bluuebunny/crossref_metadata_2025 huggingface dataset:
Incidence and Determinants of Maternal Sepsis in Ghana in the midst of a pandemic
Authors: Noora Charles Lwanga , Manu Adom , Addo-Lartey Adolphina , Mohammed Abdul Gafaru , Ameme Donne , Kenu Ernest , Torpey Kwesi , Adanu Richard
Published: March 2022

Background: Despite being preventable, maternal sepsis continues to be a significant cause of death and morbidity, killing one in every four pregnant women globally. In Ghana, maternal sepsis is increasingly becoming a major contributor to maternal mortality. The lack of a consensus definition for maternal sepsis before 2017 created a gap in determining global and country-specific burden of maternal sepsis and its risk factors. This study determined the incidence and risk factors of clinically proven maternal sepsis in Ghana.Methods: We conducted a prospective cohort study among 1476 randomly selected pregnant women in six health facilities in Ghana, from January to September 2020. Data were collected using primary data collection tools and reviewing the client’s charts. We estimated the incidence rate of maternal sepsis per 1,000 pregnant women per person-week. Poisson regression model and the cox-proportional hazard regression model estimators were used to assess risk factors associated with the incidence of maternal sepsis at a 5% significance level. Results: The overall incidence rate of maternal sepsis was 1.52 [95% CI: 1.20-1.96] per 1000 person-weeks. The majority of the participants entered the study at 10-13 weeks of gestation. The study participants' median body mass index score was 26.4 kgm-2 [22.9 - 30.1 kgm-2]. The risk of maternal sepsis was 4 times higher among women who developed urinary tract infection after delivery (aHR: 4.38, 95% CI: 1.58-12.18, p<0.05). Among those who developed caesarean section wound infection after delivery, the risk of maternal sepsis was 3 times higher (aHR: 3.77, 95% CI: 0.92-15.54, p<0.05). Among pregnant women who showed any symptoms 14 days prior to exit from the study, the risk was significantly higher among pregnant women with a single symptom (aHR: 6.1, 95% CI: 2.42-15.21, p<0.001) and those with two or more symptoms (aHR: 17.0, 95% CI: 4.19-69.00, p<0.001). Conclusions: Our findings show a low incidence of maternal sepsis in Ghana compared to most Low and Middle-Income Countries. Nonetheless, Maternal sepsis remains an important contributor to the overall maternal mortality burden. It is essential clinicians pay more attention to ensure early and prompt diagnosis. Factors significantly predicting maternal sepsis in Ghana were additional maternal morbidity, urinary tract infections, dysuria, and multiple symptoms. We recommend that Ghana Health Service should institute a surveillance system for maternal sepsis as a monthly reportable disease.
Influence of Using Food Delivery Applications on Adult Saudi Female Dietary Habits and Preferences during Covid-19 Lockdown Restrictions: Knowledge and Attitude Survey
Authors: Algheshairy Reham M. , Alhomaid Raghad M. , Almujaydil Mona S. , Alharbi Hend F. , Alsanei Wourod A.
Published: April 2022

BackgroundFood delivery applications (FDAs) shined during COVID-19 global lockdown restrictions. As a consequence, lifestyle changes imposed a greater use of these applications over this period. These changes may reflect a strong influence on the nutritional health of individuals, in particular adult Saudi females. This cross-sectional study aims to examine the influence of using FDAs during COVID-19 lockdown restrictions on knowledge and attitude lifestyle behaviours, including dietary habits and preferences among adult Saudi females. MethodsA cross-sectional study was designed and conducted to examine the influence of using FDAs during COVID-19 between February and May 2021. Participants voluntarily submitted their answers to a survey questionnaire administered via the Google Survey platform. ResultsA total of 3667 adult Saudi female volunteers were enrolled with ages from 18 to 55 years old, residing in Saudi regions. Result illustrated that the majority of Saudi female users of FDAs were aged between 18-24 years with 64.9% , 91.5% were single and 37% were ordered food online within 1-2 days a month. There were a significant association between the influence of using FDAs during Covid-19 lockdown restrictions and age, education and average days of ordering food online (p ˂0.05)ConclusionsAlthough lifestyle changes imposed a greater use of food delivery applications (FDAs) during COVID-19 global lockdown restrictions, these changes may reflect negatively associated with individuals' dietary habits and preferences, particularly adult Saudi females. These findings can aid to promote healthy diet management globally and in Saudi Arabia unless the governments lead a great changing approach toward improving food delivery applications. Additionally, future research is recommended to maximise the positive and reduce the adverse effects of using FDAs by accessing healthy foods for all populations during and post-pandemics. Thus, to succeed, all partners, healthcare providers and stakeholders, including online food delivery app's creators, providers, policy-makers, users, and academic research and development (R&D), should work together to increase the attention and awareness of healthy eating.
Geniposide suppresses NLRP3 inflammasome-mediated pyroptosis via the AMPK signaling pathway to mitigate myocardial ischemia/reperfusion injury
Authors: Li Haiyan , Yang Dong-Hua , Zhang Yanmei , Zheng Fuchun , Gao Fenfei , Sun Jiajia , Shi Ganggang
Published: March 2022

