bluuebunny/crossref_metadata_2025 huggingface dataset:
Recurrent Abdominal Pain, Vomiting, Velvet-Like Changes in the Small Intestine in a Patient with Multiple Acyl-CoA dehydrogenation Deficiency
Authors: Ye Ziqing , Shi Jieru , Lu Xiaolan , Meng Yingying , Lu Wei , Wu Bingbing , Huang Ying
Published: August 2020

BackgroundMultiple acyl-CoA dehydrogenation deficiency (MADD) is an inborn error of metabolism in fatty acid oxidation. We described an unusual case of recurrent vomiting and abdominal pain in a child with MADD, presenting with velvet-like changes in the small intestine. MethodsBecause of prominent gastrointestinal manifestations and small intestine ulcers, the patient was first diagnosed as Crohn’s disease. The patient was admitted to our institution because of recurrent symptoms despite treatment. Upper and lower endoscopy, computed tomography and trios exome sequencing were performed. ResultsThis patient underwent a repeated video endoscopy, which showed velvet-like changes in the small intestine rather than ulcers. Liver steatosis was identified by computed tomography. Serum tandem mass spectrometry showed elevated C8 and C10. Trios exome sequencing revealed compound heterozygous variants of c.250G>A, 524G>A in ETFDH. The diagnosis of multiple acyl-CoA dehydrogenation deficiency was made. Patient responded to oral riboflavin treatment. ConclusionWith this case, we aimed to highlight the importance of tandem mass spectrometry and genetic sequencing, especially when the endoscopic findings are not pathognomonic in pediatric cases with recurrent gastrointestinal complaints. We confirmed the diagnosis with next generation sequencing, and described unusual findings of velvet-like changes mimicking ulcers in the small intestine in this patient with MADD.
Non-Fermentative Gram-negative Bloodstream Infection in Northern Italy: a Multicenter Cohort Study.
Authors: Pascale Renato , Corcione Silvia , Bussini Linda , Pancaldi Livia , Giacobbe Daniele Roberto , Ambretti Simone , Lupia Tommaso , Costa Cristina , Marchese Anna , De Rosa Francesco Giuseppe , Bassetti Matteo , Viscoli Claudio , Bartoletti Michele , Giannella Maddalena , Viale Pierluigi
Published: August 2020

Background: The management of non-fermentative gram-negative bloodstream infection (NFGN-BSI) offers numerous challenges. In this study the aim is to analyse a large cohort of patients with NFGN-BSI recruited in the northern Italy to describe epidemiology, etiological and susceptibility pattern, therapeutic management and outcome.Methods: Multicentre retrospective cohort study of patients hospitalised at three large teaching hospitals in northern Italy in a fourth year period.Results: 355 BSI episodes were analyzed, due to P. aeruginosa (72.7%), A. baumannii (16.6%), and Stenotrophomonas maltophilia (10.7%). Overall, 21.4% of isolates were defined as DTR, highest rate among A. baumannii (64.4%). All-cause 30-day mortality rate was 17.5%. Rates of XDR or DTR A. baumannii isolation were significantly higher in non-surviving patients. Independent risk factors for 30-day mortality were: age (HR 1.03, 95%CI 1.00-1.04, p=0.003), septic shock (HR 2.84, 95%CI 1.67-4.82, p<0.001) and BSI due to Acinetobacter baumannii (HR 2.23, 95%CI 1.27-3.94, p=0.005). Conclusion: The overall prevalence of DTR was high in the NFGN BSI cohort analyzied, mainly among Acinetobacter baumannii episodes (64.4%). Acinetobacter baumannii is showed to be an independent predictor of mortality. These evidences marked the urgent need of new therapeutic options against this pathogen.Trial registration number: 79/2017/O/OssN. Approved: March14th, 2017.
Development and validation of a radiomics nomogram for identification of severity of patients with COVID-19
Authors: Wang Jian , Xu Zhihua , Cheng Guohua , Hu Qiuxiang , He Linyang , Xia Junli , Zhu Xiandi , Yang Guangzhao , Guo Youmin , Xie Zongyu
Published: August 2020

Background The coronavirus disease 2019 (COVID-19) is a pandemic now, and the severe COVID-19 determines the management and treatment, even prognosis. Thus, we aim to develop and validate a radiomics nomogram for identifying severe patients with COVID-19.Methods There were 156 and 104 patients with COVID-19 enrolled in primary and validation cohorts respectively. Radiomics features were extracted from chest CT images. Least absolute shrinkage and selection operator (LASSO) method was used for feature selection and radiomics signature building. Multivariable logistic regression analysis was used to develop a predictive model, and the radiomics signature, abnormal WBC counts, and comorbidity were incorporated and presented as a radiomics nomogram. The performance of the nomogram was assessed through its calibration, discrimination, and clinical usefulness.Results The radiomics signature consisting of 4 selected features was significantly associated with clinical condition of patients with COVID-19 in the primary and validation cohorts (P < 0.001). The radiomics nomogram including radiomics signature, comorbidity and abnormal WBC counts, showed good discrimination of severe COVID-19, with an AUC of 0.972, and good calibration in the primary cohort. Application of the nomogram in the validation cohort still gave good discrimination with an AUC of 0.978 and good calibration. Decision curve analysis demonstrated that the radiomics nomogram was clinically useful to identify the severe COVID-19.Conclusions We present an easy-to-use radiomics nomogram to identify the severe patients with COVID-19 for better guiding a prompt management and treatment.
Improving Lateral Safety Distance-Based on Feature Detection and Probabilistic Roadmaps for Unmanned Vehicle Path Planning
Authors: Wang Jianfeng , Chang Guangliang , Li Weihua , Yang Na , Wang Boqian , Sun Yuhui
Published: August 2020

