bluuebunny/crossref_metadata_2025 huggingface dataset:
Survival analysis of patients with stage T2a and T2b perihilar cholangiocarcinoma treated with radical resection
Authors: Zhao Jian , Zhang Wei , Zhang Jun , Zhang Yi , Ma Wenjie , Liu Siyun , Li Fuyu , Song Bin
Published: September 2020

Background: Both the 7th and 8th editions of the American Joint Committee on Cancer (AJCC) staging system for perihilar cholangiocarcinoma (pCCA) had the same definition for T2a and T2b. But the value of this classification as prognostic factor remains unclear. Methods: 178 patients with stage T2a or T2b who underwent curative intent resection for pCCA between Jan 2010 and Dec 2018 were enrolled. Relationships between survival and clinicopathological factors including patient demographics and tumor characteristics were evaluated using univariate and multivariate Cox regression analysis. The overall survival (OS) were calculated by Kaplan-Meier method.Results: There was no significant difference in OS between T2a and T2b groups，and the median OS duration were 37 and 31 months (P=0.354). Both the 7th and 8th edition of the AJCC TNM staging demonstrated a poor prognostic predictive performance. High level of preoperative AST (≥85.0IU/L) and CA19-9 (≥1000 U/mL), vascular resection and lower pathological differentiation of the tumor were the independent predictors for poor survival after resection.Conclusion: The newly released 8th edition of AJCC staging system demonstrated a poor ability to discriminate the prognosis of patients with stage T2a and T2b pCCA after resection.
Joint hemorrhage accelerates cartilage degeneration in a rat immobilized knee model
Authors: Sogi Yasuhito , Yabe Yutaka , Hagiwara Yoshihiro , Tsuchiya Masahiro , Onoda Yoshito , Sekiguchi Takuya , Itaya Nobuyuki , Yoshida Shinichiro , Yano Toshihisa , Suzuki Kazuaki , Onoki Takahiro , Itoi Eiji
Published: September 2020

Background: Joint hemorrhage is caused by trauma, ligament reconstruction surgery, and bleeding disorders such as hemophilia. Recurrence of hemorrhage in the joint space induces hemosiderotic synovitis and oxidative stress, resulting in both articular cartilage degeneration and arthropathy. Joint immobilization is a common treatment option for articular fractures accompanied by joint hemorrhage. Although it is apparent that joint hemorrhage has negative effects on the articular cartilage, there is no consensus whether a reduction in joint hemorrhage is effective to prevent articular cartilage degeneration. The purpose of this study was to investigate the articular cartilage degeneration induced by a combination of joint hemorrhage and joint immobilization in a rat immobilized knee model.

Methods: The knee joints of adult male rats were immobilized at the flexion using an internal fixator from 3 days to 8 weeks. The rats were randomly divided into the following groups: immobilized blood injection (Im-B) and immobilized-normal saline injection (Im-NS) groups. The cartilage was evaluated in two areas (contact and non-contact areas). The cartilage was used to assess chondrocyte count, Modified Mankin score, and cartilage thickness. The total RNA was extracted from the cartilage in both areas, and the expression of metalloproteinase (MMP)-8, MMP-13, interleukin (IL)-1β, and tumor necrosis factor (TNF)-α was measured by quantitative real-time polymerase chain reaction.

Results: The number of chondrocytes in the Im-B group significantly decreased in both areas, compared with that in the Im-NS group. Modified Mankin score from 4–8 weeks of the Im-B group was significantly higher than that of the Im-NS group only in the contact area. The expression of MMP-8 and MMP-13 from 2 to 4 weeks and TNF-α from 2 to 8 weeks significantly increased in the Im-B group compared with those in the Im-NS group, but there was no significant difference in IL-1β expression.

Conclusions: The results showed that joint hemorrhage exacerbated immobilization-induced articular cartilage degeneration. Drainage of a joint hemorrhage or avoidance of loading may help prevent cartilage degeneration during joint immobilization with a hemorrhage.
The functional limits of the aneurysmal aortic root. A unique pressure testing apparatus.
Authors: Surman Timothy Luke , Abrahams John Matthew , O'Rourke Dermot , Reynolds Karen , Edwards James , Worthington Michael George , Beltrame John
Published: September 2020

BackgroundThe aortic root has unique embryological development and is a highly sophisticated and complex structure. In studies that report on the biomechanical characteristics of the thoracic aorta, distinction between the aortic root and ascending aorta regions is nonexistent. Our objective is to determine the maximal pressures at which dissection occurs or tissue failure occurs in the aortic root compared to that of the ascending aorta in the presence of aortic aneurysms. This may help guide preoperative monitoring, diagnosis and the decision for operative intervention for aortic root aneurysms in the normal and susceptible populations.MethodsWe developed a simple aortic root and ascending aorta pressure testing unit in series. Ten fresh porcine hearts were obtained from the local abattoir (n=5 aortic root and n=5 ascending aorta for comparison). Using a saline filled needle and syringe, artificial fluid-filled aneurysms were created between the intima and medial layers of the aortic root. The aorta lumen was then progressively filled with saline solution. Pressure measurement was taken at time of loss of tissue integrity, obvious tissue dissection or aneurysm rupture, and the tissue structure was then visually examined.ResultsIn the aortic root, mean maximal pressure (mmHg) at tissue failure was 208mmHg. Macroscopic examination revealed luminal tears around the coronary ostia in 2/5 specimens, and in all specimens, there was propagation of the dissection in the aortic root in a circumferential direction. In all ascending aorta specimens, the maximal aortic pressures exceeded 300mmHg without tissue failure or dissection, and eventual apparatus failure.ConclusionOur results indicate that the aneurysmal aortic root tissues are at greater risk of rupture and dissection propagation at lower aortic pressure. With further analysis, this could guide clinical and surgical management.
Uniportal versus multiportal video-assisted thoracoscopic anatomical resection for NSCLC: a meta-analysis
Authors: Yan Yueren , Huang Qingyuan , Han Han , Zhang Yang , Chen Haiquan
Published: September 2020

