bluuebunny/crossref_metadata_2025 huggingface dataset:
Hemoglobin A1c as A Potential Indicator for Intraplaque Hemorrhage of Carotid Artery Atherosclerosis in Asymptomatic Adults
Authors: Wang Yu , Zhang Runhua , Jiang Yong , Yu Miaoxin , Qiao Huiyu , Han Hualu , Shen Rui , Ning Zihan , Zhao Xihai , Liu Gaifen
Published: April 2021

BackgroundTo investigate the association between hemoglobin A1c (HbA1c) and intraplaque hemorrhage (IPH) in carotid atherosclerotic plaque detected by high-resolution magnetic resonance imaging (HR-MRI) in a community-based population. MethodsIn this cross-sectional, community-based study, a total of 598 participants were recruited from May 2015 to September 2019. All participants underwent carotid artery HR-MRI. Data on demographics, medical history, and physical examinations were obtained through face-to-face interview, and fasting blood sample were collected. HbA1c was determined using high-performance liquid chromatographic analysis. Presence or absence of carotid plaque IPH was determined by HR-MRI. Multiple stepwise logistic regression analysis was performed to investigate the association between HbA1c levels and carotid plaque IPH. ResultsOf the 598 participants, 317 (53.0%) had atherosclerotic plaques, and 25 (4.2%) had IPH in carotid arteries. HbA1c was associated with the presence of IPH (OR, 1.94; 95% CI, 1.38-2.73) in the univariate analysis, and the association remained significant after adjustment for age, sex, traditional vascular factors, high-sensitivity C-reactive protein, and other potential confounders (OR, 1.70; 95% CI, 1.14-2.52).Conclusions﻿This study showed that high HbA1c was associated with carotid plaque IPH detected by HR-MRI, which suggests that individuals with high HbA1c may have a higher risk of developing vulnerable carotid plaques.
Design and Implementation of High Performance PPSK demodulator in Biomedical Implant
Authors: Katikala Hima Bindu , Murthy G.Ramana , Nath Yatavakilla Amarendra
Published: April 2021

The important challenge for the realization of hearing aids is small size, low cost, low power consumption and better performance, etc. Keeping these requirements in view this work concentrates on the VLSI (Very Large Scale Integrated) implementation of analog circuit that mimic the PPSK (Passive Phase Shift Keying) demodulator with low pass filter. This research deals with RF Cochlear implant circuits and their data transmission. A PPSK modulator is used for uplink data transmission in biomedical implants with simultaneous power, data transmission This paper deals about the implementation of PPSK demodulator with related circuits and low pass filter which are used in cochlear implants consumes low power and operates at 14MHz frequency. These circuits are designed using FINFET 20nm technology with 0.4v DC supply voltage. The performance of proposed design over the previous design is operating at low threshold voltage, reduces static leakage currents and often observed greater than 30 times of improvement in speed performance
National Trauma System Establishment Based on Implementation of Regional Trauma Centers Improves Outcomes of Trauma Care; A Follow-up Observational Study in South Korea
Authors: Jung Kyoungwon , Kwon Junsik , Huh Yo , Moon Jonghwan , Hwang Kyungjin , Cho Hyun Min , Kim Jae Hun , Park Chan Ik , Yun Jung-Ho , Kim Oh Hyun , Lee Kee-Jae , Kim Sunworl , Lim Borami , Kim Yoon
Published: April 2021

Background: Although Korea is a high-income country, its trauma system is comparable to low- and middle-income countries with high preventable trauma death rates (> 30%). Since 2012, Korea has established a national trauma system based on the implementation of regional trauma centers and improvement of the transfer system; this study aimed to evaluate its effectiveness.Methods: We compared the national preventable trauma death rates, transfer patterns, and outcomes between 2015 and 2017. The review of preventable trauma deaths was conducted by multiple panels and a severity-adjusted logistic regression model was created to identify factors influencing the preventable trauma death rate. We also compared the number of trauma patients transferred to emergency medical institutions and mortality in models adjusted with injury severity scores.Results: The preventable trauma death rate decreased from 2015 to 2017 (30.5% vs. 19.9%, p < 0.001). In the severity-adjusted model, the preventable trauma death risk had a lower odds ratio (0.68, 95% confidence interval: 0.53–0.87, p = 0.002) in 2017 than in 2015. Regional trauma centers received 1.6 times more severe cases in 2017 (according to the International Classification of Diseases Injury Severity Score [ICISS]; 23.1% vs. 36.5%). In the extended ICISS model, the overall trauma mortality decreased significantly from 2.1% (1008/47806) to 1.9% (1062/55057) (p = 0.041).Conclusions: Establishment of the national trauma system was associated with significant improvements in performance and outcomes of trauma care. This was mainly because of the implementation of regional trauma centers and because more severe patients were transferred to regional trauma centers. This study might be a good model for low- and middle-income countries, which lack a trauma system.
Crossing Empirical Trend Analysis (CETA) At Risk Levels In Hydro-Meteorological Time Series
Authors: Sen Zekai
Published: April 2021