Background: NLRP3 inflammasome activation and pyroptosis play a significant role in myocardial ischemia reperfusion injury (MI/RI). Geniposide was reported to show potential therapeutic use for MI/RI with its anti-inflammatory and anti-oxidative properties. However, research on the specific mechanism of geniposide has not been reported.Methods: The Myocardial ischemia-reperfusion injury (MI/RI) model of animal was created in male C57BL/6J mice and the hypoxia reoxygenation model was established for the in vitro experiments. Neonatal rat ventricular myocytes (NRVMs) and H9c2 cells with knockdown of TXNIP or NLRP3 were used. Geniposide was administered to mice before vascular ligation. HE staining, 2,3,5-triphenyltetrazolium chloride (TTC) staining, echocardiography, oxidative stress and myocardial enzyme detection were used to evaluate the cardioprotective effect of geniposide. Meanwhile, pharmacological approaches of agonist and inhibitor were used to observe potential pathway for geniposide cardioprotective in vitro and in vivo. Moreover, ELISA kits were adopted to detect the levels of inflammatory factors, such as IL-1β and IL-18. The gene and protein expression of NLRP3 and pyroptosis-related factors in heart tissue were performed by immunofluorescence, RT-PCR, western blotting in vivo and in vitro, respectively.Results: Our results indicate that geniposide can reduce the area of myocardial infarction, improve heart function, and inhibit the inflammatory response in mice after MI/RI. In addition, RT-PCR and western blotting shown geniposide promoting AMPK phosphorylation to activate myocardium energy metabolism and reducing the levels of genes and proteins expression of NLRP3, ASC, N-GSDMD and cleaved caspase-1, IL-1β, IL-18. Meanwhile, geniposide improved NRVMs energy metabolism, which decreased ROS levels and the protein expression of TXNIP and thus suppressed the expression of NLRP3. AMPK antagonist or agonist and siRNA downregulation of TXNIP or NLRP3 were also verify the effect of geniposide against H/R injury. Further research found that geniposide promoted the translocation of TXNIP and reduce the binding of TXNIP and NLRP3.Conclusions: In our study, geniposide can significantly inhibit NLRP3 inflammasome activation via the AMPK signaling pathway and inhibit pyroptosis of cardiomyocytes in myocardial tissues.
M6A regulator expression patterns predict the immune microenvironment and prognosis of non-small cell lung cancer
Authors: Liu Xue , Ma Changsheng , Liu Hui , Sun Zhiqiang , Luo Judong
Published: March 2022

Background: The m6A methylation modification is one of the most common mRNA modifications, and involved in a variety of biological processes, such as cell death, cancer stem cell formation and tumorigenesis. Increasing evidences have demonstrated that the expression patterns of m6A regulators are significantly correlated with PD-L1 level some solid tumors, but few study has explored the function of m6A regulators in the immune microenvironment and prognosis in non-small cell lung cancer (NSCLC). Methods: Survival analysis was independently conducted for 20 m6A regulators to explore their prognostic value in NSCLC, and then the prognostic risk model based on m6A regulator expression profiles is built to stratify NSCLC patients. Also, the correlation analysis between immune infiltrating cells and m6A regulators is used to reveal the impact of m6A on immune microenvironment of NSCLC. Furthermore, to explore the function of m6A as biomarker of anit-PD-L1 therapeutic effect, we explored the associations of tumor mutation burden (TMB) and PD-L1 levels to 20 m6A regulator expression patterns in NSCLC. Results: First, the expressions of 20 m6A regulators in NSCLC tissues were significantly increased compared to normal tissues. Survival analysis revealed that three genes, METTL3, HNRNPC and VIRMA, were markedly correlated to the prognosis of NSCLC patients. In particular, cox regression analysis verified that METTL3 could be used as an independent prognostic factor to predict the survival rate of NSCLC patients. Second, the risk prognostic model built on seven m6A regulators can effectively stratify NSCLC patients, and the low-risk subgroup had better prognosis compared to high-risk group. Finally, a few m6A regulators showed significant associations with immune microenvironment, as well as TMB and PD-L1 level, suggesting that the m6A RNA methylation is indicative of therapeutic effect of anti-PD-L1 treatment. Conclusion: Our study identified some m6A regulatory factors as independent risk factors for the prognosis of NSCLC, and the expression patterns of m6A regulators are also correlated to the immune infiltration, as well as TMB and PD-L1 level in NSCLC. The m6A regulators could be used as biomarkers indicative of immunotherapy to NSCLC patients.
Robust Sliding-Backstepping Mode Control of a wind system based on the DFIG Generator
Authors: Echiheb Farah , Ihedrane Yasmine , Bossoufi Badre , Bouderbala Manale , Motahhir Saad , Ghamrasni Madiha el
Published: March 2022

This paper presents a new contribution in the field of the optimization of the techniques of control of the wind systems, and the improvement of the quality of energy produced in the grid. The use of the Sliding Mode control technique gives quite interesting results, but its major drawback lies in the phenomenon of chattering (oscillations) which reduces the precision of the system. we propose in this work a solution to cancel this chattering phenomenon, by the implication of the adaptive Backstepping technique to control the powers of the double-fed asynchronous generator (DFIG) connected to the electrical network by two converters (network side and side machine) in the nominal part of the sliding mode model. This hybrid technique will correct errors of precision and stability and the performance of the wind system obtained in terms of efficiency, active and reactive power are very important. First, a review of the wind system was presented. Then, an exhaustive explanation of the Backstepping technique based on Lyapunov stability and optimization method has been reported. Subsequently, a validation on the Matlab & Simulink environment was carried out to test the performance and robustness of the proposed model. The results obtained from this work either by follow-up or robustness tests show a great improvement in terms of performance compared to other control techniques.
Structure Design, Performance Simulation and Plasticizing Properties of Bio-Based Copolyesters Plasticizer on PVC
Authors: Gao Chuanhui , Wang Yanqing , Gao Yiliang , Wang Rixuan , Wang Huizi , Wu Yumin , liu yuetao
Published: March 2022