Background

Uniportal video-assisted thoracoscopic surgery (U-VATS) has recently emerged as an alternative procedure for non-small cell lung cancer (NSCLC); however, whether U-VATS has advantages over multiportal VATS (M-VATS) remains unknown.

Methods

We performed a systematic review of two databases (Pubmed and Web of Science) to search comparative studies of U-VATS and M-VATS anatomical pulmonary resection for NSCLC. Parameters of continuous variables (operative time, blood loss, number of resected lymph nodes, drainage duration, length of postoperative stay and pain in postoperative day 1(POD1)) or categorical variables (conversion rates) were retrieved to estimate the comparitiveoutcomes. A subgroup analysis stratified by study type (propensity-matched analysis& randomized-controlled trial versus non-propensity matched analysis) was performed.

Result

A total of 19 studies with 3809 patients were included in this meta-analysis. U-VATS was performed on 1747 patients, whereas the other 2062 patients underwent M-VATS. This meta-analysis showed that there was no significant difference in operative time (U-VATS: 146.48±55.07min versus M-VATS: 171.70±79.40min, P=0.81), blood loss (74.49±109.03mL versus 95.48±133.67mL, P=0.18), resected lymph nodes (17.28±9.46 versus 18.31±10.17, P=0.62), conversion rate (6.18% versus 4.34%, P=0.14), drainage duration (3.90±2.94 days versus 4.44±3.12 days, p=0.09), length of postoperative stay (6.16±4.40 days versus 6.45±4.80 days, P=0.22), and pain in POD1 (3.94±1.68 versus 3.59±2.76, p=0.07). Subgroup analysis showed the value of PSM&RCT group consistency with overall value.

Conclusion

This up-to-date meta-analysis shows that the perioperative outcomes of U-VATS and M-VATS anatomical pulmonary resection are equivalent. In addition, the differences in long-term outcomes of these two approaches are still unclear. Thoracic surgeons should pay more emphasize on providing high-quality and personalized surgical care for patients, to improve the survival ultimately.
Comparisons of Health-Related Quality of Life and Impact Factors in Patients with Depression and Schizophrenia
Authors: Wan Chonghua , Zhang Jingjing , Lin Yan , Zhao Keying , Luo Jiahong , Tan Jianfeng , Zhao Xudong
Published: September 2020

Background: Depression and schizophrenia are the global common causes worldwide of long-term and devastating disability, which significantly impact the patient quality of life. This paper is aimed to analyze and compare the health-related quality of life (HRQOL) of patients with Depression and Schizophrenia, determine main impact factors of their HRQOL with these two diseases and try to distinct the difference of impacts at socio-demographic，socioeconomic and medical level. Methods: 204 out-patients and in-patients diagnosed Depression or Schizophrenia according to Chinese classification and diagnostic criteria of mental disorders (CCMD-3) were sampled, who were volunteering to participate and can understand the meaning of questionnaires with accordance of the included criteria. The Health survey questionnaire (SF-36) and self-administered measurements were used to appraisal the subjective health status, the disease characteristics and other relevant medical potential predictors of participants. Results: All of the domain scores of SF-36 of patients with Depression and Schizophrenia are both lower than healthy people and there are significant differences in all domains, compared with depression group, most domains of SF-36 in Schizophrenia group are lower besides the body pain (BP) and social function (SF), and are difference in domains of role physical (RP) and mental health (MH) between two patient groups. For depression group, the predictors of unmarried status, subject change of health status and depression degree are correlated to HRQOL in PCS, the predictors of unmarried status, ethnicity and duration of disease are correlated to HRQOL in MCS. For schizophrenia group, predictors of subjective change of health status, family annual income, educational level, severity degree and ethnicity are associated with HRQOL in PCS, only predictor of ethnicity is associated with HRQOL in MCS. Conclusion: The HRQOL of patients was likely be impacted by the factors at both socio-demographic and medical level, but the functions of the same factors were different between depression and schizophrenia.
Does implementation of the PECARN rules for minor head trauma improve patient-centered outcomes in a lower resource emergency department: A retrospective cohort study
Authors: Sawaya Rasha , Wakil Cynthia , Wazir Adonis , Shayya Sami , Berbari Iskandar , Safa Rawan , Makki Maha , Hamade Mahdi , Tamim Hani
Published: September 2020