Trend identification procedures are employed to determine the systematic monotonic trend lines in a given hydro-meteorological time series records for depiction of time dependent changes in the form of increase or decrease. Different methodologies are proposed for such identifications, but most of them require restrictive assumptions such as the normal (Gaussian) probability distribution, serial independence and long sample sizes. In order to relieve especially the serial independence requirement pre-whitening and over-whitening procedures are suggested, but they cannot render a serially dependent series into completely independent structure. In this paper, a new trend methodology is proposed on the basis of crossing features along any given straight-line within the given time series and the one with the maximum crossing number is the searched trend component. This approach does not require any restrictive assumption. Contrary to the previous trend algorithms, the suggested crossing empirical trend analysis (CETA) yields not a single trend, but a set of trends at different levels within the variation range of hydro-meteorological time series records. In this paper for the sake of brevity only three levels are considered at 10%, 50% and 90% risk levels. The comparison of the CETA approach is presented with the classical and frequently used method of Mann-Kendall (MK) trend identification procedure based on the Sen’s slope calculation. For small serial correlation coefficients and normal probability distribution (PDF) function cases CETA and classical technique yield almost the same trend line within +5% error band limits. The application of this methodology is presented for monthly and annual discharge records of Danube River and annual precipitation records from seven geographical regions of Turkey.
Large Bending Deformation of Piezoelectric Nanobeam with Surface Energy Model
Authors: Yang Fan , Li Chengbo
Published: April 2021

In the present paper, we analyze the influence of surface effect on the nonlinear bending behavior of piezoelectric nanobeams by Euler-Bernoulli model and surface energy model. Based on the principle of minimum potential energy and the electromagnetic theory, the nonlinear governing equation as well as the boundary conditions is deducted incorporated surface effects and piezoelectric effects. The effect of surface effect on bending deformation and induced charge of piezoelectric beams under different boundary conditions is discussed under the condition of small deformation and large deformation. The results show that, under the condition of small deformation, the surface effect reduces the bending deformation and the inductive charge, under the condition of large deformation, the surface effect has little effect on the bending deformation of piezoelectric nanobeams. Furthermore, the external constraints and cross-section width b of the piezoelectric nanobeam have significant effect on the bending deformation stiffness. these conclusions have important guiding significance for the design and correction of nanobeams-based nanomechanical systems and piezoelectric nanofunctional devices.
Efficacy and Complications of Regional Citrate Anticoagulation During Continuous Renal Replacement Therapy in Critically Ill Patients with COVID-19
Authors: Khadzhynov Dmytro , Berge Uwe von dem , Muench Frédéric , Karaivanov Stoyan , Koerner Roland , Kruse Jan M. , Zickler Daniel , Budde Klemens , Eckardt Kai-Uwe , Lehner Lukas J.
Published: April 2021

Background: Enhanced coagulation in coronavirus disease 2019 (COVID-19) patients is considered a major obstacle for continuous renal replacement therapy (CRRT), but systematic analyses are sparse. We compared filter survival and citrate-induced complications during CRRT with regional citrate anticoagulation (RCA) in COVID-19 and Non-COVID-19 patients.Methods: In this retrospective study we included all consecutive adult patients (n=97) with acute kidney injury (AKI) treated with RCA-CRRT at seven ICUs of a tertiary university hospital over the tree month period. Medical data were collected to compare the efficacy and complications of RCA-CRRT between COVID-19 (n=44) and Non-COVID-19 patients (n=53).Results: There was no significant difference in the number of CRRT filters used per patient in COVID-19 vs. Non-COVID-19 patients (median 5 vs 3 filters, p=0.103). Mean filter run-time was significantly higher in COVID-19 patients compared to Non-COVID-19 patients (68.4 (95%CI 67.0-69.9) vs. 65.2 (95%CI 63.2-67.2) hours, respectively; log-rank 0.014). COVID-19 patients showed significantly higher activated partial thromboplastin time (aPTT) throughout the CRRT due to systemic anticoagulation compared to Non-COVID-19 patients (54 (IQR 45 – 61) vs. 47 (IQR 41 - 58) seconds, respectively; p<0.001). A significantly higher incidence of combined metabolic disturbances (metabolic alkalosis, hypercalcemia and hypernatremia), consistent with reduced filter patency and citrate overload during RCA, was observed in COVID-19 patients compared to Non-COVID-19 patients (19.1% vs. 12.7%, respectively; p=0.04). These metabolic disarrangements were resistant to per-protocol adjustments and disappeared after replacement of the CRRT-filter. Conclusions: In contrast to initial concerns, adequate filter life-span can be achieved with RCA during CRRT in COVID-19 patients. However, close monitoring of the acid-base balance appears warranted, as these patients tend to develop reduced filter patency leading to a higher incidence of citrate overload and metabolic disturbances. Trial Registration (local authority): EA1/285/20 (Ethikkommission der Charité - Universitätsmedizin Berlin); date of registration 08.10.2020.
Squamous Differentiation in pT1 Low-Grade Bladder Urothelial Carcinoma is Associated with High Risk of Recurrence
Authors: Wei Wanqing , Zhang Jianwei , Wang Keruo , Xia Shunlin , Shang Zhiqun , Li Gang , Niu Yuanjie
Published: April 2021

