bluuebunny/crossref_metadata_2025 huggingface dataset:
Development and Validation of a Risk Prediction Nomogram for In- Stent Restenosis in Patients Undergoing Percutaneous Coronary Intervention
Authors: He Wenbo , Xu Changwu , Wang Xiaoying , Lei Jiyong , Qiu Qinfang , Hu Yingying , Luo Da
Published: July 2021

Background: This study aimed to develop and validate a nomogram to predict probability of in-stent restenosis (ISR) in patients undergoing percutaneous coronary intervention (PCI). Methods: Patients undergoing PCI with drug-eluting stents between July 2009 and August 2011 were retrieved from a cohort study in a high-volume PCI center, and further randomly assigned to training and validation sets. The least absolute shrinkage and selection operator (LASSO) regression model was used to screen out significant features for construction of nomogram. Multivariable logistic regression analysis was applied to build a nomogram-based predicting model incorporating the variables selected in the LASSO regression model. The area under the curve (AUC) of the receiver operating characteristics (ROC), calibration plot and decision curve analysis (DCA) were performed to estimate the discrimination, calibration and utility of the nomogram model respectively.Results: A total of 463 patients with DES implantation were enrolled and randomized in the development and validation sets. The predication nomogram was constructed with five risk factors including prior PCI, hyperglycemia, stents in left anterior descending artery (LAD), stent type, and absence of clopidogrel, which proved reliable for quantifying risks of ISR for patients with stent implantation. The AUC of development and validation set were 0.706 and 0.662, respectively, indicating that the prediction model displayed moderate discrimination capacity to predict restenosis. The high quality of calibration plots in both datasets demonstrated strong concordance performance of the nomogram model. Moreover, DCA showed that the nomogram was clinically useful when intervention was decided at the possibility threshold of 9%, indicating good utility for clinical decision-making.Conclusions: The individualized prediction nomogram incorporating 5 commonly clinical and angiographic characteristics for patients undergoing PCI can be conveniently used to facilitate early identification and improved screening of patients at higher risk of ISR.
Learning Curve for the Acquisition of 20 Standard Two-Dimensional Images in Advanced Perioperative Transesophageal Echocardiography: A Prospective Observational Study
Authors: Sawasdiwipachai Prasert , Thanasriphakdeekul Sasithorn , Chithiraphan Vithaya , Raksamani Kasana , Vacharaksa Kamheang
Published: July 2021

Background

Learning to perform intraoperative transesophageal echocardiography takes time and practice. We aimed to determine the cumulative success rate in the first 20 intraoperative transesophageal echocardiography cases performed by trainee anesthesiologists with no transesophageal echocardiography experience.
Methods

This prospective observational study included nine anesthesiologists (four cardiovascular and thoracic anesthesia fellows and five short-course perioperative intraoperative transesophageal echocardiography trainees). Overall, 180 studies self-performed by the trainees were reviewed by certified reviewers. A study was considered successful when at least 15 qualified images were collected within 30 minutes. The cumulative success of each trainee was used as a surrogate of a basic two-dimensional intraoperative transesophageal echocardiography learning curve.
Results

The participants comprised three male and six female anesthesiologists aged 29–43 years with 2–13 years of work experience. Most studies (146/180, 81.11%) were completed within 30 minutes, and the cumulative success rate was 70–90% (average 82.78 ± 6.71%). The average cumulative success rate in the short-course group (85 ± 7.07%) was higher than that in the official cardiovascular and thoracic fellow trainee group (80 ± 7.07%). The recommended caseload for a 75–80% success rate was 14–18 cases (95% confidence interval, 0.675–0.969).
Conclusions

We recommended a 14–18 caseload for a target success rate of 75–80% in studies performed by trainees with no previous experience. Our findings will enable the development of programs to train anesthesiologists in intraoperative transesophageal echocardiography.
Genetic Diversity of Cambuci (Campomanesia Phaea) Revealed by Microsatellite Markers
Authors: Moreira Rafael Oliveira , Bressan Eduardo de Andrade , Neto Horst Bremer , Jacomino Angelo Pedro , Figueira Antonio , Filho Francisco de Assis Alves Mourão
Published: July 2021

Campomanesia phaea (Myrtaceae), known as cambuci, is a native species from the Brazilian Atlantic Forest with great potential to be developed as a new fruit crop. Microsatellite markers were developed for cambuci to characterize the genetic diversity and to investigate the genetic structure of a group of accessions originally collected at the presumed center of diversity of the species. The work involved the collection of 145 accessions from five regional groups (Juquitiba, Paraibuna, Mogi das Cruzes, Ribeirão Pires, and Salesópolis) in São Paulo state, Brazil. Fourteen loci were identified in an enriched genomic library developed from one of these accessions. Six out of 14 loci revealed to be polymorphic, disclosing 26 alleles. Based on the allele frequencies, the calculated genetic parameters of the five groups indicated an average allele number per loci (A) of 3.83, with the expected heterozygosity (He) of 0.57 and the observed heterozygosity (Ho) of 0.54. The analysis of the genetic structure indicated that most of the genetic diversity is found within each population (HS = 0.57), whereas the genetic diversity among populations was low (GST = 0.19). The genetic diversity parameter of Nei was considered low for the cambuci analyzed populations, with no evidence of inbreeding. Based on Darwin analysis, we chose 18 accessions from the five regional populations to compose a core collection that includes most of the genetic diversity found in this study. Our findings may contribute to define better conservation strategies and genetic breeding approaches for this native species in Brazil.
Collaborative Governance, a Tool for Enhancing Compliance with COVID-19 Prevention Guidelines. A Study in Iranian Context
Authors: Akbari Jamshid , Salamzadeh Yashar , Farzad Fatemeh Sharafi
Published: July 2021

