bluuebunny/crossref_metadata_2025 huggingface dataset:
Syndrome of Inappropriate Antidiuresis Associated with Pancreatic Neuroendocrine Tumor: Case Report
Authors: Li Jingyan , Zhang Xinxin , He Qing , Feng Wenli , Wang Zhuoqun , Yu Haonan , Chen Qiusong , Lu Ning , Xu Dongbo , Cui Jingqiu , Liu Ming
Published: December 2020

BackgroundFunctional pancreatic neuroendocrine tumors (pNETs) rarely produce vasopressin. To the best of our knowledge, only one case of an ADH-producing pNET has been reported thus far. Here, we report a case of pNET producing vasopressin in a 78-year-old man with hyponatremia.Case presentationThe patient presented with anorexia 4 years ago, and the lowest serum sodium level was 121 mmol/L. Upon admission, serum osmolarity was 277 mOsm/kg·H2O, urine osmolarity was 465 mOsm/kg·H2O, urine sodium level was 82.5 mmol/L, and 24-hour urine sodium level was 140.25 mmol. There was no evidence of adrenal insufficiency or hypothyroidism. Syndrome of inappropriate antidiuresis (SIAD) was diagnosed on the basis of laboratory and clinical findings. The serum sodium level was maintained within the normal range after the oral administration of tolvaptan 7.5 mg. 68Ga-tetraazacyclododecanetetraacetic acid–DPhe1-Tyr3-octreotate positron emission tomography-computed tomography (68Ga-DOTATATE PET-CT) showed a high uptake lesion measuring approximately 1 cm in diameter in the pancreatic body, and the possibility of the pNET was considered. The patient underwent surgery, and the immunohistochemical study showed that the tumor cells were positive for somatostatin receptors 2 (SSTR2) and vasopressin. The patient was weaned from tolvaptan post-surgery, and low-dose corticosteroids were started due to signs of relative adrenal insufficiency, which was probably related to heart failure and surgery. Serum sodium level was maintained within the normal range.ConclusionsThis case illustrates the potential ectopic production of vasopressin resulting in SIAD in pNETs, highlighting the adoption of 68Ga-DOTATATE PET-CT and vasopressin immunohistochemical staining in the evaluation of the etiology of SIAD.
Development and Testing of Relative Risk-based Health Messages for Electronic Cigarette Products
Authors: Kimber Catherine , Cox Sharon , Frings Daniel , Albery Ian P. , Dawkins Lynne
Published: December 2020

Background: Health messages on e-cigarette packs emphasise nicotine addiction or harms using similar wording to warnings on cigarette packs. These may not be appropriate for e-cigarettes which constitute a reduced risk alternative for smokers. This research aimed to i) develop and test a selection of relative risk messages for e-cigarette products; ii) compare these to the two current EU Tobacco Products Directive (TPD) nicotine addiction messages; and iii) explore differences between smokers, non-smokers and dual users. Method: Twenty-six messages focusing on either harm-reduction or cessation were developed and rated by multidisciplinary experts for accuracy, persuasiveness and clarity. The eight highest ranking messages were compared alongside the TPD messages in a sample of 983 European residents (316 smokers, 327 non-smokers, 340 dual users) on understandability, believability and convincingness. Results: On all three constructs combined, the two TPD messages rated the highest, closely followed by four relative risk messages “Completely switching to e-cigarettes lowers your risk of smoking related diseases”, “Use of this product is much less harmful than smoking”, “Completely switching to e-cigarettes is a healthier alternative to smoking”, and “This product presents substantially lower risks to health than cigarettes” which did not differ statistically from the TPD messages. Non-smokers rated TPD1 significantly higher overall than dual users. Dual users rated “This product is a safer alternative to smoking” significantly higher than non-smokers. Messages did not differ on understandability. Conclusions: These alternative messages provide a useful resource for future research and for policy makers considering updating e-cigarette product labelling.
Contributing barriers to Defaulting from Antenatal Care Services in Villages Around Addis Ababa: A Qualitative Study
Authors: Tsegaye Zergu , Abawollo Hailemariam , Desta Binyam , Mamo Tsega , Heyi Atrie , Mesele Mestawot , Lose Addisu
Published: December 2020

Background: Problems during pregnancy, childbirth and postpartum are the major contributors to maternal and perinatal morbidity and mortality. Focused antenatal care is an intervention set to provide basic services for pregnant women, to reduce morbidity and mortality related to pregnancy. In Ethiopia, there is a significant antenatal care attendance dropout between the first and fourth visits. The aim of this study is to explore the potential contributing barriers to defaulting from antenatal care services in the country.Methods: A qualitative research method was used, where 20 in-depth interviews and three focus group discussions were conducted. A qualitative data analysis software, ATLAS.ti 8, was applied. Results: Low quality antenatal care service which occurs primarily due to shortage of the required drugs, supplies and equipment is a major barrier for sustainable attendance of antenatal care followed by poor care, respect and receptiveness of service providers. Lack and cost of transport as well as partners’ approval and support were also claimed to be part of the major barriers. Community culture and pervious maternal experiences as well as maternal sociodemographic factors like maternal age at time of pregnancy and educational status of mothers were also reported as barriers to the seeking and completion of antenatal care services. Conclusions: Both demand and supply side barriers play a significant role in the dropout of antenatal care services. Availing good quality antenatal care services, closer to the community by improving the health workforce and supply chain system is recommended.
Effects of a Temporary Suspension of Community-based Health Insurance in Kwara State, Nigeria
Authors: Bolarinwa Oladimeji Akeem , Akande Tanimola Makanjuola , Janssens Wendy , Boahene Kwasi , de Wit Tobias Rinke
Published: December 2020

