bluuebunny/crossref_metadata_2025 huggingface dataset:
School Suspension Predicts Trichomoniasis Five Years Later in a Matched Sample
Authors: Rosenbaum Janet E.
Published: January 2020

Background: Young adults who were suspended from school during adolescence are more likely than matched non-suspended youth to be arrested, on probation, or not graduate from high school, which are STI risk factors. This study evaluates whether suspension is a marker for STI risk among young adults who avoid subsequent negative effects.
Methods: This study evaluated whether suspension predicts a positive test for chlamydia, gonorrhea, or trichomoniasis in a urine sample using matched sampling in the National Longitudinal Study of Adolescent and Adult Health (Add Health), and evaluated potential mediators between suspension and STI status using causal mediation analysis. We used Mahalanobis and exact matched sampling within propensity score calipers to compare 381 youth suspended for the first time in a 1-year period with 980 non-suspended youth. The suspended and non-suspended youth were similar on 67 pre-suspension variables. We evaluated STI outcomes 5 years after suspension.
Results: Before matching, suspended youth were more likely to test positive for trichomoniasis and gonorrhea, but not chlamydia, than non-suspended youth. Suspended youth were more likely to test positive for trichomoniasis 5 years after suspension than matched non-suspended youth (OR=2.87 (1.40, 5.99)). Below-median household income before suspension explained 9% of the suspension-trichomoniasis association (p=0.02), but criminal justice involvement and educational attainment were not statistically significantly mediators.
Conclusions: School suspension is a marker for STI risk. Punishing adolescents for initial deviance may cause them to associate with riskier sexual networks even if they graduate high school and avoid criminal justice system involvement. Suspension may compound disadvantages for youth from below-median-income families, who have fewer resources for recovering from setbacks.
The First Study of Successful Pregnancies in Chinese patients with Phenylketonuria
Authors: Wang Lin , Ye Fang , Zou Hui , Wang Kundi , Chen Zhihua , Hui Qin , Han Bingjuan , He Chun , Li Xiaowen , Shen Ming
Published: January 2020

Background Since the inception of newborn screening programs in China in the 1990s, pregnancy among patients with inherited, metabolic disorders has become more common. This study explores the management and outcomes of planned, full-term pregnancies in patients with phenylketonuria (PKU). Method Married patients with PKU from 2012 to 2017 were enrolled to receive prenatal counseling and regular health assessments. Study-related assessments included the timing of Phe-restricted diets, maternal weight gain, gestational age, pregnancy complications, and blood Phe concentrations (both pre-conception and during pregnancy), obstetrical data, and offspring outcomes(e.g.anthropomorphic measurements and developmental quotients [DQs]). Results A total of six offspring were successfully delivered. The mean±SD (range) age of the mother at delivery was 26.3±4.7 (range:21.1-32.5) years. The mean duration of Phe control before pregnancy was 5.5±1.3(range:3.1-6.5) months. During pregnancy, the proportion of blood Phe concentrations within the clinically-recommended target range (120–360μmol/L) ranged from 63.2-83.5%. Low birth weight (<2500g) offspring occurred in two women who experienced suboptimal metabolic control. In addition, offspring DQ was related to the proportion of blood Phe levels per trimester that were within the recommended range (r=0.886, p=0.016). Conclusion This is the first report of women in China with PKU who successfully gave birth to clinically healthy babies. Infant outcomes were related to maternal blood Phe management prior to and during pregnancy. In maternal PKU patients with poor compliance todietary treatment, sapropterin dihydrochloride（6R-BH 4 ）may be an option to improve the management of blood Phe levels.
Autologous plasma versus fetal calf serum as a supplement for the culture of neutrophils.
Authors: Alipour Razieh , Fatemi Alimohammad , Alsahebfosul Fereshteh , Andalib Alireza , Pourazar Abbasali
Published: January 2020

Objective Currently the replacement of fetal calf serum (FCS) by a more suitable alternative is a sought aim in the field of tissue and cell culture research. Autologous plasma (AP) and especially autologous serum (AS) have been shown to be effective substitutes of FCS in culture media for some of cell types. Nevertheless, there is no comparative data on the most appropriate supplement for cell media in neutrophil studies, it is now unclear whether AP have relatively an equal, superior or inferior performance to FCS in neutrophil cell culture. In the present study, human blood neutrophils were isolated and cultured in FCS- or AP-supplemented medium. After 12, 36 and 60 hours of incubation, cell viability, oxidative burst and CD11b expression were determined by flow cytometry.Results Compared to the culture of neutrophils in FCS 10% medium, the culture of neutrophils in a medium with AP 10% could prolong their life span without affecting their function. The findings introduce AP as a better supplement for human neutrophil cell culture than FCS and propose a simple and economical procedure for neutrophil isolation and culture.
The association between symptoms of depression during pregnancy and low birth weight:a prospective study
Authors: Li Xiu xiu , Gao Rui , Dai Xiaowei , Liu Hong , Zhang Jinxin , Liu Xuemei , Si Dongmei , Deng Te , Xia Wei
Published: January 2020

