bluuebunny/crossref_metadata_2025 huggingface dataset:
No detection of SARS-CoV-2 RNA on urethral swab in patients with positive naso-pharyngeal swab
Authors: Spirito Lorenzo , Pinchera Biagio , Patrì Angela , Delfino Mario , Imbimbo Ciro , Salvatore Paola , Gentile Ivan , Fabbrocini Gabriella
Published: August 2020

Background

The recent SARS-CoV-2 infection is the cause of one of the most important pandemics that history has ever experienced. SARS-CoV-2 can lead to a MOF (Multiple Organ Failure) that is critical for life of patients. Viral RNA is found in human tissues as lung, intestine, testicle, kidney, etc. and it is the reason to theorize different ways of transmission of the virus in addition to respiratory droplets. The aim of our study was to evaluate the presence of SARS-CoV-2 in urethral swabs.
Methods

We enrolled 10 patients with SARS-CoV-2 infection who attended the Infectious Diseases Unit of the A.O.U. Federico II of Naples, from March 2020 to April 2020. For each patient, one urethral swab was collected at the time of SARS-CoV-2 infection.
Results

All ten patients had a negative urethral swab for SARS-CoV-2 RNA when the rhino-oropharyngeal swab was found to be positive for SARS-CoV-2 RNA. Our data show for the first time that the virus would not affect the urinary tract and therefore would not be found in the urine and even less would it be transmissible through the urine. This result was independent of the stage of the disease, in fact, regardless of the severity of the clinical conditions, all patients had a negative urethral swab for SARS-CoV-2 RNA.
Conclusion

This observation, which needs to be further investigated with further studies and a larger sample, could be the cornerstone for understanding the role of SARS-CoV-2 in relation to the genitourinary system.
The Barriers and Facilitators of Iranian Men's Involvement in Perinatal Care: a Qualitative Study
Authors: hajian sepideh , mehran nahid , simbar masoumeh , majd hamid alavi
Published: August 2020

Introduction: Pregnancy and childbirth are crucial events in women's lives that can be done well with the support of people around them, especially their husbands. However, a number of factors can reduce or increase the supportive role of spouses during this period. The aim of the present study was to explain the barriers and facilitators of Iranian men's involvement in perinatal care.Materials and Methods: This qualitative phenomenological study was conducted with the conventional content analysis approach and with use of purposeful sampling method with the involvement of pregnant women or the women who have recently given birth (one week to six months after childbirth), spouses, policy makers and midwifery service providers. The inclusion criteria included: being Iranian, the ability to understand and transfer the concepts into Persian, and employment in a midwifery center for at least one year (for service providers). Data were collected through in-depth interviews until the data saturation. The collected data were analyzed by conventional content analysis based on Graneheim and Lundman method steps. MAXQDA version 10 software was used to manage the data and Guba and Lincoln criteria were also used to ensure the trustworthiness of findings. Results: After analyzing of the data, they were classified in 2 sub-categories and 3 main categories including gender authoritarian attitudes (including subjective norms, stereotypes and hidden fears), constraints (including individual, organizational, socio-economic and legislative constraints), and incentives (including individual, family, economic, legislative, and organizational incentives).Conclusion: The results revealed that men face a number of declining and increasing factors in participating in perinatal care, which have been neglected and it is necessary to pay attention to role of these factors in maternal and neonatal health promotion programs.
A comprehensive analysis of the lncRNAs and genes for the gastric carcinoma
Authors: Cheng Wei , Li Minzhe , Lin Shaofeng , Xiao Jun
Published: August 2020

BackgroundGastric carcinoma (GC) in one of the most common malignant tumors in the worldwide. Despite numerous studies, the molecular mechanism of is still unclear and the prognosis of GC remains poor.MethodsThe present study obtained expression data from The Cancer Genome Atlas (TCGA) and Gene Expression Omnibus (GEO) database. The gene risk signature and lncRNA signature were constructed by performing the univariate cox regression analysis and least absolute shrinkage and selection operator (LASSO) analysis. The receive operator curve (ROC) analysis was applied to evaluated the specificity and sensitivity of risk signature. The potential pathway was performed by using the Gene Set Enrichment Analysis (GSEA).ResultsIn total, 1641 differentially expressed genes (DEGs) and 985 differentially expressed lncRNAs (DElncRNAs) were obtained among GC samples. A 6 prognostic DEGs (DIRC1, IQCM, MATN3, SOX14, C5orf46 and CYP19A1) classifier and 9 prognostic DElncRNAs (AC007126.1, AC011352.1, AL356417.2, AP000695.1, LINC01210, LINC01614, VCAN-AS1, AC005165.1 and AC011586.2) classifier were identified using lasso-penalized multivariate survival modelling with 10 fold cross-validation. According to median risk score, patients were divided into high risk group and low risk group. The overall survival result for patients have a significant divergence between high rosk group and low risk group (p < 0.001). The 6 DEGs signature risk model and 9 DElncRNAs signature risk model was further verified that can served as an independent prognostic biomarkers for GC prediction among the clinical traits (P < 0.001). Moreover, two independent cohort GEO dataset (GSE13911 and GSE70800) was employed to evaluate the specificity and sensitivity of the prognostic gene and prognostic lncRNA. Gene set enrichment analysis (GSEA) result for the risk model revealed that these gene involved in ECM receptor interaction pathway, ERBB signaling pathway, UBIQUITIN mediated proteolysis, cell adhesion molecules CAMS, ECM receptor interaction, focal adhesion, pathways in cancer and TGF beta signaling pathway, meaning that the prognostic gene risk model and lncRNAs risk model play an crucial role and have important prognostic values.ConclusionThese findings may have important significance in understanding the molecular mechanism of GC and potential therapeutic method for the GC patients.
Natural products as inhibitors of COVID-19 main protease – A virtual screening by molecular docking
Authors: omrani Marzieh , Bayati Mohammad , Mehrbod Parvaneh , Nejad-Ebrahimi Samad
Published: August 2020

