bluuebunny/crossref_metadata_2025 huggingface dataset:
Immune landscape of periodontitis unveils alterations of infiltrating immunocytes and molecular networks-aggregating into an interactive web-tool for periodontitis related immune analysis and visualization
Authors: Zhang Xiaoqi , Wang Qingxuan , Yan Xinyu , Shan Yue , Xing Lu , Li Minqi , Long Hu , Lai Wenli
Published: November 2020

Background: Immunity reaction plays an essential role in periodontitis progress and we aim to investigate the underlying regulatory network of immune reactions in periodontitis. Methods: CIBERSORT was used to estimate immunocyte fractions in different clinical statuses. Logistic regression was used to assess the immunocyte enrichment in periodontitis. Immune-related periodontitis subtypes were identified by the Nonnegative Matrix Factorization algorithm. Gene-set enrichment analysis and Gene-set variation analysis were conducted to analyze pathway activities. Immunocytes related gene modules were identified by Weighted gene co-expression network analysis. Results: Altered immunocytes in healthy-vs-periodontitis, aggressive-vs-chronic, male-vs-female and age were identified. Immunocytes enriched in periodontitis were calculated, and their correlation was also explored. Two distinct immune-related periodontitis subtypes were identified and one is characterized by B cell reaction and the other is IL-6 cytokine reactions. 463 statistically significant correlations between 22 immunocytes and pathways were revealed. Immunocytes and clinical phenotypes matched their gene modules, and their functions were annotated. Last, an easy-to-use and user-friendly interactive web-tool were developed for periodontitis related immune analysis and visualization (http://118.24.100.193:3838/tool-PIA/).Conclusions: This study systematically investigated periodontitis immune atlas and caught a glimpse of the underlying mechanism of periodontitis from gene-pathway-immunocyte networks, which can not only inspire researchers but also help them in periodontitis related immune researches.
Vaccines to prevent COVID-19: a protocol for a living systematic review with network meta-analysis including individual patient data (The LIVING VACCINE Project)
Authors: KORANG STEVEN KWASI , Juul Sophie , Nielsen Emil Eik , Feinberg Joshua , Siddiqui Faiza , Ong Giok , Klingenberg Sarah , Veroniki Areti Angeliki , Bu Fanlong , Thabane Lehana , Thomsen Allan Randrup , Jakobsen Janus C , Gluud Christian
Published: November 2020

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes corona virus disease 2019 (COVID-19) which has rapidly spread worldwide. Several human randomized clinical trials assessing potential vaccines are currently underway. There is an urgent need for a living systematic review that continuously assesses the beneficial and harmful effects of all available vaccines for COVID-19.Methods/design: We will conduct a living systematic review based on searches of major medical databases (e.g. MEDLINE, EMBASE, CENTRAL) and clinical trial registries from their inception onwards to identify relevant randomized clinical trials. We will update the literature search once a week to continuously assess if new evidence is available. Two review authors will independently extract data and conduct risk of bias assessments. We will include randomized clinical trials comparing any vaccine aiming to prevent COVID-19 (including but not limited to messenger RNA; DNA; non-replicating viral vector; replicating viral vector; inactivated virus; protein subunit; dendritic cell; other vaccines) with any comparator (placebo; ‘active placebo’; no intervention; standard care; an ‘active’ intervention; another vaccine for COVID-19) for participants in all age groups.Primary outcomes will be all-cause mortality; a diagnosis of COVID-19; and serious adverse events. Secondary outcomes will be quality of life, and non-serious adverse events. The living systematic review will include aggregate data meta-analyses, Trial Sequential Analyses, network meta-analyses, and individual patient data meta-analyses. Within-study bias will be assessed using Cochrane risk of bias tool. The Grading of Recommendations, Assessment, Development and Evaluations (GRADE) and Confidence in Network Meta-Analysis (CINeMA) approaches will be used to assess certainty of evidence. Observational studies describing harms identified during the search for trials will also be included and described and analyzed separately.Discussion: COVID-19 has become a pandemic with substantial mortality. A living systematic review assessing the beneficial and harmful effects of different vaccines is urgently needed. This living systematic review will regularly inform best practice in vaccine prevention and clinical research of this highly prevalent disease.Systematic review registration: PROSPERO CRD42020196492
Screening for the Prevention and Early Detection of Cervical Cancer: Protocol for Systematic Reviews to Inform Canadian Recommendations
Authors: Gates Allison , Pillay Jennifer , Reynolds Donna , Stirling Robert , Traversy Gregory , Korownyk Christina , Moore Ainsley , Thériault Guylène , Thombs Brett D , Little Julian , Popadiuk Catherine , Niekerk Dirk van , Keto-Lambert Diana , Vandermeer Ben , Hartling Lisa
Published: November 2020