Background: Social health insurance has been widely proposed as a key strategy to improve access to healthcare and provide financial protection. The Kwara Community Health Insurance Programme (KCHIP) in Nigeria was temporarily suspended in 2016 in anticipation of the roll-out of a state-wide health insurance scheme. This article reports the adverse consequences of the scheme’s suspension on enrollees’ healthcare utilization and the associated factors with the ability to pay for care. Methods: A mixed-methods study was carried out in Kwara State, Nigeria, in 2018 using a semi-quantitative cross-sectional survey amongst 600 former KCHIP clients, and in-depth interviews with 24 clients and 29 participating public and private healthcare providers in the program. Quantitative data was analyzed using Statistical Package for Social Science (SPSS) version 22 while qualitative data was analyzed thematically.Results: Most of former enrollees (95.3%) kept utilizing programme facilities after the suspension, mainly because of the high quality of care. However, majority of the enrollees (95.8%) reverted to out-of-pocket (OOP) payment while 67% reported constraints in payment for healthcare services after suspension of the program. In the absence of insurance, the most common coping mechanisms for healthcare payment were personal savings (63.3%), donations from friends and families (34.7%) and loans (11.8%). Being a male enrollee (OR=1.61), living in a rural community (OR=1.77), exclusive usage of KCHIP prior to suspension (OR=1.94) and suffering an acute illness (OR=3.38) increased the odds of being financially constrained in accessing healthcare. Expectedly, the wealthy respondents were less likely (OR = 0.78) to be constrained by the suspension of the programme. All healthcare facilities in the study sample experienced a reduced patient load after suspension of the scheme. Seventeen of 29 healthcare facilities recorded a decrease in revenue, more noticeable among private facilities. Conclusion: After the suspension of the KCHIP, many enrollees and health facilities experienced financial constraints. These underscore the importance of sustainable health insurance schemes as a risk-pooling mechanism to sustain access to good quality health care and financial protection from catastrophic health expenditures. Moreover, the findings highlight the importance of effective processes to smooth the transition policy from community- to state-wide health insurance schemes.
Comparison of Different Calibration Techniques by Laser Induced Breakdown Spectroscopy in Bakery Products 
Authors: ESELLER KEMAL Efe , Bilge Gonca , Berberoglu Halil , Sezer Banu , Tamer Ugur , Boyaci İsmail Hakki
Published: December 2020

Laser induced breakdown spectroscopy (LIBS) is a rapid optical spectroscopy technique for elemental determination, which has been used for quantitative analysis in many fields. However, the calibration involving atomic emission intensity and sample concentration, is still a challenge due to physical-chemical matrix effect of samples and fluctuations of experimental parameters. To overcome these problems, various chemometric data analysis techniques have been combined with LIBS technique. In this study, LIBS was used to show its potential as a routine analysis for Na measurements in bakery products. A series of standard bread samples containing various concentrations of NaCl (0.025%–3.5%) was prepared to compare different calibration techniques. Standard calibration curve (SCC), artificial neural network (ANN) and partial least square (PLS) techniques were used as calibration strategies. Among them, PLS was found to be more efficient for predicting the Na concentrations in bakery products with an increase in coefficient of determination value from 0.961 to 0.999 for standard bread samples and from 0.788 to 0.943 for commercial products.
SERPINB10 Contributes to Asthma by Inhibiting the Apoptosis of Allergenic Th2 Cells
Authors: Mo Yuqing , Ye Ling , Cai Hui , Zhu Guiping , Wang Jian , Zhu Mengchan , Song Xixi , Yang Chengyu , Jin Meiling
Published: December 2020

