bluuebunny/crossref_metadata_2025 huggingface dataset:
Small Fiber Neuropathy in Pulmonary Sarcoidosis and Tuberculosis: Clinical and Histological Correlates
Authors: Starshinova Anna , Basantsova Natalia , Zinchenko Yulia , Shapkina Valeria , Malkova Anna , Belyaeva Ekaterina , Pavlova Maria , Yablonskiy Piotr , Shoenfeld Yehuda
Published: August 2020

Sarcoidosis (SC) is the granulomatous disease of an unknown origin, where the differential diagnosis with tuberculosis (TB) is challenging and vital for patients’ prognosis. The common neurological complication in SC is a small fiber neuropathy (SFN), that is considered to be the result of the chronic inflammation, and remains significantly understudied. There is no reliable data, whether such complication is observed in TB patients, where the systemic inflammation is also described. Aim: To identify the clinical and histological correlates of the small fiber neuropathy in sarcoidosis and tuberculosis patients.Materials and methods. A study was performed in 2018 – 2019 years and included 71 patients with pulmonary sarcoidosis (n=25), pulmonary tuberculosis (n=21), and healthy subjects (n=25). For the clinical verification of the SFN, the “Small fiber neuropathy screening list” (SFN-SL) was used. A punch biopsy of the skin was performed followed by the enzyme immunoassay analysis with PGP 9.5 antibodies.Results of the study: Up to 60% of sarcoidosis patients and 19% tuberculosis patients report the presence of at least one complaint, which may be associated with SFN. The most frequent complaints included dysfunctions of the cardiovascular, musculoskeletal system and gastrointestinal tract. A negative, statistically significant correlation between the intraepidermal nerve fiber density (IEND) and SFN-SL score was revealed in both groups (Spearman coefficient, r = -0.3508, p = 0.0102, and r = -0.7382, p = 0.0064, respectively). Wherein, the density of small nerve fibers in the patients with pulmonary sarcoidosis was lower, compared to the patients with tuberculosis (Mann-Whitney test, p = 0.0047). Conclusion: In patients with pulmonary sarcoidosis, small fiber neuropathy may develop as a result of systemic immune-mediated inflammation. The most common symptoms of this complication were dysautonomia and mild sensory dysfunction. Wherein, in tuberculosis patients clinical and histological symptoms of the small fiber neuropathy were subsequently less prominent, which may represent the difference between the autoimmune and bacterial inflammation. The validated questionnaires and histologic verification of the diagnosis help to establish the severity of neuropathy of small fibers, to determine the prognosis, to plan the treatment strategн, and also may allude the possibility for the additional criteria of differential diagnosis between two diseases.
Respiratory Microbiome Profiles Differ by Recent Hospitalization and Nursing Home Residence in Patients on Mechanical Ventilation
Authors: Baek Min-gyung , Woo Seongji , Kim Nam-Eun , Baek Chaeyun , Won Sungho , Kim Youngmi , Lee Jae Jun , Yi Hana , Hong Ji Young
Published: August 2020

Background: Healthcare-associated pneumonia (HCAP) is a heterogeneous disease. Previous studies reported that identifying risk factors for HCAP may lead to more accurate predictions of drug-resistant pathogens. We examined new nursing-home- and hospital-associated infections (NHAI) by revising existing HCAP risk factors. Our aim was to determine whether respiratory microbiota profiles are related to newly defined risk factors for NHAI in critically ill patients on mechanical ventilation.Methods: The NHAI group comprised nursing home residents with a poor functional status, or recent (past 90 days) hospitalization or recent (past 180 days) antibiotic therapy. Endotracheal aspirates were prospectively collected from patients in the intensive care unit (ICU) of a university hospital. The 180 endotracheal aspirates from 60 mechanically ventilated ICU patients (NHAI group, n = 24; non-NHAI group, n = 36) were obtained on days 1, 3 and 7. The bacterial community profiles of the endotracheal tube aspirates (ETAs) were explored by 16S rRNA gene sequencing. A phylogenetic-tree-based microbiome association test (TMAT), generalized linear mixed models (GLMMs), the Wilcoxon test and the reference frame method were used to analyze the association between microbiome abundance (number of operational taxonomic units [OTUs]) and disease phenotype.Results: The microbiome analysis revealed significantly lower α-diversity in the NHAI group than in the non-NHAI group. In the analysis of β-diversity, the structure of the microbiome also differed significantly between the two groups (weighted UniFrac distance, Adonis, P <0.001). The abundance of Corynebacterium was significantly higher, and the relative abundances of Granulicatella, Staphylococcus, Streptococcus and Veillonella were significantly lower, in the NHAI than in the non-NHAI group. Conclusions: The microbiota signature of the ETAs distinguished between patients with and without risk factors for NHAI. Thus, the lung microbiome may serve as a biomarker and therapeutic target for intubated patients exposed to nursing home and hospital environments.
High expression of ABCG2 is associated with doxorubicin resistance of osteosarcoma
Authors: Shu Hao , Yuan Bin , Huang Yao , Wang Lei , He Bing , Sun Qi , Sun Luning
Published: August 2020

Objectives

Previous studies showed overexpression of ABCG2 in a variety of tumor tissues, which could potentially indicate the probability of chemotherapy resistance. This study aimed to reveal the role of ABCG2 in the development of doxorubicin (DOX) resistance and the prognosis of OS.
Methods