Purpose. To inform recommendations by the Canadian Task Force on Preventive Health Care on screening in primary care for the prevention and early detection of cervical cancer by systematically reviewing evidence of: (a) effectiveness; (b) test accuracy; (c) individuals’ values and preferences, and (d) strategies aimed at improving screening rates.Methods. De novo reviews will be conducted to evaluate effectiveness and to assess values and preferences. For test accuracy and strategies to improve screening rates, we will integrate studies from existing systematic reviews with search updates to the present. Two Cochrane reviews will provide evidence of adverse pregnancy outcomes from the conservative management of cervical intraepithelial neoplasia. We will search Medline, Embase, and Cochrane Central (except for individuals’ values and preferences, where Medline, Scopus, and EconLit will be searched) via peer-reviewed search strategies, and the reference lists of included studies and reviews. We will search ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform for ongoing trials. Two reviewers will screen potentially eligible studies and agree on those to include. Data will be extracted by one reviewer with verification by another. Two reviewers will independently assess risk of bias and reach consensus. Where possible and suitable, we will pool studies via meta-analysis. We will compare accuracy data per outcome and per comparison using the Rutter and Gatsonis hierarchical summary receiver operating characteristic model and report relative sensitivities and specificities. Findings on values and preferences will be synthesized using a narrative synthesis approach and thematic analysis, depending on study designs. Two reviewers will appraise the certainty of evidence for all outcomes using GRADE (Grading of Recommendations Assessment, Development and Evaluation) and come to consensus.Discussion. The publication of guidance on screening in primary care for the prevention and early detection of cervical cancer by the Task Force in 2013 focused on cytology. Since 2013, new studies using human papillomavirus tests for cervical screening have been published that will improve our understanding of screening in primary care settings. This review will inform updated recommendations based on currently available studies and address key evidence gaps noted in our previous review.Systematic review registration: not registered.
Financial Accountability Mechanisms in Local Governments in Uganda.A Case of Kabale District Local Government
Authors: Arinaitwe Perpetua - , Eton Marus - , Agaba Moses - , Turyahebwa Abanis - , Ogwel Benard Patrick , Mwosi Fabian -
Published: November 2020

The paper presents financial accountability mechanisms in local governments, with reference to Kabale district local government. A cross-sectional research design, which used both quantitative and qualitative approaches to collect and analyze data, was adopted. Both simple random and purposive sampling techniques were used to select 117 respondents from 174 subjects. Questionnaires and personal interviews were used to collect data from respondents. Frequencies and percentages were used to analyze quantitative data while direct quotes from interviews conducted among key informants formed the basis for qualitative analysis. Quantitative analysis was aided by software for document analysis (SPSS V 20.0). In descending order of perception, service delivery was found to be the most commonly used financial accountability mechanism, followed by financial reporting, expenditure control and budget. The paper therefore, concluded that service delivery is the most used mechanism of financial accountability, though the district’s local budget seemed unclear on reflecting the priorities of the local people. This paper recommended that the local government should ensure that the district’s budget demonstrates community preference; salaries and wages should be paid in accordance with the district’s approved budget; expenditures on development should always be as per the approved budget, and the mode of financial reporting, particularly on liabilities should be standardized. Due to the scope of this paper, which could not quantitatively relate financial accountability and service delivery, there is need for a comprehensive study on the effect of financial accountability and service delivery in Kabale district local government
The economic burden of measles in children under five in Bangladesh
Authors: de Broucker Gatien , Ahmed Sayem , Hasan Md. Zahid , Mehdi Gazi Golam , Campo Jorge Martin del , Ali Md. Wazed , Uddin Md. Jasim , Constenla Dagna , Patenaude Bryan
Published: November 2020

Background: This study estimated the economic cost of treating measles in children under-5 in Bangladesh from the caregiver, government, and societal perspectives.Method: We conducted an incidence-based study using an ingredient-based approach. We surveyed the administrative staff and the healthcare professionals at the facilities, recording their estimates supported by administrative data from the healthcare perspective. We conducted 100 face-to-face caregiver interviews at discharge and phone interviews 7 to 14 days post-discharge to capture all expenses, including time costs related to measles. All costs are in 2018 USD ($).Results: From a societal perspective, a hospitalized and ambulatory measles cost $159 and $18, respectively. On average, the government spent $23 per hospitalized measles. At the same time, caregivers incurred $131 and $182 in economic costs, including $48 and $83 in out-of-pocket expenses in public and private not-for-profit facilities, respectively. Seventy-eight percent of the poorest caregivers faced catastrophic health expenditures compared to 21% of the richest. In 2018, 2263 cases of measles were confirmed, totaling $348,073 in economic costs to Bangladeshi society, with $121,842 in out-of-pocket payments for households.Conclusion: The resurgence of measles outbreaks is a substantial cost for society, requiring significant short-term public expenditures, putting households into a precarious financial situation. Improving vaccination coverage in areas where it is deficient (Sylhet division in our study) would likely alleviate most of this burden.
Prevalence and predictors of child labour among junior public secondary school students in Enugu, Nigeria: a cross-sectional study
Authors: Enebe Nympha Onyinye , Enebe Joseph Tochukwu , Agunwa Chuka Chike , Ossai Edmund Ndudi , Ezeoke Uchechukwu Enuma , Idoko Arthur Chinedu , Mbachu Chinyere Ojiugo
Published: November 2020