Background: Serine peptidase inhibitor, clade B, member 10 (SERPINB10) contributes to allergic inflammation in asthma. However, its role in the T-helper type 1 (Th1) /Th2 response of allergic asthma is not known. The goal of this study was to unveil the function of SERPINB10 in the Th2 response of allergic asthma and the mechanism by which SERPINB10 affects the viability of Th2 cells.Methods: Th2 cytokines and serum levels of house dust mite (HDM)-specific IgE in bronchoalveolar lavage fluid were examined by ELISA in an HDM-induced asthma model. The number and apoptosis of Th1 and Th2 cells in mouse lungs were measured by flow cytometry. Naïve CD4 T cells from patients with asthma were cultured under appropriate polarizing conditions to generate Th1 and Th2 cells. SERPINB10 expression in polarized Th1 and Th2 cells was quantified by real-time reverse transcription-quantitative polymerase chain reaction. SERPINB10 expression was knocked down in CD4 T cells with lentivirus. Results: Knockdown of SERPINB10 expression significantly diminished HDM-induced Th2 cytokine secretion and level of HDM-specific IgE. After HDM exposure, SERPINB10-knockdown mice had diminished numbers of Th2 cells, but similar numbers of Th1 cells, compared with those in negative-control mice. Th2 cells of SERPINB10-knockdown mice were more susceptible to apoptosis than that of control mice. Stimulating T-cell receptors (TCRs) with anti-CD3 antibody caused upregulation of SERPINB10 expression in polarized Th2 cells, but not polarized Th1 cells. Knockdown of SERPINB10 expression resulted in fewer numbers and greater apoptosis of polarized Th2 cells.Conclusion: Our results suggest that SERPINB10 may contributes to allergic inflammation and the Th2 response of asthma by inhibiting the apoptosis of Th2 cells.
Predictors of Undertriage after Major Trauma in a Physician-led Prehospital System: Insights of a French Registry
Authors: BENHAMED Axel , FRATICELLI Laurie , CLAUSTRE Clément , DOUPLAT Marion , MARCOTTE Guillaume , CESAREO Eric , GOSSIOME Amaury , BOURGEOIS Jean-Baptiste , HEIDET Matthieu , EMOND Marcel , DAVID Jean-Stéphane , KHOURY Carlos EL , TAZAROURTE Karim
Published: December 2020

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

The authors have requested that this preprint be removed from Research Square.
Malaria Finance, Household Mosquito Net Ownership & Use, Intermittent Preventive Treatment in Pregnancy (IPTp) in Ghana; A Socioeconomic Comparative Analysis
Authors: Lukwa Akim Tafadzwa , Atta-Obeng Christian , Kaseke Tinashe Warren , Aggrey Siya , Alaba Olufunke
Published: December 2020

Background Malaria to date remains one of the top five killer diseases in sub-Saharan Africa (SSA), the malaria burden is skewed towards pregnant women and children under five. Insecticide Treated Bed-Net (ITN) usage and intermittent preventive treatment has been credited to be among the most cost-effective, preventive interventions against malaria. MethodsThe study used Ghana’s Malaria Indicator Surveys (GMIS) of 2016 and 2019. Socioeconomic status was assessed using the wealth index reported in both surveys. Household mosquito net ownership, mosquito net use among under 5’s and women, IPTp coverage, health insurance and awareness of malaria covered by national health insurance were binary variable, therefore the study adopted the Wagstaff normalized index. Concentration curves were computed to present a graphical picture of the concentration indices.ResultsTreated household net ownership and use among under-5s’ and pregnant women for both time periods was highest in among poor literate rural women, as well as the Intermittent Preventive Treatment in pregnancy coverage. However, even though poor households were more likely to have health insurance, wealth household were more likely to be aware that malaria treatment is finance by the National Health Insurance Scheme in Ghana.Conclusion In conclusion for the period under-review the concentration indices for; household net ownership, usage of treated nets among under-5s and pregnant women increased reflecting widening socioeconomic inequalities in net ownership and usage in Ghana. While, health insurance ownership and awareness of malaria finance under NHIS showed socioeconomic gaps to be contracting.
Take Home Injectable Opioids for Opioid Use Disorder During and After the COVID-19 Pandemic Is in Urgent Need: A Case Study
Authors: Oviedo-Joekes Eugenia , MacDonald Scott , Boissonneault Charles , Harper Kelli
Published: December 2020

Background: In North America the opioid poisoning crisis currently faces the unprecedented challenges brought by the COVID-19 pandemic, further straining people and communities already facing structural and individual vulnerabilities. People with opioid use disorder (OUD) are facing unique challenges in response to COVID-19, such as not being able to adopt best practices (e.g., physical distancing) if they’re financially insecure or living in shelters (or homeless). They also have other medical conditions that make them more likely to be immunocompromised and at risk of developing COVID-19. In response to the COVID-19 public health emergency, national and provincial regulatory bodies introduced guidance and exemptions to mitigate the spread of the virus. Among them, clinical guidance for prescribers were issued to allow take home opioid medications for opioid agonist treatment (OAT). Take Home for injectable opioid agonist treatment (iOAT) is only considered within a restrictive regulatory structure, specific to the pandemic. Nevertheless, this risk mitigation guidance allowed carries, mostly daily dispensed, to a population that would not have access to it prior to the pandemic. In this case it is presented and discussed that if a carry was possible during the pandemic, then the carry could continue post COVID-19 to address a gap in our approach to individualize care for people with OUD receiving iOAT.Case Presentation: Here we present the first case of a patient in Canada with long-term OUD that received take home injectable diacetylmorphine to self-isolate in an approved site after being diagnosed with COVID-19 during a visit to the emergency room where he was diagnosed with cellulitis and admitted to receive antibiotics. Conclusion: In the present case we demonstrated that it is feasible to provide iOAT outside the community clinic with no apparent negative consequences. Improving upon and making permanent these recently introduced risk mitigating guidance during COVID-19, have the potential not just to protect during the pandemic, but also to address long-overdue barriers to access evidence-based care in addiction treatment.
A Comparison of Six Approaches for Measuring Utility Values Among Patients With Locally Advanced Cervical Cancer: a Cross-sectional Study
Authors: Katanyoo Kanyarat , Thavorncharoensap Montarat , Chaikledkaew Usa , Riewpaiboon Arthon
Published: December 2020