Most of the existing path-planning algorithms do not consider lateral safe distance requirements in practical applications. Hence, in this study, a new path point selection algorithm is proposed for path planning. The algorithm first used the Harris and Line Segment Detector(LSD) algorithms to detect and obtain the corner and edge information of obstacles. A vertical line was provided to the edge of the surrounding obstacles along each corner successively. In this process, the narrow impassable area in the map was filtered and removed by setting a safety threshold, and the foot of the vertical coordinates were simultaneously obtained. The corresponding midpoint coordinates were solved by using the corner coordinates and the foot of the corresponding perpendicular coordinates. The midpoint coordinates were used as candidate points to generate path points. These candidate points are screened and relaxed using the Probabilistic Roadmaps(PRM) algorithm to obtain the series of path points required. Finally, the path was planned according to these path points and smoothed using the Quadratic polynomial interpolation method(QPMI). Through simulation experiments, the method proposed in this study can solve a unique path without randomness under given conditions, and the probability of a collision in practical applications was reduced.
Cancer Cell Nucleus Leads the Way
Authors: Renz Malte
Published: August 2020

ObjectiveCancer cell metastasis determines disease prognosis. During cancer cell metastasis, the cancer cell and the cancer cell nucleus have to undergo extreme shape changes. To monitor shape changes of cancer cells and cancer cell nuclei and the positioning of the cancer cell nucleus during cancer cell invasion, a customized invasion assay with 8-μm pores and reconstituted basal membrane was imaged using fluorescence live-cell microscopy.ResultsThe observed cells changed their shape from a distinct fibroblast-like spindle shape to an amoeboid shape without polarization immediately after the passage through an 8-μm pore of the invasion assay. During the process of invasion, the cancer cell centered the cancer cell nucleus over the 8-μm pore, and cancer cell nucleus and adjacent cytoplasmic areas moved first through such a pore. Seemingly testing if the largest and least deformable organelle may fit, the cancer cell nucleus led the way through the porous membrane of the invasion assay.
Analysis of mRNA-lncRNA and mRNA-lncRNA-Pathway co-expression networks based on WGCNA in developing pediatric sepsis
Authors: Zhang Xiaojuan , Cui Yuqing , Ding Xianfei , Liu Shaohua , Han Bing , Duan Xiaoguang , Zhang Haibo , Sun Tongwen
Published: August 2020

Background: Pediatric sepsis is a great threat in death worldwide. However, the pathogenesis has not been clearly understood until now in sepsis.Methods: This study identified differentially expressed mRNA (DEMs) and lncRNAs (DELs) based on Gene Expression Omnibus (GEO) database. And the weighted gene co-expression network analysis (WGCNA) was performed to explore co-expression modules associated with pediatric sepsis. Then Gene Ontology (GO), KEGG (Kyoto Encyclopedia of Genes and Genomes) pathway, DEMs‑DELs and DEMs‑DELs-Pathway co-expression network analysis was conducted in selected significant module. Results: A total of 1941 DEMs and 225 DELs were used to conduct WGCNA. And the turquoise module was selected as the significant module that was associated with particular traits. The DEMs functions associated with many vital processes were also shown by GO and KEGG pathway analysis in the turquoise module. Finally, 15 DEMs and 4 DELs (GSEC, NONHSAT160878.1, XR_926068.1 and RARA-AS1) were selected as candidate biomarkers in DEMs-DELs-Pathway co-expression network. Conclusions: Our study identified 15 DEMs and 4 DELs as diagnostic markers, which could also provide more directions to study molecular mechanism of pediatric sepsis.
Cholesterol, hypertension and chronic spine problems: a logit model focusing on rural Brazilian residents in 2013
Authors: Cruz Alice Aloísia da , Garcias Marcos de Oliveira
Published: August 2020

Background: Over recent decades, Brazil’s health indicators have improved; however, access to the country’s health services is not homogeneous, with urban areas being better served than rural areas. The general objective of this work is to identify the influence of rural residence and other factors on the incidence of chronic spine problems, hypertension, and elevated levels of cholesterol in Brazil using the last Brazilian National Health Survey (NHS - 2013)) definitions and data. The analysis provided by this study contributes data that can be used to determine the probability of these three conditions occurring in Brazil and identifies the most vulnerable rural groups as defined by diet, physical activity, smoking, and alcohol consumption. Method: A logit model was estimated to identify the influence of the variables rural residence, sex, age, race, education, health insurance, work, Body Mass Index (BMI), consumption habits, and region of residence on the chronic conditions analyzed. Results: Results show that rural residents are 5.8% more likely to have chronic spine problems and 0.9% less likely to have hypertension than urban residents. The incidence of all conditions was lower in men than women. The Body Mass Index (BMI) value also influences the chance of having the conditions studied. Individuals with at least a secondary education were less affected by the analyzed conditions than those less educated. There were regional differences in these conditions’ incidence, mainly chronic spine problems and hypertension. Conclusions: The variables BMI, gender, and years of alcohol consumption had significance in all diseases analyzed. To correct underreporting issues, public policies should be directed to expand rural health services. Additionally, actions should be taken to raise the public's awareness of the effects of obesity and alcohol consumption on health.
Can’t see the wood for the trees: Using common likelihoods to share information regarding selection of functional form in survival analysis
Authors: Hawkins Neil , Parker Chris , Scott David A.
Published: August 2020

