bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of Keluoxin Capsule Combined with Losartan Potassium on Diabetic Kidney Disease with Qi and Yin Deficiency and Blood Stasis Syndrome: Study Protocol for a Randomized Double-Blind Placebo-Controlled Multicenter Clinical Trial
Authors: Wu Rui , Wei Junping , Wei Fan , Qu Lianlian , Bai Litao , Li Jun , Li Fei , Yan Weitian , Wang Qiuhong
Published: July 2020

Background: Diabetic kidney disease (DKD) is one of the most important microvascular complications of diabetes, and its prevalence has increased dramatically in the past few decades. DKD is responsible for considerable morbidity and mortality of patients with diabetes. Keluoxin capsule (KLX) is a Chinese patent medicine that has been used in the clinic to control DKD for years. Thus, we aim to evaluate whether losartan potassium combined with KLX is more effective than losartan potassium in DKD treatment and to provide validated evidence for the application of KLX in the treatment of DKD.Methods: We will conduct a randomized double-blind placebo-controlled multicenter clinical trial. A total of 252 participants diagnosed with DKD recruited from 18 institutions will be randomly allocated to either a KLX treatment group (n=126) or a placebo control group (n=126). The participants will be administered KLX or placebo in addition to losartan potassium for 24 weeks. The primary outcome measure will be the decline in the estimated glomerular filtration rate (eGFR; ml/min/1.73 m2/year) from baseline within 24 weeks, and the secondary outcomes will be the incidence of serum creatinine doubling, the incidence of end-stage renal disease (ESRD), the proportion of subjects with a progressive decline in eGFR >30%, the percent change in 24 h urinary total protein (UTP), the change in the urinary albumin/creatinine ratio (UACR), and the traditional Chinese medicine (TCM) syndrome scale scores.Discussion: This study will be the first randomized clinical trial to evaluate the efficacy and safety of KLX versus placebo for the treatment of patients with DKD. The outcome of this trial will provide a basis for prescribing KLX to patients with DKD.Trial registration: The trial was registered at Chinese Clinical Trial Registry (www.chictr.org.cn) under approval number ChiCTR1900021113 (approval date: 2019/01/29).
Bioinformatics analysis reveals key genes and pathways that promote melanoma metastasis
Authors: su wenxing , guan yi , huang biao , wang juanjuan , wei yuqian , zhao ying , Jiao qingqing , ji jiang , yu daojiang , Xu Longjiang
Published: July 2020

Melanoma has the highest mortality rate of all skin tumors, and metastases are the major cause of death from it. The molecular mechanism leading to melanoma metastasis is currently unclear. With the goal of revealing the underlying mechanism, three data sets with accession numbers GSE8401, GSE46517 and GSE7956 were downloaded from the Gene Expression Omnibus (GEO) database. After identifying the differentially expressed gene (DEG) of primary melanoma and metastatic melanoma, three kinds of analyses were performed, namely functional annotation, protein‐protein interaction (PPI) network and module construction, and co-expression and drug-gene interaction prediction analysis. 41 up-regulated genes and 79 down-regulated genes were selected for subsequent analyses. Results of pathway enrichment analysis showed that extracellular matrix organization and proteoglycans in cancer are closely related to melanoma metastasis. In addition, seven pivotal genes were identified from PPI network, including CXCL8, THBS1, COL3A1, TIMP3, KIT, DCN, and IGFBP5, which have all been verified in the TCGA database, but only CXCL8, THBS1 and KIT had significant differences in expression. To conclude, CXCL8, THBS1 and KIT may be the key genes in the metastasis of melanoma and thus may be regarded as therapeutic targets in the future.
Clinical features of 35 COVID-19 patients with hospitalization for more than 20 days
Authors: Zhang Yiling , Zhang Cheng , Yao Hongmei , Zhao Li , Hu Ying , Zeng Xianchun , Huang Jia , Zhang Peibei , Liu Weijia , Ye Xianwei , Zhang Xiangyan
Published: July 2020

Background: As we know, some patients with Coronavirus disease 2019 (COVID-19) may stay longer in the hospital, but whether the different hospitalization days are associated with different clinical features is not clear yet. Methods: This study is a single-centered, observational and retrospective case series.97 patients with COVID-19 were divided into two groups:patients with hospitalization for more than 20 days (Group1,n=35)and those with hospitalization for less than 20 days (Group2,n=62).Data were collected Results Acute Respiratory Distress Syndrome(ARDS) and Hospital acquired pneumonia (HAP)were more common in Group1 than in Group2 . There were more patients administered quadruple antiviral therapy in Group1 than in Group2 . In group1, 14.3% patients’ specimens showed positive again after they were discharged from the hospital.Compared with Group2,Group1 had higher percentages of oxygenation index<300mmHg leucopenia and lymphopenia. In Group1, 19 patients were treated with chloroquine phosphate,whose nucleic acid tests were negative soon,but 5 patents who hadn’t used the medicine had positive testing again . Conclusions: COVID-19 patients with longer hospitalization are more severe and need more quadruple antiviral therapy ;For patients who don't use chloroquine phosphate, the nucleic acid tests are more likely to return to positive again even if they have no symptoms at that time .
Quasi-liquid crystals of electrons and positrons
Authors: Balzo Gianluigi Zangari del
Published: July 2020

