bluuebunny/crossref_metadata_2025 huggingface dataset:
Economic impact of clinical decision support interventions based on electronic health records
Authors: Lewkowicz Daniel , Wohlbrandt Attila , Boettinger Erwin
Published: July 2020

Background Unnecessary healthcare utilization, non-adherence to current clinical guidelines or insufficient personalized care are perpetual challenges and remain potential major cost-drivers for healthcare systems around the world. Implementing decision support systems into clinical care is promised to increase quality of care and thereby yield substantial effects on reducing healthcare expenditure. In this article we evaluate the economic impact of clinical decision support (CDS) interventions which are based on electronic health records (EHR). Methods We searched for studies published after 2014 using MEDLINE, CENTRAL, WEB OF SCIENCE, EBSCO, and TUFTS CEA registry databases that encompass an economic evaluation or consider cost outcome measures of EHR based CDS interventions. Thereupon, we identified best practice application areas and categorized the investigated interventions according to an existing taxonomy of front-end CDS tools. Results and discussion Twenty-seven studies are investigated in this review. Of those, twenty-two studies indicate a reduction of healthcare expenditure after implementing an EHR based CDS system, especially towards prevalent application areas, such as unnecessary laboratory testing, duplicate order entry, efficient transfusion practice or reduction of antibiotic prescriptions. On the contrary, order facilitators and undiscovered malfunctions revealed to be threats and could lead to new cost drivers in healthcare. While high upfront and maintenance cost of CDS systems are a worldwide implementation barrier, most studies do not consider implementation cost. Finally, four included economic evaluation studies report mixed monetary outcome results and thus highlight the importance for further high quality economic evaluations for these CDS systems. Conclusion Current research studies lack to consider comparative cost-outcome metrics as well as detailed cost-components in their analyses. Nonetheless, the positive economic impact of EHR based CDS interventions especially with regard to reducing waste in healthcare is highly promising.
High sensitivity of one-step real-time reverse transcription quantitative PCR to detect low virus titers in large mosquito pools
Authors: Tang Zhaoyang , Yamada Hanano , Kraupa Carina , Canic Sumejja , Busquets Núria , Talavera Sandra , Jiolle Davy , Vreysen Marc J. B. , Bouyer Jérémy , Abd-Alla Adly
Published: July 2020

Background Mosquitoes are the deadliest animals in the world. Their ability to carry and spread diseases to humans causes millions of deaths every year. Due to the lack of efficient vaccines, the control of mosquito-borne diseases primarily relies on the management of the vector. Traditional control methods such as source reduction and chemical insecticides, have proven to be sufficient to prevent the proliferation and spread of mosquito populations. The sterile insect technique (SIT) is an additional control method that can be combined with other control tactics to suppress specific mosquito populations. The SIT requires the mass-rearing and release of sterile males with the aim to induce sterility in the wild female population. Samples collected from the environment for laboratory colonization, as well as the released males, should be free from mosquito-borne viruses (MBV). Therefore, efficient detection methods with defined detection limits for MBV are required. Although a one-step reverse transcriptase quantitative polymerase chain reaction (RT-qPCR) method was developed to detect arboviruses in human and mosquito samples, its detection limit in mosquito samples has yet to be defined. Methods We evaluated the detection sensitivity of one step RT-qPCR for targeted arboviruses in large mosquito pools, using pools of non-infected mosquitoes of various sizes (165, 320 and 1600 mosquitoes) containing one infected mosquito body with defined virus titers of chikungunya virus (CHIKV), usutu virus (USUV), West Nile virus (WNV) and Zika virus (ZIKV).Results CHIK, USUV, ZIKV, and WNV virus were detected in all tested pools using the RT-qPCR assay. Moreover, in the largest mosquito pools (1600 mosquitoes), RT-qPCR was able to detect the targeted viruses using different total RNA quantities (10, 1, 0.1 ng per reaction) as a template. Correlating the virus titer with the total RNA quantity allowed the prediction of the maximum number of mosquitoes per pool in which the RT-qPCR can theoretically detect the virus infection. The corresponding equation uses a Ct value of 36 as a cut-off value for virus detection and a virus copy number of 108 for the positive mosquito body used to spike mosquito pools, to predict the possibility of detecting CHIK, USUV, ZIKV and WNV in mosquito pools composed of 5.08 x 105, 8.74 x 106, 2.33 x 107, and 5.24 x 105 mosquitoes respectively.Conclusion Mosquito borne viruses can be reliably detected by RT-qPCR assay in pools of mosquitoes exceeding 1000 specimens. This will represent an important step to expand pathogen-free colonies for mass-rearing sterile males for programmes that have an SIT component by reducing the time and the manpower needed to conduct this quality control process.
Production Losses Five Months After Outbreak With A Recombinant Of Two Prrsv Vaccine Strains In 13 Danish Sow Herds
Authors: Kristensen Charlotte Sonne , Kristiansen Michael Groes , Pedersen Kasper , Larsen Lars Erik
Published: July 2020

