bluuebunny/crossref_metadata_2025 huggingface dataset:
Sex trafficking, prostitution, and increased HIV risk among women during and after the 2015 Nepal earthquake
Authors: Joshi Ranjila , Andersen Pernille Tanggaard , Thapa Subash , Aro Arja R
Published: September 2020

Women might be at increased risk of HIV infection after a disaster situation due to several interlinked environmental and social factors, such as increased sex trafficking and prostitution, in resource-limited settings. However, this information has not been clearly understood. Based on the review of available gray and peer-reviewed evidence, the present debate paper summarizes potential factors for increasing women’s HIV risk during/after two earthquakes that hit Nepal in 2015. Poverty and socio-economic crisis, displacement and reduced social capital, increased rate of sex trafficking and prostitution, and poor access to health care seem to be the factors to increase women’s HIV risk in the earthquake-affected areas of Nepal. There is a lack of essential empirical evidence on environmental and social factors (e.g. increased sex trafficking and prostitution) that are linked with women’s HIV risk in the post-disaster phase. Therefore, the factors and interactions discussed should be further studied potentially in disaster-affected areas so that locally and culturally salient and sustainable relief and reconstruction strategies, which include strategies for preventing HIV risk in post-disaster situations, can be developed.
Modern radiopharmaceuticals for lung cancer imaging with positron emission tomography/computed tomography scan: A systematic review
Authors: Theodoropoulos Athanasios S , Gkiozos Ioannis , Kontopyrgias Georgios , Charpidou Adrianni , Kotteas Elias , Kyrgias George , Tolia Maria
Published: September 2020

Introduction:

In this study, we evaluated the use and the contribution of radiopharmaceuticals to the field of lung neoplasms imaging using positron emission tomography/computed tomography.

Methods:

We conducted review of the current literature at PubMed/MEDLINE until February 2020. The search language was English.

Results:

The most widely used radiopharmaceuticals are the following: Experimental/pre-clinical approaches: (18)F-Misonidazole (18F-MISO) under clinical development, D(18)F-Fluoro-Methyl-Tyrosine (18F-FMT), 18F-FAMT (L-[3-18F] (18)F-Fluorothymidine (18F-FLT)), (18)F-Fluoro-Azomycin-Arabinoside (18F-FAZA), (68)Ga-Neomannosylated-Human-Serum-Albumin (68Ga-MSA) (23), (68)Ga-Tetraazacyclododecane (68Ga-DOTA) (as theranostic agent), (11)C-Methionine (11C-MET), 18F-FPDOPA, ανβ3 integrin, 68Ga-RGD2, 64Cu-DOTA-RGD, 18F-Alfatide, Folate Radio tracers, and immuno-positron emission tomography radiopharmaceutical agents. Clinically approved procedures/radiopharmaceuticals agents: (18)F-Fluoro-Deoxy-Glucose (18F-FDG), (18)F-sodium fluoride (18F-NaF) (bone metastases), and (68)Ga-Tetraazacyclododecane (68Ga-DOTA). The quantitative determination and the change in radiopharmaceutical uptake parameters such as standard uptake value, metabolic tumor volume, total lesion glycolysis, FAZA tumor to muscle ratio, standard uptake value tumor to liver ratio, standard uptake value tumor to spleen ratio, standard uptake value maximum ratio, and the degree of hypoxia have prognostic and predictive (concerning the therapeutic outcome) value. They have been associated with the assessment of overall survival and disease free survival. With the positron emission tomography/computed tomography radiopharmaceuticals, the sensitivity and the specificity of the method have increased.

Conclusion:

In terms of lung cancer, positron emission tomography/computed tomography may have clinical application and utility (a) in personalizing treatment, (b) as a biomarker for the estimation of overall survival, disease free survival, and (c) apply a cost-effective patient approach because it reveals focuses of the disease, which are not found with the other imaging methods.
Conspiracy theories, election rigging, and support for democratic norms
Authors: Albertson Bethany , Guiler Kimberly
Published: September 2020

Under what conditions does conspiratorial rhetoric about election rigging change attitudes? We investigated this question using a survey experiment the day before and the morning of the 2016 US presidential election. We hypothesized that exposure to conspiratorial rhetoric about election interference would significantly heighten negative emotions (anxiety, anger) and undermine support for democratic institutions. Specifically, we expected that Democrats who read conspiratorial information about interference by the Russians in US elections, and that Republicans who read conspiratorial information about interference by the Democratic Party in US elections would express less support for key democratic norms. Our evidence largely supported our hypotheses. Americans exposed to a story claiming the election would be tampered with expressed less confidence in democratic institutions, and these effects were moderated by prior partisan beliefs about the actors most likely responsible for election meddling.
A Novel Local Cancellous Autograft Source for Anterior Cervical Discectomy With Fusion
Authors: O’Neill Conor N. , Walterscheid Zakk J. , Carmouche Jonathan J.
Published: September 2020

Study Design:

Case series.

Objectives:

Successful clinical outcome scores following anterior cervical discectomy and fusion (ACDF) have been correlated with high fusion rate. Published fusion rates using iliac crest bone graft (ICBG) have been shown to be as high as 100% for single-level fusions in some studies; however, there is potential associated morbidity with ICBG harvest. This technical description and preliminary case series assessed the clinical efficacy and results of a novel grafting technique for ACDF.

