bluuebunny/crossref_metadata_2025 huggingface dataset:
Consumption of Fortified Infant Cereals and Association with Anemia and Growth: Insights from Demographic Health Surveys (DHS) Data Analysis
Authors: Detzel Patrick , Prieto-Patron Alberto
Published: November 2020

After approximately 6 months of age, term breastfed infants are increasingly depending on other sources of iron to avoid iron deficiency anemia. The appropriate complementary feeding must include a balance composition of foods containing an adequate amount of macro- and micronutrients to reduce the risk of iron deficiency anemia. This study aims to compare the anemia and growth status of infants receiving commercial fortified infant cereals (FIC) with infants not receiving them. We use all complete multiple Demographic Health Surveys (DHS) from 2005 to 2018 to understand global infant feeding patterns. To better control for the strong household wealth effect in nutritional choices and possibly health awareness, we use propensity score technique as applied in outcome research to better control the effect of covariates. After matching and controlling for confounders, we did find a significant association between reduced risk of anemia and consumption of FIC. After matching and adjusting for confounders the small but positive effects of consumption of FIC on Height for age z-score and Weight for Height Z-score are no longer statistically significant.
Antibacterial Bio-Based Polymers for Cranio-Maxillofacial Regeneration Applications
Authors: Martin-del-Campo Marcela , Fernadez-Villa Daniel , Cabrera-Rueda Gabriela , Rojo Luis
Published: November 2020

Cranio-maxillofacial structure is a region of particular interest in the field of regenerative medicine due to both its anatomical complexity and the numerous abnormalities affecting this area. However, this anatomical complexity is what makes possible the coexistence of different microbial ecosystems in the oral cavity and the maxillofacial region, contributing to the increased risk of bacterial infections. In this regard, different materials have been used for their application in this field. These materials can be obtained from natural and renewable feedstocks or by synthetic routes with desired mechanical properties, biocompatibility and antimicrobial activity. Hence, in this review, we have focused on bio-based polymers, which by their own nature, by chemical modifications of their structure, or by their combination with other elements, provide a useful antibacterial activity as well as the suitable conditions for cranio-maxillofacial tissue regeneration. This approach has not been reviewed previously, and we have specifically arranged the content of this article according to the resulting material and its corresponding application, reviewing guided bone regeneration membranes; bone cements; and devices and scaffolds for both soft and hard maxillofacial tissue regeneration, including hybrid scaffolds, dental implants, hydrogels and composites.
GENAVOS: A New Tool for Modelling and Analyzing Cancer Gene Regulatory Networks Using Delayed Nonlinear Variable Order Fractional System
Authors: Yaghoobi Hanif , Maghooli Keivan , Asadi-Khiavi Masoud , Jafarnia Dabanloo Nader
Published: November 2020

Complex diseases such as cancer are caused by changes in the Gene Regulatory Networks. Systems that model the complex dynamics of these networks along with adapting to real gene expression data are closer to reality and can help understand the creation and treatment of cancer. In this paper, for the first time, modelling of gene regulatory networks is performed using delayed nonlinear variable order fractional systems in the state space by a new tool called GENAVOS. This tool uses gene expression time series data to identify and optimize system parameters. This software has several tools for analyzing system dynamics. The results show that the nonlinear variable order fractional systems have very good flexibility in adapting to real data. We found that regulatory networks in cancer cells actually have a larger delay parameter than in normal cells. It is also possible to create chaos, periodic and quasi-periodic oscillations by changing the delay, degradation and synthesis rates. Our findings indicate a profound effect of time-varying order on these networks, which may be related to a type of cellular memory due to epigenetic and environmental factors. We showed that by changing the delay parameter and the variable order function for a normal cell system, its behavior changes and becomes quite similar to the behavior of a cancer cell. This work also confirms the effective role of the miR-17-92 cluster in the cancer cell cycle. GENAVOS is available at https://github.com/hanif-y/GENAVOS with its user guide and MATLAB codes.
Maxwell Equations for Material Systems, Version 1
Authors: Eisenberg Robert
Published: November 2020

The Maxwell equations of electrodynamics describe electrical and magnetic forces with great accuracy in the vacuum of space. But the equations of electrodynamics applied to material systems are usually written in a way that obscures their accuracy. The usual formulation of the Maxwell equations includes a dielectric constant as a single real number that grossly over-approximates the actual properties of matter, particularly liquid matter so important in applications of electrodynamics to biology and chemistry. We rewrite two Maxwell equations here to make clear the precision of the Maxwell equations in the presence or absence of matter. We discuss and derive two well known corollaries that are as universal and precise as the Maxwell equations themselves: (1) a continuity equation that relates charge and flux and (2) a conservation equation in which total current never accumulates at all. The total current is the right hand side of the Ampere-Maxwell law. Total current is perfectly incompressible. It is conserved exactly, everywhere and at every time, independent of the microphysics of charge conduction. The total current combines the flux of charges and the ethereal current. The ethereal current \varepsilon_{o\ }\sfrac{\partial\mathbf{E}}{\partial t}\ exists everywhere, including the interior of atoms, because it is a property of space, not matter. The ethereal current exists, and thus flows, in a vacuum devoid of mass. The ethereal current is a consequence of the relativistic (Lorentz) invariance of charge. Charge does not change even if it moves at speeds approaching the velocity of light. Total current has properties quite distinct from flux of mass because of the ethereal current. Most strikingly, in the one dimensional unbranched systems of electronic circuits and biological ion channels, the total current is independent of location, even if the flux of charges varies a great deal. Indeed, the Maxwell equations—and thus conservation of total current—act as a perfect low pass spatial filter, converting the infinite variation of (the Brownian model of) thermal motion of charges to the zero variation of the total current.
Hypertension and Hypercholesterolemia: is it Time for Anti-«Lipitensive» Therapy?
Authors: Kobalava Z. D. , Kokhan E. V.
Published: November 2020