Background A large number of studies have confirmed that squamous differentiation is closely related to the prognosis of bladder cancer, and studies also showed that it is an independent predictor for the prognosis of such disease. However, the role of squamous differentiation in pT1 low-grade bladder cancer (LGBC) has not been reported yet. This study mainly intends to explore the clinical significance of squamous differentiation in pT1 LGBC.Methods The clinicopathological data of 582 patients with pT1 LGBC from April 2007 to December 2018 were retrospectively analyzed, including 51 cases pathologically diagnosed as pT1 LGBC with squamous differentiation, and 531 cases as pT1 LGBC without squamous differentiation. The clinicopathological characteristics and prognosis of patients in the two groups were compared.Results 51 cases (8.7%) were pathologically diagnosed as pT1 LGBC with squamous differentiation. As compared with non-squamous differentiation, squamous differentiation was closely related to the age of patients (P=0.009) and postoperative recurrence (P<0.001). Further studies on the pT1 LGBC recurrence group showed that the patients in the squamous differentiation group were more prone to multiple recurrences (P=0.033) and invasive recurrence (P<0.001) after surgery. The Kaplan-Meier analysis indicated that pT1 LGBC patients with squamous differentiation had shorter recurrence-free survival (RFS) time. The Cox proportional hazard analysis confirmed that squamous differentiation was an independent predictor of RFS time in patients with pT1 LGBC.Conclusions Squamous differentiation is closely related to postoperative recurrence of pT1 LGBC, especially multiple recurrences and invasive recurrence after surgery. Squamous differentiation is an independent predictor of the RFS time in patients with pT1 LGBC.
Epigenetic Axis of Long Noncoding RNA HCG18 and miR-146a-5p Regulates Sepsis‐Associated Myocardial Injury
Authors: Wang Hua , Zhao Wen-Shu , xu lin
Published: April 2021

The authors have requested that this preprint be removed from Research Square.
Low Lactic Acid and Hypercholesterolemia Reduce 90-day Mortality in Patients Suffering From Septic Shock According to the Sepsis-3 Definition
Authors: Wang Dong , Sun Yali , Liu Huan , Zhang Xiaojuan , Ding Xianfei , Liu Shaohua , Han Bing , Wang Haixu , Duan Xiaoguang , Sun Tongwen
Published: April 2021

Background: Dyslipidemia and lactic acid levels are associated with poor prognosis of septic shock. After the revised definition of sepsis and septic shock (Sepsis-3) in 2016, data on the prognostic value of lactic acid levels and hypocholesterolemia were lacked. This study aimed to evaluate whether lactic acid and cholesterol can be used to predict mortality in ICU patients suffering from septic shock.Methods: Prospective observational study, 349 patients suffering from septic shock as defined by Sepsis-3. The COX model and the binary logistic regression model evaluate the correlation between lactic acid or total cholesterol and death from septic shock, and are adjusted according to the demographics, chronic diseases, and biomarkers of the participants.Results: Total cholesterol, total protein, and albumin levels were significantly lower, and lactic acid, acute physiology, and chronic health assessment (APACHE II) were significantly higher in the surviving group compared to those in the non-surviving group. Lactate levels < 4.4 mmol/L and total cholesterol levels < 2.42 mmol/L were associated with mortality after adjusting for confounders (odd ratio, 3.06 [95% CI, 1.78-5.27] and 1.99 [95% CI, 1.15-3.46]). In multivariate analysis, urogenital origin, albumin levels < 25 g/L, age < 60 years, and APACHE II < 20 were independent risk factors for death from septic shock.Conclusions: In those suffering from septic shock, increased blood lactate levels and decreased total cholesterol levels were associated with higher mortality. Furthermore, it was found that lactic acid and total cholesterol are sensitive markers of mortality in an ICU setting.
An Iranian patient affected by autosomal recessive hypercholesterolemia due to a novel variant in the LDLRAP1 gene
Authors: Nikasa Parisa , Rabbani Bahareh , Hejazi Mohammad Saeid , Firouzi Ata , Baharvand Hossein , Totonchi Mehdi , Mahdieh Nejat
Published: April 2021

Background: Autosomal recessive hypercholesterolemia (ARH) is a rare monogenic disorder resulting from mutations of the LDLRAP1 gene, which leads to elevated LDL-C levels. Here, using whole exome sequencing (WES), we describe a 22-year-old Iranian female who carries a novel nonsense mutation in LDLRAP1. Methods: Genetic investigations were performed for the patient and her family. She showed LDL-C level of 720 mg/dL since the age of 11 years. At the age of 13 years old, aortic valve repair surgery was performed due to severe aortic valve stenosis (AVS). At the age of 17, along with prescription of rosuvastatin plus ezetimibe, coronary angiography displayed the presence of serious stenotic lesions of the coronary arteries and also aortic valve, making the patient eligible for coronary artery bypass grafting (CABG) and aortic valve replacement (AVR).Results: Genetic analysis showed the presence of a previously unreported homozygous LDLRAP1 gene variant, c.649G>T, generating a nonsense mutation at amino acid 217, shortening the ARH protein from 308 to 217 amino acid, which removes AP-2 binding domain of ARH, as an important part in LDL uptake.Conclusion: During a 10-year treatment, we observed a 74% reduction in LDL-C level. Despite the treatment with maximal dose of rosuvastatin plus ezetimibe, the results of coronary angiography demonstrated severe supravalvular aortic stenosis (SVAS) resulted in significant stenotic lesions of the coronary arteries and aortic valve. This highlights the importance of WES in early diagnosis of ARH, and it is proposed to prevent or at least delay the onset of the cardiovascular events.
Risk factors for acute kidney injury after unilateral radical nephrectomy and inferior vena cava thrombectomy under cardiopulmonary bypass: a retrospective study
Authors: Zhang Qi , Li Ming , Fu Dongmei , Wang Dongxin , Diao Shiqi
Published: April 2021