Methods:

Twelve patients underwent novel grafting technique for ACDF in which autograft was procured from the cervical vertebra adjacent to the operative disk. Patients were followed for 2 years using visual analogue pain scale (VAS) and radiological assessment of fusion.

Results:

Patients experienced clinically meaningful reduction of radicular symptoms in the affected arm(s) with an average preoperative VAS score of 5.0 ± 0.8 and an average 2-year postoperative score of 1.108 ± 0.475 ( P = .0013). Patients also experienced significant resolution of neck pain with an average preoperative VAS score of 7.1 ± 0.5 and average 2-year postoperative score of 2.708 ± 0.861 ( P = .0018). All patients achieved solid fusion by 1 year. There were no major or minor complications noted during follow-up.

Conclusions:

This procedure allows for both autograft harvest and cervical decompression to be performed through a single incision. In this series, this technique eliminated the morbidity associated with autograft harvest from the iliac crest while achieving high fusion rates and without additional technique-related complications.
Building Emotional Resilience with Big Five Personality Model Against COVID-19 Pandemic
Authors: Sahni Shalini , Kumari Shyama , Pachaury Prachi
Published: September 2020

The outbreak of novel coronavirus, which is declared as a ‘Global Pandemic’ by the World Health Organization (WHO), has affected around 210 countries and India is not an exception. It is an unprecedented ‘public health emergency’ and therefore, it is important that individuals should not fall into a prolonged depression or any other unhealthy psychological condition. Being concerned about the population at risk, the current study thus investigates how Big Five personality model can help in building emotional resilience during pandemic conditions. The current study thus investigates a sample of 254 adults at Delhi, selected through purposive sampling. Cluster analysis and stepwise regression analysis were conducted to establish the relationship and identify the significant personality traits required for building emotional resilience. The cluster analysis showed three main personality types (resilient, overcontrollers, and emotionally dysregulated) and further stepwise regression showed that individuals high on conscientiousness, openness and neuroticism were found to be associated with more change in emotional resilience. The findings thus achieved are a step towards psychological health of the individuals at risk. Additionally, the results of the study may be added to the psychological first aid (PFA) guide as reference point. Bearing in mind the potential for future research, it is recommended that longitudinal studies should be conducted, and the relationship should also be examined in the presence of other variables such as culture, life stressors and gender.
Preliminary Results From a US Clinical Trial of a Novel Synthetic Polymer Meniscal Implant
Authors: McKeon Brian P. , Zaslav Kenneth R. , Alfred Richard H. , Alley R. Maxwell , Edelson Richard H. , Gersoff Wayne K. , Greenleaf Jonathan E. , Kaeding Christopher C.
Published: September 2020

Background:

At least 760,000 outpatient meniscectomies are performed in the United States each year, making this the most common musculoskeletal procedure. However, meniscal resection can alter the joint biomechanics and overload the articular cartilage, which may contribute to degenerative changes and the need for knee replacement. Avoiding or delaying knee replacement is particularly important in younger or more active patients. Synthetic meniscal implants have been developed in an attempt to restore the natural joint biomechanics, alleviate pain and disability, and potentially minimize degenerative changes in patients who require meniscectomy.

Purpose

To evaluate the preliminary results from 2 ongoing trials that are evaluating the safety and effectiveness of a synthetic polymer meniscal implant (NUsurface; Active Implants, LLC).

Study Design:

Cohort study; Level of evidence, 2.

Methods:

This was a preliminary analysis of the first 100 patients enrolled across 2 studies for 12 months: a single-arm, intervention-only study and a randomized controlled trial comparing the investigational meniscal implant with nonsurgical therapy. There were 65 patients in the implant group (30 randomized) and 35 in the control group. Outcomes included Knee injury and Osteoarthritis Outcome Score (KOOS) and adverse events (AEs) collected at baseline and follow-up visits of 6 weeks, 6 months, and 12 months.

Results:

No statistically significant differences were found in baseline characteristics between the implant and control groups. At 12 months, follow-up KOOS data were available for 87% of the 100 included patients. Significantly greater improvements from baseline were observed in the implant group compared with controls in all KOOS subcomponents, except for symptoms (119%-177% greater improvement at 12 months). AEs were reported at similar rates between the 2 groups, with 12 AEs among 11 patients in the implant group (16.9%) versus 5 AEs among 5 patients (14.3%) in the control group ( P = .99).

Conclusion:

These preliminary results suggest significant improvements in pain and function scores with the implant over nonsurgical therapy and a similar adverse event rate.
Machine Learning Approach to Predict Risk of 90-Day Hospital Readmissions in Patients With Atrial Fibrillation: Implications for Quality Improvement in Healthcare
Authors: Hung Man , Hon Eric S. , Lauren Evelyn , Xu Julie , Judd Gary , Su Weicong
Published: September 2020

Background:

Atrial fibrillation (AF) in the elderly population is projected to increase over the next several decades. Catheter ablation shows promise as a treatment option and is becoming increasingly available. We examined 90-day hospital readmission for AF patients undergoing catheter ablation and utilized machine learning methods to explore the risk factors associated with these readmission trends.