68 OS patients were included in this study. Tumor tissues were collected for each patient during surgery. DOX-resistant OS cell lines were induced by consecutive exposure of gradually increasing concentration of DOX to the parental cell lines. Lentivirus was used for the knockdown of ABCG2 in OS cells. Cells were treated with the gradient concentration of DOX and the viability was assessed by CCK8 assay. Total RNA was isolated from the tumor tissues or tumor cells, and the expression of ABCG2 was analyzed by qPCR. The relationship between ABCG2 expression and clinicopathological characteristics of the patients was analyzed using the Student’s t-test or the Chi-square test. Cumulative survival time was calculated by the Kaplan-Meier method and analyzed by the log-rank test. P < 0.05 was considered statistically significant.
Results

DOX-resistant OS cells were successfully established through continuous exposure to DOX. 48 h after DOX exposure, the IC 50 value of DOX-resistant HOS cells and DOX-resistant U2OS were 3.5 µM and 3.25 µM, respectively. By contrast, those of the untreated HOS and U2OS cells were 1.15 µM and 0.93 µM, respectively (p < 0.01). The mRNA expression level of ABCG2 was significantly increased in DOX-resistant cell lines. The CCK-8 assay showed that the DOX-resistant HOS cells and DOX-resistant U2OS cells transfected with ShABCG2 were more sensitive to the DOX treatment than those transfected with ShCtrl. Analysis of gene expression in OS tissues showed remarkably higher expression of ABCG2 as compared with adjacent normal tissues (p < 0.01). The disease-free survival time of patients with high expression level of ABCG2 had obviously decreased survival time than the patients with low expression (p < 0.01).
Conclusions

ABCG2 expression level was significantly associated with the resistance to DOX and the overall survival of OS patients. ABCG2 may become a promising therapeutic target for OS patients.
A novel indicator weight tuning method based on fuzzy theory in mobile social networks
Authors: Gao Min , xu li , Wang Xiaoding , Zhang Xinxin
Published: August 2020

Mobile social network supports mobile communication and asynchronous social networking. How to measure the importance of nodes is critical and this problem remains to be answered. Most of the existing methods are subjective, so how to determine the weights of the centrality indicators is the key to solve the problem. In this paper, 9 common centrality indicators are viewed as our research object. We introduce fuzzy theory to partition the indicator weights, and to be more specific, we define a membership degree function to get the initial weight interval. With relative entropy, the weights of each centrality indicator can be obtained. By calculating the random data generated by simulation, genetic algorithm with single point crossover is used to optimize the weight of each indicator. Experiments show that the optimized weights are more effective and differentiable.
Solidarity and Suffering: Patients and their Caregiver's Experiences Enrolled in the Community-Based Palliative Care Program in an Urban Slum of Bangladesh
Authors: Akter Sayema , Sarker Malabika , Hossain Puspita , Ahmad Nezamuddin , Zaman Shahaduz
Published: August 2020

Background: Palliative care has been recognized as a global health challenge. Although access has increased, there is very low recognition of the importance of palliative care in low and middle-income countries. In Bangladesh, institutional palliative care is not accessible due to a lack of awareness, financial constraints, and fewer facilities. Hence, there needs to be a better understanding of how to provide and improve existing community-based palliative care. This study aimed to explore the experiences of palliative patients and their primary caregivers enrolled in the palliative care project “Momotamoy Korail” run by Bangabandhu Sheikh Mujib Medical University in an urban slum of Dhaka.Methods: A focused ethnography was conducted where observation and nineteen in-depth interviews were carried out using semi-structured guidelines with the palliative care patients and their primary caregivers. Results: In a family, mostly wives and daughters-in-law are the primary caregivers. Therefore, male patients are more likely to receive family care compared to female patients. Both male and female patients expressed the desire for death free of suffering. All patients shared their feelings of loneliness and social abandonment, accentuated by the guilt of being a burden to their families, created a feeling of social death. Despite the sense of duty, sympathy and empathy, presence of the physical, social, psychological, and spiritual suffering, both patients and caregivers felt cared and hopeful.Conclusion: There is a need for innovative approaches for an integrated palliative care service within the main stream health system. Gaps in research, workforce shortages, and lack in public and professional knowledge need to be addressed if care for people with a terminal illness and their silent savior is to be further improved.
Factors Associated with Health Checkups and Cancer Screening Participation Among Family Caregivers of Individuals with Dementia
Authors: Kim Bomgyeol , Lee Yejin , Noh Jin-Won , Kim Tae Hyun
Published: August 2020

Background: Providing care for dementia can negatively influence the physical health and health behaviors of family caregivers. A better understanding of the factors associated with health checkups and cancer screening is vital to better develop effective interventions. Thus, this study aimed to identify factors associated with participation in health checkups and cancer screening among family caregivers of individuals with dementia. Methods: This study analyzed a total of 2,414 family caregivers of individuals with dementia, using the Korea Community Health Survey (KCHS) data in 2017. A binomial logistic regression analysis was performed to identify demographic, socioeconomic, and health status factors associated with health checkups and cancer screening participation among family caregivers of individuals with dementia. Results: The health checkups and cancer screening rates among family caregivers of individuals with dementia patients were 68.7% and 61.4%, respectively, which were significantly lower than those who do not provide care. Those with lower education level had lower odds ratios for both health checkups(OR: 0.60) and cancer screening(OR: 0.59). In addition, symptoms of depression were associated with lower participation(Health checkups OR: 0.67; Cancer screening OR: 0.65). Conclusions: It is needed to develop more targeted disease prevention and management strategies for family caregivers of individuals with dementia, particularly those with lower education level and symptoms of depression.
Evidence on Article 5.3 of FCTC (Tobacco Industry Interference in Tobacco Control Activities) in India - A Qualitative Scoping Study
Authors: Goel Sonu , Kar Sitanshu Sekhar , Verma Madhur , Sivanantham Parthibane , Naik Bijay Nanda
Published: August 2020