Plasticizer is an important assistant in the production process of polyvinyl chloride (PVC), which can effectively improve the plasticity of PVC. However, the durability and plasticizing effect of traditional phthalate plasticizers need to be further improved. In this paper, a variety of copolyesters are designed and synthesized from succinic acid, hexanediol and other four different diols. The plasticizing performance of the copolyester is characterized by FT-IR, H-NMR, XPS and DMA. It is found that the side chain groups in the structural units of the copolyester have a great influence on its plasticizing properties. The glass transition temperature of PVC plasticized by polybutylene succinate 3-chloro-1,2-propanediol ester (PSCH) is 8.1℃ lower than the temperature of PVC which is plasticized by DOP, and the elongation at break is increased by 104.7%. The obtained copolyester plasticizer with flexible long alkane chains and polar C-Cl groups shows improved solvent extraction resistance and better compatibility between plasticizer and PVC compared DOP. It is verified that the hydrogen bonding interaction between the C = O group of plasticizers and α-hydrogen of PVC exhibited in FT-IR, XPS and solubility parameters DS is the main reason for the effective plasticizing efficiency of PSCH on PVC.
Serological screening of patients diagnosed with alveolar echinococcus disease in their home regions
Authors: Akkaş Onder , Uslu Hakan , YILMAZ Isa , AYDIN Yener , KORKUT Ercan , YILMAZ Ahmet
Published: March 2022

This study, it was aimed to determine the ELISA prevalence of Alveolar echinococcus parasitosis in our region, to perform the specific differentiation of species by using the WB method, to diagnose and treat this disease effectively in early periods, and to inform the patients about the results quickly. Blood Samples were provided from a total of 305 participants (volunteer patients and their relatives), including 151 females (49.50%) and 154 males (50.50%), whose ages ranged between 6-85 and were diagnosed as Alveolar echinococcosis (AE) and operated in concerned clinics. In this study, EgIgG ELISA was determined as positive in a total of 29 (9.5%) participants, including 17 (11.3%) female and 12 (7.8%) male. In addition, Em2-Em18 ELISA was also determined as positive in a total of 15 (4.9%) participants, including 9 (6%) females and 6 (3.9%) males. 12 (3.94 %) of these findings were observed as positive in terms of both tests. Through the verification done by Anti-EWB IgG, EM was identified in 7 (21.9%) of the female participants, EG in 1 (3.1%), and both parasites in 2 (6.2%). For male participants, EM was determined in 3 (9.3%) of them, EG in 1 (3.1%), and both parasites in 1 (3.1%). This study has shown that AE continues to threaten public health in the region. We think that in families where AE is detected positive, the reason for disease is based on nutrition; thus, it will be proper to check up all family members in the terms of infection.
“I felt not prepared to provide care to patients on my own” Challenges experienced by newly qualified nurse-midwives transitioning to practise in selected midwifery settings in northern Malawi
Authors: Mtegha Mathews Brave , Chodzaza Elizabeth , Chirwa Ellen , Kalembo Fatch Welcome , Zgambo Maggie
Published: March 2022

Background: Literature shows that newly qualified nurse-midwives face challenges integrating into the workforce during their transition period from training to practice. However, little is known about the needs and challenges of Malawian nurse-midwives during their transition from training to practice. The aim of the study was to explore the transition experiences of newly qualified nurse-midwives working in selected midwifery units in Northern Malawi.Methodology: A qualitative descriptive approach was used. Data were collected through in-depth interviews using a semi-structured interview guide from a purposive sample of 19 participants (13 newly qualified nurse-midwives and 6 key informants). Participants were from three selected hospitals from the Northern part of Malawi that have maternity units. Data were analysed manually using thematic analysis. Findings: Five themes related to challenges faced by newly qualified nurse-midwives during their transition to practice in midwifery units emerged from the thematic analysis of the data. These included (1) Theory - practice gap, (2) Lack of confidence and skills, (3) Inadequate resources, (4) Transition support system, and (5) Workplace conflict. Conclusion: Newly qualified nurse-midwives in Malawi encounter many challenges while transitioning from training to practice. The study findings underscore the need to develop a national framework support system that could not only help newly qualified midwives adjust positively to their new role but also create more opportunities for learning and developing and strengthening a collaborative partnership between colleges and hospitals.
5-methylcytosine profile of mRNA in breast cancer brain metastasis
Authors: Cai Peiying , Jiang Bo , Zhang Anqi , Wang Yiting , Meng Min , Li Peng , Fu Bo
Published: March 2022