Background: In July 2019, a PRRSV-negative boar station was infected with a recombinant of two PRRSV vaccine strains, which subsequently spread to at least 36 herds that had received semen from the boar station. In the following months, all the infected herds reported reduced productivity. The aim of the present study was to evaluate the impact of the PRRS outbreak. Results: Production data were collected from 13 of the herds. The average levels of farrowings/week, liveborns/litter, stillborns/litter, pre-weaning mortality and weaned pigs/litter were compared for the five-month period after infection and the preceding seven months before infection with the new variant of PRRSV-1. Twelve herds experienced a decrease in farrowings/week (0.1-10.8 percent fewer farrowings/week), and all herds experienced fewer liveborns (0.8-4.8 fewer liveborns/litter) and more stillborns (0.6-2.6 more stillborns/litter). Pre-weaning mortality nearly doubled in half of the herds. Overall, the 13 herds were missing 2.4-6.5 pigs/litter at weaning during the five months after infection compared to the seven preceding months before infection. Conclusion: In this study, the impact of this new PRRSV-1 variant on productivity exceeded that typically seen in Danish herds infected with PRRSV-1.
Structural impairments of the heart associating with ETB mutation, a cause of Hirschsprung disease
Authors: Chen Ko-Chin , Chen Ko-Chien , Song Zan-Min , Croaker Geoffrey David
Published: July 2020

Background HSCR, a colonic neurocristopathy affecting 1/5000 births, was suggested to associate with cardiac septal defects and conotruncal malformations. However, we question subtle cardiac changes maybe more commonly present due to multi-regulations by HSCR candidate genes, in this instance, ETB. To investigate, we compared the cardiac morphology and quantitative measurements of sl/sl rat to those of the control group.Methods Eleven neonatal rats were generated from heterozygote (ETB+/-) crossbreeding. Age and bodyweight were recorded at time of sacrifice. Diffusion-staining protocols with 1.5% iodine solution was completed prior to micro-CT scanning. All rats were scanned using an in vivo micro-CT scanner, Caliper Quantum FX, followed by two quality-control scans using a custom-built ex vivo micro-CT system. All scans were reviewed for gross cardiac dysmorphology. Micro-CT data were segmented semi-automatically post-NLM filtering for: whole-heart, LV, RV, LA, RA, and aortic arch. Measurements were taken with Drishti. Following image analysis, PCR genotyping of rats was performed: five sl/sl rats, three wildtype, and three heterozygotes. Statistical comparisons on organ volume, growth rate, and organ-volume/bodyweight ratios were made between sl/sl and the control group. Results Cardiac morphology and constituents were preserved. However, significant volumetric reductions were recorded in sl/sl rats with respect to the control: whole heart (38.70%, p-value = 0.02); LV (41.22%, p-value = 0.01), RV (46.15%, p-value = 0.02), LA (44.93%, p-value = 0.06), and RA (39.49%, p-value = 0.02). Consistent trend was observed in growth rate (~20%) and organ-volume/bodyweight ratios (~25%). On the contrary, measurements on aortic arch demonstrated no significant difference among the two groups. Discussion Despite the presence of normal morphology, significant cardiac growth retardation was detected in sl/sl rat, supporting the likely association of cardiac anomalies with HSCR, at least in ETB-/- subtype. Structural reduction was likely due to a combination of failure to thrive from enteric dysfunction, alterations to CaNCC colonization, and importantly coronary hypoperfusion from elevated ET-1/ETA-mediated hypervasoconstriction. Little correlation was detected between aortic arch development and sl/sl rat, supporting minor ETB role in large vessels. Although further clinical study is warranted, HSCR patients may likely require cardiac assessment in view of congenital cardiac defects.
Apolipoprotein A1 is A Protective Factor for Male Papillary Thyroid Cancer Patients. A Cross-Sectional Study of Single Academic Center in China.
Authors: Ma Maoguang , Wang Mingdian , Zhang Zhanqiang , Lin Bo , Sun Zicheng , Guan Haoyan , Lv Weiming , Li Jie
Published: July 2020

Background: Papillary thyroid cancer (PTC) is the most common type of thyroid cancer and the incidence of PTC has continued to increase over the past decades. Many studies have shown that obesity is an independent risk factor for PTC and obese PTC patients tend to have a relative larger tumor size and higher grade of tumor stage. Obesity is associated with disordered lipid metabolism and the relationship between serum lipids and PTC remains unclear. Therefore, this study aimed to investigate the association between serum lipid level and PTC.Methods: We retrospectively analyzed 1018 PTC patients diagnosed and treated in our hospital, all these cases were first diagnosed with PTC and had complete clinical information including ultrasound reports before surgery, serum lipid (CHOL, TG, HDL-c, LDL-c, Apo-A1, Apo-B, Apo-E) results, surgical records and pathological reports. Results: None of these lipid markers were associated with tumor size in the whole cohort and in the female group. In the male group, on crude analysis, Apo-A1 showed a marginally significant association with tumor size, [OR=0.158 (0.021-1.777)], p=0.072. After adjusting for age and multifocality, Apo-A1 showed a significant association with tumor size [OR=0.126 (0.016-0.974)], p=0.047. This association become more apparent in a young male subgroup, [OR=0.051 (0.005-0.497)], p=0.009. CHOL, TG, HDL-c, LDL-c, Apo-B, Apo-E did not show significant association with tumor size. As for LNM, neither in the male group nor in the female group were found to be associated with any serum lipid biomarkers.Conclusion: As PTC incidences continues to increase, our finding a negative association between PTC and apoA-1 imply that these lipids are protective factors for male PTC patients and provide us new clues about PTC and lipid metabolism, which may contribute to further investigation concerning diagnosing and preventing this most common type of thyroid cancer.
Rasch analysis of the Living with Chronic Illness Scale in Parkinson’s disease
Authors: Ambrosio Leire , Rodriguez-Blazquez Carmen , Ayala Alba , Forjaz Maria João
Published: July 2020