In patients with renal cell carcinoma (RCC) and cancer-related thrombosis in the inferior vena cava (IVC) or right atrium (AT), it is still unknown whether nephrectomy, anesthesia, and surgical trauma can cause postoperative acute kidney injury (AKI) and what are the risk factors for AKI. To examine the incidence and risk factors of postoperative AKI in patients who underwent unilateral radical nephrectomy and cardiopulmonary bypass (CPB)-assisted thrombectomy in the IVC and/or atrial AT due to RCC complicated with cancer-associated thrombosis. This retrospective study included patients who underwent unilateral radical nephrectomy and CPB-assisted thrombectomy in the inferior vena cava and/or atrial pulmonary artery due to RCC, under general anesthesia, from December 2011 to June 2015, at Peking University First Hospital. Among 31 patients, 15 (48.4%) had postoperative AKI. Compared with the non-AKI group (n = 16), patients in the AKI group (n = 15) were older (59.0 ± 8.7 vs. 48.5 ± 12.9 years, P = 0.012) had smaller intraoperative urine volume (1225 ± 639 vs. 1685 ± 597 mL, P = 0.048). There were no differences in preoperative creatinine clearance. Age (OR = 1.10, 95%CI: 1.02–1.20, P = 0.020) was independently associated with AKI occurrence. The patients undergoing unilateral radical nephrectomy and CPB-assisted IVC thrombectomy have a high rate of AKI. Older ones are at a higher risk of postoperative AKI.
Impact of COVID-19 on Academic Activities of Final Year Nursing Students in Zambia: Evidence from Zambia
Authors: Mwila Kennedy , Kalolo Florence , Mudenda Steward , Hikaambo Christabel Nang’andu
Published: April 2021

Background: The novel coronavirus disease 2019 (COVID-19) has had many impacts on the education sector. The pandemic has had negative impacts on the academic activities of nursing students globally. Therefore, we assessed the impact of the COVID- 19 on the academic activities of final year nursing students in Lusaka and Mufulira Districts of Zambia. Materials and methods: This was a cross-sectional study that employed quantitative methods using a structured questionnaire among 196 final year nursing students. Data were analysed using the Statistical Package for Social Sciences (SPSS) version 21. Results: A female predominance (67.9%) and a response rate of 95.14% were achieved. Many students strongly agreed (32.7%) and agreed (20.4%) that they did not complete their course work resulting in some concepts being poorly taught, 86.1% strongly agreed that they had delayed final examinations, and 51.5% strongly agreed that they did not do their clinical attachments. Students strongly disagreed (40.3%) that the e-library and wireless facilities in their school were well-stocked. Hence, this resulted in some students (40.3%) missing class lessons and assessments. Conclusion: The COVID-19 epidemic has negatively affected the academic activities of nursing students in Zambia. Ministries responsible for education must put in place measures that will mitigate the impact of COVID-19 on the education sector. Schools must adapt to the changes in the way of conducting learning and assessment sessions. Finally, schools must improve on their e-library and wireless facilities to effectively support online learning.
Rapid Resolution of severe feline infectious peritonitis using natural products
Authors: Zhang Yue , Zhang Yuanfeng , Zhu Lili , Lu Fang , Du Xin , Zhao Xin , Lu Tao
Published: April 2021

This is the first report of a successful treatment of a severe feline infectious peritonitis (FIP) case using Lianhuaqingwen (LH) capsule, a Chinese patent medicine （natural products）and it has been used for the treatment of coronavirus disease 2019. A 1-year-old cat was diagnosed FIP and presented with severe ascites, aphagia, inflammation, breathing difficulties and weight loss. Within 22 days of LH capsule treatment, all indicators of the cat eventually returned to normal, and the ascites gradually disappeared. This case report is the first description of the clinical recovery features of a cat with a systemic FCoV infection using LH capsules.
Cautious Addition of Targeted Therapy to PD-1 Inhibitors after Initial Progression of BRAF Mutant Metastatic Melanoma on Checkpoint Inhibitor Therapy
Authors: Samlowski Wolfram , Adajar Camille
Published: April 2021

Background: Virtually all metastatic melanoma patients who progress after initial treatment with PD-1 or CTLA-4 directed antibodies will die of their disease. Salvage options are urgently needed. It is theoretically attractive to combine immunotherapy with targeted agents in progressing patients with BRAF mutation positive melanoma, but the toxicity of combined treatment has proven challenging. We have observed striking responses with the cautious addition of low doses of targeted therapy to PD-1 antibody treatment at the time of disease progression following initial immunotherapy. This allowed conversion of a significant number of rapidly progressing patients to durable complete responses in BRAF mutant melanoma. Results: We therefore performed a retrospective analysis of our large patient database and identified 23 patients who progressed on initial checkpoint inhibitor treatment, who subsequently had cautious addition of BRAF±MEK inhibitor therapy to PD-1 antibody treatment. We found an objective response rate of 55% in second line therapy, with a median progression-free survival of 33.4 months and median overall survival of 34.1 months, with 40% of patients in remission over 3 years. Ten of 12 responding patients were able to discontinue all therapy and continue in unmaintained remission. Toxicity of this approach was generally manageable (only 21.7 % grade 3-5 toxicity). There was 1 early sudden death for unknown reasons in a responding patient. Conclusions: Our results suggest that 2nd line therapy with PD-1 inhibitors plus BRAF±MEK inhibitors has substantial activity and manageable toxicity. This treatment can induce additional durable complete responses after failure of initial immunotherapy of metastatic melanoma. These remarkable results suggest further evaluation be performed of sequential checkpoint inhibitor therapy with cautious addition of targeted therapy in appropriate patients.
Identification of The Potential Signature Genes Between Lung Adenocarcinoma and Lung Squamous Cell Carcinoma
Authors: Li Xue , wang zhenni , Xie Jun , Zhu Naishuo
Published: April 2021