Despite the widespread awareness that hypertension and dyslipidemia are risk factors of prime importance for cardiovascular disease, the prevalence of these risk factors is still high, and the success of their control can hardly be considered satisfactory. The latest European guidelines for the management of hypertension strengthened the position of fixed-dose combinations, the main advantage of which is increased adherence to treatment. The purpose of this review was to discuss the background and the possibility of using fixed-dose combinations containing antihypertensive drugs and a statin in the treatment of patients with hypertension and dyslipidemia. We outlined the theoretical concepts that substantiate the possibility of using such therapy and discussed the results of randomized clinical trials investigating the efficacy of combined administration of antihypertensive and lipidlowering drugs. Illustrated by single pill combination of indapamide, perindopril and rosuvastatin, the requirements for fixed drug combinations are discussed, as well as clinical scenarios when their use is considered justified.
The CES1 Gene rs2244613 Minor Allele Impact on the Safety Profile of Dabigatran Etexilate: Meta-Analysis
Authors: Abdullaev S. P. , Mirzaev K. B. , Bochkov P. O. , Sychev I. N. , Sychev D. A.
Published: November 2020

Aim. A meta-analysis of studies on the CES1 gene c.1168-33A>C polymorphism (rs2244613) carriage influence on the equilibrium concentration and the risk of bleeding during dabigatran taking.

Material and methods. The search was carried out in the Russian Science Citation Index, Google Academy, Medline PubMed, Embase databases. The meta-analysis included patients who according to the indications (atrial fibrillation, stroke, joint orthopedic surgery) were prescribed dabigatran in various doses. The association was identified in rs2244613 allele C carriers (genotypes AC and CC) and non-carriers (genotype AA). Quantitative synthesis was performed using OpenMetaAnalyst software. In statistical analysis the fixed effects model was used to estimate the influence of the allele C carriage on the any bleeding frequency and the random effects model was used to estimate the influence on the equilibrium plasma concentration level of dabigatran. The homogeneity of the analyzed studies was verified by Cochrane Q-test.

Results. The analysis resulted in selection of 5 works matching all meta-analysis inclusion/exclusion criteria. All selected works included 2030 patients in total. The carriage of the rs2246613 allele C was associated with reduction of risk of any bleeding during dabigatran taking (risk ratio [RR] 0.732, 95% confidence interval [CI] 0.629-0.851; p<0.001). The heterogeneity test did not reveal any reliable differences between the study results (Q=2.183; p=0.535). The level of equilibrium residual concentration of dabigatran was not statistically significant lower for the carriers of C allele of the rs2244613 (mean difference -69.324, 95%CI -236.687-98.039; p=0.417). This might be related to the small sample size and the number of studies included in the meta-analysis. The heterogeneity test did not reveal statistically significant differences between studies (Q=0.388; I2=0%, p=0.534).

Conclusion. The carriage of minor C allelic variant of rs2244613 reduces the risk of any bleeding during dabigatran taking, however, no significant association with decrease in dabigatran concentration was found.
Possible Approaches to Primary Prevention of Cardiovascular Diseases
Authors: Larina V. N. , Mkrtychev D. S. , Kuznetsova V. A. , Tyazhelnikov A. A.
Published: November 2020

In recent years there is a positive trend in the development of preventive medicine, in particular, primary prevention of diseases. However, in most cases, patients seek help from a doctor after the manifestation of the disease, and therefore, early identification of risk factors (RF) remains relevant. Conduction of a large number of studies that are aimed at studying modifiable RF associated with the development of cardiovascular diseases (CVD), allowed the experts of the American Heart Association to develop recommendations “Life's Simple 7”, which makes it possible to structure methods of primary prevention of CVD and minimize the risk of their development. In 2019, experts from the American College of Cardiology presented a simplified version of these recommendations, to improve approaches to primary prevention and their effectiveness not only for doctors but also for patients. Thus, by involving the patient in the decision-making process about follow-up treatment, doctors can achieve a high level of compliance, which is essential for improving the prognosis. The “ABCDE” recommendations, in name of which are reflected the first letters of the leading CVD RF, include such paragraphs as RF assessment, the use of antiaggregating therapy, correction of blood pressure, cholesterol levels, smoking elimination, correction of high glucose levels and diabetes treatment, weight loss, assessment of social and economic factors affecting the morbidity in a particular patient. Despite the undoubted benefit of the “ABCDE” recommendations, some problems of primary prevention currently cannot be solved: the inability to accurately assess social and economic RF; the imperfection of the used CVD risk scales. The updated version of the recommendations allows not only to assess the existing RF of the patient, but also to effectively correct them. In addition, the patient himself can read the recommendations, which improves understanding of the primary prevention importance.
Treatment of Patients with Acute Coronary Syndrome with ST Segment Elevation in Clinical Practice of the Republic of Karelia: the Results of 10-year Register
Authors: Skopets I. S. , Vezikova N. N. , Malafeev A. V. , Malygin A. N. , Litvinova V. A.
Published: November 2020

Aim. To study the clinical course, treatment, and outcomes in the patients with ST segment elevation acute coronary syndrome (STeACS) in real clinical practice

Material and methods. Our study is based on data of 5694 patients who were sequentially hospitalized in the Regional Vascular Center from 01.01.2009 to 01.01.2019 due to STeACS and included in the Federal Hospital Register. Men prevailed (65.8%); the average age was 68 years old. 14.1% of the patients had the history of myocardial infarction (MI) before this hospitalization. The reperfusion strategy, drug therapy, as well as the risks of complications and outcomes in real clinical practice of the Republic of Karelia were analyzed. Descriptive statistics methods were used to evaluate the results.

