bluuebunny/crossref_metadata_2025 huggingface dataset:
Mental Health and Community-Based Rehabilitation: A Qualitative Description of the Experiences and Perspectives of Service Users and Carers in Bangladesh
Authors: Koly Kamrun Nahar , Shammi Fahima Akter , Abdullah Rehnuma , Akter Taslima , Hasan Tasdik , Eaton Julian , Ryan Grace
Published: August 2020

BackgroundSince 2016, Promotion of Human Rights of Persons with Disabilities in Bangladesh (PHRPB) has been working to include people with psychosocial disabilities in their community-based inclusive development work, and to increase access to formal mental health care.MethodsField visits were carried out to PHRPBD catchment areas in Dhaka and Chittagong for a case study on the integration of mental health into community-based rehabilitation (CBR). This paper synthesizes the results of twenty-five semi-structured interviews carried out as part of the case study. Participants included people with psychosocial disabilities, intellectual disabilities, epilepsy or other cognitive impairments and their carers as needed. Interviews were audio-recorded, transcribed and translated from Bangla to English, then hand-coded for content analysis.ResultsResults were organized into five overarching categories: (1) explanatory models, (2) help-seeking behaviors, (3) impact of services, (4) challenges and barriers to improving mental health, (5) recommendations of users and carers. Respondents either had no explanation for why service users had become unwell or attributed it to physically and/or emotionally traumatic events or supernatural causes. Before attending PHRPBD’s mental health services, most had visited formal or informal health care providers, often with disappointing results. Despite positive feedback on PHRPBD’s services, participants identified ongoing challenges. Stigma, discrimination and human rights abuses persist and are compounded by issues of gender inequality. Participants also identified barriers and made recommendations specific to the program itself, mainly regarding accessibility (e.g., cost, distance, frequency).ConclusionsThis study adds to the limited body of qualitative research on mental health in Bangladesh, reinforcing previous findings on explanatory models and health-seeking behaviors while providing new insights into the impact of a CBR program in this context. Feedback of service users and carers suggests that CBR may indeed be a useful approach to increase access to services in Bangladesh for people with psychosocial or intellectual disabilities, epilepsy or other cognitive impairments. However, this program is not without its limitations, some of which are the product of broader issues within the mental health system and others of the social and cultural context. More research is needed to formally evaluate this and other CBR programs in the Global South.
The effects of neoadjuvant chemoradiotherapy and an in-hospital exercise training programme on physical fitness and quality of life in locally advanced rectal cancer patients: A randomised controlled trial (The EMPOWER Trial)
Authors: Loughney Lisa , West Malcolm , Moyses Helen , Bates Andrew , Kemp Graham , Hawkins Lesley , Varkonyi-Sepp Judit , Burke Shaunna , Barben Chris , Calverley Peter , Cox Trevor , Palmer Daniel , Mythen Monty , Grocott Michael , Jack Sandy
Published: August 2020

BackgroundThe EMPOWER trial aimed to assess the effects of a 9-week exercise prehabilitation programme on physical fitness compared with a usual care control group. Secondary aims were to investigate the effect of 1) the exercise prehabilitation programme on psychological health; and 2) neoadjuvant chemoradiotherapy (NCRT) on physical fitness and psychological health.MethodsBetween October 2013 and December 2016, adults with locally advanced rectal cancer undergoing standardised NCRT and surgery were recruited to a multi-centre trial. Patients underwent cardiopulmonary exercise testing (CPET) and HRQoL questionnaires (EORTC-QLQ-C30 and EQ-5D-5L) pre-NCRT and post-NCRT (week 0/baseline). At week 0, patients were randomised to exercise prehabilitation or usual care (no intervention). CPET and HRQoL questionnaires were assessed at week 0, 3, 6 and 9, whilst semi structured interviews were assessed at week 0 and week 9. Changes in oxygen uptake at anaerobic threshold (VO2 at AT (ml.kg− 1.min− 1)) between groups was compared using linear mixed modelling.ResultsThirty-eight patients were recruited, mean age 64 (10.4) years. Of the 38 patients, 33 were randomised: 16 to usual care and 17 to exercise prehabilitation (26 male and seven female). Exercise prehabilitation significantly improved VO2 at AT compared to the usual care. The change from baseline to week 9, when adjusted for baseline, between the randomised groups was + 2.9 ml.kg− 1.min− 1; 95% CI (0.8 to 5.1); p = 0.011.ConclusionA 9-week exercise prehabilitation programme significantly rescued fitness following NCRT. These findings have informed the WesFit trial (NCT03509428) which is investigating the effects of community-based multimodal prehabilitation before cancer surgery.Trial registrationClinicalTrials.gov NCT01914068. Registered 1 August 2013, https://clinicaltrials.gov/ct2/show/NCT01914068.
Well-being and mental stress in the Population Study of Women in Gothenburg, Sweden: Cohort comparisons from 1980 to 2016 of 36-year trends and socioeconomic disparities in 38-and 50-year old women
Authors: Waller Maria , Lissner Lauren , Hange Dominique , Sundh Valter , Blomstrand Ann , Björkelund Cecilia
Published: August 2020