Background
Neurologists play an essential role in facilitating the patient’s process of living with Parkinson’s disease (PD). The Living with Chronic Illness Scale-PD (LW-CI-PD) is a unique available clinical tool that evaluates how the patient is living with PD. The objective of the study was to analyse the LW-CI-PD properties according to the Rasch model.
Methods
An open, international, cross-sectional study was carried out in 324 patients with Parkinson’s disease from four Latin American countries and Spain. Psychometric properties of the LW-CI-PD were tested using Rasch analysis: fit to the Rasch model, item local independency, unidimensionality, reliability, and differential item functioning by age and gender.
Results
Original LW-CI-PD do not fit Rasch model. Modifications emerged included simplifying the response scale and deleting misfit items, the dimensions Acceptance, Coping and Integration showed a satisfactory fit to the Rasch model, with reliability indices greater than 0.70. The dimensions Self-management and Adjustment to the disease did not reach fit to the Rasch model.
Conclusion
Suggestions for improving the LW-CI-PD include a multidimensional and shorter scale with 12 items grouped in three subscales with a simpler response scheme. The final LW-CI-PD Scale version is a reliable scale, with good internal construct validity, that provides Rasch transformed results on linear metric scale.
Dengue virus non structural protein 1 disrupts the TGF-β/Smad signaling by utilizing E3 ligase Smurf2
Authors: Lahon Anismrita , Arya Ravi , Kumar Vivek , Banerjea Akhil
Published: July 2020

TGF-β signaling is tightly regulated to ensure cellular functions. Role of DENV on the TGF-β/Smad signaling has not been well established. Therefore, we aimed to study the association between DENV replication and TGF-β/Smad signaling. We observed impaired expression of Smad2/3/4 during DENV replication along with significant reduction in the expression of phosphorylated Smad3. Overexpression of Smad6/7 showed inhibitory effect on DENV replication. We observed DENV-NS1 not only physically interacts with Smad2/3/4 but also impaired their expression by utilizing Smurf2 E3 ligase. Co-immunoprecipitation of NS1 and Smurf2 suggests that NS1 may acts as a co-factor to escalate the lysosomal mediated degradation of Smads. Additionally we observed, NS1 is capable of blocking the nuclear translocation of Smad3 and thus further ensuring inhibition of Smad signaling. Therefore, our results confirm that DENV-NS1 interacts with Smads and reduces their expression that may favor in virus replication.
Serum Metabolomic Profiling Reveals Potential Biomarkers in Assessing The Management of Women with Polycystic Ovary Syndrome: A Randomized Controlled Trial
Authors: Ding Xuesong , Deng Yan , Wang Yan-fang , Xue Wei , Zhu Shi-yang , Ma Xiao , Ma Ruilin , Sun Ai-jun
Published: July 2020

Background: As one of the most common endocrinal disorder for the women at childbearing age, the diagnostic criteria of polycystic ovary syndrome (PCOS) have been defined distinctly among different international health organizations. The diverse manifestations and heterogenic etiology of PCOS also bring about difficulties for its diagnosis and management assessment. Though the elevated androgen level is acknowledged to be the most obvious biomarker for PCOS diagnosis and management evaluation, it is not always present in patients and the mechanism of hyperandrogenism has not been fully elucidated. Therefore, more efficient biomarkers representing progression of PCOS are expected to be integrated into monitoring the management process using metabolomic approach. Methods: In this prospective randomized controlled trial, classical diagnostic parameters, blood glucose, and metabolome were measured in 123 PCOS patients simultaneously before and at 2 and 3 months of different medical interventions. The metabolite fingerprints were detected filtered out by comparing data at baseline and 3 months based on multivariate statistical analysis, followed by validation with receiver operating characteristic (ROC) curve on data collected at 2 months. Results: A set of metabolites including glutamic acid, aspartic acid, 1-methylnicotinamide, acetylcarnitine, glycerophosphocholine, and oleamide, were filtered out with high performance in representing the improvement through three-month management of PCOS with high sensitivity and specificity in ROC analysis. Conclusions: The 6 metabolites were representative for the remission of PCOS through medical intervention, making them a set of potential biomarkers on assessing the outcome of PCOS management. Trial registration: ClinicalTrials.gov, NCT03264638. Registered 29 August 2017 - Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03264638
Association of ApoE Gene Polymorphisms With Cardio-cerebrovascular Complications in Type 2 Diabetes Mellitus in the Chinese Population
Authors: Kong Lulu , Gao Yinting , Li Wei , Shi Bimin
Published: July 2020

Objective

To analyze and study the relationship between ApoE gene polymorphism and cardio-cerebrovascular complications in type 2 diabetes mellitus(T2DM) in the Chinese Population.
Methods

From January 2018 to January 2019, 1140 patients with type 2 diabetes admitted to the Department of Endocrinology, the Affiliated Hospital of Xuzhou Medical University were selected as the case group, including 590 patients with coronary heart disease(CHD) and 550 patients with cerebral infarction(CI), and 1198 patients with type 2 diabetes without complications during the same period were selected as the control group. General baseline data of the two groups were collected, such as gender, age, course of disease, lipid profile, HbA1C, BMI, blood pressure, carotid plaque and complications. ApoE genotypes were identified in all participants who participated in the study.
Results