Background: The novel coronavirus (2019-nCoV) causes a severe respiratory illness that was unknown in the human before. Its alarmingly quick transmission to many countries across the world resulted in a worldwide health emergency. It has caused a notable percentage of morbidity and mortality. Therefore, an imminent need for drugs to combat this disease has been increased. Global collaborative efforts from scientists are underway to find a therapy to treat infections and reduce death cases. Herbal medicines and purified natural products have been reported to have antiviral activity against Coronaviruses (CoVs).Methods: In this study, a High Throughput Virtual Screening (HTVS) protocol was used as a fast method on the discovery of novel drug candidates as the COVID-19 main protease inhibitors. Over 180,000 natural product-based compounds were obtained from the ZINC database and virtually screened against the COVID-19 main protease. In this study, the Glide docking program was applied for high throughput virtual screening. Extra precision (XP) and in a combination of Prime module, induced-fit docking (IFD) approach was also used. Additionally, the ADME properties of all compounds were analyzed, and the final selection was carried out based on the Lipinski rule of five. Results: The nineteen compounds were selected and introduced as new potential inhibitors. The compound ZINC08765174 (1-[3-(1H-indol-3-yl) propanoyl]-N-(4-phenylbutan-2-yl)piperidine-3-carboxamide) showed a strong binding affinity (-11.5 kcal/mol) to the crucial residues of COVID-19 main protease comparing to peramivir (-9.8 kcal/mol) as a positive control.Conclusions: The excellent ADME properties proposed the opportunity of this compound to be a promising candidate for the treatment of COVID-19.
Focus on renal blood flow in mechanically ventilated patients with SARS-CoV-2
Authors: Fogagnolo Alberto , Grasso Salvatore , Dres Martin , Gesualdo Loreto , Morelli Elena , Ottaviani Irene , Marangoni Elisabetta , Volta Carlo Alberto , Spadaro Savino
Published: August 2020

Background: Patients with ARDS due to the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) seem particularly susceptible to AKI. Our hypothesis was that the renal blood flow could be more compromised in SARS-CoV-2 patients than in patients with “traditional” ARDS. We compared the renal resistivity index (RRI) and the renal venous flow (RVF) in ARDS patients with SARS-CoV-2 and in ARDS patients due to other etiologies.Materials and Methods: Prospective, observational study performed on 30 mechanically ventilated patients (15 with SARS-COV-2 ARDS and 15 with ARDS). Ultrasound Doppler measurements of RRI and RVF pattern were performed in each patient.Results: Patients with SARS-COV-2 ARDS had higher RRI than patients with ARDS (0.71[0.67–0.78] vs 0.64[0.60–0.74], p=0.04). RVF was not-continuous in 9/15 patients (71%) in the SARS-COV-2 ARDS group and in and 5/15 (33%) in the ARDS group (p=0.27). A linear correlation was found between PEEP and RRI in patients with SARS-COV-2 ARDS (r2=0.31; p=0.03) but not in patients with ARDS. Occurrence of AKI was 53% in patients with SARS-COV-2 ARDS and 33% in patients with ARDS (p=0.46).Conclusions: We found a more pronounced impairment in renal blood flow in mechanically ventilated patients with SARS-COV-2 ARDS, compared with patients with “traditional” ARDS.
A Method to evaluate analytical sensitivity of qRT-PCR kits for SARS-CoV-2 detection
Authors: Wang Di , Wang Zhidong , Wu Xiao , Zhang Yongzhuo , Gao Yunhua
Published: August 2020