Objectives:The purpose of this study was to identify and compare the potential signature genes along with the key pathways related to the pathogenesis of lung adenocarcinoma and lung squamous cell carcinoma through bioinformatics analysis.Methods:The differential expressions of miRNAs (DEmiRNAs) and mRNAs (DEmRNAs) in lung adenocarcinoma (AD) and lung squamous cell carcinoma (SC) were identified using the microarray data of 2miRNA and 6 mRNA from the Gene Expression Omnibus (GEO) database. The interaction between the DEmiRNAs and DEmRNAs was explored, followed by the KEGG pathway enrichment, Gene Ontology annotation (GO) enrichment analysis, DEmiRNA-gene interactive network, and protein-protein interaction (PPI) network to predict the hub genes and identify the key pathways. The sequencing data was then downloaded from The Cancer Genome Atlas (TCGA) to validate the hub genes, perform survival analysis, construct the ROC curve along with identifying the regulatory networks of mRNA-miRNA-lncRNA. Finally, the resulting signature genes and significant regulatory networks in AD and SC were filtrated across these analyses.Results:The DEmiRNAs and DEmRNAs were found to be significantly enriched in the phagosomes, human T-cell leukemia virus 1 infection, and ECM-receptor interaction in the AD, whereas in SC, they were enriched in the cell cycle and p53 signaling pathways. Furthermore, we found that the hsa-miR-21-5p, hsa-miR-200a-5p, and COL1A1 may act as potential meaningful biomarkers for the AD while hsa-miR-141-3p, hsa-miR-429, hsa-miR-130b-3p, hsa-miR-205-5p, and FRMD6 may play an important role in SC. The HMGA1/hsa-miR-424-5p/PVT1 maybe a significant regulatory network of AD while KIF11/hsa-miR-30d-5p/DLEU2, CCNE2/hsa-miR-30d-5p/DLEU2, and SPTBN1/hsa-miR-218-5p/MAGI2-AS3 may be the useful networks in regulating the SC progression.Conclusion: This study provided the signature targets and theoretical basis for further research on the biomarkers and molecular mechanisms of the SC, AD, and NSCLC.
Injection of hydrogel spacer increased intrafractional prostate motion during volumetric modulated arc therapy-stereotactic body radiation therapy for prostate cancer
Authors: Sawayanagi Subaru , Yamashita Hideomi , Ogita Mami , Nozawa Yuki , Watanabe Yuichi , Imae Toshikazu , Abe Osamu
Published: April 2021

BackgroundThe aim of this study was to clarify the association between intrafractional prostate shift and hydrogel spacer.MethodsThirty-eight patients who received definitive volumetric modulated arc therapy (VMAT)-stereotactic body radiation therapy (SBRT) for prostate cancer with prostate motion monitoring in our institution in 2018–2019 were retrospectively evaluated. In order to move the rectum away from the prostate, hydrogel spacer (SpaceOAR system, Boston Scientific, Marlborough, the United States) injection was proposed to the patients as an option in case of meeting the indication of use. We monitored intrafractional prostate motion by using a 4-dimensional (4D) transperineal ultrasound (US) device: the Clarity 4D ultrasound system (Elekta AB). The deviation of the prostate was monitored in each direction: superior-inferior (SI), left-right (LR), and anterior-posterior (AP). We also calculated the vector length (VL). The maximum intrafractional displacement (MID) per fraction for each direction was detected and mean of MIDs was calculated per patient. The MIDs in the non-spacer group and the spacer group were compared using the unpaired t-test.ResultsWe reviewed 33 fractions in eight patients as the spacer group and 148 fractions in 30 patients as the non-spacer group. The superior MID was 0.47 ± 0.07 (mean ± SE) mm vs. 0.97 ± 0.24 mm (P = 0.014), the inferior MID was 1.07 ± 0.11 mm vs. 1.03 ± 0.25 mm (P = 0.88), the left MID was 0.74 ± 0.08 mm vs. 0.87 ± 0.27 mm (P = 0.55), the right MID was 0.67 ± 0.08 mm vs. 0.92 ± 0.21 mm (P = 0.17), the anterior MID was 0.45 ± 0.06 mm vs. 1.16 ± 0.35 mm (P = 0.0023), and the posterior MID was 1.57 ± 0.17 mm vs. 1.37 ± 0.22 mm (P = 0.56) in the non-spacer group and the spacer group, respectively. The max of VL was 2.24 ± 0.19 mm vs. 2.89 ± 0.62 mm (P = 0.19), respectively.ConclusionsOur findings suggest that intrafractional prostate motion during VMAT-SBRT was larger in patients with hydrogel spacer injection in the superior and anterior directions.
Spread of Mycobacterium tuberculosis lineage 4 in South China influenced by Maritime Silk Road and “Huguang Filling Sichuan” population migration
Authors: Wu Wei , Liang Peng-Kuan , Luo Dong-Xia , Tian Yu-Ang , Jiang Zhong-Hua , Liu Zhuo-Chong , Luo Mei , Yuan Hai-Bing , Rastogi Nalin , Sun Qun
Published: April 2021

