bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of Methylation Capture Sequencing and Infinium EPIC Methylation Array in Peripheral Blood Mononuclear Cells
Authors: Shu Chang , Zhang Xinyu , Aouizerat Bradley E. , Xu Ke
Published: June 2020

Background: Epigenome-wide association studies (EWAS) have been widely applied to identify methylation CpG sites associated with human disease. To date, the Infinium Methylation EPIC array (EPIC) is commonly used for high-throughput DNA methylation profiling. However, the EPIC array covers only 30% of the human methylome. Methylation Capture bisulfite sequencing (MC-seq) captures target regions of methylome and has advantages of extensive coverage in the methylome at an affordable price. Methods: Epienome-wide DNA methylation in four peripheral blood mononuclear cell samples was profiled by using SureSelectXT Methyl-Seq for MC-seq and EPIC platforms separately. CpG site-based reproducibility of MC-seq was assessed with DNA sample inputs ranging in quantity of high (> 1000ng), medium (300-1000ng), and low (150ng-300ng). To compare the performance of MC-seq and the EPIC arrays, we conducted a Pearson correlation and methylation value difference at each CpG site that was detected by both MC-seq and EPIC. We compared the percentage and counts in each CpG island and gene annotation between MC-seq and the EPIC array.Results: After quality control, an average of 3,708,550 CpG sites per sample was detected by MC-seq with DNA quantity >1000ng. Reproducibility of MC-seq detected CpG sites was high with strong correlation estimates for CpG methylation among samples with high, medium, and low DNA inputs (r > 0.96). The EPIC array captured an average of 846,464 CpG sites per sample. Compared with the EPIC array, MC-seq detected more CpGs in coding regions and CpG islands. Among the 472,540 CpG sites captured by both platforms, methylation of a majority of CpG sites was highly correlated in the same sample (r: 0.98~0.99). However, methylation for a small proportion of CpGs (N=235) differed significantly between the two platforms, with differences in beta values of greater than 0.5.Conclusions: Our results show that MC-seq is an efficient and reliable platform for methylome profiling with a broader coverage of the methylome than the array-based platform. Although methylation measurements in majority of CpGs are highly correlated, a number of CpG sites show large discrepancy between the two platforms, which warrants further investigation and needs cautious interpretation.
Incidence and Outcome of Acute Kidney Injury In Hospitalized Children
Authors: Paudel Rajan , Shah Gauri Shankar , chaudhary Shipra , Timilsina Anuradha
Published: June 2020

Background: Acute kidney injury (AKI) is now increasingly common in hospitalized children with adverse short and long term outcomes. The objective of this study is to know the incidence, etiology and short term outcome of AKI in developing nation.Methods: This prospective observational study is done in pediatric wards and pediatric intensive care unit (PICU) of tertiary center of eastern Nepal, between age group 2 months to 14 years. AKI is defined according to pRIFLE criteria.Results: From May 2015 to March 2016 942 patient enrolled in Pediatric wards and PICU are evaluated. The incidence of AKI was 5.9% and 21.76% in PICU. AKI was commonest among cases having infectious etiology compromising 73.2% (n=41), 16.1%(n=9) due to primary renal disease , 5.35%(n=3) secondary to congenital heart disease, and 5.35% due to other causes. Inotropes was required in 55.4% (n=31) cases, nineteen(33.9%)required mechanical ventilator while 3 (5.36%) underwent hemodialysis. Out of 56 AKI patients 71.4% (n=40) improved and 28.6% (n=16) expired. Patient with AKI had significant longer duration of hospital stay as compared to Non AKI (7 day vs 3 days , P< 0.001). Mortality was high in AKI patient who required mechanical ventilation, inotropes (p<0.001) and AKI Injury and Failure stage(p=0.003) .Conclusion: The incidence of AKI is high in pediatric patients. Patients with AKI increases the duration of hospital stay and mortality is more in patients requiring mechanical ventilation and inotropes.
The Impact of Choice Architecture on Clinical Decision-Making in Sepsis: A Proof of Concept Study
Authors: Mansoori Jason , Clark Brendan , Havranek Edward , Douglas Ivor
Published: June 2020

Background: Despite improved survival and increasing hospital mandates, discordance with sepsis resuscitation guidelines is common. We sought to determine whether choice architecture can promote faster or slower decision-making among physicians and the associated risk of guideline-discordance in sepsis.Methods: We conducted an electronic, survey-based time-to-event analysis using a sepsis clinical vignette and multivariable Cox proportional hazards regression. Respondents included physicians from multiple specialties and levels of training at an academic tertiary-care hospital and academic safety-net hospital. Respondents were randomized to one of three distinct answer sets: control (6 options with no time limit), time constraint (10 seconds, intended to promote faster thinking) or choice overload (24 options, intended to promote slower thinking). The primary outcomes were response time and discordance with Surviving Sepsis Campaign 2016 fluid resuscitation guidelines, adjusting for physician characteristics. Physician risk tolerance and predisposition towards intuitive or analytical thinking were assessed for effect modification.Results: 189 of 624 (30.3%) physicians completed the survey. Total response time was lower in time constraint (45.8s, IQR 38.3s-56.6s, P<0.001) and higher in choice overload (94.2s, IQR 73.0s-142.6s, P=0.005) groups compared to control (71.5s, IQR 52.6s-100.6s). In contrast, relative hazard for guideline discordance was increased in time constraint (3.38, 1.97-5.79, P<0.001) and decreased in choice overload (0.52, 0.30-0.93, P=0.03) groups dependent on Cognitive Reflection Test (7.87, 1.80-34.44, P=0.006) and risk tolerance scores (JPI-RTS 2.00, 1.05-3.84, P=0.04 and MFS 0.42, 0.20-0.88, P=0.02), respectively.Conclusions: Choice architecture may impact clinical decisions and guideline discordance in sepsis, warranting further investigation in real-world contexts.
Nurse Home Visit Program to Promote Parenting In Brazil: Premises And Planning
Authors: siqueira luciola , Chiesa Anna Maria , Miguel Euripedes , Silva Leticia , Vadakattu Sharonya , Alarcao Fernanda , Fracolli Lislaine
Published: June 2020

