bluuebunny/crossref_metadata_2025 huggingface dataset:
Nucleic Acids In Inclusion Bodies Obtained From E. Coli Cells Expressing Human Interferon-Gamma
Authors: Krachmarova Elena , Ivanov Ivan , Nacheva Genoveva
Published: June 2020

BackgroundInclusion bodies (IBs) are protein aggregates in recombinant bacterial cells containing mainly the target recombinant protein. Although it has been shown that IBs contain functional proteins along with protein aggregates, their direct application as pharmaceuticals is hindered by their heterogeneity and hazardous contaminants with bacterial origin. Therefore, together with the production of soluble species, IBs remain the main source for manufacture of recombinant proteins with medical application. The quality and composition of the IBs affect the refolding yield and further purification of the recombinant protein. The knowledge whether nucleic acids are genuine components or concomitant impurities of the IBs is a prerequisite for the understanding of the IBs formation and for development of optimized protocols for recombinant protein refolding and purification. IBs isolated from Escherichia coli overexpressing human interferon-gamma (hIFNγ), a protein with therapeutic application, were used as a model. ResultsIBs were isolated from Escherichia coli LE392 cells transformed with a hIFNγ expressing plasmid under standard conditions and further purified by centrifugation on a sucrose cushion, followed by several steps of sonication and washings with non-denaturing concentrations of urea. The efficiency of the purification was estimated by SDS-PAGE gel electrophoresis and parallel microbiological testing for the presence of residual intact bacteria. Phenol/chloroform extraction showed that the highly purified IBs contain both DNA and RNA. The latter were studied by UV spectroscopy and agarose gel electrophoresis combined with enzymatic treatment and hybridization. DNA was observed as a diffuse fraction mainly in the range of 250 to 1000 bp. RNA isolated by TRIzol® also demonstrated a substantial molecular heterogeneity. Hybridization with 32P-labelled oligonucleotides showed that the IBs contain rRNA and are enriched of hIFNγ mRNA.ConclusionsThe results presented in this study indicate that the nucleic acids might be intrinsic components rather than co-precipitated impurities in the IBs. We assume that the nucleic acids are active participants in the aggregation of recombinant proteins and formation of the IBs that originate from the transcription and translation machinery of the microbial cell factory. Further studies are needed to ascertain this notion.
Impacts of triglycerides-glucose index on prognosis of patients with type 2 diabetes mellitus and non-ST-segment elevation acute coronary syndrome: results from an observational cohort study in China
Authors: Zhao Qi , Zhang Ting-Yu , Cheng Yu-Jing , Ma Yue , Xu Ying-Kai , Yang Jia-Qi , Zhou Yu-jie
Published: June 2020

Background: The relationship between triglycerides-glucose index (TyG index) and the prevalence and prognosis of cardiovascular disease has been confirmed by former studies. However, it remains uncertain whether TyG index has a prognostic impact in patients with type 2 diabetes mellitus (T2DM) and non-ST-segment elevation acute coronary syndrome (NSTE-ACS) undergoing percutaneous coronary intervention (PCI).Methods: The study retrospectively enrolled 798 patients (mean age: 60.9 ± 8.3 years; 68.3% men) with T2DM and NSTE-ACS who underwent PCI at Beijing Anzhen Hospital from January to December 2015. TyG index was calculated as previously reported: ln [fasting TGs (mg/dL) * FBG (mg/dL) / 2]. The primary endpoint was a composite of adverse events as follows: all-cause death, non-fatal myocardial infarction (MI) and ischemia-driven revascularization.Results: TyG index were significantly higher in patients with a primary endpoint event compared with those without. Multivariate Cox analysis showed that 1-unit increase of TyG index was independently associated with higher risk of primary endpoint, independent of other risk factors [hazard ratio (HR) 3.208 per 1-unit increase, 95% confidence interval (CI) 2.400-4.289, P < 0.001]. The addition of TyG index to a baseline risk model had an incremental effect on the predictive value for adverse prognosis [AUC: baseline risk model, 0.800 vs. baseline risk model + TyG index, 0.856, P for comparison < 0.001; category-free net reclassification improvement (NRI) 0.346, P < 0.001; integrated discrimination improvement (IDI) 0.087, P < 0.001].Conclusions: Increased TyG index is a significant predictor of adverse prognosis in patients with T2DM and NSTE-ACS undergoing PCI. Further studies need to be performed to determine whether interventions for TyG index have a positive impact on improving clinical prognosis.
Integrated 3D Printing Solution to Mitigate Shortages of Airway Consumables and Personal Protective Equipment During the COVID-19 Pandemic
Authors: Fillat-Gomà Ferran , Coderch-Navarro Sergi , Martínez-Carreres Laia , Monill-Raya Núria , Nadal-Mir Toni , Lalmolda Cristina , Luján Manel , de Haro Candelaria , Blanch Lluís
Published: June 2020