Background: The ongoing Coronavirus disease 2019 (COVID-19) pandemic has spread across the globe and is representing a huge challenge for all human population. Many commercial qRT-PCR assays have been developed to detect SARS-CoV-2, but related method validation especially the sensitivity evaluation has been insufficient, resulting in some false-negative cases have been reported. Methods: The analytical sensitivity of nine brands of qRT-PCR kits for detecting SARS-CoV-2 was evaluated in parallel based on a newly developed certified reference material, which was derived from genomic RNA of SARS-CoV-2 from clinical positive specimens. After validation of the the reference material by digital PCR, the detection sensitivity of these kits was preliminarily tested using the serially diluted reference material, resulting in three kits with two significantly different sensitivity levels were selected for further evaluation. We sequenced the qRT-PCR products for assay specificity evaluation, and used serial dilutions of the reference material to calculate amplification efficiency and estimate the limit of quantification as well as 95% limit of detection..Results: The results indicated that the analytical sensitivity varied markedly among these kits. For the three types of qRT-PCR kits (Kit-1, Kit-2 and Kit-7), specificity of the PCR products was confirmed by sequence alignment, in which the target amplicons completely matched the corresponding parts of the genome of SARS-CoV-2. The resulting limit of detection from replicate tests for the Kit-1 and Kit-2 was 5.6 copies (N), 3.5 copies (ORF 1ab), and 6.4 copies (N), 4.6 copies (ORF 1ab), respectively, at 95% probability. Compared with Kit-7, the limit of detection as well as limit of quantification of Kit-1 and Kit-2 were significantly lower, further supporting that the both kits worked well to detect low abundance of SARS-CoV-2.Conclusions: Considering that most of the tested kits have been approved for in vitro diagnostics (IVD) in China, the established method here provides a reliable tool to evaluate the sensitivity performance of various qRT-PCR kits for SARS-CoV-2 detection and thus enhance quality control of qRT-PCR assays, improving the laboratory diagnostic capability for fighting the COVID-19 pandemic.
Participatory analysis of groundnut (Arachis hypogaea L) cropping system and production constraints in Burkina Faso
Authors: Boubacar Sinare , Desmae Hailemichael , Miningou Amos , Nebie Baloua , Eleblu John , Kwadwo Ofori , Traore Appolinaire , Zagre Bertin , Tabo Ramadjita
Published: August 2020

Background: Groundnut (Arachis hypogaea L) is one of the major legume crop grown as food and cash crops across the agro ecological zone in Burkina Faso. It is ranked 2nd legume crop in the country, in term of importance, for household food, nutrition and income generation for both rural and urban zone, contributing significantly to food supply and the country economy. However, groundnut was downgrade long ago, forsaken and the groundnut sector is still struggling, with a low productivity, disorganized groundnut sector and a weak breeding program, due to several constraints. Assessing and describing the present groundnut cropping system and production constraint will eventually serve as a basis to guide efficiently the groundnut breeding activities. Methods: A Participatory Rural Appraisal (PRA) study was conducted in three groundnuts production areas (Central-Eastern, Central-Northern and Central- Western). A total of 124 farmers were involved in the study to collect data on socio-demographics, farming system, cropping practices and identified production constraints. Analysis was carried out for qualitative and quantitates variables using STATA 14. Mean variance were determined across regions and gender, and pairwise ranking were used to assess the level of agreement for variables ranking among the three regions using Kendall's W. Pearson's correlation was carried out to assess the relationship between variables. Results: The study revealed a cropping system of groundnut in an environment largely affected by climate change, and in a subsistence and extensive agriculture. There is a variance in groundnut cropping system across the regions with similarities in the cropping practices. Gender plays a key role in the production of the groundnut and 48.39% of women are engaged in groundnut cropping with less access to land and production resources. A yield gap between men and women has been observed denoting a huge inefficiency between men and women. Production constraints, although similar, are perceived and appreciated differently across the region. The lack of improved varieties, Absence of agricultural credit, lack of materials, high price of seeds, high price of fertilizer, drought and disease are some of the important constraints compromising the crop. Conclusion: This study provides a recent view of groundnut cropping, allowing good understanding of farmer’s situation. The result, will contribute to an efficient refining of breeding priorities and guide further activities in groundnut breeding in Burkina Faso.
Impact of Acute Kidney Injury on Survival in Patients With Chronic Hepatitis C
Authors: Jeon Hankyu , Kim Jae Heon , Lee Sang Soo , Kim Hee Jin , Cha Ra Ri , Cho Hyun Chin , Lee Jae Min , Ha Chang Yoon , Kim Hyun Jin , Kim Tae Hyo , Jung Woon Tae , Lee Ok-Jae
Published: August 2020

Background: Acute kidney injury (AKI) is expected to occur commonly in patients with chronic hepatitis C. In addition, AKI may affect the survival of patients with chronic hepatitis C. However, few studies are available on this topic. We aimed to evaluate the incidence of AKI in patients with chronic hepatitis C and investigate the factors related to overall mortality. Methods: Between January 2005 and December 2018, 1252 patients with chronic hepatitis C virus (HCV) infection were retrospectively enrolled at two centers. Of them, 1008, 123, and 121 patients had chronic hepatitis (CH), compensated cirrhosis (Com-LC), and decompensated cirrhosis (Decom-LC) or hepatocellular carcinoma (HCC) at entry, respectively. Results: Over a mean follow-up period of 5.2 years, 285 patients developed AKI, with an incidence rate of 4.35 per 100 person-years. The incidence of AKI increased gradually with progression of chronic hepatitis C: CH (3.32 per 100 person-years), Com-LC (5.86 per 100 person-years), and Decom-LC or HCC (17.28 per 100 person-years). Patients without AKI showed a better survival rate than patients with AKI (P < 0.001). In multivariate Cox regression analysis, AKI (hazard ratio, 6.66; 95% confidence interval, 4.26–10.41) remained an independent risk factor for overall mortality. Conclusion: AKI is common in patients with chronic HCV infection and is associated with significant overall mortality. Therefore, clinicians should carefully monitor the occurrence of AKI, which is an important predictor of mortality in patients with chronic hepatitis C.
Perceptions of mothers and healthcare professionals to contributors and preventions of loss-to-follow-up and child mortality at the PMTCT program after option B + guideline implementation in northwest Ethiopia
Authors: Kassaw Mesfin Wudu , Matula Samuel T. , Mamo Ayele , Kassie Ayelign , Abate Biruk
Published: August 2020