This work concerns the discovery of a time-domain "anomaly" in the Infra-Red synchrotron radiation spectra emitted by electrons and positrons from both the DA NE -Factory (Frascati National Laboratories, Italy) and HFL (Hefei Light Source at NSRL(National Synchrotron Radiation Laboratory, People’s Republic of China). The study was conducted with the SHT unconventional statistical category calculus system, developed and patented by the present author for the analysis of complex systems. The anomaly found in the IR synchrotron radiation emission profile of each single bunch of electrons and positrons, has been resolved by SHT analysis in two distinct waveform components, one of which is "delayed" by a few hundred of ps with respect to the other. A detailed and in-depth analysis excludes that the anomaly is the result of systematic errors The measured time differences between the two signals leads to an apparent discrepancy in the value of the speed of light in a vacuum. A deep time series analysis of the anomaly, based on considerations on the coherent emission of synchrotron radiation (CSR), demonstrates the existence of a distribution of structures and degrees of freedom inside a bunch of particles. This evidence is in contrast with the "rigid bunch" model (J. Schwinger 1945). We therefore pro- pose a model called "CFNM" (Coherent Fractal Nematic Mesophase), which describes the transition from a phase of maximum symmetry to a condensed phase, homologous to the nematic mesophase of liquid crystals. This model could have significant consequences in the study, modeling and measurement of the operating parameters of future ma- chines and collectors of accelerators, in particular with regard to emission and brightness.
Genome-wide Variant-based Study of Genetic Effects with the Largest Neuroanatomic Coverage
Authors: Li Jin , Liu Wenjie , Li Huang , Fang Shiaofen , Chen Feng , Luo Haoran , Bao Peihua , Li Yanzhao , Jiang Hailong , Gao Yue , Liang Hong
Published: July 2020

Background: Brain image genetics provides enormous opportunities for examining the effects of genetic variations on the brain. Many studies have shown that the structure, function, and abnormality (e.g., those related to Alzheimer's disease) of the brain are heritable. However, which genetic variations contribute to these phenotypic changes is not completely clear. Advances in neuroimaging and genetics have led us to obtain detailed brain anatomy and genome-wide information. These data offer us new opportunities to identify genetic variations such as single nucleotide polymorphisms ( SNPs ) that affect brain structure. In this paper, we perform a genome-wide variant-based study, and aim to identify top SNPs or SNP sets which have genetic effects with the largest neuroanotomic coverage at both voxel and region-of-interest ( ROI ) levels. Based on the voxelwise genome-wide association study ( GWAS ) results, we used the exhaustive search to find the top SNPs or SNP sets that have the largest voxel -based or ROI -based neuroanatomic coverage. For SNP sets with > 2 SNPs , we proposed an efficient genetic algorithm to identify top SNP sets that can cover all ROIs or a specific ROI . Results: We identified an ensemble of top SNPs , SNP -pairs and SNP -sets, whose effects have the largest neuroanatomic coverage. Experimental results on real imaging genetics data show that the proposed genetic algorithm is superior to the exhaustive search in terms of computational time for identifying top SNP -sets. Conclusions: We proposed and applied an informatics strategy to identify top SNPs , SNP -pairs and SNP -sets that have genetic effects with the largest neuroanatomic coverage. The proposed genetic algorithm offers an efficient solution to accomplish the task, especially for identifying top SNP -sets.
Computational Predictions for Protein Sequences of COVID-19 Virus via Machine Learning Algorithms
Authors: Afify Heba M. , Zanaty Muhammad S.
Published: July 2020

The coronavirus infection is increasingly evolving to be an international epidemic in 27 countries as a serious respiratory disease. Therefore, the computational biology carrying this virus that correlated with the human population is urgently needed. In this paper, the classification of the human protein sequences of COVID-19 according to the country is applied by machine learning algorithms. The proposed model is based on the distinguishing of 9238 sequences by three stages including data preprocessing, data labeling, and classification. In the first stage, the function of data preprocessing converts the amino acids of COVID-19 protein sequences to eight groups of numbers based on volume and dipole of the amino acids. In the second stage, there are two methods for data labeling of 27 countries from 0 to 26. The first method is based on the selection of one number for each country according to the code number of countries while the second method is based on binary elements only for each country. The classification algorithms are executed to discover different COVID-19 protein sequences according to their countries. The findings are concluded that the accuracy of 100% performed by country based binary labeling method with Linear Regression (LR) or K-Nearest Neighbor (KNN) or Support Vector Machine (SVM) classifiers. Further, it found that the USA with large data records in infection rate has more priority for correct classification compared to other countries with a low data rate. The unbalanced data for COVID-19 protein sequences is considered a major issue, especially the available data in USA represented 76% from a total of 9238 sequences. As a consequence, this proposed model will help as a diagnostic bioinformatics tool for the COVID-19 protein sequences among different countries.
Asymmetrizing an icosahedral virus capsid by hierarchical assembly of subunits with designed asymmetry
Authors: Zhao Zhongchao , Wang Joseph , Zhang Mi , Lyktey Nicholas , Jarrold Martin , Jacobson Stephen , Zlotnick Adam
Published: July 2020

