bluuebunny/crossref_metadata_2025 huggingface dataset:
For better response to clinical trials under public health emergency: a descriptive analysis COVID-19, SARS, MERS and Ebola intervention clinical trials registration
Authors: Xiang Yuxia , Zhang Zeyu , Zeng Chan , Hu Zhanqing , Liu Yaxin , Chen Wenjing , Huang Zhijun , Wang Xiaomin , Yang Guoping
Published: May 2020

BackgroundCOVID-19 is a novel and highly virulent virus, which caused a rapid and massive onset of clinical trials in a short period of time.With the aim to obtain suggestions in the guidance on performing public health emergency clinical trials, and control this virus in China and other countries and for the prevention of the onset of other infectious viruses in the future. Methods COVID-19, SARS, MERS and Ebola clinical trials registered in the Chinese clinical trial registry and clinical trials.gov were collected and analyzed and intervention protocols were descriptively analyzed, focusing on the analysis and comparison of the drug used. The search period ended on February 24, 2020.ResultsThe number of the registered COVID-19 clinical trials was 295. Among 203 intervention trials, 78.3% (159) were drug clinical trials. The 159 COVID-19 trials were designed and analyzed with the highest proportion of random, open control study [66.0% (105)], and blind randomized trials [13.8% (22)]. The drug mostly used was Lopinavir/Ritonavir (15.1%). The sample size median 100,IQR(interquartile range) 140. The number of the registered SARS was 6, MERS 15, and Ebola 97. Among 3 MERS and 19 Ebola drug intervention clinical trials, MERS and Ebola were randomized, blind, and placebo-controlled drug clinical trials accounting for 100% (3) and 31.6% (6), respectively, while SARS were vaccine trials, without drug intervention clinical trials registered.Conclusions Some of the COVID-19 clinical trials and drug selection performed are somewhat disordered, requiring greater attention to the needs, science assumptions, ethics and quality management of the clinical research. Thus, during the epidemic period, the country should deliver guidance on how to perform appropriate emergency clinical trials, design a scientifically based clinical trial program and focus on researching drugs or vaccines that have great potential.
Relationship between visceral adipose tissue and triglyceride glucose index with liver status in men and women with metabolic syndrome features: sex differences
Authors: Bullón-Vela Vanessa , Abete Itziar , Tur Josep A. , Konieczna Jadwiga , Romaguera Dora , Pintó Xavier , Corbella Emili , Martínez-González Miguel A. , Sayón-Orea Carmen , Toledo Estefanía , Corella Dolores , Macias-Gonzalez Manuel , Tinahones Francisco J. , Fitó Montserrat , Estruch Ramon , Ros Emilio , Salas-Salvadó Jordi , Daimiel Lidia , Mascaró Catalina M. , Zulet M. Angeles , Martínez J. Alfredo
Published: May 2020

BackgroundMetabolic syndrome (MetS) comprises several clinical and metabolic risk factors that increase the risk to develop cardiovascular disease and other comorbidities. Meanwhile, ageing and biological differences between men and women play an important role in body fat distribution and health status. The current study aimed to evaluate the association of visceral adipose tissue (VAT) and the triglyceride and glucose index (TyG) with metabolic and liver risk factors among subjects diagnosed with MetS with emphasis on differences attributable to sex.MethodsA cross-sectional study was performed including 326 individuals with MetS (54–75 years) from the PREDIMED-Plus study. Liver markers, visceral fat (VAT) and the triglyceride glucose index (TyG) were assessed. Participants were stratified according to VAT and TyG tertiles. Receiver operating characteristic (ROC) curve was used to analyze the efficiency of TyG for VAT.ResultsSubjects with greater visceral fat depots showed worse lipid profile, higher HOMA-R, TyG, ALT, fibroblast growth factor-21 (FGF-21), fatty liver index (FLI) and hepatic steatosis index (HSI) compared to participants in the 1st tertile. The multi-adjusted linear regression analyses indicated that individuals in the third tertile of TyG (> 9.1–10.7 units) had a positive association with HOMA-IR (β = 3.07 [95% CI, 2.28–3.86]; p-trend < 0.001), ALT (β = 7.43 [95%CI, 2.23–12.63]; p-trend = 0.005), GGT (β = 14.12 [95% CI, 3.64–24.61; p-trend = 0.008]), FGF-21 (β = 190.69 [95% CI, 93.13-288.25; p-trend < 0.001]), FLI (β = 18.65 [95%CI, 14.97–22.23]; p-trend < 0.001) and HSI (β = 3.46 [95% CI, 2.23–4.68; p-trend < 0.001]) versus participants from the first tertile. Interestingly, the TyG showed the largest AUC for women (AUC = 0.713; 95%CI, 0.62–0.79) compared to men (AUC = 0.570; 95%CI, 0.48–0.66), despite the differences in VAT content associated to sex.ConclusionsBoth, VAT and the TyG are strongly associated with cardiometabolic and liver risk factors linked with non-alcoholic fatty liver disease in men and women diagnosed with MetS. The TyG could be used as suitable marker estimator of VAT in women.Trial registrationRetrospectively registered at the International Standard Randomized Controlled Trial (http://www.isrctn.com/ISRCTN89898870), registration date: 24 July 2014.
A Clinical Control Study on the Retroperitoneal Laparoscopy for Unilateral Simple Renal Cyst Decortication in the Day Ward
Authors: Zhu Xiao-Liang , Bano Yasmeen , wu song-jiang , Jiang Hai-Hong
Published: May 2020