BackgroundPromoting good parenting has been a challenge for public policies since child development became part of the Sustainable Development Goals until 2030. Home visitation programs have been proved to be effective in supporting the most vulnerable families, especially the vulnerable, first time pregnant’s teenagers, in acquiring skills and incorporating parenting practices that promote integral child development. The Young Mothers Caregivers is an innovative, experimental program, implemented in the context of a RCT. This paper aims to analyze the fidelity of the HVs, regarding the planning and the operative framework of the young Mothers Cargivers’ protocol.MethodsThis qualitative study was conducted by content analysis from nurse’s records of 390 HVs delivered for 39 teenagers, attended by YMCP. The software Wordart was used to visualize the frequency of themes. The analysis examined, 1) which priority areas were most focused on in HV records, and 2) which themes were prominent in each content priority area, according to the five axes that compose the bases of the interventions. ResultsThe first trimester of HV focused on “Care with Health” axis (specially “Nutrition”); along with “Life Course” axis, “Familiar&Social Network”, “Environment” and “Parenting”. In the second trimester of HV, again “Care with Health” axis (primarily focused on “Nutrition” and “Birth”) was identified in records, as was the concept of “Parenting” (“Praise”, “Attachment”, and “Expressing Feelings”). In the third trimester of HV, “Care with Health” axis (primarily through Breastfeeding and Birth) and “Parenting” axis(through Praise, Attachment, and Readiness to Address Concerns) were prominent. ConclusionsThe content priorities raised in each HV trimester, with different themes within each category, indicating the capacity to adjust the protocol according to the youth interest. At different times, some categories were more highlighted than others. The study found recurring emphasis on praise and the nurse’s ability to address concerns, underscoring the importance of a strong relationship among the nurse visitor and the young mother. Relevance to PracticeData highlights the role of responsive communication and participant’s centered needs as skills for nurses that delivers HV. This is a crucial aspect to structure the monitoring and supervision axes of the Program, for further scaling up.
Metabolites of Bacterial-Feeding Nematodes Stimulate Bacterial Indole-3-Acetic Acid (IAA) Synthesis
Authors: Li Mengsha , Li Mengdi , Zhou Ming , Zhao Yexin , Xu Jingjing , Hu Feng , Li Teng , Li Huixin
Published: June 2020

Interorganismal metabolites play significant roles in regulating behaviors and communications between organisms. Nematodes are the most abundant animals on earth, and function well in soil ecosystem due to their interactions with microbes. Bacterial-feeding nematodes stimulate the activity of indole-3-acetic acid (IAA)-producing bacteria and increase the content of IAA in soil. However, we do not fully understand how bacterial-feeding nematodes interact with bacteria and affect IAA synthesis. In this study, the model nematode Caenorhabditis elegans and three species of soil-dwelling IAA-producing bacteria ( Bacillus amyloliquefaciens JX1, Arthrobacter pascens ZZ21 and A. chlorphenolicus L4) were employed to determine the effect of nematodes on the IAA biosynthesis of bacteria. Then the metabolites and extracts of C. elegans were tested the effect on three bacterial IAA synthesis (but only A. pascens ZZ21 for the extracts). Lastly, two soil-dwelling bacterial-feeding nematodes ( Mesorhabditis sp. and Acrobeloides sp.) and two IAA-producing bacteria ( B. amyloliquefaciens JX1 and A. pascens ZZ21) were subsequently used to explore the universality of this interaction. Our results showed that the metabolites or extracts of nematodes could promote the IAA biosynthesis of IAA-producing bacteria, and implied this stimulatory effect maybe widely spread in metabolites of bacterial-feeding nematodes and IAA-producing bacteria, but vary with nematodes and bacteria species. Our findings indicate that bacterial-feeding nematodes could mediate the interaction between nematodes and bacteria by their metabolites, except for their feeding behavior, and offer insights into the ecological function of the metabolites of nematodes.
An experts’ opinion-based comparison and benefit cost analysis of post-mortem versus tuberculin skin test surveillance systems, Mpumalanga, South Africa
Authors: Marange Rudo , Fasina Folorunso , Reininghaus Bjorn , Morar-Leather Darshana
Published: June 2020