Background: Millions of children have been identified globally to be involved in child labour with low-income countries being mostly hit. This study was aimed at assessing child labour and its predictors among public secondary school students in Enugu metropolis. Methods: The study was a descriptive cross-sectional study of 332 junior secondary school students attending public secondary schools in Enugu metropolis, Nigeria. A structured interviewer-administered questionnaire was used for data collection and analyses were done using SPSS version 23 and STATA Software. The level of statistical significance was set at 5% p-value.Results: The prevalence of overall child labour among the respondents was high (71.7%) likewise its different categories: domestic (52.1%) and economic (34.0%) child labour. About 35.2% of the respondents worked under hazardous conditions while 8% were forced to work. Approximately 65% (236) of the respondents who have heard about child labour perceived it as wrong. They mainly worked to render financial assistance to their parents. Class of study (AOR=2.208 (95% CI: 1.199-4.066) and weekly income earned (AOR=0.316 (95% CI: 0.176-0.567) predicted child labour among the respondents. Conclusion: The prevalence of child labour among public secondary schools in Enugu was high and the predictors were the class of the respondents and the weekly income they made. This may imply that child labour in Enugu was driven by poverty as respondents who earned higher were more involved in child labour thereby calling for concerted economic and social reforms to reduce this menace.
Investigating the molecular control of deer antler extract on articular cartilage 
Authors: Yao Baojin , Zhou Zhenwei , Zhang Mei , Leng Xiangyang , Zhao Daqing
Published: November 2020

Background: Deer antler is considered as a precious traditional Chinese medicinal material, and has been widely used to reinforce kidney’s yang, nourish essence and strengthen bone function. The most prominent bioactive components in deer antler are water-soluble proteins that play potential roles in bone formation and repair. The aim of this study was to explore the molecular control and therapeutic targets of deer antler extract (DAE) on articular cartilage.Methods: DAE was prepared as previously described. All rats were randomly divided into Blank group and DAE group (10 rats per group) after 7-day adaptive feeding. The rats in DAE group were orally administrated with DAE at a dose of 0.2 g/kg per day for 3 weeks and the rats in Blank group were fed with drinking water. Total RNA was isolated from the articular cartilage of knee joints. RNA sequencing (RNA-seq) experiment combined with quantitative real-time polymerase chain reaction (qRT-PCR) verification assay were carried out to explore the molecular control and therapeutic targets of DAE on articular cartilage.Results: We demonstrated that DAE significantly increased the expression levels of functional genes involved in cartilage formation, growth and repair, and decreased the expression levels of susceptibility genes involved in the pathophysiology of osteoarthritis. Conclusions: DAE might serve as a candidate supplement for maintaining cartilage homeostasis, and preventing cartilage degeneration and inflammation. These effects were possibly achieved by accelerating the expression of functional genes involved in chondrocyte commitment, survival, proliferation and differentiation, and suppressing the expression of susceptibility genes involved in the pathophysiology of osteoarthritis. Thus, our findings will contribute towards deepening the knowledge about the molecular control and therapeutic targets of DAE on the treatment of cartilage related diseases.
Effects of the COVID-19 Pandemic on Medical Students: A Multicenter Quantitative Study
Authors: Harries Aaron , Lee Carmen , Jones Lee , Rodriguez Robert M. , Davis John , Boysen-Osborn Megan , Kashima Kathleen , Krane N. Kevin , Rae Guenevere , Kman Nicholas , Langsfeld Jodi , Juarez Marianne
Published: November 2020

Background: The COVID-19 pandemic disrupted the United States (US) medical education system with the necessary, yet unprecedented Association of American Medical Colleges (AAMC) national recommendation to pause all student clinical rotations with in-person patient care. This study is a quantitative analysis investigating the educational and psychological effects of the pandemic on US medical students and their reactions to the AAMC recommendation in order to inform medical education policy.Methods: The authors sent a cross-sectional survey via email to medical students in their clinical training years at six medical schools during the initial peak phase of the COVID-19 pandemic. Survey questions aimed to evaluate students' perceptions of COVID-19's impact on medical education; ethical obligations during a pandemic; infection risk; anxiety and burnout; willingness and needed preparations to return to clinical rotations. Results: 741 (29.5%) students responded. Nearly all students (93.7%) were not involved in clinical rotations with in-person patient contact at the time the study was conducted. Reactions to being removed were mixed, with 75.8% feeling this was appropriate, 34.7% guilty, 33.5% disappointed, and 27.0% relieved.Most students (74.7%) agreed the pandemic had significantly disrupted their medical education, and believed they should continue with normal clinical rotations during this pandemic (61.3%). When asked if they would accept the risk of infection with COVID-19 if they returned to the clinical setting, 83.4% agreed. Students reported the pandemic had moderate effects on their stress and anxiety levels with 84.1% of respondents feeling at least somewhat anxious. Adequate personal protective equipment (PPE) (53.5%) was the most important factor to feel safe returning to clinical rotations, followed by adequate testing for infection (19.3%) and antibody testing (16.2%). Conclusions: The COVID-19 pandemic disrupted the education of US medical students in their clinical training years. The majority of students wanted to return to clinical rotations and were willing to accept the risk of COVID-19 infection. Students were most concerned with having enough PPE if allowed to return to clinical activities.
Pain is a common problem in patients with ILD
Authors: Shen Qinxue , Guo Ting , Song Min , Guo Wei , Zhang Yi , Duan Wang , Peng Yating , Ni Shanshan , Ouyang Xiaoli , Peng Hong
Published: November 2020

