-Meier survival analysis to construct the riskscore, another independent cohort (including 228 HCC patients) from the International Cancer Genome Consortium (ICGC) were used for external validation regarding the prognostic signature.Results: A risk score composed of 8 metabolic genes can accurately predict the OS of training cohort(TCGA) and testing cohort(ICGC). It is important that the risk score could widely used for people with different clinical characteristics, and is an independent predictor independent of other clinical factors affecting prognosis. As expected, high-risk group exhibited an obviously higher macrophage abundance relative to low-risk group, and the risk score presented a positive relation to the expression level of three commonly used immune checkpoints(PD1,PDL1,CTLA4).Conclusion: Our study constructed and validated a novel eight‑gene signature for predicting HCC patients’ OS, which possibly contributed to making clinical treatment decisions.
Galectin-3: A Potential Biomarker of Rheumatic Diseases
Authors: Gruszewska Ewa , Cylwik Bogdan , Gińdzieńska-Sieśkiewicz Ewa , Kowal-Bielecka Otylia , Mroczko Barbara , Chrostek Lech
Published: June 2020

Background: The purpose of our study was to assess the serum galectin-3 level and its potential association with disease activity and severity indexes in patients with rheumatic diseases.Methods: Eighty-two patients with rheumatoid arthritis (RA), 49 patients with systemic sclerosis (SSc), and 18 patients with systemic lupus erythematosus (SLE) were enrolled in this study. The control group comprised 30 healthy controls. Galectin-3 concentration in serum was measured using immunochemical method. Results: The galectin-3 concentration were significantly elevated in the RA, SSc and SLE in comparison to the control group (P=0.000, P=0.000, P<0.001; respectively). But there were no significant differences in the serum galectin-3 levels between rheumatic diseases (H=0.395, P=0.821). In RA and SSc patients, galectin-3 positively correlated with erythrocyte sedimentation rate (R=0.332, P=0.004; R=0.384, P=0.009; respectively). The diagnostic accuracy (ACC) of galectin-3 was high in all rheumatic diseases (87.5% for RA, 83.1% for SSc, 81.1% for SLE). ROC analysis revealed that galectin-3 had an excellent diagnostic power in RA (AUC=0.911) and SSc (AUC=0.903) and very good for SLE (AUC=0.859).Conclusions: We concluded that serum galectin-3 due to the high diagnostic power can be a very good laboratory marker in RA and SSc patients and a useful tool in the diagnosis of SLE.
WITHDRAWN: Applicability of a Tool for Comprehensive Assessments: the Expanded Guide for Monitoring Child Development
Authors: Pekcici Emine Bahar Bingoler
Published: June 2020

Background: Pediatricians globally are in critical need of tools enabling comprehensive information about children and families while also saving face-to-face time. This study examined the applicability of the expanded version of the Guide for Monitoring Child Development (GMCD), a free-of-charge tool used in over 30 countries.The Expanded GMCD is a written tool incorporating the biopsychosocial model of healthcare delivery, bioecological theory of child development, and two World Health Organization frameworks: International Classification of Functioning, Disability and Health, and Nurturing Care. Methods: Parents of children attending Ankara University Developmental Pediatrics Division, Turkey, were given or digitally sent the Expanded GMCD to complete before their first assessment. The completeness of the responses to the four Expanded GMCD domains and factors associated with full completion were ascertained using multivariate analyses. Results: Of 480 children, 57% were boys, median age was 17.0 (IQR: 9.0-27.0) months. Completion rates were 78%, 87% and 92% for all four, at least three and at least two domains, respectively. All four domains “body structures and functioning,” “health conditions,” “activities and participation,” and “environmental factors” had completion rates >80%. The Expanded GMCD provided holistic information: 87% of children had developmental difficulties and special needs; 60% had chronic conditions requiring follow-up; over 20% of parents reported stigmatization and maternal depression; over 10% unemployment and financial difficulties, not getting enough support from friends and relatives, paternal depression; and 5% intra-family conflict. In the logistic regression analyses, parents of children ≤ 6 months more likely completed <4 domains compared to parents of older children (OR: 2.24; 95% CI: 1.25-3.72); maternal education less than high school (OR: 1.38; 95% CI: 0.87-2.20) and having multiple children (OR: 1.48; 95% CI: 0.94-2.35) were not significantly associated with the full completion of the Expanded GMCD.Conclusion:The applicability of the Expanded GMCD in this study in children with diverse health conditions and families with different educational levels implies its potential for applicability in other settings. Using the free-of-charge Expanded GMCD in healthcare delivery including telemedicine may address the gaps in the implementation of the theory, model and framework-based comprehensive tools for children and their families.
The impact of COVID-19 pandemic on pediatric rheumatology patients under immunosuppressive therapy: A single-center experience
Authors: Koker Oya , Demirkan Fatma Gul , Kayaalp Gulsah , Cakmak Figen , Tanatar Ayse , Karadag Serife Gul , Sonmez Emine , Omeroglu Rukiye , Ayaz Nuray Aktay
Published: June 2020