This study showed that the ApoE genotypes in both the case group and the control group had the highest frequency of E3/E3. The E3/E4 genotype frequency and E4 allele frequency in the case group were higher than those in the control group (P < 0.05). In the case group, the frequency of E2/E3 and E3/E4 genotypes of CI group was lower than that of CHD group, while the frequency of E3/E3 genotype was higher than that of CHD group. TC and LDL-c levels were significantly increased in patients with ApoE E3/E4 genotype(P < 0.05). ApoE genotype E3/E4 was more associated with carotid plaque than E2/E3. ApoE genotype and ApoE allele were positively correlated with TC and LDL-c levels (P < 0.05).Logistic regression results show that ApoE gene polymorphism is associated with cardio-cerebrovascular complications in T2DM patients. ApoE E3/E4 genotype and allele E4 may be risk factors for T2DM patients with cardio-cerebrovascular complications.
Conclusion

ApoE E3/E4 genotypes and T2DM patients carrying E4 allele have a higher risk of cardio-cerebrovascular complications than other genotypes. E4 allele may be a risk factor for cardio-cerebrovascular complications in T2DM patients, and its mechanism may be related to the effect of ApoE gene on lipid metabolism.
Carboxymethyl Chitosan Reduces Inflammation and Promotes Osteogenesis in a Rabbit Knee Replacement Model
Authors: Liu Feng , Li Hai-yan , Wang Zhen , Zhang Hai-ning , Wang Ying-zhen , Xu Hao
Published: July 2020

Background: The major causes of failure after total knee arthroplasty (TKA) include prosthesis loosening and infection. This study aimed to investigatethe role of carboxymethyl chitosan (CMC) in knee arthroplasty. Methods: A total of 20 New Zealand white rabbits that were divided into two groups (10 in the control group and 10 in the chitosan group) were included in the study. They underwent TKA surgery, and all were implanted with titanium rod prostheses; the prosthesis in the chitosan group was coated with CMC. After 12 weeks, all rabbits were euthanized, and the followinganalyses of some specific surface membrane tissues around the prosthesis were performed: X-ray analysis; micro-computed tomography scan; haematoxylin and eosin, Van Gieson, and Von Kossa staining; reverse transcription polymerase chain reaction; and Western Blotting. Results:The result of CCK8 test showed CMC can promote cell proliferation and increase cell viability. Radiological result showed better amount of bone deposits and more bone formation in the chitosan group. HE staining result showed CMC reduces inflammation around the prosthesis. The VG and Von Kossa staining results showed CMC can promote bone deposition around prosthesis.And according to the results of PCR and WB, the OCN content was higher in the chitosan group, while the MMPs content was lower. The chitosan group has an increased OPG/RANKL ratio than the control group.Conclusion: CMC can effectively inhibit the inflammatory response around the prosthesis and osteoclast activation and promote osteogenesis by interfering with the osteoprotegerin/receptor activator of nuclear factor kappa-Β ligand/receptor activator of nuclear factor kappa-Β signalling pathway.
Prevalence, Predictors, and Mortality of Bloodstream Infections Due to Methicillin-Resistant Staphylococcus Aureus in Patients with Malignancy: Systemic Review and Meta-Analysis
Authors: Li Zhouqi , Zhuang Hemu , Wang Guannan , Wang Hui , Dong Ying
Published: July 2020

Background: Cancer patients are more likely to develop and die of bloodstream infection (BSI) than noncancer patients. Methicillin-resistant Staphylococcus aureus (MRSA), which is associated with immense mortality and economic burden worldwide, is not covered by the recommended initial antibiotic therapy for cancer patients with BSI. This systemic review was performed to estimate the global methicillin-resistant Staphylococcus aureus (MRSA) prevalence among bacteremia in patients with malignancy, and further study the predictors and mortality of cancer patients with MRSA bacteremia. Methods: The PubMed and EMBASE databases were searched for studies published from Jan. 2000 to Mar. 2020 that provided primary data on the prevalence, predictors, or mortality of MRSA bacteremia in cancer patients. A random-effects model meta-analysis was performed to estimate the pooled prevalence of MRSA with 95% confidence intervals (95% CIs).Results: The pooled prevalence of MRSA was 3% (95% CI 2–5%) among all bloodstream infections (BSIs) and 44% (95% CI 32–57%) among S. aureus bacteremia in cancer patients. Based on geographical stratification, the pooled prevalence was 5% in Africa (95% CI 1–14%), 1% in Americas (95% CI 1–2%), 2% in Europe (95% CI 1–4%), 4% in Western Pacific (95% CI 2–7%), 8% in South-east Asia (95% CI 4–14%) and 0% in Eastern Mediterranean (95% CI 0–3%). No significant temporal change in MRSA rates was detected in this analysis (R2 = 0.06; P=0.24). Predictors for MRSA BSIs among cancer patients were identified by comparison with their methicillin-susceptible counterparts, and they were mainly related to healthcare-associated infections and immunosuppression. Finally, the 60-day mortality in adult cancer patients with MRSA BSIs was reported to be 12%, and the 6-month overall mortality was 43.2%, with community-onset infection, secondary BSI, and vancomycin MIC≥2g/mL being the risk factors for mortality.Conclusions: Although the prevalence of MRSA BSIs among cancer patients is relatively low, it did not decline over time as MRSA BSIs in the general hospital population and the high mortality rate was related to MRSA BSIs in patients with malignancy.
Characteristics and Recovery Prognosis Factors Among COVID-2019 Infected Cases: A Tunisian Nationwide Analysis
Authors: Harizi Chahida
Published: July 2020