Background: The third United Nations Sustainable Development Goal includes a commitment to end HIV. In lined with the Sustainable Development Goal, Option B+ programs hold great promise for preventing transmission of HIV and moving towards an “AIDS-free generation. However, an estimated 110,000 AIDS-related deaths occurred among children in 2015. The Global Plan also identified Ethiopia as one of 22 high priority countries for improved prevention of mother to child HIV transmission services. But, there is a scarcity of data on the contributors of loss to follow up and mortality after option B+ guideline implementation in the Amhara regional state, Ethiopia. Methods: This study conducted in five zones of the Amhara regional state, Ethiopia. The study considers mothers that admitted to the 5-referral hospitals’ PMTCT departments, midwifery professionals who work in the respective hospital’s PMTCT departments, and HIV officers. The period for data collection was from March 21 to May 18/2019. An in-depth qualitative interview employed to gain access to the participants’ experiences and conducted an inductive qualitative content analysis.Results: Mothers, health professionals, and HIV officers were asked about the contributors of lost to follow up in the Amhara region. The participants’ suggestions on the causes categorized into a health facility, stigma and discrimination, and socioeconomic status themes. On the prevention of loss to follow up, the views of study participants were categorized into health facility improvement, psychosocial support, and loss to follow up retention mechanisms. On the causes of HIV related mortality, participants’ views categorized into vertical HIV transmission, carelessness of parents, and poor socioeconomic status themes. In the recommendations to prevent loss to follow up and mortality, participants forwarded their suggestions for health facilities and professionals and civic societies. On the prevention of mortality, participants’ views categorized into health care and mothers’ awareness.Conclusions: The participants were emphasizing the health facilities, health care professionals, and awareness of families to prevent loss to follow up and mortality among exposed infants after admission to the PMTCT program. Hence, concerned bodies mainly minister of health should outline on improving the service provided in the PMTCT department.
Paraganglioma with Hyperglycaemia as the Main Symptom: A Case Report.
Authors: Wu Yanbin , Wang Xuewen , Guo Chenglong , Cao Xuefeng , Cheng Yu , Chen Qiangpu , Zhang Xingyuan , Kong Lingqun
Published: August 2020

Background: Paraganglioma (PGL) is a rare neuroendocrine tumour derived from the extra- adrenal gland that is also known as ectopic pheochromocytoma (PHEO). The typical clinical symptoms are paroxysmal hypertension with headache, sweating and palpitation. However, PGL with abnormal glucose metabolism as the main manifestation is rare.Case Presentation: In this case, the patient had a history of diabetes for 13 years and showed persistently increased blood glucose. The application of multiple hypoglycaemic drugs to control the patient’s blood glucose was ineffective, and a limited effect of high-dose insulin was observed. This patient underwent a contrast-enhanced computed tomography scan(CT),showing a soft tissue density shadow (3.2×2.4cm) with clear edges and slight enhancement in the medial side of inferior vena cava. Exploratory laparotomy was performed and significant blood pressure changes were observed when the tumourwas removed during the operation. The patient’s blood glucose decreased significantly and hypoglycaemiawas noted when the patient’s original dose of insulin was maintained. The patient recovered uneventfully and was discharged after the operation.Conclusions: Hyperglycaemia caused by PGL is rare in the clinic; therefore, it is necessary to pay attention to the relevant blood glucose indexes during the preoperative examination and diagnosis process to improve the examination process and further assist in the preoperative diagnosis of PGL. It is necessary to pay attention to changes in blood pressure during and after the operation to avoid hypoglycaemia. Lifetime follow up is necessary after the operation.
The Nature of Self-Injurious Behaviours Prevalent Among the Youth.
Authors: Singh Ritika , Rizvi Sabeen
Published: August 2020

Background

Self-injurious thoughts and behaviours (SITBs) include a spectrum of self-harming behaviours that an individual may choose to engage in - one such behaviour is labelled as Non-Suicidal Self-Injury (NSSI). The current study was carried out to assess the epidemiological factors associated with NSSI, regarded as a clinical disorder included under the Conditions for Further Study in the DSM-5, and to explore its association with borderline personality traits. Additionally, it also aimed at assessing the reasons why individuals indulge in SITBs.
Methods

Inclusion criteria for the participants were age 18–24 (in years) and provision of written informed consent to participate in the research. The Alexian Brothers Assessment of Self-Injury, McLean Screening Instrument for Borderline Personality Disorder, and Self-Injurious Thoughts Behaviours Interview were used as the clinical assessment tools. The data was analysed using descriptive statistics (mean and SD), along with a qualitative measure to explore the themes associated with SITBs.
Results