Background

The estimation of mean survival is a key consideration when estimating the cost-effectiveness of interventions. Estimation typically requires extrapolation using parametric survival analysis and may be sensitive to choice of functional form. We demonstrate a simple method that allows goodness-of-fit information to be assessed jointly across studies, where such information is believed likely to be exchangeable, to help inform the selection of functional form for parametric survival analysis.
Methods

Individual patient data for survival was estimated from digitised Kaplan-Meier curves for four trials in advanced soft tissue sarcoma. A range of parametric survival models were fitted. Two approaches were explored for identifying the preferred parametric model: (i) selecting functional forms independently for each study; and (ii) selecting a common functional form across studies. Akaike’s Information Criterion (AIC) or Bayesian Information Criterion (BIC) were used to select optimal functional form. For approach (ii) joint BIC or AIC statistics were calculated for each model by combining the components of the AIC or BIC, respectively, across studies. A bootstrap analysis was conducted to estimate the uncertainty in selection of functional form.
Results

Estimates of mean survival varied markedly according to choice of functional form. Independent selection led to different functional forms being selected for each study with considerable uncertainty regarding the optimum functional form according to AIC or BIC. In this case study, selecting an optimum functional form based on joint AIC or BIC across studies reduced uncertainty in model selection and variance in mean survival compared to selection of functional form independently.
Conclusion

Extrapolation of estimates of survival may be sensitive to choice of functional form. If it is believed, a priori, reasonable to share information regarding the choice of functional form for survival analysis across studies, estimating joint goodness-of-fit information across studies could reduce uncertainty and lead to more reliable estimates of mean survival and cost-effectiveness.
Hemodynamic and Behavioural Changes in Older Adults During Cognitively Demanding Dual-Tasks
Authors: Salzman Talia , Vallejo Diana Tobón , Polskaia Nadia , Michaud Lucas , St-Amant Gabrielle , Lajoie Yves , Fraser Sarah
Published: August 2020

Background: Executive functions play a fundamental role in walking by integrating information from cognitive-motor pathways. Subtle changes in brain activation and behaviour may help identify older adults who are more susceptible to executive function deficits with advancing age due to prefrontal cortex deterioration. This study aims to examine how older adults mitigate executive demands while walking during cognitively demanding tasks.Methods: Twenty healthy older adults (M = 71.8 years, SD = 6.4) performed simple reaction time (SRT), go/no-go (GNG), n-back (NBK) and double number sequence (DNS) cognitive tasks of increasing difficulty while walking (i.e., dual-task). Functional near-infrared spectroscopy (fNIRS) was used to measure the hemodynamic response (i.e., oxy- [HbO2] and deoxyhemoglobin [HbR]) changes in the prefrontal cortex (PFC) during dual- and single-tasks (i.e., walking alone). In addition, performance was measured using gait speed (m/s), response time (s) and accuracy (% correct). Results: Using repeated measures ANOVAs, neural findings demonstrated a main effect of task such that ∆HbO2 (p = 0.047) and ∆HbR (p = 0.040) decreased between single- and dual-tasks. An interaction between task and cognitive difficulty (p = 0.014) revealed that gait speed decreased in the DNS between single- and dual-tasks. A main effect of task in response time indicated that the SRT response time was faster than all other difficulty levels (p < 0.001). Accuracy performance declined between single- and dual-tasks (p = 0.028) and across difficulty levels (p < 0.001) but were not significantly different between the NBK and DNS.Conclusion: Findings suggest that a healthy older adult sample might mitigate executive demands using an automatic locomotor control strategy such that shifting conscious attention away from walking during the dual-tasks resulted in decreased ∆HbO2 and ∆HbR. However, decreased prefrontal activation was inefficient at maintaining response time and accuracy performance and may be differently affected by increasing cognitive demands.
Maternal DHA supplementation influences sex-specific disruption of placental gene expression following early prenatal stress
Authors: Jašarević Eldin , Hecht Patrick M. , Fritsche Kevin L. , Geary David C. , Rivera Rocío M. , Beversdorf David
Published: August 2020