BackgroundTuberculosis (TB) is a global health concern caused mostly by Mycobacterium bovis (M. bovis) and Mycobacterium tuberculosis (M. tuberculosis) in animals and humans respectively. As part of TB control strategies, most governments instituted test and slaughter policies for bovine TB (bTB) eradication with varied level of success.MethodsUsing the SurvCost® (http://www.cdc.gov/idsr/survcost.htm), we evaluated the postmortem surveillance (PMS) system as an alternative to the tuberculin skin test (TST). Experts’opinions survey was used to collect information on the perceived level of acceptability of PMS and TST, successes and challenges of both surveillance systems, economic and budget data. Benefit cost analysis of both systems were evaluated and the comparative economic benefit of PMS over TST was determined.ResultsTST implementation was challenging due to poor logistics, procurement challenge, poor feedback, inconsistency in testing and poor return rate for retesting. Experts agreed that PMS was cheaper but almost impracticable due to late detection and probable poor compliance rate but farmers were more open to PMS than TST. Personnel cost remains the largest part of the surveillance cost (47.8% of total costs). TST and PMS systems can be up to 4.40 and 5.96 times more beneficial that not tackling bTB respectively and PMS is 1.35 more cost beneficial that TST.ConclusionWhile TST is empirical, compliance by farmers was poor due to the associated inconveniences. In the alternative, PMS was convenient for farmers but experts believed that adherence will be poor unless increased manpower is available. We advocated for a blended approach between the two systems. Improved field surveillance and detailed economic data should benefit future economic assessment.Trial registrationNot applicable.
PFKFB4 Overexpression Facilitates Proliferation by Promoting the G1/S Transition and is Associated with a Poor Prognosis in Triple-Negative Breast Cancer
Authors: Cai Yu-Chen , Yang Hang , Shan Hong-Bo , Su Hui-Fang , Jiang Wen-Qi , Shi Yan-Xia
Published: June 2020

Background:6-Phosphofructo-2-kinase/fructose-2,6-biphosphate-4 (PFKFB4) is a key factor that plays an important role in tumorigenesis. However, its role in triple-negative breast cancer (TNBC) progression needs to be further validated.We investigated whether PFKFB4 is directly involved in the oncogenic signaling networks of TNBC.Methods: First, we assessed the expression level of PFKFB4 in tumor tissue specimens by immunohistochemistry and evaluated its prognostic value. Next, the effect of PFKFB4 on TNBC cell growth and associated mechanisms were investigated.Finally, the results were further verified in vivo. Results: We found that PFKFB4 overexpression was associated with an unfavorable prognosis in TNBC patients. PFKFB4 was overexpressed in TNBC cell lines in hypoxic environments, and its overexpression promoted tumor progression in vitro and in vivo. Further analyses demonstrated that the possible mechanism might be that PFKFB4 overexpression facilitates TNBC progression by enhancing the G1/S phase transition by increasing the proteinlevelof CDK6 and phosphorylation of Rb.Conclusions: These data suggest that PFKFB4 plays significant roles in the tumorigenesis and development of TNBC.Trial registration: Retrospectively registered.
Bringing to light a new energy path: the case of Minas Gerais State, Brazil
Authors: Ribeiro Ana Pimenta
Published: June 2020

Background

In Brazil, more than 60% of the energy comes from hydroelectricity, making the system highly vulnerable in the context of global climate change, with precipitation and temperature shifts over the years. Characterized by its multiple opportunities of sources and conversion technologies for energy, biomass has a high potential to become responsible for a relevant share on the renewable energy supply. Previous studies on biomass energy production in Brazil confirm promising results. This paper highlights possibilities for biomass power generation in Minas Gerais State. To estimate the energy productivity, a Sustainable Technical Coefficient was adopted: a conservative index that considerers the portion of residues that could be used maintaining the integrity of the soil.
Results

This index was applied, together with the data on the silviculture and selected crops yield. The local energy demand was also calculated and compared to the potential energy production. Results show that 78% of the municipalities could have their basic energy needs and 18% of the demand for productive uses met by residues of crops and silviculture production.
Conclusion

For the state Minas Gerais, with its tradition of agriculture, the biomass residual energy is viable and should be considered by policymakers.
From qualitative to quantitative: a new approach for determining heat tolerance in cotton using triphenyl tetrazolium chloride
Authors: Jaconis Susan Yvonne , Conaty Warren C , Thompson Alan J. E. , Smith Shanna L , Trimarchi Chiara , Cottee Nicola S , Bange Michael P
Published: June 2020

Background

Susceptibility of cotton to heat stress in cotton production systems is a major concern for breeding programs. It is hypothesised that in order to maintain or improve cotton yields and quality in sub-optimal future climates, the negative effects of high temperature stress must be mitigated. To address this need, a fast and effect way of quantifying thermotolerant phenotypes is required. Triphenyl tetrazolium chloride (TTC) based enzyme viability testing following high temperature stress can be used as a heat tolerance phenotype. This is because when live cells encounter a TTC solution, TTC undergoes a chemical reduction producing a visible, insoluble red product called triphenyl formazan, that can be quantified spectrophotometrically. However, existing TTC based cell viability assays cannot easily be deployed at the scale required in a crop improvement program.
Results

In this study, a heat stress assay (HSA) based on the use of TTC enzyme viability testing has been refined and improved for efficiency, reliability, and ease of use through four experiments. Sampling factors which may influence assay results such as leaf age, plant water status, and short-term cold storage were also investigated. Experiments conducted in this study have successfully down scaled the assay and identified an optimal sampling regime, enabling measurement of large segregating populations for application in breeding programs. The optimal durations of leaf disc exposure to TTC and the subsequent extraction of the formazan product in ethanol were identified as 16 h and 13 h, respectively; leading to enhanced clarity of assay results.
Conclusions

These improvements in the methodology provide a new level of confidence in results, ensuring applicability of the assay to a breeding program. The improved HSA methodology is important as it is proposed that long-term improvements in cotton thermotolerance can be achieved through concurrent selection of superior phenotypes based on the HSA and yield performance in hot environments. Additionally, a new way of interpreting both heat tolerance and heat resistance were developed to differentiate genotypes that perform well at the time of a heat stress event and those that maintain a similar level of performance to a non-stressed control.
Corona Virus Disease 2019 (COVID-19): Intensive Care Admission Prediction Model
Authors: Hachim Mahomood Y. , Hachim Ibrahim Y. , Naeem Kashif Bin , Hannawi Haifa , Salmi Issa Al , Hannawi Suad
Published: June 2020