Background: Managing children with minor head trauma remains challenging for physicians who evaluate for the need for computed tomography (CT) imaging for clinically important traumatic brain injury (ciTBI) identification. The Pediatric Emergency Care Applied Research Network (PECARN) prediction rules were adopted in our pediatric emergency department (PED) in December 2013 to identify children at low risk for ciTBI. This study aimed to evaluate this implementation’s impact on CT rates and clinical outcomes. Methods: Retrospective cohort study on pediatric patients with head trauma presenting to the PED of the American University of Beirut Medical Center in Lebanon. Participants were divided into pre- (December 2012 to 2013) and post-PECARN (January 2014 to December 2016) groups. Patients were further divided into <2 and ≥2 years and stratified into groups of low, intermediate and high risk for ciTBI. Bivariate analysis was conducted to determine differences between both groups. Results: We included 1362 children of which 425 (31.2%) presented pre- and 937 (68.8%) presented post-PECARN rules implementation with 1090 (80.0%) of low, 214 (15.7%) of intermediate and 58 (4.3%) of high risk for ciTBI. CTs were ordered on 92 (21.6%) pre- versus 174 (18.6%) patients post-PECARN (p=0.18). Among patients <2 years, CT rates significantly decreased from 25.2% (34/135) to 16.5% (51/309) post-PECARN (p=0.03), and dropped in all risk groups but only significantly for low risk patients from 20.7% (24/116) to 11.4% (30/264) (p=0.02). There was no significant decrease in CT rates in patients ≥2 years (20% pre (58/290) vs 19.6% post (123/628), p=0.88). There was no increase in bounce back numbers, nor in admission rates or positive CT findings among bounce backs. Conclusions: PECARN rules implementation did not significantly change the overall CT scan rate but reduced the CT scan rate in patients aged <2 years at low risk of ciTBI. The implementation did not increase the number of missed ciTBI.
Significance of accurate hilar and intrapulmonary lymph node examination and prognostication in stage IA-IIA non-small cell lung cancer, a retrospective cohort study
Authors: Zhai Wenyu , Duan Fangfang , Zheng Yuzhen , Yan Qihang , Dai Shuqin , Chen Tao , Chen Jianlong , Wang Junye
Published: September 2020

Background: The examination of lymph nodes (LNs) plays an important role in the nodal staging of non-small cell lung cancer (NSCLC). For patients without LN metastasis, the main role of thorough LN examination is accurate staging, which weakens the effect of staging migration. To date, on the role of hilar and intrapulmonary (N1) station LNs has not been fully appreciated. In this study, we aimed to confirm the significance of N1 LNs in long-term survival for stage IA-IIA NSCLC patients and to find the minimum number of LN to examine.Methods: The data of patients who underwent radical lobectomy and were confirmed as having nonmetastatic LNs from January 2008 to March 2018 were retrospectively screened. Pathology records were reviewed for the number of LNs examined. The Kaplan-Meier method and Cox regression model were used to identify survival and prognostic factors.Results: The median number of resected N1 LNs was 8. The number of patients with 0-2 N1 LNs, 3-5 N1 LNs, 6-8 N1 LNs, 9-11 N1 LNs and more than 11 N1 LNs examined was 181, 425, 477, 414 and 531, respectively. Sex (P=0.004), age (P<0.001), tumor size (P=0.004), differentiation degree (P=0.001) and number of N1 LNs examined (P=0.008) were independent prognostic factors of overall survival. Gender (P=0.006), age (P=0.031), tumor size (P=0.001), differentiation degree (P=0.001), vascular invasion (P=0.034) and number of N1 LNs examined (P=0.007) were independent prognostic factors of disease-free survival. Compared with patients with 0-5 N1 LNs examined, patients with more than 5 N1 LNs examined had better OS (P=0.015) and had better DFS (P=0.015) if only a landmark 5-year follow-up was performed.Conclusion: Increasing the number of N1 LNs examination might improve the long-term survival of T1-2N0 NSCLC patients. These data indicate that the at least 6 N1 nodes examined is an essential part in surgical and pathological management but cannot prove this. This finding should be confirmed in a large, prospective randomized clinical study.
A biomechanics study on ligamentous injury in anterior posterior compression type II pelvic injury
Authors: Kong Jianzhong , Chu Yupeng , Zhou Chengwei , Sun Shuaibo , Bao Guodong , Xu Yu , Guo Xiaoshan , Shui Xiaolong
Published: September 2020