Background: As it is less known about the prevalence and characteristics of pain in the patients with interstitial lung disease (ILD), this paper aims at determining the characteristics of the pain in the patients with ILD.Methods: Subjects with ILD and health controls with the matched ages and genders completed Short Form McGill Pain Questionnaire (SF-MPQ) and part of the Brief Pain Inventory (BPI) Short Form to elicit the characteristics of the pain. The patients with ILD were also assessed through Pulmonary Function Test, Six Minutes Walking Test (6MWT), modified Medical Research Council Dyspnea Scale (mMRC) for state of the illness and measured health-related quality of life (HRQoL) by Short Form-36 (SF-36) and psychological associations by Hospital Anxiety and Depression Scale (HADS).Results: A total of 63 subjects with ILD and 63 healthy controls (HC) were recruited in our study. The prevalence of the pain was 61.9% in ILD versus 25.3% in HC (p=0.005) and the median score of the pain rank index (PRI) in ILD was higher than that in HC (P=0.014). Chest (46.1%) accounted for the highest of overall pain locations in subjects with ILD. Associated clinical factors for pain intensity in the patients with ILD included exposure history of risk factors of ILD, with a longer distance of 6MWD (≥250m), and a higher mMRC score (2-4). The patients with ILD and pain are more likely to suffer impaired HRQoL (P=0.0014) and psychological problems (P=0.0017, P=0.044).Conclusion: The pain is common in those with ILD and the pain intensity is associated with exposure history, 6MWD, and mMRC score. The patients with ILD and pain were possibly to suffer depression, anxiety, and impaired HRQoL.
Correlation between sestrin2 expression and airway remodeling in COPD
Authors: Zhang Da-Wei , Wei Yuan-Yuan , Ji Shuang , Fei Guang-He
Published: November 2020

Background. Airway remodeling is a major pathological characteristic of chronic obstructive pulmonary disease (COPD), and has been shown to be associated with oxidative stress. Sestrin2 has recently drawn attention as an important antioxidant protein. However, the underlying correlation between sestrin2 and airway remodeling in COPD has yet to be clarified.Methods. A total of 124 subjects were enrolled in this study, including 62 control subjects and 62 COPD patients. The pathological changes in airway tissues were assessed by different staining methods. The expression of sestrin2 and matrix metalloproteinase 9 (MMP9) in airway tissues was monitored by immunohistochemistry. Enzyme-linked immunosorbent assays (ELISAs) were used to detect the serum concentrations of sestrin2 and MMP9. The airway parameters on computed tomography (CT) from all participants were measured for evaluating airway remodeling. The relationship between serum sestrin2 and MMP9 concentration and airway parameters in chest CT was also analyzed.Results. In patients with COPD, staining of airway structures showed distinct pathological changes of remodeling, including cilia cluttered, subepithelial fibrosis, and reticular basement membrane (Rbm) fragmentation. Compared with control subjects, the expression of sestrin2 and MMP9 was significantly increased in both human airway tissues and serum. Typical imaging characteristics of airway remodeling and increased airway parameters were also found by chest CT. Additionally, serum sestrin2 concentration was positively correlated with serum MMP9 concentration and airway parameters in chest CT.Conclusion. Increased expression of sestrin2 is related to airway remodeling in COPD. We demonstrated for the first time that sestrin2 may be a novel biomarker for airway remodeling in patients with COPD.
Psychometric Evaluation of the Arabic Version of the Higher Education Inventory Scale for Nursing Students
Authors: Masha’al Dina , Hayajneh Audai A. , Tawalbeh Loai Issa
Published: November 2020

Background: Studies in the literature have relied on a single instrument to assess stress levels and sources among nursing students in Jordan and in other Arab countries. Thus, there is a need for adopting Arabic versions of psychometrically validated instruments for evaluating a wider range of aspects related to stress and stressors. The Higher Education Stress Inventory (HESI) is an instrument used to assess various features of stress and stressors related to higher education in different educational settings and among different student populations. To date, no exploratory or confirmatory factor analyses (EFA) (CFA) have been conducted to study the factor structure of the Arabic version of the HESI. The current study aimed to evaluate the psychometric properties of the Arabic version of the HESI (Arabic-HESI) among nursing students in Jordan.Methods: The structure of the instrument was tested using EFA, CFA and using maximum likelihood estimation among a sample of 355 nursing students at five Jordanian universities.Results: The Arabic-HESI proved to have excellent content validity (CVI = 0.92The instrument showed good internal consistency reliability (Cronbach’s α was0.75), as well as for the two emerged factors “challenges” and “dissatisfaction” (Cronbach’s α were 0.75, 0.72 respectively). The results support the two-factor model for the Arabic-HESI because it has robust structure and acceptable goodness-of-fit indices.Conclusion: The Arabic-HESI is a reliable and valid instrument for assessing stress levels and stressors among nursing students in Jordan. Using the reduced version of the HESI to assess stress among nursing students is recommended. Identifying new features of stress and stressors among nursing students in Jordan will enable universities and nursing faculties to better support their students.
Estimating risk factors for three negative outcomes in pregnant women admitted to the Centre de Références et Urgences Obstétricales (CRUO) and their neonates in Port-au-Prince, Haiti between January 2013 and June 2018
Authors: Schuurmans Jorien , Borgundvaag Emily , Finaldi Pasquale , Senat-Delva Rodnie , Desauguste Fedner , Badjo Colette , Lekkerkerker Michiel , Grandpierre Reynaldo , Lerebours Gerald , Ariti Cono , Lenglet Annick
Published: November 2020

