bluuebunny/crossref_metadata_2025 huggingface dataset:
Chronic Heart Failure in Patients with Arterial Hypertension Associated with Obstructive Sleep Apnea Syndrome: Possible Options to Pathogenetic Therapy
Authors: Yakovlev A. V. , Shilov S. N. , Berezikova E. N. , Yakovleva N. F. , Teplyakov A. T. , Grakova E. V. , Kopeva K. V. , Efremov I. A.
Published: July 2021

Aim. To study approaches to the treatment of chronic heart failure (CHF) with reduced and mid-range left ventricular ejection fraction (LVEF) in patients with arterial hypertension (AH) against the background of obstructive sleep apnea (OSA).

Material and methods. The study included 136 patients with CHF and AH. Inclusion criteria for the study: 1) moderate and severe OSA (with an apnea/hypopnea index of more than 15 per hour); 2) II-IV functional class of CHF according to NYHA; 3) the level of brain natriuretic peptide precursor (NT-proBNP) ≥125 pg/ml; 3) LVEF <50%; 4) the duration of hypertension is at least 2 years. Patients received drug therapy, including beta-blockers, mineralocorticoid receptor antagonists, diuretics, ACE inhibitors or angiotensin receptor inhibitors or valsartan/sacubitrile. After 12 months of followup, the patients were divided into 2 groups depending on the medication being administered. Group 1 included patients (n = 50) receiving therapy with valsartan/sacubitril, group 2 included patients (n = 86) receiving therapy without this drug. Effective CPAP-therapy also was registered in each group.

Results. In patients with CHF who received valsartan/sacubitril, disease progression was recorded in 28% of cases, while in patients who did not receive therapy with this drug, an unfavorable course of CHF was recorded in 42.8% (p = 0.001). In group 1, the NT-proBNP level significantly (p = 0.034) decreased by 34%, while in group 2, a significant (p = 0.002) increase in biomarker levels was revealed by 35.5%. In the group of patients receiving therapy with valsartan/sacubitril an increase in LVEF (p = 0.007) was revealed by 12.5%. In group 1, an increase in exercise tolerance was achieved in the form of a significant (p = 0.012) increase in the distance of the six-minute walk test by 18.2%, while in group 2, the six-minute walk distance decreased by 19.2% (p = 0.034). In the subgroup of patients receiving CPAP therapy in combination with valsartan/sacubitril therapy (n=8), LVEF increased by 11.6% (p = 0.043), the six-minute walk test distance increased by 29.7% (p = 0.046), and NT-proBNP decreased by 22.5% (p = 0.039), while in the group of patients who received only CPAP therapy (n=19).

Conclusion. The most significant slowdown in the rate of progression of CHF in patients with AH associated with OSA, an increase in exercise tolerance, as well as the most pronounced tendency to the reverse development of pathological echocardiographic changes in the myocardium when using valsartan/sacubitrile in drug therapy in combination with effective hardware CPAP therapy.
Thrombolytic Therapy in Treatment in Patients with Pulmonary Embolism not High-risk: SIRENA Registry Data
Authors: Cherepanova N. A. , Mullova I. S. , Pavlova T. V. , Erlikh A. D. , Barbarash O. L. , Berns S. A. , Schmidt E. A. , Duplyakov D. V.
Published: July 2021

Aim. To study the features of the use of thrombolytic therapy (TLT) in normotensive patients with pulmonary embolism (PE) in real clinical practice in Russian hospitals.

Material and Methods. From 04/1 5/2018 to 04/15/2019 patients hospitalized with a diagnosis of PE consistently were included in the Russian multicenter observational prospective register "SIRENA” (RusSIan REgistry of pulmoNAry embolism).

Results. For 12 months in the registry was included 609 patients with a lifetime confirmed diagnosis of PE. TLT was performed in 152 patients with PE (25.0%), of which only 51 (33.8%) were indicated as "high risk" (shock or hypotension). In 101 not high risk patients, the indications for TLT were: severe shortness of breath/respiratory failure - 19 (18.8%), massive venous thrombosis - 7 (6.9%), signs of massive/submassive PE - 10 (9.9%), intermediate-high risk - 14 (13.9%), suspicion of acute coronary syndrome with ST segment elevation - 3 (2.9%), high pulmonary hypertension -2 (2.0%). The other 46 (45.5%) non-high-risk patients had no clear indication of the reasons for TLT in their medical history. To study the features of management of patients with not high-risk PE who received TLT (group 1), a selection of pairs of patients from the "SIRENA” registry, comparable in gender and age, in a ratio of 1:1 of patients with not high-risk PE who did not perform TLT (group 2). Hospital mortality was 4 (4%) patients in the TLT group and 6 (5.9%) patients in group 2 (р=0,748). Logistic regression analysis showed that floating blood clot in the veins of the lower extremities, syncopes in the debut of PE, respiratory rate over 22 per minute were independent clinical factors that significantly influence the doctor's decision to perform thrombolysis, and probability of completion TLT decreased in the presence of a history of bleeding, chronic kidney disease, surgery in the previous 12 months, increase in the size of the right atrium on EchoCG (statistical significance of the model x2=51.574; p<0.001). The development of bleeding during hospitalization was recorded only in 10 (9.9%) patients of group 1, including severe (3 stage on the BARC scale) in 2 patients. Patients without TLT more often developed an acute heart failure (25.9% vs. 8.5%, p=0.043).