Background: Tobacco Industry (TI) strives to portray itself as being “socially responsible” and contest for pertinent decision-making positions, which it uses to deter, delay or dilute tobacco control measures. There is little documented evidence of Tobacco Industry Interference (TII) from India, the scope of their interference and challenges faced by the experts for effective tobacco control.Methods: A cross-sectional qualitative research design, based upon in-depth interviews (N=26), was used to explore the opinion of key stakeholders regarding TII in India. The interview schedule collected information about the socio-demographic information of the study participant, the participant’s roles and responsibilities in tobacco control, the nature of TII faced by the participant, means of influence by TI, barriers and challenges to tobacco control efforts using a set of questions. Principles of the ‘grounded theory’ were used to understand beliefs and thoughts of key-experts about TII in India, its interactions and interference at various levels. Results: Most of the respondents were engaged in tobacco control, training, advocacy, and awareness generation activities from the last 5-10 years or more. The respondents defined the TI and its scope as per their experience. We identified six major domains (Influencing the policy and administrative decisions, Interference with implementation of tobacco control laws and activities, False propaganda and hiding the truth, manipulating front action groups, Rampant tobacco advertising and promotion activities, and others) under which TII activities can be classified comprehensively. Conclusions: The activity documented a significant level of TII in different domains with stakeholders acting at various hierarchical levels. This can help to provide insights about the nefarious tactics of TI, enable stakeholders to anticipate and pre-empt the kinds of alliances the TI may attempt to build, stimulate academicians and researchers to undertake in-depth analysis into various strategies and underscore the need for ensuring transparency in official interactions with the TI and their representatives.
Bone marrow mesenchymal stem cells transfer in patients with ST-segment elevation myocardial infarction: single-blind, randomized controlled muticentre trial
Authors: Zhang Runfeng , Yu Jiang , Zhang Ningkun , Li Wensong , Wang Jisheng , Cai guocai , Chen Yu , Yang Yong , Liu Zhenhong
Published: August 2020

Objective: Our aimed to evaluate efficacy and safety of intracoronary autologous bone morrow mesenchymal stem cells (BM-MSCs) transplantation in patients with ST-segment elevation myocardial infarction（STEMI）. Methods: In this randomised, single-blind, controlled trial, patients with STEMI (aged 39-76 years) were enrolled at 6 centers in Beijing (the People's Liberation Army Navy General Hospital, Beijing Armed Police General Hospital, Chinese People's Liberation Army General Hospital, Beijing Huaxin Hospital, Beijing Tongren Hospital, Beijing Chaoyang Hospital West Hospital). Patients underwent optimum medical treatment and percutaneous coronary intervention,and were randomly assigned in a 1:1 ratio to BM-MSCs group or control group. The primary endpoint was change of myocardial viability at 6 months' follow-up and left-ventricular (LV) function at 12 months' follow-up.The secondary endpoints were incidence of cardiovascular event, total mortality and adverse event at 12 months' follow-up. The myocardial viability assessed by single- photon emission tomography (SPECT). The left ventricular ejection fraction was used to assess LV function. All patients underwent dynamic ECG and laboratory evaluations. This trial is registered with ClinicalTrails.gov, number NCT04421274. Results: Between March , 2008, and July , 2010, 43 patients were randomly assigned to BM-MSCs group (n=21)or control group(n=22) and followed up for 12 months. LV ejection fraction increased from baseline to 12 months in the BM-MSCs group and control group ( mean baseline-adjusted BM-MSCs treatment differences in LV ejection fraction 4.8% (SD 9.0) and mean baseline-adjusted control group treatment differences in LV ejection fraction 5.8% (SD 6.04) ). After 6 months of follow-up, there was no significant improvement in myocardial metabolic activity in the BM-MSCs group before and after transplantation. however,there was no statistically significant difference between the two groups in the change of LV ejection fraction (p=0.30) and myocardial metabolic activity(p>0.05). We noticed that ,after 12 months of follow-up, except for 1 death and 1 coronary microvascular embolism in the BM-MSCs group, no other events occurred and Alanine transaminase(ALT) and C-reactive protein(CRP) in BM-MSCs group were significantly lower than that in control group. Conclusions: It is unreasonable to speculate that intracoronary transfer of autologous bone marrow MSCs could augment recovery of LV function and myocardial viability after acute myocardial infarction.Trial registration: clinicaltrials,NCT04421274. Registered 06,08,2020- Retrospectively registered, https://register.clinicaltrials.gov/NCT04421274.
Can statistical adjustment guided by causal inference improve the accuracy of effect estimation? A simulation and empirical research based on Meta-analyses of case-control studies
Authors: Yan Ruohua , Liu Tianyi , Peng Yaguang , Peng Xiaoxia
Published: August 2020