Background: Identifying clinical-features or a scoring-system to predict a benefit from hospital admission for patients with COVID-19 can be of great value for the decision-makers in the health-sector. We aim to identify differences in patients' demographic, clinical, laboratory and radiological findings of COVID-19 positive cases to develop and validate a diagnostic-model predicting who will develop severe-form and who will need critical-care in the future.Methodology: Patients were classified according to their clinical state into mild, moderate, severe, and critical. All their baseline clinical data, laboratory, and radiological results were used to construct a prediction-model that can predict if the COVID-19 patients will develop a severe condition that will necessitate their ICU-admission. An ensemble feature selection tool was used to identify the relative importance of each variable. The performance of the selected features compared to all features using logistic regression and area under curve test.Results: Patients with ICU admission showed a distinct clinical, demographic as well as laboratory features when compared to pattients that did not need ICU admission. This includes elder age group, male gender and presence of comorbidities like diabetis and history of hypertension.Out of the different demographic, clinical and laboratory charasteristics of these patients, Age at diagnosis, Lymphocyte count, C-reactive protein (CRP), lactate dehydrogenase (LDH), Albumin, Urea, and Procalcitonin levels were found to be able to predict which patients may need ICU admission. Conclusion: Higher CRP, LDH, Age at diagnosis, Urea, Procalcitonin, and lower Albumin, Lymphocyte count are significant determinant in ICU admission for COVID-19 patients.
In-depth Validation of CHERG’S Verbal Autopsy-Social Autopsy (VASA) Tool for Ascertaining Determinants and Causes of Under-Five Child Mortalities in Karachi, Pakistan.
Authors: Siddiqui Muhammad Bilal , Ng Chiu Wan , Low Wah Yun , Ahmed Hassan , Abid Khadijah
Published: June 2020

Background: Globally, child mortality estimates are more clustered among the developing countries where quality data on estimates and determinants of child mortality are compromised. To achieve sustainability in reducing child mortality estimates, the integrated Verbal Autopsy and Social Autopsy (VASA) tool help in estimating prevalence and assigning medical and social causes and determinants of child survival, especially in the developing countries. A validation study of the Child Health Epidemiology Reference Group’s (CHERG) Verbal autopsy/Social Autopsy (VASA) tool has been undertaken for employing in a Karachi VASA Integrated Child Mortality Investigation-ICMI study in its urban slums. Methods: Validity and reliability of the CHERG VASA-tool were tested using face, content, discriminant validation and reliability tests on one hundred randomly selected mothers, with a recent child death event. Data were computed on SPSS (version-21) and R. Results: Testing yielded high I-CVI (>81.43%); high Cronbach's Alpha (0.843); accuracy of between 75% and 100% of the discriminants classifying births to live and stillbirths. The tool showed ICVI (>82.07% and 88.98% respectively) with high accuracy (92% and 97% respectively) for assigning biological and social causes of child deaths respectively. Conclusion: The CHERG VASA questionnaire is valid, reliable, and relevant to the conceptual framework. This valid tool is one of the assets for child health policy as it can assign accurate medical and non-medical causes (pertaining to health-seeking practices) of child mortality cases occurring in Pakistan.
Initial Predictors for Short-termprognosisin Anti-melanoma Differentiation-associated Protein-5 Positive Patients
Authors: Yang Qihua , Li Tianfang , Zhang Xin , Lyu Kunlong , Wu Shujun , Chen Yan , Liu Shengyun , Yu Zujiang
Published: June 2020

Background: Anti-melanoma differentiation-associated protein-5 (anti-MDA5) positive patients are characterized by the high mortality rate caused by interstitial lung disease (ILD). We conducted a retrospective study to summarize the clinical features and identify the initial predictors for death in anti-MDA5 positive patients.Methods:We designed a retrospective cohort of anti-MDA5 positive patients.The demographic and clinical data recorded on first admission, as well as the outcomes during the first six months follow-up were collected. Risk factors for death were identified using multivariate analyses.Results: A total of 90 anti-MDA5 positive patients were included in this study. Eighty-one (90%) patients presentedILD on admission and 35(38.9%) patients developed rapidly progressive ILD (RP-ILD) subsequently.During the first six months of follow-up, 22 (24.4%) patients died of respiratory failure at an average time of 6.6 ± 5.9 weeks.Univariate analysis identified several factors associated with death, including demographic, clinical, laboratory and image variables. Multivariate analysis showed that total CT GGO score≥4(HR 4.8, 95%CI 1.3-17.9,P=0.020), KL-6>1600U/ml (HR3.7, 95%CI 1.5-9.1, P=0.004) and CRP>5.8mg/L (HR3.7, 95%CI 1.0-12.8, P=0.044) were poor prognostic risk factors, however initial combined treatment(HR 0.3, 95%CI 0.1-0.8, P=0.019) predicted good prognosis in anti-MDA5 positive patients.Conclusion: Anti-MDA5 positive patients demonstrated a high prevalence of ILD on admission, leading to a high short-term mortality rate. Higher total GGO score, higher levels of initial KL-6 and CRP predict poor outcome in anti-MDA5 positive patients. However, in tial intensive treatment may improve the prognosis.
Histone Methyltransferase G9a Promotes Invasion of Non-small Cell Lung Cancer Through Enhancing Focaladhesionkinase Activationvia NF-KB Signaling Pathway
Authors: Sun Ting , Zhang Keqiang , Pangeni Rajendra P. , Li Wendong , Du Yong , Chaurasiya Shyambabu , Arvanitis Leonidas , Raz Dan J.
Published: June 2020