Background: 5-methylcytosine (m5C) modification is involved in various physiological process of diseases. Great amount of research has been conducted to reveal the m5C profile, while the m5C profile of mRNA in breast cancer brain metastasis is unknown. Materials & methods: We performed methylated RNA immunoprecipitation sequencing (MeRIP-seq) to identify the m5C profile of mRNA in breast cancer brain metastasis cells (231-BR cells). Results: mRNA m5C profiles showed difference in peak numbers, length and modification level between 231-BR cells and its parental nonspecific metastatic MDA-MB-231 cells. Compared with the control cells, we gained 1048 higher and 1866 lower methylation peaks in 231-BR cells. The most significant differentially methylated genes in m5C level included NSCN7, YBX3, SHANK1, MMP9, and LCN2. In addition, through GO and KEGG analysis, differently m5C methylated genes were chiefly engaged in the pathways of cancer cell focal adhesion, basal carcinoma, and endocytosis. Finally, the conjoint analysis of mRNA expression and RNA m5C modification was performed and that there are 346 ﻿genes showed coefficient changes. Conclusion: This study may comply a novel vision as a basis for subsequent mechanism research of breast cancer brain metastasis.
Robust locating research of welding fixtures for the aluminum alloy sidewall of a high-speed train body
Authors: Yu Kuigang , Wang Xianjin , Peng Weili
Published: March 2022

The sidewall of a high-speed train body is welded by multiple hollow extruded aluminum alloy sheets. Due to the material characteristics of aluminum alloy, excessive welding deformation is easy to occur in the welding process of the sidewall. The welding quality of the sidewall is mainly guaranteed by fixtures, and the reasonable arrangement of sidewall fixtures can reduce the welding deformation. In this paper, a robust design of sidewall fixtures is carried out based on the Taguchi method and the double response surface method. Firstly, simplified shell element models of the sidewall are established and verified, and a welding deformation evaluation index of the sidewall is put forward. Secondly, based on the inside and outside table experimental design, the Taguchi method is used to design the robust parameters of sidewall fixtures, and robust locating parameters of sidewall fixtures are determined according to the SNR. Thirdly, the mean and standard deviation models of welding deformation are established based on the double response surface method, and the robust design of sidewall fixtures are carried out with the minimization of the square sum of the mean close to the target and the standard deviation. Finally, by comparing the original scheme, the fixture design scheme based on the Taguchi method and the fixture design scheme based on the double response surface method, it shows that the robust scheme of sidewall fixtures based on the double response surface method is best.
Herders’ Perspectives on pastoral systems in the face of changing climate in Karakoram Mountains of Northern Pakistan
Authors: Ali Irfan , Raza Ghulam , Hussain Azhar , Khan Muhammad Zafar , Akram Wasim , Begum Farida
Published: March 2022

Pastoralists in Karakorum Mountains are experiencing rapid climatic change, causing new challenges for the pastoral systems with negative impacts on livestock herding due to shrinking pastures, declining forage productivity, and varying weather patterns. We investigated perceptions of local pastoralists about climate change and its impact on pastoralism, by interviewing 135 households in the study area. We also assessed climatic changes using meteorological data acquired during 1984–2013. The results revealed that pastoralists in the study area perceive climate change and its negative impacts on herding patterns and pastoral livelihoods. The perceived impacts on the local climate were increasing temperature and unpredictable rainfalls with extreme events. The climatic data also showed increasing trends of temperature (mean annual increase of 0.042°C) and precipitation (mean annual increase of 1.42 mm) over 1984–2013. Local people adapt to climate stresses through their traditional and local experiences. The majority of the respondents used some traditional adaptation measures such as raising the different types of livestock, rotational use of pastures, changing traditional grazing patterns, changing herd composition, building new channels to pasture lands, changing feeding strategies to cope with climate change and its consequences. These responses are not enough to cope with such large variability in climate and its adverse impacts. A better adaptation mechanism can be promoted by integrating the traditional practices with science-based improved adaptation measures.
Cellulose-Based Hybrid Composites Enabled by Metal Organic Frameworks for CO2 Capture: The Effect of Cellulosic Substrate
Authors: Jabbar Saysam Qusai , Janani Halimeh , Janani Hamed
Published: March 2022

A comparative study of two cellulosic materials i.e., cotton fabrics and nanobacterial cellulose (NBC), is reported as substrates for metal organic frameworks (MOF-199), to prepare micro and nanocompistes of cellulose@MOF-199 for CO 2 capture. The CO 2 uptake performance was investigated using gravimetric adsorption and desorption kinetics. NBC was an efficient substrate with full coverage and uniform distribution of MOF crystals observed in NBC@MOF-199 nanocomposite. The surface area for NBC@MOF-199 and Cotton@MOF-199 were 553.4 m 2 .g -1 and 168.9 m 2 .g -1 , respectively. NBC@MOF-199 showed a high adsorption capacity (2.9 mmol g 1 ) at ambient temperature and pressure, followed by Cotton@MOF-199 (1.2 mmol g -1 ). The kinetic studies revealed that the adsorption process is controlled by film diffusion at lower temperatures, and by sorption to active sites at higher temperatures. The estimated thermodynamic parameters represent a spontaneous adsorption with low activation energies of adsorption/desorption, promising a fast adsorption and facilitated regeneration adsorbent system with minimum energy costs.
A New Analytical Method for Determination Bisphenol A in Canned meat
Authors: Sarkis Nazira , shaghel Joud Al
Published: March 2022