Background: The outbreak of coronavirus disease (COVID-19) continues to constitute a public health of international concern. Few data are available on the duration and prognosis factors for recovery. We aimed to study the recovery time among a Tunisian cohort of COVID-19 confirmed patients and identify its prognosis factors.Methods: A retrospective and national study was conducted from March 2 to May 8, 2020, recruiting all patients who were diagnosed with COVID-19, by RT-PCR methods, in Tunisia. Data were collected via phone call interview. Kaplan-Meir Methods and Cox proportional hazards regression models were, respectively, used to study the recovery time and estimate its prognosis factors.Results: 1030 patients with COVID-19 (aged 43.2 ± 18.2 years, 526 female (51.1%)) were enrolled. Among them 174 (16.9%) were healthcare professionals. Out of 173 patients (17.8%) admitted to the hospital, 47 were admitted in an intensive care unit. Among those who didn’t require specialized care, 55.5% were self-isolated at home, while the rest were in specialized centers. Almost ¾ of the patients were symptomatic. A total of 634 (61.6 %) patients have recovered and 45 (4.4 %) patients died. The median duration of illness was estimated to be 31 days (95% CI: [29 - 32]). Older age (HR=0.66, CI:[ 0.46-0.96], P=0.031) and symptoms (HR=0.61, CI:[ 0.43-0.81], P=0.021) were independently associated with a delay in recovery time. Being a healthcare professional (HR=1.52, CI :[1.10-2.08], P=0.011) and patients in home isolation compared to isolation centers (HR=2.99, CI :[1.85-4.83], P<10¯³) were independently associated with faster recovery time. Conclusion: the duration of illness was estimated to be one month. However, this long estimated duration of illness may not equate to infectiousness. A particular attention must to be paid to elderly and symptomatic patients with closer monitoring.
Modulating Electronic Structure of Metal-Organic Frameworks by Introducing Atomically Dispersed Ru for Efficient Hydrogen Evolution
Authors: Sun Yamei , Xue Ziqian , Liu Qinglin , Jia Yaling , Li Yinle , Liu Kang , Lin Yiyang , Liu Min , Li Guangqin
Published: July 2020

Developing high-performance electrocatalysts toward hydrogen evolution reaction is important for clean and sustainable hydrogen energy, yet still challenging. Herein, we report a single-atom strategy to construct excellent metal-organic frameworks (MOFs) hydrogen evolution reaction (HER) electrocatalyst (NiRu0.13-BDC, BDC: terephthalic acid) by introducing atomically dispersed Ru. Significantly, the obtained NiRu0.13-BDC exhibits outstanding HER activity in all pH, especially with a low overpotential of only 36 mV at a current density of 10 mA cm-2 in 1 M phosphate buffered saline (PBS) solution, which is comparable to commercial Pt/C. X-ray absorption fine structures and the density functional theory calculations reveal that introducing Ru single-atom can modulate electronic structure of metal center in the MOF, leading to the optimization of binding strength for H2O and H*, and the enhancement of HER performance. This work establishes single-atom strategy as an efficient approach to modulate electronic structure of MOFs for catalyst design.
Tolvaptan-Induced Hypernatremia Related to Low Serum Potassium Level Accompanying High Blood Pressure in Patients with Acute Decompensated Heart Failure
Authors: Fukuoka Hidetada , Yachibana Koichi , Shinoda Yukinori , Minamisaka Tomoko , Inui Hirooki , Ueno Keisuke , Inoue Soki , Mine Kentaro , Ueda Kumpei , Hoshida Shiro
Published: July 2020

Backgrounds: Tolvaptan significantly increases urine volume in acute decompensated heart failure (ADHF); serum sodium level increases due to aquaresis in almost all cases. We aimed to elucidate clinical factors associated with hypernatremia in ADHF patients treated with tolvaptan.Methods: We enrolled 117 ADHF patients treated with tolvaptan in addition to standard therapy. We examined differences in clinical factors at baseline between patients with and without hypernatremia in the initial three days of hospitalization. Results: Systolic (p=0.045) and diastolic (p=0.004) blood pressure, serum sodium level (p=0.002), and negative water balance (p=0.036) were significantly higher and serum potassium level (p=0.026) was significantly lower on admission day in patients with hypernatremia (n=22). In multivariate regression analysis, hypernatremia was associated with low serum potassium level (p=0.034). Among patients with serum potassium level ≤3.8 mEq/L, the cutoff value obtained using receiver operating characteristic curve analysis, those with hypernatremia related to tolvaptan treatment showed significantly higher diastolic blood pressure on admission day (p=0.004).Conclusion: In tolvaptan treatment combined with standard therapy in ADHF patients, serum potassium level ≤ 3.8mEq/L may be a determinant factor for hypernatremia development. Among hypokalemic patients, those with higher diastolic blood pressure on admission may be carefully managed to prevent hypernatremia.
An efficient Turing-type Ag2Se-CoSe2 multi-interfacial oxygen-evolving electrocatalyst
Authors: Zhang Xiao-Long , Yang Peng-Peng , Zheng Ya-Rong , Duan Yu , Hu Shaojin , Ma Tao , Gao Fei-Yue , Niu Zhuang-Zhuang , Wu Zhi-Zheng , Qin Shuai , Chi Li-Ping , Yu Xing-Xing , Wu Rui , Gu Chao , Zheng Xu-Sheng , Zheng Xiao , Zhu Junfa , Gao Min-Rui
Published: July 2020