Background: To cope with shortages of equipment during the COVID-19 pandemic, we established a nonprofit end-to-end system to identify, validate, regulate, manufacture, and distribute 3D-printed medical equipment. Here we describe the local and global impact of this system. Methods: Together with critical care experts, we identified potentially lacking medical equipment and proposed solutions based on 3D printing. Validation was based on the ISO 13485 quality standard for the manufacturing of customized medical devices. We posted the design files for each device on our website together with their technical and printing specifications and created a supply chain so that hospitals from our region could request them. We analyzed the number/type of items, petitioners, manufacturers, and catalogue views.Results: Among 33 devices analyzed, 26 (78·8%) were validated. Of these, 23 (88·5%) were airway consumables and 3 (11·5%) were personal protective equipment. Orders came from 19 (76%) hospitals and 6 (24%) other healthcare institutions. Peak production was reached 10 days after the catalogue was published. A total of 22,135 items were manufactured by 59 companies in 18 sectors; 19,212 items were distributed to requesting sites during the busiest days of the pandemic. Our online catalogue was also viewed by 27,861 individuals from 113 countries.Conclutions: 3D printing helped mitigate shortages of medical devices due to problems in the global supply chain.
Investigation of Glucose-6-Phosphate Dehydrogenase (G6PD) Deficiency Prevalence in a Plasmodium vivax Endemic Area in the Republic of Korea (ROK)
Authors: Lee Wonsig , Lee Sang-Eun , Noh Kyung Tae
Published: June 2020

Background: Glucose-6-phosphate dehydrogenase (G6PD) deficiency is the most prevalent inborn disorder. This X-chromosome-linked recessive disease affects more than 400 million people globally, and is associated with hemolytic anemia after medication with the anti-latent malaria drug, primaquine. To prevent malaria, the Republic of Korea (ROK) Army administers malaria chemoprophylaxis. Due to the previously low G6PD deficiency prevalence in the ROK, prior to primaquine distribution, testing for G6PD deficiency was not mandatory. Here, we investigate G6PD deficiency prevalence to evaluate the risk from malaria chemoprophylaxis.Methods: Blood specimens from 1,632 soldiers entering training camp for the 3rd Infantry of the ROK Army were collected. CareStart™ Biosensor for G6PD and Hemoglobin was used to detect G6PD levels. G6PD variants using the DiaPlexC G6PD Genotyping kit (Asian type) and full-length sequencing were examined.Results: Of 1,632 blood specimens tested, none were observed to be G6Pd deficient. The median value of all tested samples was 7.582 U/g Hb. An investigation of 170 G6PD DNA variants were analyzed and categorized as partially low (n=134, 30%–80% (2.27–6.05 U/g Hb) of the median value), high (n=3, >150% (>11.373 U/g Hb) of the median value), or normal (n=36, 4.6–13.5 U/g Hb), and none were amplified by the DiaPlexC kit. Five silent mutations (C→T) in 38 partially abnormal specimens were found at the 1311th nucleotide position by sequence analysis. Another 8 silent mutations (T93C) were also detected in 134 partially abnormal specimens. Thus, we inferred that these silent mutations could be related to G6PD deficiency.Conclusions: This G6PD deficiency prevalence study, conducted among participants from the 3rd Infantry of the ROK Army, provided crucial evidence for the safety of malaria chemoprophylaxis. Here, we found that the prevalence of G6PD deficiency among 1,632 young soldiers was nearly 0. Although G6PD phenotypic mutations were not detected, many silent mutations (C1311T and T93C) were observed. Thus, we inferred that malaria chemoprophylaxis is relatively safe against G6PD deficiency-mediated hemolytic anemia. However, given the number of individuals whose G6PD were at the low end of the normal range and the frequent detection of G6PD deficiency-related mutations, consistent monitoring of G6PD deficiency is needed.
A Programme to improve health services in rural South Africa: Perceptions from participating hospital managers, health science students and graduates
Authors: Gumede Dumsani Mandla , Taylor Myra , Kvalsvig Jane D.
Published: June 2020

Background: The shortage of HCPs negatively affects health services in rural areas in many parts of the world, as is the case in South Africa. A NPO, the UYDF, initiated a programme designed to improve the health system in a rural area. It consisted of a scholarship and mentorship programme in 1999 for youth from the area to study for health science degrees on condition that they would take up a post at the hospital in their community once qualified.Aims: This paper reports the perceptions and experiences of the students and graduates sponsored by the foundation, and those of managers from the facilities where the students were ultimately placed, in order to gauge whether such a programme can make a sustainable contribution to address the shortage of health personnel in rural areas and to what extent this is happening.Methods: The study used qualitative methods. Students and senior health managers were interviewed using a semi-structured in-depth format, and graduates took part in focus group discussions at three hospitals, in different districts. The data were analyzed thematically.Results: The students interviewed appreciated the financial and socio-emotional support that they received, and the graduates were appreciative that posts awaited them in their home community on completion of their studies. The managers reported the success of the programme in increasing the number of healthcare personnel at the hospitals, and the range of available medical services. Since the graduates are familiar with the language and culture of their patients the managers considered that they are better able to assist them.Conclusion: The system was well thought-out and achieved its goal of improving health services in an underdeveloped rural area of South Africa. More could be achieved if other government services in the area were simultaneously improved and if the system were replicated elsewhere.
Can voucher scheme enhance primary care provision for older adults: cross-sectional study in Hong Kong
Authors: Cheung Johnny , Wong Samuel Y.S. , Chan Dicken C. C. , Zhang Dexing , Luk Lawrence H.F. , Chau Patsy Y.K. , Yip Benjamin H.K. , Lee Eric K.P. , Wong Eliza L.Y. , Yeoh E.K.
Published: June 2020