Background

Lineage 4 of Mycobacterium tuberculosis complex (MTBC), mainly epidemic in Europe and Americas, presents in high proportions in South China and is believed to enter China around the 13th century, when the important human migratory events of the Maritime Silk Road and “Huguang Filling Sichuan” population migration happened in China. This study was to explain the coincidence of these two events with lineage 4’s high proportion in South China.
Methods

Based on the spatial interpolation analysis of the genotyping data of 25,575 MTBC isolates, the distribution of lineage 4 was compared with that of targeted surname populations and the Maritime Silk Road’s main ports.
Results

The results showed that lineage 4 distribution in China could be mapped to the regions affected by “Huguang Filling Sichuan” population migration; while the distribution of lineage 4’s two sub-lineages in Asia, Europe, Africa and Oceania could be best explained by the Maritime Silk Road.
Conclusion

Our results suggest that these two events might pose a crucial shared influence, leading to the greater incidence of lineage 4 in South China. And this may contribute to our better understanding of the prevailing tuberculosis landscape in China and facilitate the epidemiological investigations and tracking of emerging MTBC clones.
High-Potency Polypeptide-based Interference for Coronavirus Spike Glycoproteins
Authors: Wang Qinghua , Ma Jianpeng , Acevedo Adam
Published: April 2021

The world is experiencing an unprecedented coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). SARS-CoV-2 spike protein-based vaccines are currently the main preventive agent to fight against the virus. However, several variants with extensive mutations in SARS-CoV-2 spike proteins have emerged. Some of these variants exhibited increased replication, higher transmission and virulence, and were partially resistant to antibody neutralization from natural infection or vaccination. With over 130 million confirmed cases and widespread vaccination around the globe, the emergence of new escape SARS-CoV-2 variants could be accelerated. New therapeutics insensitive to mutations are thus urgently needed. Here we have developed an inhibitor based on SARS-CoV-2 spike protein that potently reduced pseudovirus infectivity by limiting the level of SARS-CoV-2 spike proteins on virion envelope. Most importantly, the inhibitor was equally effective against other coronavirus spike proteins that shared as low as 35% amino-acid sequence identity, underscoring its extreme tolerance to mutations. The small-sized inhibitor would also allow simple delivery by, for instance, nasal spray. We expect the inhibitor reported here to be an invaluable aid to help end COVID-19 pandemic. Furthermore, the use of a partial native sequence or its homologues to interfere with the functions of the native protein represents a novel concept for targeting other viral proteins in combating against important viral pathogens.
Analysis of the Clinical Management and Quality of Life of Frail Patients with Cancer and Breakthrough Pain in Clinical Practice.
Authors: González Gemma Soler , Cajaraville Juan Pérez , Sanjuan Silvia Forcano , Pérez José Luis Firvida , Ferri César Margarit , Banaclocha Natividad Martínez , López Antonio Javier Jiménez , Álvarez Ana Cabezón , González Ibone Huerta , Soler-López Begoña
Published: April 2021

BackgroundThe purpose of this study was to analyse the clinical management and quality of life of frail patients with cancer, chronic pain and breakthrough pain (BTP) and to assess whether treatment was conditioned by their frailty status.Methods This was an observational study in adult frail patients with cancer, chronic background pain and BTP. Outcomes of interest collected include clinical and sociodemographic data, Karnofsky Performance Status, quality of life (EuroQoL-5D-5L), chronic pain and BTP characteristics, as well as treatments administered for their control.ResultsA total of 222 patients were included with a mean age of 68 years (range 24-91), 60.5% men, with a mean Karnofsky of 63.2%. The number of daily episodes of BTP was 3.8 (95% CI 3.3-4.3), with a duration of 34.6 minutes (95% CI 28.8-40.3), and 56.8% had a gradual onset. Opioids were administered to 88.3% of patients for the chronic pain, and to 83.8% for BTP. The treatment's daily doses administered for chronic pain and BTP did not differ from those usually recommended. Quality of life was significantly worst in frail patients with cancer than no frail patients and was related to performance status (p<0.001) and to the social-familial status (p=0.045). ConclusionsBTP in frail patients with cancer presents with more episodes, of a shorter duration and more gradual onset compared to other patients with BTP, and Quality of life was seriously affected. No relevant differences were seen in the doses or method of administration of treatments for chronic pain and BTP in frail patients with cancer as compared to the standard recommendations for non-frail patients. Trial registration: Not applicable to the study.
Discussing the Costs and Financial Burden of Cancer and its Treatment: A Systematic Review of Clinical Guidelines
Authors: Agarwal Anupriya , Livingstone Ann , Karikios Deme J , Stockler Martin R , Beale Philip J , Morton Rachael L
Published: April 2021