Background: Anterior posterior compression (APC) type II pelvis fracture is caused by the destruction of pelvic ligaments. This study aims to explore ligaments injury in APC type II pelvic injury.Method: Fourteen human cadaveric pelvis samples with sacrospinous ligament (SPL), sacrotuberous ligament (SBL), anterior sacroiliac ligament (ASL), and partial bone retaining unilaterally were acquired for this study. They were randomly divided into hemipelvis restricted and unrestricted groups. We recorded the separation distance of the pubic symphysis and anterior sacroiliac joint, external rotation angle, and force when ASL ruptured. We observed the external rotation damage to the pelvic bone and ligaments.Result: When ASL failed, there was no significant difference in pubic symphysis separation (28.6 ± 8.4 mm to 23.6 ± 8.2 mm, P = 0.11) and anterior sacroiliac joint separation (11.4 ± 3.8 mm to 9.7 ± 3.9 mm, P = 0.30) between restricted and unrestricted groups. The external rotation angle (33.9 ± 5.5° to 48.9 ± 5.2°, P < 0.01) and force (553.9 ± 82.6 N to 756.6 ± 41.4 N, P < 0.01) were significantly different. Pubic symphysis separation between two groups ranged from 14 mm to 40 mm. In the restricted group, both SBL and SPL were injured. SPL ruptured first, and then SBL and the interosseous sacroiliac ligament were damaged while the posterior ligament remained unharmed. In the unrestricted group, interosseous sacroiliac ligament and posterior sacroiliac ligaments were damaged, while SBL and SPL were not. When the ASL, SBL, and SPL all failed, pubic symphysis and anterior sacroiliac joint separation between two groups increased significantly (from 28.6 ± 8.4 to 42.0 ± 7.6 mm, 11.4 ± 3.8 to 16.7 ± 4.2 mm respectively, all P < 0.05).Conclusion: Pelvic external rotation injury is either hemipelvic restricted or unrestricted, which can result in different outcomes. When the ASL ruptures, the unrestricted group needs greater external rotation angle and force, without SBL or SPL injury, while both SBL and SPL were injured in another group. When ASL fails in two groups, pubic symphysis separation fluctuates considerably. Finally, when the ASL ruptures, SBL and SPL may be undamaged.
Artificial neural networks improve LDCT lung cancer screening: A comparative validation study
Authors: Hsu Yin-Chen , Tsai Yuan-Hsiung , Weng Hsu-Huei , Hsu Li-Sheng , Tsai Ying-Huang , Lin Yu-Ching , Hung Ming-Szu , Fang Yu-Hung , Chen Chien-Wei
Published: September 2020

Background: This study proposes a prediction model for the automatic assessment of lung cancer risk based on an artificial neural network (ANN) with a data-driven approach to the low-dose computed tomography (LDCT) standardized structure report.Methods: This comparative validation study analysed a prospective cohort from Chiayi Chang Gung Memorial Hospital, Taiwan. In total, 836 asymptomatic patients who had undergone LDCT scans between February 2017 and August 2018 were included, comprising 27 lung cancer cases and 809 controls. A derivation cohort of 602 participants (19 lung cancer cases and 583 controls) was collected to construct the ANN prediction model. A comparative validation of the ANN and Lung-RADS was conducted with a prospective cohort of 234 participants (8 lung cancer cases and 226 controls). The areas under the curves (AUCs) of the receiver operating characteristic (ROC) curves were used to compare the prediction models.Results: At the cut-off of category 3, the Lung-RADS had a sensitivity of 12.5%, specificity of 96.0%, positive predictive value of 10.0%, and negative predictive value of 96.9%. At its optimal cut-off value, the ANN had a sensitivity of 75.0%, specificity of 85.0%, positive predictive value of 15.0%, and negative predictive value of 99.0%. The area under the ROC curve was 0.764 for the Lung-RADS and 0.873 for the ANN (P=0.01). The two most important predictors used by the ANN for predicting lung cancer were the documented sizes of partially solid nodules and ground-glass nodules.Conclusions: Compared to the Lung-RADS, the ANN provided better sensitivity for the detection of lung cancer in an Asian population. In addition, the ANN provided a more refined discriminative ability than the Lung-RADS for lung cancer risk stratification with population-specific demographic characteristics. When lung nodules are detected and documented in a standardized structured report, ANNs may better provide important insights for lung cancer prediction than conventional rule-based criteria.
Geographic location of health facility and immunization program performance in Hoima district, western Uganda, a facility level assessment
Authors: Kwikiriza Nicholas Magambo , Bajunirwe Francis , Bagenda Fred
Published: September 2020

Background

Globally immunization coverage for childhood vaccines is below the immunization target of achieving at least 90% coverage with the pentavalent vaccine. In Uganda, a recent survey shows 80% of districts had poor immunization program performance. However, there is significant variation in performance within and between districts. We hypothesized that geographic location of health facility may influence performance of their immunization programs. Therefore, the purpose of this study was to examine whether geographical location of health facility within a district is associated with performance of the immunization program in Hoima district, western Uganda.

Methods

We conducted a cross sectional study using a mixed methods approach. The study unit was a health center and we interviewed health workers in-charge of the facilities and reviewed their health facility records. We reviewed the Uganda Health Management Information System (HMIS) 105 reports of six months to obtain data on immunization program performance. Performance was categorized using World Health Organization’s Reach Every District (RED) criteria and classified as poor if a facility fell in category 3 or 4 and good if 1 or 2. We also conducted key informant interviews with immunization focal persons in the district. We examined the association between dependent and independent variables using Fisher’s exact test.

Results

We collected data at 49 health facilities. Most of the health units (55.1%) had poor immunization program performance. Proximal location to the central district headquarters was significantly associated with poor immunization program performance (p<0.05). Attitudes of health workers in the more urban areas, differences in strategies for outreach site selection and community mobilization in the rural and urban areas were suggested as possible explanations.