Background
The Hong Kong government has launched the Elderly Health Care
Voucher (EHCV) scheme to facilitate primary care in the private
sector for older adults. This study aimed to examine whether
voucher use was associated with a shift of healthcare burden from
the public to the private sector, vaccine uptake and continuity of
care.
Methods
This cross-sectional survey recruited older adults with ≥3
chronic diseases through convenience sampling from seven general
outpatient clinics, seven geriatric day hospitals, and five
specialist outpatient clinics in Hong Kong. We used multiple
logistic regression to address the study objective.
Results
A total of 1032 patients participated in the survey. We included
714 participants aged 70 or above in the analysis. EHCV use was
associated with higher utilization of private primary care
services, including general practitioner and family doctor
(Adjusted Odds Ratio (AOR) 2.67, 95% Confidence Interval (95%CI)
1.51–4.72) and Chinese medicine clinic (AOR 3.53, 95%CI 1.47–8.49).
There were no significant associations of EHCV use with public
general outpatient clinic attendance, Accident & Emergency
attendance, and hospitalization. Furthermore, EHCV users were more
likely to receive pneumococcal vaccination (AOR 2.17, 95%CI
1.22–3.85) and were less likely to visit the same doctors for
chronic disease management (AOR 0.10, 95%CI 0.01–0.73).
Conclusions
While the EHCV may promote private primary care utilization and
preventive care, older patients continue to rely on public services
and the EHCV may worsen continuity of care. Policy-makers should
designate voucher usage for chronic disease management and
continuity of care.
Development and Performance Test of Molten Carbonate Fuel Cell Stack
Authors: Zhang Ruiyun , Lu Chengzhuang , Li Hao , Cheng Jian , Zhou Xian , Xu Shisen , Yang Guanjun , Huang Hua
Published: June 2020

In order to solve the problems of the preparation and matching characteristics of key materials in the development of large area and large power molten carbonate fuel cell(MCFC) stack, the assembly and test operation method of 10 kW MCFC stack is proposed. In this paper, the preparation method of matrix and electrode for large area MCFC is proposed. A 10 kW class MCFC power generation system with 120 cells and an effective area of 0.2 m2 for each cell is assembled and operated. In the constant voltage discharge test, the maximum output power is 16.51kw and the current density is greater than 95 mA/cm2. In view of many experiments and analysis, an effective online evaluation method for the baking effect of MCFC electrolyte matrix is obtained, which makes the matrix, electrode and molten salt electrolyte in the molten carbonate fuel cell body form a good match, which has an important guiding significance for improving the assembly and long-term operation of MCFC battery stack. The development and performance test method of the MCFC stack in this paper will provide effective theoretical and experimental guidance for the subsequent development of the larger MCFC power generation system, which is of great significance to promote the commercial demonstration and promotion of MCFC.
To Be or Not To Be: Relationship Between Grandparent Status and Health and Wellbeing
Authors: Lai Daniel W.L. , Li Jia
Published: June 2020

Background It is common for older people to become grandparents in later life. However, the impacts of grandparenting on their health and well-being remain under-investigated, especially in Chinese society where family is in the core of culture. The current study explored the relationship between grandparenthood and Chinese older people’s health and psychological well-being in Hong Kong. Methods Data was collected from a sample of 1,208 Hong Kong Chinese older people aged 55 and above through a telephone survey conducted in 2019. Participants were grouped into three categories: current grandparents (n = 507), grandparents-to-be (n = 275), and grandparents-not-to-be (n = 426).. Multivariate linear regressions were performed to examine the relationship between grandparenting status and health and well-being outcomes, including self-rated physical health, mental health, resilience, and happiness, while controlling for age, gender, education, marital status, financial status, and physical activity level. Results Bivariate analyses suggested statistically significant differences between health and well-being across the three groups of participants. Regression models showed that, when compared with grandparents-not-to-be, being a current grandparent was associated with a significantly higher level of happiness, while being a future grandparent was associated with significantly higher levels of happiness, resilience, and self-rated physical health.Conclusions The current study offers preliminary insights into the significant relationship between grandparenthood and older adults’ health and well-being. It calls for future studies to further explore the mechanisms behind the benefits of grandparenthood. Grandparenting is a potentially good starting point to build older adults’ capacity to promote healthy ageing.
Genome-wide identification and characterization of long non-coding RNAs conferring resistance to Colletotrichum gloeosporioides in walnut (Juglans regia)
Authors: Feng Shan , Fang Hongcheng , Liu Xia , Dong Yuhui , Yang Ke Qiang
Published: June 2020