Background: Since the spread of COVID-19 disease around the world, several practitioners have sought to the ways that hasten control of the pandemic. There is a gap in contemplation of governance system’s effect on compliance with prevention guidelines targeting decrease in the disease’s consequences. This article is aimed to clear this gap. Methods: A model of collaborative governance was chosen to examine the effect of governance elements, composing of starting condition, institutional design, facilitative leadership and collaborative process. The SEM method was applied using PLS software and the survey was held among 220 people all around Iran. Results: Findings showed that collaborative process has a significant effect on compliance with prevention guidelines. Also, facilitative leadership and institutional design have positive impact on compliance variable. Conclusion: Examining the effect of collaborative governance model on compliance with COVID-19 prevention guidelines is a novel idea, especially because it is held on Iran with its complex cultural conditions. Based on the results, it is strongly suggested that policy makers in Iran consider joint actions and collaborative measures in controlling the disease. The measure can also be useful in other countries or other upcoming pandemics with regards to their socio-cultural context.
Spinocerebellar Ataxia Type 28 in a Chinese Pedigree: A Case Report and Literature Review
Authors: Wang Linlin , Liu Xiaoyang , Chen Jiajun , Kang Chunyang , Li Jia
Published: July 2021

Spinocerebellar ataxia (SCA) is a common neurogenetic disease, which mainly manifests as ataxia of posture, gait and limbs, cerebellar dysarthria, cerebellar and supranuclear eye movement disorders. It is found that SCA is a kind of progressive neurodegenerative disease including many subtypes, which is mainly mapped to two genetic patterns as: autosomal dominant cerebellar ataxia (ADCA) and autosomal recessive cerebellar ataxia (ARCA). Molecular genetic diagnosis functions as a necessity in its clinical diagnosis and treatment. In our previous clinical work, we found a family with ataxia who presented a c.1852A > G missense mutation in the exon region of AFG3L2 gene by whole exome sequencing (WES) and Sanger validation. Spinocerebellar ataxia type 28 (SCA28) was suspected, which was not reported in the previous literature. We here report the case and review the literature.
Superalkalis as Building Block for Efficient Lewis Base
Authors: Sinha Swapan , Das Subhra , Roymahapatra Gourisankar , Giri Santanab
Published: July 2021

In quest for efficient Lewis base an in-silico investigation on NH3 and its structurally similar different molecules have been carried out. It has been observed that the ionization energy of the groups attached to N-centre play an important role in determining their stability and reactivity. Among different groups, superalkali ligands make better Lewis base. Several conceptual DFT descriptors like electrophilicity, nucleophilicity, dual descriptors have been used to analyse the stability and reactivity of proposed Lewis base. Calculated charge transfer descriptor describes the efficiency of the designed Lewis base to form an adduct with Lewis acid. nc-2e (n=1,2) AdNDP calculation lend additional support to the bonding of the studied molecules.
Development of a Finite Element Framework for Modeling Flexible Pavement Maintenance Patching
Authors: Lu Yujia , Hajj Ramez
Published: July 2021

Patching of flexible pavements is one of the most important functions of pavement maintenance. Although finite element modeling has become commonplace in the world of pavement engineering, modeling has not yet been significantly leveraged for maintenance applications which improve safety, ride quality, and pavement service life. The objective of this study was to model viscoelastic properties of pavement and patching materials to determine the effect of various repair factors on pavement performance using the finite element method. Two types of models were simulated; the first model applied static loading to a surface layer fixed on a plate and the second model applied cyclic traffic loading to a two-layered flexible pavement system. The results demonstrate the importance of patching using a semi-permanent method. The results also demonstrated the accumulated effect of repeated loading using a time-dependent material response. Results also indicated that a larger patching area resulted in less influence of the shape of the area, while a circular area proved superior to a conventional rectangular patch for sizes near the tire footprint and smaller than it.Different responses were observed depending on the type of patching material modeled, demonstrating the effect of material choice in maintenance applications. Finally, mesh optimization was performed to ensure appropriate mesh sizes are used in future studies to accurately represent the pavement layers and patches.
Efflux Transporters in Rat Placenta and Developing Brain: Transcriptomic and Functional Response to Paracetamol
Authors: Koehn Liam , Huang Yifan , Habgood Mark David , Nie Shuai , Chiou SheneYi-Shiuan , Banati Richard , Dziegielewska Katarzyna Magdalena , Saunders Norman Ruthven
Published: July 2021