BackgroundUnder the constraints of the increasingly tight medical environment and market economy, day surgery has a good development trend and attracts more and more attention from clinicians. To investigate the feasibility and safety of unilateral simple renal cyst decortication by retroperitoneal laparoscopy in the day ward and to compare the advantages and disadvantages of conventional inpatient ward.MethodsA total of 41 patients with unilateral simple renal cysts meeting surgical indications were included in this study. The patients were divided into the day ward group and inpatient ward group by the patients' wishes. The indexes of operation time, time of hospitalization, intraoperative blood loss, time of postoperative extubation, postoperative complication rate, patients’ satisfaction rate, quality of life scores and total costs of hospitalization were compared between the two groups.Results41 cases of unilateral simple renal cyst decortication were completed successfully. Patients were followed up 10–12 months after surgery. CT or b-ultrasound examination indicated that the original renal cyst had been decorticated surgically and no recurrence of the cyst was observed after 10 months of postoperative follow-up. Time of postoperative extubation were (9.7 ± 1.8) hours and (20.8 ± 5.5) hours, total hospitalization costs were (5790 ± 99.8) RMB and (7496 ± 120.6) RMB, time of hospitalization were (22.7 ± 1.4) hours and (46.4 ± 11.3) hours in the day ward group and the inpatient ward group, respectively. In the above three aspects, the differences between the two groups were statistically significant (P < 0.05).ConclusionIn this study, we concluded that the retroperitoneal laparoscopy for unilateral simple renal cyst decortication in patients aged between 48 and 80 years, with no previous history of abdominal surgery, unilateral renal cysts (Bosniak grades I or II) on CT, ASA grades I or II, and no surgical or anesthetic contraindications, was safe and feasible in the day ward. Its obvious advantages of reducing time of hospitalization and total costs of hospitalization were worthy of clinical promotion.
Bicondylar Tibial Plateau Fractures Involving the Posterior Fragment: Injury Mechanism and Fracture Characteristics
Authors: Pan Shuo , Peng Aqin , Hu Yaning , Wang Shuai , Zhang Xiao
Published: May 2020

Background: Bicondylar tibial plateau fracture (BTPF) involving the posterior fragment is the most complex intra-articular fracture to treat. Although the fracture characteristics of BTPFs have been reported by many researchers, due to the sophisticated kinematics of the knee, reports focused on the injury mechanism are still scarce. The current injury mechanism is insufficient to explain the various fracture characteristics and to guide surgery. This study used a three-dimensional (3D) simulation method to investigate the injury mechanism and fracture characteristics of BTPFs involving the posterior fragment.Methods: Ninety-six BTPFs involving the posterior fragment were included. A computer-assisted 3D technique, which enabled us to move the femoral condyles to match the displaced fracture fragments of the tibial plateau, was applied to analysis the injury mechanism for all cases. The 3D and two-dimensional (2D) morphology of each fracture were reviewed thoroughly, and the main fracture lines were mapped and superimposed on a template. Results: After simulation andquantitatively analysis, three main types (extension, flexion-internal rotation, flexion-external rotation) and six sub-types (valgus and varus in each main type) of injury mechanism had been classified according to the degree of knee motion in three planes. In the extension type, femoral condyles compress the anterolateral tibial plateau and central medial plateau, resulting in an anterior-to-posterior fracture line. In the flexion-internal rotation type, the compressed areas are located on the posterolateral and anteromedial plateau, forming an oblique anteromedial-to-posterolateral fracture line. In the flexion-external rotation type, the compressed areas are located on the anterolateral and posteromedial plateau, exhibiting an anterolateral-to-posteromedial fracture line. Conclusions: Differentinjury mechanisms result in different fracture characteristics. A thorough understanding of the injury mechanisms underlying complex BTPFs involving the posterior fragment is meaningful not only for fracture characteristics reorganization but also for surgical decision making. The 3D simulation method employed in this study may be a useful supplemental method for investigating the mechanisms underlying fracture injuries.
Kneeling Assessment After Anterior Cruciate Ligament Reconstruction Using Bone-Patellar Tendon-Bone Autograft Versus Hamstring Autograft
Authors: Hulaibi Fahad Al , Eid Zainab Al , Taher Saad Al , Albarrak Abdulaziz , Alzaid Zaid
Published: May 2020

Background: ACL reconstruction surgeries is a common surgery that aim to provide stability and return functionality post ACL injury. Commonly, bone patellar tendon-bone (BPTB) and hamstring tendon autografts are used for the reconstruction. The choice of optimal autograft remains debatable to achieve satisfactory outcomes for various activities after reconstruction, including kneeling as widely needed, especially in prayers among Muslims. Kneeling with considerable ranges of motion and the minimum level of pain is still under rigorous investigations to choose proper autograft.Purpose: Hereby, we compare kneeling outcomes post-operatively using bone-patellar tendon-bone autografts with hamstring autografts for ACL reconstruction.Methods: A retrospective cohort study; Level of evidence (III) has enrolled. Adult patients underwent primary ACL reconstruction using either BPTB or HS autografts after they consented at a single institution with a minimum of 1-year as follow-up post-operatively were reviewed for assessment of the surgery’s outcomes in regards of kneeling pain and subjective assessment measures using International Knee Documentation Committee (IKDC) evaluation system.Results: A total of Thirty-two males were met our inclusion criteria. Analysis of data provided that 12 patients were in the BPTB group and 20 patients in the HS group. All patients show ACL rupture was sustained during participation in the athletic activity. After a follow-up of 1-year, there was no statistically significant difference between scores of two groups when comparing patient-reported outcome measures, with mean IKDC scores of 68.5 and 62.55 in the BPTB and HS groups, respectively. Interestingly, insignificant statistical differences observed in both groups regarding kneeling pain in the BPTB group when compared with the HS group.Conclusion: The findings of our study have shown that Arthroscopic ACL reconstruction using either hamstring autograft or bone patellar tendon autograft ends with equally reasonable satisfactory outcomes, with an insignificant difference in kneeling pain between both groups.
Compositional and functional comparisons of the microbiota in the colostrum and mature milk of dairy goats
Authors: Niyazbekova Zhannur , Yao Xiao-Ting , Liu Ming-Jie , Bold Nomin , Tong Juan-Zhen , Chang Jian-Jun , Wen Ying , Li Li , Wang Yong , Chen De-Kun , Ma Wen-Tao
Published: May 2020