Objectives Most studies have showed that maternal depression is associated with pregnancy complications. However, there were limited evidences in Chinese population. We examined the associations of the antenatal depression symptoms with pregnancy outcomes, especially for low birth weight. Methods A total of 1377 singleton pregnant women were recruited from Nanshan Maternity & Child Healthcare Hospital of Shenzhen in this prospective cohort study. Depression symptoms were assessed by the Edinburgh postnatal depression scale (EPDS) questionnaire in the second trimester of gestation; cut-points for the indication of antenatal depression were ≥12 scores in this study. Sociodemographic data, life-style and pregnancy outcomes were collected through Shenzhen Maternity & Child Healthcare database. The risks of adverse outcomes in patients with depression were determined by multivariate logistic regression and represented as odds ratios (ORs) and 95% confidence intervals (CIs). Results Of the 1377 subjects, the prevalence of antenatal depression was 19.1%. The EPDS scores were 13.8±2.0 and 6.5±2.9 ( P <0.001) in subjects with and without antenatal depression, respectively. After adjustment for maternal age, education, parity, pre-pregnancy body mass index (BMI), residential area, fetal gender, an EPDS score≥12 (versus. <12) was associated with an increased risk for low birth weight (odds ratio: 2.05, 95% CI: 1.12-4.64), but not for preterm birth, large for gestational age, small for gestational age and macrosomia. Conclusion Pregnant women presenting antenatal depressive symptoms are at elevated risk of low birth weight. Mental health problems of pregnancy should be addressed for the prevention of low birth weight.
Slower, shorter, sadder: A qualitative study exploring how dog walks change when the canine participant develops osteoarthritis
Authors: Belshaw Zoe , Asher Lucy , Dean Rachel S
Published: January 2020

Background: Dog walking may have multiple physical and mental health advantages, but not all dog owners appear to benefit. Dog health is a described barrier to dog walking activity, but specific causes and impacts of reduced exercise in owners of dogs with health problems have not previously been reported. The current study used a qualitative methodology to explore the impact of canine osteoarthritis on dog walking activity. Methods: Owners of dogs with osteoarthritis living in the United Kingdom (UK) were recruited through veterinary practices for semi-structured interview about life with an osteoarthritic dog. Participants were asked to reflect on walks that they had taken with their dog before he/she developed osteoarthritis, and to describe how those walks had changed. Interviews were transcribed verbatim and thematic analysis was used to construct key themes. Results: Forty owners of 35 osteoarthritic dogs were interviewed. Prior to their dog’s development of osteoarthritis, dog walking distance, speed and location were usually decided by the owner to satisfy the needs and enjoyment of dog and walker. A diagnosis of canine osteoarthritis led to both dogs and their owners altering the walks undertaken. Walks were typically slower, shorter and limited to locations where physical infrastructure, underfoot surface and gradients were perceived by the owner to be navigable by their dog. Most owners did not go on additional walks without their dog due to feelings of guilt and because walking without a dog was less enjoyable. Many owners described negative effects on their own physical health and diminished enjoyment of walking as a result of their dog’s condition. Conclusion: Our research suggests that osteoarthritic dogs may reduce the walking exercise their owners are able or willing to undertake. Since osteoarthritis is a common condition in older dogs, this is an important finding for those advocating dog ownership as a positive public health intervention. Strategies may be needed to ensure that owners of dogs that develop physical incapacities can continue to enjoy the health benefits they previously associated with dog walking. Future studies investigating dog walking activity should ensure that the health status of the dog has been considered.
Comparison of Sequential, Delayed and Simultaneous Resection Strategies for Synchronous Colorectal Liver Metastases
Authors: Wang Li-Jun , Wang Hong-Wei , Jin Ke-Min , Li Juan , Xing Bao-Cai
Published: January 2020

Background: The present study aimed to compare the perioperative safety and long-term survival of patients with synchronous colorectal liver metastases undergoing sequential resection (SeR), delayed resection (DeR) and simultaneous resection (SiR). Methods: From January 2007 to December 2016, data from patients undergoing surgery at Peking University Cancer Hospital for synchronous colorectal liver metastases were retrospectively collected. The above three different surgical strategies were compared. Results: A total of 233 cases were included, with 49 in the SeR group, 98 in the DeR group and 86 in the SiR group. The incidence of severe complications was 26.7% in the SiR group, higher than that in the DeR group (11.2%, P = 0.007) and the SeR group (16.3%, P =0.166). The overall survival at 1 and 3 years in the SeR group (93.9% and 50.1%) was lower than that in the DeR group (94.9% and 64.8%, P = 0.019), but not significantly different from that in the SiR group (93.0% and 55.2%, P = 0.378). Recurrence-free survival at 1 and 3 years in the SeR group (22.4% and 18.4%) was lower than that in the DeR group (43.9% and 24.2%, P = 0.033) but not significantly different from that in the SiR group (31.4% and 19.6%, P = 0.275). Cox multivariate analysis indicated that T4, lymph node-positive primary tumour, liver metastases >30 mm and SiR (compared with DeR) were correlated with poor prognosis. Conclusion: Simultaneous resection has a relatively higher incidence of severe complications, and with a staged resection strategy, the prognosis of delayed resection was better than that of sequential resection.
Association of CYP2A6 gene deletion with cancers in Japanese elderly: an autopsy study
Authors: Abudushataer Maidina , Sato Noriko , Mieno Makiko , Sawabe Motoji , Muramatsu Masaaki , Arai Tomio
Published: January 2020