Conclusion. In real clinical practice, there is a high frequency of TLT in patients with not high-risk PE. Floating blood clot in the veins of the lower extremities, syncope in the debut of PE, respiratory rate over 22 per minute were independent clinical factors that significantly influence the doctor's decision to perform thrombolysis.
The “Inverse” Seasonal Blood Pressure Variability Phenotype
Authors: Gorbunov V. M. , Smirnova M. I. , Koshelyaevskaya Y. N. , Panueva N. N. , Furman N. V. , Dolotovskaya P. V.
Published: July 2021

The seasonal blood pressure variability (BPV) is known to demonstrate a typical winter peak. Recently, more attention is paid to the opposite situation: the summer BP levels being higher than those in winter. This phenomenon is called inverse BPV. The present article summarizes recent data on this topic. The data of the HOMED-BP project, as well as the results of the original prospective study in 770 hypertensive patients from two Russian Federation regions (mean follow-up duration 6.4 years), were used. According to the preliminary knowledge, the prevalence of inverse BPV in hypertensive patients is relatively high (15-25%). This phenomenon is more typical for treated patients, particularly for those on combination therapy, and is associated with beta-blocker intake. Higher duration of hypertension and higher levels of some risk factors (smoking) characterize the patients with inverse BPV. According to the HOMED-BP data, patients with inverse BPV had the highest overall cardiovascular risk (hazard ratio in comparison with the reference group of “minimal” “normal” BPV was 3.07; p=0.004). In summary, inverse BPV is a potentially unfavorable BP phenotype. However, its reproducibility and prospective value deserve further investigation. The absolute magnitude of seasonal BPV in these patients, calculated using different BP measurement methods, warrants special attention.
Comparative Characteristics of Beta-Blockers in Patients with Congenital Long QT Syndrome
Authors: Proshlyakov A. Yu. , Chomakhidze P. Sh. , Novikova N. A.
Published: July 2021

Congenital long QT syndrome is a pathology that requires special attention and knowledge about the safety and effectiveness of various medications. Prolongation of the QT interval due to congenital or acquired causes is an important factor in the development of an unfavorable life forecast with the formation of an elongated QT syndrome. With an unfavorable course, patients suffer from loss of consciousness, episodes of tachycardia. Often, stable polymorphic ventricular tachycardia develops. The risk of sudden cardiac death in this pathology can vary from 0.33% to 5%. In people who have suffered an episode of cardiac arrest, and do not have a permanent prescribed antiarrhythmic therapy, the mortality rate reaches 50% within 15 years. Preventive administration of antiarrhythmic drugs is not always effective. A positive result of treatment depends on the severity of long QT syndrome and its genotype. Beta-blockers are often prescribed to patients of different ages with various cardiac pathologies, including for the prevention of arrhythmia in long QT syndrome. Beta-blockers differ in various pharmacokinetic and pharmacodynamic parameters (lipophilicity/hydrophilicity, selectivity, presence/absence of internal sympathomimetic activity), which, along with the variant of the disease genotype, can affect their effectiveness and safety in the considered pathology. This review article presents the results of major studies on the safety and effectiveness of different groups of beta blockers in various variants of long QT syndrome. The preferred beta-blockers for various genotypes of the syndrome were determined, and a comparative characteristic of beta-blockers for their safety and preventive effectiveness was given.
Avulsion Injuries and Ruptures of the Proximal Rectus Femoris in Skeletally Mature, High-Level Athletes
Authors: Knapik Derrick M. , Trasolini Nicholas A. , Diaz Connor C. , Chahla Jorge , Forsythe Brian
Published: July 2021

» Injuries to the proximal rectus femoris remain rare, occurring primarily in soccer and American football athletes during kicking and sprinting because of its unique biarthrodial nature.

» The appropriate diagnosis is dependent on careful physical examination and imaging interpretation.

» While no universal treatment algorithm has been adopted for high-level athletes, recent investigations support operative repair using suture anchors to restore strength and function in order to allow an effective return to competition while minimizing the risk of injury recurrence.

» Complications following surgical management include injury to the lateral femoral cutaneous nerve and hematoma formation, and there are reports of residual pain and weakness with chronic injuries that fail the initial nonoperative treatment.

» Current investigations examining outcomes following treatment remain limited, warranting additional studies that examine patient-reported results, return-to-play rates, and the role of orthobiologics and accelerated rehabilitation protocols following injury to further improve athlete health and safety.
Fixation of Displaced Medial Epicondylar Fractures in Adolescents
Authors: Zlotolow Dan A. , Tueting Jonathan L. , Kozin Scott H.
Published: July 2021

Background:

Fractures of the medial epicondyle are often a marker of injury of the medial collateral ligament complex of the elbow, regardless of displacement. The medial epicondyle serves as the origin for the flexor/pronator mass superficially and the medial collateral ligament near the base. These fractures occur most commonly through the apophysis at the base of the epicondyle, making differentiation of muscular versus ligamentous avulsion difficult. Fractures associated with elbow dislocation and fractures with an intra-articular incarcerated medial epicondyle are ligamentous injuries, requiring at least intraoperative examination and most likely fixation of the fracture. Degree of displacement has traditionally been considered the deciding factor for fracture fixation, but this concept has been proven unreliable both in the literature and in our experience. Regardless of the degree of displacement, we recommend examination under anesthesia for all displaced fractures, with fixation of any fractures that render the elbow unstable to valgus stress.