Adenosine triphosphate binding cassette (ABC) transporters transfer lipid-soluble molecules across cellular interfaces either directly or after enzymatic metabolism. RNAseq analysis identified transcripts for ABC transporters and enzymes in rat E19, P5 and adult brain and choroid plexus and E19 placenta. Their functional capacity to efflux small molecules was studied by quantitative analysis of paracetamol (acetaminophen) and its metabolites using liquid scintillation counting, autoradiography and ultra-performance liquid chromatography coupled with tandem mass spectrometry (UPLC-MS/MS). Animals were treated acutely (30min) and chronically (5 days, twice daily) with paracetamol (15mg/kg) to investigate ability of brain and placenta barriers to regulate ABC transport functionality during extended treatment. Results indicated that transcripts of many efflux-associated ABC transporters were higher in adult brain and choroid plexus than at earlier ages. Chronic treatment upregulated certain transcripts only in adult brain and altered concentrations of paracetamol metabolites in circulation of pregnant dams. Combination of changes to metabolites and transport system transcripts may explain observed changes in paracetamol entry into adult and fetal brains. Analysis of lower paracetamol dosing (3.75mg/kg) indicated dose-dependent changes in paracetamol metabolism. Transcripts of ABC transporters and enzymes at key barriers responsible for molecular transport into the developing brain showed alterations in paracetamol pharmacokinetics in pregnancy following different treatment regimens.
Comparison of The Variability of Small Extracellular Vesicles Derived From Human Liver Cancer Tissues And Cultured From The Tissue Explants Based On A Simple Enrichment Method: Yield, Purity And Molecular Markers
Authors: Chen Jie , Jiao Zhigang , Mo Jianwen , Huang Defa , Li Zhengzhe , Zhang Wenjuan , Yang Tong , Zhao Minghong , Xie Fangfang , Hu Die , Wang Xiaoxing , Yi Xiaomei , Jiang Yu , Zhong Tianyu
Published: July 2021

A potential of using small extracellular vesicle (sEV) for diagnostic and therapeutic purposes has attracted great interest. Some sEVs, directly derived from various tissues, can reflect the physiological and pathological state of the organism. Currently, there are two sources for obtaining tissue-derived sEV: the interstitial space of tissues and cultivation of tissue explants. The former was obtained from tissues that were digested with enzymes and the latter was released by tissue explants. In the present study, we established a new method for the isolation and purification of sEVs from the interstitial space of human liver cancer tissue. Tissues-derived sEVs (TdsEVs) isolated by this method and cultured explants-derived sEVs (cedsEVs) were both characterized by nano-flow cytometry (NanoFCM) for concentration, size distribution and purity. These vesicles were identified and compared by transmission electron microscopy and western blot. TdsEVs have a larger particle size, higher particle concentration and purity than cedsEVs. This study establishes a simple sEV isolation and purification protocol and provides a basis for selection and reference for researches of tdsEVs and cedsEVs.
House Dust Mite Induces IL-33 Release From Human Nasal Epithelial Cells via P2Y Purinergic Signals and ERK/P38 MAPK Pathways.
Authors: Liu Bin , Zhou Pei , Feng Tingting , Li Jiping
Published: July 2021

BackgroundAllergic rhinitis (AR) is an inflammatory disease of the nasal mucosa, which is triggered by stimulations of environmental allergens such as house dust mite (HDM). Th2-type proinflammatory factor interleukin 33 (IL-33) plays an important role in the pathogenesis of AR, but it remains unknown how IL-33 products in human nasal epithelial cells (HNECs) mediated by HDM. MethodsWe investigated the effect of HDM allergens by analyzing the accumulation of Ca2+ levels and IL-33 release in HNECs. Involvements of Adenosine triphosphate (ATP)-dependent activation of P2Y-PLC-IP3 pathways, downstream of Ca2+ signaling and P38/ERK pathways were studied, using the P2Y-PLC-IP3 pathways agonists, the calcium chelators, and P38/ERK pathways inhibitors. ResultsDer p induced expression of IL-33 mRNA and protein in HNECs via ERK/P38 pathways. Average 69.4% of co-localization of quinacrine and Lyso-tracker fluorescent puncta revealed that ATP was mainly stored in the lysosomes of nasal epithelial cells. After stimulation with Der p, ATP released from lysosomes by P2Y-PLC-IP3-Ca2+pathways. The ATP assay of HNECs culture supernatants implied an acute accumulation of extracellular ATP immediately after the Der p stimulation. Using P2Y-PLC-IP3 signaling inhibitors, we found that the Der p-induced IL-33 release was dependent on ATP-P2Y-PLC-IP3 signaling, followed by abolishing the ERK/P38 pathways. ConclusionDer p induced an acute accumulation of extracellular ATP which activated PY2-PLC-IP3 pathways to induce Ca2+ releasing from endoplasmic reticulum (ER), and intracellular Ca2+ induced ATP release from lysosomes from HNECs. ATP activated PY2-PLC-IP3 pathways followed by transactivation of ERK/P38 pathways which induced the expression of IL-33 mRNA and protein.
Role of Serum Chromogranin A in Early Diagnosis of Diabetic Nephropathy
Authors: Yu Hui , Wang Hong-Ping , Su Xue , Cao Ai-Li , Yao Xing-Mei , Wang Yun-Man , Zhu Bing-Bing , Wang Hao , Fang Ji
Published: July 2021