In recent years, attention has grown to bisphenol A (BPA), as it is an important compound in the manufacture of food packaging materials and many other plastic materials. Therefore, the focus has been recently on studying the characteristics and migration of cans to food, as well as the harmful effect on health. In this research, a reverse phase high liquid chromatography coupled with UV-detector (HPLC-UV) was developed for determining of BPA in canned meat. For quantitative determination of BPA, the following experimental conditions were established: mobile phase (acetonitrile: water, 55:45 v/v), a flow rate of 1mL/min, column temperature of 25oC, injection volume 20µL and UV-detection at 227 nm. To validate the analytical method, it was based on the following parameters: Linearity, precision, recovery, and limit detection. A good linear correlation with R2 = 0.9989 was observed over the range of 1 to 500 mg/Kg. The limit of quantitation (LOQ) was measured to be 0.982 mg/Kg, while the limit of detection (LOD) was measured to be 0.294 mg/Kg. The extraction recoveries for BPA were 90.006% in canned tuna, 98.299% in canned luncheon. The precision of the method, based on relative standard deviations (RSD %), ranged from 1.77–3.44%. The proposed method was found to be suitable and praised for the determination of BPA 1.56 to 1.96 mg/Kg, 0.34 to 0.90 mg/Kg in canned tuna, and canned luncheon meat, respectively.
Iodine Nutrition and Related Factors of Mothers with Children under 2 Years Old from Three Different Areas in China: A Cross-sectional Survey
Authors: Shan Xiaoyun , Zou Yan , Huang Lichun , Jiang Shan , Zhou Weiwen , Qin Qiulan , Liu Changqing , Luo Xiaoyan , Lu Jiaxi , Mao Deqian , Li Min , Yang Zhenyu , Yang Lichen
Published: March 2022

To analyze the iodine nutritional status and related factors of mothers with children under 2 years old, we collected data from the 2016–2017 National Nutrition and Health Surveillance of Children and Lactating Women. A total of 1311 mothers from Hebei, Zhejiang, and Guangxi province were included in the study. Urinary iodine concentration (UIC), thyroid-stimulating hormone (TSH), body mass index (BMI), vitamin A (VA), and vitamin D (VD) were measured. The distributions of UIC and TSH were assessed. Relationships between UIC, TSH and the possible factors were analyzed. The median UIC (MUIC) (P25-P75) of total mothers and mothers in lactation was 142.00 µg/L (99.10-209.40 µg/L) and 139.95 µg/L (96.22-208.03) µg/L, respectively. No differences in UI were found between breastfeeding mothers and non-breastfeeding mothers. The prevalence of mothers with UICs < 50µg/L was 5.03%, and 91.30% of mothers showed TSH normality. UICs and UIC distributions were significantly different among the three provinces, and between rural and urban areas. Obese mothers tended to have higher MUIC and higher prevalence of excessive TSH. Linear correlations between lnUIC and VA/VD were observed with or without adjusting for confounding factors. Higher TSHs were observed in both VD deficiency and insufficiency groups (P < 0.01). However, typical U-shaped relationship between TSH and UIC was not observed in this population. In conclusion, Mothers in our study had no iodine deficiency, but numbers of mothers were still having a UIC of < 100 µg/L or > 300 µg/L. Region, area type, age, BMI, VA, or VD should be taken into consideration in the future iodine evaluation and surveillance.
Technique of enlarged retrosternal tunnel in Nuss procedure
Authors: Li Xiu-qin , Zhang Da , Zhao Ge , Xie Tan , Jia Jia , Yang Lin
Published: March 2022

OBJECTIVE: The Nuss procedure for pectus excavatum involves the risk of cardiopulmonary injury during the creation of retrosternal tunnel. This study describes the enlargement of retrosternal tunnel during Nuss procedure to prevent such problems caused by the inability to directly visualize the left pleural cavity.METHODS: From January 2018 to August 2021, 132 patients with pectus excavatum who underwent the Nuss procedure were divided into the modified group and the conventional group , according to the surgical method performed. The preoperative, intraoperative and postoperative indicators of the two groups were compared. In 70 consecutive patients undergoing the modified Nuss procedure, the separation was expanded by inserting the introducer bluntly and creating a retrosternal tunnel width of 4-5 cm in a coronal horizontal position. Once the pericardium, left parietal pleura and lung had been observed from the right thoracic cavity during the separation, the parietal pleura was punctured to induce a left pneumothorax and left lung collapse. Under thoracoscopic guidance, the introducer was passed through the left intercostal space.RESULTS: All children completed the surgery successfully; there were no cases of death, pericardial or cardiopulmonary injury, or bar displacement. There was no statistical significance in other indicators except age between two groups.CONCLUSION: Coronal plane enlargement of the retrosternal tunnel during the Nuss procedure allows direct visualization of the pericardium, left parietal pleura, and left lung, which has the promise of reducing the incidence of serious complications such as intraoperative cardiopulmonary injury and does not increase the incidence of general complications.
Wearable Adjunct Ozone and Antibiotic Therapy System for Treatment of Gram-negative Dermal Bacterial Infection
Authors: Roth Alexander , Maruthamuthu Murali Kannan , Nejati Sina , Krishnakumar Akshay , Selvamani Vidhya , Sedahat Sotoudeh , Nguyen Juliane , Seleem Mohamed N. , Rahimi Rahim
Published: April 2022