Background: Early life adversity is a risk factor for early developmental perturbations and contributes to the presentation of neuropsychiatric disorders in adulthood. Neurodevelopmental disorders exhibit a strong sex-bias in susceptibility, presentation, onset and severity, although mechanisms conferring vulnerability are not well understood. Environmental perturbations during pregnancy, such as malnutrition or stress, have been associated with sex-specific reprogramming that contribute to increased disease risk in adulthood, whereby stress and nutritional insufficiency may be additive and further exacerbate poor offspring outcomes. Methods: To determine whether maternal docosahexanoic acid (DHA) supplementation effects offspring outcome following exposure to early prenatal stress (EPS), dams were fed nutritionally complete semi-purified diets that either contained adequate essential omega-6 (n-6) and omega-3 (n-3) fatty acids from corn and soy oils (control diet, CTL) or an experimental diet that was nutritionally-equivalent to the CTL diet, but contained 1% by weight DHA, a long-chain omega-3 fatty acid (22:6n-3). Dams were administered chronic variable stress during the first week of pregnancy (Embryonic day, E0.5 – 7.5). Developmental milestones were assessed at E 12.5. Results: Exposure to early prenatal stress (EPS) decreased placenta and embryo weight in males, but not females, exposed to CTL diet. DHA-enrichment reversed the sex-specific decrease in placenta and embryo weight following EPS. Early prenatal exposure upregulated expression of genes associated with oxygen and nutrient transport, including hypoxia inducible factor 3α (HIF3α), peroxisome proliferator-activated receptor alpha (PPARα), and insulin like growth binding factor 1 (IGFBP1), in placenta of CTL diet males exposed to EPS. DHA-enrichment in EPS-exposed animals abrogated male-specific upregulation of PPARα, HIF3α, and IGFBP1. Conclusions: This suggests that maternal dietary DHA enrichment may buffer against maternal stress programming of sex-specific outcomes during early development.
Converting Scores Between the PANSS and SAPS/SANS Beyond the Positive/Negative Dichotomy
Authors: Grot Stéphanie , Giguère Charles-Édouard , Smine Salima , Mongeau-Pérusse Violaine , Nguyen Dana Diem , Preda Adrian , Potvin Stéphane , Erp Theo van , Orban Pierre
Published: August 2020

Background: Previous work provided conversion equations for overall indices of positive and negative symptomatology between the two most widely used scales to assess symptom severity in schizophrenia, namely the Positive and Negative Syndrome Scale (PANSS) and the Scales for the Assessment of Positive/Negative Symptoms (SAPS/SANS). Our objective was to provide such conversion equations for subdomains of positive and negative symptomatology in order to better account for the diversity of symptom profiles in schizophrenia. Method: Symptoms severity was assessed using both the PANSS and SAPS/SANS in 205 patients with schizophrenia. Two exploratory factor analyses combining items from both scales were first performed separately in the positive and negative symptom domains. For each identified factor, linear regression analyses were then conducted to obtain conversion equations from the PANSS to the SAPS/SANS and vice versa. Linear regression model estimation was performed on 80% of the data, and reliability was then evaluated on the 20% remaining data using intra-class correlation coefficient between the original and predicted scores. This procedure was repeated 100 times with random samplings for each factor cross-scale conversion.Results: Three-factor solutions were favored both in the positive and negative symptom domains. Based on the nature of items that strongly loaded on the different factors, positive factors were termed ‘Hallucinations’, ‘Delusions’ and ‘Disorganization’, while negative factors were associated with ‘Expressivity’, ‘Amotivation’ and ‘Cognition’. Intra-class correlation coefficients between the original and predicted scores were good to excellent (0.68-0.87) for all regressions, but for the cognition factor which were deemed as low (0.25, 0.26).Conclusion: The symptom subdomains identified by the decomposition of the positive and negative domains were consistent with current descriptions of symptom dimensions in schizophrenia. With the exception of the cognition subdomain, symptom severity scores can be converted with good accuracy between scales, beyond the positive/negative symptom dichotomy. Conversion equations are implemented in an R Shiny app to facilitate their use by the clinical research community.
Gradually increased dyslipidemia in human immunodeficiency virus infected male patients with tenofovir plus lamivudine plus efavirenz primary treatment: a 3-year follow-up study
Authors: liu dafeng , Zhao Bennan , Zhang Xinyi , Gao Fengjiao , Kang Jun , Zheng Xue , Lan Lijuan , He Yinsheng , He Shenghua
Published: August 2020

IntroductionSince the start of highly active antiretroviral therapy (HAART) with TDF plus 3TC plus EFV, the long-term dynamic characteristics of lipid and purine metabolism in patients infected with human immunodeficiency virus (HIV) was unclear and worth studying.MethodsA prospective follow-up cohort study was the way. Sixty-one treatment-naive HIV infected male patients were divided into three groups based on the baseline CD4 + T cell count (26, 12, 23cases in < 200, from 200 to 350, > 350 three groups, respectively). Lipid and purine metabolism parameters of those patients within 144 weeks were analyzed.ResultTG, TC, LDL-c and HDL-c level all gradually increased within 144 weeks, but statistical significances of TC level and HDL-c level were only found (F = 4.214, 5.518, P = 0.001, 0.000 ,respectively). Moreover the percentage of hypercholesterolemia, hyper LDL cholesterolemia and hypertriglyceridemia all gradually increased, low HDL cholesterolemia gradually decreased, but there was only obvious difference of the latter (χ2 = 16.105, P = 0.0007).Furthermore the lower the baseline CD4 + T lymphocyte counts, the higher TG level, the lower TC level, LDL-c level and HDL-c level, but only significant difference of LDL-c level between three groups at baseline was found (F = 3.256,P = 0.0457).Although UA level and the percentages of hyperuricemia gradually increased within 144 weeks, but there was no significant difference between different follow-up time points groups and between three CD4 + T cell count groups (all P༞0.05).ConclusionsThese findings provide a reference for clinicians to monitor lipid metabolism parameters closely during long-term HAART with TDF plus 3TC plus EFV regimen.
Comprehensive Effect of Salt Stress and Peanut Cultivars on the Bacterial Community Structure and Diversity of Peanut Rhizosphere Soils
Authors: Xu Yang , Ding Hong , Wen Saiqun , Ci Dunwei , Zhang Guanchu , Yuan Guang , Qin Feifei , Dai Liangxiang , Zhang Zhimeng
Published: August 2020