BackgroundGoat milk is essential for the initial development of kids by providing a great source of commensal bacteria. Here we analyzed the microbiota of goat colostrum which was collected daily for five days post delivery and mature milk collected at the 7th, 10th, 20nd, 30th, 40th, 50th and 60th days, respectively, from three farms of Shaanxi province.ResultsThe result showed that microbial alpha diversity was higher in the mature milk compared with that in the colostrum. According to taxonomy results, Proteobacteria, Firmicutes, Actinobacteria and Bacteroidetes were the predominant bacteria phyla in both colostrum and mature milk. In addition, lactation stage noticeably influenced the composition of milk microbiota. Specifically, Novosphingobium, Brachybacterium, Psychrobacter, Lactobacillus, Yersinia, Roseatelesand, Rothia, Sanguibacter, Cloacibacterium, Variovorax, Sphingobacterium, Coxiella were enriched in the colostrum while Georgenia, Peptostreptococcus, Bacteroidales, Yaniella, Planomicrobium, Cloacibacterium, Azospirillum, Turicibacter, Cupriavidus, Herbaspirillum, Rhodobacteraceae, Aeromonadales were the dominant genera in the mature milk. The enriched metabolic functions of the goat milk microbiota were predicted by PICRUSt and classified by KEGG patway. Moreover, the abundances of the environmental information processing, cellular processes pathway, genetic information processing pathway, organismal systems pathway and metabolism pathway were significantly different between microbiota of colostrum and mature milk.ConclusionsAltogether, our study disclosed the significant difference between the microbial communities of colostrum and mature milk and provided grounds for further research in dairy microbiology.
Changes between longissimus dorsi muscle from donkey, cow, and goat assessed by transcriptomic and proteomic analyses
Authors: Sun Yan , Wang Jinpeng , Li Yuhua , Yang Chunhong , Wang Xiuge , Ju Zhihua , Jiang Qiang , Huang Jinming , Wang Changfa
Published: May 2020

Background: Domestic donkeys (Equus asinus) are farm animals; they are used mainly for carrying loads in the past centuries. Recently, interests on donkey milk and meat production have increased in many countries. Donkey meat is extremely popular in China due to its high nutritional value and unique flavor. Except the origin and domestication of donkeys, few genetic studies have been conducted. Moreover, data from transcriptional profiling and microRNA (miRNA) regulation of skeletal muscle tissues in donkey are scarce. Recent developments in high-throughput sequencing techniques can offer large-scale analysis of gene expression in different species. This study aimed to explore the differences of the molecular and regulation mechanisms among donkey meat, beef, and mutton using genome-wide transcriptomic analysis and proteomic methods to provide more effective genetic information.Methods: RNA sequencing and proteomic analysis (on the basis of isobaric tags for relative and absolute quantitation) on donkey, cow, and goat muscles, and miRNAs in donkey muscles were detected. We performed a comprehensive research on total RNA, including miRNAs from donkey muscles. The mRNA expression profiles were characterized and differences in single-copy homologous genes among species were analyzed.Results: Most differentially expressed genes were associated with pathways related to protein and fat synthesis and metabolism, muscle formation, and development. We identified single nucleotide polymorphisms (SNPs) in donkey muscle and alternative splicing (AS) events. A total of 57,201 putative SNPs were found, and the main SNP variations were located in known genes. Several AS events occurred in genes related to muscle fiber. Different AS events were also noted among species. Muscle proteomic data were obtained, including all expressed proteins and differentially expressed proteins. Combined transcriptomic and proteomic analysis effectively revealed pivotal mRNAs and proteins in muscles. We found five genes associated with thin and thick filaments, which indirectly explained the characteristics of donkey muscle fibers.Conclusion: RNA-seq and iTRAQ analysis revealed altered expression of genes and proteins in three kinds of muscle. In the highly expressed genes of donkey muscle, we discovered 31 expressed genes were involved in muscle contraction and skeletal muscle fiber development. Compared with mutton, five genes related to muscle fiber synthesis were found and showed differences both at transcriptional and proteome levels in donkey muscle. Meanwhile, genetic variation and regulatory factors can combine as a database to provide more valuable molecular information for further analysis.
Influence of reversal with sugammadex or neostigmine on postoperative bowel movement following robotic thyroidectomy: a retrospective study
Authors: Lee Min Jeong , Chun Duk-Hee , Hong Jung Hwa , Choi Seung Yeon , Kim Na Young
Published: May 2020

Background

Postoperative bowel dysfunction poses difficulty during recovery, and reversal agents may affect bowel function. The purpose of this study was to determine whether time to first postoperative bowel movement after non-abdominal surgery differs among neuromuscular (NM) blockade reversal with either anticholinesterase/anticholinergic combination or sugammadex.
Methods