Background: A variety of instruments to measure health utilities are available. Nevertheless, there was a lack of agreement between utility scores generated by the different instruments. To avoid difference in estimates of cost-effectiveness arising from the use of different instruments, it is essential to know whether these widely used instruments can be used interchangeable or not. While Euro-Quality of Life Five-Dimension (EQ-5D) is recommended as a preferred instrument for measuring health utilities there is no clear consensus on the preferred version of EQ-5D. Besides EQ-5D, time-trade-off (TTO), and visual analog scale (VAS) were commonly used instruments. This study aims to investigate agreement and performance of the following 6 utilities measures; EQ-5D-3L, EQ-5D-5L (cTTO Model), EQ-5D-5L (DCE Model), EQ-5D-5L (Hybrid model), TTO, and VAS among patients with locally advanced cervical cancer in Thailand. Methods: Face-to-face interview were conducted with 194 locally advanced cervical cancer patients. Comparison of median utility scores derived from the 6 approaches was made using Friedman test. The agreement of utility scores between each pairwise comparison was assessed by intraclass correlation coefficient (ICC) and Bland-Altman plot. Known-validity was determined by comparing two known groups with respect to status of treatment (i.e. treatment, disease free, and progression), and presences of symptoms (no symptoms, 1 symptom, and > 1 symptoms). Results: The mean (SD) utility values derived from the 6 approaches were, from low to high, 0.755±0.248 (EQ-5D-3L), 0.801±280 (TTO), 0.806±0.156 (VAS), 0.871±0.184 (cTTO model), 0.875±0.168 (Hybrid model), and 0.900±0.142 (DCE model). Intraclass correlation coefficient showed high agreement between EQ-5D-5L and EQ-5D-3L and very high agreement between all 3 models of EQ-5D-5L. Bland-Altman plots showed wide limit of agreement except the pairwise comparison between each model of the EQ-5D-5L; cTTO model and DCE model, cTTO model and Hybrid model, and DCE model and Hybrid. All 6 approaches can significantly differentiate treatment status and presence of symptoms.Conclusions: The commonly used utility measures, which are TTO, VAS, EQ-5D-3L and EQ-5D-5L cannot be used interchangeable among locally advanced cervical cancer patients. High agreement was found only between each pairwise comparison of the 3 value sets of EQ-5D-5L.
Synergistic Impact of Symptom Clusters on Health-related Quality of Life in Patients With Chronic Obstructive Pulmonary Disease: a Secondary Data Analysis
Authors: Fei Fei , Koffman Jonathan , Zhang Xiaohan , Gao Wei
Published: December 2020

Background: Clinical experiences and middle range Theory of Unpleasant Symptoms indicate that the existence of symptom clusters (SCs) may synergistically affect patients’ health-related quality of life (HRQoL). However, no studies have examined this issue. The aim of this study was to identify symptom clusters and quantify the synergistic impact of symptom clusters on health-related quality of life among patients with chronic obstructive pulmonary disease (COPD).Methods: Secondary data analysis of cross-sectional data collected via convenience sampling from patients with COPD in a Chinese university hospital. Assessments included modified MRC dyspnoea scale, Beck Depression Inventory, Beck Anxiety Inventory and Pittsburgh Sleep Quality Index. Health-related quality of life was assessed using the St George's Respiratory Questionnaire. Chi-squared tests were used to identify symptom clusters. Multiple linear regressions were used to examine associations between symptom clusters and health-related quality of life.Results: 106 COPD subjects were recruited. Three symptom clusters were identified in COPD patients and comprised of dyspnoea and depression (OR=2.69, 95%CI:1.19-6.02); anxiety and sleep (OR=2.72, 95%CI:1.20-6.15); depression and anxiety (OR=6.13, 95%CI:2.57-14.60). Two symptom clusters were identified in patients with severe-stage COPD, which were anxiety and sleep (OR=6.21, 95%CI:1.70-22.74), depression and anxiety (OR=5.33, 95%CI:1.64-17.40). All three symptom clusters (anxiety and sleep; dyspnoea and depression; depression and anxiety) were independently associated with health-related quality of life (β=14.56, 95%CI: 5.80-23.31; β =13.95, 95%CI:5.72-22.18; β=13.30, 95%CI:6.88-19.73).Conclusions: This is the first study to validate the synergistic impacts of symptom clusters on health-related quality of life in COPD patients compared with single symptoms. These findings, which offer a detailed understanding of symptom clusters present in COPD, provide a basis to guide efficient clinical assessment and management symptom-related distress.
A Method for Cryopreservation and Single Nucleus RNA-sequencing of Normal Adult Human Interventricular Septum Heart Tissue Reveals Cellular Diversity and Function
Authors: Larson Amy , Chin Michael T.
Published: December 2020