Results. In the study group a high frequency of reperfusion interventions (83.5%) with a predominance of percutaneous coronary intervention (PCI; 76.2%) was revealed, as well as optimal drug therapy in most patients. Thus, 99.4% of patients took aspirin, 82.8% – clopidogrel, 91.1% – anticoagulants, 91.6% – beta-blockers, 95.6% – statins, 94.2% – angiotensin-converting-enzyme inhibitors/angiotensin II receptors blockers. A risk assessment of hospital and 6-month mortality was performed using GRACE score. The distribution of the hospital risk mortality were the following: 25.7% of patients had a low (49-125 points), 33.7% an average (126-154 points), and 40.6% of patients had a high risk (more than 154 points). At the same time, the risk of 6-month mortality in a half of the patients (51.6%) was low (27-99 points), the average risk (100-127 points) was determined in 23.0% of patients and the high risk (more than 127 points) – in 25.5% of patients. Life threatening complications developed in 38.1% of patients and the most frequent ones were arrhythmias (31.5%). The outcomes at the discharge from the hospital were as follows: 1432 patients (63.5%) had Q MI, 390 (17.3%) – non Q MI, 76 (3.4%) – unstable angina, 21 (0.9%) – MI of unspecified localization and 317 patients (14.1%) – repeated myocardial infarction.

Conclusion. According to the results of a 10-year hospital registry of patients with STeACS, a high frequency of reperfusion interventions and an optimal drug therapy in most patients was revealed. However, to increase the effectiveness of treatment, it is necessary to minimize temporary losses both at the prehospital treatment and during reperfusion.
Doctors’ Adherence to the Guidelines on the Oral Anticoagulants Usage
Authors: Perepech N. B. , Mikhailova I. E. , Tregubov A. V.
Published: November 2020

Aim. To study doctors’ knowledge of the clinical guidelines on the use of oral anticoagulants and identify the reasons for poor adherence.

Material and methods. The results of the 218 questionnaires completed by the doctors trained in the 2018-2019 were analyzed. The questionnaire included 12 items regarding the main aspects of oral anticoagulants use. 71.6% of respondents were cardiologists, 18.8% were therapists (including general practitioners) and 9.6% were representatives of other specialties.

Results. The obtained data show that therapists are worse than cardiologists aware of indications for oral anticoagulants in atrial fibrillation, and do not always correctly assess the risk of thromboembolism. Only 24.4% of therapists consider prescribing rivaroxaban in a dose of 2.5 mg 2 times a day to a patient suffering from myocardial infarction with an ST segment elevation on the electrocardiogram. One third of therapists either do not know or do not support current recommendations regarding oral anticoagulants use in paroxysmal atrial fibrillation. 65.3% cardiologists are inclined to start anticoagulant therapy only in patients at high risk for thromboembolism, while 36.6% therapists are ready to start such treatment even at moderate risk. Respondents' answers to the questionnaire demonstrate their great alertness regarding possible bleeding. Overestimation of the bleeding risk is more often among therapists than cardiologists (44.9% and 17.1%, respectively). More than one third of therapists (36.6%) are ready to recommend a reduced dose of oral anticoagulant to patients without clear reasons. Fear of bleeding has a greater influence on the decision to prescribe an anticoagulant and the choice of treatment regimen for atrial fibrillation than the desire to effectively prevent thromboembolism.

Conclusion. The results of the survey show that the doctors’ adherence to the clinical guidelines’ basic principles of the use of oral anticoagulants among cardiologists is higher than that of therapists. Wherein, even among cardiologists it cannot be considered sufficient. The lack of doctors’ awareness about the identification, assessment, and modification of risk factors for bleeding was revealed.
Postoperative Controls of ventilation tubes in children - by general practitioner or otolaryngologist? Study protocol for a multicenter randomized non-inferiority study (The ConVenTu study)
Authors: Austad Bjarne , Nilsen Ann Helen , Helvik Anne-Sofie , Albrektsen Grethe , Nordgård Ståle , Thorstensen Wenche Moe
Published: November 2020