The electronic medical records of 108 patients who underwent robotic thyroidectomy between March 2018 and July 2018 were retrospectively reviewed. The use of agents to reverse NM blockade (neostigmine 1 mg and glycopyrrolate 0.2 mg, or sugammadex 2 mg/kg) was decided by the attending anesthesiologist. Demographic, clinical, and laboratory findings and first gas-passing time after surgery were assessed.
Results

The median gas passing time after operation was 957.5 min (425–1455) in the neostigmine group and 600 min (310–1080) in the sugammadex group (P = 0.113). Univariate logistic regression analysis indicated that first gas-passing time within 12 h after operation was significantly associated with perioperative use of opioid analgesics (odds ratio = 2.85, 95% confidence interval 1.26–6.43, P = 0.012). Multivariate logistic regression analysis revealed no significant association of reversal agents, perioperative opioid use, or postoperative hypocalcemia with first gas-passing time within 12 h after operation.
Conclusions

Sugammadex may not cause a delay in postoperative gastric motility compared to neostigmine/glycopyrrolate in patients undergoing robotic thyroidectomy.
Effects of dexmedetomidine addition to low concentration of lidocaine/ropivacaine mixtures for ultrasound-guided axillary brachial plexus block
Authors: Wang Qi , Ding Wengang , Feng Lu , Li Wenzhi
Published: May 2020

BackgroundDexmedetomidine(DEX) has been used in combination with different local anesthetics (LAs) to improve the quality of peripheral nerve blocks. However, there is little evidence of the effects of DEX in a mixture of two LAs for brachial plexus block (BPB).The aim of this study was to investigate if DEX combined with low concentration of lidocaine/ropivacaine mixtures may further reduce the onset time and prolong block duration and analgesia time for performing ultrasound-guided axillary BPB.MethodsSeventy-five ASA Ι or II patients, scheduled for forearm or hand surgery were randomly allocated into three groups: Group R (n = 25) received 30 mL of 0.25% ropivacaine + 3 mL of 0.9% NaCl; Group RL (n = 25) received 30 mL of 1:1 0.25% ropivacaine/0.5% lidocaine + 3 mL of 0.9% NaCl; Group RLD (n = 25) received 30 mL of 1:1 0.25% ropivacaine/ 0.5%lidocaine + 3 mL of 0.75 µg/kg DEX. The hemodynamic changes, BIS values, onset time and duration of sensory and motor blocks, the analgesic time and the times of rescue analgesics within 48 h were recorded.ResultsThe onset times of sensory and motor blocks were significantly shorter in group RL and group RLD compared with group R (P < 0.0001), but no significant difference was detected between group RL and group RLD (P > 0.05). The analgesic time and the block durations in group RLD were significantly longer than that in group R and group RL (P < 0.0001). In group RLD, the times of flurbiprofen treatment were significantly reduced compared with group R and group RL(P < 0.0001). The BIS values in group RLD were significantly decreased than those of group R and group RL from 20 min till 60 min(P < 0.05).ConclusionsCombination of ropivacaine and lidocaine produces shorter onset time than ropivacaine alone in axillary BPB. DEX added to ropivacaine/lidocaine mixtures prolongs the duration of sensory and motor blocks, extends analgesic time and exerts a considerable sedative effect.Trial registrationThe clinical trial was registered in “Chinese Clinical Trial Registry” (http://www.chictr.org.cn/index.aspx) and the registered number was “ChiCTR-IPR-16007742”, on 12th January 2016.
Identification of prognostic genes from the breast cancer microenvironment
Authors: Zhang Xiao-lu , Wang Jia , Liu Cun , Gao Chun-di , Zhuang Jing , Liu Li-juan , Ma Xiao-ran , Wu Ji-biao , Sun Peng , sun Changgang
Published: May 2020

Background Prognostic evaluation of breast cancer is crucial in deciding the course of clinical treatment. The levels of immune cells and stromal cells in tumor microenvironment provide a new approach to evaluate the prognosis of breast cancer.Method: We obtained mRNA gene expression profiles of breast cancer patients from The Cancer Genome Atlas (TCGA), evaluated immune and stromal scores in tumor microenvironment (TME) using the ESTIMATE algorithm. We also constructed a protein-protein interaction (PPI) network, and performed function enrichment analysis and prognostic analysis.Results A total of 898 samples were divided into two groups corresponding to high and low score for both stromal as well as immune scores. 247 differentially expressed genes were identified, most of which were associated with T cell activation, lymphocyte differentiation, and cytokine receptor activity. We finally found 10 hub genes. Among them, we were able to confirm the following genes significantly association with prognosis: CCR5, CD2, CD3E, and CD5. Two important modules were isolated from the PPI network and for further analysis.Conclusion This study identified a group of genes significantly associated with the prognosis of breast cancer, and their efficacy still requires further clinical data validation.
Construct ion of co - expression modules related to survival by WGCNA and identif ication of potential prognostic biomarkers in glioblastoma
Authors: Zhou Jing , Guo Hao , Liu Likun , Hao Shulan , Guo Zhi , Zhang Fupeng , Wang Zhi , Zhang Weiwei
Published: May 2020