Methods:

Data from the 2013 Nationwide Readmissions Database on AF cases were used to predict 90-day readmissions for AF with catheter ablation. Multiple machine learning methods such as k-Nearest Neighbors, Decision Tree, and Support Vector Machine were employed to determine variable importance and build risk prediction models. Accuracy, precision, sensitivity, specificity, and area under the curve were compared for each model.

Results:

The 90-day hospital readmission rate was 17.6%; the average age of the patients was 64.9 years; 62.9% of patients were male. Important variables in predicting 90-day hospital readmissions in patients with AF undergoing catheter ablation included the age of the patient, number of diagnoses on the patient’s record, and the total number of discharges from a hospital. The k-Nearest Neighbor had the best performance with a prediction accuracy of 85%. This was closely followed by Decision Tree, but Support Vector Machine was less ideal.

Conclusions:

Machine learning methods can produce accurate models in predicting hospital readmissions for patients with AF. The likelihood of readmission to the hospital increases as the patient age, total number of hospital discharges, and total number of patient diagnoses increase. Findings from this study can inform quality improvement in healthcare and in achieving patient-centered care.
Cue Ball Arthroplasty With Humeroradial Total Elbow Arthroplasty (TEA) Revision: An Approach to Managing Infection and Severe Ulnar Bone Loss in TEA
Authors: Gerow Daniel E , Tan Emily H , Bamberger H Brent
Published: September 2020

Total elbow arthroplasties (TEA) have become more prevalent as indications expand. However, TEA complications remain a treatment conundrum. One such complication, periprosthetic joint infections (PJIs) have been reported to occur in up to 12% of all TEA procedures. Irrigation and debridement with retention of hardware and antibiotic suppression has a high failure rate. Two stage revisions of TEA, while more morbid, is an effective approach with previous studies showing a 79% eradication rate. These cases are often associated with periprosthetic bone loss, adding to the surgical complexity. In our case report, we present the case of a 59 year old diabetic male with a primary TEA secondary to a distal humerus fracture who developed a deep infection and was successfully treated with explantation, cue ball antibiotic cement arthroplasty, and humeroradial revision. This case report will discuss the cue ball antibiotic spacer technique and humeroradial revision as a salvage procedure in TEA revisions in the setting of extensive ulnar bone loss.
VFFVA: dynamic load balancing enables large-scale flux variability analysis
Authors: Guebila Marouen Ben
Published: September 2020

Background

Genome-scale metabolic models are increasingly employed to predict the phenotype of various biological systems pertaining to healthcare and bioengineering. To characterize the full metabolic spectrum of such systems, Fast Flux Variability Analysis (FFVA) is commonly used in parallel with static load balancing. This approach assigns to each core an equal number of biochemical reactions without consideration of their solution complexity.

Results

Here, we present Very Fast Flux Variability Analysis (VFFVA) as a parallel implementation that dynamically balances the computation load between the cores in runtime which guarantees equal convergence time between them. VFFVA allowed to gain a threefold speedup factor with coupled models and up to 100 with ill-conditioned models along with a 14-fold decrease in memory usage.

Conclusions

VFFVA exploits the parallel capabilities of modern machines to enable biological insights through optimizing systems biology modeling. VFFVA is available in C, MATLAB, and Python athttps://github.com/marouenbg/VFFVA.
pmTM-align: scalable pairwise and multiple structure alignment with Apache Spark and OpenMP
Authors: Chen Weiya , Yao Chun , Guo Yingzhong , Wang Yan , Xue Zhidong
Published: September 2020

Background

Structure comparison can provide useful information to identify functional and evolutionary relationship between proteins. With the dramatic increase of protein structure data in the Protein Data Bank, computation time quickly becomes the bottleneck for large scale structure comparisons. To more efficiently deal with informative multiple structure alignment tasks, we propose pmTM-align, a parallel protein structure alignment approach based on mTM-align/TM-align. pmTM-align contains two stages to handle pairwise structure alignments with Spark and the phylogenetic tree-based multiple structure alignment task on a single computer with OpenMP.

Results

Experiments with the SABmark dataset showed that parallelization along with data structure optimization provided considerable speedup for mTM-align. The Spark-based structure alignments achieved near ideal scalability with large datasets, and the OpenMP-based construction of the phylogenetic tree accelerated the incremental alignment of multiple structures and metrics computation by a factor of about 2–5.

Conclusions

pmTM-align enables scalable pairwise and multiple structure alignment computing and offers more timely responses for medium to large-sized input data than existing alignment tools such as mTM-align.
Identification of Y chromosome markers in the eastern three-lined skink (Bassiana duperreyi) using in silico whole genome subtraction
Authors: Dissanayake Duminda Sampath Bandara , Holleley Clare Ellen , Hill Laura Kate , O’Meally Denis , Deakin Janine Eileen , Georges Arthur
Published: September 2020

Background

Homologous sex chromosomes can differentiate over time because recombination is suppressed in the region of the sex determining locus, leading to the accumulation of repeats, progressive loss of genes that lack differential influence on the sexes and sequence divergence on the hemizygous homolog. Divergence in the non-recombining regions leads to the accumulation of Y or W specific sequence useful for developing sex-linked markers. Here we use in silico whole-genome subtraction to identify putative sex-linked sequences in the scincid lizardBassiana duperreyiwhich has heteromorphic XY sex chromosomes.