Background Women`s life situations has dramatically changed in recent decades. Self-reported health in women has been reported significantly lower than in men in all age groups 18-70 years. In Sweden, the National Public Health Report 2005 showed that stressful work environments have become more common especially for women. The purpose of the study was to monitor trends in well-being and mental stress in the populations of 38- and 50-year-old women and to examine associations with socioeconomic position (SEP). Subjects Population-based cohorts of 38- and 50-year-old women as a part of the Prospective Population Study of Women in Gothenburg were invited in 1980, 2004 and 2016 to health examinations, with similar protocols on each occasion Methods Cohort comparisons between three representative samples of 38- and 50-year-old women. Well-being (scale 1-7) and perceived mental stress (scale 1-6) based on questionnaires were the main outcomes studied in relation to time. Socioeconomic position (SEP) based on socio-occupational group, i.e. occupational and educational level combined were examined as correlates well-being and mental stress at different points in time. Results Perception of good well-being increased in 50-year-old women between 1980 to 2016, but no significant time trends were seen in 38-year-old women. Perception of high mental stress increased between 1980 and 2016, for both 38-and 50-year-old women. Belonging to a low socio-occupational group was associated with lower perceived well-being in 1980 but not in 2016. Belonging to a low socio-occupational group was not associated with perceived mental stress at any examination. Conclusions Contemporary women of today have generally higher perceptions of well-being and higher mental stress regardless of belonging to low or high socio-occupational group. Associations between poor well-being and belonging to a low socio-occupational group that were observed in 1980 disappeared in 2016. Trial registration The Prospective Population Study of Women in Gothenburg, Sweden was approved by the ethics committee of University of Gothenburg (Dnr 65-80; Ö564-03; 258-16). The studies comply with the Declaration of Helsinki and informed consent has been obtained from the subjects.
High-Throughput Metabolomics for Discovering Potential Biomarkers and Identifying Metabolic Mechanisms in Aging and Alzheimer’s Disease
Authors: Xie Kun , Qin Qi , Long Zhiping , Yang Yihui , Peng Chenghai , Xi Chunyang , Li Liangliang , Wu Zhen , Daria Volontovich , Zhao Yashuang , Wang Fan , Wang Maoqing
Published: August 2020

Background and Aims: Alzheimer’s disease (AD) is an aging-related neurodegenerative disease. The current diagnosis of AD may fail to identify a substantial number of asymptomatic individuals who will progress to AD. We aimed to investigate the metabolic mechanisms of aging and AD and to identify potential biomarkers for the early screening of AD in a natural aging population.Methods: To analyse the plasma metabolites related to aging, we conducted an untargeted metabolomics analysis using ultra-high-performance liquid chromatography/quadrupole time-of-flight mass spectrometry in a two-stage cross-sectional study. Spearman’s correlation analysis and random forest were applied to model the relationship between age and each metabolite. Moreover, systematic reviews of metabolomics studies of AD in the PubMed, Cochrane and Embase databases were searched to extract the differential metabolites and altered pathways from original studies. Pathway enrichment analysis was conducted using Mummichog.Results: In total, 669 metabolites were significantly altered with aging, and thirteen pathways were enriched and correlated with aging. Five metabolites (palmitic acid, stearic acid, linoleic acid, glutamine, and oleic acid) were identified as potential biomarkers for AD based on a systematic review. Arginine and histidine were considered candidate monitoring markers of disease progression in the mild cognitive impairment (MCI) population. Moreover, three pathways (purine metabolism, arginine and proline metabolism, and the TCA cycle) were shared between aging and AD. Arginine and proline metabolism play a key role in the progression from CN to MCI and to AD in the natural aging population. Three metabolites, 16-a-hydroxypregnenolone, stearic acid and PC (16:0/22:5(4Z,7Z,10Z,13Z,16Z)), were finally proposed as potential markers of AD in the natural aging population.Conclusion: The underlying mechanism shared between aging and AD and the potential biomarkers for AD diagnosis were proposed based on multistep comparative analysis.
Inguinal hernias in patients on continuous ambulatory peritoneal dialysis: is tension-free mesh repair feasible?
Authors: Chi Qiyu , Weng Shangeng , Shi Zheng , Zhang Zhibo , Lin Chunzhong , Liu Guozhong
Published: August 2020

PurposeContinuous ambulatory peritoneal dialysis (CAPD), which often causes a common complication such as abdominal wall hernia, is a prevalent alternative therapy for end-stage renal failure patients. However, relevant studies are somewhat rare, and the peritoneal dialysis (PD) protocol during the perioperative period is still controversial. The aim of this study was to evaluate the effectiveness and perioperative management of tension-free mesh repair for inguinal hernias in CAPD patients.MethodsBetween January 2013 and December 2019, 18 CAPD patients with 20 inguinal hernias who underwent tension-free mesh repair were retrospectively analyzed. Data on demographics, perioperative features, the perioperative dialysis protocol and surgical complications were collected and assessed.ResultsAll hernias were diagnosed after the start of CAPD, and the median duration from PD onset to hernia formation was 16 months (2-61 months). All patients underwent successful tension-free mesh repair, including 17 Lichtenstein and 3 anterior Kugel procedures. The median operation time was 62.5 min, and the median postoperative hospital stay was 3 days. Fifteen patients received low-exchange volumes and high-frequency exchanges from 1-3 days after surgery for 2 weeks with gradual resumption of the original CAPD regimen within 4 weeks. Complications included seroma (n = 2) and hematoma (n = 1). No wound or mesh infection or recurrence occurred during the follow-up period.ConclusionsTension-free mesh repair is safe and feasible for inguinal hernias in CAPD patients, The Lichtenstein mesh repair should be the first choice, and anterior Kugel repair may be considered an effective procedure. Bridging hemodialysis seems unnecessary except for emergency surgery.
External Validation of the Surgical Outcome Risk Tool (Sort) In 3305 Abdominal Surgery Patients In The Independent Sector In The United Kingdom
Authors: Oakland Kathryn , Cosentino Daria , Cross Timothy , Bucknall Cliff , Dorudi Sina , Walker David
Published: August 2020