Background: Otitis media with effusion is the major cause of acquired hearing problems in children. Some of the affected children need surgery with ventilation tubes in the tympanic membrane to reduce ear complaints and to improve hearing, middle ear function and health-related quality of life. This is one of the most common ambulatory surgeries performed on children. Postoperative controls are needed to assess that the tubes are functional, evaluate whether hearing loss has been improved, and to handle potential complications. The follow-up may continue for years and are usually done by otolaryngologists. Nevertheless: there exist no evidence-based guidelines concerning the level of expertise needed for postoperative controls of the ventilation tubes. The aim of this protocol is to describe the ConVenTu study that evaluates whether postoperative controls performed by general practitioners (GPs), represent a safe and sufficient alternative to controls performed by otolaryngologists. Methods/design: Multicenter randomized non-inferiority study conducted in clinical settings in seven hospitals located in Norway. Discharged children with ventilation tubes, aged 3-10 years are allocated randomly to receive postoperative controls by either an otolaryngologist at the hospital where they had ventilation tube surgery or their regular GP. Study participants are enrolled consecutively until 200 patients are included in each group. Two years after surgery we will compare pure tone average of hearing thresholds (primary endpoint) and middle ear function, complication rate, health-related quality of life and the parents’ evaluations of the postoperative care (secondary endpoints). Discussion: This protocol describes the first randomized non-inferiority study of GPs performing postoperative controls after surgery with ventilation tubes. Results from this study may be utilized for deriving evidence-based clinical practice guidelines of the level of postoperative controls after ventilation tube surgery which is safe and sufficient.
Pulling Metallic Glasses Ductile
Authors: Mota Rodrigo Ojeda , Lund Ethen , Sohn Sungwoo , Browne David , Schroers Jan
Published: November 2020

A major shortcoming of most known bulk metallic glasses (BMGs) is that they lack sufficient ductility, or toughness, when fabricated under conditions resulting in bulk glass formation. To address this, processing techniques to improve ductility that mechanically affect the glass have been developed, however it remains unclear for which BMG formers they work, and by how much. We show here that, instead of manipulating the glass state, an applied strain rate can excite the liquid, and simultaneous cooling results in freezing of the excited liquid into a glass with a higher fictive temperature. Microscopically, straining causes the structure to dilate, hence “pulling” the structure energetically up the potential energy landscape. Upon further cooling, the resulting excited liquid freezes into an excited glass that exhibits enhanced ductility. We use Zr44Ti11Cu10Ni10Be25 to demonstrate how pulling BMGs through this excited liquid cooling methods can lead to a tripling of the bending ductility.
Pre-Transplant Donor HBV DNA+ and Male Recipient are Independent Risk Factors for Treatment Failure in HBsAg+ Donors to HBsAg- Kidney Transplant Recipients
Authors: Wang Xianding , Feng Shijian , Liu Jinpeng , Song Turun , Huang Zhongli , Fan Yu , Shi Yunying , Chen Liyu , Xu Zilin , Li Xiaohong , Wang Li , Lin Tao
Published: November 2020

Background: In order to lighten the burden of organ shortage around the world, using potential infectious donor might be an option. However, scarce evidences have been published on Kidney transplantation (KTx) from hepatitis B surface antigen (HBsAg)+ donors to HBsAg- recipients [D(HBsAg+)/R(HBsAg-)] without hepatitis B virus (HBV) immunity. Here, we reported the results of D(HBsAg+/HBV DNA- or +)/R(HBsAg-) living KTx recipients with or without HBV immunity.Methods: We retrospectively identified 83 D(HBsAg+)/R(HBsAg-) living KTx recipients, and 83 hepatitis B core antibody (HBcAb)+ living donors to HBcAb- recipients [D(HBcAb+)/R(HBcAb-)] were used as control group by reviewing medical archives and propensity score matching. Treatment failure (defined as any HBV serology conversion, liver injury, graft loss, or recipient death) is the primary end-point.Results: 24 donors (28.9%) were HBV DNA+, and 20 recipients had no HBV immunity in the D(HBsAg+)/R(HBsAg-) group pre-transplantation. HBV prophylaxis was applied in all D(HBsAg+)/R(HBsAg-) recipients, however, we did not use any in D(HBcAb+)/R(HBcAb-) group. We observed a significant higher treatment failure in D(HBsAg+)/R(HBsAg-) than D(HBcAb+)/R(HBcAb-) group (21.7% vs. 10.8%, P<0.001). Interestingly, no significant difference was found between groups on HBV seroconversion, liver and graft function, rejection, infection, graft loss, or death. However, 2/20 recipients without HBV immunity in the D(HBsAg+)/R(HBsAg-) group became HBV DNA+ or HBsAg+, none observed in the D(HBcAb+)/R(HBcAb-) group. HBV DNA+ donor and male recipient were significant risk factors for treatment failure.Conclusion: D(HBsAg+)/R(HBsAg-) should be considered for living kidney transplantation, but with extra caution on donor with HBV DNA+ and male candidates.
Increased Expression of Fatty Acid and ABC Transporters Enhances Seed Oil Production in Camelina
Authors: Cai Guangqin , Wang Geliang , Kim Sang-Chul , Li Jianwu , Zhou Yongming , Wang Xuemin
Published: November 2020

Background: Lipid transporters play an essential role in lipid delivery and distribution, but their influence on seed oil production in oilseed crops is not well studied. Results: Here we examined the effect of two lipid transporters, FAX1 (fatty acid export1) and ABCA9 (ATP-binding cassette transporter subfamily A9) on oil production and lipid metabolism in the oilseed plant Camelina sativa. Overexpression (OE) of FAX1 and ABCA9 increased seed weight and size, with FAX1-OEs and ABCA9-OEs increasing seed length and width, respectively, whereas FAX1/ABCA9-OEs increasing both. FAX1-OE and ABCA9-OE displayed additive effects on seed oil content and seed yield. Also, OE of FAX1 and ABCA9 affected membrane lipid composition in developing siliques, especially on phosphatidylcholine, phosphatidylethanolamine, and phosphatidylglycerol. The expression of some genes involved in seed oil synthesis was increased in developing seeds of FAX1- and/or ABCA9-OEs. Conclusions: These results indicate that increased expression of FAX1 and ABCA9 can potentially be applied to improving camelina oil production.
Crucial Conversations for High Risk Populations Before Surgery: Advance Care Planning in a Preoperative Setting
Authors: Patel Roma Gautam , Torke Alexia , Nation Barb , Cottingham Ann , Hur Jennifer , Gruber Rachel , Sinha Shilpee
Published: November 2020