BackgroundOverexpression of euchromatic histone methyltransferase 2 (EHMT2 or G9a) is frequently found in a number of human cancers. Potential roles of G9a in invasion and metastasis are not well understood in non-small cell lung cancer (NSCLC). Here we investigated the effect and underlying mechanisms of G9a, and therapeutic implications of targeting G9a in the invasion of NSCLC. MethodsG9a-associated gene sets were identified by RNAseq analysis. Migration and invasion assays were applied to examine the impact of targeting G9a by siRNA knockdown orits specific inhibitor UNC0638 in NSCLC cells. Rescue experiments were designed to investigate the effect of focal adhesion kinase (FAK) and NF-κB inhibitors on the invasion of NSCLC cells overexpressing G9a. Correlation between the protein level of phosphorylated FAK and G9a was analyzed in NSCLC tissues.ResultsKnockdown and inhibition of G9a drastically suppressed in vitro cellular proliferation, migration, and invasion; while overexpression of G9a significantly enhanced proliferation, migration, and invasion of A549 and H1299 NSCLC cells. Targeting G9a led to a significant decrease in the expression of FAK protein and activation of FAK signaling pathway in both A549 and H1299 cells. Additionally, defactinib, a potent FAK inhibitor, partially abolished the enhanced migration and invasion by overexpression of G9a in these NSCLC cells. Furthermore, G9a was found to boost nuclear factor-kappa B (NF-κB) transcriptional activity in NSCLC cells through partially downregulating inhibitor of κB (IκBα), and an NF-κB inhibitor partially abolished the enhanced FAK activation by overexpressed G9a, which suggests that G9a-enhanced invasion and activation of FAK may be mediated by elevated NF-κB activity. Notably, a strong positive correlation between the immunohistochemical staining of G9a and phosphorylated FAK proteins was identified in H1299 xenografts and 159 cases of NSCLC tissues (R = 0.408).ConclusionsThese data strongly demonstrate that G9a may promote invasion and metastasis of NSCLC cells by enhancing FAK signaling pathway via elevating NF-κB transcriptional activity, indicating potential significance and therapeutic implications of these pathways in the invasion and metastasis of NSCLCs that overexpress G9a protein.
Development and Validation of Multiparametric Mri-based Nomogram for Predicting Occult Metastasis Risk in Early Tongue Squamous Cell Carcinoma
Authors: Saenthaveesuk Pensiri , Yang Le , Zeng Bin , Xu Meng , Young Simon , Liao Guiqing , Liang Yujie
Published: June 2020

Background: Nomograms are currently used in predicting individualized outcomes in clinical oncology of several cancers. However, nomograms for evaluating occult nodal metastasis of patients with squamous cell carcinoma of lateral tongue (SCCLT) have not been widely investigated for their functionality. This retrospective cohort study was designed to address this question.Methods: This study was divided into primary and validation cohorts. The primary cohort comprised 120 patients diagnosed between 2012 and 2017, whereas the validation cohort included 41 patients diagnosed thereafter. The diagnostic value of multiparametric MRI, including radiologic tumor thickness threshold (rTTT) in three-dimensions, paralingual distance, and sublingual distance were investigated. A nomogram was developed based on stepwise logistic regression of potential predictors associated with nodal metastasis in the primary cohort and then tested for predictive accuracy in the validation cohort using area under the curve (AUC) and goodness-of-fit tests.Results: Multivariate analysis, tumor size (odd ratio [OR] 15.175, 95% confidence interval [CI] 1.436-160.329, P = 0.024), rTTT (OR 11.528, 95% CI 2.483-53.530, P = 0.002), paralingual distance (OR 11.976, 95% CI 1.981-72.413, P = 0.005), and tumor location (OR 6.311, 95% CI 1.514-26.304, P = 0.011) were included in the nomogram to predict the likelihood of having cervical metastasis. A nomogram cutoff value of 210 points (sensitivity 93.8%, specificity 87.5%) was significantly different to classify the patients metastasis risk group (P< 0.001). Nomogram showed predictive accuracy with AUC 0.881 (95% CI 0.779–0.983, P< 0.001) and good calibration after the validation.Conclusions: A preoperative nomogram incorporating multiparametric MRI demonstrated good prediction and performed adequately in our study. Three-dimensional assessment of occult metastasis risk value obtained from this nomogram can assist in preoperative decision making whether to manage with neck surgery for individual patients with early-stage SCCLT. The probability of nodal metastasis tended to be greater than 20% in patients with high metastasis risk or nomogram total score > 210 points.
Research on Steering Stability Control of Dual In-Wheel Motor-Driven EV
Authors: Guo Xiangrong , Chen Yi , Li Hong
Published: June 2020

The dual in-wheel motor electric vehicle has the advantages of fast response and high flexibility, while its stability and safety are more difficult to control. To study the stability control of the dual in-wheel electric vehicle when turning, firstly, the paper establishes the Ackerman model of the dual in-wheel electric vehicle, and controls the wheel speed and slip rate by the method of logical threshold value; then establishes the linear two degree of freedom model of the double hub electric vehicle, obtains the vehicle yaw moment and ideal yaw rate by using the mathematical formula, and controls the wheel speed and slip rate by the sliding mode control. The moment is distributed so that the actual yaw rate keeps tracking the ideal value. The electronic differential control strategy of wheel slip rate and wheel yaw rate is established. Finally, the control strategy is simulated by MATLAB. The simulation results show that the proposed control strategy of slip rate and yaw rate can make the vehicle drive stably when turning.
Identifying predictive factors of rapid response/code blue: A retrospective study using logistic regression analysis
Authors: Thomas Brittany , Knapp Herschel , Patmon Frances
Published: June 2020