Background CYP2A6 is an enzyme involved in oxidation of a number of environmental chemicals, including nicotine, pro-carcinogenic nitrosamines and polycyclic aromatic hydrocarbons (PAHs). The whole gene deletion of CYP2A6 (CYP2A6*4) is prevalent in East Asian population. Whether or not CYP2A6*4 associates with cancer is still controversial. Methods We undertook an association study to determine whether deletion of CYP2A6 gene associates with total cancer and major cancer types employing data of consecutive autopsy cases registered in the Japanese single-nucleotide polymorphisms for geriatric research (JG-SNP) database. The presence of cancer were inspected at the time of autopsy and pathologically confirmed. Genotyping for CYP2A6 wild type (W) and deletion (D) was done by allele specific RT-PCR method. Results Among 1373 subjects, the genotype frequency for WW, WD and DD were 65.0%, 30.6% and 4.4%, respectively, which obeyed the Hardy-Weinberg equilibrium. Association for total cancer presence, as well as major cancers including gastric, lung, colorectal, and blood cancers did not show any positive association. When male and female were separately analyzed, CYP2A6 deletion associated with decreased gastric cancer risk in female (OR=0.49, 95%CI: 0.25-0.95, p=0.021, after adjustment for age, smoking and drinking). When smoker and non-smoker were separately analyzed, CYP2A6 deletion associated with decreased total cancer in female nonsmokers (OR=0.67, 95%CI: 0.45-0.99, p=0.041 after adjustment). On the other hand, CYP2A6 deletion associated increase blood cancers in smokers (OR=2.05, 95%CI: 1.19-3.53, p=0.01 after adjustment). Conclusion The CYP2A6 deletion may not grossly affect total cancer. It may associate with individual cancers in sex and smoking dependent manner. Further studies with larger sample size are warranted to confirm our results.
Facilitation of motivation to self-management in pediatric diabetes health care consultations with adolescents with type 1 diabetes. A qualitative triangulation study
Authors: Teyken Rose Marie , Lomholt Johanne Jeppesen , Schou Anders Jørgen
Published: January 2020

Background. The impact of health care professionals on the motivation for self-management in adolescents with type 1 diabetes has been highlighted as important. It is, however, not well understood how pediatric diabetes health care practitioners can help adolescents become more motivated to self-management. The aim of the study was to investigate how practitioners can motivate their patients to self-management in consultation and how adolescents with type 1 diabetes experienced that consultation could facilitate motivation to self-management.
Methods. Based on a qualitative research design, the study triangulated participant observations of 11 consultations at a pediatric health care clinic and 10 interviews of the adolescents (15-17 years of age) about their experiences of consultations. Using Giorgi’s phenomenological method, the analysis showed five categories important to consultation-facilitated motivation to self-management: 1. Consultation setting, 2. Consultation conversation, 3. Roles in treatment, 4. Assuming consultation-facilitated responsibility for self-management, and 5. Relationship in treatment. Results from the analysis were compared to fulfilment of the motivational needs for autonomy, competence and relatedness described in Self-Determination Theory.
Results. Overall findings showed that the adolescent’s developmental process of becoming autonomous in relation to self-management was influenced by consultations, and that the need for relatedness was experienced as valued by the adolescents.
Conclusions. The conclusion of the study was that relatedness and development of autonomy were experienced as important for how consultations could facilitate motivation to self-management in 15-17-year-olds and may be fundamental to adolescents’ experience of competence in relation to self-management.
Spectrophotometric Analysis Evaluating Apical Microleakage in Retrograde Filling using GIC, MTA and Biodentine: An in-vitro study
Authors: Nepal Manisha , Shubham Snigdha , Tripathi Rupam , Khadka Jwolan , Kunwar Deepa , Gautam Vanita , Gautam Narayan
Published: January 2020

Background The present study compares the apical microleakage of three different root-end filling materials in which the retrograde cavity is prepared by two different burs.Methods Eighty extracted single rooted maxillary and mandibular premolars were taken. Root canal treatment was completed. Apical 3 mm of all the teeth were resected with diamond disk. The tooth were divided into four groups with two subgroups for each group containing 10 tooth (N= 10) as: Group IA (Negative Control and IB (Positive Control); Group IIA and IIB: Prepared with round carbide bur and round diamond bur respectively, filled with GIC; Group IIIA and IIIB: Prepared with round carbide bur and round diamond bur respectively, filled with MTA; Group IVA and IVB: Prepared with round carbide bur and round diamond bur, filled with Biodentine. After applying two coats of nail varnish leaving apical 3 mm (except for negative control group) all teeth were immersed in 2% methylene blue for 3 days and again in 65% nitric acid for next 3 days for extraction of dye. The obtained solution was then transferred to eppendorf tube and centrifuged in microcentrifuges at 14,000 revolution per minutes (RPM) for 5 minutes. Optical density or absorbance of the supernatant solution was measured with UV spectrophotometer at 550 nm.esults The absorbance of the supernatant solution after dye extraction is decreasing in the order of positive control> GIC> MTA> Biodentine> negative control group. The significant difference was observed between GIC and MTA (p=0.0001) and GIC and Biodentine (p=0.0001) with two different burs but statistically non-significant difference was observed between MTA and Biodentine with Carbide bur (p=0.127) and Diamond bur (p=0.496) respectively.Conclusions Within the limitations of the present study, it can be concluded that Biodentine and MTA showed less microleakage as compared to GIC. There is no significant difference between mean microleakage of MTA and Biodentine. However, the mean OD of the Biodentine was least of all evaluated materials. Preparation of the root-end using round carbide bur as well as round diamond burs showed comparable microleakage for all three filling materials.
Prevalence and correlates of Alzheimer’s disease and related dementias in rural Uganda: cross-sectional, population-based study
Authors: MUBANGIZI VINCENT , Maling Samuel , Obua Celestino , Tsai Alexander C.
Published: January 2020