Background: Glioblastoma (GBM) is a malignant brain tumor with poor prognosis. However, the potential pathogenesis and therapeutic target s still needs to be explored.Methods: Herein, The Cancer Genome Atlas (TCGA) expression profile data and clinical information were downloaded, and the Weighted Gene Co-expression Network Analysis (WGCNA) was conducted. Subsequently, hub genes which closely related to the poor prognosis of GBM were obtained. Further, the relationship between the genes of interest and prognosis of GBM patients, and immune microenvironment were analysed. Patients from TCGA were divided into high- and low-risk groups.Results: Top 10 hub genes (CDC20, NCAPH, CDCA5, BUB1, CDCA8, PBK, KIF2C, TPX2, TTK and TOP2A) were obtained. Then, we performed single-gene analysis on CDCA5 and CDCA8 as genes of interest. We found that their expression levels were closely related to overall survival (OS). They had good correlations with the genes that regulate cell cycle in p53 signaling pathway. Moreover, it revealed that high amplication of CDCA5 was correlated with CD8 + T cells while CDCA8 with CD4 + T cells, and the expression of these two genes showed a significant difference in OS.Conclusions: These results might provide new molecular targets and intervention strategy for GBM.
The incidence rate, species distribution and dynamic trends of bloodstream infection in China, 2010-2019
Authors: Cui Jiewei , Li Meng , Wang Juan , Zhu Qiang , Qiang Xiaofei , Liang Zhixin
Published: May 2020

Background

Recent epidemiological studies on bloodstream infections (BSIs) that include the incidence rate, species distribution and dynamic changes are scarce in China. This study was performed to understand these epidemiological data of BSIs over the past 10 years in China.

Method

Using real-time nosocomial infection surveillance system, this study was retrospectively performed on BSIs in one of the largest hospitals in China, from January 2010 to December 2019.

Results

From 2010 to 2019, there were totally 9381 episodes of BSIs out of 1,437,927 adult hospitalized patients in the hospital, the total incidence rate of BSIs was 6.50‰ (6.50 episodes per 1000 adult-hospitalized patients per year) and the incidence rates had significantly decreased (8.24‰ to 6.00‰, time trend P <0.05). Among the 9381 episodes of BSIs, 93.1% were bacteremia and others (6.9%) were fungemia. As the most common species, the composition ratios of coagulase-negative staphylococcus (25.6% to 32.5%), Escherichia coli (9.8% to 13.6%) and Klebsiella pneumonia (5.3% to 10.4%) had been dynamic increased (time trends P <0.05) and the proportion of Pseudomonas aeruginosa had dynamic decreased (4.0% to 2.4%, time trend P =0.007). However, Staphylococcus aureus (3.3% to 3.1%) and Acinetobacter baumannii (4.4% to 4.2%) had not changed significantly (time trend P >0.05). These common species were consistent with China Antimicrobial Surveillance Network reported in 2018 (2018 CHINET report), but their composition ratios were different. Additionally, among bacteremia, the proportion of the multidrug-resistant bacteria gradually increased from 52.9% to 68.4% (time trend P <0.001).

Conclusion

The incidence rate and the species distribution had been dynamic changing and this study could be supplements to the 2018 CHINET report.
Preoperative prediction of complicated appendicitis using machine learning method
Authors: Kang Chunbo , Li Xubin , Chi Xiaoqian , Yang Yabin , Shan Haifeng , Zhang Jie , Zhang Qijun
Published: May 2020

BACKGROUND Accurate preoperative prediction of complicated appendicitis (CA) could help selecting optimal treatment and reducing risks of postoperative complications. The study aimed to develop a machine learning model based on clinical symptoms and laboratory data for preoperatively predicting CA.METHODS 136 patients with clinicopathological diagnosis of acute appendicitis were retrospectively included in the study. The dataset was randomly divided (94: 42) into training and testing set. Predictive models using individual and combined selected clinical and laboratory data features were built separately. Three combined models were constructed using logistic regression (LR), support vector machine (SVM) and random forest (RF) algorithms. The CA prediction performance was evaluated with Receiver Operating Characteristic (ROC) analysis, using the area under the curve (AUC), sensitivity, specificity and accuracy factors.RESULTS The features of the abdominal pain time, nausea and vomiting, the highest temperature, high sensitivity-CRP (hs-CRP) and procalcitonin (PCT) had significant differences in the CA prediction (P<0.001). The ability to predict CA by individual feature was low (AUC<0.8). The prediction by combined features was significantly improved. The AUC of the three models (LR, SVM and RF) in the training set and the testing set were 0.805, 0.888, 0.908 and 0.794, 0.895, 0.761, respectively. The SVM-based model showed a better performance for CA prediction. RF had a higher AUC in the training set, but its poor efficiency in the testing set indicated a poor generalization ability.CONCLUSIONS The SVM machine learning model applying clinical and laboratory data can well predict CA preoperatively which could assist diagnosis in resource limited settings.
PBL facilitator training focusing on the skills of promoting student critical thinking
Authors: Asoom Lubna Ibrahim Al
Published: May 2020

Background Critical thinking is an essential skill for medical graduates. The aim of the following study is to train the facilitators to boost critical thinking during the PBL sessions. Method Forty PBL facilitators of the college of Medicine, the year 2019-2020, were invited to fill a questionnaire and participate in a workshop. The questionnaire measures the background knowledge of the facilitators about critical thinking. The workshop started with a presentation then followed by exercises to apply different techniques for critical thinking. Results Most of the facilitators (>80%) believe that PBL supports critical thinking. > 50% are using questioning technique. None were aware of any other technique. Following the workshop, > 50% were able to suggest other relevant techniques such as debate, hypothesis and role play. Most of the facilitators admired the activity and requested similar training sessions. Conclusion Facilitators training workshop needs to be tailored toward specific PBL outcomes. Critical thinking is one of the most important targets of PBL. However, facilitators of previous facilitation experience and exposure to general PBL workshops lack the skills to support critical thinking. The currently focused workshop yields promising reflection by the participants' feedback and performance.
Follow-up Chest CT findings from discharged patients with severe COVID-19: an 83-day observational study
Authors: Ye Tianhe , Fan Yanqing , Liu Jiacheng , Yang Chongtu , Huang Songjiang , Xiong Bin
Published: May 2020