Background
Assessing risk of post-surgical mortality is a key component of pre-surgical planning. The Surgical Outcome Risk Tool (SORT) uses pre-operative variables to predict 30-day mortality. The aim of this study was to externally validate SORT in patients undergoing major abdominal surgery.
Methods
Data were collected from patients treated in five Independent hospitals in the United Kingdom. Individualised SORT scores were calculated and area under the receiver operating characteristic (AUROC) and precision-recall curves (PRC) plus 95% confidence intervals (CI) were drawn to test the ability of SORT to identify in-hospital death. Outcomes of patients with a SORT predicted risk of mortality of ≥ 5% (high risk) were compared to those with a predicted risk of < 5% (standard risk).
Results
The study population comprised 3305 patients, mean age 51 years, 2783 (84.2%) underwent elective surgery most frequently involving the colon (24.6%), or liver, pancreas or gallbladder (18.2%). Overall 1551 (46.9%) patients were admitted to ICU and 29 (0.88%) died. The AUROC of SORT for discriminating patients at risk of death was 0.899 (95% CI 0.849 to 0.949) and the PRC 0.247. In total 72 (2.18%) patients were stratified as high risk. There were more unplanned ICU admissions and deaths in this group compared to the standard risk group (25.0% and 3.3%, versus 3.1% and 0.5%, respectively).
Conclusion
We externally validated SORT in a large population of abdominal surgery patients. SORT performed well in patients with lower risk profiles, but some patients that were predicted to be standard risk did experience adverse outcomes.
Incidence and Risk Factors associated with Post-operative Nausea and Vomiting in Elective Adult Surgical Patients at Wolaita Sodo Teaching Referral Hospital: An Institutional Based Cross-sectional Study
Authors: Temesgen Ashagrie Sintayhu , Wolde Getahun Dendir
Published: August 2020

Background

Postoperative nausea and vomiting is among the most common postoperative complications, despite modern anesthetics and surgical techniques. It can occur during the operation and persisting in the postoperative period cause reduces patient comfort, delayed discharge from the hospital and an increase in costs. The risk factors that affect the incidence of post-operative nausea and vomiting are multifactorial in origin and occur in 20 to 30% of all patients and can extend up to 60–70% in high-risk patients. The objective of this study was to determine the incidence and associated risk factors of postoperative nausea and vomiting.
Methods

An institution-based, cross-sectional study was conducted from March to August 2019 in Wolaita Sodo University teaching referral hospital (WSUTRH). A total of 371 adult elective patients who operated during this period were included in the study. Data were collected by interviewing patients and reviewing their cards then entered and analyzed using SPSS version 25. Variables with P value less than < 0.2 in the bivariate analysis were fitted into the multivariable logistic regression analysis to identify factors associated with postoperative nausea and vomiting and a P value of < 0.05 was considered statistically significant.
Results

The incidence of postoperative nausea and vomiting 24hour after surgery was 29.1%. In multivariable analysis, previous history of PONV (AOR = 5.1, 95%CI = 4.00-6.58), use of opioids (AOR = 4.91, 95%CI = 3.08–10.37), use of inhalational anesthetic agent (AOR = 2.38, 95%CI = 1.45–5.30), and long duration of surgery AOR = 6.65, 95%CI = 5.52–8.30) were significantly associated with the incidence of postoperative nausea and vomiting.
Conclusions

The incidence of postoperative nausea and vomiting was high compared to other studies done in different settings. Previous history of PONV, use of opioids, use of inhalational anesthetic agents and long duration of surgery are predictors of postoperative nausea and vomiting. We recommend routine preoperative PONV risk evaluation and give antiemetic premedication for those high-risk patients.
Health Professional Assisted Kangaroo Mother Care Practice in Ethiopian Health Facilities: Evidence from the 2016 Ethiopian Demographic and Health Survey Data
Authors: Kassaw Mesfin Wudu , Abebe Ayele Mamo , Abate Biruk Beletew , Kassie Ayelign Mengesha , Tegegne Kirubel Dagnaw
Published: August 2020