Background: High-risk patients undergoing elective surgery may experience life-threatening complications. Preoperative assessment clinics provide an opportunity to conduct Advance Care Planning but it is unknown how often this is accomplished or subsequently needed for goals of care discussions. Objective: 1) assess the relationship between advance directives with readmissions and mortality at one year 2) qualitatively examine clinical events that occurred for patients who died during follow-up.Design: This was an observational cohort study conducted via chart review. Patients were followed for one year.Participants: Four hundred patients who were undergoing preoperative evaluation for elective surgery at two academic hospitals. Main measures: The prevalence of advance directives at the time of surgery, prevalence of advance directives in the electronic medical record during the one year follow-up period, readmissions and mortality at one year. Key Results: Three hundred and ninety patients were included. There were 102 (26.4%) patients were readmitted, which was not associated with having an AD on file. Seventeen (4.4%) filed an AD during follow-up. Twelve of 19 (63%) patients who died had an AD on file at the time of death. There was a significant association between having an AD at any time with mortality (chi-square p-value <0.001). Total mortality for the cohort was 4.9%. Of the 19 patients who died, seven (37%) underwent resuscitation, four of whom had an AD on file. Conclusions: A minority of patients who die within a year after major surgery have an AD, highlighting the missed opportunity to conduct advance care planning in a preoperative clinic.
Determination of Critical Criterion of Tensile-shear Failure in Brazilian Disc Based on Theoretical Analysis and Meso-macro Numerical Simulation
Authors: Zhao Zenghui , Yang Peng , Chen Shaojie , Yin Dawei , Liu Hao , Chen Bosen
Published: November 2020

To define the critical criterion between tensile failure and shear failure of Brazilian disc is crucial for determination of tensile strength under combination of tensile and compressive stresses. Although Griffith's tensile failure criterion is consistent with theoretical solution of radial splitting disc, there are still some shortcomings in which the compression-tension ratio is regarded as a constant and the critical criterion only depend on single parameter of tensile strength. Therefore a critical criterion for tensile-shear failure including tensile truncation was proposed firstly based on Mohr-Coulomb criterion. Then, a new calculation method of shear strength parameters was deduced based on the critical state stress circle. Finally, effective diameter and range of compression-tension ratio of Brazilian disc under tensile failure are proposed, and failure process of Brazilian disc from meso to macro is carried out based on numerical simulation. The results show that the modified Mohr-Coulomb criterion can be determined by two indexes of compressive strength and tensile strength. The deduced compression-tension ratio is in good agreement with experiment results. The accuracy of tensile strength test results is closely related to this ratio. When the ratio is greater than 6, failure of rock can be regarded as ideal tensile failure. If the ratio is less than 6, wedge-shape failure in loading area is the main failure type. On this condition, even if radial crack occurs, it is still not considered to be caused by pure tension.
Distribution and Factors Associated With Urogenital Schistosomiasis in Tiko Health District, A Semi-urban Setting, South West Region, Cameroon
Authors: Green Adeline Enjema , Anchang-Kimbi Judith Kuoh , Wepnje Godlove Bunda , Ndassi Vicky Daonyle , Kimbi Helen Kuokuo
Published: November 2020

Background: Increased risk of schistosomiasis in peri-urban and urban towns is not uncommon. An epidemiological survey was carried out in the Tiko Health District (THD), an unmapped transmission focus for urogenital schistosomiasis (UGS), to assess the distribution, intensity and risk factors associated with the occurrence of UGS in the District. Methods: In this cross-sectional survey, 1029 individuals were enrolled from twelve communities purposively selected from four health areas (Likomba, Holforth, Holforth-Likomba and Mutengene) between June and August 2018. A semi-structured questionnaire was used to collect information on sociodemographic and water contact behaviour. Urine samples were examined for S. haematobium infection using test strip, filtration and microscopy methods. Bivariate and binary logistic regression analyses were used to identify predictors of infection. Results: The overall prevalence of UGS in the Likomba, Holforth-Likomba and Holforth was 31.5% (95% CI: 28.3 – 34.8). Schistosoma haematobium infection was not found in Mutengene HA. Infection was unevenly distributed among the HAs, Holforth-Likomba and Holforth being the most and least affected, respectively. The prevalence of infection varied (p < 0.001) among the affected communities, ranging from 0 – 56.9%. Infection status of the community related positively (p < 0.001) with proximity to stream (< 100m), the degree of contact (II) with water and number of improved water sources. Younger age group (5 – 14 years) (aOR = 3.6, 95% CI: 1.1 – 12.0) and intense water contact (Degree II) (aOR = 5.2, 95% CI: 3.4 – 8.1) were associated with increased risk of infection as well as higher worm egg load excretion. Conclusion: Generally, THD is a moderate risk endemic focus for UGS but prevalence higher than 50% was observed in some communities. These findings warrant immediate mass chemotherapy with praziquantel to reduce morbidity. Provision of portable water and health education are proposed measures to reduce and eventually eliminate transmission in the area.
Geospatial Epidemiology of Leprosy in Northwest Bangladesh: A 20-year Retrospective Observational Study
Authors: Bulstra Caroline , Blok David J. , Alam Khorshed , Butlin C. Ruth , Roy Johan Chandra , Bowers Bob , Nicholls Peter , de Vlas Sake J. , Richardus Jan Hendrik
Published: November 2020