Background: Chest computed tomography (CT) has been used to be a monitoring measure to assess the severity of lung abnormalities in corona virus disease 19 (COVID-19). Up to date, there has been no reports about follow-up chest CT findings from discharge patients with severe COVID-19. This study aims to describe the change pattern of radiological abnormalities from admission, to discharge, and to the last chest CT follow-up through an 83-day retrospective observation, and focuses on follow-up chest CT findings in discharged patients with severe COVID-19.Methods: Twenty-nine discharged patients (17 males, 12 females; median age, 56 years, IQR, 47-67) confirmed with severe COVID-19 from 13 January to 15 February were enrolled in this study. A total of 80 chest CT scans was performed from admission to the last follow-up. Images were mainly evaluated for ground-glass opacity, consolidation, parenchymal bands, and crazy-paving pattern. A semi-quantitative CT scoring system was used for estimating lung abnormalities of each lobe.Results: All patients received nasal cannula or/and high-flow mask oxygen therapy. Admission occurred 9 days (IQR, 5-13) after symptom onset. The median in-hospital period was 18 days (IQR, 11-26). The last follow-up chest CT was performed 66 days (IQR, 61-77) after symptom onset. Total CT scores in follow-up decreased significantly compared to that of performed in-hospital ([3, IQR, 0-5] to [13, IQR, 10-16], P < 0.001). Predominant patterns on follow-up chest CT performed 64 days after symptom onset were subpleural parenchymal bands (47%, 9/19) and complete radiological resolution (37%, 7/19). Consolidation absorbed earlier than ground-glass opacity did, and subpleural parenchymal bands were the longest-lasting feature during radiological resolution.Conclusions: Radiological abnormalities in patients of severe COVID-19 could be completely absorbed with no residual lung injury in more than two months’ follow-up. Serial chest CT scans could be used as a monitoring modality to help clinician better understand the disease course.
Integrated approaches for COVID-19 case finding and their impact on timeliness for disease containment in Changning District, Shanghai, China
Authors: Zheng Xubin , Wang Jie , Cai Enmao , Jiang Yu , Ma Xiaomei , Tang Hong , Xu Biao
Published: May 2020

The authors have removed this preprint from Research Square.
Psychosocial Distress and Exposure to Sexually Explicit Materials as Correlates of Sexual Intercourse among Adolescents in Dodoma–Tanzania
Authors: Hussein Abdalla , Ismail Abbas , Malero Augustine , Dadi Habibu , Charles James , Sando Mery , Fawzi Wafaei , Vuai Said
Published: May 2020

Background: Adolescents’ sexuality is topical in public health discussions owing to its ability to increase the risk of HIV infection and other sexually transmitted diseases. Research shows that adolescents’ sexual behavior, psychosocial distress, and exposure to sexually explicit material are interconnected in that they need collective health interventions for adolescents. However, although mental health factors, such as psychological distress, are common in developing and middle-income countries, including Tanzania, mental health factors are less considered in HIV research. Thus, there is a need to raise awareness on the role of mental health factors in HIV epidemic. This study is, therefore, a response to this requirement by examining the contribution of psychosocial distress and exposure to sexually explicit materials on sexual intercourse among adolescents in Dodoma Region using Dodoma Health and Demographic Surveillance System (HDSS) data.Methods: A cross-sectional survey was conducted in five villages of Chamwino District from April to June 2017 among 1,226 adolescents of 10-19 years age. The villages of Chamwino District were used as sampling strata while a stratified random sampling technique was used to select the respondents. A weighted logistic regression model was used to examine the independent contribution of psychosocial distress and exposure to sexually explicit materials on sexual intercourse while accounting for study design. Results: The overall lifetime prevalence of adolescent sexuality was 20.38%. The prevalence was observed to be higher among males (32.15%) as compared to females (10.92%). Adolescent sexuality was significantly associated with both psychosocial distress and exposure to sexually explicit materials. The odds ratios showed that adolescents reported psychosocially distressed (AOR=1.61, 95 %CI: 1.32- 1.96) and those exposed to sexually explicit materials (AOR=4.26, 95% CI: 3.65- 4.97) were at higher risk of having sexual intercourse. Other variables associated with sexual intercourse were age, sex, alcohol use, and current schooling status. Conclusion: The analysis made through this study came to the conclusion that as HIV risk continues to be a serious concern among adolescents, adolescent sexuality, psychosocial distress, and exposure to sexually explicit materials are interconnected. This calls for upfront interventions on school health education and services, particularly on the ventures to lower psychosocial distress and avert exposure on sexually explicit materials to prevent the spread of HIV and other sexually transmitted diseases.
Genome-Wide DNA Methylation Profile Reveals Potential Therapeutic Targets at the Late Stage of Knee Osteoarthritis
Authors: Shen Hongyan , Long Jie , Zhang Mingmei , Chen Xing , Wang Tao , Xie Qingyun , Wei Meng
Published: May 2020