Background Worldwide, 15 million babies born prematurely every year and over one million babies died because of premature birth complications. However, three-fourths of deaths from preterm birth complications are preventable without intensive care units. One of the prevention methods is Kangaroo Mother Care, which is a method of holding a small neonate in skin-to skin contact, upright prone position on the maternal chest. An evidence stated that KMC can prevent up to half of all deaths in babies weighing <2000 gm at birth. Ethiopian guidelines also mentioned that all LBW babies need to receive KMC. The aim of this study was to assess health professional assisted Kangaroo mother care practice and association among mothers who gave birth in a health facility in Ethiopia.Methods This study produced from the 2016 Ethiopian Demographic and Health Survey data (EDHS). The 2016 EDHS used a stratified two stage sampling method to select a representative sample for the country, Ethiopia. According to the 2016 EDHS data, all the regions were stratified into urban and rural areas. The study sample refined from EDHS and used in this secondary analysis is 2,760 mother-child pairs. A logistic regression model was used to assess the associations with the size of a child at birth. Results mothers who gave birth in a health facility and practiced kangaroo mother care were 1808 (62.1%), 95% CI (60,3, 63.9).The others 1102(37.9%), 95%CI(36.1, 39.7) of mothers did not practiced KMC, although they were gave birth in health facilities under the support of trained health professionals. In the multivariable logistic regression analysis, only wealth index, poorest ((AOR), (95%CI)), ((0.60), (0.43, 0.81)), and poorer ((0.62), (0.46, 0.86)) were associated with health professionals assisted KMC practice.Conclusions The prevalence of health professional assisted KMC practice was low, which was far lower than the expectation for mothers who gave birth in health facilities. Low socio-economic status was protective for not practicing KMC. The reason might be that mothers from higher income households might not initiate breast feeding, which might contribute for not practicing KMC. Thus, the minister of health or other researchers should study further why mothers from high income did not practicing KMC in considering the assumption of this author.
Three-year Longitudinal Skill-based Teaching Curriculum for All Residents
Authors: Rowat Jane , Johnson Krista , Antes Lisa , White Katherine , Rosenbaum Marcy , Suneja Manish
Published: August 2020

BACKGROUND. Despite significant teaching responsibilities and national accreditation standards, many residents do not receive adequate instruction in teaching methods. Published reports of residents-as-teachers programs vary from brief one-time exposures to curricula delivered over several months. A majority of interventions described are one or two-day workshops with no clear follow-up or reinforcement of skills. A three-year longitudinal teaching skills curriculum was implemented with these goals: 1) deliver an experiential skill-based teaching curriculum allowing all residents to acquire, practice and implement specific skills; 2) provide spaced skills instruction promoting deliberate practice/reflection; and 3) help residents gain confidence in their teaching skills.METHODS. One hundred percent of internal medicine residents (82/82) participated in the curriculum. Every 10 weeks residents attended a topic-specific experiential skills-based workshop. Each workshop followed the same pedagogy starting with debriefing/reflection on residents’ deliberate practice of the previously taught skill and introduction of a new skill followed by skill practice with feedback. Every year, participants completed: 1) assessment of overall confidence in each skill and 2) retrospective pre-post self-assessment. A post-curriculum survey was completed at the end of three years.RESULTS. Residents reported improved confidence and self-assessed competence in their teaching skills after the first year of the curriculum which was sustained through the three-year curriculum. The curriculum was well received and valued by residents.CONCLUSIONS. A formal longitudinal, experiential skills-based teaching skills curriculum is feasible and can be delivered to all residents. For meaningful skill acquisition to occur, recurrent continuous skill-based practice with feedback and reflection is important.
Internationalization of Medical Education in China: An Overview of Students' Outward Mobility in a Medical University
Authors: Jiang Qin , Sun Hong , Duan Wei , Wu Yang , Yuan Feng , Liu Shenjun
Published: August 2020

Background: Challenged by globalization, internationalization of medical education has become an irreversible trend. By analyzing students’ outward mobility in a medical university, eastern China, this study tries to investigate the internationalization of medical education in China.Methods: The data, obtained from international affairs office of Xuzhou Medical University, China, provided information about outward students’ backgrounds, destinations, program types and funding plans in the past nine years, and were analyzed with the use of MS Excel.Results: Students’ outward mobility has increased in the past nine years, though with a low number. Students with characteristics of undergraduate, traditional discipline related, the second and third year were more motivated in going outward. Traditional destinations like US and UK were still popular, Australia and other European countries were not hot. Developed countries and regions in Asia were becoming more and more vigorous, but developing countries were deep in freeze. Outward students demonstrated great interest in short-term programs, but little in course study and research program. The effect of financial support in students’ outward mobility was obvious, yet the investment was quite limited. Conclusion: The results suggest that students’ outward mobility has been improving in the past nine years. However, European countries and developing countries did not receive enough attention, and communication in interdisciplinary fields was insufficient, neither was it in course and research collaborations. Our findings provide important reference information for policy-makers of various countries and universities. At the same time, since a big potential for future mobility can be seen, the university should do the best to call for concerted efforts from governments, education institutions and the society to further improve internationalization of medical education.
QALYs and DALYs are Better with Concurrent ChemoRT than Induction Chemo Followed by ChemoRT in Nasopharyngeal Carcinoma.
Authors: Nittala Mary R , Kanakamedala Madhava R. , Mundra Eswar K. , Woods Williams C. , Smith Maria L. , Hamilton Robert D. , Jefferson Gina D , Jackson Lana , Packianathan Satyaseelan , Vijayakumar Srinivasan
Published: August 2020