Background: Rapid response calls and cardiac arrests are often preceded by observable signs of clinical deterioration often hours prior to the adverse event.Objectives: The purpose of this retrospective study was to identify risk factors that provide predictive value in determining the likelihood of a Rapid Response Call on adult telemetry patients at a single-centre community hospital.Design: This was a retrospective study based on secondary data analysis. After approval by the Institutional Review Board was obtained (CANV DHIRB-2018-362), we utilized the electronic medical record system to extract de-identified quantitative data from patient medical records.Setting: This study utilized medical records from patients on the Telemetry unit at a single-centre, 230-bed community hospital.Participants: The sample consisted of 250 randomized de-identified medical records from both patients who did and did not require a rapid response between January and December, 2018. Patients who were less than 18 years of age and those who were transferred to another facility or to another hospital were excluded from the analyses.Methods: The variables that were collected included age, gender, race, primary admitting medical diagnosis, hemoglobin, potassium, magnesium, creatinine, lactic acid, and urine output. Additional variables collected in four-hour increments included the vital signs: temperature, heart rate, oxygen saturation, respirations, systolic and diastolic blood pressure, and level of consciousness which was scored using the adult Glasgow Coma Scale. Logistic regression analysis was used to identify which of these variables were statistically significant in predicting patient deterioration.Results: The following predictors were statistically significant (a = 0.05 with 95% Confidence Intervals [CI]): For every one beat increase in heart rate 4 hours prior to a RRT, the odds of a RRT increased by 4.9% (p=0.003) (CI=95% 1.016, 1.084). For every one increase in respirations, the odds of a RRT increased by 42.8% (p=0.004) (95% CI 1.11, 1.82), 8 hours before the RRT, and by 47% (p=0.002) (95% CI 1.15, 1.87), 12 hours before a RRT. African Americans had 20.6 times the odds of experiencing an RRT compared to Caucasians (p<0.001) (95% CI 3.4, 124.6), Hispanics had 56.6 times the odds of experiencing a RRT compared to Caucasians (p<0.001) (95% CI 11.4, 280.4), and other races had 6.3 times the odds of a RRT compared to Caucasians (p=0.044) (95% CI 1.05, 38.5).Conclusions: Such predictors can be used to identify early signs of deterioration that can alert health care providers to early intervention.
Awareness and level of knowledge of Surgical Site Infection among Surgical Staff in King Abdullah Medical City in Hajj-2019: A Cross-Sectional Study
Authors: Bamoosa Eman , Idris Khalid , Alsabbah Rufaydah , Faidah Ghali , Alharbi Shahd , Bar Abdullah , Alahdal Amin
Published: June 2020

Background: Surgical site infection (SSI) is a microbial infection of the surgical wound during 30 days of any procedure or within 1 year after the operation. More than 1,600 operations are performed in Makkah during Hajj every year. Many studies examined SSI awareness internationally but up to our knowledge non studies were conducted in Makkah. The purpose of this study is to assess the level of knowledge about SSI among Surgical staff in KAMC during Hajj. Methods: A cross-sectional study conducted to assess the Awareness and level of knowledge of Surgical Site Infection among Surgical Staff in King Abdullah Medical City those who had been participating in healthcare provider team of Hajj season of 2019 using a 20-item anonymous multiple-choice questionnaire Result: About 39.2% of respondents had poor knowledge, 50% had fair knowledge while only 13.7% had good knowledge. There was a relationship between years of experience and level of knowledge. Surgical subspecialty was not associated with the level of knowledge. Almost 20% of respondents did not recognize the SSI definition. There was no association between surgical subspecialty and the level of knowledge. Doctors were more aware than nurses about epidemiological part questions. Age of Surgical Staff was associated with and level of knowledge.Conclusion: Level of knowledge among Surgical Staff needs reinforcement on a larger scale thus we recommend proper awareness courses regarding SSI.
Co-Existence of Diabetes Mellitus And Pre-Existing Cardiovascular Disease, Diabetes Mellitus, And Pre-Existing Cardiovascular Disease And Mortality in Peritoneal Dialysis Patients
Authors: Zhan Xiaojiang , Wen Yueqiang , Zhou Qian , Feng Xiaoran , Peng FenFen , Wang Niansong , Wang Xiaoyang , Wu Xianfeng
Published: June 2020