Background
Statistical adjustment is often considered to control confounding bias in observational studies, especially case-control studies. However, different adjustment strategies may affect the estimations of odds ratios (ORs), and in turn affect the results of their pooled analyses. Our study is aimed to investigate how to deal with the statistical adjustment in case-control studies to improve the validity of Meta-analyses.
Methods
We carried out a series of Monte Carlo simulation experiments based on predesigned scenarios, and assessed the accuracy of effect estimations from Meta-analyses of case-control studies by combining ORs calculated according to different adjustment strategies. The strategies included fully adjustment of all preset confounders guided by causal inference, insufficiently adjustment of less confounders, and improperly adjustment of covariates other than confounders.
Results
For all scenarios with different strength of causal relations, combining ORs adjusted for confounders as far as possible would get the most precise effect estimation, regardless of the sampling approaches of case-control studies and the scale of Meta-analysis. By contrast, combining ORs that were not sufficiently adjusted for confounders or improperly adjusted for mediators or colliders would easily introduce bias in causal interpretation, especially when the true effect of exposure on outcome was weak or none.
Conclusions
Statistical adjustment guided by causal inference are recommended for effect estimation. Therefore, when conducting Meta-analyses of case-control studies, the causal relationship formulated by exposure, outcome, and covariates should be firstly understood through a directed acyclic graph, and then reasonable original ORs could be extracted and combined by suitable methods.
The Immunogenomic Landscape of and Immune Cell Infiltration in Bladder Cancer
Authors: Yang Zeyu , Du Tianjing , Xiong Qiao , Zhang Weiwei , Wang Chao , Xiang Longqing , Zeng Shuxiong , Xu Chuanliang
Published: August 2020

Background

The role of immune cell infiltration in tumor biology and the potential of immunotherapy for the treatment of several cancers have been proven. However, the immunogenomic landscape and immune cell infiltration need to be comprehensively analyzed in bladder cancer (BC). This study aimed to explore the immune-related genes (IRGs) in BC to create a prognostic risk assessment model and gain some insights into the molecular underpinnings of BC.
Methods

Based on the datasets retrieved from The Cancer Genome Atlas (TCGA) database, we identified survival-associated IRGs via univariate Cox analysis. Then, we created an immune-related gene-based prognostic factor (IRGPF) and validated it by multivariable Cox analysis. We displayed the profiles of 22 types of immune cells by using CIBERSORT and explored the relationship between IRGs and immune cell infiltration.
Results

Altogether, 58 differentially expressed IRGs were found to be associated with the prognosis of patients with BC. We constructed a prognostic assessment model as an IRGPF with IRGs (THBS1, CXCL9, CXCL11, FABP6, BIRC5, and PPY). Profiles of the infiltrating immune cells confirmed their significance based on clinical factors and individual differences. The IRGPF was related to immune cell infiltration, and the key gene was identified as THBS1.
Conclusions

Our findings confirmed that IRGs could act as independent prognostic factors and immune-driver factors. Patients with high levels of activated memory CD4 T cells but low levels of resting memory CD4 T cells had a better prognosis. This study indicates the possibility of developing new immunotherapeutic strategies and individualized treatment based on this approach.
Metastatic hepatocellular carcinoma to the parotid gland Associated with multiple metastasis: Case report
Authors: Sun Mingxia , Cang Shundong
Published: August 2020

Introduction: The incidence of liver cancer is very high in China, and it is more common in patients with a history of hepatitis B.Most patients with liver cancer have distant metastasis at the time of visiting, but parotid metastasis is very rare. We report a patient with parotid enlargement who was diagnosed with multiple metastasis of liver cancer. Presentation of Case: A 52-year-old male presented with parotid enlargement for one month.after the right deep maxillofacial neck mass was cut and biopsied,Metastatic hepatocellular carcinoma of the parotid gland associated with multiple metastasis was diagnosed. Discussion: Metastasis of liver cancer to the parotid gland is very rare, to date, only 7 cases HCC metastasis to the parotid gland have been reported, this case is the first report in China. For patients with parotid enlargement at the first diagnosis, no history of hepatitis or liver cancer, and normal or slightly elevated AFP,It is very easy to misdiagnose and miss diagnosis.Pathological diagnosis and complete systemic examination are very important in the diagnosis of tumor.Although very rare, parotid metastases in HCC should be maintained with high suspicion.
Patient-Centered Practices for Engaging Transgender and Gender Diverse Patients in Clinical Research Studies
Authors: Asquith Andrew , Sava Lauren , Harris Alexander B. , Radix Asa E. , Pardee Dana J. , Reisner Sari L.
Published: August 2020

Background: The purpose of this formative study was to assess barriers and facilitators to participation of transgender and gender diverse (TGD) patients in clinical research to solicit specific feedback on perceived acceptability and feasibility of research methods to inform creation of a multisite longitudinal cohort of primary care patients engaged in care at two community health centers.Method: Between September-November 2018, four focus groups (FGs) were convened at two community health centers in Boston, MA and New York, NY (N=28 participants across all 4 groups; 11 in Boston and 17 in New York). FG guides asked about patient outreach, acceptability of study methods and measures, and ideas for study retention. FGs were facilitated by TGD study staff, lasted approximately 90 min in duration, were audio recorded, and then transcribed verbatim by a professional transcription service. Thematic analyses were conducted by two independent analysts applying a constant comparison method. Consistency and consensus were achieved across code creation and application aided by Dedoose software.Results: Participants were a mean age of 33.9 years (SD 12.3; Range 18-66). Participants varied in gender identity with 4 (14.3%) being male, 3 (10.7%) female, 8 (28.6%) transgender male, 10 (35.7%) transgender female, and 3 (10.7%) nonbinary. Eight (26.6%) were Latinx, 5 (17.9%) Black, 3 (10.7%) Asian, 3 (10.7%) another race, and 5 (17.9%) multiracial. Motivators and facilitators to participation were: research creating community, research led by TGD staff, compensation, research integrated into healthcare, research applicable to TGD and non-TGD people, and research helping TGD communities. Barriers were: being research/healthcare averse, not identifying as TGD, overlooking questioning individuals, research coming from a ‘cisgender lens”, distrust of how the research will be used, research not being accessible to TGD people, and research being exploitative.Conclusion: Though similarities emerged between the perspectives of TGD people and research citing perspectives of other underserved populations, there are barriers and facilitators to research which are unique to TGD populations. It is important for TGD people to be involved as collaborators in all aspects of research that concerns them.
Analysing the impact of a guideline for the use of new potassium binders for treatment of chronic hyperkalaemia to maximise inhibition of renin–angiotensin–aldosterone system (RAAS) within the general nephrology clinic?
Authors: Patel Priyank , Frankel Andrew
Published: August 2020