Participants included 123 (female − 72.35%) young adults (age in years: M = 21.26, SD = 3.67), selected with purposive sampling. 51.21% (female n = 51; age in years: M = 21.03, SD = 1.55) of the total participants endorsed NSSI behaviour, and among them, 39.68% reported having suicidal ideation at least once in their lifetime. Further, the study revealed that participants who endorsed SITBs scored high on MSI-BPD, suggesting an association between the two. 22.22% met the diagnostic criteria of NSSI Disorder under DSM-5. Engagement in SITBs was found to be motivated by automatic negative and positive reinforcement, social negative reinforcement, and self-punishment. Lastly, cognitive appraisal of circumstances acts as a primary precipitant to SITBs. This study draws attention on the alarming ubiquity of SITBs and the similar factors associated with it in many countries of the world.
Conclusions

The study reiterates emphasis on the notion that adolescents are incredibly vulnerable to adapting harmful mechanisms to cope with their struggles. The research indicates high prevalence rates of different forms of SITBs in the general population and the risk at which self-harming individuals operate.
Development and Validation of the Psychometric Properties of the Perceived Barriers of Mammography Scale
Authors: Shirzadi Shayesteh , Asghari-Jafarabadi Mohammad , Harrison Mahnaz M. , Allahverdipour Hamid
Published: August 2020

Background: To improve women’s participation in early detection of breast cancer we need to understand women’s perceived barriers to Mammography. Due to lack of women participation in referrals to mammography centers, this study aims to develop and test the psychometric properties of the Perceived Barriers of Mammography Scale (PBMS-23) for Iranian women.Methods: A mixed method design was performed to develop the PBMS-23 during 2016-2017. The item pool was mainly generated through qualitative data and literature review. Next, the developed questionnaire was answered by 500 women ages 40 to 69 years. The internal consistency, test-retest reliability, content and face validity and construct validity (both exploratory and confirmatory) were assessed.Results: Twenty eight items were initially extracted and next, based on content validity assessment, twenty three items (PBMS-23) were remained. The exploratory factor analysis revealed eight factors of believe in fate and destiny, breast conflict, defense avoidance, inconveniences/difficulties of mammography screening, contrasting/competing priorities, fear, distrust of mammography, and lack of knowledge in the PBMS-23 that accounted for 59.20 of the total variance. The confirmatory factor analysis also showed a model with appropriate fitness for the data. The Cronbach’s alpha coefficient and the intra-class correlation coefficient were 0.68, 0.90 respectively.Conclusion: The findings showed that the developed PBMS-23 instrument was a valid and reliable instrument for assessing perceived barriers of mammography screening that can be used both in practice and in future studies especially in the Middle East.
Integrating Pathology, Chromosomal Instability and Mutations for Risk Stratification in Early-stage Endometrioid Endometrial Carcinoma
Authors: Li Yuan , Li Jiaqi , Guo Ensong , Huang Jia , Fang Guangguang , Chen Shaohua , Yang Bin , Fu Yu , Li Fuxia , Wang Zizhuo , Xiao Rourou , Liu Chen , Huang Yuhan , Wu Xue , Lu Funian , You Lixin , Feng Ling , Xi Ling , Wu Peng , Ma Ding , Sun Chaoyang , Wang Beibei , Chen Gang
Published: August 2020

Background: Risk stratifications for endometrial carcinoma (EC) depend on histopathology and molecular pathology. Histopathological risk stratification lacks reproducibility, neglects heterogeneity and contributes little to surgical procedures. Existing molecular stratification is useless in patient with specific pathological or molecular characteristics, and cannot guide postoperative adjuvant radiotherapies. Chromosomal instability (CIN), the numerical and structural alterations of chromosome resulting from ongoing errors of chromosome segregation, is an intrinsic biological mechanism for the evolution of different prognostic factors of histopathology and molecular pathology, which may be applicable to the risk stratification of EC.Results: By analysis of CIN25 and CIN70, two reliable gene expression signatures for CIN, we found that EC with unfavorable prognostic factors of histopathology or molecular pathology had serious CIN. However, POLE-mutant, as a favorable prognostic factor, had elevated CIN signatures, and CTNNB1-mutant, as an unfavorable prognostic factor, had decreased CIN signatures. Only if these two mutations were excluded were CIN signatures strongly prognostic for outcomes in different adjuvant radiotherapy subgroups. Integrating pathology, CIN signatures and POLE / CTNNB1 mutation stratified stageⅠendometrioid EC into four groups with improved risk prognostication and treatment recommendations.Conclusions:We revealed the possibility of integrating histopathology and molecular pathology by CIN for risk stratification in early-stage EC. Our integrated risk model deserves for further improvement and validation.
Role of NR2B/ERK signaling in the neuroprotective effect of dexmedetomidine against sevoflurane induced neurological dysfunction in the developing rat brain
Authors: Li Guohua , Jin Yanwu , Cao Fang , Wang Dawei , Zhou Limin
Published: August 2020