Introduction There is a paucity of data on the prevalence and correlates of Alzheimer’s disease and related dementias in sub-Saharan Africa.Objective To estimate the prevalence and correlates of Alzheimer’s disease and related dementias in rural Uganda.Methods We conducted a cross-sectional, population-based study in a rural region of southwestern Uganda. The Brief Community Screening Instrument for Dementia was administered to a multi-stage area probability sample of 400 people aged 60 years and over. Multivariable logistic regression was used to estimate correlates of probable dementia.Results Overall, 80 (20%) of the sample screened positive for dementia. On multivariable regression, we estimated the following correlates of probable dementia: age (adjusted odds ratio [AOR], 1.02 per year; 95% confidence interval [CI], 1.10-1.03, p˂0.001), having some education (AOR, 0.57; 95% CI, 0.41-0.81, p=0.001), exercise (AOR, 0.44; 95% CI, 0.27-0.72, p=0.001), and having a ventilated kitchen (AOR, 0.43; (95% CI, 0.24-0.77, p=0.001).Conclusion In this population-based sample of older-age adults, nearly one-fifth screened positive for dementia.
Complete mitochondrial DNA sequence analysis of Bluespotted seabream, Pagrus caeruleostictus (Perciformes: Sparidae)
Authors: Afriyie Gyamfua , Guo Yusong , Kuebutornye Felix K.A , Larbi Christian Ayisi , Wang Zhongduo
Published: January 2020

The authors have withdrawn this preprint from Research Square
Annual and seasonal patterns in etiologies of pediatric community-acquired pneumonia due to respiratory viruses and Mycoplasma pneumoniae requiring hospitalization in South Korea
Authors: LEE EUN , Kim Chul-Hong , Lee Yong Ju , Kim Hyo-Bin , Kim Bong-Seong , Kim Hyung Young , Kim Yunsun , Kim Sangyoung , Park Chorong , Seo Ju-Hee , Sol In Suk , Sung Myongsoon , Song Min Seob , Song Dae Jin , Ahn Young Min Ahn , Oh Hea Lin , Yu Jinho , Jung Sungsu , Lee Kyung Suk , Lee Ju Suk , Jang Gwang Cheon , Jang Yoon Young , Chung Eun Hee , Chung Hai Lee , Choi Sung-Min , Choi Yun Jung , Han Man Yong , Shim Jung Yeon , Kim Jin-Tack , Kim Chang-Keun , Yang Hyeon-Jong
Published: January 2020

Background: Community–acquired pneumonia (CAP) is one of the leading worldwide causes of childhood morbidity and mortality. Its disease burden varies by age and etiology and is time dependent. We aimed to investigate the annual and seasonal patterns in etiologies of pediatric CAP requiring hospitalization.
Methods: We conducted a retrospective study in 30,994 children (aged 0-18 years) with CAP between 2010 and 2015 at 23 nationwide hospitals in South Korea. Mycoplasma pneumoniae (MP) pneumonia was clinically classified as macrolide-sensitive MP, macrolide-less effective MP (MLEP), and macrolide-refractory MP (MRMP) based on fever duration after initiation of macrolide treatment, regardless of the results of in vitro macrolide sensitivity tests.
Results: MP and respiratory syncytial virus (RSV) were the two most commonly identified pathogens of CAP. With the two epidemics of MP pneumonia (2011 and 2015), the rates of clinical MLEP and MRMP pneumonia showed increasing trends of 36.4% of the total MP pneumonia. In children < 2 years of age, RSV (34.0%) was the most common cause of CAP, followed by MP (9.4%); however, MP was the most common cause of CAP in children aged 2-18 years of age (45.3%). Systemic corticosteroid was most commonly administered for MP pneumonia. The rate of hospitalization in intensive care units was the highest for RSV pneumonia, and ventilator care was most commonly needed in cases of adenovirus pneumonia.
Conclusions: The present study provides fundamental data to establish public health policies to decrease the disease burden due to CAP and improve of pediatric health.
Different profiles of body mass index evolutions among patients with multidrug-resistant tuberculosis: a retrospective cohort study.
Authors: Diallo Alhassane , Diallo Boubacar Djelo , Camara Lansana Mady , Kounoudji Lucrèce Ahouéfa Nadège , Bah Boubacar , N’Zabintawali Fulgence , Carlos-Bolumbu Miguel , Diallo Mamadou Hassimiou , Sow Oumou Younoussa
Published: January 2020