Background
Renin–angiotensin–aldosterone system (RAAS) inhibitors provide significant cardiorenal benefits with improved long-term outcomes for patients. This is most significant for patients receiving maximal RAAS inhibition, but some patients are unable to tolerate this therapy because of hyperkalaemia. Recently published National Institute for Health and Care Excellence (NICE) technology appraisal guidance recommended using sodium zirconium cyclosilicate (SZC) and patiromer for patients with chronic kidney disease (CKD) stage 3b to 5 or heart failure with reduced ejection fraction, who are not taking an optimised dosage of RAAS inhibitor because of hyperkalaemia.

Objective
Determine the impact of a locally produced guideline on effective implementation of NICE recommendation for use of SZC or patiromer to help maximise inhibition of the renin–angiotensin–aldosterone system within the general nephrology clinic.

Methods
A local guideline to practically support the implementation of recommendations made by NICE in the chronic use of new potassium binders was produced. One hundred sequential patients in a general nephrology clinic with non-immune chronic kidney disease (CKD 3 to 5) had their electronic records reviewed. Those with an indication for RAAS inhibition were identified.

Results
Of the 100 consecutive patients audited, 46 were female and 54 were male. The mean age of these patients was 64 and the mean estimated glomerular filtration rate (eGFR) was 33. Sixty-eight patients had an indication for being on RAAS inhibition with only 10 on maximal doses. Of the remaining 58 patients, 26 (45%) were limited by hyperkalaemia. Of these 26 patients, 12 of these patients (46%) had hyperkalaemia associated with an episode of acute kidney injury (AKI). Therefore, 14% of patients attending a general nephrology clinic were identified suitable for SZC and patiromer.

Conclusions
A significant proportion (14%) of unselected patients attending a general nephrology clinic were not on optimum RAAS inhibition due to hyperkalaemia. These patients would meet the criteria established within a working guideline for the implementation of the chronic use of SZC or patiromer and are likely to attain prognostic long-term benefit by using these new potassium binders to maximise RAAS inhibition. This analysis has implications for renal centres across the UK.
Enhanced Recovery Protocol Versus Conventional Perioperative Management For Three-Dimensional Laparoscopy-Assisted Gastrectomy: A Prospective Cohort Study
Authors: Zhang Kecheng , Lu Canrong , Cui Jianxin , Qiao Zhi , Chen Lin
Published: August 2020

Background: It remains unclear whether patients undergoing three-dimensional (3D) laparoscopy-assisted gastrectomy could benefit from enhanced recovery protocol. The aim of present study is to compare enhanced recovery protocol and the conventional perioperative management after 3D laparoscopy-assisted gastrectomy in gastric cancer.Methods: A prospective cohort of patients received 3D laparoscopy-assisted gastrectomy were enrolled between 2017 and 2018. A hospital-based enhanced recovery protocol was established and implemented. Patient’s clinic-pathological characteristics and perioperative outcomes were compared between enhanced recovery group (ERG) and conventional group (CG). ER protocol compliance rate was calculated for patients in ERG. Univariate and multivariate binary logistic regression analysis were performed to investigate influential factors for delayed discharge and for postoperative complications.Results: One hundred and eighty-seven patients received 3D laparoscopy-assisted gastrectomy in ERG and 111 patients in CG were enrolled in the final analysis. Patients had comparable baseline characteristic between groups. However, patients in ERG had shorter time to oral feeding, reduced postoperative hospital stay and less medical cost (all P < 0.05). The postoperative complication rate were 10.7% for ERG and 10.8% for CG respectively. Regarding individual items in enhanced recovery protocols, prevention of postoperative nausea and vomiting had the highest compliance of 100% (187/187) while ambulation on postoperative day one had the lowest compliance of 32.1% (60/187). Univariate logistic regression analysis revealed operation time (P < 0.001), blood loss (P = 0.007), intraoperative transfusion (P = 0.003) and compliance (P < 0.001) were correlated with delayed discharge, while multivariate analysis demonstrated that only compliance [odds ratio (OR), 0.939; P < 0.001] and operation time (OR, 1.010; P = 0.048) were statistically significant. Additionally, univariate analysis showed blood loss (OR, 1.002; P = 0.028) and compliance (OR, 0.978; P = 0.030) were associated with postoperative complications, but multivariate analysis showed neither was statistically significant. Spearman correlation analysis revealed compliance was negatively correlated with postoperative hospital stay (Spearman r = -0.64, P < 0.001) and with medical cost (Spearman r = -0.26, P < 0.001).Conclusion: The present prospective cohort study suggests it is safe and feasible to incorporate 3D laparoscopic gastrectomy into enhanced recovery settings. Furthermore, improving compliance with enhanced recovery protocol may shorten hospital stay and promote postoperative recovery.
Disaster Safety Assessment in Primary Healthcare Facilities: A Cross-Sectional Study, Kurdistan, Iran
Authors: Yari Arezoo , Zarezadeh Yadolah , Fatemi Farin , Ardalan Ali , Vahedi Siamak , Khoshsabeghe Homa Yousefi- , Boubakran Mohsen Soufi , Bidarpoor Farzam , Motlagh Mohamad Esmaeil
Published: August 2020