Background
Dexmedetomidine (DEX) is a new-generation, and has been widely applied in clinic. The present study confirmed the protective effect of DEX on sevoflurane induced learning and cognitive impairment and examined its underlying mechanism.
Methods
Sprague-Dawley rats were exposed to 0.85% sevoflurane for 6 h and injected with DEX in different dose. Morris water maze (MWM) test was performed to evaluate the learning and memory function of rats. Western blot was used for the measurement of protein levels.
Results
MWM results indicated that sevoflurane treatment increased the escape latency but reduced the time spent in original quadrant of rats. The protein levels of NR2B, phosphorylated ERK were significantly influenced by sevoflurane. Ifenprodil administration alleviated sevoflurane induced neurological impairment. DEX treatment reversed the effect of sevoflurane on both escape latency and time in original quadrant in a dose manner, and pretreatment with 75 µg/kg DEX had the most dramatic effect. DEX regulates the NR2B/ERK signaling in sevoflurane treated rats.
Conclusion
NR2B/ERK signaling is involved in sevoflurane induced neurological impairment. DEX may protect against sevoflurane induced neurological dysfunction in the developing rat brain via regulating the NR2B/ERK signaling.
Why do some inter-organisational collaborations in healthcare work when others do not? A realist review
Authors: Aunger Justin Avery , Millar Ross , Greenhalgh Joanne , Mannion Russell , Rafferty Anne Marie , McLeod Hugh
Published: August 2020

BackgroundInter-organisational collaboration is increasingly prominent within contemporary healthcare systems. A range of collaboration types such as alliances, networks, and mergers have been proposed as a means to turnaround organisations, by reducing duplication of effort, and enabling resource sharing, greater influence, and novel innovations. However, in practice, due to the complexity of the process, such efforts are often rife with difficulty. Notable contributions have sought to make sense of this area, however further understanding is needed in order to gain a better understanding of why some inter-organisational collaborations work when others do not, to be able to more effectively implement collaborations in the future.MethodsRealist review methodology was used, combining systematically searched papers and purposively searched ‘middle-range’ theories. The systematic review encompassed searches for reviews, commentaries, opinion pieces and case studies on HMIC, Medline, PsychINFO, and Social Policy and Practice databases and further searches were conducted using Google Scholar. Data were extracted from included studies according to relevance to the realist review.ResultsThirty-eight systematically-identified studies were included, in addition to twelve purposively-identified papers, informing the development of programme theories of how, why, and when partnerships in healthcare work. The findings led to the proposal of programme theories formulated as context-mechanism-outcome configurations, which outline what outcomes may be expected when partnerships are attempted in differing contexts. We found that it was essential to consider mechanisms underlying partnership functioning, such as building trust and faith in the collaboration, in a context of strong initial trust, to enable maximal synergy and thus collaborative performance.ConclusionAs the first realist review of inter-organisational collaborations in healthcare as an intervention for improvement, this review provides actionable evidence for policymakers and implementers, enhancing understanding of mechanisms underlying the functioning and performing of inter-organisational collaborations, as well as configuring context and entry point to aid success. Next steps in this research will test the results against further case studies and primary data to produce a further refined theory. Review registrationThis review is registered at PROSPERO with ID CRD42019149009.
Effect of primary decompressive craniectomy on outcomes in severe traumatic brain injury with mass lesions and the independent predictors for operation decision
Authors: Yang Chen , Zhang Jia-Rui , Zhu Gang , Guo Hao , Gao Fei , Wang Bao , Cui Wen-Xing , Shi Ying-Wu , Du Yong , Li Zhi-Hong , Wang Liang , Ma Lian-Ting , Qu Yan , Ge Shunnan
Published: August 2020

Background: Although operative indications for traumatic brain injury (TBI) have been evaluated, neurosurgeons often face a dilemma of whether or not to remove the bone flap after mass lesion evacuation, and a useful predictive scoring model for which patients should be decompressive craniectomy (DC) has yet to be developed. The aim of this study was firstly to compare the outcomes of craniotomy and DC, and secondly to determine independent predictors and develop a multivariate logistic regression equation to determine whom should perform primary DC in TBI patients with mass lesions.Methods: A total of nine different variables were evaluated. All 245 patients with severe TBI in this study were retrospectively evaluated between June 2015 and May 2019 and all underwent decompressive craniectomy (DC) or craniotomy for mass lesion removal. The 6-month mortality and Extended Glasgow Outcome Scale (GOSE) were compared between DC and craniotomy. By using univariate, multiple logistic regression and prognostic regression scoring equations it was possible to draw Receiver Operating Characteristic curves (ROC) to predict the decision for DC.Results: The overall 6-month mortality in the entire cohort was 11.43% (28/245). DC patients had a lower mean preoperative Glasgow Coma Scale (GCS) (p = 0.01); more patients with GCS of 6 (p=0.007);more unresponsive pupillary light reflex (p< 0.001); more closed basal cisterns (p< 0.001); and more patients with diffuse injury (p=0.025) than craniotomy patients. Given the greater severity, patients undergoing primary DC had higher 6-month mortality than the remainder of the cohort. However, in the surviving patients, the favorable GOSE rate was similar in two groups. We found that pupillary light reflex and basal cisterns were independent predictors for DC decision. Using ROC curve to predict the probability of DC, the sensitivity was 81.6% and the specificity was 84.9%.Conclusion: Our preliminary findings showed that the primary DC may benefit subgroups of sTBI with mass lesions, and unresponsive pre-op pupil reaction, and closed basal cistern to predict the DC decision were useful. These sensitive variables can be used as a referential guideline in our daily practice to decide to perform or avoid primary DC.
Factors Associated with Prolonged Hospitalization Among Patients Transported by Emergency Medical Services: A Population-based Study in Osaka, Japan
Authors: Katayama Yusuke , Kitamura Tetsuhisa , Tanaka Jun , Nakao Shota , Nitta Masahiko , Fujimi Satoshi , Kuwagata Yasuyuki , Shimazu Takeshi , Matsuoka Tetsuya
Published: August 2020