Background

The prevalence of (pre-)eclampsia in pregnant women in Haiti is high and access to maternal health services is scarce. Limited evidence exists around negative maternal and neonatal outcomes in Haitian women and their offspring. We describe the patient profile of women admitted to an obstetric emergency hospital in Port-au-Prince between January 2013 and June 2018 and the estimated risk factors for maternal death, stillbirth and low birthweight (LBW).
Methods

We calculated frequencies of age groups, singleton vs. multiple pregnancies, delivery procedures and antenatal care (ANC) services for all maternal admissions. We estimated the associated risk between these factors and the three negative outcomes by calculating odds ratios (OR) and their 95% confidence intervals (CI) using univariate and multivariate logistic regression. We adjusted for an interaction between delivery procedure and pregnancy category in the regression models for maternal death and stillbirth.
Results

We included 31,509 women and 24,983 deliveries and documented 204 (0.6%) maternal deaths (648/100,000 women giving birth), 1,962 (7.9%) stillbirths and 11,008 (44.1%) LBW neonates. 34.9% of all admissions (n = 10,991) were women with (pre-)eclampsia. Maternal death was more likely in women with complicated pregnancies and/or deliveries and women with (pre-)eclampsia when undergoing a C-section compared to women with uncomplicated vaginal deliveries (OR 4.8; CI 1.7–13.8 and OR 2.3; CI 1.5–3.6 respectively). Stillbirth was more likely in women ≥ 35 years compared to women 20–34 years in complicated pregnancies and/or deliveries (OR 1.3; CI 1.1–1.6) and (pre-)eclampsia (OR 1.4; CI 1.2–1.7). C-sections in women with a complicated pregnancy and/or delivery and women with (pre-)eclampsia reduced the risk of stillbirth (OR 0.7; CI 0.6–0.9 and OR 0.3; CI 0.2–0.3 respectively). Not attending ANC was associated with a higher risk of stillbirth (OR 4.8; CI 3.6–6.6) and LBW (OR 1.4; CI 1.1–1.9) for women with complicated pregnancies and/or deliveries.
Conclusion

Maternal mortality in high-risk pregnancies in CRUO is higher than the national estimate of 529 per 100,000 deliveries. Attendance of ANC services is associated with a decrease in adverse neonatal outcomes including LBW and stillbirth. We recommend that access to maternal and neonatal healthcare facilities in Port-au-Prince is improved.
Exploring the mRNA expression level of RELN in peripheral blood of schizophrenia patients before and after antipsychotic treatment
Authors: Yin Jiajun , Lu Yana , Yu Shui , Dai Zhanzhan , Zhang Fuquan , Yuan Jianmin
Published: November 2020

Background: The Reelin (RELN) gene encodes the protein reelin, which is a large extracellular matrix glycoprotein that plays a key role in brain development. Additionally, this protein may be involved in memory formation, neurotransmission, and synaptic plasticity, which have been shown to be disrupted in schizophrenia (SCZ). A decreasing trend in the expression of RELN mRNA in the brain and peripheral blood of SCZ patients has been observed. There is a need to determine whether changes in RELN mRNA expression in SCZ patients are the result of long-term antipsychotic treatment rather than the etiological characteristics of schizophrenia. The expression levels of RELN mRNA in the peripheral blood of 48 healthy controls and 30 SCZ patients before and after 12-weeks of treatment were measured using quantitative real-time PCR.Results: The expression levels of RELN mRNA in the SCZ group were significantly lower than that of healthy controls; however, after 12-weeks of antipsychotic treatment, RELN mRNA levels were significantly increased in the SCZ group.Conclusion: The up-regulation of RELN mRNA expression was current in SCZ patients after antipsychotic treatment, suggesting that the changes in RELN mRNA expression were related to the effect of the antipsychotic treatment.
Re-positive discharged COVID-19 patients are at low transmission risk for SARS-CoV-2 infection– a finding from recovered COVID-19 patients in Wuhan, China
Authors: Wei Sheng , Tong Yeqing , Liu Jiafa , Guan Xuhua , Wang Siquan , Yang Bo , Lu Xingxing , Wang Gaoming , Chen Qinhua , Xu Dandan , Liu Shi , Cai Li , Dong Minna , Ding Chenghui , Yu Hui , Liu Linlin , Lu Jingya , Wang Huanzhuo , Zhang Zhen , Yan Yizhong , Huang Xibao , Shi Tingming , Li Yanan , Wu Yang , Zhang Quanhong , Liu Sizhe , Luo Yingbo , Huang Jiao
Published: November 2020

