bluuebunny/crossref_metadata_2025 huggingface dataset:
Risk factors for stillbirth and early neonatal death: A case-control study in tertiary hospitals in Addis Ababa, Ethiopia
Authors: Weldetensaye Eskinder Kebede , Kekulawala Melani
Published: July 2020

Background: Globally, Ethiopia is ranked seventh in the absolute number of stillbirths. Attempts to decrease this number have been obstructed by an inadequate understanding of the risk factors leading to stillbirth and early neonatal death in Ethiopia. This study was conducted in two tertiary hospitals in Addis Ababa, Ethiopia, to identify the risk factors for stillbirth and neonatal death in this setting.Methods: This case-control study was conducted between October 2016 and May 2017 at Tikur Anbessa Hospital (TAH) and Gandhi Memorial Hospital (GMH). All enrolled women who had a stillbirth or early neonatal death during this period were included as cases and a random sample of women delivering at the hospital was selected to enroll as controls for a 2:1 ratio of controls to cases. Data on potential risk factors were retrieved from medical records including health passports, delivery records, and treatment charts. Statistical differences in background and social characteristics of cases and controls were determined by t-test and chi-squared (or fisher’s exact test) for quantitative and categorical variables, respectively. Binary logistic regression analysis was completed to determine any associations between risk factors and stillbirth/early neonatal death.Results: During the study period, 366 women delivering at the hospitals were enrolled as cases and 711 women delivering at the hospitals were enrolled as controls. During the study period, hospital records indicated that the estimated stillbirth and neonatal death rates were 30.7 per 1000. Neonatal causes (43.4%) were the most common, followed by antepartum (32.5%) and intrapartum (24.5%). Risk factors for stillbirths and early neonatal death were maternal education (aOR 1.747, 95%CI 1.098-2.780), parity (aOR 1.114, 95%CI .058- 2.484), previous stillbirth (aOR 9.447, 95%CI 6.245-14.289), previous preterm birth (aOR 3.620, 95%CI 2.363-5.546), and previous child with congenital abnormality (aOR 2.190, 95% 1.228-3.905), and antepartum hemorrhage during pregnancy (aOR 3.273, 95% 1.523-7.031).Conclusion: Antepartum hemorrhaging is the only risk factor in our study amenable for direct intervention. Efforts should be maximized to improve patient education and antenatal and obstetric services, particularly for women who have a history of obstetric complications identified as risk factors.
Effect of Health Transformation Plan on the Public Hospitals Performance Indicators; a case study in Iran
Authors: Ranjbar Mohammad , Jafari Hassan , Baziyar Mohammad , Pakdaman Mohsen , Pirasteh Vahid
Published: July 2020

Introduction: Health systems need constant changes and reforms in their structure in order to adapt to changing conditions and meet the needs of society. One of the fundamental changes in the health system of Iran is the health transformation plan (HTP), the effects of which must be examined from different aspects. Therefore, the purpose of this study is to investigate the effect of HTP on the performance indicators of public hospitals in the context of Yazd. Methods: The present cross-sectional study was carried out in all public hospitals in Yazd. Six performance indicators were examined on a monthly basis and in two time periods of 12 months before and after the implementation of HTP. Data were analyzed using SPSS software program version 22, the paired T-test and the Interrupted Time Series model. Findings: The implementation of the health transformation plan did not have a significant effect on the bed rotation distance, average length of stay and the ratio of surgical operations to bed indicators (p> 0.05). However, it had a statistically significant effect on the level and trend of mortality and hospitalization rates (p <0.05). Moreover, the implementation of HTP had a significant effect on the level of the bed occupancy indicator (P <0.05), but did not have a significant effect on the trend of this indicator (p> 0.05).Conclusion: Based on the research findings, all the selected indicators changed to some extent after the implementation of HTP, which in a way showed the effect of this plan on the performance of hospitals. Therefore, the continuation of such a plan, provided that sustainable financial resources are planned and human and physical resources are organized properly, can be an important step towards achieving universal health coverage and increasing justice in access to services.
Assessment of Isokinetic Trunk Muscle Strength and its Association with Health- Related Quality of Life in Patients with Degenerative Spinal Deformity
Authors: Yang Sen , Chen Can , Du Shiyu , Tang Yong , Li Kai , Yu Xueke , Tan Jiulin , Zhang Chengmin , Rong Zhigang , Xu Jianzhong , Wu Wenjie , Luo Fei
Published: July 2020