Background: As traditional measures such as overall survival (OS) or disease-free survival (DFS) alone does not give a holistic view of the outcomes of a treatment paradigm, we determine to add the evidence of quality-adjusted life year (QALY) and disability-adjusted life year (DALY) to the outcomes of the nasopharyngeal carcinoma patients (NCP) treated with definitive chemoradiation therapy (chemoRT) with or without induction chemotherapy.Methods: This is a retrospective analysis of 85 NCPs treated at an academic state institution. The OS estimated by Kaplan–Meier method and the multivariate Cox regression model determined the co-variables associated with the OS. The relationship between QALYs gained and DALYs saved were calculated from age of the disease onset, duration of the disease, quality of life (QoL) and disability weights.Results: Of the 85 eligible NCPs of this cohort, the disease frequency distribution per the World Health Organization (WHO) classification was 41.2% for Type-I, 42.4% for Type-II, and 16.5% for Type-III. The median follow-up (24 months). The 5-year OS of patients treated with concurrent chemoRT vs. induction chemo followed by concurrent chemoRT was 54.7 vs. 14.8% for WHO Type I, 60.1 vs. 58.3% for WHO Type II, and 83.3 vs. 50.0% for WHO Type III (p= 0.029). The average DALYs saved with concurrent chemoRT was 12.2 years vs. 5 years for induction chemo followed by concurrent chemoRT. The average QALYs gained with concurrent chemoRT was 6.9 years vs. 3.1 years for induction chemo followed by concurrent chemoRT.Conclusion: Patients treated with concurrent chemoRT had an increased QoL when compared to induction chemo followed by concurrent chemoRT. The average DALYs saved were higher in the patients treated with concurrent chemoRT than treated with induction chemo followed by concurrent chemoRT.
Clinical Utility of Complex Assessment With Evoked Potentials in Acute Lymphoblastic Leukemia Survivors: Comparison of Various Treatment Protocols
Authors: Kroczka Slawomir , Stepien Konrad , Witek-Motyl Izabela , Kwiecinska Kinga , Kapusta Eryk , Biedron Agnieszka , Skorek Pawel , Skoczen Szymon
Published: August 2020

Background: One of the largest success in a pediatric hematology is a prominent improvement of survival in acute lymphoblastic leukemia (ALL). Simultaneously, it encourages to focus on long-term effects of the treatment such as neurotoxicity. One of the few diagnostic methods that allow an objective assessment of sensory organization are evoked potentials (EP).Methods: We analyzed the group consisted of 167 ALL long-term survivors, aged 4.9-28.4 years, without auditory, visual and sensory deviations. Patients were treated with New York (NY, n=35), previous modified Berlin-Frankfurt-Münster (pBFM, n=47) and BFM95 (n=85) protocols. In order to assess the impact of radiotherapy on recorded EP, a joint analysis of NY and pBFM groups was performed. The control group consisted of 35 patients, aged 6-17 years. The analyzed patients underwent a complex assessment with visual EP (VEP), somatosensory EP (SEP) and brainstem auditory EP (BAEP) in accordance with current standards.Results: ALL treatment contributed to the shortening of wave I latency (1.59 vs 1.90, P=0.003) and prolongation of I-III (2.23 vs 2.04, P=0.004) and I-V (4.57 vs 4.24, P=0.002) interwave latencies in BAEP. A significant effect was also noticed in P100 (106.32 vs 101.57, P<0.001) and N135 (151.42 vs 138.22, P<0.001) latencies for VEP and N18 amplitude (3.24 vs 4.70, P=0.007) and P25 latency (21.32 vs 23.39, P<0.001) for SEP. The distribution of abnormalities between protocols was similar in BAEP (NY - 68.6%, pBFM - 61.7%, BFM95 - 69.4%, P=0.650), VEP (NY - 68.6%, pBFM - 42.5%, BFM95 - 58.3%, P=0.053) and significantly different for SEP (NY - 62.9%, pBFM - 36.2%, BFM95 - 53.0%, P=0.045). The harmful effect of radiotherapy was most clearly marked in numerous disturbances of SEP parameters.Conclusions: The presented analysis indicates a high frequency of subclinical abnormalities in EP regardless of the analyzed protocol. To our knowledge current study is the largest and one of the most complex research examining the role of EP in ALL patients. The obtained results indicate the possibility of using a single, objective and non-invasive measurement of EP in ALL survivors in order to stratify the risk of developing sensory abnormalities in adulthood.
Antimicrobial resistance in Neisseria gonorrhoeae isolates and gonorrhoea treatment in the Republic of Belarus, Eastern Europe, 2009-2019
Authors: Aniskevich Aliaksandra , Shimanskaya Iryna , Boiko Iryna , Golubovskaya Tatyana , Golparian Daniel , Stanislalova Iryna , Jacobsson Susanne , Adaskevich Aliaksandr , Unemo Magnus
Published: August 2020