Conclusions

Proximal location to the urban setting near district headquarters was strongly associated with poor immunization program performance. To be able to reach larger numbers of children for vaccination, interventions to improve performance should target health facilities in urban settings.
Genetic relatedness of the Enterococcus faecalis isolates in stool and urine samples of patients with community-acquired urinary tract infection
Authors: Ghalavand Zohreh , Alebouyeh Masoud , Ghanati Kiandokht , Azimi Leila , rashidan marjan
Published: September 2020

Background: Community-acquired urinary tract infection (CA-UTI) could be caused by endogenous or exogenous routes. To show this relationship, we investigated molecular fingerprints and genotypes of paired Enterococcus faecalis isolated from the urine of symptomatic patients and their fecal samples. Results: Out of the studied patients, 63 pairs of E. faecalis isolates were obtained simultaneously from their urine and feces samples. All the strains were sensitive to vancomycin, linezolid, nitrofurantoin, and daptomycin (MIC value: ≤4 µg/ml), while resistance to tetracycline (Urine: 88.9%; stool: 76,2%) and minocycline (Urine: 87.3%, stool: 71.4%) was detected in most of them. The most common detected virulence genes were included efbA, ace, and gelE. RAPD-PCR and PFGE analyses showed the same patterns of molecular fingerprints between paired of the isolates in 26.9% and 15.8% of the patients, respectively. Conclusions: Similarity of E. faecalis strains between the urine and feces samples confirmed the occurrence of endogenous infection via contamination with colonized bacteria in the intestinal tract. Carriage of a complete virulence genotype in the responsible strains was statistically in correlation with endogenous UTI, which shows their possible involvement in pathogenicity of uropathogenic E. faecalis strains.
Perioperative Hypoalbuminemia is a Risk Factor for Wound Complications Following Posterior Lumbar Interbody Fusion
Authors: He Zhongyuan , Zhou Kai , Tang Ke , Quan Zhengxue , Liu Shaoyu , Su Bao
Published: September 2020

Background: Although serum albumin levels are increasingly used as an indicator of nutritional status in the clinic, the relationship between perioperative hypoalbuminemia and wound complications after posterior lumbar interbody fusion in the treatment of lumbar degenerative disease remains ambiguous. The aim of this study was to evaluate perioperative serum albumin in relation to postoperative wound complications after posterior lumbar interbody fusion in the treatment of single-segment lumbar degenerative disease. Material and methods: We reviewed patients who underwent single-segment posterior lumbar interbody fusion surgery from December 2014 to April 2017 in the Department of Orthopedics at the First Affiliated Hospital of Chongqing Medical University. Perioperative (preoperative and early postoperative) serum albumin levels were assessed in all patients and were used to quantify nutritional status. We divided the patients into a surgical wound dehiscence (SWD) group and a normal wound healing group, and into a surgical site infection (SSI) group and a non-SSI group. To evaluate the relationship between perioperative serum albumin level and postoperative wound complications, we conducted univariate and multiple logistic regression analyses.Results: A total of 554 patients were enrolled in the study. The univariate and multiple logistic regression analysis of these differences showed that preoperative serum albumin <3.5 g/dl (P =0.001) and postoperative serum albumin <3.0 g/dl (P =0.001) were significantly correlated to SWD. There were also significant differences between the SSI groups in terms of preoperative serum albumin <3.5 g/dl (P=0.001), Chronic steroid use (P=0.003). Additionally, the increased hospitalization costs (P<0.001) and length of hospitalization (P<0.001) were statistically significant for patients with perioperative hypoalbuminemia. Conclusions: For patients who underwent single-segment posterior lumbar interbody fusion surgery, we need to pay more attention to perioperative hypoalbuminemia and chronic steroid use,which are more likely to be associated with increased wound complications, hospitalization costs and length of hospitalization after surgery. Adequate assessment and management of these risk factors will help reduce wound complications and hospital stays for surgical patients and will save medical costs.
Prediction and Evolution of B Cell Epitopes of Surface Protein in SARS-CoV-2
Authors: Lon Jerome Rumdon , Bai Yunmeng , Zhong Bingxu , Cai Fuqiang , Du Hongli
Published: September 2020

Background In order to obtain antibodies that recognize natural proteins, it is possible to predict the antigenic determinants of natural proteins, which are eventually embodied as polypeptides. The polypeptides can be coupled with corresponding vectors to stimulate the immune system to produce corresponding antibodies, which is also a simple and effective vaccine development method. The discovery of epitopes is helpful to the development of SARS-CoV-2 vaccine. Methods The analyses were related to epitopes on 3 proteins, including spike(S), envelope(E) and membrane(M) proteins, which were associated with the lipid envelope of the SARS-CoV-2. Based on the NCBI Reference Sequence: NC_045512.2, the conformational and linear B cell epitopes of the surface protein were predicted separately by various prediction methods. Furthermore, the conservation of the epitopes, the adaptability and other evolutionary characteristics were also analyzed, the sequences of the whole genome of SARS-CoV-2 were obtained from the GISAID. Results 7 epitopes were predicted, including 6 linear epitopes and 1 conformational epitope. One of the linear and one of the conformational consist of identical sequence, but represent different forms of epitopes. It is worth mentioning that all of the 6 dominated epitopes were conservative in nearly 3500 SARS-CoV-2 genomes, and they showed a phenomenon which is helpful to obtain stable and long-acting epitopes under the condition of high frequency of amino acid mutation, and deserved further study at the experiment level. Conclusion The findings would facilitate the vaccine development, had the potential to be directly applied on the prevention in this disease, but also have the potential to prevent the possible threats caused by other types of coronavirus.
Low Complexity Channel Estimation Algorithm Using Paired Spatial Signatures for UAV 3D MIMO Systems
Authors: Xie Peizhong , Wan Yingqing , Li Ting , Ju Renjie
Published: September 2020