Background: A considerable portion of the elderly population are increasingly afflicted by degenerative spinal deformity (DSD), which seriously affects patient health-related quality of life (HQOL). This index is used across many studies to show correlations between radio-graphical alignment, disability, and pain in patients with DSD. However, imaged structural deformity represents only one aspect for consideration, namely, the disability effect of DSD.We assessed the isokinetic strength of trunk muscle in patients with degenerative spinal deformity (DSD), and investigated its relationship with health-related quality of life (HQOL).Methods: In total, 38 patients with DSD (DSD group) and 32 healthy individuals (control group) were recruited. Both groups were homogeneous for age, weight, height and body mass index (BMI). Assessments were performed using the isokinetic dynamometer IsoMed-2000; trunk extensor, flexor strength and flexion/extension (F/E) ratios were explored concentrically at speeds of 30°, 60° and 120° per second. The grip strength of both hands was measured using a hand-held dynamometer. Visual analogue scale (VAS) scores, the Oswestry Disability Index (ODI), a Roland-Morris disability questionnaire (RDQ), and a 36-item Short Form Health Survey (SF-36) evaluated patient HQOL. Correlations between trunk strength and HQOL were analyzed.Results: When compared with the control group, the DSD group showed lower trunk extensor strength at three velocity movements, and higher F/E ratios at 60° and 120°/s (p < 0.05). Both groups exhibited similar trunk flexor strength and grip strength (p > 0.05). In DSD group，trunk extensor strength at 60°/s was negatively associated with ODI and RDQ (p < 0.05). A negative relationship between trunk flexor strength at 120°/s and ODI was also recorded (p < 0.05). In addition, trunk extensor strength at 60°/s and trunk flexor strength at 120°/s were positively correlated with physical functioning and role-physical scores according to the SF-36 (p < 0.05). Conclusions: We identified isolated trunk extensor myopathy in DSD, which causes an imbalance in trunk muscle strength. Isokinetic trunk extensor strength at 60°/s and trunk flexor strength at 120°/s can predict disability, and decrease physical HQOL in DSD patients.
Development and External Evaluation of Predictions Models for Mortality of COVID-19 Patients using Machine Learning Method
Authors: Li Simin , Lin Yulan , Zhu Tong , Fan Mengjie , Xu Shicheng , Qiu Weihao , Chen Can , Li Linfeng , Wang Yao , Yan Jun , Wong Justin , Naing Lin , Wang Minghuan , Qin Chuan , Song Jia , Xu Shabei , Liu Zheng
Published: July 2020

Background To develop and evaluate the prognostic machine-learning model for mortality in patients with coronavirus disease 2019 (COVID-19).Methods Clinical data of confirmed COVID-19 were retrospectively collected from Wuhan between 18th January and 29th March 2020. Gradient Boosting Decision Tree (GBDT), logistic regression (LR) model, and simplified LR with selected 5 features (LR-5) model were built to predict the mortality of COVID-19. 5-fold area under curve (AUC), accuracy, positive predictive value (PPV), and negative predictive value (NPV) were calculated and compared between models.Results A total of 2,924 patients were included in the final analysis, 257(8.8%) of whom died during hospitalization and 2,667 (91.2%) survived. There were 21(0.7%) mild cases, 2,051(70.1%) moderate case, 779(26.6%) severe cases, and 73(2.5%) critically severe cases of COVID-19 on admission. The overall 5-fold AUC was observed highest in GBDT model (0.941), followed by LR (0.928) and LR-5 (0.913). The diagnostic accuracy were 0.889 in GBDT, 0.868 in LR and 0.887 in LR-5. GBDT model also showed the highest sensitivity (0.899) and speciality (0.889). The NPV of all three models exceeded 97%, while the PPV were relatively low in all models, 0.381 for LR, 0.402 for LR-5 and 0.432 for GBDT. In subgroups analysis with severe cases only, GBDT model also performed the best with a accuracy of 0.799 and 5-fold AUC (0.918).Conclusion The finding revealed that mortality prediction performance of the GBDT was superior to the LR models in confirmed cases of COVID-19, regardless of disease severity.
Dose Response of a Novel Exogenous Ketone Supplement on Physiological, Perceptual, and Performance Parameters
Authors: Prins Philip , D’Agostino Dominic P. , Rogers Christopher Q. , Ault Dana L. , Welton Gary L. , Jones Dalton W. , Henson Samuel R. , Rothfuss Tyler J. , Aiken Kylie G. , Hose Jantzen L. , England Emilia L. , Atwell Adam D. , Buxton Jeffrey D. , Koutnik Andrew P.
Published: July 2020

Background: Interest into the health, disease, and performance impact of exogenous ketone bodies has rapidly expanded due to their multifaceted physiological and signaling properties but limiting our understanding is the isolated analyses of individual types and dose/dosing protocols. Methods: Thirteen recreational male distance runners (24.8±9.6y, 72.5±8.3kg, VO2max 60.1±5.4ml/kg/min) participated in this randomized, double-blind, crossover design study. The first two sessions consisted of a 5-km running time trial (TT) familiarization and a VO2max test. During subsequent trials, subjects were randomly assigned to one (KS1:22.1g) or two (KS2:44.2g) doses of beta-hydroxybutyrate (βHB) and medium chain triglycerides (MCTs) or flavor matched placebo (PLA). Blood R-βHB, glucose, and lactate concentrations were measured at baseline (0-min), post-supplement (30 & 60mins), post-exercise (+0min, +15mins). Time, HR, RPE, affect, RER, VO2, VCO2, and VE were measured during exercise. Cognitive performance was evaluated prior to and post-exercise. Results: KS significantly increased R-βHB, with more potent and prolonged elevations in KS2, illustrating an administrative and dosing effect. R-βHB was significantly decreased in KS1 compared to KS2 illustrating a dosing and exercise interaction effect. Blood glucose elevated post-exercise but was unchanged across groups. Blood lactate significantly increased post-exercise but was augmented by KS administration. Gaseous exchange, respiration, heart rate, affect, RPE, and exercise performance was unaltered with KS administration. However, clear responders and none-responders were indicated. KS2 significantly augmented cognitive function in pre-exercise conditions, while exercise increased cognitive performance for KS1 and PLA to pre-exercise KS2 levels. Conclusion: Novel βHB+MCT formulation had a dosing effect on R-βHB and cognitive performance, an administrative response on blood lactate, while not influencing gaseous exchange, respiration, heart rate, affect, RPE, and exercise performance.
Objectively Measured Physical Activity Patterns in Children With Overweight and (Morbid) Obesity Across Different Weight Categories, Age Groups and Gender; Baseline Data of a Multidisciplinary Tailored Intervention Program
Authors: Velde Gabrielle ten , Plasqui Guy , Dorenbos Elke , Winkens Bjorn , Vreugdenhil Anita
Published: July 2020