Objective: The aim of the research was to further broaden current knowledge of whether severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease 2019 (COVID-19) entails a risk for children with rheumatic diseases regarding immunosuppressive treatment.Methods: Telephone-survey was administered by conducting interviews with the parents. A message containing a link to the actual questionnaire was sent to their phones simultaneously. The medical records of the patients were reviewed for gathering information about demographic data, clinical follow-up, and treatments.Results: Patients who were followed up with immunosuppressive treatment (n=439) were attempted to be contacted between 1 May 2020 and 15 May 2020. The diagnostic distribution of patients who were accessible and eligible for the study was as follows; juvenile idiopathic arthritis (JIA) (n=243, 58.7%), autoinflammatory diseases (n=109, 26.3%), autoimmune connective tissue diseases (n=51, 12.3%) and vasculitis (n=11, 2.7%). In the entire cohort, the mean age was 12 ± 4.7 years, and 54.1% (n=224) of the patients were female. One patient with seronegative polyarticular JIA, previously prescribed methotrexate and receiving leflunomide during pandemic has been identified to be diagnosed with COVID-19. None of the patients, including the patient diagnosed with COVID-19, had any severe symptoms. More than half of the patients with household contacts required hospitalization as they were asymptomatic.Conclusion: Although circumstances such as compliance in social distancing policy, transmission patterns, attitude following contact may influence the results, immunosuppressive treatment does not seem to pose additional risk in terms of COVID-19.
Prognostic value of tumor-infiltrating immune cells in primary colorectal cancer and metastases
Authors: Martin Steve Zacharias , Tagscherer Katrin E. , Deckert Stefanie , Horst David , Moehler Markus , Lang Hauke , Roth Wilfried
Published: June 2020

Background

Precise prognostic biomarkers are urgently needed to improve treatment and hence prognosis for patients with metastasized colorectal carcinoma. Tumor-infiltrating CD3 and CD8 positive lymphocytes have been shown to robustly predict survival of colorectal cancer in stages I-III in retro- and prospective studies. Their clinical value in metastasized tumors or the role of other types of immune cells is not well known.
Methods

We performed a detailed characterization of tumor infiltrating immune cells of primary colorectal cancer and metastases of 55 patients. Immune infiltrates were assessed visually and digitally.
Results

High densities of CD3, CD8, CD20, CD4, CD45R0, CD68, FOXP3, PD1 and PD-L1- positive cells in both primary colorectal cancer and metastases were significantly associated with prolonged survival in univariate and multivariate analysis. For CD3-CD8 immunoscore, CD8-CD20 TB cell score, CD45R0, CD68 and PD1 the evaluation of metastatic immune infiltrates showed superior hazard ratios, compared to evaluation of primary tumor-infiltrating immune cells (hazard ratio = 9.2; 5.7; 8.9; 5.7; 6.0, respectively). In case of FOXP3, CD4 and PD-L1 the combined evaluation of primary and metastatic immune infiltrates increased prognostic precision even further (hazard ratio = 5.7; 19.6 and 8.5, respectively). Visual analysis confirmed digital image analysis, but showed inferior hazard ratios.
Conclusions

A broad range of types of immune infiltrates predicts longer survival in metastasized colorectal cancer patients. Of all immune infiltrates, CD4 showed the highest prognostic precision. The combined assessment in primary colorectal cancer and metastases is valuable in most cases. Thus, automated digital analysis of immune infiltrates in colorectal metastases could improve the prognostic stratification of patients.
Indications of Lymph Node Metastasis and Survival Analysis in T1N+M0 Gastric Cancer: a Population-Based Study
Authors: Jin Peng , Li Yang , Ma Shuai , Kang Wenzhe , Liu Hao , Ma Fuhai , Hu Haitao , Li Weikun , Tian Yantao
Published: June 2020

Background

Since the definition of early gastric cancer (EGC) was first proposed in 1971, the treatment of gastric cancer with or without lymph node metastasis (LNM) has changed a lot. The present study aims to identify risk factors for LNM and prognosis, and to further evaluate the indications for adjuvant chemotherapy (AC) in T1N + M0 gastric cancer.
Methods