Background: Despite the predictor role of the body weight variation on multidrug-resistant tuberculosis (MDR-TB) treatment outcome, little data are available to corroborate this finding. We aimed to study the course of weight in patients with MDR-TB, to identify subgroups of weight evolutions, and to determine factors that influence these evolutions.
Methods: Patients treated with a shorter MDR-TB treatment regimen between June 07, 2016 and June 22, 2018 from three major drug-resistance TB centers in Guinea, who had rifampicin resistance, and who were cured or died were analyzed. Patients were seen monthly until the end of treatment. Clinical outcome was the Body Mass Index (BMI). We used a linear mixed model to analyze the course of BMI and a latent class mixed model to identify subgroup of BMI evolutions.
Results: Of 232 patients treated for MDR-TB during the study period, 165 were analyzed. These patients had a total of 1387 visits, with a median of 5 visits (interquartile range, 3 – 8 visits). Monthly BMI increase was 0.24 (SE 0.02) per kg/m 2 . Factors that associated with faster BMI progression were cured to MDR-TB treatment (0.24 [SE 0.09] per kg/m 2 ; p = 0.0205), and the absence of lung cavities on X-ray (0.18 [0.06] per kg/m 2 ; p = 0.0068). Two subgroups of BMI evolution were identified: “Rapid BMI (n = 121; 85%) and “Slow BMI evolution (n = 22; 15%). Patients in the slow increasing BMI group were mostly female (68%) without history of TB treatment (41%), with positive HIV infection (59%), with most severe clinical condition at baseline, characterized by a higher frequency of symptoms including depression (18%), dyspnea (68%), poor adherence to MDR-TB treatment (64%), lower platelets count, and higher liver SGOT count. These patients had also a longer time to-initial culture conversion delay (log-rank test: p = 0.0087).
Conclusion: The available data provided quantitative information on BMI progression of patients with MDR-TB treated with a shorter regimen, and allowed the identification of the subgroup of patients with different BMI evolutions. Furthermore, they emphasized the usefulness of BMI as biomarker to monitor MDR-TB treatment outcome.
LipoDDx: a mobile application for identification of rare lipodystrophy syndromes
Authors: Araujo-Vilar David , Fernández-Pombo Antia , Rodríguez-Carnero Gemma , Martínez-Olmos Miguel Angel , Cantón Ana , Villar-Taibo Rocio , Hermida-Ameijeiras Alvaro , Santamaría-Nieto Alicia , Díaz-Ortega Carmen , Martínez-Rey Carmen , Antela Antonio , Losada Elena , Muy-Pérez Andrés , González-Méndez Blanca , Sánchez-Iglesias Sofía
Published: January 2020

Background: Lipodystrophy syndromes are a group of disorders characterized by a loss of adipose tissue once other situations of nutritional deprivation or exacerbated catabolism have been ruled out. With the exception of the HIV-associated lipodystrophy, they have a very low prevalence, which together with their large phenotypic heterogeneity makes their identification difficult, even for endocrinologists and pediatricians. This leads to significant delays in diagnosis or even to misdiagnosis. Our group has developed an algorithm that identifies the more than 40 rare lipodystrophy subtypes described to date. This algorithm has been implemented in a free mobile application, LipoDDx®. Our aim was to establish the effectiveness of LipoDDx®.40 clinical records of patients with a diagnosis of certainty of most lipodystrophy subtypes were analyzed, including subjects without lipodystrophy. The medical records, blinded for diagnosis, were evaluated by 13 physicians, 1 biochemist and 1 dentist. Each evaluator first gave his/her results based on his/her own criteria. Then, a second diagnosis was given using LipoDDx®. The results were analysed based on a score table according to the complexity of each case and the prevalence of the disease. Results: LipoDDx® provides a user-friendly environment, based on usually dichotomous questions or choice of clinical signs from drop-down menus. The final result provided by this app for a particular case can be a low/high probability of suffering a particular lipodystrophy subtype. Without using LipoDDx® the success rate was 17 ± 20%, while with LipoDDx® the success rate was 79 ± 20% (p <0.01). Conclusions: LipoDDx® is a free app that enables the identification of subtypes of rare lipodystrophies with around 80% effectiveness, which will be of help to doctors who are not experts in this field.
Postoperative collateral formation after indirect bypass for hemorrhagic moyamoya disease
Authors: Ge Peicong , Zhang Qian , Ye Xun , Liu Xingju , Deng Xiaofeng , Wang Jia , Wang Rong , Zhang Yan , Zhang Dong , Zhao Jizong
Published: January 2020

Background: The research on postoperative collateral formation for hemorrhagic moyamoya disease (MMD) evaluated by using digital subtraction angiography (DSA) is limited. Our study objective was to investigate the postoperative collateral formation after indirect bypass for hemorrhagic MMD.

Methods: All consecutive inpatients with hemorrhagic MMD who received indirect bypass at Beijing Tiantan Hospital, Capital Medical University from January 2010 through December 2018 were screened. The site of the hemorrhage was classified as either anterior or posterior. Postoperative collateral formation was evaluated on lateral views using the Matsushima scale. Univariate and multivariate logistic regression analyses were carried out to determine the factors influencing postoperative collateral formation.

Results: Six-four patients (64 hemispheres) were included in this study. After a median 8.5 months DSA follow-up, 14 (21.9%) hemispheres had grade A collateral circulation, 13 (20.3%) had grade B, and 37 (57.8%) had grade C. Twenty-seven (43.2%) hemispheres had good postoperative collateral formation and 37 (57.8%) had poor postoperative collateral formation. The univariate logistic regression analyses showed that age at operation (OR, 0.954; 95% CI, 0.908–1.003; p=0.066), hemorrhagic site (OR, 4.694; 95% CI, 1.582–13.923; p=0.005), and PCA involvement (OR, 3.474; 95% CI, 0.922–13.086; p=0.066) may effect postoperative collateral formation. The multivariate logistic regression analyses showed that only anterior hemorrhage (OR, 5.222; 95% CI, 1.605–16.987; p=0.006) was significantly related to good postoperative collateral formation.