Discharged COVID-19 patients have been found to be retested positive for SARS-CoV-2 (re-positive), which has widely raised concern among the public. We investigated the prevalence and transmission risk of re-positive cases in discharged COVID-19 patients and their SARS-CoV-2-specific antibody levels in Wuhan, China. Of 1065 discharged COVID-19 patients investigated, 518 (48.64%) patients were males; the mean age was 53.29 ± 14.91 years, with a median duration of 40 (IQR: 31–47) days since discharge. 63 patients were tested re-positive for SARS-CoV-2, with the re-positive prevalence to be 5.92% (95%CI: 4.50%-7.33%). The re-positive prevalence was higher in females (7.86%, 95%CI: 5.61%-10.12%) than that in males (3.86%, 95%CI: 2.20%-5.52%, P = 0.006). Re-positive prevalence was similar in patients tested positive and negative for IgG (6.01% vs 5.56%, P = 0.821) or IgM (6.38% vs 5.07%, P = 0.394). Illness severity and duration from illness onset to retest were not associated with the risk of positive results for SARS-CoV-2 after discharge. All 196 environmental samples collected from 49 re-positive patients were tested negative for SAR-CoV-2. Only one close contact to the re-positive patient had been tested positive for SARS-CoV-2; however, he might be a previous COVID-19 case but had not been detected before. Viral culture of 6 nasopharyngeal specimens presented no cytopathic effect of Vero E6 cells. Virus sequencing of 11 nasopharyngeal specimens indicated genomic fragments of SARS-CoV-2. 898 (84.72%) patients and 705 (66.51%) patients were tested positive for SARS-CoV-2-specific IgG and IgM, respectively. Self-report symptoms at the survey were similar, regardless of the level of antibody. All the re-positive patients and their matched non-re-positive patients were tested negative for SARS-CoV-2 four months later. These findings indicate that Testing re-positive of SARS-CoV-2 is common in discharged COVID-19 patients, but no evidence showed the transmission risk of these re-positive cases. Further isolation of recovered COVID-19 patients is unnecessary. However, only 85% recovered COVID-19 patients had SARS-CoV-2-specific antibody, which suggested discharged COVID-19 patients still had potential re-infection risk.
How to Define Boolean Low Disease Activity in Rheumatoid Arthritis: Experience from a Large Real-World Cohort
Authors: Xie Wenhui , Li Guangtao , Huang Hong , Zhang Zhuoli
Published: November 2020

Objectives: To propose Boolean-defined low disease activity (LDA) and to test its utility in rheumatoid arthritis (RA). Methods: We used data from a longitudinal academic clinical database of RA in Peking University First Hospital over a decade. The initial proposal of Boolean-defined LDA with ascending thresholds from 2 to 5 in steps of 1. Agreement and residual swollen joint count (SJC) pattern with the index-based (Simplified Disease Activity Index [SDAI] and Clinical Disease Activity Index [CDAI]) LDA was analyzed. To confirm discovery, we randomly classified RA patients in a 3:2 ratio into either analysis cohort or validation cohort.Results: In total 4,881 visits of 672 patients were included in the analysis cohort. Of these visits, the frequencies of achieving LDA were 71.9% (SDAI), 73.6% (CDAI), 52.8% (Boolean-LDA2), 65.2% (Boolean-LDA3), 73.5% (Boolean-LDA4), and 80.7% (Boolean-LDA5). High consistency and similar SJC pattern with SDAI-LDA or CDAI-LDA were observed in Boolean-LDA3 (kappa=0.796, 0.771). Further analysis found meeting SDAI-LDA but not Boolean-LDA3 were largely attributable to higher patient’s global assessment (PGA) scores (62.9%). In further modification of Boolean-LDA3, best agreement with SDAI-LDA or CDAI-LDA was reached when evaluator’s global assessment (EGA) replaced PGA with cutoff of 3.0 (kappa=0.851, 0.825), rather than exclusively increasing the PGA cut-offs. These findings were further replicated in randomly-generated validation cohort of 449 patients with 3,306 clinic visits. Conclusions: Using cut-off of 3 to Boolean-LDA with a substitute EGA for PGA provides highest consistency and similar residual SJC pattern with index-based LDA. This may deserve considering in clinical practice.
Intracellular pH Regulation: Characterization and Functional Investigation of H+ Transporters in Stylophora Pistillata
Authors: Capasso Laura , Ganot Philippe , Planas-Bielsa Víctor , Tambutté Sylvie , Zoccola Didier
Published: November 2020

Background: Reef-building corals regularly experience changes in intra and extracellular H+ concentration ([H+]) due to physiological and environmental processes. Stringent control of [H+] is required for the maintenance of homeostatic acid-base balance in coral cells and is achieved through the regulation of intracellular pH (pHi). This task is especially challenging for reef-building corals that share an endosymbiotic relationship with photosynthetic dinoflagellates (family Symbiodinaceae), which exert a significant effect on the pHi of coral cells. Despite their importance, the pH regulatory proteins involved in the homeostatic acid-base balance have been scarcely investigated in corals. Here, we reported the full characterisation in terms of genomic structure, domain topology and phylogeny of three majors H+ transporter families implicated in pHi regulation; we investigated their tissue-specific expression and we assessed the effect of seawater acidification on their level of expression.Results: We identified members of the Na+/H+ exchanger (SLC9), vacuolar-type electrogenic H+-ATP hydrolases (V-ATPase) and voltage-gated proton channels (HvCN) families in the genome and transcriptome of S. pistillata. In addition, we identified a novel member of the HvCN gene family in the cnidarian subclass Hexacorallia, which has never been described in any species to date. We also reported key residues that participate to the H+ transporters substrate specificity, protein function and regulation. Lastly, we demonstrated that some of these have different tissue expression patterns and are mostly unaffected by exposure to seawater acidification.Conclusions: In this study, we provide the first characterization of the H+ transporters genes that contribute to homeostatic acid-base balance in coral cells. This work will enrich knowledge about basic aspects of coral biology, bearing important implications for our understanding of how corals regulate their intracellular environment.
The Effects of Smoking, Regular Drinking, and Unhealthy Weight on Healthcare Utilization in China
Authors: Li Changle , Mao Zhengzhong , Yu Caixia
Published: November 2020