A total of 1291 patients with T1N + M0 gastric cancer were retrieved from the Surveillance, Epidemiology, and End Results (SEER) database. Univariate and multivariate analyses were performed to identify risk factors for LNM. The effect of LNM on overall survival (OS) and cancer-specific survival (CSS) was compared with patients grouped into T1N0-1 and T1N2-3, as the indications for AC.
Results

The rate of LNM was 19.52%. Multivariate analyses showed age, tumor size, invasion depth, and type of differentiation and retrieved LNs were associated with LNM (p < 0.05). Cox multivariate analyses indicated age, sex, tumor size, N stage were independent predictors of OS and CSS (p < 0.05), while race was indicator for OS (HR 0.866; 95%CI 0.750–0.999, p = 0.049), but not for CSS (HR 0.878; 95% CI 0.723–1.065, p = 0.187). In addition, survival analysis showed the proportion of patients in N+/N0 was better distributed than N0-1/N2-3b. There were statistically significant differences in OS and CSS between patients with and without chemotherapy in pT1N1M0 patients (p༜0.05).
Conclusions

Both tumor size and invasion depth are associated with LNM and prognosis. LNM is an important predictor of prognosis. pT1N + M0 may be appropriate candidates for AC. Currently, the treatment and prognosis of T1N0M0/T1N + M0 are completely different. An updated definition of EGC, taking into tumor size, invasion depth and LNM, may be more appropriate in an era of precision medicine.
Reliability of SNIP test in healthy children from 6 to 11 years.
Authors: Marcelino Ana Aline , Fregonezi Guilherme , Marques Layana , Lista-Paz Ana , Torres-Castro Rodrigo , RESQUETI VANESSA R.
Published: June 2020

Background

Sniff nasal inspiratory pressure (SNIP) is a voluntary inspiratory maneuver measured through a plug occluding one nostril. The investigation of the number of maneuvers necessary to reach the highest peak of SNIP in pediatric populations has been inconsistent. Thus, our goal was to assess the reliability SNIP in healthy children aged 6 to 11 years and compare with regard to sex and age group, as well as to determine the adequate number of maneuvers.
Methods

This cross-sectional study included healthy children with normal pulmonary function. Were performed 12 to 20 maneuvers SNIP near functional residual capacity, with a 30 s rest between each. Reliability was tested using intraclass correlation coefficient (ICC), standard error of measurement (SEM), minimal detectable change (MDC), and Bland-Altman analysis for agreement.
Results

A total of 121 children (62 girls [51%]) were included. The ICC and corresponding confidence interval (CI) between the highest measure and the first reproducible maneuver was 0.752 (0.656–0.824), SEM of 10.37 cmH2O and MDC of 28.74 cmH2O. For children aged 6–7 and 8–11 years, the ICC (CI) was 0.669 (0.427–0.822), SEM = 10.76 cmH2O and MDC = 29.82 cmH2O, and 0.774 (0.662–0.852), with SEM = 9.74 cmH2O and MDC = 26.05 cmH2O, respectively. For girls, the ICC (CI) was 0.817 (0.706–0.889), SEM = 9.40 cmH2O and MDC = 26.05 cmH2O; for boys, 0.671 (0.487–0.798), SEM = 11.51 cmH2O and MDC = 31.90 cmH2O. Approximately 80% of the total sample reached the highest SNIP before the 10th maneuver.
Conclusions

SNIP demonstrated moderate reliability between the maneuvers in children aged 6 to 11 years. Otherwise, older children and girls reached the SNIP peak faster. Finally, results suggested that 12 maneuvers were sufficient for healthy children aged 6 to 11 years to achieve the highest SNIP peak.
Association between Decreased Thyroid Stimulating Hormone and Hyperuricemia in Type 2 Diabetic Patients with Early-stage Diabetic Kidney Disease
Authors: Feng Xiaomeng , Huang Jing , Peng Yan , Xu Yuan
Published: June 2020

Background

Serum uric acid (SUA) is associated with the development of diabetic kidney disease (DKD). Thyroid hormones can regulate metabolism and insulin resistance. The relationship between SUA and thyroid function is still uncertain.
Methods

254 type 2 diabetic patients with early-stage DKD were enrolled in current study and were further classified as high SUA group (SUA > 360 µmol/L, n = 126) and normal SUA group (SUA ≤ 360 µmol/L, n = 128). 85 control subjects were recruited as control group. The clinical characteristics were obtained via face-to-face surveys and medical records.
Results