Although the Turing structures, or stationary reaction-diffusion patterns, have received increasing attention in biology and chemistry, making such unusual patterns on inorganic solids is fundamentally challenging. We report a simple cation exchange approach to produce Turing-type Ag2Se on CoSe2 nanobelts relied on diffusion-driven instability. The resultant Turing-type Ag2Se-CoSe2 material is highly effective to catalyze the oxygen evolution reaction (OER) in alkaline electrolytes with an 84.5% anodic energy efficiency. Electrochemical measurements show that the intrinsic OER activity correlates linearly with the length of Ag2Se-CoSe2 interfaces, determining that such Turing-type interfaces are more active sites for OER. Combing X-ray absorption and computational simulations, we ascribe the excellent OER performance to the optimized adsorption energies for critical oxygen-containing intermediates at the unconventional interfaces. Our work offers opportunities for creating Turing structures in other inorganic nanomaterials with unexplored catalytic abilities.
Sulfoxonium ylides for direct methylation of N-heterocycles in water
Authors: Ghosh Prithwish , Kwon Na Yeon , Kim Saegun , Han Sangil , Lee Suk Hun , An Won , Mishra Neeraj , Han Soo Bong , Kim In Su
Published: July 2020

The direct methylation of N-heterocycles is an important transformation for the advancement of pharmaceuticals, agrochemicals, functional materials, and other chemical entities. Herein, the unprecedented C(sp2)–H methylation of iminoamido N-heterocycles as nucleoside base analogues is described. Notably, trimethylsulfoxonium salt was employed as a methylating agent under aqueous conditions. A wide substrate scope and excellent level of functional group tolerance were attained. Moreover, this method can be readily applied to the site-selective methylation of azauracil nucleosides. The feasibility of gram-scale reactions and various transformations of the products highlight the synthetic potential of the developed method. Combined deuterium-labeling experiments aided the elucidation of a plausible reaction mechanism.
How Competition and Wildfire Affect Tree Range Shifts in the American West
Authors: Hill Avery , Field Christopher
Published: July 2020

Due to climate change, plant populations experience environmental conditions to which they are not adapted. Our understanding of the next century’s vegetation geography depends on the distance, direction, and rate at which plants redistribute in response to a changing climate. Although plant redistribution in response to contemporary climate change is widely observed, our understanding of its mechanics is nascent. In this study we test the response of plant range shift rates to wildfire occurrence using 33,838 Forest Inventory Analysis plots across five states in the western United States. Wildfire increased the rate of observed range shifts for 6/8 tree species by more than 22% on average, suggesting that incumbent vegetation can act as a barrier to plant range shifts and that fire management may play an important role in facilitating transitions between vegetation types in response to climate change.
Model-Size Reduction for Reservoir Computing by Concatenating Internal States Through Time
Authors: Sakemi Yusuke , Morino Kai , Leleu Timothee , Aihara Kazuyuki
Published: July 2020

Reservoir computing (RC) is a machine learning algorithm that can learn complex time series from data very rapidly based on the use of high-dimensional dynamical systems, such as random networks of neurons, called "reservoirs." To implement RC in edge computing, it is highly important to reduce the amount of computational resources that RC requires. In this study, we propose methods that reduce the size of the reservoir by inputting the past or drifting states of the reservoir to the output layer at the current time step. To elucidate the mechanism of model-size reduction, the proposed methods are analyzed based on information processing capacity proposed by Dambre et al. (2012). In addition, we evaluate the effectiveness of the proposed methods on time-series prediction tasks: the generalized Hénon-map and NARMA. On these tasks, we found that the proposed methods were able to reduce the size of the reservoir up to one tenth without a substantial increase in regression error.
Is Teachers’ Depression Contagious to Students? A Study Based on Classes’ Hierarchical Models
Authors: Wu Wenfeng , Lu Yongbiao , Wang Ya
Published: July 2020

Background: According to the theory of emotional contagion, emotions in one person can trig-ger similar emotions in groups within social networks. In schools, the class just like a small social network, that teachers’ emotion, such as depression, might be contagious to their students, however, until now there is little studies reporting this issue. This study aims to determine whether teachers’ depression be contagious to students and what mechanics behind the phe-nomenon.Methods: Using Children’s depression and cognitive scales to assess 2579 students, meanwhile using teachers’ depression and emotional labor scales assess 529 teachers. The nested data from 112 classes were analyzed.Results: Teachers’ depression was positively correlated with emotional labor surface and deep acting, and teachers’ depression cross-level predicted students’ depression inversely. For teach-ers with higher levels of depression, the teacher’s deep acting affected their students’ depression significantly, the more effortful the teachers’ deep acting, the lower the degree of the students’ depression, however, for teachers with lower levels of depression, the deep acting was not sig-nificant.Conclusion: The results maybe state that depression in teachers is not readily transmitted to students, one of reasons is that teachers’ emotional labor may alleviate the influence of their depression on students. However, considered that teachers' emotional labor was positively cor-related with their depression, the teachers’ emotional labor may be like a double-edged sword, while alleviating the influence of teachers' depression on students, it also deteriorated their own depression, making it impossible sustainable. For students’ depression interventions based in school, including teachers maybe a better selection.Trial registration: This article is not a interventional research, so it was not registered.
A case-report of widespread pulmonary embolism in a middle-aged male seven weeks after asymptomatic suspected COVID 19 infection
Authors: Beckman Mats , Nyren Sven , Kistner Anna
Published: July 2020

We present a case of suspected Covid-19 with widespread pulmonary embolism in a patient unaware of having had the disease.
Flexural Behavior of Glass Fiber Reinforced Silica Composites via Multiple Infiltration Processing
Authors: Awan Faizan Siddique , Rasheed Raheela , Qazi Ibrahim , Saeed Muhammad Umar
Published: July 2020