This paper proposes a low complexity channel estimation algorithm for unmanned aerial vehicle (UAV) three dimension multi-user multiple-input-multiple-output (3D MIMO) systems with the uniform planar array (UPA) at base station (BS) using paired spatial signatures. With the aid of antenna array theory and array signal processing, 3D channel is firstly modeled based on the angles between the direction of arrival (DOA) along x- and y-axis of the UPA. And 3D MIMO channels can be projected onto the x- and y-directions, respectively. Then, channel estimation for multi-user uplinks using small amount of training resources is divided into two phases. At the first uplink preamble phase, each user is assigned the orthogonal pilot, and the paired spatial signatures and optimal rotation angle of each user through the same pilot sequence are obtained. We also propose a user grouping strategy based on three-dimension angle-division multiple access (3D-ADMA) to ensure that the user's spatial signatures do not overlap. At the second phase during several coherence times, the same pilot sequence within a group and orthogonal pilot sequences between groups are assigned, then, the channel state information of the user's x- and y-directions are recovered by the paired space signatures and optimal rotation angle of each user obtained in the preamble phase, respectively. And dynamically updating the user's paired spatial signatures and optimal rotation angle utilizes the obtained channel parameter of x- and y-directions. Finally, the channel parameter of the x- and y-directions are reconstructed by the updated user's space signatures and the optimal rotation angle, and the 3D MIMO channel estimation is obtained through the Kronecker product. Compared with the conventional channel estimation method of the 3D MIMO system under UPA using a low-rank model, the proposed methods reduce the computational complexity without degrading the estimated performance to a large extent. Furthermore, it is carried out with limited training resources, and the pilot resource overhead of the system is greatly reduced by the 3D-ADMA packet and the two-stage pilot allocation. Simulation results verified that the proposed algorithm is effective and feasible.

Keywords 3D MIMO, 3D Channel Modeling, Unmanned Aerial Vehicle, Channel Estimation, Computational Complexity
Knockdown of hspg2 is associated with mandibular jaw joint fusion and neural crest cell dysfunction in zebrafish
Authors: Castellanos Barbara S. , Reyes-Nava Nayeli G , Quintana Anita
Published: September 2020

Background: Heparan sulfate proteoglycan 2 (HSPG2) encodes for perlecan, a large proteoglycan that plays an important role in cartilage formation, cell adhesion, and basement membrane stability. Mutations in HSPG2 have been associated with Schwartz-Jampel Syndrome (SJS) and Dyssegmental Dysplasia Silverman-Handmaker Type (DDSH), two disorders characterized by skeletal abnormalities. These data indicate a function for HSPG2 in cartilage development/maintenance. However, the mechanisms by which HSPG2 regulates cartilage development are not completely understood. Here, we explored the relationship between this gene and craniofacial development through morpholino-mediated knockdown of hspg2 using zebrafish. Results: Knockdown of hspg2 resulted in abnormal development of the mandibular jaw joint at 5 days post fertilization (DPF). We surmised that defects in mandible development were a consequence of neural crest cell (NCC) dysfunction, as these multipotent progenitors produce the cartilage of the head. Early NCC development was normal in morphant animals as measured by distal-less homeobox 2a (dlx2a) and SRY-box transcription factor 10 (sox10) expression at 1 DPF. However, subsequent analysis at later stages of development (4 DPF) revealed a decrease in the number of Sox10 + and Collagen, type II, alpha 1a (Col2a1a)+ cells within the mandibular jaw joint region of morphants. Concurrently, morphants showed a decreased expression of NK3 homeobox 2 (nkx3.2), a jaw joint molecular marker at 4 DPF. Conclusions: Collectively, these data suggest a complex role for hspg2 in jaw joint formation and late stage NCC differentiation.
Performance of the Parasympathetic Tone activity (PTA) index to predict changes in mean arterial pressure in anaesthetized horses with different health conditions
Authors: Mansour Christelle , Mocci Rita , Santangelo Bruna , Chaaya Rana , Allaouchiche Bernard , Bonnet-Garin Jeanne-Marie , Boselli Emmanuel , Junot Stéphane A
Published: September 2020

Background: The parasympathetic tone activity (PTA) index is based on heart rate variability recently and has been developed in animals to assess their relative parasympathetic tone and their analgesia nociception balance. The present study aimed to evaluate the variation of PTA in anaesthetized horses according to haemodynamic status and health conditions and to determine the performance of dynamic variations of PTA (∆PTA) to predict mean arterial pressure (MAP) variations.Results: Thirty-nine client-horses admitted to the Veterinary Campus of Lyon were anaesthetized for elective or emergency surgery and divided into “Colic” and “Elective” groups. During anaesthesia, dobutamine was administered as treatment of hypotension (MAP < 60 mmHg). No significant variation of PTA and MAP were detected immediately before and after the time of cutaneous incision. PTA increased 5 min before each hypotension (+15% in Elective and +11.4% in Colic group), conversely, PTA decreased 1 min after the administration of dobutamine (-12.7% in Elective and -9% in Colic group). Horses of the Colic group had lower PTA values than those in Elective group, whereas MAP didn’t differ between groups. Globally, to predict a 10% increase in MAP, ΔPTA performance was associated with: AUC ROC [95% CI] = 0.77 [0.70 to 0.83] (p<0.0001), with a sensitivity of 88.2% and a specificity of 57.7% for a threshold value of −1%. Besides, to predict a 10% decrease in MAP, ΔPTA performance was associated with: AUC ROC [95% CI] =0.80 [0.73 to 0.85] (p<0.0001), with a sensitivity of 62.5% and a specificity of 94.6% for a threshold value of 25%.Conclusions: The PTA index in anaesthetized horses appears to be influenced by the haemodynamic status and the health condition. The shift toward lower PTA values in colic horses may potentially reflects a sympathetic tone predominance. Of clinical significance, a PTA increase of >25% in 1 min showed an acceptable performance to predict a MAP decrease of >10% within 5 min. Even though these results require further evaluation, this index may thus help to predict potential autonomic dysfunctions in sick animals.
Psychological Distress among Iranian Health-Care Providers Exposed to Coronavirus Disease 2019 (COVID-19): A Qualitative Study
Authors: Alizadeh Azizeh , Khankeh Hamid Reza , Barati Mohammad , Ahmadi Yazdan , Hadian Arash , Azizi Maryam
Published: September 2020