Compared with normal SUA group and control group, high SUA group exhibited the increased SUA, free triiodothyronine and free thyroxine levels, and the decreased thyroid stimulating hormone (TSH) level (P < 0.017 for all), and no significant difference was detected in these parameters between normal SUA group and control group. Furthermore, the increased creatinine (β = 2.049, P < 0.001), triglycerides (β = 10.068, P < 0.001), urinary albumin-to-creatinine ratio (β = 0.262, P = 0.001), fasting blood glucose (β = 5.280, P = 0.003) and fasting insulin (β = 1.440, P = 0.034) levels, and the decreased TSH (β = -24.906, P < 0.001) level were independently correlated with higher SUA level in type 2 diabetic patients with early-stage DKD. Notably, decreased TSH retained a significant association (odds ratio = 1.654, P = 0.002) with hyperuricemia in type 2 diabetic patients with early-stage DKD.
Conclusions

TSH is negatively correlated with SUA, and decreased TSH is an independent risk factor for hyperuricemia in type 2 diabetic patients with early-stage DKD. These results indicate that thyroid hormones, TSH in particular, might participate in regulating uric acid metabolism in patients with early-stage DKD.
Correction of Radial Load Distribution Integral for Radial Bearings
Authors: Hou Yu , Yin Yi , Wang Xi
Published: June 2020

The radial load distribution integral is corrected for radial bearings. The error of Harris integral method for calculating the radial load distribution is analysed. The error is found absolutely caused by the inaccurate values of the radial load distribution integral given by Harris. Based on the extent of the load zone, the radial load distribution integral is corrected by three stages. The corrected radial load distribution integral is capable of calculating the load distribution of a bearing with a small load zone caused by a light external load or a great radial clearance. The corrected radial load distribution integral is found affected by the number of rolling elements. According to the variation of the number of rolling elements participating in the radial load transfer, the corrected radial load distribution integral can be divided into different phases. Some specific numerical examples are shown to illustrate the performance of the corrected radial load distribution integral. The comparison between the results obtained from the corrected radial load distribution integral and Harris integral shows the higher accuracy and superiority of the corrected radial load distribution integral.
Gender equity and norms in health programs: learnings from a drowning reduction program in Bangladesh
Authors: Gupta Medhavi , Rahman Aminur , Dutta Notan Chandra , Hossain Md. Shafkat , Nambiar Devaki , Parveen Samina , Ivers Rebecca , Jagnoor Jagnoor
Published: June 2020

Background: Community-based health programs implemented in low-and middle-income countries have additional health impacts beyond their targeted outcomes, such as on gender norms, roles and relationships, partly due to their engagement of local human resources. We conducted a gender analysis on a drowning reduction program in rural Bangladesh providing survival swimming classes to children to identify unexpected consequences.Methods: A mixed-methods approach was used. Quantitative program monitoring data was analysed to assess gender differences in program staff recruitment, participation and engagement. A qualitative approach using interviews, focus group discussions and observations aimed to find explanations for quantitative findings and additional experiences of the program. The analysis was conducted using Family Health International 360’s Gender Integration Framework.Results: Women were not hired in leadership roles in the implementing organisation due to constraints on transport access and perceptions on women’s ability to conduct labour-intensive activities. However, the program influenced communities to become more accepting of local women’s mobility and involvement in employed work due to their engagement in the program as swim instructors. Women swim instructors were also more satisfied with the pay and part-time nature of the work as men were able to earn more elsewhere, and so women were recruited in higher numbers by the implementing organisation. Fewer girls participated in the swimming classes than boys due to cultural perceptions on appropriate activities for girls and their greater involvement in domestic work.Conclusions: Within the implementing organisation, changes to attitudes and the formulation of gender-specific strategies will support women in leadership roles, ensuring that women-specific issues are considered in program delivery. The implementing organisation may also consider strategies to combat perceptions that lower-paying part time work is more suitable for women than men. Systematised strategies are required to ensure equal participation of girls and boys in swim classes and enable equitable drowning outcomes. Addressing these issues would have positive implications for the health and equity of both men and women in these rural communities.
Electronic Forms for Patient Reported Outcome Measures (PROMs) are an Effective, Time-Efficient, and Cost-Minimizing Alternative to Paper Forms
Authors: Yu Jennifer Y , Goldberg Talia , Lao Nicholas , Feldman Brian M , Goh Y. Ingrid
Published: June 2020