Background: Plant rhizosphere bacterial communities influence plant growth and stress tolerance, which differs across cultivars and external environments. Peanut (Arachis hypogaea. L) as an important oil crop cultivated worldwide. However, relatively little is known about the comprehensive effects of environmental conditions and peanut cultivars on rhizosphere bacterial community structure and diversity. Results: Here, bacterial community structure diversity from rhizosphere soils of various susceptible and resistant peanut cultivars with or without salt stress was analyzed by 16S rRNA gene deep sequencing and quantitative PCR assays. Taxonomic analysis showed that the bacterial community predominantly consisted of phyla Actinobacteria, Proteobacteria, Chloroflexi, Acidobacteria, and Cyanobacteria. Among these bacteria, numbers of beneficial bacteria Cyanobacteria and Proteobacteria increased, while that of Acidobacteria decreased after salt treatment. Metabolic function prediction showed that the percentages of reads categorized to signaling transduction and inorganic ion transport and metabolism were higher in the salt-treated soils, which may be beneficial to plant survival and salt tolerance. Conclusions: Overall, rhizosphere bacterial community structure and population metabolism are affected by salt stress, which may be conducive to peanut stress tolerance in saline-alkali soil. The study is therefore crucially important to develop the foundation for improving the salt tolerance of peanuts via modifying the soil bacterial community.
Estimation of sensitivity and specificity and calculation of sample size for a validation study with stratified sampling
Authors: Kubota Kiyoshi , Iwagami Masao , Yamaguchi Takuhiro
Published: August 2020

Background:We propose and evaluate the approximation formulae for the 95% confidence intervals (CIs) of the sensitivity and specificity and a formula to estimate sample size in a validation study with stratified sampling where positive samples satisfying the outcome definition and negative samples that do not are selected with different extraction fractions. Methods:We used the delta method to derive the approximation formulae for estimating the sensitivity and specificity and their CIs. From those formulae, we derived the formula to estimate the size of negative samples required to achieve the intended precision and the formula to estimate the precision for a negative sample size arbitrarily selected by the investigator. We conducted simulation studies in a population where 4% were outcome definition positive, the positive predictive value (PPV)=0.8, and the negative predictive value (NPV)=0.96, 0.98 and 0.99. The size of negative samples, n0, was either selected to make the 95% CI fall within ± 0.1, 0.15 and 0.2 or set arbitrarily as 150, 300 and 600. We assumed a binomial distribution for the positive and negative samples. The coverage of the 95% CIs of the sensitivity and specificity was calculated as the proportion of CIs including the sensitivity and specificity in the population, respectively. For selected studies, the coverage was also estimated by the bootstrap method. The sample size was evaluated by examining whether the observed precision was within the pre-specified value.Results:For the sensitivity, the coverage of the approximated 95% CIs was larger than 0.95 in most studies but in 9 of 18 selected studies derived by the bootstrap method. For the specificity, the coverage of the approximated 95% CIs was approximately 0.93 in most studies, but the coverage was more than 0.95 in all 18 studies derived by the bootstrap method. The calculated size of negative samples yielded precisions within the pre-specified values in most of the studies.Conclusion:The approximation formulae for the 95% CIs of the sensitivity and specificity for stratified validation studies are presented. These formulae will help in conducting and analysing validation studies with stratified sampling.
Expression and Diagnostic Value of Serum Protein Z, Protein Z-dependent Protease Inhibitor and Coagulation-related Indicators in Foetal Growth Restriction.
Authors: Luo Xiaohua , Huang Yulian , Gu Cunhua , Guo Xiaopei , Guo Jing , Tao Lingling , Sun Peiyan
Published: August 2020

Objective: This study aimed to explore the expression and associations between levels of serum protein Z (PZ), protein Z-dependent protease inhibitor (ZPI), and coagulation-related indicators and foetal growth restriction (FGR).Methods: A total of 50 pregnant women with FGR, 50 healthy pregnant women (Healthy control, HC), and 30 childbearing-age women without pregnancy group (Blank control, BC) were collected in this study. The serum PZ, ZPI, protein C (PC), protein C (PS), and antithrombin III (ATIII) levels of women in each group were determined and compared. Moreover, correlations between these indices and FGR were assessed using Spearman analysis and diagnostic values of these indices for FGR were evaluated using the receiver operating characteristics (ROC) curves.Results: Serum levels of PZ, ZPI, PC, PS, and ATIII were significantly downregulated in the HC and FGR groups compared with the BC group (P <0.001), while PZ, ZPI, PS, and ATIII levels in the FGR groups were significantly lower than that in the HC group (P <0.01). PZ serum concentration was positively correlated with ZPI concentration in the HC and FGR groups, and PZ and ZPI levels were negatively correlated with FGR (r = -0.198, r = -0.247, P <0.05). Combined of PZ, ZPI, PS, and ATIII performed a better value than each of them with AUC of 0.935 (95% CI=0.890-0.981), a sensitivity of 0.920, and a specificity of 0.800.Conclusion: Serum PZ, ZPI, PS, and ATIII were significantly decreased in pregnant women with FGR and could be used for FGR screening in pregnant women.
Dynamic Public Health Interventions Consistent With the Development of COVID-19 Epidemic: The Targeted Prevention and Control Guidelines in Mainland, China
Authors: Miao Xinlei , Wu Zhiyuan , Qiao Chen , Liu Mengmeng , Li Zhiwei , Wang Yijie , Xu Zongkai , Guo Xiuhua , Meng Qun
Published: August 2020