Background: The preventable risk factors such as smoking, harmful drinking, and unhealthy weight have contributed to the accelerated rise in non-communicable chronic diseases that are dominant drivers of health care use and spending in China. This study aimed to ascertain the effects of smoking, regular drinking, and unhealthy weight on healthcare utilization in China. Methods: The database used in this study was obtained from the China Family Panel Studies (CFPS), and the final sample consisted of 63,260 adults in all the five waves of data collection. The fixed effects logistic regression model was used for the analysis. Results: The current study found that among Chinese adults, current and former smokers were more likely to use outpatient and inpatient care compared to those who never smoked. Former smokers increased the odds of using outpatient and inpatient care than current smokers. Moreover, compared to healthy weight people, obese people increased the likelihood of using outpatient and inpatient care, and overweight people were more likely to be hospitalized. In contrast, people who regularly drank alcohol were less likely to use outpatient and inpatient care than non-regular drinkers. Conclusion: This study ascertained the effects of smoking, regular drinking, and unhealthy weight on healthcare utilization in China using a five-waves of balanced panel data set. These results may have important implications for supporting the government to make healthcare resources allocation decisions.
WITHDRAWN: Correlation Between MSTS, TESS and QOL-CSV Scores in Patients With Soft Tissue and Bone Tumors
Authors: Singh Vivek Ajit , Haseeb Amber , Pathak Mandeep , Madhialagan Venotha
Published: November 2020

Purpose:Limb salvage surgery (LSS) is the preferred treatment when compared to amputation. Although LSS provides a desirable outcome, it still presents with some functional limitation. The quality of life (QOL) amongst patients with musculoskeletal sarcomas is an important factor to consider in the management. This study investigates the correlation between MSTS and TESS score versus QOL for musculoskeletal cancer survivors.Methods:Patients with musculoskeletal tumors on follow up were recruited. Any age, gender and race were included provided they had completed surgical treatment. The functional scores were evaluated using MSTS and TESS tools while QOL was determined with QOL-CSV tool. Their correlation was compared. Results:The study involved 96 patients, 54.2% were females and 45.8% were males. The highest range of age was 21-30 years old (27.1%). Majority had bone sarcoma (63.3%). The mean MSTS score was 71.32% ± 23.34 (0-100), TESS was 78.92% ± 17.38 (0-100) and QOL-CSV was 71.51% ± 12.05 (0-100). Both MSTS (49.0%) and TESS (54.2%) scores had a good response. However, only 25% had a good QOL_CSV. All the tools had a positive correlation. Multiple linear regression model demonstrated that the effect of TESS on QOL was significant but the effect of MSTS was insignificant. The R-squared value of MSTS (0.073) and TESS (0.013) combined was 0.17. Conclusion:A single tool is not a good predictor therefore all 3 tools should be taken into consideration when assessing the QOL of those undergone musculoskeletal tumor surgery.
The Screening Value of Mammography for Breast Cancer: An Overview of 22 Systematic Reviews with Evidence Mapping
Authors: Shi Jiyuan , Li Jiang , Zhang Lili , Gao Ya , Chen Yamin , Zhao Liang , Kang Yingying , Chen Wanqing , Tian Jinhui , Li Ni , He Jie
Published: November 2020

Background: Several meta-analyses have evaluated the screening value of mammography for breast cancer, but the overall results have remained mixed or inconclusive. Methods: Comprehensive literature search was conducted for SRs (systematic reviews) in Chinese Biomedical Databases (CBM), Cochrane Library, EMBASE, and PubMed until July 10, 2020. SRs with meta-analysis reported the benefit and performance of mammography screening were included. Two reviewers independently extracted data and performed the methodological quality assessments using The Risk Of Bias In Systematic Reviews (ROBIS). The characteristics of included SRs, the results of the quality of Risk of bias (RoBs) assessment and the pooled estimates of effect size were descriptively summarized using systematically structured tables and evidence mapping. Results: Twenty two systematic reviews with meta-analysis were included. Only 13.6% of SRs were assessed as low-risk bias according to the overall risk of bias rating results in ROBIS tool. Pooled estimates for a reduction in breast cancer mortality attributable to mammography screening were range from 0.51 (OR, 95% CI: 0.46-0.55) to 1.04 (RR, 95% CI: 0.84-1.27). Sensitivity of difference mammography was ranged from 55% to 91%, specificity of difference mammography was ranged from 84% to 97%. According to the results of included SRs suggested, the statistically significant was observed that digital breast tomosynthesis (DBT) increased the cancer detected rate (CDR) and reduced the recall rate compared to digital mammography (DM), DM increased the CDR compared to screen-film mammography (SFM), and add DBT to digital or synthetic mammography increases the sensitivity, specificity, and CDR than DBT alone. Conclusions: Further study should investigate the value of different imaging technology in breast cancer screening.Systematic review registration: PROSPERO CRD42020207227
DNA Methylation in the Adipose Tissue and Whole Blood of Agent Orange-exposed Operation Ranch Hand Veterans
Authors: Rytel Matthew Rae , Butler Rondi , Eliot Melissa , Braun Joseph M. , Houseman E. Andres , Kelsey Karl T.
Published: November 2020