Background
Walnut anthracnose caused by Colletotrichum gloeosporioides (Penz.) Penz. and Sacc. is an important walnut production problem in China. Although the long non-coding RNAs (lncRNAs) are important for plant disease resistance, the molecular mechanisms underlying resistance to C. gloeosporioides in walnut remain poorly understood.
Results
The anthracnose-resistant F26 fruits from the B26 clone and the anthracnose-susceptible F423 fruits from the 4–23 clone of walnut were used as the test materials. Specifically, we performed a comparative transcriptome analysis of F26 fruit bracts and F423 to identify differentially expressed LncRNAs (DELs) at five time-points (tissues at 0 hpi, pathological tissues at 24 hpi, 48 hpi, 72 hpi, and distal uninoculated tissues at 120 hpi). Compared with F423, a total of 14525 DELs were identified, including 10645 upregulated lncRNAs and 3846 downregulated lncRNAs in F26. The number of upregulated lncRNAs in F26 compared to in F423 was significantly higher at the early stages of C. gloeosporioides infection. A total of 5 modules related to disease resistance were screened by WGCNA and the target genes of lncRNAs were obtained. Bioinformatic analysis showed that the target genes of upregulated lncRNAs were enriched in immune-related processes during the infection of C. gloeosporioides, such as activation of innate immune response, defense response to bacterium, incompatible interaction and immune system process, and enriched in plant hormone signal transduction, phenylpropanoid biosynthesis and other pathways. And 124 known target genes for 96 hub lncRNAs were predicted, including 10 known resistance genes. The expression of 5 lncRNAs and 5 target genes was confirmed by qPCR, which was consistent with the RNA-seq data.
Conclusions
The results of this study provide the basis for future functional characterizations of lncRNAs regarding the C. gloeosporioides resistance of walnut fruit bracts.
PSMA-Targeting Redox Hyperbranched Poly (Amido Amine)-Mediated miR-133a-3p Delivery to Inhibit Bone Metastasis of Prostate Cancer
Authors: Ye Yongheng , Zhang Lingli , Dai Yuhu , Wang Zhi , Li Cuie , Peng Yue , Ma Dong , He Peiheng
Published: June 2020

Treatment of bone metastasis of prostate cancer remains a formidable challenge. The skeleton has a poorer blood supply, leading to inadequate drug distribution into the bone after administration. This study aimed to develop aptamer-anchored hyperbranched poly (amido amine) (HPAA) for the systemic delivery of miRNA-133a-3p and to evaluate its therapeutic potential against bone metastasis of prostate cancer in vivo and in vitro. A glutathione (GSH)-responsive cationic HPAA was prepared by the Michael addition reaction. Furthermore, HPAA-PEG was produced by PEGylation, and then the aptamer targeted to prostate-specific membrane antigen (PSMA) was conjugated to the HPAA-PEG. The obtained HPAA-PEG-APT could form nanocomplexes with miRNA-133a-3p through electrostatic adsorption. The results of immunocytochemistry indicated that the complexes could target PSMA-expressing LNCaP cells. The ability of HPAA-PEG-APT to facilitate the delivery of miRNA-133a-3p into LNCaP cells was proven, and HPAA-PEG-APT/miRNA-133a-3p demonstrated enhanced antitumor activity, lower cytotoxicity and better biocompatibility in vitro. Moreover, in a mouse tibial injection tumor model, the intravenous injection of the HPAA-PEG-APT/miRNA-133a-3p complex significantly inhibited cancer growth and extended the survival time. In summary, this study provided an aptamer-anchored HPAA-loaded gene system to deliver miRNA-133a-3p for better therapeutic efficacy of bone metastasis of prostate cancer.
Exploiting an Early Warning Nomogram for Predicting the Risk of ICU Admission in COVID-19 patients: A Multi-Center Study in China
Authors: Zhou Yiwu , He Yanqi , Yang Huan , Yu He , Wang Ting , Chen Zhu , Yao Rong , Liang Zongan
Published: June 2020

Background Novel corona virus disease 2019 (COVID-19) is an urgent event in the worldwide. We aimed to develop and validate a practical model for early identifying and predicting which patients will be admitted to intensive care unit (ICU) based on a multi-center cohort in China. Methods Data from 1087 patients of laboratory-confirmed COVID-19 were collected from 49 sites between January 2 and February 28 2020 in Sichuan and Wuhan. Patients were randomly divided into the training and validation cohorts (7:3). The least absolute shrinkage and selection operator (LASSO) analysis and logistic regression analysis were employed for the development account. The performance of the nomogram was evaluated for the C-index, calibration, discrimination, and clinical usefulness. The nomogram was further assessed in a different cohort as external validation. Results The individualized prediction nomogram included 6 predictors, including age, respiratory rate, systolic blood pressure, smoking status, fever and chronic kidney disease. The model showed high discrimination ability in the training cohort (C-index = 0.829), which was confirmed in the external validation cohort (C-index = 0.776). In addition, the calibration plots confirmed good concordance for prediction the risk of ICU admission. Decision curve analysis showed that the prediction nomogram was clinically useful.Conclusion We established an early prediction model incorporating clinical characteristics that could be quickly obtained on hospital admission even in community health center. This model can be conveniently used to facilitate predicting the individual risk for ICU admission of COVID-19 patients and optimizing use of limited resources.
COVID-19: Does lifestyle intervention improve the course of the disease? A case series and literature review
Authors: Rios Salete da Silva , Chen Ana Carolina Rios , Chen Juliana Rios
Published: June 2020

The new disease COVID-19 is associated with high mortality, as the virus attacks our defences and our immune system. Despite the amount of research by scientists from around the world, currently, no specific antiviral treatment is recommended, and no vaccine is available. However, there is already robust research showing how to improve our immune systems through a balanced diet and lifestyle intervention in order to fight against the virus. We report a series of 10 cases of patients with COVID-19 from a poor community in Brazil who were monitored by telephone due to the lack of resources in the public health system. They received conventional medical drugs and were additionally instructed to change their eating patterns as well their lifestyles. These patients showed favourable results in their illnesses. Lifestyle interventions with balanced nutrition are not antagonistic to traditional medicine. They interact harmoniously to achieve a positive result faster. Although today we know little about the treatment of COVID-19 with drugs, we know a lot about how to improve our immune systems to help our bodies in this battle against COVID-19. Until new treatments and effective vaccines are discovered, perhaps we can revisit the teachings of the father of medicine, who 2500 years ago spoke of the importance of lifestyle interventions such as changes in nutrition, sleep and exercise for the prevention and treatment of diseases.
A Precise TIN Clipping Algorithm for Digital Mining Design of the Open-pit Coal Mine
Authors: Zhao Jingchang , Gao Fei , Liu Guangwei , Wang Dong
Published: June 2020