Symmetrical protein complexes are ubiquitous in natural biological systems. Many have been reengineered in vitro for chemical and medical applications. Symmetrical viral capsids and their assembly are frequent platforms for these investigations. Lacking a means to create asymmetric capsids may limit broader applications. Here, starting with the homodimeric Hepatitis B Virus capsid protein, we developed a heterodimer, designed a hierarchical assembly pathway, and produced asymmetric capsids. We showed that the heterodimers assemble into hexamers, and such preformed hexamers can nucleate co-assembly, leading to “Janus” capsids with two discrete patches. We removed the hexamer patches specifically and observed asymmetric holey capsids by cryo-EM reconstruction. The resulting holes can be refilled with new engineered dimers. This programmed assembly pathway provides windows for specific engineering and modification inside and outside of the capsid. This strategy can also be generalized to other capsid assembly systems.
The effect of online multimedia psychoeducational interventions on the perceived stress and resilience of hospitalized patients with COVID-19: a quasi-experimental study
Authors: Shaygan Maryam , Yazdani Zahra , Valibeigi Adib
Published: July 2020

Background
There are evidence suggesting that quarantine might have undesirable psychological impacts on the patients. Therefore, it is important to seek for ways to alleviate the psychological pressure as well as increase the resilience of the patients who are quarantined due to infection with COVID-19. The present study was conducted to examine the effect of an online multimedia psychoeducational intervention on perceived stress and resilience of patients hospitalized with confirmed COVID-19.
Method:
Participants in this fully online trial were 50 consecutive patients who were hospitalized in 2 hospitals in Shiraz, after being diagnosed with COVID-19. Before the start of intervention, four inpatient wards of two hospitals were randomly assigned to either experimental or control condition. All eligible participants in wards allocated to the intervention condition received online multimedia psychoeducational interventions during 2 weeks, whilst patients in wards allocated to the control condition only received face-to-face or telephone based psychological counseling in case of need. Psychoeducational interventions mainly included cognitive–behavioural techniques, mindfulness-based stress reduction and positive psychotherapy. Patients were assessed on perceived stress and resilience at baseline and 2 weeks later.
Results
Compared with the control group, patients who used online multimedia psychoeducational interventions reported fewer perceived stress and greater resilience after 2 weeks.
Discussion
The findings of the present study provide a successful first attempt at implementing online multimedia psychoeducational interventions to promote resilience and mitigate stress of patients who are hospitalized due to infection with COVID-19. The present results could help mental health professionals to determine which psychological techniques should be emphasized to promote patients' resilience in the context of COVID-19 disease.
Epidemiology of COVID-19 in Yemen: A Descriptive Study
Authors: Al-Naggar Redhwan , Almaktari Lutfi , Madram Salem , Al-shaikhli Hisham
Published: July 2020

In Yemen, the first COVID-19 confirmed case was reported on 10 April 2020. The OBJECTIVE of this study is to identify the epidemiological characteristics of COVID-19 patients in Yemen. METHODOLOGY: From May 20 to 31, 2020, the data were obtained from the National Center of Public Health Laboratories, Ministry of Health and population, Aden, Yemen. A retrospective study used to determine the epidemiological characteristics of the first 53 confirmed cases of patients with COVID-19. This data includes the date of diagnosis, gender, age, governorates, and clinical symptoms. Data analyzed using SPSS version 22. RESULTS: A total number of 53 confirmed cases were obtained from the National Center of Public Health Laboratories, Ministry of Health and population, Aden, Yemen. The majority of the participants were male (72%), their age were less than 39 years (40%) and from Aden governorate (43%). The commonest symptoms reported among the participants were fever (%), sore throat and cough. Conclusion: Male, less than 39 years old and from Aden is the trend of COVID-19 in Yemen. The findings of this study may help provide guidance for frontline medical staff in the clinical management of the outbreak.
Study of the derived based catalysts from Theobroma cacao pod husks for the conversion of Beef Tallow blend with Waste used vegetable oil for fatty acid ethyl ester synthesis: Burnt, Submerged fermented, Calcination, Hybrid Design, Catalyst refining and reusability
Authors: FOLORUNSHO Adepoju TUNDE , Mayen Ibeh A , O Babatunde E , Jackson Asuquo A , C Eloboka
Published: July 2020