Background: Leprosy is known to be unevenly distributed between and within countries. High risk areas or ‘hotspots’ are potential targets for preventive interventions, but the underlying epidemiologic mechanisms of these areas remain not fully understood. In this study, we identified and characterized leprosy hotspots in Bangladesh, a high endemic country. Methods: Data were used from four high-endemic districts in ﻿northwest Bangladesh, including 20,623 registered cases (among ~7 million population) between January 2000 and April 2019. Incidences per union were calculated using geospatial population density estimates. A geospatial Poisson model was used to detect incidence hotspots over three (overlapping) 10-year timeframes: 2000-2009, 2005-2014 and 2010-2019. Ordinal regression models were used to assess whether patient characteristics were significantly different for cases outside hotspots, as compared to cases within weak (i.e. relative risk (RR) of one to two), medium (i.e. RR of two to three), and strong (i.e. RR higher than three) hotspots.Results: New case detection rates dropped from 44/100,000 in 2000 to 10/100,000 in 2019. Statistically significant hotspots were identified during all timeframes, and were often located at areas with high population densities. The RR for leprosy was up to 12 times higher for inhabitants of hotspots than for people living outside hotspots. Within strong hotspots (1,930 cases among less than 1% of the population), significantly more child cases (i.e. below 15 years of age) were detected, indicating recent transmission. Cases in hotspots were not significantly more likely to be detected actively. Conclusions: Leprosy showed a heterogeneous distribution with clear hotspots in northwest Bangladesh throughout a 20-year period of decreasing incidence. Findings confirm that hotspots have higher active transmission and are not solely the result of active case finding strategies.
Prevention and Emergency Management in Cardiac Intensive Care Units After Effective Control of the COVID-19: A Chinese Tertiary Hospital Experience
Authors: Wu Zhijian , Li Muzheng , Chen mingxian , Liu Yanxia , Tudahun Ilyas , Peng Zengjin , Hu Qingdan , Qi Nenghua , Chen Yaqin , Tang Jianjun
Published: November 2020

ObjectiveAfter effective control of the 2019 Coronavirus Disease (COVID-19) in China, how to reopen the hospital and avoid the outbreak in the hospital is a problem that needs to be carefully considered. The aim of this descriptive study is to share the experience of prevention and emergency management in our hospital and cardiac intensive care units (CCU) when medical services were reopened after COVID-19 was under control.Methods and ResultsWe conducted a retrospective, descriptive and single-centre study. Management strategy and data were collected from the Second Xiangya Hospital of Central South University, Hunan and CCU. We have implemented some strategies to prevent the prevalence of covid-19 in hospitals while ensuring that more critical cardiac patients can be admitted to CCU. These measures are summarized as follows: 1. gradually expanding medical services; 2. risk classification and routine strict screening of patients admitted to CCU; 3. strengthening the management of hospitalized patients, accompanying person and medical staffs; 4. strengthening screening and isolation of suspected cases of inpatients; 5. other measures such as strengthening training of medical workers, protective equipment and environmental management, and so on.ConclusionWe share the experience of prevention and emergency management in our hospital and CCU when medical services were reopened after effective control of the COVID-19 epidemic and hope it will be helpful for cardiologist or critical care physician all around the world to continue to provide critical care in a safe and orderly manner.
Computational Flow Cytometric Analysis to Detect Epidermal Subpopulations In Human Skin
Authors: Zhang Lidan , Cen Ying , Huang Qiaorong , Li Huifang , Mo Xianming , Meng Wentong , Chen Junjie
Published: November 2020

BackgroundThe detection and dissection of epidermal subgroups could lead to an improved understanding of skin homeostasis and wound healing. Flow cytometric analysis provides an effective method to detect the surface markers of epidermal cells while producing high-dimensional data files.MethodsA 9-color flow cytometric panel was optimized to reveal the heterogeneous subgroups in the epidermis of human skin. The subsets of epidermal cells were characterized using automated methods based on dimensional reduction approaches (viSNE) and clustering with Spanning-tree Progression Analysis of Density-normalized Events (SPADE).ResultsThe manual analysis revealed differences in epidermal distribution between body sites based on a series biaxial gating starting with the expression of CD49f and CD29. The computational analysis divided the whole epidermal cell population into 25 clusters according to the surface marker phenotype with SPADE. This automatic analysis delineated the differences between body sites. The consistency of the results was confirmed with PhenoGraph.ConclusionA multicolor flow cytometry panel with a streamlined computational analysis pipeline is a feasible approach to delineate the heterogeneity of the epidermis in human skin.
Integrated Analysis of Methylation-driven Genes and Pretreatment Prognostic Factors in Patients with Hepatocellular Carcinoma
Authors: He Dongsheng , Cai Lifang , Huang Weiming , Xie Xuehua , You Mengxing , Liao Shengyin
Published: November 2020