TIN clipping algorithm is one of the basic algorithms for digital mining design of open-pit coal mine based on TIN model. In this paper, a precise TIN clipping algorithm for digital mining design of open-pit coal mine is proposed. Based on the constructed grid index of the clipped TIN and the clipping polygon, the clipping polygon is embedded into the clipped TIN by interpolating the vertex elevation of the clipping polygon and calculating its intersections with the clipped TIN. Then, according to the reconstructed topology of the TIN triangles located inside (outside) the clipping polygon, generate the boundary of those two triangles set, and construct the TIN between the boundaries using the one-time edge-prior CDT growth algorithm, thus , achieve the precise TIN clipping keeping the clipped TIN’s local detail features. The experiment results show that the algorithm proposed in this paper is efficient, stable in performance, and it has been applied to the digital mining design of the open-pit coal mine.
Benthic Invertebrates Monitoring of the Muling River basin in Northeast China
Authors: Sun Xu , Yu Hongxian
Published: June 2020

Background: Muling River is the ﬁfth-largest river in Heilongjiang Province, and it is also the main feeding river to the Ussuri River which is the boundary river of China and Russia in Heilongjiang Province northeast of China. Muling River basin located in the south of Sanjiang Plain. Macroinvertebrate samples were collected using a D-frame net and Shannon-Wiener index were calculated in terms of abundance. Results: A total of 158 genera or species macroinvertebrate were collected from the 28 sampling sites and classified into six functional feeding groups including 61 gatherers/collectors, 42 predators, 22 scrapers, 14 shredders, 11 filterers/collectors and 8 omnivores. The correlation and relationship between environmental variables and macroinvertebrate functional feeding groups was explored using Pearson analysis and redundancy analysis. The analysis results displayed that macroinvertebrate functional feeding groups had strong relationships with the environmental variables in the Muling River basin.Conclusions: All FFGs, total abundance and Shannon-Wiener index were not significantly different. Total abundance of macroinvertebrates was higher in summer and biodiversity index was higher in autumn. Environmental factors of natural gradients and nutrition indicator were not significantly different, while others were significantly different.
Pain management in patients with end-stage renal disease and calciphylaxis- A survey among physicians and clinical practice recommendations
Authors: Chinnadurai Rajkumar , Sinha Smeeta , Lowney Aoife , Miller Mary
Published: June 2020

Background Calciphylaxis is a rare condition usually seen in patients with end-stage renal disease. Pain is a hallmark of this condition and can be extremely difficult to control. Anecdotal data suggests that pain management in calciphylaxis is challenging with variable approaches across the United Kingdom (UK) and internationally. A knowledge and practice survey was conducted to establish current practice in the management of pain in patients with calciphylaxis, in the UK. Based on the results and clinical experience the authors suggest a clinical practice guideline.MethodsAn online questionnaire was circulated among physicians (renal and palliative care) involved in the management of pain in calciphylaxis. The questionnaire included a mix of open-ended questions and questions with drop down options. ResultsOne hundred and six clinicians responded to the survey of which 60 (57%) respondents were from palliative medicine; the remaining 46 (43%) were from renal medicine. 31 (30%) respondents across both specialties had not encountered any patients with a diagnosis of calciphylaxis (renal-2, palliative care-29). A referral to the palliative care team was undertaken by 18% of renal physicians, 32% referred to the pain team and 50% referred to both. Only 3% of the palliative medicine respondents indicated that they had received a referral from the renal team at the time of diagnosis. Opioids were the preferred initial drug of choice for the management of all types of pain. Paracetamol was universally selected as the preferred first-choice adjuvant agent for management of all types of pain. The importance of advance care planning was highlighted with 72% undertaking advanced care planning discussions often or most of the time.ConclusionThere was wide variation in the current practice of pain management in patients with calciphylaxis, with variation between renal specialists and palliative care specialists. Referral to specialists in pain management is not universal despite the severe nature of the pain experienced by patients with calciphylaxis. The data generated has facilitated the development of a clinical practice guideline to support complex pain management in a group of patients with multiple comorbidities.
Awareness and Attitude to the Risk of Cervical Cancer and Screening Method Among Women in the Najran Region of Southern Saudi Arabia
Authors: Alshahrani Majed Saeed , Sultan Salem Ali Alatef
Published: June 2020