Background: Increasing antimicrobial resistance (AMR) in Neisseria gonorrhoeae , including to first-line treatment options, is a great concern worldwide. However, very limited gonococcal AMR data are available in Eastern Europe. We investigated the AMR in N. gonorrhoeae isolates (n=522) cultured in three regions of the Republic of Belarus, 2009-2019, antimicrobial treatment recommended nationally, and treatment given to 1652 gonorrhoea patients in two of the regions (Minsk, 2013-2018; Mogilev, 2010-2019). Methods: Determination of minimum inhibitory concentrations (MICs) of eight antimicrobials was performed using Etest and, where available, resistance breakpoints from the European Committee on Antimicrobial Susceptibility Testing were applied. β-lactamase production was examined using a Nitrocefin test. Gonorrhoea treatment was analysed from medical records. Results: In total, 27.8% of isolates were resistant to tetracycline, 24.7% to ciprofloxacin, 7.0% to benzylpenicillin, 2.7% to cefixime, and 0.8% to azithromycin. No isolates were resistant to ceftriaxone, spectinomycin, or gentamicin. However, four (0.8%) isolates had a ceftriaxone MIC of 0.125 mg/L, which is exactly at the resistance breakpoint (MIC>0.125 mg/L). Only one (0.2%) isolate, from 2013, produced β-lactamase. From 2009-2019, the levels of resistance to ciprofloxacin and tetracycline were relatively stably high. Resistance to cefixime was not identified before 2013, but peaked at 22.2% in 2017. Only sporadic isolates with resistance to azithromycin were found in 2009 (n=1), 2012 (n=1) and 2018-2019 (n=2). Overall, 862 (52.2%) patients received first-line treatment in accordance with national guidelines (ceftriaxone 1 g). However, 154 (9.3%) patients received a nationally recommended alternative treatment (cefixime 400 mg or ofloxacin 400 mg), and 636 (38.5%) patients were given treatment non-compliant to the Belarusian national gonorrhoea guideline. Conclusions: Ceftriaxone 1 g, in combination with azithromycin 2 g particularly when chlamydial infection has not been excluded, should be recommended as empiric first-line treatment. Spectinomycin 2 g, where available, together with azithromycin 2 g could be an alternative treatment. When susceptibility has not been confirmed by testing, fluoroquinolones should not be used for treatment. Timely updating of and high compliance to national evidence-based gonorrhoea treatment guidelines that are based on quality-assured AMR data is imperative. Continued and expanded gonococcal AMR surveillance in Belarus is crucial.
The evaluation of annuloplasty in bicuspid aortic valve repair using cardiac magnetic resonance
Authors: Jasinski Marek , Miszalski-Jamka Karol , Gocol Radoslaw , Wenzel-Jasinska Izabella , Bielicki Grzegorz , Berezowski Mikolaj , Kosiorowska Kinga , Lukaszewski Marceli , Kansy Andrzej , Deja Marek
Published: August 2020

Background: The incompetent bicuspid aortic valve (BAV) can be replaced or repaired using various surgical techniques. This study sought to assess the efficacy of external annuloplasty and postoperative reverse remodeling using cardiac magnetic resonance (CMR) and compare the mid-term results of external and subcommissural annuloplasty. Methods: Out of a total of 200 BAV repair performed between 2004 and 2018, 21 consecutive patients (median age 54 years) with regurgitation requiring valve repair with annuloplasty without concomitant aortic root surgery were prospectively referred for CMR and transthoracic echocardiography (TTE) one year after the operation. Two aortic annulus stabilization techniques were used: external, circumferential annuloplasty (EA), and subcommissural annuloplasty (SCA). Results: 11 patients received EA and 10 patients were treated using SCA. There was no in-hospital mortality and all patients survived the follow-up period. CMR showed strong correlation between postoperative aortic recurrent regurgitant fraction and left ventricular end-diastolic volume (r=0.62; p=0.003) as well as left ventricular ejection fraction (r=-0.53; p=0.01). Patients treated with EA as compared with SCA had larger anatomic aortic valve area measured by CMR (3.5cm2 (2.5; 4.0) vs. 2.5cm2 (2.0; 3.4); p=0.04). In both EA and SCA group, aortic valve area below 3.5cm2 correlated with no regurgitation recurrency. EA (vs. SCA) was associated with lower peak transvalvular aortic gradients (10mmHg (6; 17) vs. 21mmHg (15; 27); p=0.04). Conclusions: The repair of the bicuspid aortic valve provides significant mid-term postoperative reverse remodeling, provided no recurrent regurgitation and durable reduction annuloplasty can be achieved. External, circumferential annuloplasty is associated with better hemodynamics compared to subcommissural annuloplasty.
Analysis of STAG3 Mutations in Chinese Non-Obstructive Azoospermia Patients with Germ Cell Maturation Arrest
Authors: Liu Wen , Gao Xuan , Zhang Haobo , Liu Ran , Cao Yongzhi , Yu Ruimei , Fang Ge , Ma Jinlong , Zhao Shidou
Published: August 2020

Background STAG3 is essential for male meiosis and testis of male Stag3-/- mice shows the histopathological type of germ cell maturation arrest (MA). Whether mutations of the STAG3 gene exist in Chinese idiopathic non-obstructive azoospermia (NOA) patients needs to be determined. Methods We recruited 58 Chinese NOA men with MA who underwent testis biopsy and 192 fertile men as the control group. The 34 exons of the STAG3 gene were amplified using polymerase chain reaction (PCR) and sequenced. Results We identified eight novel single nucleotide polymorphisms (SNPs), including two missense SNPs (c.433T>C in exon2 and c.553A>G in exon3), three synonymous SNPs (c.539G>A, c.569C>T in exon3, and c.1176C>G in exon8), and three SNPs in introns. The allele and genotype frequencies of the novel and other SNPs have no significant differences between two groups. Conclusions Our results indicated that mutations in the coding sequence of the STAG3 gene were uncommon in NOA patients with MA in Chinese population. Future studies in large cohorts of different ethnic populations will be needed to determine the association between the STAG3 gene and NOA.
Expression of Alpha-Enolase 1 (ENO1) in Villi from Patients with Recurrent Miscarriage and Its Effect on Proliferation and Invasion of Villous Trophoblasts
Authors: Tang Huai-Yun , Pan Lin-Qing , Tang Li-Sha , Cui Yu-Gui , Liu Jia-Yin
Published: August 2020