Billions of dollars paid by industries on catalysts used as feedstocks to obtain their end products are increasing at a geometrical rate, the report revealed that the global market size was estimated at USD 26.1 billion in 2019 and is expected to reach USD 34.0 billion in 2025. To salvage the world from extravagance spending, there is an urgent need for biomass wastes consideration and utilization. In this paper, three novel CaO-based catalysts derived from Theobroma cacao pod husks were tested based on efficacy for the synthesis of fatty acid ethyl ester (FAEE) from the blend of beef tallow-waste use oil in the ratio of 5:95 (BTO5),10:90 (BTO10),15:85 (BTO15), 20:80 (BTO20),….., 95:5 (BTO95), respectively. Process optimization of the transesterification reaction was carried out using a hybrid design to determine the effects of catalyst on the FAEE yield. The efficiencies of the catalyst were tested via the refining and reusability test. Results revealed the oil blend ratio of BTO60: WUO40 sufficiently produced low viscous oil that was easily converted to biodiesel. Catalysts' characterization revealed the three catalysts produced high CaO-based of 68.20, 81.46, and 87.65 (wt.%), which accounted for the high yield of FAEEs. Mathematical optimization showed that the catalyst amount (F-value between 14159.69-3063.24 with P-value between 0.0053–0.0115), played the most significant role in oil conversion to biodiesel among the constraint factors considered (reaction time, catalyst amount, reaction temperature, and EtOH/OMR). Based on Box-Cox transformation, the values of the lambda obtained indicated a normal data results with an inverse function of Y2 and Y3 and normal function of Y3 for polynomial model accuracy. Optimum validated FAEEs yields of 92.81, 93.02, and 99.64 (%wt.), respectively, with high R2. The qualities of the FAEEs were within the standard specification and the produced catalysts can serve as feedstocks for industrial application.
Person-centered, non-pharmacological intervention in reducing psychotropic medication use among residents with dementia in Australian rural aged care homes
Authors: Parajuli Daya Ram , Kuot Abraham , Hamiduzzaman Mohammad , Gladman Justin , Isaac Vivian
Published: July 2020

BackgroundHigh rates of psychotropic medications are prescribed in aged care homes despite their limited effectiveness and associated adverse effects. We aim to evaluate the changes in prescription patterns for elderly residents with advanced dementia in the ‘Harmony in the Bush Dementia Study’. Harmony in the Bush is a person-centered model of dementia care in nursing homes, based on the principles of Progressively Lowered Stress Threshold (PLST) and person-centered music intervention.MethodsOur larger study was a quasi-experimental design conducted in five rural nursing homes in Queensland and South Australia. Medication charts (n = 31) were collected retrospectively from three Australian rural aged care facilities through contacting the facility managers before the intervention and after 6 months. Fifty-three staff participated in 31 semi-structured interviews and 8 focus group at post-intervention, and at 1-month and 3-months follow up.ResultsThe median age of the participants was 83 years, and 68% of them were female. Polypharmacy was measured in 87% of the participants. Hypertension, hyperlipidemia, diabetes, and the Alzheimer’s disease were the major comorbidities identified in residents. None of the residents received more than the maximum dose of psychotropic medications recommended by the guidelines. There was a reduction of 22.4% in the use of at least any psychotropic medication, 19.6% reduction in antipsychotics and benzodiazepines, and 6.5% reduction in antidementia medicines prescription from baseline to at post-intervention, however, these were not statistically significant. There was a decreasing trend in the use of inappropriate use of medications. Psychotropic medications were prescribed up to 43% and antidementia in 45% of participants for more than 6 months. Major themes extracted from qualitative data were reduced/decreased/cessation of medication use, introducing a rest period and the music intervention combined was an alternative approach for medications use, and less behaviors, and ultimately the less use of medications.ConclusionsOur findings indicate that the Harmony in the Bush model as a non-pharmacological approach reduces the prescription of psychotropic medications and inappropriate medications in rural nursing homes as supported by findings from both quantitative and qualitative data.Trial registration: ANZCTR, ACTRN12618000263291. Registered on 20th February 2018. http://www.ANZCTR.org.au/ACTRN12618000263291p.aspx).
A Machine Learning Study to Improve Surgical Case Duration Prediction
Authors: Huang Ching-Chieh , Lai Jesyin , Cho Der-Yang , Yu Jiaxin
Published: July 2020

Since the emergence of COVID-19, many hospitals have encountered challenges in performing efficient scheduling and good resource management to ensure the quality of healthcare provided to patients is not compromised. Operating room (OR) scheduling is one of the issues that has gained our attention because it is related to workflow efficiency and critical care of hospitals. Automatic scheduling and high predictive accuracy of surgical case duration have a critical role in improving OR utilization. To estimate surgical case duration, many hospitals rely on historic averages based on a specific surgeon or a specific procedure type obtained from electronic medical record (EMR) scheduling systems. However, the low predictive accuracy with EMR data leads to negative impacts on patients and hospitals, such as rescheduling of surgeries and cancellation. In this study, we aim to improve the prediction of surgical case duration with advanced machine learning (ML) algorithms. We obtained a large data set containing 170,748 surgical cases (from Jan 2017 to Dec 2019) from a hospital. The data covered a broad variety of details on patients, surgeries, specialties and surgical teams. In addition, a more recent data set with 8,672 cases (from Mar to Apr 2020) was available to be used for external evaluation. We computed historic averages from the EMR data for surgeon- or procedure-specific cases, and they were used as baseline models for comparison. Subsequently, we developed our models using linear regression, random forest and extreme gradient boosting (XGB) algorithms. All models were evaluated with R-square (R2), mean absolute error (MAE), and percentage overage (actual duration longer than prediction), underage (shorter than prediction) and within (within prediction). The XGB model was superior to the other models, achieving a higher R2 (85 %) and percentage within (48 %) as well as a lower MAE (30.2 min). The total prediction errors computed for all models showed that the XGB model had the lowest inaccurate percentage (23.7 %). Overall, this study applied ML techniques in the field of OR scheduling to reduce the medical and financial burden for healthcare management. The results revealed the importance of surgery and surgeon factors in surgical case duration prediction. This study also demonstrated the importance of performing an external evaluation to better validate the performance of ML models.
Increased Inclusion of Dietary Methionine Sources Improves Pork Quality in Association with the Regulation of Energy and Protein Metabolism and Muscle’s Fiber Profile
Authors: Yuan Peiqiang , Lin Sen , Peng Jiyong , Li Yunxia , Liu Yunhan , Wang Peng , Zhong Hejv , Yang Xiaomin , Che Lianqiang , Feng Bin , Alavo Dolores Batonon , Mercier Yves , Zhang Xiaoling , Lin Yan , Xu Shengyu , Li Jian , Zhuo Yong , Jiang Xuemei , Wu De , Fang Zhengfeng
Published: July 2020