Two-dimensional glass fibers reinforced silica matrix composites (GFS) were fabricated by silica sol infiltration (SSI) method by varying the number of infiltration cycles. A uniform weight gain was observed after each infiltration up to 9 th infiltration suggesting the uniform loading of nano silica within GFS composites. The relationship between the infiltration cycle and the physical and flexural behavior of composites was measured by means of a density and 3-point flexural test along with supporting evidences via microstructural characterization. The results of mechanical testing indicated an increase in the flexural properties by up to 25%, after each infiltration cycle, due to increase in density. Finally, microstructural study revealed the presence of various toughening mechanisms during fracture, under flexural loading in the GFS composites.
Impact of Urban Family Physician Program on health indicators in Iran: an interrupted time series analysis
Authors: Hajibadali Parisa , Hashemiparast Minasadat , Iraji Zeinab , Lotfalinejad Elham , Allahverdipour Hamid , Nadrian Haidar
Published: July 2020

Background: In 2015, the Iranian Urban Family Physician Program (UFPP) was implemented in urban health centers. In the present study, we aimed to evaluate the trend of health indicators across a ten-year period in an Iranian population and to measure the possible effects of this intervention on health indicators.Methods: An interrupted time series analysis (ITSA) was performed on a ten-years (from 2009 to 2018) of annual data set covering all healthcare indicators associated to the UFPP in Bonab County, Iran. The time of intervention was at the 7th data point in 2015. Health indicators were divided into two groups including process indicators (Modern Contraceptives Use (MCU), Prenatal and Postpartum care visits, Clinical Breast Examinations (CBE), brucellosis and tuberculosis (TB) incidence), and outcome indicators (Total fertility rate (TFR), Maternal Mortality Rate (MMR), Stillbirth Rate (SBR), Infant mortality Rate (IMR), Neonatal Mortality Rate (NMR), 1-59 months old Mortality Rate, Low Birth Weight (LBW), crud birth rate (CBR) and the rates of Infants fed by Formula milk.Results: The ratio of some process indicators, including the MCU (b = -5.13. 95% Confidence Interval (CI): -8.01 to -2.26), incidence of tuberculosis (b = .016. 95% CI: -1.01 to 1.34) and brucellosis (b = 3.04. 95% CI: -3.4 to 9.50) had a decreasing trend from 2008 to 2018. However, the CBE (b = 0.60. 95% CI: -4.97 to 6.18), prenatal care visits, (b= -4.25. 95% CI: -10.4 to 1.5) postpartum care visits (b = -22.83. 95% CI: -31.44 to -14.21), and first time care visits during pregnancy (b = -5.59. 95% CI: -14.52 to 3.32) were found with increasing trends. In contrast, the rate of at least six-time care visits during pregnancy was found to be in a decreasing trend (b = -10.32. 95% CI: -16.82 to -3.82). A series of outcome indicators including MMR (b = 24.78. 95% CI: 2.88 to 46.61), TFR (b= 0.07. 95% CI: 0.01 to 0.13), 1-59 Month old Mortality Rate (b = -.16. 95% CI: -.45 to .12), LBW (b = .33. 95% CI: -.08 to .40), Formula-fed infant rate (b = .48. 95% CI: -.007 to .97), Delivery rate in high-risk groups (b = 1.85. 95% CI: 1.22 to 2.49) and CS (b = -3.43. 95% CI: -5.73 to -1.12) had increasing trends from 2008 to 2018. In contrast, SBR (b = -.04. 95% CI: -.21 to .12), NMR (b = -.77. 95% CI: -2.91 to 1.36), IMR (b = -1.05. 95% CI: -2.99 to .89) and CBR (b = -.97. 95% CI: -1.85 to -.09) were in decreasing trends. Conclusion: The UFPP was found with positive impacts on some process, proximal and distal outcome indicators, but its positive impacts on the trends of some critical indicators, including MMR, NMR and IMR remained questionable. Our findings may shed light on the role of some other factors like social determinants of health in the programs like the UFPP.
Transforaminal interbody debridement and fusion with antibiotics impregnated bone graft to treat pyogenic discitis and vertebral osteomyelitis: A technique note with preliminary result.
Authors: Chang Hsiao-Kang , Lu Meng-Ling , Wegner Adam M. , Wu Re-Wen , Chen Sung-Hsiung , Hsu Chieh-Cheng , Chen Hou-Tsung , Yin Tsung-Cheng
Published: July 2020

Background

Surgical treatment of pyogenic discitis and vertebral osteomyelitis (PDVO) is indicated for neurologic deficit, spinal instability, unknown pathogen, poorly controlled infection, or intractable pain. Although the posterior-only approach has been proved a safe, effective procedure that minimizes the risks and complications of anterior or staged surgery, parenteral antibiotic treatment for 4–6 weeks postoperatively is still necessary. We hypothesized that antibiotic-impregnated bone graft used in an all posterior approach could result in infection control and shorten the postoperative course of pyogenic discitis and vertebral osteomyelitis.
Methods