Background: The aim of this study was to use the latest BeadChip technology to obtain a genome-wide DNA methylation profile for cartilage from patients with primary knee osteoarthritis (OA), providing the first comprehensive description of DNA methylation changes in advanced knee OA. Methods: Cartilage tissues were taken from patients after total knee arthroplasty and were divided into eroded group and intact group according to the cartilage status. The genome-wide DNA methylation profile was obtained using the Infinium MethylationEPIC BeadChip kit, which enables the analysis of >850,000 CpG sites. Comparisons of the two groups were performed to identify differentially methylated (DM) probes (DMPs). Gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analyses were applied to the functional annotation clustering of the DM genes. Results: There was significant differential methylation between the two groups, and a total of 16,776 DMPs covering approximately 6,700 genes were identified, 92% of which were hypomethylated. Functional enrichment results revealed that the DM genes were significantly enriched for the extracellular matrix (ECM) proteins, cell adhesion molecules (CAM) and proteins in some inflammatory response pathways, especially the PI3K/Akt signalling pathway. Six genes including RNF43, SEMA4D, F11R, PKN1, FLT-1 and PTPN11 may be the potential biomarkers for OA.Conclusion: Our data demonstrate the epigenetic dysregulation of many genes and pathways in the late stage of knee OA that appear to be involved in potential aetiological mechanisms of OA. DM genes closely associated with OA may become targets for treatment and may open new avenues for further research in the field.
Lamina Slope Angle Is A Risk Factor for Ligamentum Flavum Hypertrophy in Patients with Lumbar Degenerative Disease: A Retrospective Study.
Authors: Yu Xiaosheng , Zhao Junduo , Feng Fan , Han Yingchao , Zhong Guibin , Liu Zude , Chen Jianwei
Published: May 2020

Background.One previous work confirmed that laminar slope angle was associated with the ossification of thoracic ligamentum flavum. Several studies have investigated the relevance of disc degeneration grade, thickness of ligamentum flavum, along with cross section area of multifidus and its fatty infiltration. However, there has been no research between the angle and them. This retrospectivestudyof clinical materials from 122 patients was designed to investigate the influence of laminar slope angle on degeneration of lumbar when eliminating the interference of age.Methods.122 individuals were retrospected randomly on the basis of age difference from 687inpatients scheduled to undergo a lumbar operation between January and December 2017.We registered their age and sex, evaluated and measuredL4-L5 disc degeneration grade,correspondingcross section area of multifidus, muscle-fat index,thickness of ligamentum flavum and laminar slope angle from preoperative magnetic resonance imagingand three-dimensional computer tomography. Independent-sample T tests were used to assess the association between age and measurement indices. The Pearson correlation coefficient, and partial correlation excluding age, was also performed to analyze thecorrelation between clinical parameters.Results.Our results showed that age was positively connected withthe laminar slope angle(L4:r=0.298, p=＜0.01; L5:r=0.303, p=＜0.01). Excluding the interference of age, revealed a credibly negative relationship between the angle of L4 and the thickness of the ligamentum flavum(Left: r=-0.303, p=＜0.01;Right:r=-0.340, p=＜0.01). However, there was no correlationwithother parameters(disc: r=-0.141, p＞0.05; left multifidus: r=0.248, p＞0.05; right multifidus: r=0.225, p＞0.05; left muscle-fat index: r=0.033, p＞0.05; right muscle-fat index: r=0.016, p＞0.05).Conclusion.Excluding the interference of age, Inclination of small laminar slope angle leads to hypertrophy of lumbar ligamentum flavum.LEVEL OF EVIDENCE:Level 4.
Neuroinflammation and Disrupted Synaptic Plasticity, the Main Pathological Processes in Multiple Sclerosis and Obsessive-Compulsive Disorder: An Enrichment Analysis
Authors: Sepehrinezhad Ali , Bozorgmehr Ali , Negah Sajad Sahab , Karimi Minoo , Shahbazi Ali
Published: May 2020

Background: Multiple sclerosis (MS) is an autoimmune, inflammatory demyelinating, and disabling disorder of the central nervous system (CNS) with various clinical symptoms. Approximately 30% of the patients experience a variety of psychiatric problems during their disease course. Obsessive-compulsive disorder (OCD) is correlated with MS, but little is known about common molecular mechanisms of two diseases. Methods: In this study, after a comprehensive review of the existing literature, we collected almost all the genes involved in MS and OCD, and then analyzed the common genes between MS and OCD. Next, the connections and functional interactions between these three gene sets were investigated in the STRING database and analyzed in 3 separate networks by Cytoscape software. Eventually, after a multi-part enrichment analysis, we found the main molecular and cellular pathways, biological processes, brain areas, and, more importantly, cells/tissue related to the shared genes between MS and OCD. Results: Three genes of brain-derived neurotrophic factor (BDNF), tumor necrosis factor-alpha (TNFα), and neurexin-1 (NRXN1) are the major genes that were common between MS and OCD. Also, the deficit in synaptogenesis and neurotransmitter release in the nervous system are the most common complications of MS and OCD. Signaling receptor activity and estrogen receptor activity are the most important signaling pathways that are disturbed. Moreover, the presynaptic membrane, membrane raft, and growth cone are the main microenvironments that are affected in MS and OCD.Conclusions: In addition to an enrichment analysis that showed physical and functional interactions of genes related to MS and OCD, we demonstrated and predicted some new genes and microRNAs that can be promising biomarkers/targets for future experimental studies. Also, our finding indicated that neuroinflammation and synaptic plasticity are two significant pathological processes that are affected in MS and OCD.
Assessing Mental Health and Physical Fitness in Young Chinese Doctors Using the Short-Form 36 Health Survey (SF-36)
Authors: Wang Tianqi , Li Cen , Liu Ye , Yang Yuanyuan , Wang Yaozhou , Zhang Qian , Huang Dong , Cui Yuxia , Zhou Hao
Published: May 2020