Background: The potential reversibility of aberrant DNA methylation indicates an opportunity for oncotherapy. This study aimed to integrate methylation-driven genes and pretreatment prognostic factors and then construct a new individual prognostic model in hepatocellular carcinoma (HCC) patients.Methods: The gene methylation, gene expression dataset and clinical information of HCC patients were downloaded from The Cancer Genome Atlas (TCGA) database. Methylation-driven genes were screened with a Pearson’s correlation coefficient less than -0.3 and a P value less than 0.05. Univariable and multivariable Cox regression analyses were performed to construct a risk score model and identify independent prognostic factors from the clinical parameters of HCC patients. The least absolute shrinkage and selection operator (LASSO) technique was used to construct a nomogram that might act to predict an individual’s OS, and then C-index, ROC curve and calibration plot were used to test the practicability. The correlation between clinical parameters and core methylation-driven genes of HCC patients was explored with Student’s t-test.Results: In this study, 44 methylation-driven genes were discovered, and three prognostic signatures (LCAT, RPS6KA6, and C5orf58) were screened to construct a prognostic risk model of HCC patients. Five clinical factors, including T stage, risk score, cancer status, surgical method and new tumor events, were identified from 13 clinical parameters as pretreatment-independent prognostic factors. To avoid overfitting, LASSO analysis was used to construct a nomogram that could be used to calculate the OS in HCC patients. The C-index was superior to that from previous studies (0.75 vs 0.717, 0.676). Furthermore, LCAT was found to be correlated with T stage and new tumor events, and RPS6KA6 was found to be correlated with T stage.Conclusion: We identified novel therapeutic targets and constructed an individual prognostic model that can be used to guide personalized treatment in HCC patients.
Release Characteristics of Enoxaparin Sodium Loaded Polymethylmethacrylate Bone Cement
Authors: Sun Hui , Ma Xinzhe , Li Zhiyong , Liu Jianning , Wang Wei , Qi Xiangbei
Published: November 2020

Background: This study aimed to prepare the polymethylmethacrylate (PMMA) bone cement release system with different concentrations of enoxaparin sodium (ES) and to investigate the release characteristics of ES after loading into the PMMA bone cement. Methods: In the experimental group, 40g Palacos®R PMMA bone cement was loaded with various amount of ES 4000, 8000, 12000, 16000, 20000, and 24000 AXaIU, respectively. The control group was not loaded with ES. Scanning electron microscopy (SEM) was used to observe the surface microstructure of the bone cement in the two groups. In the experiment group, the mold was extracted continuously with pH7.4 Tris-HCL buffer for 10 days. The extract solution was collected every day and the anti-FXa potency was measured. The experiment design and statistical analysis were conducted using a quantitative response parallel line method. Results: Under the SEM, it was observed that ES was filled in the pores of PMMA bone cement polymer structure and released from the pores after extraction. There was a burst effect of the release. The release amount of ES on the first day was 0.415, 0.858, 1.110, 1.564, 1.952 and 2.513 respectively from the six groups with various ES loading amount of 4000, 8000, 12000, 16000, 20000 and 24000 AXaIU, all reaching the peak of release on the first day. The release decreased rapidly on the next day and entered the plateau phase on the fourth day. Conclusion: PMMA bone cement can be used as a carrier to effectively release enoxaparin sodium within a short term.
pUDK-HGF Gene Therapy to Relieve CLI Rest Pain and Ulcers: A Phase II, Double-Blind, Randomized Placebo-Controlled Trial
Authors: Gu Yongquan , Cui Shijun , Liu Changjian , Zhao Jichun , Li Ming , Li Yiqing , Yang Xinglong , Lv Bonan , Li Mingzhang , Zhao Wenguang , Guo Wei , Huang Jianhua , Huang Wen , Qiu Zhenming , Zhao Jun , Yin Ping , Qiu Tingting , zhu Dan , Sun Wenjie , Lu Yuxin , Cheng Xiaochen , Du Li , Zhang Qinglin , Wu Zuze
Published: November 2020

BackgroundCritical limb ischemia (CLI) has become a global problem. Less invasive therapy is needed. Hepatocyte growth factor (HGF) is one of the most potent angiogenic protein and the plasmid encoding human hepatocyte growth factor (HGF) is considered to be the most promising gene therapy for CLI.MethodsWe conducted a randomised, double-blind, placebo-controlled trial to assess the efficacy and safety of intramuscular injection of plasmid pUDK-HGF expressing HGF. Pain-at-rest patients and ulcer patients were enrolled as two cohorts and randomized to receive intramuscular injection of placebo or pUDK-HGF. Efficacy assessments included pain scale, ulcer size, TBI, ABI, and TcPO2 over 180 day. Safety analysis was based on the occurrence of adverse events. ResultsIn the pain-at-rest cohort, the proportion of patients with complete pain relief after receiving pUDK-HGF injections was significantly higher than that of the placebo group on day 180 (p = 0.0148). More responders with >50% pain reduction were also observed in the pUDK-HGF groups than in the placebo groups (p = 0.0168). In the ulcer cohort of patients, pUDK-HGF treatment tended to be superior to the placebo in the percentage of patients with both complete ulcer healing and >50% ulcer healing. No significant differences in the incidence of adverse events or serious adverse events were observed among the groups. ConclusionIntramuscular injection of pUDK-HGF is safe and can significantly reduce pain-at-rest and possibly promotes ulcer healing in CLI patients. The mid dose pUDK-HGF (6 mg) was the most efficacious, and is an appropriate dose for phase III clinical trial. Clinical Trial RegistrationChina Food and Drug Administration number: 2013L00637, Data: 2013/03/15. China Clinical Trial Registry URL: http://www. chinadrugtrials.org.cn. Unique Identifier: 20130378)
Low Surgical Morbidity and Mortality After Fast-Track Liver Surgery for Colorectal Liver Metastases: A Study of Complications in a High-Volume Centre
Authors: Egeland Charlotte , Rostved Andreas Arendtsen , Schultz Nicolai Aagaard , Pommergaard Hans-Christian , Daugaard Thomas Røjkjær , Thøfner Line Buch , Hillingsø Jens G. , Rasmussen Allan
Published: November 2020