BackgroundReduced physical activity (PA) is associated with childhood obesity and is a target for intervention. This study aimed to assess objectively measured PA patterns in Dutch children across weight categories, age groups and gender at the start of a lifestyle intervention.Methods202 children with overweight and (morbid) obesity (55% girls, 12 ± 3y of age, BMI z-score + 3.15 ± 0.73), referred to the Centre for Overweight Adolescents and Children’s Healthcare (COACH, Maastricht UMC+) were included. Children were categorized as overweight, obese or morbidly obese according to their BMI z-score. PA was measured with the GT3X Actigraph accelerometer.ResultsPA levels in children with morbid obesity were higher compared to children with obesity, also after correction for age and gender (corrected difference (B) 118 counts per minute (cpm), p = .006). Sedentary behaviour (SB) was lower in children with morbid obesity compared to children with obesity (B -51 min/day, p = .018). Girls performed significantly less moderate to vigorous PA than boys (B -11 min/day, p < .001) and with increasing age, children performed less PA (B -46 cpm, p < .001) and SB increased (B 18 min/day, p < .001).ConclusionWeight category morbid obesity, lower age and male gender were positively associated with PA and negatively with SB. These findings highlight the need for tailored PA promotion.Trial registration: The trial is registered with Clinicaltrials.gov NCT02091544. Registration date: March, 19th, 2014. (https://clinicaltrials.gov/ct2/show/NCT02091544?term=NCT02091544&draw=2&rank=1)
Secondary pneumothorax as a potential marker of apatinib efficacy in osteosarcoma: a multicenter analysis
Authors: Tian Zhichao , Yang Yang , Gao Songtao , Zhao Yao , Wang Xiaofeng , Zhang Fan , Li PO , Yao Weitao
Published: July 2020

Background
Studies have shown that apatinib is effective for treatment of osteosarcoma. However, pneumothorax is a major adverse event associated with treatment of osteosarcoma with apatinib. This study was performed to investigate pneumothorax characteristics and association with clinical outcomes in patients with osteosarcoma treated with apatinib.
Methods
We retrospectively reviewed the medical records of osteosarcoma patients treated with apatinib between January 2016 and April 2020 at three institutions. We evaluated the prevalence, healing time, recurrence, severity, clinical management, and prognosis of pneumothorax in these patients.
Results
A total of 54 osteosarcoma patients who received apatinib treatment were enrolled in this study. Among them, 14 patients had pneumothorax. There were significant differences between the patients with and without pneumothorax with regard to the cavitating rate of lung metastases (92.86% vs 32.50%, respectively, p < 0.001), objective response rate (42.86% vs 10.00%, p = 0.013), disease control rate (85.71% vs 42.50%, p = 0.006), 4-month progression-free survival (PFS) rate (57.10% vs 20.00%, p < 0.001), and median PFS (5.65 months vs 2.90 months, p = 0.011).
Conclusions
Pneumothorax and cavitation in lung metastases may be effective prognostic markers for patients with osteosarcoma treated with apatinib.
Lead Exposure Induced Copper Clearance Disorder of Blood-CSF Barrier
Authors: He Bin , Wang Liyuan , Li Shuang , Cao Fuyuan , Wu Lei , Chen Song , Pang Shulan , Zhang Yanshu
Published: July 2020

Lead is a heavy metal commonly found in the environment with known neurotoxicity, hematological and other toxicities. It has been found that lead exposure can disturb partial metal regulatory function in the blood-CSF barrier (BCB). Copper, which play an important role in maintaining normal brain function, can accumulate in brain after lead exposure. The studies of Alzheimer's disease (AD) indicated that abnormal copper homeostasis in cerebrospinal fluid (CSF) may be involved in the pathogenesis. However, the mechanism of copper disturbance in the brain caused by lead is still unknown. This study was designed to investigate copper clearance by the BCB in central nervous system after lead exposure, with focus on copper transporter protein CTR1/ATP7A. Inductively coupled plasma mass spectrometry (ICP-MS) and principal component analysis (PCA) were used to identify the changes of heavy metal level in hippocampus and CSF after lead exposure. It was found that the change in copper level was most pronounced in the brain between 3 to 12 weeks post lead exposure. Ventriculo-cisternal (VC) perfusion in Sprague Dawley (SD) rat suggested that the ability of BCB to deliver copper from the CSF to blood was decreased after lead exposure. Confocal microscope showed evidence of the presence of excess copper in the choroid plexus cells leading to CTR1/ATP7A shifting toward the apical microvilli facing the CSF after lead exposure. Finally, transmission electron microscopy (TEM) was used for observation of the microstructure of choroid plexus showed altered mitochondrial morphology with decreased microvilli after lead exposure. Our data suggested that lead exposure may alter BCB cellular microscopic structure and its copper transport, clearance function that might further cause brain injury.
Novel oxygen saturation imaging endoscopy to assess anastomotic integrity in a porcine ischemia model
Authors: Hasegawa Hiro , Takeshita Nobuyoshi , Ito Masaaki
Published: July 2020