Background Psychological and physical problems regarding the quality of life (QOL) of doctors have attracted increasing attention in recent years, especially in China. The objective of this study was to measure the mental health and physical fitness of young clinical doctors with the SF-36 and to evaluate related psychometric properties and factors.Subjects and methods Young doctors from Guizhou Provincial People’s Hospital completed the SF-36 between November 1, 2017, and February 28, 2018. The Physical Component Summary (PCS) and Mental Component Summary (MCS) were measured to represent physical and mental health conditions.Results A total of 444 doctors aged 20–40 years, with 138 (31.08%) surgeons, 110 (24.77%) physicians, 26 (5.86%) pediatricians, 28 (6.31%) obstetricians/gynecologists and 142 (31.98%) doctors from other departments were enrolled in this study, and their data were analyzed. The mean PCS scores (71.30 ± 16.54 vs. 77.54 ± 15.96, p < 0.0001) and MCS scores (63.72 ± 18.91 vs. 71.29 ± 17.86, p < 0.0001) were significantly lower than the normative values of Chinese respondents. Pediatricians and obstetricians/gynecologists reported the lowest PCS and MCS scores. Young doctors with master’s degrees and above (OR = 1.68, 95%CI: 1.03–2.75, p < 0.05), those who were unmarried (OR = 2.40, 95%CI: 1.40–4.08, p < 0.01), and those who had low family incomes (OR = 2.45, 95%CI: 1.00-6.01, p < 0.05) had increased odds of poor MCS scores.Conclusions Poor mental and physical health were common in young doctors in China. Pediatricians and obstetricians/gynecologists had the poorest physical and mental health status. Having a high education level, being unmarried and having a low family income were negatively associated with mental health.
Midwives’ Knowledge of Non-Pneumatic Anti-Shock Garment and Associated Factors among Midwives Working in Public Hospitals of Jimma Zone, South-West Ethiopia.
Authors: Terefe Gemechu Sori , Bekele Gadisa Bedada
Published: May 2020

Background: The non-pneumatic anti-shock garment is a unique, simple, life-saving first-aid device made of neoprene and velcro. Neoprene is a stretchy material, and Velcro is a “hook and loop” material that closes things tightly . I n 2017 e very day, approximately 810 women died from preventable causes related to pregnancy and childbirth . From this death about 94% of all maternal deaths occur in low and lower middle-income countries.Objective: The objective of this study was designed to assess Midwives knowledge of non-pneumatic anti-shock garment and associated factors among Midwives. Methods: Facility based a quantitative cross-sectional studies design method was employed among 150 Midwives. Data was collected by pretested semi-structured self-administered questionnaire . The collected data were checked, coded and entered into Epi-data version 3.1 by double data enter and exported to SPSS version 23 for analysis. Bivariable and multivariable logistic regression were done to identify factors associated with Midwives’ Knowledge of non-pneumatic anti-shock garment. Results: Eighty one (54%) of Midwives have good knowledge of non-pneumatic anti-shock garment. Having positive attitude [ (AOR= 4.9 , 95% CI :( 2.06, 11.65 )], attending training [AOR= 3.91 , 95% CI :( 1.48, 10.32 ], presence guideline of non-pneumatic anti-shock garment at their hospitals [AOR= 2.57 , 95% CI :( 1.13, 5.82 )] were significantly associated with Midwives’ knowledge of non-pneumatic anti-shock garment. Conclusion and Recommendation: The knowledge Midwives’ on non-pneumatic anti-shock garment was low. The identified factors that significantly associated with Midwives’ knowledge of non-pneumatic anti-shock garment were positive attitude; attend training and presence of guideline of non-pneumatic anti-shock garments. The Midwives that involved in the maternity service should be improving their knowledge on non-pneumatic anti-shock garment.
Cellular Mechanisms Involved in the Pathogenesis of Airway Remodeling in Chronic Lung Disease
Authors: Arellano-Orden Elena , Calero-Acuña Carmen , Sánchez-López Verónica , López-Ramírez Cecilia , Otero-Candelera Remedios , Marín-Hinojosa Carmen , López-Campos José Luis
Published: May 2020

Background/Aims: Epithelial cells and lung fibroblasts play an important role in the development of chronic lung disease but the exact mechanisms responsible for this role have not been fully clarified. Our objective was to investigate the involvement of these cells in the inflammatory response associated to chronic lung disease.Methods Human lung fibroblasts (MRC-5) and bronchial epithelial cells (NuLi-1) were challenged with pro-inflammatory (interleukin (IL)-1β, and hypoxia), and inhibitory (simvastatin) stimuli. Expression of markers of local inflammation (IL-8, monocyte chemoattractant protein-1, nuclear factor-κB), systemic inflammation (C-reactive protein, serum amyloid A) and proteases (matrix metalloproteinase’s 9 and 12) were assessed by polymerase chain reaction and ELISA. Apoptosis/necrosis was also analyzed by flow cytometry.Results Although both cell types upregulated their expression of local and systemic inflammation and protease activity markers when they were treated with IL-1β, MRC-5 showed a higher gene and protein expression compared to NuLi-1 and a different expression in MMP at 48 hours. Under hypoxic conditions, we observed a decrease in serum amyloid gene expression in MRC-5, which was further attenuated by simvastatin. Apoptosis was not altered by any stimulus.Conclusions The inflammatory responses occurring in airway cells differ from one another. Fibroblasts seem to be the main cells involved in the inflammatory response associated with chronic lung disease, with a role roughly equivalent to that of protein imbalance. Apoptosis is not a predominant mechanism in these cells.