Background: Single cell sequencing of human heart tissue is technically challenging and methods to cryopreserve heart tissue for obtaining single cell information have not been standardized. Studies published to date have used varying methods to preserve and process human heart tissue, and have generated interesting datasets, but development of a biobanking standard has not yet been achieved. Heart transcription patterns are known to be regionally diverse, and there are few single cell datasets for normal human heart tissue. Methods: Using pig tissue, we developed a rigorous and reproducible method for tissue mincing and cryopreservation that allowed recovery of high quality single nuclei RNA. We subsequently tested this protocol on normal human heart tissue obtained from organ donors and were able to recover high quality nuclei for generation of single nuclei RNA-seq datasets, using a commercially available platform from 10x Genomics. We analyzed these datasets using standard software packages such as CellRanger and Seurat. Results: Human heart tissue preserved with our method consistently yielded nuclear RNA with RNA Integrity Numbers of greater than 8.5. We demonstrate the utility of this method for single nuclei RNA-sequencing of the normal human interventricular septum and delineating its cellular diversity. The human IVS showed unexpected diversity with detection of 23 distinct cell clusters that were subsequently categorized into different cell types. Cardiomyocytes and fibroblasts were the most commonly identified cell types and could be further subdivided into 5 different cardiomyocyte subtypes and 6 different fibroblast subtypes that differed by gene expression patterns. Ingenuity Pathway analysis of these gene expression patterns suggested functional diversity in these cell subtypes. Conclusions: Here we report a simple technical method for cryopreservation and subsequent nuclear isolation of human interventricular septum tissue that can be done with common laboratory equipment. We show how this method can be used to generate single nuclei transcriptomic datasets that rival those already published by larger groups in terms of cell diversity and complexity and suggest that this simple method can provide guidance for biobanking of human myocardial tissue for complex genomic analysis.
Emotional Fusion and Design Optimization Method Based on Kansei-AD: A Case Study of Laser Additive Manufacturing Equipment
Authors: Ma Mingyu , Jiang Xingyu , Liu Weijun , Wang Xu , Zhao Chen , Liu Dan , Yang Guozhe
Published: December 2020

To improve the level of integration between the psychological and emotional needs of laser additive manufacturing equipment personnel and the cognitive interactive design of human-machine systems, an emotional optimization design method for laser additive manufacturing equipment based on Kansei engineering and axiomatic design (Kansei-AD) is proposed. By exploring the emotional cognitive process of personnel on equipment, the representation means of the psychological and emotional needs of personnel are clarified. To clarify the psychological and emotional needs of users, the Kansei semantic difference experiment is applied to determine the user domain of axiomatic design. To resolve the difficulty of accurately mapping and expressing between user emotional factors and design elements in the design process, a combination of rough analytic hierarchy process (rough AHP) and quality function deployment (QFD) is used in the functional domain to determine the user Kansei design needs. In addition, the mapping relationship between Kansei design requirements and design requirements is judged by independent axioms of axiomatic design. A matrix of morphological elements-design requirements is constructed, and the morphological design elements that meet the psychological and emotional needs of personnel are determined using the GRA-TOPSIS method. LDM4030 laser coaxial powder feeding equipment is taken as an example to verify the feasibility of the optimization method. The result shows that the method effectively optimizes the design of the equipment according to the psychological and emotional needs of personnel. It provides a new research idea for the psychological and emotional design of laser additive manufacturing equipment.
Significance of Frailty in Prognosis After Surgery in Patients with Pancreatic Ductal Adenocarcinoma
Authors: Yamada Shinichiro , Shimada Mitsuo , Morine Yuji , Imura Satoru , Ikemoto Tetsuya , Saito Yu , Miyazaki Katsuki , Tokunaga Takuya , Nishi Masaaki
Published: December 2020

Background: Frailty is an important consideration for older patients undergoing surgery. We aimed to investigate whether frailty could be prognostic factor in patients with pancreatic ductal adenocarcinoma who underwent pancreatic resection.Methods: One hundred and twenty patients who underwent pancreatic resection for pancreatic ductal adenocarcinoma were enrolled. Frailty was defined as a clinical frailty scale score ≥4. Patients were divided into frailty (n = 29) and non-frailty (n=91) groups, and clinicopathological factors were compared between two groups. Results: The frailty group showed an older age, lower serum albumin concentration, lower prognostic nutritional index, larger tumor diameter, and higher rate of lymph node metastasis than the non-frailty group (p < 0.05). Neutrophil–lymphocyte ratio and modified Glasgow prognostic score tended to be higher in the frailty group. Cancer-specific and disease-free survival rates were significantly poor in the frailty group (p < 0.05). With a multivariate analysis, frailty was an independent prognostic factor of cancer-specific survival.Conclusions: Frailty can predict the prognosis of patients with pancreatic ductal adenocarcinoma who undergo pancreatic resection.
The Knowledge and Attitudes of Health Professionals Working in Mother-Friendly Hospitals About Complementary Therapy and Supportive Care Methods
Authors: Bolsoy Nursen , Tayhan Esra Bozhan , Durgun Secil Köken , Damar Elif , Kayıp Emine
Published: December 2020