BackgroundBetween 1962 and 1971, the US Air Force sprayed Agent Orange across Vietnam, exposing many soldiers to this dioxin-containing herbicide. Several negative health outcomes have been linked to Agent Orange exposure, but data is lacking on the effects this chemical has on the genome. Therefore, we sought to characterize the impact of Agent Orange exposure on DNA methylation in the whole blood and adipose tissue of veterans enrolled in the Air Force Health Study (AFHS). MethodsWe received adipose tissue (n=37) and whole blood (n=42) from veterans in the AFHS. Study participants were grouped as having low, moderate, or high TCDD body burden based on their previously measured serum levels of dioxin. DNA methylation was assessed using the Illumina 450K platform.ResultsEpigenome-wide analysis indicated that there were no FDR-significantly methylated CpGs in either tissue with TCDD burden. However, 3 CpGs in the adipose tissue (contained within SLC9A3, LYNX1, and TNRC18) were marginally significantly (q<0.1) hypomethylated, and 1 CpG in whole blood (contained within PTPRN2) was marginally significantly (q<0.1) hypermethylated with high TCDD burden. Analysis for differentially methylated DNA regions yielded SLC9A3, among other regions in adipose tissue, to be significantly differentially methylated with higher TCDD burden. Comparing whole blood data to a study of dioxin exposed adults from Alabama identified a CpG within the gene SMO that was hypomethylated with dioxin exposure in both studies. ConclusionWe found limited evidence of dioxin associated DNA methylation in adipose tissue and whole blood in this pilot study of Vietnam War veterans. Nevertheless, loci in the genes of SLC9A3 in adipose tissue, and PTPRN2 and SMO in whole blood, should be included in future exposure analyses.
COVID-19 Infection Across Workplace Settings in Qatar, a Comparison of COVID-19 Positivity Rates of Screened Workers From March 1st Until July 28th, 2020
Authors: Kuwari Mohammed Al , Nuaimi Asma Al , AbdulMajeed Jazeel , semaan sandy , Romaihi Hamad Al , Kandy Mujeeb , Swamy Selvakumar
Published: November 2020

IntroductionCOVID-19 transmission was significant amongst Qatar’s working population during the March-July 2020 outbreak. The study aimed to estimate the risk of exposure for COVID-19 across various workplace settings in the State of Qatar. MethodsA cross-sectional study was conducted utilizing surveillance data of all workplaces with ten or more laboratory-confirmed cases of COVID-19. These workplaces were categorized using a mapping table adapted from the North American Industry Classification System (NAICS) codes 2017 version. The data was then analyzed to estimate and compare the positivity rate as an indicator of the risk of developing COVID-19 infection across various workplace settings in the State of Qatar. ResultsThe highest positivity rate was reported amongst the Construction (40.3%) and the Retail & Wholesale Trade sectors (40.3%) whereas, the lowest positivity rate was attributed to the healthcare workplace setting (11.0%). The private funded sector employees had higher positivity rates than employees of the governmental funded sector. ConclusionThe elevated risk of infection amongst screened workers in Construction and Retail & Wholesale Trade was probably due to Environmental and Educational vulnerabilities. On the other hand, the better containment within healthcare workplace settings can be attributed to the enforcement of infection control and occupational safety measures. These findings underline the importance of appropriately using preventive and surveillance strategies for high-risk workplace settings to mitigate the risk of infection.
Mortality Associated With Acute Respiratory Distress Syndrome 2009-2019: A Systematic Review and Meta-regression 
Authors: Sadana Divyajot , Kaur Simrat , Sankaramangalam Kesavan , Banerjee Kinjal , Siuba Matthew , Amaral Valentina , Gadre Shruti , Torbic Heather , Krishnan Sudhir , Duggal Abhijit
Published: November 2020

Background: Acute respiratory distress syndrome (ARDS) is a common occurrence in an intensive care unit. The reported mortality in studies evaluating acute respiratory distress syndrome is highly variable. The adherence to ventilatory specific and adjunctive therapies is also highly variable. We investigated the mortality of ARDS since the 2009 H1N1 pandemic and examined the adherence to ventilatory specific and adjunctive therapies.Methods: We performed a systematic search in MEDLINE and EMBASE using a highly sensitive criterion from January 2009 to May 2019. We then ran a proportional meta-analysis for mortality and a meta-regression analysis using certain variables to address heterogeneity. Results: We screened 5361 citations, of which 85 fully met inclusion criteria. The weighted pooled mortality of all 85 studies published from 2009 to 2019 was 38% (95% CI 35,40). Mortality was higher in observational studies [40% (95% CI 37, 42)] compared to RCTs [35% (95% CI 30,39)], (p=0.04) Significant variability exists in literature of reported tidal volumes, positive end expiratory pressures, plateau pressures, and use adjunctive therapies. The tidal volumes in our systematic review ranged from 5.8 to 8.9 ml/kg with a mean of 7.2 ml/kg. PEEP ranged from 4.6 to 16.1 cm H2O at the time of enrollment with a mean of 10.2 cm H2O. Reported plateau pressures ranged from 21.0 to 35.1 cm H2O, with a mean of 25.6 cm H2O. Higher reported initial PaO2/FiO2 ratios were associated with decreased mortality. A trend towards decreased mortality was seen with lower reported tidal volumes in the included studies.Conclusions: Over the last decade, the mortality in ARDS has marginally improved and there exists significant heterogeneity in the utilization of low tidal volume strategies, application of PEEP and the adoption of adjunctive therapies in the management of these patients in published literature.