Background: Kidney is the main site for the removal of Chromogranin A (CgA). Previous studies have found that patients with renal impairment displayed elevated concentrations of CgA in plasma and the CgA concentrations reflect deterioration of renal function. In this study, we aimed to estimate the serum CgA levels and to evaluate the role of serum CgA in early diagnosis of diabetic nephropathy (DN).Methods: A total of 219 patients with type 2 diabetes mellitus (T2DM) were included in this cross-sectional study. They were classified into normoalbuminuria (n = 121), microalbuminuria (n = 73), or macroalbuminuria (n = 25) groups based on their urine albumin to creatinine ratios (UACR). A control group consisted of 45 healthy subjects. The serum CgA levels were measured by ELISA and other key parameters were assayed.Results: The serum CgA levels were higher in patients with T2DM compared to control subjects and a statistically significant difference among studied subgroups regarding CgA was found (P<0.05). Levels of serum CgA were increasing gradually with the degree of DN (P<0.001). Serum CgA levels were moderate intensity positively correlated with UACR (P<0.001). A cut-off level of 3.46 ng/ml CgA showed 69.86% sensitivity and 66.12% specificity to detect DN in early stage.Conclusions: Levels of serum CgA increased gradually with the degree of DN, and can be used as a biomarker in early detection of DN.
Uncovering the pharmacological mechanism of strychnos nux-uomical in the treatment of peripheral neuropathy based on a network pharmacology approach
Authors: Xiang JingJing , Lin Chen-Jun , Zhang Yu , Zhu Ni , Shen Jian-Ping , Chen Jun-Fa , Gu Jian-You , Zhou Yan , Jin Ke-Ting , Hong Zi-Rui , Deng Shu
Published: July 2021

Background: Strychnos nux-uomical (Ma Qianzi in pinyin), a classic chinese herb, has been extensively used to treat peripheral neuropathy in clinical practice in china for many years. However, the pharmacological mechanisms of strychnos nux-uomical remain vague. The aim of this study was to decrypt the underlying mechanisms of strychnos nux-uomical in the treatment of peripheral neuropathy using a systems harmacology approach.Methods: Using pharmacokinetic parameters [oral bioavailability (OB)≥30% and drug likeness (DL)≥0.18] of traditional chinese medicine system pharmacology platform (TCMSP) to screen the active ingredient of strychnos nux-uomical, and then integrating target prediction human gene database to predict and screen its target genes for the treatment of strychnos nux-uomical, network topology attribute analysis software cytoscape 3.6.0 was utilized to construct the active components-peripheral neuropath targets network. String database and cytoscape software were used to draw the protein interaction network. Finally gene ontology (GO) and kyoto encyclopedia of genes and genomes (KEGG) pathway enrichment analyses by panther database. Results: A total of 13 potential active ingredients were screened based on their OB and DL parameters, and 72 core targets were related to disease target. The results of pathway enrichment analysis indicated that putative targets of strychnos nux-uomical mostly participated in various pathways associated with cellular process, response to stimulus, biological regulation, metabolic process, localization. The putative targets of strychnos nux-uomical (endothelial growth factor, tumor necrosis factor-α, interleukin-10, interleukin-6, interleukin 1β and so on) were recognized as active factors involved in the main biological functions of treatment, which implied that these were involved in the underlying mechanisms of strychnos nux-uomical on peripheral neuropathy.Conclusions: In this study, a network pharmacology-based strategy integrating target prediction, network construction, GO and KEGG pathway enrichment analyses, was adopted to predict the targets of strychnos nux-uomical relevant to the treatment of peripheral neuropathy and to further explore the involved pharmacological mechanisms.
lncRNA AK141955 Acts as a ceRNA to Regulate Macrophage Polarization via the miR-124-3p/Sema6d Axis in Viral Myocarditis
Authors: Bi Runlei , Li Xueqin , Pei Weiya , Zhang Yingying , Lv Kun
Published: July 2021

BackgroundMacrophage polarization is vital for coxsackievirus B3 (CVB3)-induced viral myocarditis (VM). However, only a few empirical studies have focused on exploring the relationship between macrophage polarization and VM. MethodsQuantitative real-time PCR was used to determine the ex-pression levels of AK141955 and miR-124-3p in M1/M2 cells. The functional role of macrophage polarization was investigated by in vitro gene silencing assays. Mechanistically, dual-luciferase reporter and RNA immunoprecipitation (RIP) assays were performed to confirm that AK141955 sponged miR-124-3p and alleviated the suppression of target Sema6d expression. ResultsFunctionally, AK141955 knockdown significantly reduced inflammation, inhibited the M1 phenotype, and promoted the M2 phenotype in vitro and in vivo, whereas miR-124-3p inhibitors counteracted these effects. Evidence is presented, showing that AK141955 acted as a “ceRNA” of miR-124-3p to relieve the repressive effect of miR-124-3p on its target Sema6d, then promoted VM development.ConclusionCollectively, our findings reveal that AK141955 functions as a pro-inflammatory factor in pro-moting VM progression through the miR-124-3p/Sema6d axis, providing a solid evidence base for treating VM patients.
VCD induces premature ovarian insufficiency (POI) in rats by triggering the autophagy of granulosa cells through regulating the AKT/mTOR signal pathway
Authors: Li Hui , Jin Xin , Dou Xiaoqing , Wang Jiaxi , Wang Xue , Chen Qiaoling , Chen Wenjun
Published: July 2021

Purpose

Investigating the pathological mechanism underlying POI modeling in animals with VCD.
Methods

QRT-PCR was used to detect the expression of miR-144 in the peripheral blood of POI patients, granulosa cells and the ovary tissues. MTT assay was used to evaluate the proliferation and the concentration of E2, FSH, LH, and AMH was determined by ELISA assay. The numbers of autophagosomes were detected by transmission electron microscope and autophagic flux assay. The expression of key proteins in AKT pathway and autophagy proteins was determined by Western blot. HE staining was used to check the state of follicles in the ovary tissues. Immunohistochemistry assay was used to evaluate the expression level of p-AKT, P62, and caspase-3 in the ovary tissues. Finally, the pregnancy rate and embryo resorption rate were calculated.
Results