Description:

The patient is placed in the supine position, and an examination under anesthesia is performed. If the elbow is stable to valgus load, the patient is placed into a long arm cast and awakened from anesthesia. If the elbow is unstable, the patient is placed in the lateral decubitus position, and the arm is prepared and draped. The fingers and wrist are wrapped with a self-adhesive bandage in flexion to relax the flexor/pronator mass. Under tourniquet control, a curvilinear medial incision is made just dorsal to the medial epicondyle. The ulnar nerve is identified and transposed if necessary. A guidewire is placed through the fracture fragment and used as a joystick. The hand is then positioned on the posterior aspect of the hip to provide varus load to the elbow and assist with reduction. The medial epicondyle is reduced, and the guidewire is advanced unicortically. A 3.0-mm, partially threaded cannulated screw is then advanced over the guidewire. A long arm cast is applied after closure of the wound with buried absorbable sutures.

Alternatives:

Nonoperative treatment in a cast has been suggested. Surgical variations include supine positioning, bicortical screws, and use of washers.

Rationale:

Lateral decubitus positioning and wrapping of the hand and wrist in flexion facilitate reduction by both applying a varus load and relaxing the flexor/pronator mass. Unicortical fixation is sufficient and does not risk injury to anterolateral structures. Washers have a higher complication rate than screws alone and may not be necessary in most cases
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Present tendencies in landscape planning and recognition of the opinion of local citizens on the example of the Tiszazug
Authors: Csorba Péter
Published: July 2021

A survey based on online and face-to face interviews with 104 persons who live in the Tiszazug in the central part of the Great Hungarian Plain. According to the answers the character of the landscape here would change dramatically by disappearance of oxbow lakes, floodplain forests and vineries. The decreasing population and aging of the citizens result in decreasing intensity of landuse, increasing number of abandoned buildings and the attractiveness of the landscape is spoiled by illegal waste disposals and weedy water banks.
Rezső Milleker and political geography
Authors: Dövényi Zoltán , Perényi Bálint
Published: July 2021

This paper aims to examinate and to present the political geographical work of Rezső Milleker. Although political geography was not his main specialty, time to time he tried to create something of scientifical value in this field of science, but the attention of professional circles and the success avoided him. By evaluating these works we try to answer the question, where his place was in Hungarian political geography between the two world wars.

Keywords: Milleker, political geography, Zeitschrift für Geopolitik, ethnic maps
The appearance of renewable energy sources in the settlement development documents of local authorities in Jász-Nagykun-Szolnok County
Authors: Kozma Gábor , Monyók Bence
Published: July 2021

In recent decades, several new trends can be observed in the field of energy management, one of which is the increase of the role of renewable energy sources. As a result of this fact, local authorities in Hungary have also devoted increasing attention to this question in recent years. The first step of their interventions is the drawing up of the appropriate development documents, relying on which specific steps/investments can also take place later. In the spirit of the above, the objective of the present paper is to analyse the development documents of local authorities in Jász-Nagykun-Szolnok County. The most important findings of the study could be summarised as follows. Firstly the Integrated Settlement Development Strategies prepared for the period 2014 to 2020 dealt with the topic of renewable energy sources in much more detail than earlier documents. Secondly from the various renewable energy sources, the development document devoted most attention to solar and geothermal energy and thirdly the appearance of renewable energy sources in the development documents shows a close link with the size of the settlements.
Urban vegetation classification with high-resolution PlanetScope and SkySat multispectral imagery
Authors: Szabó Loránd , Abriha Dávid , Phinzi Kwanele , Szabó Szilárd
Published: July 2021

In this study two high-resolution satellite imagery, the PlanetScope, and SkySat were compared based on their classification capabilities of urban vegetation. During the research, we applied Random Forest and Support Vector Machine classification methods at a study area, center of Rome, Italy. We performed the classifications based on the spectral bands, then we involved the NDVI index, too. We evaluated the classification performance of the classifiers using different sets of input data with ROC curves and AUC values. Additional statistical analyses were applied to reveal the correlation structure of the satellite bands and the NDVI and General Linear Modeling to evaluate the AUC of different models. Although different classification methods did not result in significantly differing outcomes (AUC values between 0.96 and 0.99), SVM’s performance was better. The contribution of NDVI resulted in significantly higher AUC values. SkySat’s bands provided slightly better input data related to PlanetScope but the difference was minimal (~3%); accordingly, both satellites ensured excellent classification results.
ТЕОРЕТИЧЕСКИЕ ВОПРОСЫ ВИДОВ ГРАЖДАНСКОГО СУДОПРОИЗВОДСТВА
Authors: ТАРАНОВА Т.
Published: July 2021

Проблеме видов производства в юридической литературе в последнее время стало уделяться много внимания, но многие вопросы остаются дискуссионными и нераскрытым в силу их многоаспектности и сложности. На основе анализа существующих в науке точек зрения и законодательства, автор делает собственные выводы по рассматриваемой проблематике.
ДОСТУПНОСТЬ ОБРАЗОВАНИЯ ДЛЯ ЛИЦ С ОГРАНИЧЕННЫМИ ВОЗМОЖНОСТЯМИ
Authors: ЦЕЛИКИН А.
Published: July 2021

Статья посвящена рассмотрению аспектов развития образования доступного для лиц с ограниченными возможностями. В ней рассмотрен организационный механизм формирования социальной среды образования
ПРОБЛЕМЫ ПРЕДУПРЕЖДЕНИЯ И ПРОФИЛАКТИКИ В СФЕРЕ ПРОТИВОДЕЙСТВИЯ ПРЕСТУПНОСТИ: ТЕОРЕТИКО-ПРАВОВЫЕ АСПЕКТЫ
Authors: ШАБАНОВ В. , КРАСИКОВ В.
Published: July 2021