BackgroundOptimising the care of individuals with cancer without imposing significant financial burden related to their anticancer treatment is becoming increasingly difficult. The American Society of Clinical Oncology (ASCO) has recommended clinicians discuss costs of cancer care with patients to enhance shared decision-making. We sought information to guide oncologists’ discussions with patients about these costs.MethodsWe searched Medline, EMBASE and clinical practice guideline databases from January 2009 to 1 June 2019 for recommendations about discussing the costs of care and financial burden. Guideline quality was assessed with the AGREE-II instrument.ResultsTwenty-seven guidelines met our eligibility criteria, including 16 from ASCO (59%). 21 of 27 (78%) guidelines included recommendations about discussion or consideration of treatment costs when prescribing, with information about actual costs in four (15%). Recognition of the risk of financial burden or financial toxicity was described in 81% (22/27) of guidelines. However, only nine guidelines (33%) included information about managing the financial burden.ConclusionsCurrent clinical practice guidelines have limited information to guide discussions regarding costs of anticancer treatment and management of financial burden. This limits the ability of patients to control the costs of treatment, and of the healthcare team to reduce the incidence and severity of financial burden. Current guidelines recommend clinician awareness of price variability and high costs of treatment. Clinicians are recommended to explore cost concerns and address financial worries, especially in high risk groups. Future guidelines should include advice on facilitating cost transparency discussions, with provision of costs information and resources.
Impact of Factors on Acute Radiation Oral Mucositis for Nasopharyngeal Carcinoma Patients Treated with Concurrent Intensity-Modulated Radiation Therapy and Chemoradiotherapy:A Retrospective Study
Authors: Yin Yan , Qu Shupei , Wu Haibiao , Liu Xia , Tong Qin , Liu Xuehua , Tan Derong , Gong Jie , Zhang Jing-Ping , Mao Ting
Published: April 2021

Background

To retrospectively studied the medical records in the latest 4 years in order to investigate the occurrence and influencing factors of radiation-induced oral mucositis in patients with nasopharyngeal carcinoma treated with concurrent intensity-modulated radiation therapy and chemoradiotherapy.
Methods

Between January 2014 and December 2018, 262 patients with non-metastatic nasopharyngeal carcinoma treated with concurrent intensity-modulated radiation therapy and chemoradiotherapy were enrolled in the study.The patients' age,gender,body mass index,smoking,diabetes,clinical stage, hematological parameters before radiotherapy before radiotherapy(leukocyte count,erythrocyte count,hemoglobin level,platelet count,lymphocyte count, neutrophil count),PGTV, PCTV1, PCTV2, induction chemotherapy, concurrent chemotherapy interval(weekly or three-weekly chemotherapy) and the concurrent chemotherapeutic drugs (single cisplatin or single lobaplatin or docetaxel plus cisplatin regimen) were examined, and the associations of variables with oral mucositis were analyzed by multivariate logistic regression analysis.
Results

Only platelet count before radiotherapy is the risk factor for grade 2 and higher acute oral mucositis(p = 0.028) with an odds ratio of 1.005 (95% CI: 1.001–1.009).There was no difference in the risk of grade 2 and higher oral mucositis between the single platinum regimen and docetaxel plus cisplatin regimen.The study also found similar responses to oral mucositis between weekly regimen and three-weekly regimen.
Conclusion

The present retrospective study demonstrated that certain factor may predispose patients with with nasopharyngeal carcinoma treated with concurrent intensity-modulated radiation therapy and chemoradiotherapy to develop oral mucositis.
Assessment of laboratory waste management and laboratory staff awareness in Khartoum state
Authors: Hussein Hussein Abker
Published: April 2021

Background A good environmental health conditions is a challenge worldwide. However, Majority of Laboratory wastes extremely dangerous to the environment, animals, and human because of increasing numbers of laboratories and health facilities especially on big cities in Africa like Khartoum state Capital of Sudan.Materials and Methods A cross-sectional study was carried out on a group included 34 laboratories in Khartoum state from February to march 2021. Approvals have taken from each laboratory and participants voluntary informed consent and the data were collected using administered questionnaire and the data were analyzed by SPSS .Result Majority of the laboratories have sharp and needles waste , biological waste of human samples mainly (urine, stool, blood) and regular waste. Followed by chemical waste, culture media respectively, and radioactive waste which is the least frequent waste in Khartoum medical laboratories.More than two thirds of laboratory personal did not get training in waste management. greater portion of laboratories have specialized company approved by authorities to collect the medical waste and treat it. similar percentage of laboratories have dustman for this job and in few laboratories the collection and treatment of the waste done by laboratory staff.Majority of laboratories staff are separating the medical sharps from other types of wastes in safety boxes and get rid of it by specialized company in medical waste. Few laboratories throw the safety box in landfill and reuse the safety box again and others burring or burning it. Majority of laboratory staff they don’t know how to manage chemical waste. Conclusion Laboratories wastes are harmful to the environment, human, and animals. laboratories staff have inadequate training in waste management and disposable .there is no unique protocol for waste management and disposal followed by laboratories in Khartoum state so jeopardize laboratorian and community .
Colorectal Cancer Screening: Knowledge and Practice among Private General Practitioners in Northeast Peninsular Malaysia
Authors: Yusoff Masliza , Mohd Zin Faridah , Daud Norwati , Mohamed Yusoff Harmy , Draman Nani
Published: April 2021