Conclusion: Anterior hemorrhage was significantly related to good postoperative collateral formation after indirect bypass.
Heterogeneous components of lung adenocarcinomas confer distinct EGFR mutation and PD-L1 expression
Authors: Cai Yi-Ran , Wu Hongbo , Shi Xiaoqin , Dong Yujie , Chang Xiujun , Zhang Li , Zhou Lijuan , Su Dan , Yang Ming
Published: January 2020

Background
Lung adenocarcinoma (LAC) is composed of lepidic, papillary, mucinous, micropapillary and solid components in its parenchyma. Complex responses to therapeutics result from intratumoral heterogeneity. However, it remains confused that what components in a mixed LAC tumor are responsible to the heterogeneous EGFR mutation and PD-L1 expression.
Methods
We investigated EGFR status via laser microdissection to capture spatially separated cancer cell subpopulations and digital droplet PCR to determine the abundance of EGFR sensitizing mutation and naïve T790M. Whilst, PD-L1 expression level via tumor proportion score (TPS) was evaluated by Ventana immunohistochemistry using SP263 antibody. PD-L1 expression levels were tiered in <1%, 1%-49% and >=50% groups.
Results
EGFR mutation harbored in 154 (59%) of 261 LAC patients and more frequently occurred in papillary, lepidic and micropapillary constituents. Higher levels of PD-L1 were found in LACs at stage III and IV (68.3%) versus those at stage I and II (31.7%) ( P =0.04). Solid predominant LACs (41.3%) expressed PD-L1 with TPS >=50%, versus mucinous and lepidic LACs ( P <0.01). LACs with solid constituents also had more positive proportion of PD-L1 protein. Cut-offs <1%, 1%–49% or >=50% were associated with patients’ progression-free survival and longer in the <1% group (22.9 month, 95% CI 17.6-28.2) (P<0.05). LACs consisting of two constituents with PD-L1 TPS <1% had a better prognosis than the groups with single component and more than two components ( P <0.05). Eighteen LACs (6.9%) had concomitantly deletion in exon 19 or L858R and naïve T790M mutation. The abundance of T790M varied diversely with sensitizing mutation. PD-L1 expression was not concordant in same components and usually negative in the EGFR -mutated constituents. Heterogeneous PD-L1 expression occurred in the vicinity of stromal tissues.
Conclusion
Intratumoral genetic heterogeneity of LACs was demonstrated associated with histological patterns. Heterogeneous PD-L1 expression in higher level usually occurred in solid component both in EGFR mutated and EGFR wild-typed LACs. EGFR mutated LACs heterogeneously had sensitizing and resistant mutation and was accompanied with PD-L1 expression, but discordant among histological constituents. Immune checkpoint inhibitor combined with third generation EGFR tyrosine kinase inhibitor should be more effective to these LACs.
Associations with rates of falls among home care clients in Ontario, Canada: a population-based, cross-sectional study
Authors: Manis Derek R. , McArthur Caitlin , Costa Andrew P.
Published: January 2020

Background Accidental falls among older adults are a leading cause of injury-related hospitalizations. Reducing falls is an ongoing quality improvement priority for home care, given that many home care clients experience falls. In this study, we identify factors associated with the rate of falls among home care clients.Methods We conducted a population-based, cross-sectional study using secondary data from the Hamilton, Niagara, Haldimand, and Brant health region of Ontario, Canada from January 1 – March 31, 2018. We captured person-level characteristics with falls from the Resident Assessment Instrument – Home Care (RAI-HC). Negative binomial regression was used to model the rate of falls.Results Functional characteristics of home care clients had strong, statistically significant associations with the rate of falls. Declines in activities of daily living, assistive device use for locomotion indoors, polypharmacy, and health conditions, such as dizziness or lightheadedness, and parkinsonism, were associated with a higher rate of falls. Males who used assistive devices had a higher rate of falls compared to females; however, males with neurological and cardiovascular health conditions had a decrease in the rate of falls compared to females. Home care clients with parkinsonism who used a cane and took eight or more drugs had stronger associations with an increased rate of falls compared to those who do not have parkinsonism.Conclusions Functional characteristics, polypharmacy, and health conditions are associated with increased rates of falls among home care clients. Home care clients who are at a greater risk of falls may require environmental adjustments in their home to reduce or eliminate the possibility of falling.
G-Protein-Coupled Estrogen Receptor Activation Upregulates Interleukin-1 Receptor Antagonist in the Hippocampus after Global Cerebral Ischemia: Implications for Neuronal Self Defense
Authors: BAI NING , ZHANG QUANGUANG , ZHANG WENLI , LIU BIN , YANG FANG , Brann Darrell , Wang Ruimin
Published: January 2020