Introduction:The aim of this study was determined the level of awareness among women regarding risk factors for cervical cancer and screening methods, their sources of information, and general attitudes toward Pap smear screening tests and human papilloma virus vaccination.Method:A cross-sectional interviewer administered an electronic questionnaire among women in Najran City during the period from March 1, 2019 to June 30, 2019. The data were analyzed using IBM SPSS Statistics for Windows, Version 25.0. Armonk, NY: IBM Corp.Result: A total of 3,387 women participated in this study and the response rate was 100%. Less than 10% of the participants had good awareness and 70% had poor awareness about the risk factors for cervical cancer. In terms of the major barriers to taking the Pap smear test among married women, 968 (56.7%) had no knowledge of the test and 338 (19.85%) considered it unnecessary. Significant predictors of the level of awareness about cervical cancer and Pap smear testing were identified as the age of women, occupation, family history of cancer, monthly income (P < 0.001) and education level (P = 0.003).Conclusion: we detected a lack of awareness about risk factors for cervical cancer and the benefits of early detection among women in this region. Healthcare providers should implement policies or programs for cervical cancer screening and vaccination throughout all primary healthcare centers.
Zymosan exerts radiation protection on AHH-1 and HIEC cells through TLR2/4-MyD88-G-CSF/GM-CSF/IL-12/IL-6 pathway
Authors: Zhang Yue-zhi , Ge Shu-jing , Leng Qing-zhen , Ma Jian-jun , Liu Hanchen
Published: June 2020

Background: This study was to confirm the radiation protective effect of different doses of zymosan on AHH-1 and HIEC cells irradiated at different times and different doses, and further to explore whether zymosan exerts a radiation protection mechanism by targeting TLR2/4.Methods: AHH-1 and HIEC cells were respectively administered to Zymosan at 0, 20, 40, 80 and 160 μg/ml. CCK-8 and cell flow cytometry were used to detect the cell activity and apoptosis at 24 h, 48 h, and 72 h after administration to determine the dose-limiting toxicities of zymosan. Twelve hours before irradiation, cells were treated with zymosan at 0, 5, 10, and 20 μg/ml, and then irradiated with 4Gy X-rays. The cell activity and apoptosis were measured by CCK-8 and cell flow cytometry at 24 h to determine the optimal dose of zymosan. LPS was used as a positive control to compare the protective effect of zymosan. The cells were treated with MyD88 inhibitors to explore the protective mechanism of zymosan.Results: The activity of AHH-1 and HIEC cells treated with different concentration of zymosan at different time was not affected and the apoptosis of cells was not promoted. The radiation protection effect of Zymosan pretreated cells on cells is dose-dependent. After zymosan pre-treated the cells, its radiation protection effect on the cells was dose-dependent. The higher zymosan’s concentration was, the stronger the activities of AHH-1 cells and HIEC cells were, and the lower the apoptosis rate was. The activity of cells pretreated with zymosan was higher than that pretreated with LPS at the same dose (20 μg/ml), and the cell apoptosis rate was lower than that pretreated with LPS. After zymosan pretreated AHH-1 and HIEC cells, TLR2/4-MyD88-G-CSF/GM-CSF/IL-12/IL-6 pathway was activated.Conclusion: Zymosan is nontoxic to cells and has better radiation protection effect than LPS. Its mechanism of action is related to the activation of the TLR2/4-MyD88/G-CSF/GM-CSF/IL-12/IL-6 pathway.
Association between surgical volumes and hospital mortality in patients: a living donor liver transplantation single center experience
Authors: Hsieh Chia-En , Hsu Ya-Lan , Lin Kuo-Hua , Lin Ping-Yi , Hung Yu-Ju , Lai Yi-Chun , Weng Li-Chueh , Chen Yao-Li
Published: June 2020

Background: Many factors cause hospital mortality (HM) after liver transplantation (LT). Methods: We performed a retrospective research in single center from October 2005 to June 2019. The study included 466 living donor LT patients. They were divided into a no-HM group (n=436, 93.56%) and an HM group (n=30, 6.44%). Logistic regression analysis of factors affecting clinical features and surgical volume of HM. We regrouped patients into met the surgical volume periods based cutoffs of LTs, and analyze the clinical features.Results: Multivariate analysis revealed that donor age (OR= 1.049, 95% CI: 1.011– 1.090, p=0.013), blood loss (OR=1.000, 95% CI: 1.000–1.000, p=0.004), and annual surgical volumes being < 30 LTs (OR=2.521, 95% CI: 1.004–6.332, p=0.049) were significant risk factors. A comparison of years based on surgical volume found that when the annual surgical volumes were at least 30 there was significantly higher recipient age (p=0.022), donor age (p=0.024), and ABO-incompatible operations (p<0.001) and also significantly blood loss (p<0.001), operative time (p<0.001), intensive care unit days (p<0.001), length of stay (p=0.013), re-operative (p<0.001), and HM (p=0.029) compared to when the annual surgical volumes were less than 30. Conclusions: Donor age, blood loss and an annual surgical volume < 30 LTs were significant pre- and peri-operative risk factors. Hospital mortality and annual surgical volume were associated with statistically significant differences; surgical volume may impact quality of care and transplant outcomes.
The 5X2 Backward Planning Model for faculty Development
Authors: Ahmed Samar A. , Younas Ayesha , Salem Urooj , Mashhood Shama
Published: June 2020