Background: Novel corona virus, named COVID-19, has spread rapidly to other countries like Italy, Iran and South Korea and affected all people, especially health-care providers. Therefore, due to the rapid spread of the disease in Iran, the aim of the present study was to explore psychological distress experienced by Iranian health-care providers in the first few weeks of the corona virus outbreak.Methods: The present qualitative study was conducted on 18 Iranian health-care providers exposed to COVID -19 using a content analysis method. Purposeful sampling was used to select the participants and continued until data saturation was reached. Data were collected using semi-structured interviews and then the qualitative data were analyzed through direct content analysis.Results: By analyzing 236 primary codes, two main categories were extracted from the experiences of health-care providers during corona virus outbreak. The first category included Occupational demands with three sub-categories: nature of illness, Organizational demands and social demands. The second category was Supportive resources included personal support and social support.Conclusions: The results of this study found that there were some barriers and challenges to medical personnel exposed to COVID-19 that caused psychological distress. Some of these problems related to the nature of illness, others related to social and organizational demands and some of supportive resources buffer the relationship between occupational demands and psychological distress.
Young age increases the risk of lymph-node metastasis in patients with muscle-invasive bladder urothelial carcinoma
Authors: Tian Zijian , Meng Lingfeng , Wang Xin , Diao Tongxiang , Hu Maolin , Wang Miao , Liu Ming , Wang Jianye
Published: September 2020

Background: The risk of positive lymph nodes in patients with muscle-invasive bladder urothelial carcinoma (MIBC) can be used to guide treatment recommendations. However, little is known about the effect of age on lymph node positivity (LN+). This study aimed to evaluate the effect of age on LN+ in MIBC. Methods: We analyzed patients with stage T2–T4 bladder urothelial carcinoma who had not received preoperative radiotherapy, had at least one lymph node examined, and underwent cystectomy between 1998 and 2015. The Cochran–Armitage trend test and logistic univariate and multivariate analyses were used to evaluate the effect of age on LN+ in all T stages.Results: In total, 15624 patients with MIBC were identified, including 747 patients aged ≤50 years (4.78%), 2614 patients aged 50–59 years (16.73%), 4914 patients aged 60–69 years (31.45%), 5225 patients aged 70–79 years old (33.44%), and 2124 patients aged >80 years (13.59%). In T2–T4 staging, LN+ was negatively correlated with age. After adjustment for several covariates, multivariate logistic regression analysis revealed that age was an independent risk factor for LN+.Conclusions: In this large SEER analysis, Young patients with MIBC have a higher risk of lymph node metastasis. This finding is worthy of further study and may eventually affect the treatment decisions of young patients.
Uroguanylin-decorated Nanosystems Containing Etoposide, a Potential Targeted Combination Therapy for Colorectal Cancer
Authors: Bouzo Belén L. , Lores Sainza , Jatal Raneem , Alijas Sandra , Alonso María José , Conejos-Sánchez Inmaculada , Fuente María de la
Published: September 2020

The authors have withdrawn this preprint due to erroneous posting.
Paraganglioma Not Only Secrete Catecholamines but Also Inflammatory Cytokines: A Case Report 
Authors: Song Keke , Yang Tingting , Wang Qiang , Tan Jing
Published: September 2020

Background: Paraganglioma not only can secrete catecholamines with vasoconstriction activity resulting in hypertension and metabolic disorders,but also cytokines which can induce inflammatory response syndrome.Case presentation: We report a 19-year-old girl with a paraganglioma that presented with fever and thrombocytosis, leukocytosis, and elevated high sensitivity C-reactive protein. After paraganglioma’s resection, the little girl had no fever and the platelet, white blood cell and high sensitivity C-reactive protein recover to nomal level. Conclusion: We propose in the future we should check cytokine in patients with paroxysmal hypertension complicated with inflammatory response syndrome and thrombocytosis, and think of that it may be caused by pheochromocytoma or paraganglioma.
Improving Anti-trafficking Response in Bihar and Uttar Pradesh: Lessons Learned From a Qualitative Analysis of Stakeholder Interviews
Authors: Burns Courtney Julia , Chen Keiko , Stoklosa Hanni
Published: September 2020