Background: It is important that the healthcare professionals who are with the mother at the moment of birth and afterwards know and apply effective complementary treatment and supportive care methods, their effects and limitations. The aim of this study is to determine the knowledge levels and attitudes of health personnel about complementary therapy and supportive care methods to be used in the management of labor pain and postpartum period.Methods: A descriptive study included 142 midwives / nurses and physicians working in the delivery room and maternity services of mother-friendly hospitals in Manisa. The questionnaire form consisting of 25 questions evaluated the knowledge and attitudes of the participants about complementary therapy and supportive care methods.Results: It was found that 30.6% of the healthcare professionals participating in the study used complementary treatment and supportive care methods in their patients. The least heard method was chiropractic (81.0%), the best known method was hydrotherapy (water birth) (5.8%). The most used method is massage with a rate of 14.0%. It was determined that the mean total attitude score of the healthcare workers on complementary treatment and supportive care methods was 18.57 ± 5.12 (min: 8, max: 40). A statistically significant difference was found between the education level and the institution they work for of healthcare professionals and their attitude scores (p <0.05). Conclusions: 1 out of every two healthcare professionals did not have information about complementary treatment and supportive care methods. It can be said that the use of these methods will increase with the learning desire and positive attitude of healthcare professionals.
Investigating The Relationship Between Insomnia, Menopausal Syndrome and Depression and Exploring The Therapeutic Effects of Jieyu Pill
Authors: Wang Hui , Hou Xucan , Tian Xuemei , Wang Yun
Published: December 2020

Background: This paper explores the effects of insomnia and menopausal syndrome on the depressive process at the cellular and molecular levels, and investigates the mechanisms by which the commonly used antidepressant formula, Jieyu Pill (JYP), also has efficacy in insomnia and menopausal syndrome. Methods: Neo4j was used to construct a graph database based on three diseases and mechanism of JYP; PPI data were used to analyze the molecular mechanism of effects of the diseases on depression process; the entity grammar system was used to resolve the mechanism of JYP in treatment of two diseases. Results: A database of JYP and three disease charts was constructed. The relationship between insomnia and menopausal syndrome in terms of molecular mechanisms and cellular communication on the depressive process was obtained. The mechanism of JYP in insomnia and menopausal syndrome was obtained. Conclusions: The results of this paper, which was conducted from the point of view of cellular communication and molecular mechanisms, show that insomnia and menopausal syndrome can have an impact on the course of depression. Therefore, synergistic treatment should be given to patients with depression associated with these two disorders. JYP is effective for all three disorders, can comprehensively regulate the organism and has high compliance, making it a clinical formula worth promoting.
WITHDRAWN: Healthcare Professional Association Agency In Preparing For Artificial Intelligence: A Multi-Case Study Protocol
Authors: Gillan Caitlin , Hodges Brian , Wiljer David , Dobrow Mark
Published: December 2020

BackgroundThe emergence of artificial intelligence (AI) in healthcare impacts on most aspects of our healthcare systems including consideration of employment, training, education, and professional regulation for healthcare professions. It is incumbent on healthcare professional associations (HPAs) to assist their membership in defining and preparing for AI-related change. HPAs, or the national groups convened to represent the interests of the members of a profession, hold a unique role in establishing and maintaining the socio-cultural, normative, and regulative elements of healthcare professions. The objective of this study is to examine how, when faced with AI as a disruptive technology, HPAs engage in sense-making and legitimization of change in order to support their membership in preparing for future practice.MethodsAn exploratory multi-case study approach will be employed. This study will be informed by normalization process theory (NPT), which suggests behavioural constructs required for complex change, providing a novel lens through which to consider the agency of macro-level actors in practice change. Four HPAs will be studied, with each representing an instrumental case and related fields, selected for their early consideration and adoption of AI technologies. Data collection will consist of key-informant interviews, observation of relevant meetings, and document review. Individual and collective sense-making activities and action toward change will be identified and characterized using stakeholder network mapping. A hybrid inductive/deductive model will be used for a concurrent thematic analysis, mapping emergent themes against the NPT framework to assess fit and identify areas of discordance. DiscussionA linear cross-case analytic approach will be taken to present the data, highlighting both guidance for the implementation of AI and implications for the application of NPT at the macro level. The ability to inform consideration of AI will depend on the degree to which the engaged HPAs have considered this topic at the time of the study, and hence what priority it has been assigned within the HPA and what actions have been taken to consider or prepare for it. The fact that this may differ between HPAs and associated professions and practice environments will require consideration throughout the analysis. Ultimately, this protocol outlines a case study approach to understanding how, when faced with AI as a disruptive technology, HPAs engage in sense-making and legitimization of the change in order to support their membership in preparing for future practice.
Subtyping Salmonella of Pet Dogs With Multilocus Sequence Typing (MLST) and Clustered Regularly Interspaced Short Palindromic Repeats (CRISPRs)
Authors: Yang Cheng , Shao Wangfeng , Wei Lingling , Chen Lingxiao , Zhu Aihua , Pan Zhiming
Published: December 2020