Background: Establishing anastomotic integrity is crucial for avoiding anastomotic complications in colorectal surgery. This study aimed to evaluate the safety and feasibility of assessing anastomotic integrity using novel oxygen saturation imaging endoscopy in a porcine ischemia model.Methods: In three pigs, a new endoscope system was used to check the mechanical completeness of the anastomosis and capture the tissue oxygen saturation (StO2) images. This technology can derive the StO2 images from the differences in the absorption coefficient in the visible light region between oxy- and deoxy-hemoglobin. Bowel perfusion at the proximal rectum was assessed before and after the anastomosis, and one minute and thirty minutes after the ligation of the cranial rectal artery (CRA).Results: The completeness of the anastomoses was confirmed by the absence of air leakage. Intraluminal oxygen saturation imaging was successfully performed in all animals. There was no significant difference in the StO2 level before and after the anastomosis (52.6 ± 2.0 vs. 52.0 ± 2.6; p = 0.76, respectively). The StO2 level of the intestine on the oral side of the anastomosis one minute after the CRA ligation was significantly lower than immediately after the anastomosis (15.9 ± 6.0 vs. 52.0 ± 2.6; p = 0.006, respectively). There was no significant difference in the StO2 level between one minute after and thirty minutes after the CRA ligation (15.9 ± 6.0 vs. 12.1 ± 5.3; p = 0.41, respectively).Conclusion: Novel oxygen saturation imaging endoscopy was safe and feasible to assess the anastomotic integrity in the experimental model.
Diet Quality and Mental Health Amongst Acute Inpatient Psychiatric Patients
Authors: Gill Raveena , Tyndall Sean F , Vora Darshini , Hassan Rashedul , Megna James , Leontieva Luba
Published: July 2020

Background: Poor diet quality has been found to be prevalent in people with mental illness [71] and even contribute to mental illness [71]. The purpose of this exploratory study is to examine the relationship between diet quality, mental health problems, socioeconomic variables, physical activity level, and body mass index amongst acute psychiatric inpatients.Method: The study sample were 100 adult inpatients. Tools administered were Eating Habit Questionnaires (Dana Farber Institute) and the KIDMed index to assess food compliance in accordance with a Mediterranean diet. The Index marks all individuals as either having an “unhealthy score” or “healthy score”. The study utilized a descriptive correlation research design.Results: The results showed that 75% of the patients displayed an unhealthy score as per the KIDMed index. The findings displayed an inverse relationship of BMI and the KIDMed score. There was a significant positive correlation between the level of education and the KIDMed score. There is a positive correlation towards increased consumption of sugar in schizophrenic patients. There was no statistical significance between age, gender, income and physical activity with regards to the KIDMed score.Conclusion: Psychiatric inpatients display unhealthy eating habits which is likely both an effect of and a contributing factor to the various mental illnesses. Prospective interventional randomized controlled studies are necessary for clarification of cause-effect relationships.
Diagnostic value of chest CT in outpatient for COVID-19 compare with RT-PCR
Authors: Zhang Weiwei , Zhu Meifen , Zhang Min
Published: July 2020

ObjectivesThe pneumonia caused by the 2019 novel coronavirus recently break out in Wuhan, China, and was named as COVID-19. With the spread of the disease, it bring numbers of casualties,so now we need a way could fast and accuracy diagnose the disease.This paper aims to compare two way for diagnose COVID-19 in outpatient :Chest CT and RT-PCR.Materials and methodsThe study picked 248 patients who treated in fever clinical of GanZhou people's hospital,their complete clinical and imaging data were analysed retrospectively.Epidemiological data,symoptoms,laboratory test results include RT-PCR and the CT results include CT features,lesion location,lesion distribution of suspected COVID-19 infected patients were gathered.ResultsAll of 248 patients,at last 20 patients confirmed COVID-19,15 patients were confirmed in outpatient.More than 200 cases has laboratory test results disnormal.Only 15/248 patients had initial positive RT-PCR for COVID-19,5 patients had COVID-19 confirmed by two or more RT-PCR.50 cases(20.2%) had Ground glass opacity,42 cases(16.9%) had Consolidation,39 cases(15.7%) had Spider web pattern,38 cases(15.3%) had Interlobular septal thickening.For lesion location,22 cases(8.9%) involved Single lobe of one lung,13 cases(5.2%) involved Multiple lobes of one lung,174 cases(70.2%) involved Multiple lobes of both lungs,9 cases(3.6%) involved Bilateral lower lungs,25 cases(10.1%) involved Bilateral middle and lower lungs.Regarding the distribution of the lesions in the lung lobes,119 cases(47.98%) involved Subpleural distribution,19 cases(7.7%) involved Diffuse distribution,7 cases(2.8%) involved Peribronchial distribution,81 cases(32.7%) involved Mixed distribution.ConclusionChest CT can be applied in outpatient to make early diagnosis with sensitivity and accuracy better than that of nucleic acid detection.Trial registrationChiCTR2000032574. Registered 3 May 2020. retrospectively registered
Efficient and Accurate Determination of Genome-Wide DNA Methylation Patterns in Arabidopsis with Enzymatic Methyl Sequencing.
Authors: Feng Suhua , Zhong Zhenhui , Wang Ming , Jacobsen Steven E.
Published: July 2020