Background

Intensive selection for faster growth rate and higher lean percentage led to increase in protein deposition but deterioration in meat quality of pigs, thus there is growing interest in exploring the nutritional strategies to improve meat quality. Methionine has been shown to activate mechanistic target of rapamycin complex 1 protein kinase that plays pivotal roles in the regulation of protein and lipid synthesis. However, few study reports are available regarding the effects of dietary methionine supplementation at levels beyond growth requirements on lipid and protein metabolism and thus on pork quality. The objective of this study was to assess whether pork quality was improved by increasing dietary digestible sulfur amino acids (SAA) levels, with pigs fed the control (100% SAA), DL-Methionine (125% SAA)- or OH-Methionine (125% SAA)-supplemented diets during 11–110 kg period.
Results

Increasing SAA above requirements did not significantly affect growth performance, whereas improved pork quality as indicated by the decreased drip loss and a tendency towards decrease in shear force of longissimus lumborum muscle. Moreover, fresh muscle from barrows fed OH-Methionine showed a higher lightness value compared with the control and DL-Methionine treatments. The relatively lower shear force might be explained by the decrease in crude protein and increase in glycolytic potential, while the decreased drip loss was associated with down-regulation of genes (like fast glycolytic IIx) regulating fiber types. The increased lightness value of fresh muscle from barrows fed OH-Met diets appeared to be associated with the increased lactate level, which can be further explained by the increased plasma short-chain fatty acids concentrations, up-regulated G-protein coupled receptor 43 activation and enhanced glucagon-like peptide 1 secretion.
Conclusion

Increased SAA consumption appeared to improve pork water-holding capacity and tenderness likely through regulation of energy and protein metabolism and muscle’s fiber profile, which provides new insights into the nutritional strategies to improve meat quality.
The Effects of Scapulothoracic Mobilization in Patients with Neck Pain and Scapular Dyskinesis: A Single-Blind, Randomized, Clinical Trial
Authors: Alshami Ali M. , AlSadiq Abrar I.
Published: July 2020

Background: No studies are available on the effects of scapulothoracic mobilization with neck movement (MWM) on patients with neck pain and scapular dyskinesis. Objective: To investigate the effects of scapulothoracic MWM on neck pain, range of motion (ROM), and function in patients with neck pain who demonstrated scapular dyskinesis.Methods: This was a single-blind, randomized, clinical trial. Forty participants with neck pain and scapular dyskinesis were randomly assigned to one of two 2-week regimens: experimental (scapulothoracic MWM + corrective exercises + tape) or comparison (corrective exercises + tape). The visual analog scale (VAS), pressure pain threshold (PPT), cervical and scapular ROM, and Neck Disability Index (NDI) were measured at baseline, after the third session, and after the sixth session.Results: Pain decreased after the sixth session in both the experimental [mean difference: 3.1; 95% confidence interval (CI): 2.1-4.1] and comparison groups (1.8; 95%CI: 0.81-2.8). PPT and scapular ROM did not change in either group at any session. After the sixth session, the ROM of neck extension, right rotation, and right and left side bending improved significantly (p£ 0.031) in both groups, but did not reach the minimal detectable change. The NDI improved in both the experimental (7.2-10.6; 95%CI: 2.5-15.7) and comparison groups (5.9-10.3; 95%CI: 1.2-15.4). There were no significant differences between the groups in any outcome measure at any session. Conclusions: Adding scapulothoracic MWM to corrective exercises and tape over a 2-week period did not seem to add benefit for pain and function in patients with neck pain with scapular dyskinesis.Trial registration: ClinicalTrials.gov, NCT03046160. Registered 8 February 2017 - Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT0304616
Sex differences in short-and long-term survival among critically ill patients with sepsis: a real-world study using propensity scoring methods
Authors: Lin Shan , Ge Shanhui , He Wanmei , Bai Lihong , Zeng Mian
Published: July 2020

Background

At present, there have been studies showing a correlation between sex differences and prognosis. Nevertheless, the evidence of short- and long-term survival of sex-based differences among critically ill patients with sepsis is still limited and controversial. The purpose of this study was to evaluate the effect of sex on the short- and long-term survival of critically ill patients with sepsis.
Methods

We used the Medical Information Mart for Intensive Care III database. Cox proportional hazards models were conducted to determine the relationship of 28-day and 1-year mortality rates with a different sex. Interaction and stratified analyses were conducted to test whether the effect of sex differed across various subgroups.
Results