The authors have requested that this preprint be removed from Research Square.
Non-nutritive sweeteners consumption during pregnancy associates with reduced Lactobacillaceae in colostrum and lower gestational age at birth: A pilot study
Authors: Esquivel-Veláz Marcela , Bueno-Hernández Nallely , Cacho-Zayas Ana P , Rosa-Ruiz Leticia de la , Aguayo-Guerrero José A , de-León-Barrera Karen L , Mendoza-Martínez Viridiana M , Briones-Garduño Jesús C , Snowball-del-Pilar Lenin , Escobedo Galileo , Meléndez-Mier Guillermo , Méndez-García Lucía A
Published: March 2022

Background. Human milk is essential for establishing the newborn’s gut microbiota, which can have an impact on future health. Several studies indicate that Non-nutritive Sweeteners (NNS) can modify the intestinal microbiota, promoting metabolic dysfunction in humans and rodents; however, the influence of NNS on human milk microbiota is unknown. This study aimed to assess changes in the relative abundance of several of bacterial groups in colostrum of women who consumed NNS during pregnancy. Methods. This cross-sectional, pilot study included 39 women that gave birth to a live, healthy newborn in the General Hospital of Mexico. We assessed mothers’ diet and NNS consumption by validated questionnaires and the relative abundance of Bifidobacteriaceae, Lactobacillaceae, Lachnospiraceae, Roseburia, Eubacteriales, and Bacteroidales in colostrum samples by real-time PCR.Results. Twenty-six women (66%) showed a low NNS consumption (<350 mg/week), whereas 13 (33%) showed a high NNS consumption (≥350 mg/week). The Lactobacillaceae relative abundance significantly decreased in the high NNS consumption group compared to the low NNS group (12.36±11.29 vs. 4.41±2.84, respectively; P<.001). NNS consumption associated with lower gestational age determined by the Capurro method or Ultrasound/Last Menstrual Period (r=-0.320, P= .025; and r=-0.355, P= .018, respectively).Conclusion. NNS consumption during pregnancy is associated with decreased Lactobacillaceae abundance in colostrum and lower gestational age. The effects of NNS consumption during pregnancy on breast milk microbiota and gestational age should be further investigated.Study registration: This study was registered in ClinicalTrials, number NCT03912038.
Multisystem Inflammatory Syndrome in a Fully Vaccinated 18-Year-Old Without Known SARS-CoV-2 Infection
Authors: Liu Andy , Love Alexa , Katz Sophie , Patrick Anna , Parra David , Halasa Natasha , Miller Michael Raymond
Published: March 2022

Background
Multisystem inflammatory syndrome in children (MIS-C) is a febrile syndrome that is observed in the pediatric population following severe acute respiratory syndrome 2 (SARS-CoV-2) infection. Vaccines have prevented or lessened the severity of the initial acute respiratory infection, while their effectiveness against severe MIS-C is just beginning to be reported.
Case presentation
Here we report a fully vaccinated teenage female with no known history of SARS-CoV-2 infection who presented with shock and heart failure. Her presentation was initially thought secondary to a retropharyngeal abscess but was later identified as MIS-C after confirmed nucleocapsid antibody.
Conclusions
Given the recent Omicron wave, the ongoing international outbreaks with the BA.2 subvariant and the continued evolution of the COVID-19 pandemic, this case emphasizes the need to include MIS-C in the differential diagnosis, even in a fully vaccinated, previously healthy child.
Minimal important difference and patient acceptable symptom state for common outcome instruments in patients with a closed humeral shaft fracture Analysis of the FISH randomised clinical trial data
Authors: Ibounig Thomas , Juurakko Joona , Lähdeoja Tuomas , Sumrein Bakir O. , Järvinen Teppo LN , Paavola Mika , Ardern Clare L. , Karjalainen Teemu , Taimela Simo , Rämö Lasse
Published: March 2022

Background: Two common ways of assessing the clinical relevance of treatment outcomes are the minimal important difference (MID) and the patient acceptable symptom state (PASS). The former represents the smallest change in the given outcome that makes people feel better, while the latter is the symptom level at which patients feel well.Methods: We recruited 124 humeral shaft fracture patients to a randomised controlled trial comparing surgery to nonsurgical care. Outcome instruments included the Disabilities of Arm, Shoulder, and Hand score (DASH), the Constant-Murley score, and two numerical rating scales (NRS) for pain (at rest and on activities). A reduction in DASH and pain score, and increase in the Constant-Murley score represents improvement. We used four methods (receiver operating characteristic [ROC] curve, the mean difference of change, the mean change, and predictive modelling methods) to determine the MID, and two methods (the ROC and 75th percentile) for the PASS. As an anchor for the analyses, we assessed patients’ satisfaction regarding the injured arm using a 7-item Likert-scale. Results: The change in the anchor question was strongly correlated with the change in DASH, moderately correlated with the change of the Constant-Murley score and pain on activities, and poorly correlated with the change in pain at rest (Spearman’s rho 0.51, ‑0.40, 0.36, and 0.15, respectively). Depending on the method, the MID estimates for DASH ranged from -6.7 to -11.2, pain on activities from -0.5 to -1.3, and the Constant-Murley score from 6.3 to 13.5. The ROC method provided reliable estimates for DASH (-6.7 points, Area Under Curve [AUC] 0.77), the Constant-Murley Score (7.6 points, AUC 0.71), and pain on activities (‑0.5 points, AUC 0.68). The PASS estimates were 14 and 10 for DASH, 2.5 and 2 for pain on activities, and 68 and 74 for the Constant-Murley score with the ROC and 75th percentile methods, respectively. Conclusion: Our study provides credible estimates for the MID and PASS values of DASH, pain on activities and the Constant-Murley score, but not for pain at rest. The suggested cut-offs can be used in future studies and for assessing treatment success in humeral shaft fracture patients. Trial registration: ClinicalTrials.gov NCT01719887, first registration 01/11/2012
Effect of Recombinant Human Epidermal Growth Factor on Skin Reaction Induced by Radiation in Rectal and anal Cancer Patients: A Self-Controlled Study
Authors: Liu Shuai , Shi Shu-ting , Zheng Jian , Wan Xiang-bo , Liu Yan-ping
Published: March 2022