Results

We generated 96.7 × 109150 bp paired-end genomic sequence reads from a XY male and 81.4 × 109paired-end reads from an XX female for in silico whole genome subtraction to yield Y enriched contigs. We identified 7 reliable markers which were validated as Y chromosome specific by polymerase chain reaction (PCR) against a panel of 20 males and 20 females.

Conclusions

The sex ofB. duperreyican be reversed by low temperatures (XX genotype reversed to a male phenotype). We have developed sex-specific markers to identify the underlying genotypic sex and its concordance or discordance with phenotypic sex in wild populations ofB. duperreyi. Our pipeline can be applied to isolate Y or W chromosome-specific sequences of any organism and is not restricted to sequence residing within single-copy genes. This study greatly improves our knowledge of the Y chromosome inB. duperreyiand will enhance future studies of reptile sex determination and sex chromosome evolution.
A WRKY transcription factor, TaWRKY42-B, facilitates initiation of leaf senescence by promoting jasmonic acid biosynthesis
Authors: Zhao Ming-Ming , Zhang Xiao-Wen , Liu Yong-Wei , Li Ke , Tan Qi , Zhou Shuo , Wang Geng , Zhou Chun-Jiang
Published: September 2020

Background

Leaf senescence comprises numerous cooperative events, integrates environmental signals with age-dependent developmental cues, and coordinates the multifaceted deterioration and source-to-sink allocation of nutrients. In crops, leaf senescence has long been regarded as an essential developmental stage for productivity and quality, whereas functional characterization of candidate genes involved in the regulation of leaf senescence has, thus far, been limited in wheat.

Results

In this study, we analyzed the expression profiles of 97 WRKY transcription factors (TFs) throughout the progression of leaf senescence in wheat and subsequently isolated a potential regulator of leaf senescence, TaWRKY42-B, for further functional investigation. By phenotypic and physiological analyses in TaWRKY42-B-overexpressing Arabidopsis plants and TaWRKY42-B-silenced wheat plants, we confirmed the positive role of TaWRKY42-B in the initiation of developmental and dark-induced leaf senescence. Furthermore, our results revealed that TaWRKY42-B promotes leaf senescence mainly by interacting with a JA biosynthesis gene, AtLOX3, and its ortholog, TaLOX3, which consequently contributes to the accumulation of JA content. In the present study, we also demonstrated that TaWRKY42-B was functionally conserved with AtWRKY53 in the initiation of age-dependent leaf senescence.

Conclusion

Our results revealed a novel positive regulator of leaf senescence, TaWRKY42-B, which mediates JA-related leaf senescence via activation of JA biosynthesis and has the potential to be a target gene for molecular breeding in wheat.
Sevoflurane modulates breast cancer cell survival via modulation of intracellular calcium homeostasis
Authors: Deng Xiaoqian , Vipani Megha , Liang Ge , Gouda Divakara , Wang Beibei , Wei Huafeng
Published: September 2020

Background

Some retrospective and in vitro studies suggest that general anesthetics influence breast cancer recurrence and metastasis. We compared the effects of general anesthetics sevoflurane versus propofol on breast cancer cell survival, proliferation and invasion in vitro. The investigation focused on effects in intracellular Ca2+ homeostasis as a mechanism for general anesthetic-mediated effects on breast cancer cell survival and metastasis.

Methods

Estrogen receptor-positive (MCF7) and estrogen receptor-negative (MDA-MB-436) human breast cancer cell lines along with normal breast tissue (MCF10A) were used. Cells were exposed to sevoflurane or propofol at clinically relevant and extreme doses and durations for dose- and time-dependence studies. Cell survival, proliferation and migration following anesthetic exposure were assessed. Intracellular and extracellular Ca2+ concentrations were modulated using Ca2+ chelation and a TRPV1 Ca2+ channel antagonist to examine the role of Ca2+ in mediating anesthetic effects.

Results

Sevoflurane affected breast cancer cell survival in dose-, time- and cell type-dependent manners. Sevoflurane, but not propofol, at equipotent and clinically relevant doses (2% vs. 2 μM) for 6 h significantly promoted breast cell survival in all three types of cells. Paradoxically, extreme exposure to sevoflurane (4%, 24 h) decreased survival in all three cell lines. Chelation of cytosolic Ca2+ dramatically decreased cell survival in both breast cancer lines but not control cells. Inhibition of TRPV1 receptors significantly reduced cell survival in all cell types, an effect that was partially reversed by equipotent sevoflurane but not propofol. Six-hour exposure to sevoflurane or propofol did not affect cell proliferation, metastasis or TRPV1 protein expression in any type of cell.

Conclusion

Sevoflurane, but not propofol, at clinically relevant concentrations and durations, increased survival of breast cancer cells in vitro but had no effect on cell proliferation, migration or TRPV1 expression. Breast cancer cells require higher cytoplasmic Ca2+ levels for survival than normal breast tissue. Sevoflurane affects breast cancer cell survival via modulation of intracellular Ca2+ homeostasis.
Associations of multiple serum biomarkers and the risk of cardiovascular disease in China
Authors: Yao Huichen , Hou Chenyang , Liu Weihua , Yi Jihu , Su Wencong , Hou Qingzhi
Published: September 2020

Background

Previous studies focus on one or several serum biomarkers and the risk of cardiovascular disease (CVD). This study aims to investigate the association of multiple serum biomarkers and the risk of CVD and evaluate the dose-relationship between a single serum metabolite and CVD.