A total of 12,321 patients were enrolled in this study. After adjustments, the 28-day and 1-year mortality rates for female patients were reduced by 12% and 10%, respectively (HR = 0.88, 95% CI 0.81–0.96 and HR = 0.90, 95% CI 0.85–0.95) when compared to male patients. The effects of the association between sex and 28-day and 1-year mortality were broadly consistent for all subgroup variables. Only a significant interaction of age was observed in 1-year mortality (P = 0.0091). Compared with male patients, female patients (< 50 years) had better long-term survival advantages (HR 0.76 95% CI 0.62–0.94, P = 0.0124); on the contrary, for older patients (≥ 50 years), we did not find sex-based differences in long-term survival (HR 1.03, 95% CI 0.97–1.09, P = 0.3678).
Conclusions

In the current retrospective large database review, female patients had a significantly lower 28-day and 1-year mortality rates than did males among critically ill patients with sepsis. Of concern, there was an interaction between age and sex, and whether to suggest that female-associated hormones affect clinical outcomes needs to be further researched.
Identification of risk features for complication in Gaucher’s Disease patients: A Machine Learning analysis of the Spanish Registry of Gaucher Disease.
Authors: Andrade-Campos Marcio M , de Frutos Laura López , Cebolla Jorge J , Serrano-Gonzalo Irene , Medrano-Engay Blanca , Roca-Espiau Mercedes , Gomez-Barrera Beatriz , Pérez-Heredia Jorge , Iniguez David , Giraldo Pilar
Published: July 2020

Background
Since enzyme replacement therapy (ERT) for Gaucher disease (GD) (MIM#230800) has become available, both awareness of and the natural history of the disease have changed. However, there remain unmet needs such as the identification of patients at risk of developing bone crisis during therapy and late complications such as cancer or parkinsonism. The Spanish Gaucher Disease Registry (SGDR) has worked since 1996 to compile demographic, clinical, genetic, analytical, imaging and follow-up data from more than 400 GD patients. The aims of this study were to discover correlations between patients’ characteristics at diagnosis and to identify risk features for the development of late complications; for this a machine learning approach involving network and decision trees analysis was applied.
Results
A total of 358 GD patients, 340 GD1 and 18 GD3 cases were selected. 18% were splenectomyzed and 39% had advanced bone disease. 81% of cases carried heterozygous genotype. 47% of them were diagnosed before the year 2000. Mean age at diagnosis and therapy were 28 and 31.5 years old (y.o.) respectively. 4% developed MGUS or Parkinson Disease, 6% cancer, and 10% died before this study. Previous splenectomy correlates with the development of skeletal complications and severe bone disease (p = 0.005); serum levels of IgA, delayed age at ERT start (> 9.5 y.o.since diagnosis) also correlates with severe bone disease at diagnosis and with the incidence of bone crisis during ERT. High IgG (> 1750 mg/dL) levels and age over 60 y.o. at diagnosis were found to be related with the development of cancer. When modelling the decision tree, patients with a delayed diagnosis and therapy were the most severe and with higher risk of complications.
Conclusions
Our work confirms previous observations, highlights the importance of early diagnosis and therapy and identifies new risk features such as high IgA and IgG levels for long-term complications.
Locking plate for cubitus varus correction in osteogenesis imperfecta: a case report of 7 year-old girl
Authors: Hong Pan , Liu Ruikang , Rai Saroj , Xu Ruijing , Li Jin
Published: July 2020

Background
Cubitus varus deformity is a common complication of supracondylar fractures in children. However, cubitus varus in osteogenesis imperfect (OI) children is a rare but challenging situation. To the author’s knowledge, it is the first study discussing the correction of cubitus varus deformity in OI patient. Here we report a case of an 7-year-old OI girl who presented with varus deformities of the bilateral lower extremities and cubitus varus deformity of the left elbow due to a supracondylar fracture of humerus 3 year ago. The patient’s parent gave a history of supracondylar fracture of left humerus 3 years ago. Without medical intervention, the patient was admitted into our institution for corrective surgery with the diagnosis of osteogenesis imperfecta and cubitus varus deformity in the left arm.
Result
Medications including calcium, vitamin D and bisphosphonates were administered before the corrective surgery of cubitus varus, and a single locking plate was used to after the osteotomy. Right after the surgery, the appearance and ROM of the left arm was almost normal. Combined with gradual rehabilitation, the ROM of the left arm was normal without pain during daily use. The hardware was removed as the nailing of the forearm fractures was performed at the same time.
Conclusion
Cubitus varus is a common deformity in children resulting from elbow injuries, but it presents a challenging situation in OI patients. Locking plate combined with meticulous pharmacological intervention provides a good option for corrective surgery of cubitus varus in OI.
A Novel Nomogram to predict survival of patients with choroidal melanoma
Authors: Wang Zhong-Yuan , Wei Ting-Ting , Zhu Ling-Peng , Wang Wen-Juan , Gu Lan-Xin , Chen Yin-Zi , Zhang Meng-Yuan , Xie Tian-Hua , yao yong
Published: July 2020

Aim

The purpose of this study is to develop and validate a prediction model of overall survival (OS) in choroidal melanoma patients.
Methods

A total of 3415 patients with choroidal melanoma from 2004 to 2015 were collected from the Surveillance, Epidemiology, and End Results database. A novel nomogram was built based on independent risk factors evaluated by Cox proportional hazards regression model. And internal validations were performed to assess the performance of our nomogram by concordance index (C-index), calibration plot and decision curve analysis (DCA).
Results