Background
The emergency medical system, one of the essential elements of public health, has been around for more than 50 years. Although many studies have assessed the factors associated with overcrowding and prolonged length of stay in emergency departments, whether the clinical characteristics and background of a patient are associated with prolonged hospitalization among patients transported by ambulance is unknown. The purpose of this study was to reveal factors associated with the continuation of hospitalization at 21 days after hospital admission among patients transported by ambulance using a population-based patient registry in Osaka, Japan.
Method:
This was a retrospective observational study whose study period was the three years from January 2016 to December 2018. In this study, we included patients who were hospitalized after transportation by ambulance as determined using cleaned data that was recorded in the ORION system. The main outcome was continuation of hospitalization at 21 days after hospital admission. We calculated the adjusted odds ratios (AOR) and 95% confidence interval (CI) with a multivariable logistic regression model to assess factors associated with the outcome.
Results
We included 481,886 patients in this study, of whom 158,551 remained hospitalized at 21 days after hospital admission and 323,335 had been discharged home by 21 days after hospital admission. Factors associated with prolonged hospitalization were elderly (AOR: 1.767 [95% CI: 1.730–1.805]), traffic accident (AOR: 1.231 [95% CI: 1.183–1.282]), no fixed address (AOR: 4.494 [95% CI: 3.632–5.314]), need for nursing care (AOR: 1.420 [95% CI: 1.397–1.443]) and solitary person (AOR: 1.085 [95% CI: 1.050–1.120]).
Conclusion
In this study, the elderly, traffic accidents, no fixed address, need for nursing care, and solitary person were the factors associated with prolonged hospitalization of patients transported by ambulance in Japan.
Association between autoimmune diseases and COVID-19 as assessed in both a test-negative case-control and population case-control design
Authors: Murtas Rossella , Andreano Anita , Gervasi Federico , Guido Davide , Consolazio David , Tunesi Sara , Andreoni Laura , Greco Maria Teresa , Gattoni Maria Elena , Sandrini Monica , Riussi Antonio , Russo Antonio Giampiero
Published: August 2020

Background: COVID-19 epidemic has paralleled with the so called infodemic, where countless pieces of information have been disseminated on putative risk factors for COVID-19. Among those, emerged the notion that people suffering from autoimmune diseases (AIDs) have a higher risk of SARS-CoV-2 infection. Methods: The cohort included all COVID-19 cases residents in the Agency for Health Protection (AHP) of Milan that, from the beginning of the outbreak, developed a web-based platform that traced positive and negative cases as well as related contacts. AIDs subjects were defined ad having one the following autoimmune disease: rheumatoid arthritis, systemic lupus erythematosus, systemic sclerosis, Sjogren disease, ankylosing spondylitis, myasthenia gravis, Hashimoto's disease, acquired autoimmune hemolytic anemia, and psoriatic arthritis. To investigate whether AID subjects are at increased risk of SARS-CoV-2 infection, and whether they have worse prognosis than AIDs-free subjects once infected, we performed a combined analysis of a test-negative design case-control study, a case-control with test-positive as cases, and one with test-negative as cases (CC-NEG). Results: During the outbreak, the Milan AHP endured, up to April 27th 2020, 20,364 test-positive and 34,697 test-negative subjects. We found no association between AIDs and being positive to COVID-19, but a statistically significant association between AIDs and being negative to COVID-19 in the CC-NEG. If, as likely, test-negative subjects underwent testing because of respiratory infection symptoms, these results imply that autoimmune diseases may be a risk factor for respiratory infections in general (including COVID-19), but they are not a specific risk factor for COVID-19. Furthermore, when infected by SARS-CoV-2, AIDs subjects did not have a worse prognosis compared to non-AIDs subjects. Results highlighted a potential unbalance in the testing campaign, which may be correlated to the characteristics of the tested person, leading specific frail population to be particularly tested.Conclusions: Lack of availability of sound scientific knowledge inevitably lead unreliable news to spread over the population, preventing people to disentangle them form reliable information. Even if additional studies are needed to replicate and strengthen our results, these findings represent initial evidence to derive recommendations based on actual data for subjects with autoimmune diseases.
Utilization of apnea-hypopnea index as a novel predictive factor for difficult mask ventilation in the Chinese population under general anesthesia
Authors: Wang Jia-Yi , Li Jing-Jie , Zhao Peng-Cheng , Peng Jia-Li , Hu Rong , Xuan Pu , Jiang Hong
Published: August 2020