Background: Human trafficking is a critical public health issue particularly pervasive in the Indian states of Bihar and Uttar Pradesh, which share a border with Nepal. In advocating for human rights in this area, there is a need for research to identify problems hindering the efficacy of anti-trafficking programs, focusing on their success in assisting people from being re-trafficked. Methods: A qualitative study was conducted using semi-structured interviews and focus groups with key stakeholders in Bihar, Uttar Pradesh, and Nepal. Results: Thematic analysis revealed that barriers hindering the anti-trafficking movement include police corruption, lack of enforcement of national law, discrimination toward trafficking victims, lack of funding, and lack of government involvement. Recommendations for overcoming these barriers were increasing cooperation, coordination, and communications between NGOs and the government, and empowering survivors. Conclusions: In mitigating these barriers and increasing survivor autonomy, anti-trafficking interventions have the opportunity to create individualized environments for those with an experience of trafficking to thrive. Ultimately, elevating community accountability, honoring individual autonomy, and recognizing the value of the persons with a lived experience of trafficking are critical as we continue to use a public health lens in the fight against human trafficking and for human rights.
The Demography and Aetiology of Strabismus Patients in a Tertiary Eye Centre in North China, 2014-2019
Authors: wan xiaomei , wan luqin , jiang mingming , ding yichao , wang yuan , Zhang Jing
Published: September 2020

BackgroundTo analyse the epidemiology and clinical characteristics of strabismus patients in north China. MethodsThe records of strabismus patients at Qingdao Eye Hospital from January 2014 to December 2019 were reviewed retrospectively. The characteristics analysed included gender, regional distribution, constituent ratio of age and type of strabismus. Changes during the periods 2014–2016 and 2017–2019 were compared and analysed. ResultsA total of 5746 strabismus patients were recruited. The number of strabismus patients was relatively stable each year from 2014 to 2016 but gradually increased each year from 2017 to 2019. Of these, 51.7% (2868/5746) were male, and 48.3% (2778/5746) were female. The majority (89.8%, 5159/5746) of the patients were from Shandong Province. The statistical results of the constituent ratio of age showed that 32.4% (1860/5746) were 7–12 years old(primary school level). Patients under 12 years of age (preschool and primary school level) accounted for 60.0% (3447/5746) of all the patients. In terms of the types of strabismus, exotropia accounted for 63.5% (3650/5746), followed by esotropia and vertical rotational strabismus at 13.2% (758/5746) and 9.7% (555/5746), respectively. Intermittent exotropia was the most common type among the exotropia patients, accounting for 71.3% (2604/3650). Among the patients with intermittent exotropia, 62.5% (1627/2604) were children aged 4–12 years, and the basic type of intermittent exotropia was the main type. Four percent (231/5746) of the patients, of which adult patients comprised the main population, required reoperation.ConclusionPatients with strabismus at primary school level comprised the largest group of strabismus patients in north China. Exotropia was the most common type of strabismus, and intermittent exotropia was the most common type of exotropia. The rate of exotropia to esotropia was 5:1.
Increasing Newly Diagnosed Inflammatory Bowel Disease and Improving Prognosis in China: A 30-year Retrospective Study From a Single Center
Authors: Lv Hong , Jin Meng , Zhang Huimin , Chen Xuanfu , Wu Meixu , Guo Mingyue , Zhou Runing , Wang Zheng , Qian Jiaming , Yang Hong
Published: September 2020

Background: We aimed to characterize the trends of prognosis in Ulcerative Colitis (UC) and Crohn’s Disease (CD) in a Chinese tertiary hospital. Methods: A 30-year retrospective cohort analysis was conducted at Peking Union Medical College Hospital. Consecutive patients newly diagnosed with UC or CD from 1985 to 2014 were included. The primary outcome was in-hospital mortality. Second outcomes included surgery and length of stay in hospital. Pearson correlation coefficient was performed to determine the relationship between time and prognosis. Multivariable logistic regression analysis was performed to determine the risk factors for in-hospital mortality and surgery. Results: In total, 1467 patients were included in this study (898 cases with UC and 569 cases with CD). Annual admissions of UC and CD rose significantly over the last 30 years (UC, r=0.918, P<0.05; CD, r=0.898, P<0.05). Decreased in-hospital mortalities were observed in patients with UC and CD (UC, from 2.44% to 0.27%, r=-0.827, P<0.05; CD, from 12.50% to 0.00%, r=-0.978, P<0.05). A decreasing surgery rate was observed in patients with CD (r=-0.847, P<0.05) while an increasing surgery rate was observed in patients with UC (r=0.956, P<0.05). Shortened average lengths of stay in hospital were observed both in patients with UC and CD (UC, from 47.83±34.35 days to 23.58±20.05 days, r=-0.970, P<0.05; CD, from 65.50±50.57days to 26.41±18.43 days, r=-0.913, P<0.05). Toxic megacolon, sepsis shock were independent risk factors for in-hospital mortality in patients with UC. Intestinal fistula, intestinal perforation were independent risk factors for in-hospital mortality in patients with CD. Conclusions: In this cohort, the admissions of patients with UC and CD were increased with a significantly improved prognosis during past 30 years.
Differences in Inflammation, Apoptosis and Tissue Hypo-perfusion Indicators Caused by Using Two Different Gauges in Cecal Ligation and Puncture-induced Rat Models of Sepsis
Authors: Didari Tina , Baeeri Maryam , Rahimifard Mahban , Mozaffari Shilan , Haghi-Aminjan Hamed , Mojtahedzadeh Mojtaba , Najafi Atabak
Published: September 2020

The authors have withdrawn this preprint due to author disagreement.