Background: Little is known over the effect of co-existence of diabetes mellitus (DM) and pre-existing cardiovascular disease (CVD), DM, and pre-existing CVD on mortality among continuous ambulatory peritoneal dialysis (CAPD) patients.Methods: A retrospective study, with 2939 incident Chinese CAPD patients from five facilities between January 1, 2005 and December 31, 2018, was conducted. The primary and secondary outcomes were all-cause and CVD mortality. The association between these interesting comorbidities and mortality was evaluated using the Cox proportional hazards regression.Results: Over a median of 35.1 months of follow-up, 519 (17.7%) patients died, with 258 (8.8%) CVD mortality. Hypertension was independently associated with co-existence of DM and pre-existing CVD using multinomial logistic regression (odd ratio 13.72, 95% CI 6.14 to 30.63). After adjusting for confounding factors, DM plus CVD, DM, and pre-existing CVD groups had a higher risk of all-cause mortality (HR 2.85, 95% CI 2.18 to 3.72; HR 1.89, 95% CI 1.50 to 2.38; and HR 1.43, 95% CI 1.07 to 1.92) and CVD mortality (HR 2.79, 95% CI 1.91 to 4.08; HR 1.88, 95% CI 1.35 to 2.61; and HR 1.82, 95% CI 1.23 to 2.68), respectively, compared to the control group. Compared with those pre-existing CVD patients, DM patients had 1.44 (95%CI 1.04 to 1.98)-time and 1.11 (95%CI 0.72 to 1.71) risk of all-cause and CVD mortality, respectively. There was no significant interaction between DM and CVD on all-cause and CVD mortality (β=0.203, P=0.292; β=0.281, P=0.123) in the study population. Conclusions: CAPD patients with co-existence of DM and pre-existing CVD at baseline are at highest risk of all-cause and CVD mortality, followed sequentially by DM patients and pre-existing CVD patients, with hypertension as a powerful predictor for co-existence of DM and pre-existing CVD. DM patients have a higher risk of all-cause mortality and similar risk of CVD mortality compared with pre-existing CVD patients.
Community Health Worker Knowledge, Attitudes, and Practices Towards Epilepsy in Mozambique
Authors: Cumbe Vasco Francisco Japissane , Greene M. Claire , Fumo Afonso Mazine Tiago , Fumo Hélder , Mabunda Dirceu , Gouveia Maria Lídia Chaúque , Oquendo Maria A. , Duarte Cristiane S. , Sidat Mohsin , Mari Jair de Jesus , Wainberg Milton L.
Published: June 2020

Background: Epilepsy is the most common neurological disease in the world, affecting 50 million people, with the majority living in low- and middle-income countries (LMICs). A major focus of epilepsy treatment in LMICs has focused on task-sharing identification and epilepsy care by community health workers (CHWs). The present study aimed to assess the KAPs of CHWs towards epilepsy in Sofala province, Mozambique.Methods: One hundred and thirty five CHWs completed a questionnaire that included socio-demographic characteristics and 44-items divided in six subscales pertaining to KAPs towards epilepsy (QKAP-EPI) in nine districts of Sofala Province, Mozambique. The internal consistency and factor structure were examined to evaluate the reliability and construct validity of the QKAP-EPI, respectively. To examine correlates of KAPs toward epilepsy we evaluated the association between sociodemographic variables and QKAP-EPI subscales using linear regression models.Results: CHWs demonstrated adequate knowledge regarding epilepsy for medical treatment details (Mean=1.63, SD=0.28) and epilepsy safety/risks (Mean=1.62, SD=0.59). However, CHWs reported low levels of knowledge related to the causes of epilepsy, espousing stigmatizing attitudes, as well as cultural treatment, which is the perception in different cultures of how epilepsy should be treated. Knowledge about how to manage epilepsy during crisis varied across the different types of emergency care practices. Heterogeneity in the level of knowledge regarding epilepsy was observed among CHWs in the different districts of Sofala Province and when using different local names of epilepsy (Dzumba, Nzwiti).Conclusion: CHWs knowledge of medical treatment and epilepsy safety/risks were adequate. However, information on the causes of epilepsy, stigmatizing attitudes, cultural treatment, and some aspects of epileptic crisis response were low. These areas of poor knowledge should be the focus of educating CHWs in increasing their ability to provide quality care for patients with epilepsy in LMICs.
nCoV-2019 infection induces neurological outcome and manifestation, linking its historical ancestor SARS-CoV & MERS-CoV: A systematic review and meta-analysis
Authors: Prakash Ajay , Singh Harvinder , Sarma Phulen , Bhattacharyya Anusuya , Dhibar Deba Prasad , Balaini Neeraj , Shree Ritu , Goyal Manoj , Modi Manish , MEDHI BIKASH
Published: June 2020

Importance: The first systematic review and meta-analysis to help clinician to identify early the sign and symptoms of neurological manifestation in COVID-19 positive patients which further help in early management of patients. Objective: Present systematic review and meta-analysis aimed to discuss the prevalence of neurological involvement of the 2019-nCoV patients and assess the symptomatic trend of events as compared to the 2002 “SARS” and 2012 “MERS” pandemics.Methods: The articles were systematically screened through several search engine and databases. The articles published or in preprint were included in the study till 15th May 2020. The systematic review done as per the published literatures which included 31 cross sectional, observational studies and case reports which revealed neural sign and symptoms in SARS-COV-2 disease. For meta-analysis, we included 09 observational and cross sectional studies which included COVID-19 positive patients and assessed the predominance of various neurological sign and symptoms in COVID-19 patients relation to SARS-2002 and MERS-2012. Data were analyzed by using the “MedCalc Statistical Software version 19.2.6 and reported as pooled prevalence. Heterogeneity was investigated (standard I2 test). Results: We have collected and screened about a total 2615 articles, finally we have included 31 articles for the systematic review and 09 for meta-analysis as per the inclusion/exclusion criteria. The analysis was made as per the prevalence rate of neurological symptoms during the COVID-19 positive patients. The cumulative neurological outcome of SARS-2002 and MERS-2012 was assessed to get the trends which is next tried to correlate the events with the current pandemic. During the analysis severity and outcome of neurological manifestations range from simple headache to vague non-focal complaints to severe neurologic impairment associated with seizure or meningitis.Conclusion & Relevance: Central and peripheral nervous system (CNS/PNS) manifestations were seen during the SARS-2002, MERS-2012 and COVID-19. However, none of the publication found with the primary or secondary objective of finding the neurological manifestation in the COVID-19 patients and their mechanism which strengthen the importance to start more precise clinical trials.
Identification of Differentially Expressed Genes and Processes in Myocardial Tissue of Liver-Specific Gck Knockout Mice
Authors: Li Hui , Xu Wei , Mao Yiqing , Wang Xi , Zhang Ruoxuan , Li Binghua , Bai Zhen , Irwin David M , Niu Gang , Tan Huanran
Published: June 2020