Faculty are considered to be the backbone of any institute and their training and development are necessary for progressive growth of an educational organization. This necessity has been the focus of a lot of medical education research, resulting in a number of faculty development models concentrating on the methodology of program planning and implementation. Such models are mostly linear considering faculty development to be a onetime measure. However, there exists a clear distinction between faculty development and faculty training and in its true sense faculty development should emphasize on individual faculty growth over the long term synonymously with direct short-term goals related to faculty work. This idea encouraged us to develop a new model for FD to reinvent the way we approach faculty development and consider FD as a continuous cyclical process, rather than just a linear model. We conducted a qualitative study based on phenomenological observations, leading to the development of the 5x2 backward planning model. The model essentially consists of the following interchangeable stages; Decide stage (focused on decisions related to the context of the program and the kind of faculty attending it) Define stage( concerned with defining the needs of the program and its objectives); Design stage (concentrates on design of the material and the methods of delivery for the identified objectives); Direct stage ( directing both the learning and development of faculty and establishing a community of practice) lastly, the Dissect stage (focusing on scrutinizing the fulfillment of the objectives and the developmental KPIs.)
Co-infection of SARS-CoV-2 with Chlamydia or Mycoplasma pneumoniae: a case series and review of the literature
Authors: Oliva Alessandra , Siccardi Guido , Migliarini Ambra , Cancelli Francesca , Carnevalini Martina , D'Andria Maria , Attilia Ilenia , Danese Vittoria Carmela , cecchetti Veronica , Romiti Roberto , Ceccarelli Giancarlo , Mastroianni Claudio M , Palange Paolo
Published: June 2020

The novel coronavirus SARS-CoV-2 has spread all over the world causing a global pandemic and representing a great medical challenge. Nowadays, there is limited knowledge on the rate of co-infections with other respiratory pathogens, with viral co-infection being the most representative agents. Co-infection with Mycoplasma pneumoniae has been described both in adults and pediatrics whereas only 2 cases of Chlamydia pneumoniae have been reported in a large US study so far. In the present report, we describe a series of 7 patients where co-infection with C. pneumoniae (n=5) or M. pneumoniae (n=2) and SARS-CoV-2 was detected in a large teaching hospital in Rome. An extensive review of the updated literature regarding the co-infection between SARS-CoV-2 and these atypical pathogens is also performed.
Co-infection of SARS-CoV-2 with Chlamydia or Mycoplasma pneumoniae: a case series and review of the literature
Authors: Oliva Alessandra , Siccardi Guido , Migliarini Ambra , Cancelli Francesca , Carnevalini Martina , D'Andria Maria , Attilia Ilenia , Danese Vittoria Carmela , cecchetti Veronica , Romiti Roberto , Ceccarelli Giancarlo , Mastroianni Claudio M , Palange Paolo , Venditti M.
Published: June 2020

The novel coronavirus SARS-CoV-2 has spread all over the world causing a global pandemic and representing a great medical challenge. Nowadays, there is limited knowledge on the rate of co-infections with other respiratory pathogens, with viral co-infection being the most representative agents. Co-infection with Mycoplasma pneumoniae has been described both in adults and pediatrics whereas only 2 cases of Chlamydia pneumoniae have been reported in a large US study so far. In the present report, we describe a series of 7 patients where co-infection with C. pneumoniae (n=5) or M. pneumoniae (n=2) and SARS-CoV-2 was detected in a large teaching hospital in Rome. An extensive review of the updated literature regarding the co-infection between SARS-CoV-2 and these atypical pathogens is also performed.
A surprising link with unexplained infertility: a possible Covid-19 paradox?
Authors: Pacchiarotti Arianna , Frati Giacomo , Saccucci Pietro
Published: June 2020

Unexplained infertility has represented about 22-28 percent of infertility causes (1)The diagnosis is based on exclusion of common causes using standard fertility investigation. Over the years the causes of unexplained infertility or subfertility have been identified in pre-existing associated pathologies, such as alterations of the immune system, thyroid dysfunctions, coagulopathies, reducing the unexplained infertility to 15% of infertility causes
Outcomes of Single Bundle Arthroscopic Anterior Cruciate Ligament Reconstruction in a Limited Resource Setting.
Authors: Sherchan Binod , Rai Saroj , Dhungana Siddhartha , Tamang Nira , Sharma Laxmi Kanta , Marasini Rudra Prasad , Singh Janith Lal , Khanal Kiran
Published: June 2020

Purpose: Despite various challenges, orthopaedic sports surgeons are still providing the arthroscopic service in developing countries like Nepal; however, it is hardly being reported. The main purpose of this study was to compare the clinical outcomes and complications of patients undergoing arthroscopic ACLR in the Urban group and that of the Rural group. Methods: We evaluated a total of 194 patients, including 98 patients in the Urban group and 96 patients in the Rural group, undergoing arthroscopic ACLR between August 2015 and February 2018. The subjective evaluations were performed using the Tegner-Lysolm score and International Knee Documentation Committee (IKDC) form. The laxity assessments were performed using the Lachman test and the Pivot-shift test. The functional evaluation included the ROM, single-leg hop test, and overall IKDC score. Radiological assessment was performed according to the IKDC guidelines. SPSS was used for data analysis. Results: There was statistically significant differences in the subjective assessments between 2 groups. No statistically significant differences existed between 2 groups in terms of Laxity and Functional assessments. However, the proportion of laxity, in terms of Lachman test and Pivot-shift test, was higher in the young and active individuals and the proportion of abnormal and severely-abnormal in all parameters of functional outcomes was higher in the older female in the Rural group. Graft failure occurred in 19(17.6%) knees in the Urban group and 17(16.8%) knees in the Rural group. Graft failure in the urban group was higher in young and active male patients, whereas failure in the Rural group was more in female patients. Similarly, overall infection occurred in 13 (6.2%) knees, including 5 (2.3%) deep infections and 8 (3.8%) superficial infections. Conclusion: We advised the similar rehabilitation protocol for all the patients; however, the outcomes were significantly lower in patients living in rural areas as they are found to have poor compliance with the rehabilitation protocol. The overall graft failure rate was 17.2%; however, the reoperation rate was higher in the Urban group than the Rural group. The rate of deep infection was higher in the Rural group as compared to the Urban group.
Novel Coronavirus (SARS-CoV-2) Main Protease: Molecular docking of Puerarin as a Potential inhibitor
Authors: Ojo Oluwafemi Adeleke , Ojo Adebola Busola , Taiwo Odunayo Anthonia , Oluba Olarewaju M
Published: June 2020