Background: G-protein-Coupled Estrogen Receptor (GPER/GPR30) is a novel membrane-associated estrogen receptor that can induce rapid kinase signaling in various cells. Activation of GPER can prevent hippocampal neuronal cell death following transient global cerebral ischemia (GCI), although the mechanisms remain unclear. In the current study, we sought to address whether GPER activation exerts potent anti-inflammatory effects in the rat hippocampus after GCI as a potential mechanism to limit neuronal cell death.
Methods: GCI was induced by four-vessel occlusion in ovariectomized-female SD rats. Specific agonist G1 or antagonist G36 of GPER was administrated using minipump and antisense oligonucleotide (AS) of interleukin-1β receptor antagonist (IL1RA) was administrated using brain infusion kit. Protein expression of IL1RA, NFkB-P65, phosphorylation of CREB (p-CREB), Bcl2, Cleaved-caspase 3 and microglial markers Iba1, CD11b, as well as inflammasome components NLRP3, ASC, Cleaved-caspase 1, and Cle-IL1β in the hippocampal CA1 region were investigated by Immunofluorescent staining and Western blot analysis. The Duo-Link II in situ proximity ligation assay (PLA) was performed to detect the interaction between NLRP3 and ASC. Immunofluorescent staining for NeuN and TUNEL analysis were used to analyze neuronal survival and apoptosis, respectively. We performed Barnes maze and Novel object tests to compare the cognitive function of the rats.
Results: The results showed that G1 attenuated GCI-induced elevation of Iba1 and CD11b in the hippocampal CA1 region at 14d reperfusion, and this effect was blocked by G36. G1 treatment also markedly decreased expression of the NLRP3-ASC-Caspase 1 inflammasome and IL1β activation, as well as downstream NFkB signaling, the effects reversed by G36 administration. Intriguingly, G1 caused a robust elevation in neurons of a well-known endogenous anti-inflammatory factor IL1RA, which was reversed by G36 treatment. G1 also enhanced p-CREB level in the hippocampus, a transcription factor known to enhance expression of IL1RA. Finally, in vivo IL1RA-AS abolished the anti-inflammatory, neuroprotective and anti-apoptotic effects of G1 after GCI, and reversed the cognitive-enhancing effects of G1 at 14d after GCI.
Conclusions: Taken together, the current results suggest that GPER preserves cognitive function following GCI in part by exerting anti-inflammatory effects and enhancing the defense mechanism of neurons by upregulating IL1RA.
Fuzzy Epidemiology: Measures for Observational Epidemiological Studies
Authors: Melo Ana Cláudia Oliveira , Sá Laisa Ribeiro de , Vianna Rodrigo Pinheiro de Toledo , Moraes Ronei Marcos de
Published: January 2020

The authors have withdrawn this preprint from Research Square
Premedication of nalbuphine benefits children gastrointestinal endoscopy screening under sedation: a randomized, controlled, double-blinded clinical trial
Authors: li yong , Zheng jungang , Teen Mark , Huang Changshun
Published: January 2020

Backgrounds: Nalbuphine may be a useful opioid for postoperative use in children, but exact efficacy of premedication of nalbuphine in gastrointestinal endoscopy (e.g. compared to other commonly used opioids) has not been determined yet. This study aims to compare the benefits between premedication with nalbuphine and fentanyl on children undergoing gastrointes­tinal endoscopy screening under sedation with propofol. Methods: A total of 460 children with age 3-10 years old, undergoing elective gas­trointestinal endoscopy screening with ASA I -II were randomly assigned to fentanyl group or nalbuphine group, and then they were all subsequently ad­ministrated propofol through target-controlled infusion (TCI) with an effect-site concentration of 3.5 ug/ml, before and during the procedure. We compared postoperative pain, the total consumption of propofol, the cardiovascular parameters, satisfaction scores of patients’ parents, adverse events in patients, injection pain scores and recovery time.Results: The postoperative pain score at time of entering PACU and 10min later in nalbuphine group were lower than that in fentanyl group(1.75±1.87 vs 2.29±2.22 p＜0.05)(1.67±1.81 vs 2.12±1.99 p＜0.05), but the injection pain of propofol and the recovery time is approximate. Patients in two groups had similarly stable hemodynamics. The consumption of propofol was higher in fentanyl group than nalbuphine group (78.7± 13.6 mg vs 71.2 ± 13.9 mg, P <0.05). The incidence of bucking/hiccupping was lower than in the nalbuphine group than that in the fentanyl group (6% vs 14.3%, P <0.005). The incidence of body movement was also lower in the nalbuphine group than the fentanyl group (7.9% vs 18.7%, P<0.005). The satisfaction scores by patients ’parents were higher in the nalbuphine group than fentanyl group (4.9 ± 0.3 vs 4.7 ± 0.5, P<0.05). The incidence of pruritus is lower in the nalbuphine group compared to fentanyl group. (1.0% vs 4.8% P <0.05)Conclusion: Premedication of nalbuphine in children for endoscopy screening sedation has many benefits. The analgesic effect of nalbuphine is superior to that of fentanyl.
Promoting behavior-related low back health in nursing staff by in-person and interactive social media interventions in the workplace: a randomized trial
Authors: Kazemi Seyedeh Somayeh , Tavafian Sedigheh-Sadat , Hiller Claire E , Hidarnia Alireza , Montazeri Ali
Published: January 2020