Methods

Our case-control study included 161 CVD and 160 non-CVD patients who had a physical examination in the same hospital. We used stratified analysis and cubic restricted analysis to investigate the dose-response relationship of individual serum biomarkers and the CVD incident. Moreover, to investigate serum biomarkers and CVD, we used elastic net regression and logistic regression to build a multi-biomarker model.

Results

In a single serum biomarker model, we found serum FT4, T4. GLU, CREA, TG and LDL-c were positively associated with CVD. In the male group, serum T4, GLU and LDL-c were positively associated with CVD; and serum TG was positively associated with CVD in the female group. When patients ≤63 years old, serum T4, GLU, CREA and TG were positively associated with CVD, and serum TG and LDL-c were positively associated with CVD when patients > 63 years old. Moreover, serum GLU had nonlinearity relationship with CVD and serum TG and LDL-c had linearity association with CVD. Furthermore, we used elastic regression selecting 5 serum biomarkers (GLU, FT4, TG, HDL-c, LDL-c) which were independently associated with CVD incident and built multi-biomarker model. And the multi-biomarker model had much better sensitivity than single biomarker model.

Conclusion

The multi-biomarker model had much higher sensitivity than a single biomarker model for the prediction of CVD. Serum FT4, TG and LDL-c were positively associated with the risk of CVD in single and multiple serum biomarkers models, and serum TG and LDL-c had linearity relationship with CVD.
Adequacy of risk of bias assessment in surgical vs non-surgical trials in Cochrane reviews: a methodological study
Authors: Barcot Ognjen , Boric Matija , Dosenovic Svjetlana , Cavar Marija , Jelicic Kadic Antonia , Poklepovic Pericic Tina , Vukicevic Ivana , Vuka Ivana , Puljak Livia
Published: September 2020

Background

Bias in randomized controlled trials (RCTs) can lead to underestimation or overestimation of the true effects of interventions. Surgical RCTs may suffer from the risk of bias (RoB) that is avoidable in trials of other interventions, and vice versa. We aimed to compare the adequacy of RoB assessments in surgical versus non-surgical RCTs included in Cochrane reviews and to assess the most common differences in those RoB assessments. Due to specificities of surgical trials, i.e. difficulties associated with blinding of surgical interventions, we hypothesized that assessments of surgical trials may be more adequate, compared to RCTs of non-surgical interventions.

Methods

This was a methodological study, analyzing methods of published Cochrane systematic reviews. Data were extracted from RoB tables in Cochrane reviews (judgments and accompanying explanatory comment) for the following four RoB domains used in the 2011 Cochrane RoB tool: randomization, allocation concealment, blinding of participants and personnel, and blinding of outcome assessors. We defined adequate assessments as those that were in line with instructions from the Cochrane Handbook for Systematic Reviews of Interventions. The prevalence of adequate assessments was compared in surgical versus non-surgical trials. The most common differences in both groups of reviews were presented.

Results

In 729 analyzed Cochrane reviews, there were 10,537 included trials. The prevalence of adequate RoB judgments made by Cochrane authors ranged from 87.9, 95%CI (87.3 to 88.6%) for randomization to 70.7, 95%CI (69.8 to 71.5%) for blinding of participants and personnel. For all analyzed RoB domains, the prevalence of adequate RoB domains was higher in surgical trials than in non-surgical trials. For two RoB domains assessing blinding, this difference between surgical and non-surgical trials was statistically significant (P < 0.001), while the difference was not significant for the RoB domain regarding randomization (P = 0.124) and allocation concealment (P = 0.039, β < 0.8).

Conclusions

RoB judgments were more in line with instructions from the Cochrane Handbook when Cochrane reviews assessed surgical trials, compared to those that analyzed non-surgical interventions. However, further steps are warranted to scrutinize RoB assessment in trials of both surgical and non-surgical interventions.
A severe coronavirus disease 2019 patient with high-risk predisposing factors died from massive gastrointestinal bleeding: a case report
Authors: Chen Taojiang , Yang Qin , Duan Hongyu
Published: September 2020

Background

SARS-CoV-2 is highly infectious and has been a significant public health threat. Despite typical manifestations of illness are dominated by respiratory symptom, some patients have concurrent gastrointestinal manifestations, including nausea, diarrhea, and vomiting. Massive gastrointestinal bleeding, however, has rarely been reported.

Case presentation

We herein described a case of severe SARS-CoV-2 infected patient with several risk factors for poor prognosis, including male, hypertension, old age, mixed bacterial infection and multilobular infiltration on radiological imaging. After improvement of respiratory status, the onset of gastrointestinal bleeding occurred, probably resulting from direct viral invasion as evidenced by the positive findings for SARS-CoV-2 in the repeat stool specimens. Although aggressive resuscitation was administered, hematochezia was uncontrolled. The patient rapidly deteriorated, suffered from cardiac arrest, and expired.