BACKGROUND: Patient reported outcome measures (PROMs) provide valuable information to the healthcare team regarding their patient’s health status. Identified dilemmas of PROMs completed on paper include missing answers, incorrectly scored answers, and missing questionnaires. Collecting PROMS on an electronic platform can potentially avoid these challenges. The objectives of this project were to a) determine the equivalence of the paper and electronic forms (e-form) of Childhood Health Assessment Questionnaire (CHAQ) and Quality of My Life (QoML) questionnaires; b) identify potential benefits and barriers associated with using an e-form to capture patient reported outcome measures (PROMs); and c) gather feedback on user experience. METHODS: Participants completed both a paper and an e-form of the questionnaires in a randomized order, following which they completed a feedback survey. Agreement of the scores between the forms were statistically analyzed using the intraclass correlation coefficient (95% CI) and bias was assessed using a Bland-Altman plot. Completion and processing times of the forms were compared using mean and median measures. Quantitative analysis was performed to assess user experience ratings, while comments were qualitatively analyzed to identify important themes.RESULTS: 196 patients participated in this project. Scores on the forms had high intraclass correlation coefficient (ICC) agreement >0.9. New patients took longer than returning patients to complete the forms. Overall, the e-form was completed and processed in a shorter amount of time than the paper form. 83% of survey respondents indicated that they either preferred the e-form or had no preference. Approximately 10% of respondents suggested improvements to improve the user interface.CONCLUSIONS: E-forms collect comparable information in an efficient manner to paper forms. Given that patients and caregivers indicated they preferred completing PROMs in this manner, we will implement their suggested changes and incorporate e-forms as standard practice for PROMs collection in our pediatric rheumatology clinic.
Production of the 13C/15N single-labeled insecticidal protein Cry1Ab/Ac for the assessment of metabolic fate using recombinant Escherichia coli
Authors: Wang Zibo , Hu Cong , Sun Yu , Jiang Wei , Wu Guogan , Pan Aihu , Li Peng , Tang Xueming
Published: June 2020

Stable isotope-labeled Cry1Ab/Ac protein is necessary for the metabolic study of exogenous insecticidal protein in soil using the stable isotope labeling technique, but no recombinant expression protocols for this protein have been reported. The artificially synthesized gene Cry1Ab/Ac of Bt rice Huahui No. 1, which obtained the safety certificate in China, was subcloned into pUC57 in this study, and the expression vector pET-28a-CryAb/Ac was constructed and transformed into Escherichia coli BL21 (DE3) competent cells. Next, 0.2 mM IPTG was added to these cells and cultured at 37°C for 4 h to induce the expressed protein to form inclusion bodies in the presence of M9 medium containing either [U-13C] glucose (5% 13C-enriched) or [15N] ammonium chloride (5% 15N-enriched). Then Cry inclusion bodies were dissolved in urea and purified by Ni column affinity chromatography under denaturing conditions, renatured by dialysis, and further detected by SDS-PAGE and Western blot. The purities of 13C/15N-labeled Cry proteins were each 99%, the amounts of which were 12.6 mg/L and 8.8 mg/L. The δ 13C and δ 15N values of 13C-labeled Cry protein and 15N-labeled Cry protein were 3268.68‰ and 2854.28‰, respectively. An insecticidal test showed that the prokaryotic expression of Cry1Ab/Ac protein had strong insecticidal activity. The stable isotope-labeled insecticidal Cry proteins produced for the first time in this study will provide an experimental basis for future metabolic studies of Cry protein in soil and the characteristics of nitrogen (N) and carbon (C) transformation. The findings will also provide a reference and basis for elucidating the environmental behaviors and ecological effects of Cry plants and expressed products.
Multimodal Ellipsoid Model for Non-Probabilistic Structural Uncertainty Quantification and Propagation
Authors: Liu Jie , Yu Zhongbo , Zhang Dequan , Liu Hao
Published: June 2020

The traditional ellipsoid convex set is a kind of basic non-probabilistic model to measure uncertainties. However, it is difficult or inaccurate to quantify the uncertainties of variables with multimodal distributed samples. In this paper, a more generalized non-probabilistic ellipsoid model named multimodal ellipsoid model is proposed to effectively deal with the multimodal distributed samples. The samples with one or more similar properties are clustered together, and the principal directions of the samples and characteristic matrix are appropriately found through the Gaussian mixture model. Then, the multimodal ellipsoid model can be constructed by using the elliptical contour features of the Gaussian model to measure the uncertainties of variables. The proposed multimodal ellipsoid model can not only establish traditional ellipsoid model, but also establish multi-ellipsoid model for uncertain variables with multimodal samples. Furthermore, combining with the multimodal ellipsoid model and performance measure approach, the uncertain propagation results of system are obtained accurately. Three numerical examples and one engineering application are provided to demonstrate the effectiveness and accuracy of the proposed multimodal ellipsoid model.