Background: This study aims to describe the dynamic characteristics of COVID-19 transmission and the public health interventions in three phases in mainland, China.Methods: The number of daily reported new confirmed cases, severe cases and asymptomatic infected cases from Jan 10 to Jul 10 was analyzed. We calculated the effective reproduction number (Rt) to reflect the dynamic characteristics of epidemic transmission and intervention effect. According to the overall guidelines for prevention and control, we divided the past six months into three phases and summarized the features of main public health interventions in each phase.Results: The daily confirmed cases and severe cases of COVID-19 mainly concentrated in the first phase and the maximum Rt reached 10.75 (95%CI: 10.26-11.24). With the society-wide efforts and joint prevention and control strategy, Rt began to decline below 1.0 from Feb 19. In the second phase, the occurrence of imported infected cases caused small fluctuations. The preventive strategy, preventing both imported cases and local spread of epidemic, was mainly taken. In the third phase, the government adopted policies to prevent imported cases and domestic re-infections, responding to the regular epidemic prevention demands. Conclusion: Social isolation, wearing masks, digital management based on community and area hierarchical control were effective public health interventions in consistent with the development of COVID-19 epidemic. The targeted dynamic interventions in different phases could provide reference for other countries and regions to deal with COVID-19.
Effect of critical care pharmacist on antibiotic medication optimizations, reduce drug costs but not increase mortality: A retrospective cohort study in the real world research
Authors: Gu Hongyan , Sun Lulu , Sheng Bo , Gu Xuyun , Wang Suozhu , Chen Wei
Published: August 2020

Background

We aims to investigate the roles of clinical pharmacist on optimizing the antibiotic pharmacotherapy regimens and achieved better clinical and economic outcomes in the critical care unit (ICU).
Methods

A retrospective cohort study in real world was undertaken from the year of 2016 to 2017 as the pharmacist pre-intervention period and 2018 to 2019 as the pharmacist intervention period in ICU. All interventions and consensus with clinicians were recorded. The outcomes of the patients’ mortality, microorganism detections, antibiotic utilities, length of ICU stay (LOS), costs of the antibiotics and the total drugs used were reviewed.
Results

Of 1436 patients were evaluated and 1252 recommendations were identified. The main points of the pharmacist interventions were medication regimen adjustments (52.32%) and drug withdrawal (22.60%). Before and after the pharmaceutical interventions, the AUD of all antimicrobials consumed decreased from 211.83 to174.02 (p = 0.000), the rate of antimicrobial utility decreased from 89.88–86.82% (p = 0.001), mortality reduced from 18.73–15.21% (p = 0.002), antibiotic charges were from ࿥8,644 ± 12,556 to ࿥5,587 ± 7,606 (p = 0.000) with 39% reduction.
Conclusions

The services provided by the clinical pharmacist with highly professional training could optimize the antibiotic therapy regimes, saved the drug costs and did not increase mortalities.
Gender Differences in Health Insurance Coverage in China
Authors: Zhou Mei , Zhao Shaoyang , Zhao Zhi
Published: August 2020

Background: The Chinese government has been trying to build a universal public social health insurance (SHI) system since the early 2000s and has essentially achieved universal SHI coverage. By 2018, more than 97% of the entire Chinese population had SHI. However, there are still some obvious inequities in the SHI system. Methods: based on three datasets, we first use statistical methods to identify gender differences in health insurance. Next, we construct a simple multiple regression model to capture the differences in insurance coverage across age groups using the parameter of interaction terms for gender and age groups.Results: Based on data from a demographic survey that covers a large sample, we find that in the below 50 (in 2005) or 60 (in 2015) years age group, the coverage gap of urban employees' basic medical insurance (UEBMI) between men and women was relatively smaller, while a larger disparity existed in the above 50 (in 2005) or 60 (in 2015) group. Moreover, gender differences in health insurance were more pronounced in the low-education group, while no gender differences were found in the high-education group.Conclusions: This paper explains the gender gap in health insurance and the reason for the wider gap among older people. Our study indicates that because the UEBMI in China mainly covers people with formal jobs, a lower labor participation rate (even much lower in formal jobs) of women has led to their greater difficulty in obtaining health insurance. Since the older women’s greater difficulty in obtaining jobs or susceptibility to lay-offs during the period of the UEBMI’s implementation, the possibility of being covered was even much lower. In fact, it was because of the combined effects of the UEBMI system and the labor market condition at that time that older women had a lower proportion of being covered under the UEBMI.
Myocardial infarction detection using artificial intelligence and nonlinear features based on synthesis of the standard 12-lead and Frank XYZ leads
Authors: Zeng Wei , Lin Zixiang , Yuan Chengzhi
Published: August 2020