21 consecutive patients with pyogenic discitis and vertebral osteomyelitis of the lumbar or thoracic spine were treated with transforaminal interbody debridement and fusion (TIDF) with antibiotic-impregnated bone graft (AIBG) between March 2014 and January 2017. Minimum follow up was 2 years. Outcomes included visual analog scale (VAS) back pain, ASIA scale for neurological status, kyphotic angle correction, fusion status, and functional outcome using Kirkaldy-Willis criteria, and c-reactive protein (CRP) levels. CRP levels from pre-op, immediately post-op, and 1, 2, 4 & 6 wks post operatively and the duration of treatment with postoperative IV antibiotics in our patients was compared to our previous case series in which TIDF was performed without AIBG.
Results

Surgical treatment for PDVO resulted in clinical improvement and adequate infection control. There was no difference in pre-op CRP levels between the two groups. Despite shorter post-op IV antibiotic duration (Mean 21.0 d vs 39.8 d), the AIBG group had a stable decline in CRP levels and continued to decrease at 1, 2, 4 & 6 weeks, with significantly lower CRP levels at 6 weeks compared to bone graft without antibiotics. VAS scores improved from a mean of 7.2 to 2.3 one month postoperatively. Patients who had increased kyphotic angles had an average angle correction of 7.9° at last follow-up.
Conclusion

The technique of TIDF combined with AIBG can achieve local infection control with faster reduction in CRP, leading to shorter antibiotic duration for pyogenic discitis and vertebral osteomyelitis
Impact of inpatient rehabilitation on the quality of life of neurological patients in Thailand: A prospective multicenter cohort study
Authors: Kuptniratsaikul Vilai , Vongpipatana Sivaporn , Wathanadilokul Ubonwon , Lukkanapichonchut Pranee , Ingkasuthi Kanlaya
Published: July 2020

Background: Patients with neurological diseases often have residual neurological deficits that can make self-care and ambulation functions difficult, and these obstacles to independence can have an adverse effect on QoL. Many studies have investigated patient QoL in one type of condition. However, data relating to patient QoL in rehabilitation units that treat a spectrum of disorders are scarce. Accordingly, our aim was to investigate the impact of inpatient rehabilitation on the QoL of neurological patients in Thailand, and to identify factors significantly associated with patient QoL. Methods: A prospective multicenter cohort study was performed among neurological patients receiving rehabilitation program at 14 tertiary centers during January-December 2012. The Thai Euro QoL five dimensions with three levels (Thai EQ-5D-3L) was used to evaluate the patient’s QoL twice, at admission and discharge. It consists of five dimensions: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression with 3 response options for each dimension: no problems, some problems, and extreme problems. Factors related to QoL were analyzed using multiple logistic regression analysis.Results: Of the 1,197 recruited patients, 567 had spinal cord injury (SCI), 561 had stroke, and 69 had traumatic brain injury (TBI). The mean age was 52.3±17.5 years, and 67.4% were male. Over half (58.0%) of patients were admitted for intensive rehabilitation program, and 17.5% were admitted for investigation. The median QoL score was significantly higher at discharge than at admission, and most subjects (59.6%) had improved QoL during the rehabilitation period. Multivariate analysis revealed onset to admission interval (OAI) less than 3 months (p<0.001) and intensive rehabilitation program (p=0.005) to be significantly associated with improved QoL. The change in QoL score was greater in the stroke group than in the SCI and TBI groups. At admission, QoL in the intensive group was below zero compared to the non-intensive group; however, the change in QoL score at discharge was greater in the intensive group.Conclusions: Inpatient rehabilitation does improve QoL of neurological patients especially participants whose onset of less than 3 months and who are ready for intensive program. Patients with potential for rehabilitation should be admitted during 3 months after onset.
White Matter Integrity Involvement in Preclinical Stage of Familial Creutzfeldt-Jakob Disease: A Diffusion Tensor Imaging Study
Authors: Jing Donglai , Chen Yaojing , Xie Kexin , Cui Yue , Cui Chunlei , Liu Li , Lu Hui , Ye Jing , Gao Ran , Wang Lin , Liang Zhigang , Zhang Zhanjun , Wu Liyong
Published: July 2020

Background : To explore the patterns of white matter (WM) alterations using diffusion tensor imaging (DTI) in the preclinical stage of familial Creutzfeldt-Jakob disease (fCJD) . Methods: 7 asymptomatic carriers of PRNP G114V mutation and 6 non-carriers from the same fCJD kindred were recruited at baseline. Follow-up was obtained in 7 asymptomatic carriers and 2 non-carriers 2 years later. We also included 10 symptomatic CJD patients and 10 age-and gender-matched healthy controls out of the kindred to observe the overlapping patterns of WM between asymptomatic carriers and symptomatic CJD patients. All subjects received clinical, neuropsychological assessments, electroencephalogram (EEG) tests, and DTI at baseline and follow-up. Tract-based spatial statistics (TBSS) was used in DTI study for whole-brain voxel wise analysis of fractional anisotropy (FA) and mean diffusivity (MD) in WM. Results were compared in three groups: baseline carriers against non-carriers (baseline analysis), changes after 2 years in carriers (follow-up analysis), and differences between symptomatic CJD patients and healthy controls (CJD patients analysis). Results: Neither the carriers nor the non-carriers develop any neurological symptoms during 2 years follow-up. Baseline analysis showed no group differences between carriers and non-carriers in MD and FA. Follow-up analysis showed significant increased MD in left inferior fronto-occipital fasciculus, left uncinate fasciculus, bilateral superior longitudinal fasciculus, and bilateral corticospinal tract (p < 0.05), among which increased MD in bilateral superior longitudinal fasciculus and right corticospinal tract overlaps the pattern of CJD patients. Conclusion: Integrity involvement within multiple WM tracts could be detected in preclinical stage of fCJD.