Backgtound:
Recombinant human epidermal growth factor (rhEGF) was reported to be beneficial for radiation induced skin injury (RISR), however, whether it is useful in patients with rectal and anal cancers are rarely reported. High-level evidence about this is even more lacking.
Objective
The purpose of this study was to provide high-level evidence for the application of rhEGF for skin protection in rectal and anal cancer patients during radiotherapy and to analyze the factors associated with RISR.
Methods
Patients were prospectively enrolled from January 2019 to December 2020. The pelvic skin area receiving radiotherapy was randomly assigned to the experimental and control side by the midline. Self-controls were formed on both sides.The experimental side was sprayed with rhEGF, while the control side was sprayed with physiological saline. The grading of RISR on two sides were assessed. At the end of radiotherapy, the area of RISR was evaluated. Factors associated with RISR were analyzed.
Results
Totally,193 patients were enrolled. At the end of radiotherapy, between the two groups, there was not a significant difference referring to grading. while there was a difference in dermatitis area. Tumor distance from the anal edge ≤ 4cm, without colostomy, the biological effective dose of radiotherapy > 60Gy are all adverse factors affecting the area of RISR in radiotherapy.
Conclusions
rhEGF can protect the skin receiving radiotherapy in rectal and anal patients.
trial registration number:
This clinical trial has been registered in China’s Clinical trials Network ((registration time: 2019.01.20; registration number: ChiCTR1900020842).
Ultrasound-assisted high voltage cold atmospheric plasma treatment on the inactivation and structure of lysozyme: Effect of treatment voltage
Authors: Nasiru Mustapha Muhammad , Boateng Evan Frimpong , Wang Zhaobin , Yan Wenjing , Zhuang Hong , Zhang Jianhao
Published: March 2022

Emerging non-thermal processing techniques are gaining much attention due to their numerous advantages over traditional methods. Thus, in this study, we employed high voltage cold atmospheric plasma (HV-CAP) separately and synergetically with ultrasound on lysozyme to investigate its activity and structure. The HV-CAP was operated at 120, 140, and 160 kV for 3 min at a frequency of 120 Hz. A significant difference was observed between the untreated and both treatments in lysozyme activity, with a more pronounced result in the ultrasound-assisted HV-CAP treatment. Both treatments influenced the tertiary structure of the lysozyme as lipid oxidation, carbonyl content, UV spectra, intrinsic fluorescence, hydrophobicity, and sulfhydryl groups increased with increased voltage. Particle size distribution of lysozyme shows that noncovalent interactions affected the tertiary structure. The effects of both treatments on the secondary structure of lysozyme were demonstrated by FTIR-ATR, CD, and relative molar ellipticity. The results indicated that plasma-generated reactive species and ultrasound-induced cavitation influenced the unfolding of tertiary and secondary structures of the lysozyme. The CD spectra postulated that lysozyme inactivation was closely linked to the α-helices and β-sheets components of the secondary structure. This study presents an original novel knowledge on the modification of activity and structure of lysozyme subjected to ultrasound-assisted HV-CAP treatment that has been missing from the literature.
The Effect of Superplasticizer and Pozzolan on the Fresh and Hardened States of Crushed Limestone Sand Concrete
Authors: Barkat Mohamed , Mezghiche Bouzidi
Published: March 2022

The primary goal of this paper is to investigate the effects of a superplasticizer and the addition of pozzolan on the fresh and hardened states of crushed limestone sand concrete. On the one hand, it's a matter of proposing concrete mixes that replace natural sand (river sand) with crushed sand, and on the other, it's a matter of attempting to improve the qualities of the concrete thus produced. In this respect, three variants of crushed limestone sand have been proposed from the same quarry, including: sand without modification (in its initial state), sand sieved through a sieve of 0.16 mm size and washed sand; further for the comparison, natural sand is used as control. A superplasticizer and a pozzolan addition were also used for better performance.The results show that the crushed sand concrete mixes produced have mechanical strengths comparable to natural sand concrete mixes. Best mechanical strengths are those of concrete with a percentage of 12% of fine particles. Beneficial effects have been observed following the use of the superplasticizer and pozzolan, thus giving improved performance to crushed sand concrete both in its fresh and hardened states.
Central Venous Line Bundle Interventional Program: Effects on Patients’ Health Outcomes
Authors: Abd-Elsalam Shimaa Nabil Abd-Elsalam Nabil , Mostafa Heba Abd Elazeem Mostafa Abd Elazeem
Published: April 2022