Background: Difficult Mask Ventilation (DMV) is a potentially life-threatening situation that can arise during anesthesia. Accordingly, the majority of current airway management guidelines include risk assessments for DMV. Although Obstructive Sleep Apnea (OSA) is among the most important risk factors associated with DMV, other measurements such as the Apnea-Hypopnea Index (AHI) may play an important role in determining patient risk.This study investigated the relationship between DMV and AHI, and determined preoperative risk factors for DMV in Chinese patients.Methods: A prospective cohort trial enrolled patients scheduled for elective surgery. After obtaining informed consent, patient demographic information was collected, and patients were tested with pre-operative polysomnography. Inclusion criteria: Patients >18 years of age, American Society of Anesthesiologists Physical Status Classification (ASA) I-III, and planned elective surgery with general anesthesia. Exclusion criteria: malformations of the airway, patients undergoing regional anesthesia, and patients with contraindications to mask ventilation (i.e. planned awake intubation). A logistic regression model was used to analyze the association between AHI and DMV. Results: A total of 159 patients were analyzed. For both primary and secondary outcomes, the unadjusted and adjusted odds ratio for DMV showed significant increases of 5 AHI units. AHI, age, and the Mallampati classification were found to be independent predictive factors for DMV.Conclusions AHI is associated with DMV as a novel independent risk factor in Chinese patients. Along with age and Mallampati classification, AHI should be included in establishing a superior predictive strategy DMV screening.Trial registration: Chinese Clinical Trial Registry (Registration number # ChiCTR17013076; Date of Registration on October 22nd, 2017).
Impact Resistance of Steel Materials to Ballistic Ejecta and Shelter Development Using Steel Deck Plates
Authors: Yamada Hiroyuki , Tateyama Kohei , Naruke Shino , Sasaki Hisashi , Torigata Shinichi , Honda Ryou , Kubo Tomohiro , Yoshimoto Mitsuhiro , Fujii Toshitsugu
Published: August 2020

The destruction caused by ballistic ejecta from the phreatic eruptions of Mt. Ontake in 2014 and Mt. Kusatsu-Shirane (Mt. Moto-Shirane) in 2018 in Japan, which resulted in numerous casualties, highlighted the need for better evacuation facilities. In response, some mountain huts were reinforced with aramid fabric to convert them into shelters. However, a number of decisions must be made when working to increase the number of shelters, which depend on the location where they are to be built. In this study, we propose a method of using high-strength steel to reinforce wooden buildings for use as shelters. More specifically, assuming that ballistic ejecta has an impact energy of 9 kJ or more, as in previous studies, we developed a method that utilizes SUS304 and SS400 unprocessed steel plates based on existing impact test data. We found that SUS304 is particularly suitable for use as a reinforcing material because it has excellent impact energy absorption characteristics due to its high ductility as well as excellent corrosion resistance. With the aim of increasing the structural strength of steel shelters, we also conducted an impact test on a shelter fabricated from SS400 deck plates (i.e., steel with improved flexural strength provided by work-hardened trapezoidal corrugated plates) . The results show that the shelter could withstand impact with an energy of 13.5 kJ (2.66 kg of simulated ballistic ejecta at 101 m/s on impact). In addition, it was confirmed the impact absorption energy is further increased when artificial pumice is used. Observations of the shelter after the impact test show that there is still some allowance for deformation caused by projectile impact, which means that the proposed steel shelter holds promise, not only structurally, but also from the aspects of transportation and assembly. Hence, the usefulness of shelters that use steel was shown experimentally. However, shelter construction should be suitable for the target environment.
Variable Expressed Methylation Sites of Aging-related Genes in Asthma
Authors: Yang Yu , Yuan Lin , Yang Ming , Du Xizi , Qin Ling , Wang Leyuan , Wu Shuangyan , Wu Mingping , He Ruoxi , Feng JunTao , Xiang Ynag , Qu Xiangping , Liu Huijun , Qin Xiaoqun , Liu Chi
Published: August 2020

Background: Asthma is a complex pulmonary inflammatory disease which is common in the elderly. Aging-related alterations have also been found in the structural cells and immune cells of asthma patients although the pathological mechanism of the differential aging-related gene in the development of asthma is still obscure. Of note, DNA methylation (DNAm) have been proven to play an important role in the regulation of aging-related genes. However, the methylation levels of aging-related genes in asthma patients are largely unclear.Methods: First, the mRNA levels and DNAm level of the previous screened 9 aging-related genes in peripheral blood of 51 healthy controls (HCs) and 55 asthmatic patients were detected by multiple targeted bisulfite enrichment sequencing (MethTarget) and qPCR. Secondly, the correlation between the DNAm level of specific altered CpG sites and the pulmonary function indicators of asthma patients was evaluated. Lastly, the Receiver Operator Characteristic (ROC) curve and Principal Component Analysis (PCA) were used to identify the feasibility of the candidate CpG sites as asthma markers.Results: The mRNA expression of the 9 aging-related gene in peripheral blood of asthma patients was significantly different from those of HCs. Besides, the methylation level of the 9 aging-related genes also altered in asthma patients, and a total of 68 CpG sites were related to the severity of asthma. Notably, 10 of the 68 CpG sites had a significant relationship with pulmonary function parameters. Moreover, ROC curve and PCA analysis showed that the candidate differential methylation sites (DMSs) can be used as potential biomarkers for asthma.Conclusions:In summary, this study confirmed the changes in the mRNA expression and DNAm level of aging-related genes in asthma patients. The differential DMSs are associated with the clinical evaluation indicators of asthma, which may indicate the involvement of aging-related genes in the pathogenesis of asthma and provide some new possible biomarker of asthma.