Seven factors (age at diagnosis, race, sex, American Joint Committee for Cancer (AJCC) primary tumor (T) category, histological type, marital status and total number of primary tumors) were prognostic factors of OS. These factors were used to conduct a prediction model. The predictive accuracy of the nomogram for the OS has been stable at about 0.72 from 36 to 60 months evaluated by C-index. The calibration plots showed that the OS was also consistent between prediction and actual observation. Moreover, the DCA indicated our nomogram had better net benefit than the T-category.
Conclusion

The nomogram predicting the OS of choroidal melanoma may assist clinicians to decide treatment options individually.
Long-term outcome of polymethylmethacrylate-augmented screw fixation in the treatment of thoracolumbar spinal tuberculosis in elderly patients with severe osteoporosis
Authors: Yang Jun-Song , He Bao-Rong , Wei Jian-Min , Wang Xiang-Fu , Wei Dongmei , Gong Han-Lin , Chen Hao , Gong Long-Gang , Zou Peng , Li Qing-Da , He Li-Min , Hao Ding-Jun , Zhao Yuan-Ting , Chu Lei
Published: July 2020

Background: to evaluate the safety and efficacy of Polymethylmethacrylate-augmented screw fixation (PASF) in the treatment of elderly patients with thoracolumbar spinal tuberculosis accompanied with severe osteoporosis.Methods: 34 elderly patients with thoracolumbar spinal tuberculosis accompanied with severe osteoporosis underwent PASF after anterior or posterior debridement and bone grafting in our hospital from January 2010 to January 2012. The follow-ups were performed at 1, 3, 6, and 12 months postoperatively and then annually thereafter. The segmental cobb angle was measured to evaluate kyphosis improvement. The laboratory examination including ESR and CRP was also monitored. The pre- and postoperative VAS score, ODI score, and neurological function of ASIA scale were also recorded.Results: The included 21 patients completed the operation successfully. In all patients with neurological dysfunction, the ASIA grade improved by at least 1 grade. One month postoperatively, the VAS score, ODI, segmental Cobb angle, ESR, and CRP were significantly improved compared with those preoperatively (P<0.05); there was no significant difference in the values at 1 month postoperatively and last follow-up (P＞0.05). There were no complications such as implant failure, proximal junctional kyphosis, or recurrence of tuberculosis at the minimum 5-year follow-up. Conclusion: For elderly patients with thoracolumbar spinal tuberculosis complicated with severe osteoporosis, after anterior or posterior debridement and bone grafting, together with postoperative systematic anti-tuberculosis and anti-osteoporosis treatments, PASF is safe and effective without catastrophic complications such as intraspinal cement leakage. During the 5-year follow-up, there was no tuberculosis recurrence or implant failure.
Current Status and Related Factors of Turnover Intention of Primary Medical Staff in Anhui Province, China: A Cross-Sectional Study
Authors: Chen Guimei , Sang Lingzhi , Rong Jian , Yan Huosheng , Liu Hongzhang , Cheng Jing , Wang Li , Ding Hong , Chen Ren
Published: July 2020

Background This study aimed to explore the current status of turnover intention and its relationship with psychological capital, social support, and job burnout, as well as how these factors influence turnover intention of primary medical staff in Anhui province, China.Methods We used structured questionnaires to collect data, including demographic characteristics, turnover intention, psychological capital, social support, and Chinese Maslach Burnout Inventory scale. A total of 1,152 primary medical workers of Anhui were investigated. Data were analyzed by t-test, analysis of variance (ANOVA), Pearson correlation analysis, and multiple linear regression model.Results Total scores of turnover intention, psychological capital, social support, and job burnout of subjects were 14.15 ± 4.35, 100.09 ± 15.98, 64.93 ± 13.23 and 41.07 ± 9.437, respectively. Multiple linear regression showed the related factors of turnover intention were age, job position, work unit, and scores of job burnout. Pearson correlation showed psychological capital and social support were negatively correlated with turnover intention, while the score of job burnout was positively correlated with turnover intention.Conclusion The improvement of psychological capital and social support and the reduction of job burnout may play an important role in reducing turnover intention of primary medical staff. Primary medical managers should strengthen the humanistic care for primary medical staff, optimize the incentive mechanism, and improve internal management of medical institutions for stability.
Schistosomiasis, Upper Gastrointestinal Bleeding, and Health Related Quality of Life Measurements in Rural Africa
Authors: Opio Christopher Kenneth , Kazibwe Francis , Rejani Lalitha , Kabatereine Narcis B , Ocama Ponsiano
Published: July 2020