Background: 5’ methylation of cytosines in DNA molecules is an important epigenetic mark in eukaryotes. Bisulfite sequencing is the gold standard of DNA methylation detection, and whole-genome bisulfite sequencing (WGBS) has been widely used to detect methylation at single-nucleotide resolution on a genome-wide scale. However, sodium bisulfite is known to severely degrade DNA, which, in combination with biases introduced during PCR amplification, leads to unbalanced base representation in the final sequencing libraries. Enzymatic conversion of unmethylated cytosines to uracils can achieve the same end product for sequencing as does bisulfite treatment and does not affect the integrity of the DNA; enzymatic methylation sequencing may thus provide advantages over bisulfite sequencing.Results: Using an enzymatic methyl-seq (EM-seq) technique to selectively deaminate unmethylated cytosines to uracils, we generated and sequenced libraries based on different amounts of Arabidopsis input DNA and different numbers of PCR cycles, and compared these data to results from traditional whole genome bisulfite sequencing. We found that EM-seq libraries were more consistent between replicates and had higher mapping and lower duplication rates, lower background noise, higher average coverage, and higher coverage of total cytosines. Differential methylation region (DMR) analysis showed that WGBS tended to over-estimate methylation levels especially in CHG and CHH contexts, whereas EM-seq detected higher CG methylation levels in certain highly methylated areas. These phenomena can be mostly explained by a correlation of WGBS methylation estimation with GC content and methylated cytosine density. We used EM-seq to compare methylation between leaves and flowers, and found that CHG methylation level is greatly elevated in flowers, especially in pericentromeric regions. Conclusion: We suggest that EM-seq is a more accurate and reliable approach than WGBS to detect methylation. Compared to WGBS, the results of EM-seq are less affected by differences in library preparation conditions or by the skewed base composition in the converted DNA. It may therefore be more desirable to use EM-seq in methylation studies.
Responses of H. vulgare L. Seedlings to Basic Salt and Drought under Freeze-thaw Condition
Authors: Tang Wenyi , Bao Guozhang , Yan Bairu , Qu Yan , Guo Jiancai , Zhu Saning , Zhao Hongwei
Published: July 2020

Background Qinghai-Tibet Plateau is known for characteristics of high altitude, low rainfall and varying temperature, and the crops in this area are susceptible to abiotic stresses such as drought, basic salt and freeze-thaw that caused damages in different perspectives such as the permeability of biological membrane, osmotic adjustment, and antioxidant enzyme system. Hordeum vulgare L. is an indispensable crop in plateau and plays an important role in agricultural ecosystem as well.Result In this experiment, H. vulgare L. was used as experimental material and the physiological characteristics soluble protein (SP) content, malondialdehyde (MDA) content, antioxidant enzyme activity and relative water content (RWC) of seedlings were examined under freeze-thaw condition combined with drought and alkali stress.Conclusion Research results indicated that under the combined stresses of basic salt and drought, H. vulgare L. seedlings were damaged by lipid peroxidation, weakened superoxide dismutase (SOD), catalase (CAT) and peroxidase (POD) activities, while enhanced osmotic adjustment ability in plants cell. It was suggested that, in agricultural management, the simultaneous occurrence of two stresses, basic salt and drought, should be avoided in the early stage of H. vulgare L. planting to reduce the physiological stress on plants.
Fuel beds variation of coastal tropical freshwater forested wetlands in three disturbance regimes at La Encrucijada, Biosphere Reserve, Mexico
Authors: Calderón Romeo de Jesús Barrios , Mata Dulce Infante , Garnica José Germán Flores , Velázquez Jony Ramiro Torres , Sánchez-Mejía Zulia Mayari , Méndez Susana Maza-Villalobos , Alvarado Claudia Monzón
Published: July 2020

Background: Tropical freshwater forested wetlands in coastal regions are rapidly disappearing, one of the causes is forest fires. This is caused by high accumulation of fuel beds that can vary in origin and type. Therefore, the objective of this study was to characterize the fuel beds in tropical freshwater forested wetlands with three different level of disturbance at El Castaño, La Encrucijada Biosphere Reserve.Methods: Seventeen sampling units were used to described the strates of forest fuel beds (canopy, sub-canopy and understory) in both the vertical and horizontal stratum. Quantity and quality of dead (fallen woody material, surface litterfall and fermented litterfall) fuels were characterized using the planars intersections technique.Results: A total of eight tree species, two shrubs, five lianas and two herbaceous species were found in tropical freshwater forested wetlands. The vertical structure concentrates the highest proportion of trees between 2 and 12 m high, including the first two defined height classes. The horizontal structure denotes a higher percentage of trees with a normal diameter between 2.5 to 7.5 cm (61.4%) of the total. The sites none disturbance presented the highest arboreal density (2,686 ind. ha− 1), however the highest basal area was found in the sites with medium disturbance (39.41 m2 ha− 1). The richness and diversity of species shows that the Fisher, Margalef, Shannon and Simpson α indices were higher in the sites undisturbed, while the Berger-Parker index shows greater dominance in the sites high disturbance. Pachira aquatica Aubl. was the species with the highest importance value index, and contributes the most to the fuel beds. The average accumulation of dead fuel beds was higher in sites with high disturbance (222.18 ± 33.62 t ha− 1), with the largest accumulations of woody fuels occurring in the 1 h, 10 h and 1000 h classes, the latter in a state of fermentation.Conclusions: It’s important to consider the probability of occurrence of surface fires is high. In these tropical freshwater forested wetlands, independent of disturbance, underground fires have the same probability and the intensity will depend on the depth of the organic matter layer. This study contributes define fire-prone areas in these ecosystems. The results are of great importance to design fire prevention strategies.
Beneficial effect of successful simultaneous pancreas-kidney transplantation on plasma profile of metalloproteinases in type 1 diabetes mellitus patients
Authors: Chudek Jerzy , Kolonko Aureliusz , Ziaja Jacek , Francuz Tomasz , Kamińska Dorota , Owczarek Aleksander , Kuczera Piotr , Kujawa-Szewieczek Agata , Kusztal Mariusz , Kowalik Adrian , Bożek-Pająk Dominika , Kluz Joanna , Choręza Piotr , Król Robert , Krajewska Magdalena , Cierpka Lech , Więcek Andrzej
Published: July 2020