Conclusions

Digestive symptoms could be severe in SARS-CoV-2 infected patients, especially for the high-risk individuals with predisposing conditions. A more thorough protocol for preventing cross-infection through faecal-oral transmission should be implemented in the process of patient care and infection control.
Age sequences of the elderly’ social network and its efficacies on well-being: an urban-rural comparison in China
Authors: Zheng Zhenhua , Chen Hong
Published: September 2020

Background

Although social network is a known determinant of the elderly’s well-being, it is not clear, in urban-rural and age-comparison, what its structural characteristics are and how it works for well-being. The research aims to discuss the features of the elderly’s social network and the social network efficacies on the well-being of older adults in China’s urban and rural areas as well as revealing the urban-rural disparities among the elderly of different age groups.

Methods

In this study, descriptive statistical analysis and structural equation Modeling (SEM) were used to make a group comparison between the urban and rural elderly of different age groups. All data are quoted from 2014 China Longitudinal Aging Social Survey (CLASS). The survey adopted the multi-stage probability sampling method, targeting Chinese senior citizens aged 60 and above, the ultimate samples totaled 11,511.

Results

The social network of the elderly in China feature a “reverse structure” in age sequences: with ageing, family network of the elderly expand while their friend network shrink; also, the expansion scale of the rural elderly’s family network is significantly larger than that of the city’s while the shrinkage scale of their friend network is smaller compared with its urban counterpart. The effect of family network on the rural elderly’s well-being shows a remarkable increase with age. However, there is no noticeable change in urban elderly groups of different ages.

Conclusion

The social network characteristics of the Chinese elderly are different between different age stages. Namely, the family network and the friend network have the “reverse structure “ in age sequences. Meanwhile, the family network and the friend network have different efficacies on the well-being of the elderly in China, and the differences between urban and rural areas are even more obvious. For rural elderly, family network has very important effects on their well-being. Moreover, With the increase of age, family network’s efficacies increase gradually. For urban elderly, comparatively, family network is just as important as friend network.
Validation of “(fr)AGILE”: a quick tool to identify multidimensional frailty in the elderly
Authors: Liguori Ilaria , Russo Gennaro , Bulli Giulia , Curcio Francesco , Flocco Veronica , Galizia Gianlugi , Della-Morte David , Gargiulo Gaetano , Testa Gianluca , Cacciatore Francesco , Bonaduce Domenico , Abete Pasquale
Published: September 2020

Background

Several tools have been proposed and validated to operationally define frailty. Recently, the Italian Frailty index (IFi), an Italian modified version of Frailty index, has been validated but its use in clinical practice is limited by long time of administration. Therefore, the aim of this study was to create and validate a quick version of the IFi (AGILE).

Methods

Validation study was performed by administering IFi and AGILE, after a Comprehensive Geriatric Assessment (CGA) in 401 subjects aged 65 or over (77 ± 7 years). AGILE was a 10-items tool created starting from the more predictive items of the four domains of frailty investigated by IFi (mental, physical, socioeconomic and nutritional). AGILE scores were stratified in light, moderate and severe frailty. At 24 months of follow-up, death, disability (taking into account an increase in ADL lost ≥1 from the baseline) and hospitalization were considered. Area under curve (AUC) was evaluated for both IFi and AGILE.

Results

Administration time was 9.5 ± 3.8 min for IFi administered after a CGA, and 2.4 ± 1.2 min for AGILE, regardless of CGA (p < 0.001). With increasing degree of frailty, prevalence of mortality increased progressively from 6.5 to 41.8% and from 9.0 to 33.3%, disability from 16.1 to 64.2% and from 22.1 to 59.8% and hospitalization from 17.2 to 58.7% and from 27.0 to 52.2% with AGILE and IFi, respectively (p = NS). Relative Risk for each unit of increase in AGILE was 56, 44 and 24% for mortality, disability and hospitalization, respectively and was lower for IFi (8, 7 and 4% for mortality, disability and hospitalization, respectively). The AUC was higher in AGILE vs. IFi for mortality (0.729 vs. 0.698), disability (0.715 vs. 0.682) and hospitalization (0.645 vs. 0.630).

Conclusions

Our study shows that AGILE is a rapid and effective tool for screening multidimensional frailty, able to predict mortality, disability and hospitalization, especially useful in care settings that require reliable assessment instruments with short administration time.
When polyuria does not stop: a case report on an unusual complication of hantavirus infection
Authors: Schwab Sebastian , Lissmann Simon , Schäfer Niklas , Isaak Alexander , Klingmüller Dietrich , Attenberger Ulrike , Eis-Hübinger Anna M. , Hofmann Jörg , Strassburg Christian P. , Lutz Philipp
Published: September 2020

Background

The clinical features, course and outcome of hantavirus infection is highly variable. Symptoms of the central nervous system may occur, but often present atypically and diagnostically challenging. Even though the incidence of hantavirus infection is increasing worldwide, this case is the first to describe diabetes insipidus centralis as a complication of hantavirus infection in the Western world.