MiR-144 was down-regulated in the peripheral blood of POI patients. Deceased cell viability, down-regulated miR-144, and increased autophagosomes were observed in VCD treated granulosa cells, which were reversed by the introduction of SC79 or miR-144. The increased concentration of FSH, and LH, decreased concentration of E2 and AMH, increased number of autophagosomes, up-regulated PTEN, and inactivated AKT/m-TOR signal pathway induced by VCD in both granulosa cells and ovary tissues were significantly reversed by SC79 or miR-144. Finally, the decreased follicles and pregnancy rate, as well as the increased embryo resorption rate induced by VCD were greatly reversed by SC79 or miR-144.
Conclusion

VCD induced POI in rats by triggering the autophagy of granulosa cells through regulating the AKT/mTOR signal pathway.
Effectiveness Of Overuse Injury Prevention Programs On Upper Extremity Performance In Overhead Youth Athletes: A Systematic Review
Authors: Lau Rachel , Mukherjee Swarup
Published: July 2021

Background Youth athletes in single hand overhead sport are at risk of upper extremity overuse injuries due to musculoskeletal immaturity, repetitive actions and stress overload. While several upper extremity injury prevention programs have been developed, the effectiveness of upper extremity injury prevention programs on performance outcome measures in overhead youth athletes has not been investigated. This study critically evaluated the effectiveness of existing upper extremity injury prevention programs on performance outcome measures in overhead youth athletes and identified and categorized the training components of these programs.Methods A systematic search was conducted in PubMed, Physiotherapy Evidence Database (PEDro), SPORTDiscus (via EBSCOhost), ScienceDirect, and Web of Science. The inclusion criteria were youth athletes with full participation in throwing or striking sports; the intervention utilized training programs or exercises; control group performed usual training or sham exercises; reported at least one performance outcome measure; and utilized either randomized controlled trials, cluster-randomized controlled trials, or non-randomized controlled trials. Studies had to be published in the English language and within the last two decades. Methodological quality was assessed based on the PEDro Scale. Results Five studies, with a total of 456 youth athletes (age range 10.2-17.1 years) were included. The average PEDro score was 6.6. The effectiveness of the injury prevention programs on the identified performance outcome measures of strength, mobility, and sport-specific measures (ball speed and serve accuracy) were 30.4%, 28.6%, and 22.2%, respectively. The training components targeted were categorized as strength, mobility, and plyometrics. Strength was the most common training component and the most widely investigated performance outcome measure among existing upper extremity injury prevention programs. ConclusionCurrent injury prevention programs have a modest effect on sport performance outcome measures. Future upper extremity injury prevention programs should include training components of strength, mobility and plyometrics in their design given their moderate effects on strength, mobility, and sport-specific outcome measures. Standardized protocols are required for injury prevention program characteristics, and measurement and reporting of performance outcomes measures.
Configurations of Essential Factors Promoting China’s Commercial Health Insurance: A Qualitative Comparative Analysis Based on Technology-Organization-Environment Framework
Authors: Huang Xiuquan , Xu Xiaocang , Zhang Tao
Published: July 2021

Background

With the improvement in the living standards, China’s health insurance under the social security system cannot satisfy people's diversified and high-level demands. Therefore, it is necessary to promote commercial health insurance (CHI). This study identifies driving paths of CHI in China from configuration perspective.
Methods

This study innovatively constructs an analysis framework based on the Technology-Organization-Environment theory to investigate the driving path of China's commercial health insurance. Using the data of 31 provincial regions of China in 2018, the fuzzy-set Qualitative Comparative Analysis (QCA) is employed for configuration analysis. For the robustness analysis of necessary condition, we also adopt the Necessary Condition Analysis.
Results

Three main findings are discovered. First, there is no necessary relationship between any condition and high or not-high performance of CHI and any condition. Nevertheless, there are three sufficient configurations, TOE strategy, GA-EA-CD strategy, and dual EA-CD strategy, to achieve high performance, and another three, TMC-EA-CD strategy, TI-EA strategy, and TI-TMC-EA strategy, to reach not-high performance. Second, technological conditions (TI and TMC) and EA are relatively more important than other conditions. Third, it is confirmed that the financial expenditure of government departments has a negative effect on the development of commercial health insurance.
Conclusion

There are configurations or pathways to achieve high or not-high performance of promoting CHI and key factors are identified successfully. Each region should choose the driving path suitable for itself, instead of making homogenization policies and replicating policies of regions with high performance. Besides, TC and EA as key factors should be overcome. Finally, the governments should formulate policies to systematically evaluate social insurance and CHI simultaneously and promote their coordinated development.
Deep-Learning-Based Road Crack Detection Frameworks for Dashcam-captured Images under Different Illumination Conditions
Authors: Chen Da-Ren , Chiu Wei-Min
Published: July 2021