Противодействие преступности относится к числу приоритетных задач, как правоохранительных органов, так и государства в целом, неотъемлемой составляющей деятельности по обеспечению внутренней стабильности и правопорядка. В специальной, научной и учебной литературе можно встретить достаточно большое число терминов, обозначающих направления деятельности государства и общества по воздействию на преступность. Ряд авторов не разделяют понятия «профилактика преступности» и «предупреждение преступлений» и рассматривают их как синонимы, однако определённые семантические отличия между ними имеются.
МЕТОДИКА АНАЛИЗА ЭФФЕКТИВНОСТИ ЗАТРАТ НА РАЗВИТИЕ ВЫСОКОТЕХНОЛОГИЧНОЙ МЕДИЦИНСКОЙ ПОМОЩИ
Authors: УГОЛЬНИКОВ В.
Published: July 2021

Автор представил методический подход к оценке экономической эффективности услуг здравоохранения по направлению высокотехнологичной медицинской помощи (ВТМП) и построил математическую модель эффективности затрат ВТМП.
САМОРЕГУЛИРОВАНИЕ В ЖКХ МЕГАПОЛИСА
Authors: ДРОЗДОВА И. , ЧУРИЛИН А.
Published: July 2021

Статья посвящена рассмотрению управленческих аспектов развития системы саморегулирования в ЖКХ мегаполиса и снижения рисков управления ЖКХ. В ней рассмотрен организационный механизм управления системой ХКХ и управления рисками в сфере ЖКХ.
Characterization of Sand Production for Clayey-Silt Sediments Conditioned to Openhole Gravel-Packing: Experimental Observations
Authors: Jin Yurong , Li Yanlong , Wu Nengyou , Yang Daoyong
Published: July 2021

As one of the geotechnical risks, sanding has been one of the main constraints for safely and sustainably developing marine natural gas hydrate. In this study, a cylindrical vessel that is packed with the clayey-silt sediment collected from the Shenhu area of the northern South China Sea is used to microscopically observe sand detachment, migration within matrix, invasion to gravel packing, and production for openhole gravel packing. More specifically, by injecting water from the vessel boundary, the seepage and stress-strain field for sediment near the wellbore after hydrate dissociation is simulated, and the sand failure characteristics [i.e., the produced sand volume and particle size distributions (PSDs)] are quantified. The sand failure pattern is found to largely differ from that of a sandstone reservoir, whereas fractures, wormholes, and fluidized channels are successively developed along with a large scale of sand production and inlet pressure variation. Followed is a steady flow state with a stable inlet pressure without noticeable sand failure. Correspondingly, the fracture is induced and propagated by the combinational effort of shear and tensile failure, whereas wormholes and fluidized channels are associated with the liquid dragging force. At the end of each test, foraminifera are found to accumulate near the external side of the gravel-packing region, which is beneficial to sand control. In the meantime, a compact mudcake, as an infiltration medium, is observed outside the gravel-packing layer. The 30/50 mesh gravel packing is able to control grain size up to 30.0 µm in diameter with a median of 5.0 µm, whereas the produced grains account for less than 1.0 vol% of the total sediment. By performing sensitivity analysis on sand production, depressurization shall be conducted at a small rate to not only control sand production, but also to induce flow paths at the early stage. Moreover, the sand production rate associated with fracture development is larger than those of wormholes and fluidized channels. This study focuses on the experimental observations on sand failure patterns, and the theoretical formulations and modeling will be presented and explained in a future work.3
A Crisis With No End in Sight: How the ongoing crisis in Taiz Governorate continues to put civilians at risk
Authors: Mohammed Abdulwasea
Published: July 2021

Despite a UN-brokered peace agreement in December 2018, the conflict in Yemen has run into its sixth year. In Taiz Governorate, civilians continue to bear the brunt of conflict. Every day, they face death or injury from indiscriminate attacks, gender-based violence in their homes and poor access to food, water and medical care. As people’s resources are further exhausted, their safety, security and well-being are only likely to worsen. The COVID-19 pandemic has added an additional layer to the ongoing crisis. The people of Taiz –and across Yemen as a whole – desperately need a lasting and inclusive peace process to end the world’s worst humanitarian crisis.
Early crack detection using modified spectral clustering method assisted with FE analysis for distress anticipation in cement-based composites
Authors: Vedrtnam Ajitanshu , Kumar Santosh , Barluenga Gonzalo , Chaturvedi Shashikant
Published: July 2021

The present work reports an efficient way of capturing real-time crack propagation in concrete structures. The modified spectral analysis based algorithm and finite element modeling (FEM) were utilised for crack detection and quantitative analysis of crack propagation. Crack propagation was captured in cement-based composite (CBC) containing saw dust and M20 grade concrete under compressive loading using a simple and inexpensive 8-megapixel mobile phone camera. The randomly selected images showing crack initiation and propagation in CBCs demonstrated the crack capturing capability of developed algorithm. A measure of oriented energy was provided at crack edges to develop a similarity spatial relationship among the pairwise pixels. FE modelling was used for distress anticipation, by analysing stresses during the compressive test in constituents of CBCs. FE modeling jointly with the developed algorithm, can provide real-time inputs from the crack-prone areas and useful in early crack detection of concrete structures for preventive support and management.
A Rare Pathogen Comamonas Testosteroni: A Case Report And Review of The Literature
Authors: Buyukberber S. Gayenur , Mumcuoglu Ipek , Ozbay B.Orkun , Aypak Adalet , Dinc Bedia
Published: July 2021