Case presentation

A 49-year old male presenting with severe headache, nausea and photophobia to our neurology department was diagnosed with acute haemorrhage in the pituitary gland by magnetic resonance imaging. In the following days, the patient developed severe oliguric acute kidney failure. Diagnostic workup revealed a hantavirus infection, so that the pituitary haemorrhage resulting in hypopituitarism was seen as a consequence of hantavirus-induced hypophysitis. Under hormone replacement and symptomatic therapy, the patient’s condition and kidney function improved considerably, but significant polyuria persisted, which was initially attributed to recovery from kidney injury. However, water deprivation test revealed central diabetes insipidus, indicating involvement of the posterior pituitary gland. The amount of urine production normalized with desmopressin substitution.

Conclusion

Our case report highlights that neurological complications of hantavirus infection should be considered in patients with atypical clinical presentation.
The role of tissue elasticity in the differential diagnosis of benign and malignant breast lesions using shear wave elastography
Authors: Yang Hui , Xu Yongyuan , Zhao Yanan , Yin Jing , Chen Zhiyi , Huang Pintong
Published: September 2020

Background

Elastography is a promising way to evaluate tissue differences regarding stiffness, and the stiffness of the malignant breast lesions increased at the lesion margin. However, there is a lack of data on the value of the shear wave elastography (SWE) parameters of the surrounding tissue (shell) of different diameter on the diagnosis of benign and malignant breast lesions. Therefore, the purpose of our study was to evaluate the diagnostic performance of shell elasticity in the diagnosis of benign and malignant breast lesions using SWE.

Methods

Between September 2016 and June 2017, women with breast lesions underwent both conventional ultrasound (US) and SWE. Elastic values of the lesions peripheral tissue were determined according to the shell size, which was automatically drawn along the edge of the lesion using the following software guidelines: (1): 1 mm; (2): 2 mm; and (3): 3 mm. Quantitative elastographic features of the inner lesions and shell, including the elasticity mean (Emean), elasticity maximum (Emax), and elasticity minimum (Emin), were calculated using an online-available software. The receiver operating characteristic curves (ROCs) of the elastographic features was analyzed to assess the diagnostic performance, and the area under curve (AUC) of each elastographic feature was obtained. Logistic regression analysis was used to predict significant factors of malignancy, permitting the design of predictive models.

Results

This prospective study included 63 breast lesions of 63 women. Of the 63 lesions, 33 were malignant and 30 were benign. The diagnostic performance of Emax-3shell was the highest (AUC = 0.76) with a sensitivity of 60.6% and a specificity of 83.3%. According to stepwise logistic regression analysis, the Emax-3shell and the Emin-3shell were significant predictors of malignancy (p < 0.05). The AUC of the predictive equation was 0.86.

Conclusions

SWE features, particularly the combination of Emax-3shell and Emin-3shell can improve the diagnosis of breast lesions.
Migrant adolescents’ behavioral problems compared to host adolescents and adolescents in their region of origin: a longitudinal study
Authors: Fang Jian-Qun , Wang Yan-rong , Du Yun-Yun , Yan Guo-Li , Ma Fu-Li , Liu Yan-Qiu , Sun Wen-Xi , Chen Shi-Qi , Feng Li-Ping , Wei Jia , Liu Hao , Hu Jing , Zhang Zhao-Xia
Published: September 2020

Background

Since the 1990s, families from the ecologically hostile mountainous southern areas of Ningxia Province, China, have been migrating to the northern areas of the province. This study compared the prevalence of behavioral problems among migrant adolescents to those among host adolescents (adolescents from the northern areas) and adolescents in the region of origin (adolescents from the southern areas), to determine whether ecological migration is related to adolescent behavioral problems, and possible changes in such problems over time.

Methods

We used the Children and Adolescents Ecological Migration Survey on Mental Health, administered to 4805 students aged 12–16 years and their parents between 2012 and 2014 (W1), of whom 1753 students and their parents completed the follow-up between 2014 and 2017 (W2). Parents answered questions related to adolescent behavioral problems, main source of family income, parents’ desire to reverse migrate, improved standard of living, and parents’ educational attainment, while children completed the Eysenck Personality Questionnaire and a classroom environment questionnaire.

Results

The prevalence of behavioral problems among the migrant adolescents (28.04%) was significantly higher than among host adolescents (21.59%) or adolescents in the region of origin (24.37%; p < 0.001) at W1. After adjusting for gender and age, parents’ work outside the home was the main source of family income (OR = 1.42, 95% CI = 1.13–1.78), and adolescents’ learning burden (OR = 1.04, 95% CI = 1.01–1.06) in school negatively influenced behavioral problems. Strong student-teacher relationships (OR = 0.97,95% CI = 0.94–0.99) and parents who had no intention to move back to the original residence (OR = 0.70, 95% CI = 0.52–0.94) exerted a protective effect at W1; at W2, a protective effect was associated with improved living conditions (OR = 0.39–0.55, 95% CI = 0.25–0.84). The extent of behavioral problems among migrant adolescents significantly decreased after two years.

Conclusion

Ecological migration will increase children’s behavioral problems in the early stage, with various factors influencing the extent of these problems.
Prevalence and associated factors of psychological distress among a national sample of in-school adolescents in Morocco
Authors: Pengpid Supa , Peltzer Karl
Published: September 2020

Background

The goal of the study was to estimate the prevalence and correlates of psychological distress among adolescent school children in Morocco.