Machine learning techniques have been used to increase detection accuracy of cracks in road surfaces. Most studies failed to consider variable illumination conditions on the target of interest (ToI), and only focus on detecting the presence or absence of road cracks. This paper proposes a new road crack detection method, IlumiCrack, which integrates Gaussian mixture models (GMM) and object detection CNN models. This work provides the following contributions: 1) For the first time, a large-scale road crack image dataset with a range of illumination conditions (e.g., day and night) is prepared using a dashcam. 2) Based on GMM, experimental evaluations on 2 to 4 levels of brightness are conducted for optimal classification. 3) the IlumiCrack framework is used to integrate state-of-the-art object detecting methods with CNN to classify the road crack images into eight types with high accuracy. Experimental results show that IlumiCrack outperforms the state-of-the-art R-CNN object detection frameworks.
Impact of Comorbidities on Beneficial Effect of Lactated Ringers Versus Saline in Sepsis Patients
Authors: Tseng Chien Hua , Chen Tzu-Tao , Chan Ming-Cheng , Chen Kuan Yuan , Wu Sheng Ming , Shih Ming-Chieh , Tu Yu-Kang
Published: July 2021

Background: Lactated Ringers reduced mortality more than saline in sepsis patients but increased mortality more than saline in traumatic brain injury patients. Method: This prospective cohort study included sepsis patients and identified heart, lung, liver, kidney, and endocrine comorbidities by detailed history taking and routine admission survey such as HbA1C, and liver functions. We evaluate resuscitation response with central venous pressure, central venous oxygen saturation, and serum lactate level simultaneously. Propensity-score matching and Cox regression were used to estimate 60-day mortality. The competing risk model compared the lengths of hospital and ICU stays with the subdistribution hazard ratio (SHR). Mixed-effect linear models were used to fit clinical variables and electrolyte trends.Results: Overall, 874 patients were included in the analysis; 636 patients were in the saline group, and 302 patients were in the lactated Ringers group. The lactated Ringers group had a lower mortality rate (adjusted hazard ratio, 0.59; 95% CI 0.43-0.81) and shorter lengths of hospital (SHR, 1.39; 95% C.I. 1.15-1.67) and ICU stays (SHR, 1.41; 95% CI 1.17, 1.71) than the saline group; the differences were greater in patients with chronic pulmonary disease and small and nonsignificant in those with chronic kidney disease, moderate to severe liver disease and cerebral vascular disease. The resuscitation efficacy was the same between fluid types, but serum lactate levels were significantly higher in the lactated Ringers group than in the saline group (0.12 mg/dL/hour; 95% C.I.: 0.03, 0.21), especially in chronic liver disease patients receiving lactated Ringers. The serum potassium level increased within the first few hours and recovered more slowly in patients with chronic kidney disease regardless of fluid type. Compared to the saline group, the lactated Ringers group achieved target glucose level earlier in both diabetes and non-diabetes patients.Conclusion: Patients receiving lactated Ringers had lower mortality and shorter lengths of hospital and ICU stays than those receiving saline, especially patients with chronic pulmonary disease, but there were no differences in those with chronic kidney disease, chronic liver disease and cerebral vascular disease. Comorbidities are important for clinicians to consider before choosing a fluid type.
Antioxidants Significantly Improve Qinling Giant Panda (Ailuropoda Melanoleuca Qinlingensis) Sperm Quality During Cryopreservation
Authors: Zhang Ruixue , Dong Hemeng , Zhao Pengpeng , Shang Chunmei , Qi Hang , Ma Yongjie , Gao Chuxi , Zhang Danhui , Shen Jiena , Lei Yinghu , Jin Yaping , Lin Pengfei
Published: July 2021

Background: Semen cryopreservation has become an essential tool for the reproduction and long-term preservation of giant pandas (Ailuropoda melanoleuca). However, cryopreservation is severely detrimental to sperm quality, including motility, plasma membrane, acrosome integrity, and mitochondrial activity. It is necessary to screen a effective antioxidants for improvement of sperm quality. Eight groups of antioxidants were added to the freezing medium.Results:The results showed that lycium barbarum polysaccharide (LBP), Laminaria japonica polysaccharides (LJP), or goujresveratrol (RSV) added to the freezing medium significantly improved sperm motility, acrosome integrity, and mitochondrial activity during the cryopreservation process. Furthermore, the activities of glutathione and superoxide dismutase were also improved. However, the levels of reactive oxygen species and malondialdehyde in semen were notably reduced. Regarding fertility, acrosin activity was significantly increased in LBP-treated sperm. Unfortunately, sperm viability, DNA fragmentation, and hyaluronidase activity were not significantly different between the above groups. Conclusions: LBP (2.0 mg/mL) or RSV (50 μM) are the best candidate antioxidants for inclusion in the freezing medium for improving the quality of panda spermatozoa, during semen cryopreservation.
Big Data Research on Keloids in Atopic Dermatitis Patients with Allergic Comorbidities: Increased Prevalence of Keloids in Atopic Dermatitis
Authors: Kwon Hyo-eun , Ahn Hye-Jin , Jeong Su Jin , Shin Min Kyung
Published: July 2021