Introduction Health related quality of life (HRQOL) measurements, which include disability weights, are important endpoints of health care delivery. These measurements are scarce for patients with upper gastrointestinal bleeding (UGIB) in rural sub-Saharan Africa (SSA) where schistosomiasis is endemic. Methods and materials In 2014, we studied HRQOL measurements among patients with UGIB in SSA where schistosomiasis is endemic. Participants included adult inpatients and outpatients with a history of UGIB at a primary health facility. We measured HRQOL using the EuroQoL 5-dimension (EQ-VAS/EQ5D) instrument and derived disability weights from EQ-VAS and EQ5D measurements. We profiled each participant’s medical history, physical examination, laboratory tests, imaging, and endoscopy findings. These were summarized through descriptive and inferential statistics.Results We studied 107 participants with a median age of 45 years. All participants experienced ≥1 lifetime episode of UGIB, 60% were females, while 22% had acute severe UGIB requiring admission, 98% hepatic schistosomiasis, 90% splenomegaly, 80% had esophageal varices, and 20% had peptic ulcers. Most (80%) had ever received praziquantel for schistosomiasis. No participant had ever had an endoscopy for UGIB or received propranolol for prevention of recurrent variceal UGIB. Measures of the 5 dimensions of health revealed a large proportion of participants had problems related to self-care (76%), anxiety/depression (88%), and pain/discomfort (89%). Few participants had problems with mobility(37%). The mean/median EQ-VAS derived disability weights and EQ5D derived disability weights were 0.38/0.30 and 0.38/0.34, respectively. Participants with ascites, acute UGIB, and severe anemia were found to have the highest EQ-VAS and EQ5D median disability weights. At linear regression age, female gender, ascites, and acute UGIB predicted EQ-VAS derived disability weights [F(4,100)=9.35, p<0.0000,R-squared =0.27] and EQ5D derived disability weights [F(4,100)=23.24, p<0.0000, R-squared =0.44]. Within these models, all four factors were significantly predicted higher disability weights, P-value <0.05. Conclusions In our study, older age, female gender, those with ascites or acute UGIB had the highest disability weights, and the greatest probability of having higher disability weights among patients with a history of UGIB where schistosomiasis is endemic. These findings are unique and improve the definitions of different health states among patients with UGIB and schistosomiasis.
WITHDRAWN: Perceptions of students regarding the delivery of Sexual and Reproductive Health Education in schools in Fiji
Authors: Ram Sharan , Mohaammadnezhad Masoud
Published: July 2020

Background: Adolescent Sexual and Reproductive Health (SRH) remains a challenge globally. High school youths without Comprehensive Sexuality Education (CSE), are more likely to engage in high risk sexual behaviors than their peers in schools with CSE. Fiji continues to have very poor adolescents SRH indicators. This study aimed to gauge the perceptions of students towards the delivery of SRH education in schools in Fiji. Methods: A qualitative study design was used to collect data from students in Year 11-13 in public secondary schools in Suva, Fiji in 2018. Schools with equal ethnic mix were selected. A semi-structured open–ended questionnaire was used to guide Focus Group Discussions (FGDs). A male research facilitator conducted FGD with males while a female research facilitator facilitated that amongst the females. Data collected was analyzed thematically. Results: Seven FGDs were conducted. A total of 46 students (29 males) participated with the age range from 17-19 years old. Eight themes emerged: current SRH education; students’ knowledge on adverse consequences of SRH; sources of SRH information; need for sex education; provision of SRH education in schools; characteristics of teachers of SRH education; age-appropriate incremental sex education; and ideal version of SRH. Conclusions: The study shows that Fijian students desired a lot more from sex education than what is currently offered for sexual decision-making. There is a need for mandatory and comprehensive sex education for young people.
A Single-center Comparison Using Exoskeleton Rehabilitation for Cerebrovascular Accidents and Traumatic Brain Injury in a Cohort of Hispanic Patients
Authors: Treviño Lisa R , Vatcheva Kristina , Auer Michael E , Morales Angela , Abdurrahman Lama M , Viswamitra Sarajova , Torres-Reveron Annelyn
Published: July 2020

Background

Traumatic brain injury (TBI) is one of the leading causes of disability in the United States. The EKSO GT Bionics® (EKSO®) is a robotic exoskeleton approved by the Federal Drug Administration (FDA) for rehabilitation following a cerebrovascular accident (CVA or stroke) and recently received approval for use in patients with TBI. The aim of the study was to examine if the use of exoskeleton rehabilitation in patients with TBI will produce beneficial outcomes.
Methods

This retrospective chart-review reports the use of the (EKSO®) robotic device in the rehabilitation of patients with TBI compared to patients with CVA. We utilized data from a single, private rehabilitation hospital for patients that received post-CVA or post-TBI robotic exoskeleton intervention. All patients that used the exoskeleton were discharged from the hospital between 01/01/2017 to 04/30/2020. Ninety-four percent of patients in the CVA groups and 100% of patients in the TBI group were of Hispanic or Latino ethnicity. Gains in total Functional Independence Measure (FIM), walking and cognition, and length of stay in the rehabilitation facility were measured.
Results

Patients in the TBI group (n = 11) were significantly younger than the patients in the CVA group (n = 66; p < 0.05). Both groups spent a similar amount of time active, number of steps taken, and the number of sessions in the exoskeleton. Both groups also started with similar admission FIM scores. The FIM gain in the TBI group was similar to that of the CVA group (37.5 and 32.0 respectively). The length of stay between groups was not different either.
Conclusions

The use of exoskeleton rehabilitation in patients with TBI appear to produce similar outcomes as for patients with CVA, prompting further attention of this intervention for this type of injury. Trial registration: Retrospectively registered on 07/09/2020 in clinicaltrials.gov number NCT4465019.