BackgroundFor colorectal liver metastases, surgery is a high-risk procedure due to perioperative morbidity. The objective was to assess complications after fast-track liver surgery for colorectal liver metastases.MethodsAll patients were treated according to the same fast-track programme. Complications were graded according to the Clavien-Dindo classification for patients undergoing surgery from 2013 to 2015. Correlation between complications and length of stay was analysed by multivariate linear regression.Results564 patient cases were included of which three patients died within 3 months (0.53%, 95% CI: 0.17-1.64%). Complications were common with Grade 2 in 167 patients (30%) and ≥Grade 3a in 93 (16%). Patients without complications had a mean length of stay of 4.1 days, which increased with complications: 1.4 days (95% CI: 1.3 – 1.5) for Grade 2, 1.7 days (1.5 – 2.0) for Grade 3a, 2.3 days (1.7 – 3.0) for Grade 3b, 2.6 days (1.6 – 4.2) for Grade 4a, and 2.9 days (2.8 – 3.1) for Grade 4b. Following were associated with increased length of stay: complication severity grade, liver insufficiency, ascites, and biliary, cardiopulmonary, and infectious complications. Conclusions﻿Complications after liver surgery for colorectal liver metastases, in a high-volume centre, were associated with low mortality, few severe complications, and short but increased length of stay.
Short Uncemented Femoral Component for Hip Revision: Prognosis and Risk Factors Associated With Failure
Authors: Liu Zeming , Liu Bo , Zhang Bingshi , Ma WenHui , Wu Tao , Huo Jia , Liu Sikai , Han Yongtai
Published: November 2020

BackgroundThe application of short uncemented femoral stem is partially restricted in revision surgery. In some patients with mild to moderate bone deficiency, short uncemented stem is certainly a choice. This study will demonstrate the therapeutic effect and unsuitable situation for short uncemented stem revision.MethodsPatients who undergone hip revision from January 2005 to December 2015 were retrospectively analyzed in this study. Preoperative radiological images were evaluated to help estimating the bone deficiency around hip joint. Mann-Whitney U test was performed for comparison between continuous variables. Chi-square test was performed for comparison between categorical variables. Cox regression analysis was used to assess the association between potential risk factors and failure of revision surgery.ResultsA total of 381 patients were retrospectively reviewed. The mean follow-up time was 71.05±16.54 months. The mean time from primary revision surgery to secondary revision surgery was 16.41±17.47 months. According to the survival status of femoral component at final follow-up, patients were divided into two groups. Cox regression analysis revealed that the risk for revision failure approximately increased by 5.6% for every year of age increase (HR=1.056, 95%CI=1.012–1.102). Osteoporosis was another independent risk factor for revision failure (HR=2.802, 95%CI=1.097–7.157). The strongest risk factor was intraoperative periprosthetic femoral fracture during revision surgery in this study (HR=5.477, 95%CI=2.156–13.913).Conclusion﻿Three risk factors for failure are identified, such as aging, osteoporosis and intraoperative periprosthetic femoral fracture during revision surgery. Therefore, short uncemented femoral stem should be implanted in these patients with additional caution.
Association of Monocytes and the Monocyte/high-density Lipoprotein Ratio With Intracranial and Extracranial Atherosclerotic Stenosis
Authors: Liu Zhu , Fan Qingli , Wu Shizheng , Lei Yancheng , Yang Wenfang
Published: November 2020

Background and aims: Although the monocyte/high-density lipoprotein ratio (MHR) has been shown to be a potential inflammatory marker of cardiovascular and cerebrovascular diseases, there are few studies on the relationship between intracranial and extracranial atherosclerotic stenosis degree and its distribution.Methods: A total of 271 patients were admitted for digital subtraction angiography (DSA) examination. (1) The non-stenosis group and the stenosis group were compared, and the artery was grouped according to the degree of intracranial and extracranial atherosclerotic stenosis (if ≥2 branches were stenotic, the artery with the most severe stenosis was used). (2) According to the locations of the intracranial and extracranial artery stenosis groups.clinical baseline data and laboratory indexes of each group of patients were collected.Results: (1) MHR (odds ratio (OR)=1.119, P<0.001), age (OR=1.057, P=0.007), and lymphocyte (OR=0.273, P=0.002) could significantly affect cerebral atherosclerotic stenosis, the AUC (area under the ROC curve) of MHR was 0.82, and the optimal diagnostic value was 0.486. Further analysis of the mild, moderate, and severe stenosis groups showed that MHR (OR=1.07, P<0.001) significantly affected the severity of stenosis in patients. (2) According to the analysis of stenosis at different sites, the rate of extracranial artery stenosis in patients who smoked (OR=3.86, P=0.023) and had a reduced lymphocyte level (OR=0.202, P=0.001) was significantly higher than that in patients who smoked (OR=3.86, P=0.023). With increasing age, the rate of extracranial and extracranial artery stenosis increased significantly. With the increase in MHR level, the stenosis rate of each group was significantly higher than that of the non-stenosis group.Conclusion: MHR has predictive value for the diagnosis of intracranial and extracranial atherosclerotic stenosis and is correlated with the degree and distribution of stenosis.