Atopic dermatitis (AD) is associated with allergic comorbidities, such as asthma, allergic rhinitis (AR), and allergic contact dermatitis (ACD). The etiology of keloid is largely unknown; however, AD and keloid share inflammatory pathways characterized by T-helper cell 2 cytokines and increased dermal fibroblast activity. The prevalence of keloids is known to increase in patients with AD. This study aimed to estimate the prevalence of keloids in patients with AD, and compare it with the prevalence of other comorbidities of AD. We assessed the Korean National Health Information Database and medical records including coexisting asthma, AR, and ACD. Single and multiple logistic regression models were created for keloids and each allergic disease. The prevalence of keloids was higher in the AD group than in the control group. Among patients with AD, adolescents and adults had a higher prevalence of keloids than infants and children. The risk of keloids was high with AD alone, and coexisting asthma significantly increased the risk. Similarly, the risk of keloids was higher in AR associated with AD and ACD associated with AD than in AD alone. Thus, among Koreans, patients with AD have a higher risk of keloid development, with coexisting allergic diseases increasing the risk.
Community Stakeholder-Driven Technology Solutions Towards Rural Health Equity: A Concept Mapping Study
Authors: Seaton Cherisse L. , Rondier Pierre , Rush Kathy L. , Li Eric , Plamondon Katrina , Pesut Barb , Oelke Nelly D. , Dow-Fleisner Sarah , Hasan Khalad , Currie Leanne M. , Kurtz Donna , Jones Charlotte , Bottorff Joan L.
Published: July 2021

Background
Promoting inclusive health and social care for rural populations requires new community-focused innovations, technological infrastructure, creative design thinking, and multi-stakeholder collaboration. Technology holds great potential for promoting health equity for rural populations, who have more chronic illnesses than their urban counterparts but less access to services. Yet, more participatory research approaches are needed to gather community-driven health technology solutions. The purpose of this research was to collaboratively identify and prioritize action strategies for using technology to promote rural health equity through community stakeholder engagement.
Methods
Concept mapping, a quantitative statistical technique, embedded within a qualitative approach, was used to surface and synthesize technological solutions towards rural health equity from community stakeholders in three steps: 1. idea generation; 2. sorting and rating feasibility/importance; and 3. group interpretation. Purposeful recruitment strategies were used to recruit key stakeholders and organizational representatives from targeted rural communities.
Results
Overall, 34 rural community stakeholders participated in the concept mapping process. In Step 1, 84 ideas were generated that were reduced to a pool of 30. Multi-dimensional scaling and cluster analysis resulted in a 6-cluster map representing how technological solutions can contribute toward rural health equity. The clusters of ideas included technological solutions and applications, but also ideas to make healthcare more accessible regardless of location, training and support in the use of technology, ensuring digital tools are simplified for ease of use, technologies to support collaboration among healthcare professionals, and ideas for overcoming challenges to data sharing across health systems/networks. Each cluster included ideas and priority areas that were rated as equally important and feasible. Key themes included organizational and individual level solutions, and the development of new technologies while connecting patients to these technologies.
Conclusions
The concept mapping exercise enabled rural community stakeholders to co-identify technological solutions toward rural health equity. Overall, the grouping of solutions revealed that technological applications require not only access, but also support and collaboration. Concept mapping is a tool that can engage rural community stakeholders in the identification of technological solutions for promoting rural health equity.
Conjunctival Candidiasis Mimicking Ocular Surface Squamous Neoplasia
Authors: Peng Zhiyu , Qian Jiang , Han Yinan
Published: July 2021

PurposeTo report a case of conjunctival candidiasis mimicking ocular surface squamous neoplasia. Case presentationA 71-year-old man presented with a history of persistent redness, swelling and watering in the left eye accompanying an enlarging mass in the conjunctiva. He underwent excisional biopsy which showed granulomatous inflammation accompanied by irregular and atypical squamous epithelium hyperplasia. Periodic acid-Schiff stain and methenamine silver stain revealed a fungi infection. Further secretion smear was performed to clarify the pathogen as Candida albicans and a chronic fungal maxillary sinusitis was found through imaging test. Thus a diagnosis of conjunctival candidiasis was made.ConclusionsConjunctivitis caused by fungi is rare and a trigger such as agriculture trauma, immunocompromise state, contact history to fungal environment or contaminated water or infection of adjacent organs occurs in most cases. We report the case not only to share diagnostic and treatment experience, but also describe the unique histopathological manifestation leading to a speculation that chronic fungal or candida albicans infection might induce squamous metaplasia.
Preconception Care in Sub Saharan Africa: A Systematic Review and Meta-analysis on Prevalence and Its Correlation With Knowledge Level Among Women in Reproductive Age Group
Authors: Woldeyohannes Demelash , Tekalegn Yohannes , Sahiledengle Biniyam , Erkalo Desta , Hailemariam Zeleke , Mwanri Lillian
Published: July 2021