Nowadays cardiovascular diseases ( CVD ) is one of the prime causes of human mortality, which has received tremendous and elaborative research interests regarding the prevention of CVD . Myocardial ischemia is a kind of CVD which will lead to myocardial infarction (MI). The diagnostic criterion of MI is supplemented with clinical judgment and several electrocardiographic (ECG) or vectorcardiographic ( VCG ) programs. However the visual inspection of ECG or VCG signals by cardiologists is tedious, laborious and subjective. To overcome such disadvantages, numerous MI detection techniques including signal processing and artificial intelligence tools have been developed. In this study we propose a novel technique for automatic detection of MI based on disparity of cardiac system dynamics and synthesis of the standard 12-lead and Frank XYZ leads. First, 12-lead ECG signals are reduced to 3-dimensional VCG signals, which are synthesized with Frank XYZ leads to build a hybrid 4-dimensional cardiac vector. This vector is decomposed into a series of proper rotation components ( PRCs ) by using the intrinsic time-scale decomposition ( ITD ) method. Second, four levels discrete wavelet transform ( DWT ) is employed to decompose the predominant PRCs into different frequency bands, in which third-order Daubechies ( db3 ) wavelet function is selected as reference variable for analysis. Third, phase space of the reference variable is reconstructed based on db3 , in which the properties associated with the nonlinear cardiac system dynamics are preserved. Three-dimensional ( 3D ) phase space reconstruction ( PSR ) together with Euclidean distance (ED) has been utilized to derive features. Fourth, neural networks are then used to model, identify and classify cardiac system dynamics between normal (healthy) and MI cardiac vector signals. Finally, experiments are carried out on the PhysioNet PTB database to assess the effectiveness of the proposed method, in which conventional 12-lead and Frank XYZ leads ECG signal fragments from 148 patients with MI and 52 healthy controls were extracted. By using the 10-fold cross-validation style, the achieved average classification accuracy is reported to be 98.20 % . The result verifies the effectiveness of the proposed method which can serve as a potential candidate for the automatic detection of MI in the clinical application.
Evaluation of the Solar Quiet Reference Field (SQRF) Model for Space Weather Applications in the South America Magnetic Anomaly
Authors: Chen Sony Su , Denardini Clezio Marcos , Resende Láysa C. A. , Chagas Ronan A. J. , Moro Juliano , Silva Régia P. , Carmo Carolina S. , Picanço Giorgio A. S.
Published: August 2020

In the present work, we evaluate the accuracy of the Solar Quiet Reference Field (SQRF) model for forecasting and predicting the geomagnetic solar quiet (Sq) daily field variation in the South America Magnetic Anomaly (SAMA) region. The model simulates the monthly average horizontal field of the geomagnetic quiet (Sq-H) daily variation solving a set of functional fitting equations for the specified geographic coordinates. We carried out two comparisons between the simulated and observational data of the Sq-H field. The first part attempts to evaluate the accuracy for predicting the Sq-H field over Medianeira (25.30°S, 54.11°W, dip angle: -33.45°) by using linear interpolation on the SQRF coefficients. The second part of the analysis attempts to evaluate the accuracy for forecasting the quiet daily field variation over Cachoeira Paulista (22.70°S, 45.01°W, dip angle: -38.48°). The results of the simulation for both locations show that this empirical model presents a good agreement with the Sq-H field obtained from the magnetic field data. The accuracy of the SQRF model (high correlation, r>0.9) provides a high potential for estimating and forecasting geomagnetic quiet daily field variation for space weather applications. Therefore, this model could be useful in the Sq-H field regions near of SAMA.
Addressing the quality of paediatric primary care: Health worker and caregiver perspectives of PACK Child, a health systems intervention in South Africa
Authors: Curran Robyn Leigh , Murdoch Jamie , Bachmann Max , Bateman Eric , Cornick Ruth , Picken Sandy , Simelane Makhosazana Lungile , Fairall Lara
Published: August 2020

Background: The WHO’s Integrated Management of Childhood Illness (IMCI) has resulted in progress in addressing infant and child mortality. However, unmet needs of children continue to present a burden upon primary healthcare services. The capacity of services and quality of care offered require greater support to address these needs by extending and integrating curative and preventive care for the child with a long-term health condition and the child older than 5, not prioritised in IMCI. In response to these needs, the PACK Child intervention was developed, to expand the scope of integrated management and training programmes for paediatric primary care. We report health worker and caregiver perspectives of the existing paediatric primary care context as well as the extent to which PACK Child functions to address perceived problems within the current local healthcare system. Methods: This process evaluation involved 52 individual interviews with caregivers, 10 focus group discussions with health workers, 3 individual interviews with trainers, and 31 training observations. Interviews and focus groups explored participants’ experiences of paediatric primary care, perspectives of the PACK Child intervention, and tensions with implementation in each context. Inductive thematic analysis was used to analyse verbatim interview and discussion transcripts.Results: Perspectives of caregivers and health workers suggest an institutionalised focus of paediatric primary care to treating children’s symptoms as acute episodic conditions. Health workers’ reports imply that this focus is perpetuated by interactions between contextual features such as, IMCI policy, documentation-driven consultations, overcrowded clinics and verticalised care. Whilst these contextual conditions constrained health workers’ ability to translate skills developed within PACK Child training into practice, the intervention initiated expanded care of children 0-13 years and those with long-term health conditions, enhanced professional competence, improved teamwork and referrals, streamlined triaging, and facilitated probing for psychosocial risk.ConclusionPACK Child appears to be catalysing paediatric primary care to address the broader needs of children, including long-term health conditions and the identification of psychosocial problems. However, to maximise this requires primary care to re-orientate from risk minimisation on the day of attendance towards a view of the child beyond the day of presentation at clinics.
Ovarian Fibrosarcoma: 5 Case Reports and Review of Literature
Authors: Sun Tingting , Cheng Ning-Hai , Cao Dong-Yan , Peng Peng
Published: August 2020