Background: Diabetic cardiomyopathy is a ventricular disease caused by diabetes mellitus. Abnormalities in the function of the glucokinase (GCK) play an important role in the development of diabetes. The present study is aimed at exploring changes in gene expression and related molecular mechanisms of diabetic myocardial injury in Gck knockout mice. Methods: Liver-specific glucokinase gene knockout mice( Gck w/- ) and wide type ( Gck w/w )mice generated using the Cre-loxP gene targeting strategy of 30- and 60-weeks of age were used in these studies. Determination of liver glucokinase enzyme activity, liver glycogen content and serum biochemistry parameters reflect the metabolic disorder in these mice. Echocardiography and surface electrocardiographs were used to evaluate cardiac function. Superoxide dismutase activity and malondialdehyde levels reflect oxidative stress in the myocardium. RNAseq, GO enrichment analysis and qPCR wereused to detect differences in the myocardial gene expression profiles of Gck w/- and Gck w/w mice. Results: Hyperglycemia and insulin resistance induced by decreased liver glucokinase expression and enzyme activity throughout the life of heterozygous Gck knockout mice do not yield body weight significant difference. However, prolonged PR interval and QRS duration, decreased left ventricular diameter and increased thickness of the posterior wall of the left ventricle were accompanied by increase of PAS and Masson positive substances in the myocardium of 60-week-old Gck knockout mice. RNAseq analysis showed that genes related tothe myosin heavy and light chains, insulin signaling pathway and oxidative phosphorylation were significantly differentially expressedbetween60-week-old Gck w/- and Gck w/w mice. Phosphorylation of AMPKβ1 and ACC in 60-week-old Gck knockout mice was decreased. Conclusions: Liver-specific Gck knock-out can induce myocardial fibrosis at an early stage and diabetic myocardial injury at alate stage. Through this process, the proportion of myosin heavy chain and light chain falls out of balance, the insulin signal pathway becomes down regulated and mitochondrial oxidative stress is up regulated, leading to myocardial disease.
Biodiversity of new lytic bacteriophages infecting Shigella spp. in fresh water environment
Authors: Shahin Khashayar , Barazandeh Mohadeseh , Hedayatkhah Abolghasem , Mansoorianfar Mojtaba , Wang Ran
Published: June 2020

Background

Bacteriophages, viruses that infects and replicates within prokaryotic cells are the most abundant life forms in the environment, yet the vast majority of them have not been properly reported or even discovered. Almost all reported bacteriophages infecting the Enterobacteriaceae family, with E. coli being the major subject of the study, have been isolated from wastewater, sewage, and effluent resources. In the present study we focused on the distribution and biodiversity of Shigella phages in an aquatic ecosystem.

Results

While no Shigella bacteria was recovered from the Yangtze River, three lytic phages were isolated from this ecosystem and were subjected to biological, morphological, and genomic characteristics. Comparative genomics and phylogenetic analyses demonstrated that vB _SflM_004 isolate belongs to Myoviridae family, Felixounavirus genus of Ounavirinae subfamily, vB_SdyM_006 was classified under the same family, however, it is suggested to be in a new genus under Tevenvirinae subfamily with some other related bacteriophages. vB_SsoS_008 phage belongs to the Siphoviridae family, Tunavirus genus, Tunavirinae subfamily. The phages did not harbor any genes involved in the lysogenic cycles, and showed a high temperature and pH stability.

Conclusions

It can be concluded that isolation of bacteriophages could be independent of their bacterial host presence in the isolation environment.
Corticosteroids in COVID-19; is it rational? A systematic review and meta-analysis
Authors: Budhathoki Pravash , Shrestha Dhan Bahadur , Rawal Era , Khadka Sitaram
Published: June 2020

Background

Due to a lack of definitive treatment, many drugs were repurposed for COVID-19 treatment, among them corticosteroid is one. However, its benefit or harm while treating COVID-19 is not fully studied. Thus, we conducted this meta-analysis to assess the rationality on the use of corticosteroids in COVID-19.

Methods

Pubmed, Medline, Clinicaltrials.gov, Cochrane library, and Preprint publisher were searched. In the qualitative synthesis, 41 and quantitative 40 studies were included using PRISMA guidelines. Assessment of heterogeneity was done using the I-squared (I 2 ) test and random/fixed-effect analysis was done to determine the odds/risk ratio.

Results

We found severely ill COVID-19 patients almost 5 (OR 4.78, 2.76-8.26) times higher odds of getting corticosteroids during their treatment. Similarly, the odds for corticosteroids in addition to standard of care (SOC) were approximately 4 (OR 4.09, 1.89-8.84) times higher among intensive care unit (ICU) patients than non-ICU ones. A higher mortality risk with corticosteroids receiving group compared with the SOC alone (RR 2.01, 1.12-3.63) was observed. Niether increased discharge rate (RR 0.79, 0.63-0.99) nor recovery/ improvement rate was shown among corticosteroids group (OR 0.24, 0.13-0.43). Approximately, the overall 4 days longer hospital stay was found among the treatment groups (MD 4.19, 2.57-5.81). For the negative conversion of reverse transcription- polymerase chain reaction (RT-PCR), approximately 3 days (MD 2.42, 1.31-3.53) delay was observed with corticosteroids treatment cases.

Conclusion

Our study concludes that more severe and critically ill patients tend to get corticosteroids and the mortality risk increases with the use of corticosteroids. With the use of corticosteroids, delayed recovery and a longer hospital stay were observed.