BackgroundThe aim of the preconception care (PCC) is to promote the health of women in the reproductive age before the conception in order to reduce preventable poor pregnancy outcomes. Although there are several published primary studies from Sub Saharan African (SSA) countries on PCC, they do not quantify the extent of PCC Utilisation, Knowledge level about PCC and the association between them among women in the reproductive age group in this region. This systematic review and meta-analysis aimed to estimate the pooled utilisation of PCC, Pooled knowledge level about PCC and their association among women in the reproductive age group in Sub Saharan Africa.MethodsDatabases including PubMed, Science Direct, Hinari, Google Scholar and Cochrane library were systematically searched for literature. Additionally, the references of appended articles were checked for further possible sources. The Cochrane Q test statistics and I2 tests were used to assess the heterogeneity of the included studies. A random-effect meta-analysis model was used to estimate pooled the prevalence of PCC, knowledge level of PCC and their correlation among reproductive aged women in Sub-Saharan African countries.ResultsOf the identified 1593 articles, 20 studies were included in the final analysis. The pooled utilisation of PCC and good knowledge level towards PCC among women of reproductive age group in Sub Saharan Africa were found to be 24.05% (95% CI: 16.61, 31.49) and 33.27% (95% CI: 24.78, 41.77), respectively. Women in the reproductive age group with good knowledge level were two times more likely to utilize the PCC than the women with poor knowledge level in Sub Saharan Africa (OR: 2.35, 95% CI: 1.16, 4.76). Conclusion﻿In SSA Countries, the utilisation of PCC and knowledge towards PCC were low. Additionally, the current meta-analysis found good knowledge level to be significantly associated with utilisation of PCC among women in the reproductive age. These findings indicate that, it is imperative to launch programs to uplift knowledge level about PCC utilisation among women in reproductive age group in SSA countries.
Very Long-term Outcome after Linear vs. Electrogram-guided Ablation for Persistent Atrial Fibrillation: A Propensity Score-matched Analysis
Authors: Yamashita Seigo , Tokuda Michifumi , Mahida Saagar , Sato Hidenori , Ikewaki Hirotsugu , Oseto Hirotsuna , Yokoyama Masaaki , Isogai Ryota , Tokutake Kenichi , Yokoyama Kenichi , Narui Ryohsuke , Kato Mika , Tanigawa Shin-ichi , Sugimoto Ken-ichi , Yoshimura Michihiro , Yamane Teiichi
Published: July 2021

The optimal ablation strategy for persistent atrial fibrillation (PsAF) remains to be defined. We sought to compare very long-term outcomes between linear ablation and electrogram (EGM)-guided ablation for PsAF. In a retrospective analysis, long-term arrhythmia-free survival compared between two propensity-score matched cohorts, one with pulmonary vein isolation (PVI) and linear ablation including roof/mitral isthmus line (LINE-group, n = 52) and one with PVI and EGM-guided ablation (EGM-group; n = 52). Overall, 99% of patients underwent successful PVI. Complete block following linear ablation was achieved for 94% of roof lines and 81% of mitral lines (both lines blocked in 75%). AF termination by EGM-guided ablation was accomplished in 40% of patients. Non-PV foci were targeted in 7 (13%) in the LINE-group and 5 (10%) patients in the EGM-group (p = 0.76). During 100 ± 28 months of follow-up, linear ablation was associated with superior arrhythmia-free survival after the initial and last procedure (1.8 ± 0.9 procedures) compared with EGM-group (Logrank test: P = 0.0001 and P = 0.045, respectively). In multivariable analysis, longer AF duration and EGM-guided ablation remained as independent predictors of AAs recurrence. Linear ablation might be a more effective complementary technique to PVI than EGM-guided ablation for PsAF ablation.
Physiologic Cardiovascular Studies in Resuscitated Normotensive Septic Shock with Persistent Hyperlactatemia.
Authors: SOMBOONVIBOON DUJRATH , TIYANON WARAPORN , WACHARASINT PETCH
Published: July 2021

The authors have requested that this preprint be removed from Research Square.
The impact of training on perceived performance in reproductive, maternal, and newborn health service delivery among healthcare workers in Tanzania: A baseline- and endline-survey
Authors: Mwansisya Tumbwene , Mbekenga Columba , Isangula Kahabi , Mwasha Loveluck , Mbelwa Stewart , Lyimo Mary , Kisaka Lucy , Mathias Victor , Pallangyo Eunice , Edwards Grace , Mantel Michaela , Konteh Sisawo , Rutachunzibwa Thomas , Mrema Secilia , Kidanto Hussein , Temmerman Marleen
Published: July 2021

BackgroundDelivery of quality reproductive health services has been documented to depend on the availability of healthcare workers who are adequately supported with appropriate training. However, unmet training needs among healthcare workers in reproductive, maternal, and newborn health (RMNH) in low-income countries remain disproportionately high. This study investigated the effectiveness of trainings with onsite clinical mentorship towards perceived importance and performance in RMNH among healthcare workers in Mwanza Region of Tanzania.MethodsThe study used a quasi-experimental design using single group pre-and post-intervention evaluation strategy. The training needs of healthcare workers from the selected health facilities were assessed, skills gaps identified and ranked according to priority. Training courses that addressed skills gaps were developed and delivered with adaptations of the national guidelines followed by onsite clinical mentorship for one year. The baseline and endline survey were conducted at 3 years interval to assess change in HCWs on their perceived importance and performance on different aspects of RMNH care. Independent samples t-tests were used to compare differences in perceived performance in selected training areas between baseline and endline. Significance was set at p < 0.05.ResultsTNA was administered to 152 and 216 healthcare workers at baseline and endline respectively. In total, 141 (65%) of the 216 end line survey participants had received at least one IMPACT project training course and at least three mentorship visits. Participants were matched on their age and duration in RMNH services, but differed in age and duration of employment. Comparison between baseline and endline by using the training needs analysis questionnaire scores showed statistically significant positive changes (p ≤ .05) in most training needs analysis items, except for some items including those related to research capacity and provision of health education for cancer.ConclusionsThe findings revealed that the training and onsite clinical mentorship program that address the actual needs of healthcare workers to have significant positive changes in perceived performance in a wide range of RMNH services. However, further studies with rigorous designs are warranted to evaluate the long-term effect of such training programs on RMNH outcomes.