Background: Central venous line-associated bloodstream infection is an important healthcare-associated infection in the critical care units. It causes substantial morbidity, mortality and incurs high costs. The use of a central venous line insertion bundle has been shown to decrease the incidence of infection.Method: The current study is a quasi-experimental study with pre-post assessment was utilized to achieve the aim of the study carried out in the cardio-thoracic Intensive Care Units affiliated to Ain Shams University Hospital. The study involved a health care team group (50 nurses and 27 physicians) and 220 patients (110 pre and 110 posts). Five data collection tools were used, namely physicians and nurses' assessment tools, observation checklist for nurse's practice, central venous catheter insertion audit tool, patient assessment sheet, and unit policy assessment checklist. The researcher developed a training program based on the findings of the assessment and implemented it to participants. The effect of the program was evaluated by comparing post with pre-intervention phase findings.Findings: Overall, all patients had some type of infection before the intervention, compared to 69.1% after the intervention (p<0.001). The lower mean of hospital stay in the post (6.0±0.1 days) compared to the pre (8.7±0.6 days) sample, (p<0.001).Conclusion: The implementation of a training program in the CVL bundle based on their identified needs is successful in effecting significant improvements in their knowledge and performance. This is positively reflected on patient outcomes as assessed by observation for local and systemic signs of infections, and objectively through microbiological cultures.
The effect of neostigmine on postoperative delirium after colon carcinoma surgery: a randomized, double-blind, controlled trial
Authors: Bi Yanlin , Liu Fanghao , Lin Xu , Lin Yanan , Deng Xiyuan , Guo Yuwei , Wang Bin , Dong Rui
Published: March 2022

Background: Postoperative delirium (POD) is a critical complication in patients accepting colon carcinoma surgery. Neostigmine, as a cholinesterase inhibitor, can enhance the transmission of cholinergic transmitters in synaptic space, and play an important role in maintaining the normal level of cognition, attention and consciousness. The objective of this study was to investigate the effect of neostigmine on POD and clinical prognosis.Methods: A randomized, double-blind controlled trial was implemented in Qingdao Municipal Hospital Affiliated to Qingdao University. A total of 454 patients aged 40 to 90 years old accepted colon carcinoma surgery were enrolled between June 7, 2020, and June 7, 2021, with final follow-up on December 8, 2021. Patients were randomly assigned to two groups: the neostigmine group (group N) and the placebo group (group P), the patients in group N were injected with 0.04 mg/kg neostigmine and 0.02 mg/kg atropine intravenously. The primary endpoint was the incidence of POD, researchers evaluated the occurrence of POD by the Confusion Assessment Method (CAM) twice daily (at 10 a.m. and 2 p.m.) during the first 7 postoperative days, POD severity was assessed by the Memorial Delirium Assessment Scale (MDAS). The secondary endpoints were the extubating time, postanesthesia care unit (PACU) time, the incidence of various postoperative complications, length of hospital stays, and 6 months postoperative mortality.Results: The incidence of POD was 20.20% (81/401), including 19.39% (38/196) in group N and 20.98% (43/205) in group P. There was no significant statistical significance in the incidence of POD between group N and group P(P> 0.05); Compared to group P, the extubating time and PACU time in group N were significantly reduced (P< 0.001), the incidence of postoperative pulmonary complications (POPCs) decreased significantly in group N (P< 0.05), while no significant differences were observed in postoperative hospital stay and mortality in 6 months between the two groups (P> 0.05).Conclusion: For patients accepted colon carcinoma surgery, neostigmine did not significantly reduce the incidence of POD, postoperative mortality and postoperative hospital stay, while it indeed reduced the extubating time, PACU time and the incidence of POPCs.Trial Registration: The randomized, double-blind, controlled trial was registered retrospectively at www.chictr.org.cn on 07/06/2020 (ChiCTR2000033639).
A Novel Strategy Combining Mini-CEX and OSCE to Assess Standardized Training of Professional Postgraduates in Department of Prosthodontics
Authors: Niu Lin , Mei Yukun , Xu Xiaoqiao , Guo Yi , Li Zhen , Dong Shaojie , Liu Ruirui
Published: March 2022

Objective
Mini clinical evaluation exercise (mini-CEX) and objective structured clinical examination (OSCE) are widely acknowledged as effective measures of resident standardization training (RST) in European and American countries. However, in China primary mini-CEX and OSCE forms are mainly limited in undergraduate clinical examination. Little knowledge is available regarding the validity and right way of mini-CEX /OSCE evaluation system in advanced dental clinical education so far. This study aimed to explore whether combination of mini-CEX and OSCE represents a global-dimension assessment for postgraduate clinical competence in RST.
Methods
Postgraduates who received RST from June 2017 to June 2019 were selected and evaluated by modified mini-CEX/OSCE scales. Each student received evaluations at least twice in the initial and final stages of training (tested every 4 months). A questionnaire was conducted to investigate the satisfaction with the arrangement of RST.
Results
Mini-CEX/OSCE test results indicated that postgraduates have significantly improved their comprehensive competence in RST projects in the department of prosthodontics (P < 0.05). Compared to other master of Stomatology students, postgraduates taking up prosthodontics master’s degree have made more progresses through a training period of up to 1 year and four sessions of face-to-face feedback tutoring (P < 0.05). Survey results revealed high level of satisfaction on clinical practice evaluation.
Conclusion
Modified mini-CEX/OSCE combined evaluation system is an effective and reliable assessment tool for clinical comprehensive ability in the RST of professional graduates and can fully highlight their respective advantages on the improvement of students’ clinical competency, especially after several rounds of assessments.