Background: Nurses are put at high risk of work-related low back pain (LBP) due to the nature of their work. There is wide scientific evidence that the incidence and prevalence of LBP in nurses is high. Therefore, promoting behaviors for low back health in nurses is essential. The aim of this study was to develop and evaluate a theory-based educational intervention on promoting behaviors of low back health via in-person and social media education among nursing personnel with LBP. Methods: The educational content was developed with six modules: knowledge, attitude, self-efficacy, reinforcing factors, enabling factors and behavior. Evaluation of the content was undertaken in nurses, mean age 36.50 ± 5.79 years, with LBP recruited to a community randomized controlled trial with two modes of delivery: in-person (n=60) and social media (n=60). Data were collected with a self-designed questionnaire at baseline, 3 and 6 months. Baseline comparisons between groups were made with Mann-Whitney U Test for non-normal data and T-Test for normal data. Comparison of change scores between groups and two delivery types across the three time periods used the mixed between-within subject analysis of variance. Results: A total of 120 nurses received the allocated intervention and completed the baseline and follow-up questionnaires. The results indicated there were no significant statistical differences between two delivery types in the variables at the baseline (p > .05). All educational component scores increased at 3-months in both groups. At the 6-month follow-up scores increased for enabling factors and behavior in the in-person group, while in the social media group all scores increased except for attitude. Based on Bonferroni Post hoc analysis there was the difference between the delivery types; social media was more effective in knowledge (p = .01), self-efficacy (p = .03), reinforcing factor (p = .05) and behavior (p = .001) than the in-person intervention. Conclusion: An educational program for low back health was developed based on the PRECEDE-PROCEED model and proved effective at improving knowledge, attitude, self-efficacy, reinforcing factors, enabling factors and behavior. However, delivery via social media was more successful than in-person in the maintenance of behavior over the long-term.
Active Play in ASP –A matched-pair cluster-randomized trial investigating the effectiveness of an intervention in After-school programs for supporting children’s physical activity
Authors: Riiser Kirsti , Richardsen Kåre Rønn , Haugen Anders Lund Hage , Lund Siv , Løndal Knut
Published: January 2020

Background: Interventions directed at after school programs (ASPs) have the potential to support physical activity (PA) in young children. Research has indicated that interventions that emphasize competence building among the ASP staff can lead to increased PA among the children. The present study evaluates the effectiveness of the Active Play in ASP intervention—a program for ASP staff aimed at supporting physical activity physical activity among first graders in ASP. Methods: We used a matched-pair cluster randomized design and included 456 first graders from 14 schools in Norway. From these, 7 ASPs received the intervention (N = 229), while 7 acted as controls (N = 227). Measurements were taken at baseline, immediately post intervention (7 month follow-up) and after a year (19 month follow-up). The primary outcome was moderate and vigorous physical activity (MVPA), which was estimated with predefined cut points of counts per minute (CPM) and expressed as minutes/hour. Secondary outcomes were vigorous and light intensity physical activity (VPA and LPA) and sedentary behavior. The analyses of intervention effects were based on between-group differences in outcome changes between the 3 measurement points and were conducted using a mixed-effects model for repeated measures using categorical time. In separate models, we investigated gender, baseline body mass, and baseline CPM as potential effect modifiers. Results: The intervention yielded no significant short-term or long-term effects in mean MVPA 0.55 min/hour, (95% CI -0.29: 1.38), VPA, LPA, or sedentary behavior. However, subgroup analyses showed that the intervention group had a significant long-term reduction in sedentary behavior time -1.67 min/hour (95% CI -3.12: -0.21) among the 50% of children who were least active at baseline in comparison to the controls. Conclusions: Although the intervention did not significantly increase the mean MVPA among the children in the intervention ASPs compared to controls, it did seem to have an effect by reducing sedentary behavior time among the least active children. An even stronger emphasis on how to identify less active children and support their activity may be needed in order to increase their PA and further reduce sedentary behavior time.
Downregulated hsa_circ_005243 induced trophoblast cell dysfunction and inflammation via β-catenin and NF-κB pathways in gestational diabetes mellitus
Authors: Wang Huiyan , Zhou Wenbo , She Guangtong , Yu Bin , Sun Lizhou
Published: January 2020

Background: Gestational diabetes mellitus(GDM) is a common obstetric pregnancy complication, which poses a serious threat to the health of pregnant women and newborns. The specific etiology and pathogenesis of this disease have not been fully clarified, it is reported to be related with insulin resistance, inflammatory response and genetic factors etc. Circular RNA(circRNA) is a special kind of non-coding RNA, which have been attracted much attention in recent years. It has been reported that circRNAs may play a regulatory role in pregnancy-related diseases, including GDM. Methods: Previously we reported a circRNA, hsa_circ_005243, which was identified by RNA-sequencing. In this study we detected its expression in 20 GDM pregnant women and 20 normal controls using quantitative reverse transcription polymerase chain reaction analysis. Further in vitro experiments were conducted after hsa_circ_005243 knockdown in HTR8-S/Vneo cells, cell proliferation and migration ability was tested, the secretion of inflammatory factors (TNF-α and IL-6) were detected by ELISA. Then we detected the expression of β-catenin and increased nuclear factor kappa-B (NF-κB) signaling pathways which was related to GDM in the mechanism study. Results: We found the expression of hsa_circ_005243 was significantly reduced both in the placenta and plasma of GDM pregnant women. Knockdown of hsa_circ_005243 in trophoblast cells significantly suppressed cell proliferation and migration ability. In addition, increased secretion of inflammatory factors (TNF-α and IL-6) were observed after hsa_circ_005243 depletion. Further mechanism experiments showed that knockdown of hsa_circ_005243 reduced the expression of β-catenin and increased nuclear NF-κB p65 nuclear translocation. Conclusions: Collectively, our study showed that down-regulation of hsa_circ_005243 might be associated with the pathogenesis of GDM through regulating β-catenin and NF-κB signal pathways and suggest a new potential therapeutic target for GDM.