Background: Primary healthcare facilities in Iran deliver health services at all levels nationwide. Resiliency and flexibility of such facilities is important when a disaster occurs. Thus, evaluating functional, structural, and non-structural aspects of safety of these facilities is essential. Methods: In this cross-sectional study, using the safety evaluation checklist of primary healthcare centers provided by the Ministry of Health and Medical Education, 805 health centers in Kurdistan Province were evaluated in terms of functional, structural, and non-structural safety. Results: The levels of total, functional, structural, and non-structural safety were equal to 28.7, 23.8, 20.2, and 42.3 out of 100 respectively. Regarding the functional preparedness, the highest score was related to rapid response team, while the lowest score was belonged to financial affairs. Nevertheless, in structural and non-structural areas, the scores of different items were almost similar to one another. Both Iran and Kurdistan Province are disaster-prone areas. Conclusions: This study concluded that the safety score of primary healthcare facilities in total was unsatisfactory. Thus, promoting preparedness, resilience and continuity of service delivery is essential during disasters and emergencies. The finding of this study could be beneficial for national and provincial decision-makers and policymakers in this regard
Parenteral supplementation of omega-3 fatty acid on the prognosis of sepsis: a real world retrospective study
Authors: Youlian Chen , Chen Huaisheng , Liu XunFa , Jiang YiChun , Tang XueMing , Ma YongHui , Liu XueYan , Wang Wei
Published: August 2020

Objectives: The role of omega-3 fatty acids in the treatment of sepsis is always on paradox. we tried to retrieve and download the patients’ data in a certain period through the hospital information system, used data sorting so as to screen out the patients with sepsis so as to find out the role of omega-3 fatty acids in sepsis.Methods: Through the hospital information system, retrieve and include the patients who were admitted to the Department of critical medicine of Shenzhen People's Hospital from December 2016 to June 2019, screen out patients diagnosed with sepsis according to a certain criterion. The patients were grouped by whether they were applicated with omega-3 fatty acid or not.Results: A total of 1733 cases included into analysis, among of whom 303 cases were applicated with omega-3 fatty acid. The amounts and baseline conditions between both groups were imbalance. Severity of omega-3 fatty acid group was higher than that of control group. Chi-square test found that the mortality rate of omega-3 fatty acid was higher than that of control group (p < 0.0001). But age, gender, whether there is abdominal infection, whether there is septicemia, shock, the need for mechanical ventilation, and the need for renal replacement therapy may all affect the prognosis of the patients. If these factors were used as covariates, multiple logistic regression analysis showed that there was no significant difference in mortality rate between the treatment group and the control group (P = 0.574). Survival analysis showed that the survival rate of treatment group was higher than that of the control group when at the end of total treatment duration (P = 0.035).Conclusion: For patients with more severe sepsis, doctors are more likely to use omega-3 fatty acids in the early stage. Omega-3 fatty acids may improve the long-term prognosis of sepsis, but the conclusion still needs to be accepted carefully.
Asymptomatic Carotid Atherosclerosis Cardiovascular Risk Factors and Common Hypertriglyceridemia Genetic Variants in Patients with Systemic Erythematosus Lupus
Authors: Fanlo-Maresma Marta , Candás-Estébanez Beatriz , Esteve-Luque Virginia , Padró-Miquel Ariadna , Escrihuela-Vidal Francesc , Carratini-Moraes Monica , Corbella-Ingles Emili , Corbella-Virós Xavier , Pintó-Sala Xavier
Published: August 2020

Background and aims: SLE is a systemic autoimmune disease associated with an increased cardiovascular risk which is related with the characteristic dyslipidemia of SLE. This consists of an alteration of triglyceride-rich lipoprotein metabolism and an increased concentration of apoB containing particles. The objective of this study is to know the prevalence of carotid atherosclerosis and to analyze its relationship with dyslipidemia and its related genetic factors in a population of SLE patients.Methods: Seventy-one SLE female were recruited. A carotid ultrasound was performed to evaluate the presence of atheromatous plaques and cIMT. Lipid profile and analysis of ZPR1, APOA5 and GCKR genes were carried out. SLE patients were analyzed according to the presence or absence of carotid plaques. Statistical analyses were performed to evaluate the relationship between lipid parameters and these allelic variants involved in triglyceride metabolism.Results: SLE patients with carotid plaque had higher concentrations of plasma triglyceride than SLE patients without carotid plaque (1.5 vs 0.9 mmol/L, respectively, p=0.001), Non-HDLC (3.5 vs 3.1 mmol/L, p= 0.025) and apoB (1.0 vs 0.9 g/L, p=0.010). GCKR (c.1337C>T) C-allele was observed in 83.3% and 16.7% (p=0.047) of patients with and without carotid plaque, respectively. The GCKR (c.1337C>T) CC genotype (OR= 0.03; [95% CI] [0.002 to 0.53], p=0.016), and triglyceride concentrations (OR= 7.57; [95% CI] [1.43 to 40.19], p=0.017) were independently associated with the diagnosis of carotid plaque.Conclusions: plasma triglyceride concentration and CGKR CC homozygosity for CGKR gene are independent predictive factors of carotid atherosclerosis in women with systemic lupus erythematosus.Keywords: triglycerides, CGKR gene, Non-HDLC, atherosclerosis, systemic lupus erythematosus.
Investigation Risk Factors for Breast Cancer in Women: A Case–Control Study in Arak, Iran
Authors: Pezeshki Milad , Ansari Jamshid , Rezaie Jafar , Ahmadloo Mojtaba
Published: August 2020