Recurrent miscarriage (RM) is a common reproductive endocrine disease in women of childbearing age. At present, the etiology of RM in approximately 50% women remains unknown. The purpose of this study was to explore the possible mechanism(s) of enolase 1 (ENO1) in RM and to seek a new target for clinical diagnosis and treatment of the disease. In this study, we detected the expression difference of ENO1 in villous tissues between the RM group and the control group, and we found that ENO1 was significantly lower in the RM group. Immunohistochemistry was also performed to examine the localization and expression of ENO1 in villous cytotrophoblast cells, and we found that ENO1 was mainly expressed in the cytoplasm, cell membrane, and nucleus of trophoblast cells. The villous trophoblast cell membrane coloration in the control group was significantly darker than that in the RM group, suggesting that ENO1 is expressed at low levels on the cell membrane of trophoblast cells of RM. ENO1 knockdown significantly inhibited cell migration and proliferation compared with the blank control group. Therefore, we conclude that ENO1 may mediate the occurrence of RM by downregulating the proliferation and invasion of villous trophoblasts. The specific mechanism needs further clarification.
High accuracy classification of COVID-19 coughs using Mel-frequency cepstral coefficients and a Convolutional Neural Network with a use case for smart home devices 
Authors: Dunne Rob , Morris Tim , Harper Simon
Published: August 2020

Diagnosing COVID-19 early in domestic settings is possible through smart home devices that can classify audio input of coughs, and determine whether they are COVID-19. Research is currently sparse in this area and data is difficult to obtain. However, a few small data collection projects have enabled audio classification research into the application of different machine learning classification algorithms, including Logistic Regression (LR), Support Vector Machines (SVM), and Convolution Neural Networks (CNN). We show here that a CNN using audio converted to Mel-frequency cepstral coefficient spectrogram images as input can achieve high accuracy results; with classification of validation data scoring an accuracy of 97.5% correct classification of covid and not covid labelled audio. The work here provides a proof of concept that high accuracy can be achieved with a small dataset, which can have a significant impact in this area. The results are highly encouraging and provide further opportunities for research by the academic community on this important topic.
Movement Ecology of Potamodromous Top Predator in a Large Lake: Synchrony and Coexistence of Distinct Migratory Patterns 
Authors: Ivanova Silviya V. , Johnson Timothy B , Fisk Aaron T
Published: August 2020

Migrations are a key component of the life-histories of many highly mobile animals. The study of potamodromous migrations occurring within large lakes have lagged and are poorly understood for most species. This is an issue for restoration efforts and adaptive management, as understanding the movement of species, and underlying patterns and mechanisms are essential for identifying key habitat and quantifying the species role in the ecosystem. Using acoustic telemetry, this study quantified the spatio-temporal movements and migratory patterns of lake trout (Salvelinus namaycush), an iteroparous, potamodromous predator in Lake Ontario, the 13th largest lake by volume in the world that is highly managed and supports a diverse fish community of native and non-native species. Over 2.5 years (December 2016 to April 2019), the movements of 41 lake trout were quantified across a large array of 196 acoustic receivers in Lake Ontario. Individual analysis revealed annual convergence in the fall at a location other than the spawning grounds, followed by synchronized migrations to spawning sites. Consistent with divergent migrations, out-migration was asynchronous, stretching over a longer period of time than pre-spawning movements and across multiple routes. At least two groups of individuals with distinct migratory behaviors, i.e. contingents, were identified in the population. These results illustrate the presence of contingents and provide key information on migratory patterns, convergence points and routes in a potamodromous top predator population in a large lake. Thus, we provide evidence that contingents with different behavior used different habitats across seasons. As such, this study informs management on the potential success and implications of employing different rehabilitation strategies, such as diversifying a species’ population through selective strain stocking in large deep lakes to aid reestablishment across habitats. This knowledge would improve modelling of community dynamics, understanding of nutrient cycling, and overall ecosystem function of large lakes.
High-thermally Conductive AlN-based Microwave Attenuating Composite Ceramics with Spherical Graphite as Attenuating Agent
Authors: Fang Xia , Jiang Lei , Pan Limei , Yin Shuang , Qiu Tai , Yang Jian
Published: August 2020

High-thermally conductive AlN-based microwave attenuating composite ceramics with spherical graphite (SG) as the attenuating agent were fabricated through hot-pressing sintering. The SG maintains its three-dimensional morphology within the sintered bodies, which considerably impedes the sintering of the composites to some extent but slightly influences on the growth of AlN grains. The addition of SG reduces the strength of the composites, but provides a moderate toughening effect at the optimal addition amount (3.8 MPa·m1/2 at 4 wt% SG). Benefiting from the low anisotropy, high thermal conductivity, and the three-dimensional morphology of SG, the composites exhibit a relatively higher thermal conductivity (76.82 W·m-1·k-1 at 10 wt% SG) compared with composites added with non-spherical attenuating agent. The dielectric constant and loss (8.2–12.4 GHz) increase remarkably as the amount of SG added increases up to 8 wt%, revealing that the incorporation of SG improves the dielectric property of the composite. The composite with 7 wt% SG exhibits the best absorption performance with a minimum reflection loss of -14 dB at 12.4 GHz and an effective absorbing bandwidth of 0.87 GHz. The excellent overall properties of the SG/AlN microwave attenuating composites render them as a promising material for various applications. Moreover, SG has a great potential as an attenuating agent for microwave attenuating composites due to its strong attenuation upon integration, high thermal conductivity, and low anisotropy.
NLR combined with SaO2 predict severe illness among COVID-19 patients: a currently updated model
Authors: Zhang Zili , Zeng Xiansheng , Wang Jian , Guo E , Fu Minglong , Yang Xuejiao , Bai Yun , Huang Qiaoxin , Li Zhuowei , Xu Jingyi , Li Yuanyuan , Zhang Xiaodan , Liu Fei , Yuan Liang , Xie Xiaohui , Li Qiongqiong , Deng Bingxian , Chen Lingzhu , Gao Yongxuan , Wang Lan , Cai Zhou , Zhu Zhanbei , Lin Fanjie , Liu Wei , Guo Hua , Huang Qinghui , Zhong Nanshan , Lu Wenju
Published: August 2020