Comamonas testosteroni is a Gram- negative, aerobic, motile, non-spore-forming bacillus. It has not been recognized as a component of the endogenous human microflora. Due to its ability to survive in liquid environments, it can survive for a long time in a hospital environment and cause opportunistic infections. Although rare, C. testosteroni has been reported as a cause of cellulitis, peritonitis, endocarditis, meningitis, endophthalmitis, tenosynovitis, pneumonia and bacteremia. Here, we present a case of a 4-year-old girl who was operated on for persistent cloaca with C. testosteroni isolated in her urine culture. Identification studies were performed by MALDI-TOF MS (bioMerieux, France) mass spectrophotometer method. Antibiotic susceptibility tests were performed with the automatic device VITEK-2 Compact (bioMérieux, France). Microorganism was found susceptible to ceftazidime and ciprofloxacin; intermediate susceptible to meropenem and piperacillin / tazobactam and resistant to gentamicin, amikacin, imipenem and trimethoprim-sulfamethoxazole. With this case report, C. testosteroni was reported as the first cause of urinary tract infection in our country and the third in the world.
Intrapartum ultrasound use in clinical practice as a predictor of delivery mode during prolonged second stage of labor
Authors: katzir tamar , Brezinov Yoav , Kharish Ella , Hadad Shira , Vaisbuch Edi , Levy Roni
Published: July 2021

Purpose

To determine the validity of Intrapartum ultrasound (IPUS), and particularly the angle of progression (AOP), in predicting delivery mode when measured in real-life clinical practice among women with protracted second stages of labor.
Methods

Using electronic medical records, nulliparous women with a second stage of labor of ≥ 3hours ("prolonged") and a documented AOP measurement during the second stage were identified. The ability of a single AOP measurement in "prolonged" second stage to predict a vaginal delivery (VD) was assessed. Fetal head descend, measured by AOP change/hour (calculated from serial measurements) was compared between women who delivered vaginally and those who had a cesarean delivery (CD) for arrest of descent.
Results

Of the 191 women who met the inclusion criteria, 62 (32.5%) delivered spontaneously, 96 (50.2%) had a vacuum extraction (VE) and 33 (17.3%) had a CD. The mean AOP was wider among women who had VD (spontaneous or VE) compared to those who had CD (153º±19 vs. 133º±17, p < 0.001). Wider AOPs were associated with higher rates of VD and an AOP ≥ 127º was associated with a VD rate of 88.6% (148/167). Among the 87 women who had more than one AOP measurement, the mean AOP change per hour was higher in the VD group than in the CD group (15.1º±11.4º vs. 6.2º±6.3º, p < 0.001).
Conclusion

Ultrasound assessed fetal head station in nulliparous women with a protracted second stage of labor can be an accurate and objective additive tool in predicting mode and interval time to delivery in real-life clinical practice.
Study on the relationship between liver damage caused by anti-tuberculosis drug rifampicin and related metabolic enzyme gene polymorphisms
Authors: Su Qiang , Liu Qiao , Liu Juan , Fu Lingyun , Liu Tao , Liang Jing , Peng Hong , Pan Xue
Published: July 2021

Background

The occurrence of Anti-TB Drug-induced Liver Injury (ATLI) affects the progress of anti-tuberculosis treatment and the cure rate of tuberculosis. To understand the mechanism and risk factors of ATLI, it is helpful to reduce or avoid the occurrence of liver damage. It is of great significance for the smooth completion of anti-tuberculosis treatment.
Methods

In this study, 2255 pulmonary tuberculosis patients were included as the research object, and their medical records were reviewed, questionnaire surveys, liver function tests at the end of February (including patients with uncomfortable symptoms during the intensive treatment period) and blood samples were saved. Determine cases of liver damage based on the criteria for liver damage. The genotype was determined by the PCR-LDR method, and the single factor and unconditional Logistic regression methods were used to explore the relationship between genetic polymorphism and ATLI susceptibility.
Results

Through the screening of related factors affecting ATLI, this study found that ATLI may be related to gender, year and age is related to body weight; there is an association between the genetic polymorphism site CYP2C9 *2 and ATLI, and the best association model is a dominant inheritance model.
Conclusions

In-depth discussion of the genetic nature of ATLI is of great practical significance and practicality for preventing the occurrence of liver damage in patients with tuberculosis in our region, reducing the damage to the liver by anti-tuberculosis drugs, and formulating individualized chemotherapy regimens to avoid treatment failure due to liver damage.
Vitamin D Status And Parathyroid Hormone Levels In Girls With Central Precocious Puberty
Authors: Teodoro Durá-Travé , Fidel Gallinas-Victoriano , Lotfi Ahmed-Mohamed , Paula Moreno-González , María Urretavizcaya-Martinez , María Malumbres-Chacón
Published: July 2021

Background. The presence of vitamin D receptor in both the pituitary gland and female reproductive tissue suggests that vitamin D could be involved in female fertility mechanisms as well as in the activation of the hypothalamic-pituitary-gonadal axis. The objective of this study was to analyze the vitamin D status and PTH levels in 6- to 8-years-old girls with central precocious puberty. Methods. A cross-sectional clinical and blood testing (calcium, phosphorus, 25(OH)D and PTH) were carried out in 78 girls with central precocious puberty (CPP group), aged 6.1-7.9 years. A control group was recruited (157 prepubertal girls, aged 6.1-8.2 years). The criteria of the US Endocrine Society were used for the definition of hypovitaminosis D. Results. There were no significant differences in the vitamin D status between both groups. There were not significant differences in 25(OH)D levels between CPP (25.4±8.6 ng/mL) and control groups (28.2±7.4 ng/mL). In contrast, in CPP group PHT levels (44.8±16.3 pg/mL) were higher (p < 0.05) with respect to control group (31.0±11.9 ng/mL). In CPP group there was positive correlation (p < 0.05) between PTH levels and growth rate, bone age, basal estradiol, basal FSH, basal LH and LH peak. Conclusion: Vitamin D status in 6- to 8-years-old girls with CPP is similar to that in prepubertal girls. PTH levels were significantly higher in girls with CPP, and could be considered as a pubertal characteristic and, in this case, of pubertal precocity.
Estimated Impact of COVID-19 on Preventive Care Service Delivery: An Observational Cohort Study
Authors: Laing Scott , Johnston Sharon
Published: July 2021