Colorectal cancer screening is an important screening to detect colorectal cancer. Thus, the aim of this study is to determine the knowledge, practice and its associated factors of colorectal cancer screening among private general practitioners (PGPs) in Northeast Peninsular Malaysia. Crosssectional study was conducted involving 127 PGPs in Kelantan. The study used a validated selfadministrated questionnaire that contained three domains. The domains were sociodemographic, knowledge and practice of colorectal cancer screening. The inclusion criterion was doctors working in a private clinic for more than six months, while the exclusion criteria were non-residential doctors and doctors practicing in private specialised clinics. Only 21.3% of PGPs had good knowledge and 3.9% had good practice on colorectal cancer screening. The duration of practice as a PGP was significantly associated with good practice for colorectal cancer screening. Only 58.3% were aware of the current recommendation on colorectal cancer screening. Most PGPs would refer patients for a colonoscopy, but screening with faecal occult blood test (FOBT) in average-risk patients was low. Only 4% of PGPs followed the recommended guidelines for colorectal cancer screening. The main reasons for not offering FOBT screening were patients’ refusal, patients were not regular patients of the doctor and the referral system for colonoscopy was found to be difficult. This study noted that knowledge and practice of colorectal cancer screening among PGPs were inadequate. Overcoming barriers for screening is important to promote colorectal cancer screening.
Vision of Teaching in Ensuring Continuity of Clinical Teaching in Medical Training Post COVID-19 and Beyond
Authors: Hanafi Muhammad Hafiz
Published: April 2021

This article briefly addresses some teaching and learning approaches for medical and postgraduate medical training in Malaysia. The teaching approaches primarily used in clinical process include pedagogy, andragogy, heutagogy, peeragogy and cybergogy. The higher the standard of education, the more sophisticated the approach used for learning. Combining and assimilating the different strategies is the only way to meet optimal training objectives in a post-COVID-19 era.
Comprehensive analysis on the situation and path of cross-border. Labour igration in Northeast Asia
Authors:   Heilongjiang Academy of Social Sciences, Harbin City, China, NING Li
Published: April 2021

Research Purpose: Analyzing the development trend of cross-border labour migration in Northeast Asia. Research Methods: Exerting cross-subject research methods like comparative research, statistical research and international politics combined with regional politics. Research Content. Northeast Asian area is one of the most dynamic economic zones in the world, regional crossborder labour migration employment is becoming more active than before. the disparity between the level of economic development, population and labour structure, so that countries in this region have a strong supplydemand complementarity. Enhancing cooperation of cross-border labour in Northeast Asia is conducive to further improving the level of economic exchange and cooperation in Northeast Asia. It is of great significance and practical basis for countries to strengthen the development and cooperation of labor resources. China, as the biggest developing country, meanwhile is the major labour exporting and importing country, expanding cross-border labour cooperation with countries in Northeast Asia will have a positive effect on promoting the development and utilization of human resources in China and improving employment and social management policies. How to grasp the opportunities in foreign labor service cooperation and avoid potential risks is a test of Chinese wisdom. Conclusion. China should be well prepared in four aspects when dealing with cross-border labour cooperation in Northeast Asia. Establishing regional cooperation scheme and management security system; Setting up a linkage mechanism for foreign management of expatriate labor, protection and privileges protection from a micro perspective. Cultivating high quality labour resources and improving recruitment of high-tech experts. Discovering the potential of service trade and upgrading the level of cooperation is conducive to the export of high skilled labor force.
Simple stationary filtering flows of incompressible non-newtonian oil in a homogeneous formation according to a general nonlinear law
Authors:   Azerbaijan State University of Oil and Industry, Baku, Azerbaijan, ALIEVA Maral Gasan kyzy , VALIEV Niyaz Gadym ogly ,   Ural State Mining University, Ekaterinburg, Russia
Published: April 2021

Three stationary hydrodynamic theoretical problems are solved, in which filtrations obey only the General nonlinear law. Simple flows occur in tasks: plane-parallel, plane-radial, and hemispherical-radial. All derived formulas – oil flow rate, filtration rate, pressure gradient, etc. – should be used to solve various practical problems of the development of these deposits and even when drawing up a project for the development of such deposits. It should be noted that a plane-parallel simple filtration flow of oil originates from a strip-like reservoir to a straight gallery. In addition, such a simple filtration fluid flow also occurs when the oil field under development has several parallel rectilinear rows of production production wells and, in some cases, there may be rows of injection water wells in the reservoir. In oil-bearing areas between parallel adjacent rows, oil filtration is also plane-parallel. Hence, the practical significance of solving the first problem of a plane-parallel oil flow in this scientific article becomes clear. Planar-radial simple filtration flow of oil originates from a circular horizontal formation to a central production well. In addition, such a simple filtration fluid flow also occurs when a strip-like oil field being developed has several (usually three or four) parallel straight rows of production production wells. In the drainage zones of these wells, a simple flat-radial filtration flow also occurs. From the foregoing, the practical significance of a radial plane oil flow becomes clear. Hemispherical – a radial simple filtration flow of oil originates from a hemispherical reservoir to a central well, barely penetrated by the reservoir by its hemispherical concave bottom. By analyzing these calculation formulas, you can identify the specific features of the development of deposits, develop and implement measures to eliminate undesirable phenomena.