BackgroundBreast cancer is the most common malignant in women globally. In Iran, breast cancer incidence rate is continuously increasing. This study aimed to investigate the risk factors for breast cancer in Iranian women.MethodsA hospital-based case-control study was conducted between September 2016 and July 2019 in Arak, Iran. The sample size was 400 breast cancer patients and 400 healthy women. Demographical records and risk factor related data were collected. Logistic regression analysis used to calculate odds ratios (ORs) and 95% confidence intervals (CIs).ResultsData showed that among various factors, urban life (OR = 1.361, 95% CI 1.025–1.808, P = 0.033), height (OR = 3.347, 95% CI 2.0443–5.480, P = 0.000), BMI (OR = 0.397, 95% CI 0.273–0.577, P = 0.000), education level (OR = 7.048, 95% CI 3.985–12.467, P = 0.000), awareness level (OR = 0.507, 95% CI 0.349–0.736, P = 0.000), job status (OR = 0.321, 95% CI 0.122–0.846, P = 0.022), economic status (OR = 4.333, 95% CI 1.424–13.184, P = 0.010), early menarche (OR = 2.815, 95% CI 1.745–4.541, P = 0.000), Stillbirth status (OR = 1.935, 95% CI 1.087–3.446, P = 0.025), family history (OR = 10.281, 95% CI 3.628–29.134, P = 0.000), behavioral habits (OR = 0.554, 95% CI 0.386–0.796, P = 0.001), and second-hand smoking (OR = 1.472, 95% CI 1.108–1.955, P = 0.008) significantly were associated with an increased risk for breast cancer.ConclusionThe data suggest that lifestyle may have more impact on the incidence of breast cancer in Iranian women, suggesting change unhealthy lifestyle and screening for preventing breast cancer.
Exosomes Derived from Anoxia Preconditioned Mesenchymal Stem Cells alleviate Myocardial Ischemia Reperfusion Injury by Inhibiting Pyroptosis/ Caspase-1 Induced Apoptosis in The Deficiency of Gasdermin D
Authors: Mao Chengyu , Li Dongjiu , Zhou En , Gao Erhe , Zhang Tiantian , Gao Lin , Chen Kan , Wang Yue , Wang Changqian
Published: August 2020

BackgroundExosomes derived from adipose-derived mesenchymal stem cells can potentially protect cardiomyocytes from myocardial ischemia reperfusion injury. It's notable that exosomes derived from adipose-derived mesenchymal stem cells underwent anoxia preconditioning showed a better cardioprotective effect than that without anoxia. Here, in vitro and in vivo studies were used to investigate the cardioprotective effects against myocardial ischemia reperfusion injury of exosomes derived from adipose-derived mesenchymal stem cells with (Int-EXO) or without anoxia (NC-EXO), respectively. Methods: Adipose-derived mesenchymal stem cells and exosomes were identified by western blot, flow cytometry, transmission electron microscopy, and nanosight. An exosome tracer assay identified exosomes absorbed by cells. An in vitro model using mice cardiomyocytes for studying anoxia-reoxygenation and an in vivo mice model of MIRI were used to investigate the cardioprotective effects of NC-Exo and Int-Exo, respectively.ResultsWe discovered that treatment with NC-EXO and Int-EXO significantly reduced the infarct size and attenuated cardiomyocyte apoptosis, In addition, Int-EXO group had a less infarct size and apoptosis degree. The mechanism revealed by RNA sequencing showed that 40 miRNAs were up-regulated in Int-EXO compared to NC-EXO. 10 of these miRNAs could bind thioredoxin-interacting protein as a downstream target gene; among these, the top-discrepant miRNA224-5p was selected for further study. Dual luciferase reporter assay and rescue study verified TXNIP as a target gene for miR-224-5p. Furthermore, the cellular death signaling pathway which Int-EXO involved in mediating was in a special form of apoptosis, not pyroptosis, induced by activated thioredoxin-interacting protein-pyroptosis-caspase1 pathway in gasdermin D-deficient cells. ConclusionThe research demonstrated adipose-derived mesenchymal stem cells exosomes attenuated MIRI by inhibiting pyroptosis-induced apoptosis in cardiomyocytes which are lack of gasdermin D. The cardioprotective effect of Int-EXO was more significant than that of NC-EXO, possibly due to treated with anoxia preconditioning, adipose-derived mesenchymal stem cells product more miRNAs targeting thioredoxin-interacting protein in exosomes to alleviate pyroptosis-induced apoptosis. These findings provide new insights into the pathogenesis and methods for intervention of myocardial ischemia reperfusion injury.
Diabetic Patients with Comorbidities had Worse Outcomes When Suffered with COVID-19 and Acarbose might have Protective Effects
Authors: Hu Weihua , Luo Shunkui , Lu Zhanjin , Li Chang , Chen Qijian , Fan Yameng , Chen Zaishu , Wu Longlong , Ye Jianfang , Chen Shiyan , Tong Junlu , Wang Lingling , Mei Jin , Lu Hongyun
Published: August 2020