Ovarian fibrosarcoma is an extremely rare and malignant sex-cord stromal tumor. Due to its low incidence and poor prognosis, till now very few cases have been reported and most of them are sporadic. The treatments and prognostic factors of ovarian fibrosarcoma are still under discussion. Here we report 5 cases of ovarian fibrosarcoma in Peking Union Medical College Hospital during the past 20 years. The 5 patients were 41, 51, 54, 76, 76 years old with initial symptoms of pelvic mass or pain. Manifestations on ultrasound are usually as unilateral pelvic masses, within which are uneven echo enhancement and some blood flow signals. There was no significant increase in preoperative tumor markers such as serum CA125 and sex hormones. Final diagnosis depends on postoperative histopathological results since these tumors were easily misdiagnosed by intraoperative frozen sections. Pathological examinations showed the tumor cells were spindle shaped with moderate to severe atypia and high mitotic counts. Immunohistochemistry is not specific but the positive rate of Ki-67 was consistent with the degree of malignancy and prognosis of the tumor. In addition, Vimentin, α-inhibin, SMA, estrogen receptor and progesterone receptor could also be positive. There were significant differences in surgical methods and there is also no unified chemotherapy. The overall survival was >15, >7, >6, <1, <1 year for each patient. After reviewing the literature, there is a lack of evidence-based large-scale case study. As for treatments, complete cytoreductive surgery plus regimens of malignant cord stromal tumors in NCCN guidelines are recommended. Due to its low incidence, multi-center clinical studies and molecular studies are required to give gynecologists a better understanding and guidance for future managements of ovarian fibrosarcoma.
Coronary Aneurysm and IVIG Resistance Prediction in Kawasaki Disease
Authors: Varlı Yusuf Ziya , Oztarhan Kazim
Published: August 2020

Background: Kawasaki disease (KD) is the most common cause of coronary artery aneurysm (CAA) in children. This study aimed to determine the clinical characteristics, demographic features, frequency of coronary involvement, and resistance to intravenous immunoglobulin (IVIG) treatment in Turkey based on our data.Methods: Patients with KD were evaluated with demographic data, clinical, laboratory, and echocardiographic findings. Results: Between 2010–2019, a total of 259 patients (male/female: 1.67) were treated in our hospital, with 48 (%19) cases < 1 year of age. According to diagnostic criteria, 31% were diagnosed with typical KD and 69% with atypical (incomplete) KD. The frequency of clinical findings were as follows: changes in the lips and oral mucosa (79%); polymorphic rash (69%); conjunctivitis (65%); changes in the extremities (54%); and cervical lymphadenopathy (48%). There was no significant difference between typical and atypical KD in the frequency order. CAA development and IVIG resistance occurred in 11.6% and 12.3% of cases, respectively. IVIG resistance was more common in infants and hospitalization times were longer in this group. Coronary artery lesions existed in 45 patients; right coronary artery (RCA) alone (20%), left coronary artery (LCA) alone (44.5%), and RCA and LCA together were involved (35.5%). The left main coronary artery affected 20 patients, the left anterior descending artery (LAD) affected nine patients (45%), the left circumflex artery (LCx) affected two patients (10%), and the LAD and LCx together affected two patients (10%). None of the patients had myocardial infarctions or died during follow-up. Conclusion: KD is a systemic vasculitis common in pediatric infants in which coronary artery involvement affects prognosis. Due to IVIG resistance and increased coronary involvement accompanying this vasculitis, it is an important problem in countries where the disease is common. It is important to know the factors that increase the risk of coronary involvement and IVIG resistance development.
The Beneficial Effects of Square Dance on Musculoskeletal System in Early Postmenopausal Chinese Women: A Cross-sectional Study.
Authors: Sun Jie , Yao Chen , Wang Ziping , Wu Jiancheng , Zhang Bo , Zhou Zhenyu , Liu Fan , Zhang Yafeng
Published: August 2020

Background: This study was set to investigate the beneficial effects of square dance on musculoskeletal system of early postmenopausal Chinese women.Methods: Chinese postmenopausal women, who had been without menstruation for 1 to 10 years from the onset of menopause were recruited from community centers for this study. A standardized structured face-to-face interview was performed to collect demographic information, life styles, personal medical history, diet and menstrual status. Subjects who had been practicing regular square dance without participated in other sports activities for more than 2 years and over 4 hours per week (usually more than 45 minutes per time and more than 5 times per week) were assigned to square dance group. Those postmenopausal women who had not participated in regular exercises (no more than 0.5 hour per week) were recruited as the sedentary control group. Bone mineral density (BMD) of spine, total hip and femoral neck was measured by using dual-energy X-ray absorptiometry (DXA). Low limb muscle strength was measured for the non-dominant leg, body flexibility was measured by a simple trunk bend-and-reach test, and body balance was evaluated using a single-stance test for the non-dominant leg. Independent two-tailed Student’s t-test was used for data analysis.Results: 152 subjects from community centers were selected for this study and divided into square dance group (n=74) and control group (n=78). The square dance subjects had higher lumbar spine BMD (P=0.01) and total hip BMD (P=0.02) than control subjects, but there was no significant difference of femoral neck BMD (P=0.48) between these two groups. Functional testing indicated that square dance subjects had higher low limb muscle strength (P<0.01) and longer single-stance time (P=0.02) than the control subject, but there was no significant difference in trunk bend-and-reach (P=0.12) between these two groups.Conclusion: Our results show that postmenopausal Chinese women can get beneficial effects, like higher BMD, stronger low limb muscle and improved body balance ability on musculoskeletal system by participating in square dance regularly.