SARS-CoV-2 a single stranded RNA virus which triggered the global pandemic Coronavirus Disease- 2019 (COVID-2019). It has infected about 2,844,712 patients and brought forth mortality rate to about 201,315 among 216 countries as cited by WHO. Drugs including Chloroquine and Hydroxychloroquine derivatives are being administered in most urgent cases; although, with probable side effects to people with metabolic disorders. Thus, unavailability of authorized drugs and treatment for this pandemic demands the research world to discover natural compounds with potency to cure it. This paper assesses the isoflavonoid puerarin from Pueraria lobata as a possible inhibitor of the main protease of SARS-COV-2 (Mpro) via in silico approach, for example molecular docking, Lipinski’s rule of five and toxicity prediction (ADME). Puerarin revealed high binding affinity with the target site of SARS-CoV-2 main protease. This compound slightly meets the criteria of Lipinski’s rule and does not possess properties that could cause adverse effects in humans thus, making puerarin a potential drug candidate to investigate for its usage against COVID-19.
Physiotherapy management of a patient with neck pain having block vertebra: A case report
Authors: Quais Sarah , Suhail Ammar
Published: June 2020

Background: Congenital fused/block vertebrae is an accidental finding in most cases. It remains asymptomatic unless struck by any traumatic event or repetitive event occurs. Symptomatic cases can present with several musculoskeletal impairments including one starting from neck pain. It should be addressed properly to help patients recover the mechanical strains on the structures.Case Presentation: A referred case of a 21-year-old male engineering student who presented with complaints of neck pain (non-radiating) for a week. The intensity of the pain had been intermittently increasing/decreasing for about a year and about 2-3 episodes in a month for approximately one year. He presented with an X-ray which showed C-3/C-4 block vertebrae. The patient was managed using pain education and exercises along with ergonomic advice.Conclusion: Patient-reported pain was decreased significantly from the initial visit. The patient was able to sit for a longer duration and had a considerable improvement in function.
Characteristics and Outcomes of Frail Patients with Suspected Infection in Intensive Care Units: A Descriptive Analysis From A Multicenter Cohort Study
Authors: Komori Akira , Abe Toshikazu , Yamakawa Kazuma , Ogura Hiroshi , Kushimoto Shigeki , Saitoh Daizoh , Fujishima Seitaro , Otomo Yasuhiro , Kotani Joji , Sakamoto Yuichiro , Sasaki Junichi , Shiino Yasukazu , Takeyama Naoshi , Tarui Takehiko , Tsuruta Ryosuke , Nakada Taka-aki , Hifumi Toru , Iriyama Hiroki , Naito Toshio , Gando Satoshi
Published: June 2020

Background: Frailty is associated with morbidity and mortality in patients in intensive care units (ICUs). However, the characteristics of frail patients with suspected infection, including sepsis, remain unclear. We aimed to investigate the characteristics and outcomes of frail patients with suspected infection in ICUs. Methods: This is a secondary analysis of a multicenter cohort study conducted by 22 ICUs in Japan. Adult patients (≥16 years) with newly suspected infection from December 2017 to May 2018 were included. We compared baseline patient characteristics and outcomes between three frailty groups based on the Clinical Frailty Scale (CFS) score: fit (score 1–3), vulnerable (score 4), and frail (score 5–9). We conducted subgroup analysis of patients with sepsis defined based on Sepsis-3 criteria. We also produced Kaplan–Meier survival curves for 90-day survival.Results: We enrolled 650 patients with suspected infection, including 599 (92.2%) patients with sepsis. Patients with a median rating of 3 (3–5) on the CFS were included: 337 (51.8%) were fit, 109 (16.8%) were vulnerable, and 204 were (31.4%) frail. Comorbidities were more common in frail and vulnerable patients than in fit patients. The Sequential Organ Failure Assessment scores for fit, vulnerable, and frail patients were 7 (4–10), 8 (5–11), and 7 (5–10), respectively (p = 0.59). The patients' median body temperatures were as follows: fit 37.5 (36.5–38.5)℃; vulnerable 37.5 (36.4–38.6)℃; and frail 37.0 (36.3–38.1)℃ (p < 0.01). C-reactive protein levels of fit, vulnerable, and frail patients were 13.6 (4.6–24.5), 12.1 (3.9–24.9), 10.5 (3.0–21.0) mg/dL, respectively (p < 0.01). In-hospital mortality did not statistically differ according to frailty (p = 0.19). Kaplan–Meier survival curves showed little difference in the mortality rate during the acute phase. However, more vulnerable and frail patients died after the acute phase than fit patients; this difference was not statistically significant (p = 0.25). Compared with fit or vulnerable patients, fewer frail patients were discharged.Conclusion: Frail and vulnerable patients with suspected infection, including sepsis, tend to have poor disease outcomes after the acute phase of infection.