Background
It is virtually unknown whether the restoring of normal glucose metabolism after successful simultaneous pancreas-kidney transplantation (SPK) improves vascular wall morphology and function in type 1 diabetic (T1D) patients. This study has been aimed to compare arterial stiffness, assessed by pulse wave velocity (PWV), carotid intima-media thickness (IMT) biomarkers of arterial wall calcification, and parameters of calcium-phosphate metabolism in T1D patients after SPK or kidney transplantation alone (KTA).
Methods
In 39 SPK and 39 KTA adult patients of similar age, PWV and IMT were measured at a median of 83 (62–109) months post-transplantation. Additionally, carotid plaques were visualized and semi-qualitatively classified. Circulating matrix metalloproteinases (MMPs), calcification biomarkers, and calcium-phosphate metabolism parameters were measured.
Results
Although PWV and IMT values were similar, the occurrence of atherosclerotic plaques (51.3 vs. 70.3%, p < 0.01), turned to be lower, especially in case of calcified lesions (35.9 vs. 64.9%, p < 0.05) in patients after SPK. There were significantly lower concentrations of MMP-1, MMP-2, MMP-3 and osteocalcin (OC) in SPK subjects. Among the analyzed biomarkers, only log MMP-1, log MMP-2 and log MMP-3 concentrations were associated with log HbA1c. In addition, both log MMP-1 and log MMP-3 were inversely related to estimated glomerular filtration rate (eGFR). Multivariate stepwise backward regression analysis revealed that MMP-1 and MMP-3 variability were explained only by log HbA1c, whereas OC variability only by eGFR.
Conclusion
Normal glucose metabolism achieved by simultaneously transplanted pancreas in T1D renal transplant recipients is followed by the favorable profile of circulating matrix metalloproteinases, which may reflect the vasoprotective effect of SPK.
Hyperferritinemia in pediatric scrub typhus: A prospective observational study
Authors: Williams Vijai , Menon Nisha , Bhatia Prateek , Biswal Manisha , Sreedharanu Sreejesh , Jayashree Muralidharan , Nallasamy Karthi
Published: July 2020

Background: Hyperferritinemia is increasingly associated with mortality in sepsis. Studies estimating the prevalence of hyperferritinemia in pediatric scrub typhus is limited.Methods: We conducted a prospective observational study from a tertiary care teaching hospital in North India where 72 children with confirmed scrub typhus;17(24%)-PCR positive, 68(94%)-IgM ELISA positive and 13(18%)-both PCR and ELISA positive. Serum ferritin was measured in 62 children to identify the prevalence of hyperferritinemia and determine its association with mortality. Results: Hyperferritinemia (>500µg/L) was seen in 72.6% [n=45] children; 26(42%) were mild (500-2000µg/L), 13(21%) were moderate (2000-10000µg/L) and 6(9.7%) were severe (>10000µg/L). A biphasic pattern of hyperferritinemia was seen with two peaks when plotted against duration since symptoms onset; one between 2 and 3 days (early onset hyperferritinemia) and second peak between 12 and14 days (late onset hyperferritinemia). Early onset hyperferritinemia had more survivors than late onset hyperferritinemia. Non survivors had significantly higher PRISM III, PELOD-2, hyperlactatemia, hypoalbuminemia, organ dysfunction, need for mechanical ventilation and need of RRT. Ferritin had poor sensitivity and specificity in predicting survival with AUC of 0.56. Organ dysfunction and risk scores as PRISM III, PELOD 2 and VIS at admission were better predictors with AUC(95%CI) of 0.72(0.56,0.89), 0.77(0.63,0.92) and 0.90(0.78,1.0) respectively.Conclusions: Hyperferritinemia is common in scrub typhus. A distinct biphasic response was observed with worse outcome in late onset hyperferritinemia. Organ dysfunction and risk scores were better predictors of mortality than ferritin.
Patterns of Coronal and Sagittal Deformities in Adolescent Idiopathic Scoliosis
Authors: Mak Trixie , Cheung Prudence Wing Hang , Zhang Teng , Cheung Jason Pui Yin
Published: July 2020

Background: Thoracic scoliosis has been shown to be associated with hypokyphosis in adolescent idiopathic scoliosis (AIS). However, the relationship of sagittal spino-pelvic parameters with different coronal curve patterns and their influence on patient-perceived quality of life is unknown. This study aims to determine the association between coronal and sagittal malalignment in patients with AIS and to determine their effects on SRS-22r scores. Methods: A cross-sectional study was conducted on 1054 consecutive patients with AIS. The coronal Cobb angle, thoracic kyphosis (TK), lumbar lordosis (LL), pelvic incidence (PI), PI-LL mismatch (PI-LL), pelvic tilt (PT), and sacral slope (SS) were measured on standing radiographs. The coronal Cobb angle (mild: 10-20°; moderate: >20-40°; severe: >40°) and PI (low: <35°; average: 35-50°; high: >50°) were divided into 3 sub-groups for comparison. Relationship between coronal curve magnitudes and sagittal parameters was studied as was their association with SRS-22r scores. Results: Low PI had smaller SS (30.1±8.3° vs 44.8±7.7°; p<0.001), PT (-0.3±8.1° vs 14.4±7.5°; p<0.001), and LL (42.0±13.2° vs 55.1±10.6°; p<0.001), negative PI-LL mismatch (-12.1±13.1° vs 4.1±10.5°; p<0.001) as compared to large PI. There were no significant relationships with PI and TK (p=0.905) or curve magnitude (p=0.431). No differences in sagittal parameters were observed for mild, moderate or severe coronal Cobb angles. SRS-22r scores only correlated with coronal Cobb angle and larger Cobb angles were negatively correlated with the function, appearance and pain domains. Conclusions: The sagittal profile for AIS is associated with the pelvic parameters especially PI but not with the coronal curve pattern. All patients have a similar TK regardless of coronal curve type. However, it appears that the coronal deformity is a greater influence on quality of life outcomes especially those >40°.
Age Differences in the Relationships between Risk Factors and Loss of Kidney Function: a General Population Cohort Study
Authors: Toyama Tadashi , Kitagawa Kiyoki , Oshima Megumi , Kitajima Shinji , Hara Akinori , Iwata Yasunori , Sakai Norihiko , Miho Shimizu , Hashiba Atsushi , Furuichi Kengo , Wada Takashi
Published: July 2020