Background: COVID-19 has caused significant healthcare service disruptions. Surgical procedure backlogs have been calculated but not those for other healthcare services. This study aims to estimate the backlog of key primary preventive care services caused by COVID-19. Methods: This observational study assessed preventive care screening rates at three primary care clinics in Ottawa, Ontario from March to November 2020 using data from 22,685 electronic medical records. The change in cervical cancer, colorectal cancer, and type 2 diabetes screening rates were extrapolated using 2016 census data, estimating the volume of key services delayed by COVID-19 across Ontario and Canada.Results: The mean percentage of patients appropriately screened for cervical cancer decreased by 7.5% (-0.3% to -14.7%; 95% CI), colorectal cancer decreased by 8.1% (-0.3% to -15.8%; 95% CI), and type 2 diabetes decreased by 4.5% (-0.2% to -8.7%; 95% CI). Extrapolation estimated that Ontarians delayed 288,000 cervical cancer (11,000 to 565,000; 95% CI), 326,000 colorectal cancer (13,000 to 638,000; 95% CI), and 274,000 type 2 diabetes screenings (13,000 to 535,000; 95% CI). Extrapolation to the Canadian population nearly triples these numbers. Re-opening measures have not reversed these trends.Interpretation: COVID-19 decreased the delivery of preventive care services, which may cause delayed diagnoses, increased mortality, and increased health care costs. Virtual care and reopening measures have not restored the provision of preventive care services. Electronic medical record data could be leveraged to improve screening via panel management. Additional, system-wide primary care and laboratory capacity will be needed to restore pre-COVID-19 screening rates.
Weaning From Noninvasive Ventilatory Support in Infants With Severe Bronchiolitis: An Observational Study
Authors: Cassibba Julie , Freycon Claire , Doutau Julia , Pin Isabelle , Bellier Alexandre , Fauroux Brigitte , Mortamet Guillaume
Published: July 2021

Background: The aim of the study was to analyze the weaning success, the type of weaning procedures, and weaning duration in consecutive infants hospitalized over a winter season in a Pediatric Intensive Care Unit.Methods: A retrospective observational study in a pediatric intensive care unit in a tertiary center. Infants hospitalized for a severe bronchiolitis were included and the weaning procedure from continuous positive airway pressure (CPAP), noninvasive ventilation (NIV) or high flow nasal cannula (HFNC) was analyzed.Results: Data from 95 infants (median age 47 days) were analyzed. On admission, 26 (27%), 46 (49%) and 23 (24%) infants were supported by CPAP, NIV and HFNC, respectively. One (4%), nine (20%) and one (4%) infants failed weaning while supported by CPAP, NIV or HFNC, respectively (p=0.1). In infants supported by CPAP, CPAP was stopped directly in 5 patients (19%) while HFNC was used as an intermediate ventilatory support in 21 (81%). The duration of weaning was shorter for HFNC (17 hours, [IQR 0-26]) than for CPAP (24 hours, [14-40]) and NIV (28 hours, [19-49]) (p<0.01).Conclusions: The weaning phase represent a large proportion of noninvasive ventilatory support duration in infants with bronchiolitis. The weaning procedure following a “step down” strategy may lead to an increase in duration of weaning.
Impact of the COVID-19 Pandemic on Career Intention Among Undergraduate Medical Students: A Single-center Cross-Sectional Study in Hubei Province
Authors: Wang Xue-lin , Liu Ming-xiu , Peng Shuai , Yang Lei , Lu Chen , Shou Shi-cong , Wang Jian-ru , Sun Jun-yi , Wang Jia-qi , Hu Yan , Zhao Jun , Duan Peng
Published: July 2021

Background：Undergraduate medical (UM) students faced the realities of the difficulties inherent in medical careers due to the coronavirus 2019 (COVID-19) outbreak. Thus imperative containment measures could affect UM students’ career intentions. There is limited information regarding the factors potentially associated with these students’ career change intentions.Methods：we conducted a cross-sectional survey to investigate the impact of the COVID-19 pandemic on career intention and the associated factors in UM students in August 2020. Univariate analyses and logistic regression analysis were used to identify the factors that contributed to any change of career intention.Results: A total of 2,040 medical students were contained from Hubei University of Medicine. The change of career intention was related to grade, attitude towards being a health worker and the impact of the COVID-19 pandemic.Conclusions: Changes in career intentions were particularly influenced by grade, attitude towards being a health worker, and the degree of COVID-19’s impact on the participants’ lives. Treating large-scale public health emergencies in rational way, setting up correct views of occupation choice and building reasonable career planning may reduce the loss of medical talents.
The Influence of Sex on Navigating Acute Coronary Syndrome: A Hospital-Based Cohort Study in South Asia
Authors: Ralapanawa Udaya , Karunathilake Parackrama , Bandara Charith , Kumarihamy Prabhashini , Gunaratne Sujeewa , Ranasinghe Dhammika , Jayasinghe Ruwanthi , Kularathna Vishvara
Published: July 2021