Objectives: The pandemic of the coronavirus disease 2019 (COVID-19) continuously poses a serious threat to public health, highlighting an urgent need for simple and efficient early detection and prediction. Methods: We comprehensively investigated and reanalyzed the published indexes and models for predicting severe illness among COVID‑19 patients in our dataset, and validated them on an independent dataset. Results: 696 COVID-19 cases in the discovery stage and 337 patients in the validation stage were involved. The AuROC of neutrophil to lymphocyte ratio (NLR) (0.782) was significantly higher than that of the other 11 independent risk indexes in severe outcome prediction. The combination of NLR and oxygen saturation (SaO2) (NLR+SaO2) showed the biggest AuROC calculations with a value of 0.901; with a cut-off value of 0.532, it exhibited 84.2% sensitivity, 88.4% specificity and 86.8% correct classification ratio. Moreover, we first identified that principal component analysis (PCA) is an effective tool to predict the severity of COVID-19. We obtained 86.5% prediction accuracy with 86% sensitivity when PCA was applied to predict severe illness. In addition, to evaluate the performance of NLR+SaO2 and PCA, we compared them with currently published predictive models in the same dataset. Conclusions: It showed that NLR+SaO2 is an appropriate and promising method for predicting severe illness, followed by PCA. We then validated the results on an independent dataset and revealed that they remained robust accuracy in outcome prediction. This study is significant for early treatment, intervention, triage and saving limited resources.
Active School Travel is Associated With Fewer Suicide Attempts Among 127, 097 Adolescents Aged 13 to 17 Years From 34 Low-and Middle-income Countries
Authors: Chen Si-Tong , Yu Qian , Stubbs Brendon , Clark Cain , Zhang Zhihao , Zhu Mingyue , Hossain Md Mahhub , Yeung Albert , Griffiths Mark D. , Zou Liye
Published: August 2020

Background. This study explored the association between active school travel (AST) and suicide attempts among adolescents in low- and middle-income countries. Methods. We used the data from the Global School-based Health Survey, including 127, 097 adolescents aged 13-17 years from 34 LMICs. A self-reported survey was used to collect data on AST and suicide attempts as well as some key control variables. Multivariable logistic regression was performed to assess the association between AST and suicide attempts. A meta-analysis with random effects was undertaken to identify the difference in the association between AST and suicide attempts. Results. Across all the adolescents, the prevalence of AST was 37.0% and the prevalence of suicide attempts was 11.6%. Adolescents who engaged in AST were less likely to have suicide attempts irrespective of gender. The country-wise analysis indicated a large inconsistency in the association between AST and suicide attempt across the countries. Conclusions. AST would appear to be a protective factor for reducing suicide attempts among adolescents in LMICs. However, the association between AST and suicide attempts varied greatly across the countries. Future studies should confirm or negate the association between AST and suicide attempts.
Eosinophil and Anticoagulation in COVID-19 Patients
Authors: Ari Selma , Can Veysi , Demir Ömer Furkan , Ari Hasan , Ağca Fahriye Vatansever , Melek Mehmet , Çamcı Sencer , Dikiş Özlem Şengören , Huysal Kağan , Türk Tamer
Published: August 2020

Introduction: Despite prophylactic anticoagulant treatments, thrombotic complications may develop in patients with Coronavirus disease 2019 (COVID-19). This study aimed to evaluate anti-Factor Xa levels to determine the anticoagulant activity of low molecular weight heparin (LMWH) in COVID-19 patients.Materials and methods: We prospectively evaluated 80 COVID-19 patients, diagnosed using polymerase-chain-reaction test, who were admitted to our clinic and administered LMWH; enoxaparin was applied according to the weight, D-dimer levels, and clinical condition of patients. Anti-Factor Xa levels in blood, drawn 4h after the 3rd dose of LMWH, were measured and a level of <0.2IU/ml was considered subprophylactic. Patients were followed up clinically and anti-Factor Xa levels were re-examined before discharge.Results: Groups 1 and 2 included 13 and 67 patients with subprophylactic (0.18±0.06) and prophylactic (0.43±0.23) anti-Factor Xa levels, respectively. The proportion of eosinophils in patients was significantly higher in group 1 than in group 2 (2.96±2.55 vs 0.90±1.28;p=0.001). At the time of discharge the eosinophilic proportion of patients was significantly higher (3.06±1.49 vs 2.07±1.92;p=0.001) but the activated partial thromboplastin time was significantly lower (22.34±1.38 vs 24.38±3.58; p=0.01) in group 1 than in group 2. Of 14 patients with eosinophil content >4%, 6 were in group 1 ((6/13) 46.2%) while 8 were in group 2 ((8/63) 11.9%); (p=0.009), and all had a D-dimer level <1µg/mL (p=0.03). ROC analysis for the presence of anticoagulation at subprophylactic level revealed an area under curve of 0.79 (95% CI:0.64-0.93); p=0.001).Conclusions: In COVID-19 patients, eosinophil levels could be considered for determining effective prophylactic anticoagulant administration. (NCT04507282)