Background: Previous studies showed that diabetes was a common comorbidity of COVID-19, but the effects of diabetes or anti-diabetic drugs on the mortality of COVID-19 have not been well described. To investigate the outcome of different status (with or without comorbidity) and anti-diabetic medication before admission of diabetic patients after SARS-CoV-2 infected, we collected clinical data of COVID-19 patients from Hubei Province and compared between diabetes and non-diabetes.Methods: In this multicenter and retrospective study, we enrolled 1,422 cases of consecutive hospitalized patients from January 21, 2020 to March 25, 2020 at six hospitals in Hubei Province, China. The primary endpoint was in-hospital mortality.Results: Diabetes patients were 10-years older than non-diabetes (p<0.001), had higher prevalence of comorbidities such as hypertension (p<0.001), coronary heart disease (p<0.001), cerebrovascular disease (CVD) (p<0.001), chronic kidney disease (CKD) (p=0.007). The incidence of mortality (p=0.003) were more prevalent among the diabetes group. Further analysis revealed that diabetes patients who took alpha-glucosidase inhibitor (AGI) had lower mortality rate(p<0.01). Multivariable Cox regression showed that male sex, hypertension, CKD, CVD, age were risk factors for the mortality of COVID-19. Survival curve revealed that, compared with diabetes only group, the mortality was increased in diabetes with comorbidities (p=0.009), but had no significant difference in the non-comorbidity group, p=0.59).Conclusions: Patients with diabetes had worse outcome when suffered with COVID-19, however, it was not associated with diabetes itself but the comorbidities. Furthermore, the administration of AGI could reduce the risk of death in patients with diabetes.
Physicians’ Views on the Usefulness and Feasibility of Identifying and Disclosing Patients’ Last Phase of Life and their Experiences with Using the Surprise Question: A Focus Group Study
Authors: Owusuaa Catherine , Beelen Irene van , Heide Agnes van der , Rijt Carin C.D. van der
Published: August 2020

Background: Accurate assessment that a patient is in the last phase of life is a prerequisite for timely initiation of palliative care in patients with a life-limiting disease, such as advanced cancer or advanced organ failure. Several palliative care quality standards recommend the surprise question to identify those patients.Methods: Physicians’ views of identifying and disclosing the last phase of life and their experiences with using the surprise question for patients with advanced cancer or chronic obstructive pulmonary disease (COPD) were explored in a qualitative focus group study. Data were analyzed using thematic analysis.Results: Fifteen medical specialists and general practitioners participated in two focus groups. Themes discussed in the focus groups were: prediction and disclosure of the imminence of death. Participants thought prediction of imminent death, within one year, was important. The surprise question was considered a useful prognostic tool; its use is facilitated by its simplicity but hampered by its subjective character. The medical specialist was considered mainly responsible for prognosticating and gradual disclosing a patient’s imminent death. Physicians’ reluctance to disclose the imminence of death to a patient was related to the uncertainty around prognostication, concerns about depriving patients of hope or affecting the physician–patient relationship, or about a lack of time or of palliative care services. Conclusions: Physicians consider the assessment of patients’ imminent death important and support the use of the surprise question. However, they experience uncertainty and other barriers in disclosing imminent death. Future studies should examine patients’ preferences for those discussions. Trial registration: not applicable.
Bibliometric analysis of Scopus indexed publications on polymyxin resistance (2009-2018)
Authors: Quincho-Lopez Alvaro , Pacheco-Mendoza Josmel
Published: August 2020

Background: Antimicrobial resistance is a serious public health problem that has become a global threat. Special attention should be given to polymyxins (polymyxin B and colistin) which, since their reintroduction into clinical practice, are considered "last resort" drugs. The objective of this study is to perform a bibliometric analysis of scientific research on polymyxin resistance.Methods: Scopus database was used to retrieve documents relevant to polymyxin resistance. At the beginning, all kinds of documents without year restrictions were included. Subsequently, the study period (2009-2018) was limited and analyzed using SciVal. Specifically, the 10 institutions and countries with the highest production, authors, journals, and most cited articles were analyzed. The growth of publications and citations was graphed, in addition to an analysis of the keywords using VOSviewer.Results: A total of 1,306 documents were retrieved (1947-2019). Original articles (76.95%) and letters to the editor (15.47%) were the most frequent types of documents. English was the predominant language with 1,270 documents (97.2%). In the period 2009-2018, there was a significant growth in publications (p-value < 0.001) retrieving 833 (64%) documents. The received citations were 23,974, with a peak in 2016 (8,033 citations). The United States and China lead the scientific production with 146 (17.5%) and 137 (16.4%) publications, respectively. University of Fribourg (Switzerland) was the most productive institution on the subject (44 documents), although University of Zhejiang (China) has caused the greatest impact (73.5 citations/article). Antimicrobial Agents and Chemotherapy ranked first with 140 documents. Most of the documents were published in quartile 1 journals (82.7% and 69.1%, according to Scimago Journal & Country Rank and CiteScore, respectively).Conclusions: The number of documents on polymyxin resistance has increased significantly in the recent years. In the last few years alone, 64% of all documents have been published. The United States and China lead the scientific production. Greater efforts are still needed to tackle this global problem.