BackgroundThe cardiovascular risk profile and adverse events following acute coronary syndrome (ACS) differ between the Sex, indicating the importance of studying the sex differences in factors associated with ACS.MethodsA cross-sectional descriptive study was performed among ACS patients presented to Teaching Hospital Peradeniya. An interviewer-administered prevalidated questionnaire was used to collect data, and analysis was done. ResultsA total of 789 patients were included, consisting of 40.4% females. The mean age of females (62.17±11.06) was higher than males (59.80±11.24) (p=0.004), and in females, the mean age for unstable angina (60.5±10.5) was lower than NSTEMI (63.8±12.5) (p=0.022) and STEMI (64.0±9.2) (p=0.026). The male-female composition for unstable angina (46.3% vs 53.7%) and STEMI (75.8% vs 24.2%) showed varied proportions. The mean BMI (24.95±4.40 kg m-3 vs 23.77±3.88 kg m-3) (p=0.008) and obesity (21.6% vs 13.8%) (p=0.048) was higher in females. Overweight (9.4% vs 8.8%) (p=0.048) and the waist-hip ratio (0.98±0.07 vs 0.94±0.10) (p=0.006) was higher in males. Family history of hypertension was higher in females (24.1% vs 17.0%) (p=0.014). Most of the females were co-morbid with diabetes (37.9%) (p=0.008), hypertension (59.8%) (p<0.001) and dyslipidaemia (40.3%) (p<0.001) than males. The prevalence of smoking and alcohol intake was significantly higher in males (p<0.001). The predominant symptom was chest pain (93.4%), regardless of Sex. Right chest pain was primarily present in females (8.0% vs 3.6%) (p=048), and radiation of pain to the right arm mainly occurred in males (18.2% vs 7.5%) (p=0.007). Vomiting and dyspnoea was higher in females (47.7% vs 38.4%, p=0.049 and 53.1% vs 43.2%, p=0.039). The delay in presentation to the hospital was more in females (6:04±6:02) than males (3:55±4:22) with STEMI. The commonest reason for the delay was not suspecting an ACS, and a three-wheeler was the primary mode of transport in both sexes without any sex difference. Only 7.0% was delayed due to the unavailability of a transport facility.ConclusionFemale and male patients with ACS show differences in the age of onset, the spectrum of ACS, comorbidities, anthropometric measurements, risk factors like smoking and alcohol intake, clinical presentation aspects and delay in presentation to the hospital.
Effect of Mechanical Stress on Rheumatoid Arthritis of the Temporomandibular Joint: a Morphological and Histological Evaluation
Authors: Nagai Kohei , Ishii Takenobu , Nishii Yasushi
Published: July 2021

Background

Rheumatoid arthritis of the temporomandibular joint (TMJ-RA) has been reported to have a larger incidence range than systemic rheumatoid arthritis (RA). The presence or absence of mechanical stress (MS) is considered a factor in this. In this study, we hypothesized that TMJ-RA develops or worsens when excessive MS is applied to the temporomandibular joint of RA mouse models. We aimed to clarify the relationship between TMJ-RA and MS through morphological and histological evaluation.
Methods

Collagen antibody-induced arthritis (CAIA) was induced in male DBA/1JNCrlj 9–12 weeks old mice by administering Type II collagen antibody and lipopolysaccharide to produce RA model mice. MS was applied to the mandibular condyle. The group was separated into non-RA (control group (N = 5) and MS group (N = 5)), and RA group (CAIA group (N = 5)and CAIA MS group (N = 5)). To confirm the morphological changes in the mandibular condyle, micro-CT imaging was performed. Histological evaluation of the TMJ was performed by hematoxylin and eosin staining for condylar cartilage cell layer thickness, Safranin O staining for proteoglycans, and tartrate-resistant acidic phosphatase staining for osteoclast count. Immunohistochemical evaluation was performed to assess the localization of cartilage destruction enzymes using ADAMTS-5 (a disintegrin and metalloproteinase with thrombospondin motifs) antibody. Additionally, CD3 (cluster of differentiation), CD45, and γδ TCR (T cell receptor) antibodies were used to localize and identify the type of lymphocytes.
Results

In the CAIA MS model, a three-dimensional analysis of the temporomandibular joint by microcomputer tomography showed a crude change in the surface of the mandibular condyle. Histological examination revealed a decrease in the chondrocyte layer width and an increase in the number of osteoclasts in the mandibular condyle. T cell accumulation was observed, and γδ T cell involvement was confirmed.
Conclusions

In the CAIA model, the TMJ was less sensitive to the initiation of RA. However, the results suggested that it was exacerbated by MS, and that γδ T cells may be involved in TMJ-RA.
Gut Microbiome Influences The Neuroinflammatory Response To Traumatic Brain Injury
Authors: Kumar Akshita Jade , Bedi Supinder Singh , Toledano-Furman Naama , Carrillo Louis , Cardenas Fanni , Caplan Henry , Sequeira David , Speer Allison L , Olson Scott D , Wade Charles E. , Cox Charles S.
Published: July 2021