Background: Annual decline in kidney function is a widely applied surrogate outcome of renal failure. It is important to understand the relationships between known risk factors and the annual decline in estimated glomerular filtration rate (eGFR) according to baseline age; however, these remain unclear.Methods: A community-based retrospective cohort study of adults who underwent annual medical examinations between 1999 and 2013 was conducted. The participants were stratified into different age groups (40–49, 50–59, 60–69, 70–79, and ≥80 years) to assess the risk for loss of kidney function. A mixed-effects model was used to estimate the association between risk factors and annual changes in eGFR.Results: A total of 51,938 participants were included in the analysis. The age group of ≥80 years included 8,127 individuals. The mean annual change in eGFR was -0.39 (95% confidence interval -0.41 to -0.37) mL/min/1.73 m2 per year. Older age was related to faster loss of kidney function. In the older age group, higher systolic blood pressure, proteinuria, and current smoking were related to faster loss of kidney function (p trend <0.01, 0.03, and <0.01, respectively). Conversely, each age group showed similar annual loss of kidney function related to lower hemoglobin levels and diabetes mellitus (p trend 0.47 and 0.17, respectively).Conclusions: Higher systolic blood pressure, proteinuria, and smoking were related to faster loss of kidney function, and greater effect size was observed in the older participants. More risk assessments for older people are required for personalized care.
Comparative genomics and transcriptomics analyses provide insights into the high yield and regulatory mechanism of Norvancomycin biosynthesis in Amycolatopsis orientalis NCPC 2-48
Authors: Li Xingxing , Zhang Cong , Zhao Ying , Lei Xuan , Jiang Zhibo , Zhang Xuexia , Zheng Zhihui , Si Shuyi , Wang Lifei , Hong Bin
Published: July 2020

Background: Norvancomycin has been widely used in clinic to treat against MRSA (Methicillin-resistant Staphylococcus aureus) and MRSE (methicillin-resistant Staphylococcus epidermidis) in China. Amycolatopsis orientalis NCPC 2–48, a high yield strain derived from A. orientalis CPCC 200066, has been applied in industrial large-scale production of norvancomycin by North China Pharmaceutical Group. However, the potential high-yield and regulatory mechanism involved in norvancomycin biosynthetic pathway has not yet been addressed.Results: Here we sequenced and compared the genomes and transcriptomes of A. orientalis CPCC 200066 and NCPC 2–48. These two genomes are extremely similar with an identity of more than 99.9%, and no duplication and structural variation was found in the norvancomycin biosynthetic gene cluster. Comparative transcriptomic analysis indicated that biosynthetic gene cluster of norvancomycin, as well as some primary metabolite pathways for the biosynthetic precursors of norvancomycin were generally upregulated. AoStrR1 and AoLuxR1, two cluster-situated regulatory genes in norvancomycin cluster, were 23.3-fold and 5.8-fold upregulated in the high yield strain at 48 h, respectively. Over-expression of AoStrR1 and AoLuxR1 in CPCC 200066 resulted in an increase of norvancomycin production, indicating their positive role in norvancomycin biosynthesis. Furthermore, AoStrR1 can regulate the production of norvancomycin by directly interacting with at least 8 promoters of norvancomycin biosynthetic genes or operons.Conclusion: Our results suggested that the mechanism of high yield of NCPC 2–48 can be ascribed to increased expression level of norvancomycin biosynthetic genes in its cluster as well as the genes responsible for the supply of its precursors. And the norvancomycin biosynthetic genes are positively regulated by AoStrR1 and AoLuxR1, of them AoStrR1 was the ultimate pathway-specific regulator for the norvancomycin production. These results are helpful for further clarification of the holistic and pathway-specific regulatory mechanism of norvancomycin biosynthesis in the industrial production strain.
Silencing Akt1 Inhibits Starvation Induced Lung Metastasis Through Epithelial Mesenchymal Transition Independent of E-cadherin in Prostate Cancer
Authors: Yang Mei , Liu Hui , Qiu Guo Ping , Gao Fei
Published: July 2020

BackgroundEpithelial to mesenchymal transition (EMT) of prostate cancer (PCa) cells facilitates their progress to metastasis. We have recently reported Akt1 is an important EMT regulator, and silencing Akt1 induced EMT and inhibited the growth of PCa cells. These results imply Akt1 silencing may increase starvation resistance of PCa cells. However, little is known about the role of Akt1 of PCa cells in starvation.MethodsApoptosis was detected by TUNEL and flow cytometry, cell invasion was detected by transwells and ECIS, lung metastasis was evaluated by tail vein injection animal model, variation of EMT markers was detected by Western-blot.ResultsWe found starvation slowed down the growth and proliferation, and increased apoptosis of PCa cells; Silencing Akt1 gene inhibited these effects of starvation and decreased E-cadherin. Akt1 silencing enhanced invasion induced by starvation of PCa cells in vitro ; however, it inhibited lung metastasis induced by starvation of PCa cells in vivo unexpectedly.ConclusionStarvation or silencing Akt1 alone can promote lung metastasis of PCa cells, however, silencing Akt1 while starving PCa cells can significantly inhibit this function via EMT independent of E-cadherin.
The Blind Review: A Quality Assessment Measure for Review Standardization of Institutional Review Boards
Authors: Park Sinyoung , Ahn Cho Rong , Noh Yang Hee , Park Sejung , Nam Chung Mo , Kim Myoung Soo , Kim Seung Min , Kim Jin Seok , Rha Sun Young
Published: July 2020