Salmonella, as a zoonotic pathogen, has attracted widespread attention worldwide, especially in the transmission between household pets and humans. Therefore, we investigated the epidemic distribution of dog Salmonella from pet hospitals and breeding base in Xuzhou, Jiangsu Province, China, and used multilocus sequence typing（MLST）and clustered regularly interspaced short palindromic repeats（CRISPRs）to subtype Salmonella isolates. From April 2018 to November 2019, a total of 469 samples were collected from pet hospitals and breeding base, including 339 dog samples and 60 cat samples. S. Kentucky (40.74%) was the most prevalent serotype, but other, such as S. Typhimurium (18.52%) and S. Indiana (18.52%), were also widespread. Eight different sequence type (ST) patterns were Identified by MLST and ST198 was the highest proportion of these isolates. CRISPRs analysis showed that 9 different Kentucky CRISPR types (KCTs) was identified from ST198. 48 spacers including 29 (6 News) for CRISPR1 and 19 (4 News) for CRISPR2 that proved the polymorphic of Salmonella genes in samples from different sources. The analysis demonstrated that the common serotypes were widely present in pet hosts in the same area. This analysis shows that CRISPR genes have better recognition ability in the same serotype, which has a positive effect on the traceability of salmonella and the prevention and treatment of salmonellosis.
Quercetin Prevents Primordial Follicle Loss via Suppression of PI3K/Akt/Foxo3a Pathway Activation in Cyclophosphamide - Treated Mouse
Authors: Li Jianghui , Long Hui , Cong Yanyan , Gao Hongyuan , Lyu Qifeng , Yu Sha , Kuang Yanping
Published: December 2020

Background: Chemotherapy improves survival rates but often causes some adverse effects associated with ovarian damage, characterized by a decreased of primordial follicle stockpiles. Recent studies reveal that chemotherapy may stimulate the PI3K signaling pathway, who has roles in manipulating the dormancy and activation of mammalian primordial follicles, resulting in accelerated primordial follicles activation followed by the loss of ovarian reserve. As an inhibitor of PI3K pathway, whether quercetin has protective properties against chemotherapy - induced follicle loss in mice is worth to be explored.Methods: The effects of quercetin on the mouse model of cyclophosphamide-induced ovarian dysfunction were investigated. Paraffin sections of mouse ovary were stained with hematoxylin and eosin for differential follicles count and TUNEL assay for apoptosis detection. Immunohistochemistry stain with ki67 and Foxo3a were used to evaluate the activation of primordial follicles. The function of PI3K signaling pathway were assessed via the western blot of ovary.Results: Quercetin cotreatment rescued the reduction number of dormant primordial follicles induced by cyclophosphamide. Moreover, analysis of the PI3K/Akt/Foxo3a pathway demonstrated that quercetin co - administration decreased phosphorylation of proteins that stimulate follicle activation in ovary induced by cyclophosphamide. Meanwhile, Quercetin prevents cyclophosphamide - induced apoptosis in early growing follicles and early antral follicles, maintaining AMH level secreted by these follicles, preserving the quiescence of the primordial follicle pool, characterized by the intranuclear staining of Foxo3a in primordial follicle. Conclusions: Quercetin attenuates cyclophosphamide - induced follicle loss by preventing the phosphorylation of PI3K/Akt/Foxo3a pathway members and maintaining AMH level secreted by growing follicles.
Herd immunity of Covid 19 in dynamic environments with vaccination: a model based study
Authors: Yang Liwei , Chen Bochuan , Zhang Yu , Du Siyao , Zhao Lang
Published: December 2020

BackgroundThe first wave of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in Canada is entering the last stage, while the development of vaccine is still ongoing. A thorough analysis on the potential effect of restoring to the normal life was needed.MethodsWe used an infectious disease model which optimized for individual immunity to investigate the potential impact of the vaccine on the number of cases, ℛ𝑡, and the duration of the epidemic. We modeled the severity of the cases with three intervention measures and the effect of herd immunity. The combined intervention strategies with the vaccination, speed of vaccination, and the proportion of population pre-vaccinated before reopening were modeled to give an overview of the effect of the vaccination. For each simulation, we set the observation range to be from Feb, 2020 to Oct. 2021, and modeled the number of cases after the first wave, the change of reproduction number (ℛ𝑡), and the proportion of immunized population under the effect of waning immunity.FindingsWe found the proportion of immunized population to reach herd immunity in a dynamic environment to be between 1−1ℛ0and 1−1ℛ02; for Covid-19, the threshold proportion is 64·16%, the final proportion of infections could be up to 87·15% when basic reproduction number (ℛ0) is 2·79. The average number of cases predicted in Canada after the first wave was 285590, 90260, 163057, and 60082 with no intervention, social distancing, quarantining severe cases, and combined strategies; 122261, 89903, 49276, 39856, and 10983 cases with 0·1%, 0·2%, 0·3%, 0·4%, and 1·0% of the population vaccinated per day; 117475, 93502, 91634, 79418, and 8713 cases with 10%, 20%, 30%, 40%, and 50% of population immunized before reopening. Assuming the half-life of the effectivity of the antibody is 48 weeks for symptomatic cases, 24 weeks for asymptomatic cases.Interpretation Neither of these strategies cannot prevent the second wave solely nor together. However, the third wave can be prevented with both social distancing and quarantining severe cases in practice. The speed and timing of vaccination has a direct impact on the reduction of the final number of cases. Unexpectedly, the proportion of population immunized before reopening did not lead to a huge shift of the number of cases after the first wave when the immunized proportion is lower than the critical proportion (49·6%) when social distancing is in practice.
Novel Nomograms to Predict of Overall Survival and Cancer-Specific Survival of Patients of Metaplastic Breast cancer
Authors: Li Yongfeng , Chen Daobao , Xuan Haojun , Dragomir Mihnea P. , Calin George A. , Yang Hongjian , Chen Meng , Jin hongchuan
Published: December 2020