Background: Traumatic brain injury (TBI) is a systemic injury that disrupts a complex arrangement of interacting cells in the brain and in the gastrointestinal tract (GI). Disruption in the brain results in neuroinflammation, in which microglia are a central component along with cytokines and other soluble factors [pro and anti-inflammatory microglia (M1:M2)]. Disruption in the GI due to TBI results in a systemic inflammation which is dependent upon the gut microbiome (GM). Gut microbiome can influence microglia in the brain via the gut-brain axis. In order to determine if the microbiome-microglia connections via the gut-brain axis can be modulated, we used probiotics and antibiotics in a rodent TBI model to evaluate the microbiome-microglial connections in acute and chronic experiments.Methods: The temporal effects of treatment (probiotics or antibiotics) were used to evaluate the gut-associated lymphoid tissue (GALT) influence on the microglial response at 72 hours or 21 days after a cortical contusion injury (CCI), a rodent model of TBI. Injured animals received daily probiotics, antibiotics, or no treatment. Sham-injured animals (controls) did not receive any treatment.Results: Twenty-one days of probiotic treatment attenuated the pro-inflammatory response of microglia (M1:M2) after CCI. The post-injury inflammatory response was heightened in the GALT with antibiotic-induced dysbiosis which resulted in amplification of the pro-inflammatory microglial response. Conclusions: Probiotic treatment after TBI is a potential therapeutic in attenuating microglial activation through anti-inflammatory signaling.
Dynamics of Small World Effect and Random Fuzzy Graph
Authors: Zhang Yijin , Huang Jie , Lin Zongbing
Published: July 2021

Small World Effect (or Six Degrees of Separation theory) has generated significant influence in the world. Many researchers and institutes have done lots of work on the study of it. We model Small World Effect by random process and Graph, calculate the probability that any two people i and j in the world can contact each other after n steps (forwarding messages by intermediaries) based on different R (average number of acquaintances everyone has in the world).When R=50 or 80, if , the probability is 0.848 and the search is very likely to happen. When R=150, n=4, this probability is 0.99994, that is, after 4 steps, any two people in the world will establish connection almost surely. In the sense of Dunbar's number (R=150), six degrees of separation becomes four degrees of separation. We propose the concepts of (directed) Random Fuzzy Graph for the very first time which can describe the fact of recognition among people best, because the relation among persons is random and fuzzy.
Assessment of Diet Quality and Health-Related Quality of Life in Young Adults According to Household Food Security Status and Income Level
Authors: Kim Eun-kyung , Kim Se-Na , Kwon Yong-Seok , Lee Jin-Young , Park Young Hee
Published: July 2021

Background
Food insecurity is still a concern not only in low- and middle-income countries but also in high-income countries and it is reported to have a relationship with health outcome such as chronic diseases. This study was conducted to compare diet quality and health-related quality of life in young adults according to their household income and food security.
Methods
Our population-based sample included 10,224 young adults aged 19–34 y participating in the Korea National Health and Nutrition Examination Survey (KNHANES) 2008–2018. The participants were classified into four groups according to household income and food security: food security & higher-income, food insecurity & higher-income, food security & low-income, and food insecurity & low-income. General characteristics, daily diet, and nutritional quality were compared among the four groups.
Results
The percentage of participants consuming daily diet with protein, vitamin A, B1, B2, niacin, vitamin C, calcium, phosphorus, and iron less than Estimated Average Requirement increased in the food insecurity & low-income group. In case of most commonly consumed food, ramen and sprite were highly placed in the food insecurity & low-income group while apple and beef ranked relatively high in the food security & higher-income group. Multiple logistic regression analysis showed that odds ratio (OR) (95% confidence interval, CI) of Euro Quality of Life five Dimensions (EQ5D) in the food insecurity & low-income group were 1.55 (1.05–2.29) and 1.33 (1.07–1.64) for mobility and anxiety/depression respectively, compared to the food security & higher-income group after adjusting confounding factors.
Conclusions
Household food insecurity and low-income had relationships with poor diet quality and poor health-related quality of life in young adults, in particular, mobility and anxiety/depression.
Physical Activity and Sedentary Behaviors (Screen Time and Homework) Among Overweight or Obese Adolescents Before The COVID-19 Pandemic: A Cross-Sectional Observational Study in Yazd, Iran
Authors: Hadianfard Ali Mohammad , Mozaffari-Khosravi Hassan , Karandish Majid , Azhdari Maryam
Published: July 2021

Background

The growing number of adolescents who are overweight or obese (OW / OB) is a public concern. The present study was aimed to evaluate PA and sedentary behaviors (SB) (screen time (ST) and homework time (HT)) among Yazd OW/OB adolescents before the COVID-19 pandemic.
Methods

This cross-sectional study was performed among 510 students aged 12–16 in Yazd, Iran. The general information, physical activity (PA), and SB (ST and HT) were collected by interview based on the WHO standard questionnaire. Anthropometric data and daily energy intake (Energy) were assessed.
Results

There was a high prevalence of SB > 2h/day (97.6), ST > 2h/day (70.3%), overweight or obesity (40%), abdominal obesity (36.9%), low PA (29.8%) among the students. The younger age (p = 0.014), energy (p < 0.001), no access to the yard (p < 0.001), family size ≤ 4 (p = 0.023), the commuting to school by motor vehicles (p = 0.001), the highest school days’ HT (p = 0.033) and SB (p = 0.021), and the highest weekends’ HT among the students were the risk factors for OW/OB. The highest PA level was associated with a lower risk of OW/OB (p < 0.001). The findings were not the same in both sexes. Compared to the normal weight students, OW / OB spent more time on school days and weekdays for ST (P < 0.001), HT (P < 0.001, P = 0.005) and SB (P < 0.001), respectively. OW/OB students showed a higher weekends’ ST (p < 0.001) and lower HT (p = 0.048) than normal-weight students.
Conclusion

The prevalence of SB, ST, OW/OB, and low PA were common. The school days and weekends’ HT, the school days’ SB and HT, age, energy, PA, and access to the yard, family size, and the commuting to school were related to the greater chances of OW/OB students. Given that the expansion of online education and self-isolation in a new situation with COVID-19, it seems we will meet the worrying results.