Background: Challenging research environment while the multinational trials are increasing, standardization of IRB review has become more important. The inconsistency is often inevitable in that opinions on the ethical part may be different, but the standardization and understanding the differences is required to assure IRB review quality. Thus, we aimed to develop and suggest quality assessment measure of IRB named “Blind review” by reviewing the same research protocols by multiple IRB panels. We further describe an analyzed result of differences to understand the mechanism of IRB standardization.Methods: We present a description of the Blind review process. Based on the HRPP (Human research Protection Program) SOPs (Standard of Procedure), eight blind review results from January 2010 to December 2018 at a single institution with multiple panels were included using Severance Hospital HRPP database. Review results were analyzed with review scores ranged 0 to 60 points including GCP requirements and protocol issues. Panel agreement was estimated by observed multiple rater agreement. Differences between review scores according to expertise member and IRB member duration were analysed with Wilcoxon rank-sum test and Kruskal-Wallis test.Results: Observed multiple raters’ agreement was increased from 0.444 (95% CI: 0.167-1.000) in 2010 to 0.479 (95% CI: 0.271-0.708) in 2014~2018 as IRB review experiences increases. In order to analyze the review mechanism, three GCP requirements and three protocol issues were scored (range 0 to 60). Mean values for GCP requirement and protocol issues were 19.25±8.21 and 18.40±9.04, respectively. Mean score of the panels where experts participated (n=16, 28.13±10.47) is higher than control group (n=32, 25.16±10.96) (p=0.93). According to career duration of IRB members’, scores of the group whose career is less than 3 years was 25.0±10.0 (n=14), the score of group whose career is 3-5 years was 26.3±9.6 (n=23). The mean score of the group whose career was more than 5 years shown 27.3±14.2 (n=11), and it is statistically significant. (p=0.09)Conclusions: We suggest Blind Review as an effective measure for overseeing and ensuring IRB’s review quality and overall GCP compliance.
Barriers in Implementing the Dying Patient Law: The Israeli Experience - A Qualitative Study
Authors: Zigdon Avi , Nissanholtz-Gannot Rachel
Published: July 2020

Background: Coping with end-of-life issues is a major challenge for governments and health systems. Despite progress in legislation, many barriers exist to its full implementation. This study is aimed at identifying these end-of-life barriers in relation to Israel.Methods: Qualitative in-depth interviews using professionals and decision makers in the health-care and related systems (n=37) were carried out, along with two focus groups based on brainstorming techniques consisting of nurses (n=10) and social workers (n=10). Data was managed and analyzed using Naralyzer software.Results: Qualitative analysis showed identification of six primary barriers: 1) law, procedures, and forms; 2) clinical aspects; 3) human aspects; 4) knowledge and skills of medical teams; 5) communication; and 6) resource allocation. These were further divided into 44 sub area barriers.Conclusions: This study highlights the role of the family doctor in end-of-life by training physicians in decision-making workshops and increasing their knowledge in the field of palliative medicine. Effectively channeling resources, knowledge, and support for medical teams, by accounting for the structure and response of the units for home treatment will improve patient's access to information on and support for end-of-life laws, as well as reduce legislative barriers in other countries that face the same issues.
Antigens from H22 cell mutation induced by lentinan are correlated with HCC immunoprophylaxis
Authors: Yang Xin , Li Yandong , Wang Wen , Li Chong , Zhao Dandan , Hu Gaoshuang , Rao Huan , Hao Jianxiong , Han Xue
Published: July 2020

Background Lentinan can inhibit the proliferation of many kinds of tumor cells, and some studies have shown that lentinan can inhibit the growth of tumor tissue by directly killing tumor cells. The purpose of this study was to investigate the immunoprophylaxis effect and mechanism of tumor specific antigen induced by lentinan on liver cancer in mice.Methods The immunogen was prepared which was induced by lentinan. And two different mouse H22 liver cancer models (ascites tumor and solid tumor)were established after immunogen immunized. The tumor growth and immune organ index of mice in each group were measured. In order to analyze the immune mechanism, the activity of CTL cells, activation of ADCC pathway ,T lymphocyte subsets, expression of CD4 + T,CD8 + T cells and expression of DC, and surface molecular markers CD80 and CD86 in immunized mice were analyzed. The expression of cytokines such as IFN-γ and TNF-α in serum and cell supernatant of mice in each group was tested too. Finally, the immunogen was analyzed by Liquid Chromatography-Mass Spectrometry (LC-MS), and the functional proteins were screened for further analysis.Results The liver, spleen and thymus of the mice immunized with immunogen were protected to a certain extent. In immunized mice, the proportion of CD4 + T cells increased, the proportion of CD8 + T cells decreased, the ratio of CD4 + T/CD8 + T increased, and the killing activity of T lymphocytes increased significantly. The expression of CD80 in mature DC cells of immunized mice increased and cytokines increased significantly. The results of protein mass spectrometry analysis of immunogen showed that immunogen produced protein properties that inhibit cancer.Conclusion The H22 whole-cell cleavage vaccine induced by lentinan is effective in the immunity of mouse hepatoma H22 and has development value in the future.