Background Metaplastic breast cancer (MBC) is a rare type of breast cancer with an increasing incidence, we aim to develop clinical nomograms to predict the overall survival and cancer-specific survival for patients with MBC.MethodsPatients data were collected from the SEER database between 1973 and 2015. All included patients were randomly assigned into the training and validation sets. Univariate and multivariate Cox analysis were performed to identify independent prognostic factors of MBC. These essential prognostic variables were combined to construct nomogram models to predict overall survival (OS) and cancer-specific survival (CSS) in patients with MBC. Model performance was evaluated by concordance index (C-index) and calibration plots.ResultsA total of 1129 patients were collected and divided into the training (753) and validation (376) groups. The multivariate Cox model identified age, stage_ajcc, T stage, chemotherapy and radiotherapy as independent covariates associated with OS, while age, race, stage_ajcc, T stage, and radiotherapy were independent prognostic factors of CSS. The nomogram constructed based on these covariates demonstrated excellent accuracy in estimating 3-, and 5-year OS and CSS, with a C-index of 0.744 (95% CI, 0.701-0.787) for OS and 0.746 (95% CI, 0.695-0.797) for CSS in the training cohort. In the validation cohort, the nomogram-predicted C-index was in OS and 0.818 for OS (95% CI, 0.775-0.861) and 0.800 (95% CI, 0.747-0.853) for CSS. All calibration curves exhibited good consistency between predicted and actual survival.ConclusionsThese nomogram models established in this study can help to enhance the accuracy of prognostic prediction, which may thereby improve individualized assessment of survival risks and facilitate to provide constructive therapeutic suggestions.
Pre-operative External Ventricle Drainage Improves Neurological Outcomes for Patients with Traumatic Intracerebellar Hematomas
Authors: Wang Bao , Ge Shun-nan , Guo Hao , Gao Fei , Shi Ying-wu , Cui Wen-xing , Li zhi-hong , Qu Yan
Published: December 2020

Background: Traumatic intracerebellar hematoma (TICH) is a very rare entity but with high morbidity and mortality rate, and there is no consensus on its optimal surgical management. In particular, whether and when to place external ventricle drainage in TICH patients without acute hydrocephalus pre-operation is still controversial.Methods: A single-institutional, retrospective analysis of total 47 TICH patients with craniectomy hematoma evacuation in a tertiary medical center from January 2009 to October 2020 was performed. Primary outcomes were mortality in hospital and neurological function evaluated by GOS at discharge and 6 months after the ictus. The special attention was paid to the significance of external ventricular drainage (EVD) in TICH patients without acute hydrocephalus on admission.Results: Analysis of the clinical characteristics of the TICH patients revealed that the odds use of EVD was seen in patients with IVH (p=0.03), fourth ventricle compression (p=0.02), and acute hydrocephalus (p<0.01). Placement of EVD at the bedside can significantly improve the GCS score before craniotomy (p=0.02), as well as the neurological score at discharge (p=0.045) and 6 months (p=0.04). Compared with the only hematoma evacuation (HE) group, there is a trend that EVD can reduce hospital mortality (27.6% vs. 38.9%) and decrease the occurrence of delayed hydrocephalus (4.8% vs. 18.2%), although the difference is not statistically significant. In addition, EVD can reduce the average NICU stay time (p=0.04, 4.9 ± 5.1 vs. 9.4 ± 6.3), but has no effect on the total length of stay. Moreover, our data showed that EVD did not increased the risk of associated bleeding and intracranial infection. Interestingly, in terms of neurological function at discharge and 6-month after the ictus (p=0.01), even though without acute hydrocephalus on admission, the TICH patients can still benefit from EVD insertion. Conclusion: For TICH patients, EVD is safe and can significantly improve neurological prognosis. Especially for patients whose GCS dropped by more than 2 points before operation, EVD can significantly improve the patient's GCS score, reduce the risk of herniation, and gain more time for surgical preparation. Even for TICH patients without acute hydrocephalus on admission CT scan, EVD placement still has positive clinical significance. However, future studies with larger sample size are warranted to confirm whether EVD can reduce in-hospital mortality and the risk of delayed hydrocephalus in TICH.