Methods

Nationally representative cross-sectional data were analysed from 6745 adolescents (15 years median age) that responded to questions on a two-item measure of psychological distress from “2016 Morocco Global School-Based Student Health Survey (GSHS).”

Results

The prevalence of psychological distress was 23.3, 18.0% among males and 29.2% among females. In adjusted logistic regression analysis, female sex, older age, bullying victimization, infrequently physically attacked, frequent participation in physical fights, having no close friends, frequent experience of hunger, parental emotional neglect, parental disrespect of privacy, school truancy, sedentary behaviour and having sustained a single or multiple serious injuries (past year) were associated with psychological distress. In addition, in unadjusted analysis, low peer support, parents never check homework, exposure to passive smoking, substance use (current tobacco use, current cannabis use and ever used amphetamine), frequent soft drink and frequent fast food consumption were positively and fruit and vegetable intake was negatively associated with psychological distress.

Conclusion

Almost one in four students reported psychological distress and several associated factors were identified which can aid prevention and control strategies.
Predictive association between immigration status and chronic pain in the general population: results from the SwePain cohort
Authors: Dragioti Elena , Tsamakis Konstantinos , Larsson Britt , Gerdle Björn
Published: September 2020

Background

Previous studies suggest that immigration may influence the experience of pain.

Objective

This population-based study examines whether immigration status is associated with chronic pain (CP), chronic widespread pain (CWSP), and severe CP at a two-year follow-up. We also tested mediation by mood status (i.e., anxiety and depression).

Methods

15, 563 participants from a representative stratified random sample of 34,000 individuals living in south-eastern Sweden completed a postal survey, during 2013–2015, that included the following data: immigration status; presence of CP (pain lasting at least 3 months) and CWSP (a modified classification of widespread pain for use in epidemiological studies); severity of CP based on a numeric rating scale; and depression, anxiety, economic situation, and sociodemographic information. We applied logistic regressions using the generalized estimating equations (GEE), with Swedish-born as the reference group and path analyses models.

Results

Compared to the Swedish-born participants (n = 14,093;90%), the immigrants (n = 1470;10%) had an elevated risk of all pain outcomes (CP: odds ratio [OR] = 1.18; 95% confidence interval [CI = 1.04–1.33, CWSP: OR = 1.39; 95% CI: 1.15–1.69 and severe CP: 1.51; 95% CI: 1.23–1.87) after adjustments. Path analyses showed that baseline age, immigrant status, and financial hardship had a significant influence on chronic pain outcomes at follow-up with baseline mood status as the mediator. Immigration status was also associated with age and financial hardship.

Conclusion

Immigrants may have increased risk of chronic pain, widespread pain, and severe pain and this risk is mediated by mood status. Targeted interventions better tailored to the socio-economic and psychological status of immigrants with chronic pain are warranted.
Safety and Health through Integrated, Facilitated Teams (SHIFT): stepped-wedge protocol for prospective, mixed-methods evaluation of the Healthy Workplace Participatory Program
Authors: Punnett Laura , Nobrega Suzanne , Zhang Yuan , Rice Serena , Gore Rebecca , Kurowski Alicia ,   SHIFT Project Research Team
Published: September 2020

Background

Healthcare facilities are notorious for occupational health and safety problems. Multi-level interventions are needed to address interacting exposures and their overlapping origins in work organization features. Worker participation in problem identification and resolution is essential. This study evaluates the CPH-NEW Healthy Workplace Participatory Program (HWPP), aTotal Worker Health® protocol to develop effective employee teams for worker safety, health, and wellbeing.

Methods

Six public sector, unionized healthcare facilities are enrolled, in three pairs, matched by agency. The unit of intervention is a workplace health and safety committee, adapted here to a joint labor-management “Design Team” (DT). The DT conducts root cause analyses, prioritizes problems, identifies feasible interventions in light of the constraints and needs of the specific setting, makes business-case presentations to facility leadership, and assists in evaluation.

Following a stepped-wedge (cross-over) design, one site in each pair is randomly assigned to “immediate intervention” status, receiving the full coached intervention at baseline; in the “lagged intervention” site, coaching begins about half-way through the study. Program effectiveness and cost-effectiveness outcomes are assessed at both organizational (e.g., workers’ compensation claim and absenteeism rates, perceived management support of safety) and individual levels (e.g., self-rated health, sleep quality, leisure-time exercise). Targeted pre-post analyses will also examine specific outcomes appropriate to the topics selected for intervention. Process evaluation outcomes include fidelity of the HWPP intervention, extent of individual DT member activity, expansion of committee scope to include employee well-being, program obstacles and opportunities in each setting, and sustainability (within the available time frame).

Discussion

This study aims for a quantitative evaluation of the HWPP over a time period long enough to accomplish multiple intervention cycles in each facility. The design seeks to achieve comparable study engagement and data quality between groups. We will also assess whether the HWPP might be further improved to meet the needs of U.S. public sector healthcare institutions. Potential challenges include difficulty in pooling data across study sites if Design Teams select different intervention topics, and follow-up periods too short for change to be observed.

Trial registration

ClinicalTrials.govNCT04251429(retrospectively registered January 29, 2020), protocol version 1.