bluuebunny/crossref_metadata_2025 huggingface dataset:
Interrelation between Defensive Mechanisms and Coping Strategies in Psychiatry Trainees in Romania: A Multi-Centric Study
Authors: Panfil Anca-Livia , Frandes Mirela , Nirestean Aurel , Hurmuz Marinela , Lungeanu Diana , Cristanovici Madalina , Lemeti Laura , Isac Andra , Papava Ion , Bredicean Cristina
Published: February 2020

Background The challenges that a professional face when working in the field of psychiatry require the development of adequate defensive and coping styles. Aims To explore the coping strategies, the defense mechanisms and their relationship among psychiatry trainees in Romania. Materials and methods A cross-sectional study was conducted to determine and to evaluate both defensive and coping styles of Romanian psychiatry trainees. DSQ-60 and COPE scales were applied to psychiatry trainees from five training centers in Romania. By applying structural equation modeling, we studied models that presumed the existence of relationships between coping strategies and defensive mechanisms. Results The results of the study indicate that defense mechanisms and task-oriented coping style were the commonly used approach by trainees in psychiatry. In addition, our findings show significantly consistent correlations (ranging from 0.2 to 0.5) between adaptive defense mechanisms and coping styles focused on the problem, or on the emotion. Similarly, the avoidant coping strategies correlated with defense styles that are not adaptive (correlations between 0.3 and 0.5). Our model presented good fit indices, X2(34) = 50.519, p < 0.001; GFI = 0.93; RMSE = 0.08. Moreover, the results indicated a weak association, r = 0.01, p < 0.001, between the two types of adaptive processes. Conclusions Our findings suggest that trainees in psychiatry present aprofile based on two independent groups of adaptation processes, namely, adaptive defenses and problem-oriented coping scales, and non-adaptive defenses and avoidant coping scales.
Diagnosing Sepsis in the Intensive Care Unit: A Retrospective Cohort Study
Authors: Denny Kerina , Lindell-Innes Ross , Heffernan Aaron , Paterson David L. , Mcnamara John F , Lipman Jeffrey
Published: February 2020

Background: Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection. In the intensive care unit (ICU), organ dysfunction is common. The challenge lies in determining when organ dysfunction can be attributed to infection. We aimed to retrospectively determine what proportion of patients commenced on antibiotics for presumed sepsis in a mixed ICU had blood-culture positive sepsis, blood-culture negative sepsis, or an aseptic mimic.Methods: One hundred antibiotic naïve ICU patients who were clinically deemed to have an infection were enrolled. Retrospective interpretation of clinical history, biochemical, and microbiological data was performed by three clinicians from the fields of intensive care and infectious disease who aimed to differentiate infective from non-infective insults.Results: There was good interrater reliability amongst clinician assessors using this approach (Krippendorf’s alpha 0.868) for the retrospective diagnosis of infection. In the examined cohort, 35 percent of patients met the criteria of blood culture positivity and an additional 41 percent of patients were assessed as having probable blood culture negative sepsis. Twenty-four percent of patients were retrospectively determined to not have had sepsis.Conclusions: Misdiagnosis of infection as a cause for organ dysfunction in the ICU is common. The false attribution of organ dysfunction to infection in the ICU has significant clinical and research implications, and highlights the need for accurate point-of-care sepsis diagnostic tools.
Scarce Health Human Resource Wastage: No work for South African Audiologists? A descriptive Survey Study.
Authors: Hlayisi Vera-Genevey
Published: February 2020

Background: In the last decade, there has been an increase in the number of unemployed health professionals in South Africa. Since the economic downfall following the international financial crisis in 2008, unemployment rates in South Africa have since been increasing and have to date reached 29.1%, the highest in the last 11 years. The current study sought to identify the challenges in obtaining and maintaining employment for audiologists in South Africa. Methods: A descriptive online survey design was used. Participants were recruited online through professional association webpages using the snowball sampling technique. All qualified audiologists registered with the Health Professionals Council of South Africa were eligible to participate. Results: A total of 219 audiologists responded to the survey however only 132 complete responses were collected. Only the results from the 132 completed questionnaires were included in the analysis. Majority of the participants (89%) were female, between the ages 25 to 34 (67%). In the first-year post-graduation, 16% of the participants were unemployed and this increased to 19% in the second-year post-graduation. In the majority (81%) of employed participants, it is worth noting that up to a fifth (19%) were working within non-audiology fields. Employment characteristics of those working in audiology fields (n=107) show that most participants were working within the public health sector (47%) and based in clinical settings (52%). The most common workplace challenges reported were remuneration (37%) followed by lack of resources (18%), workload (18%), work environment (10%), working hours (9%) and lastly, interprofessional relationships (8%). Conclusion: In South Africa, u p to 16% of audiologists are unemployed in their first-year post-graduation and this increases to 19% in the second-year post-graduation. This study’s findings are the first to document the unemployment rate of newly graduated hearing healthcare professionals in South Africa. These findings have potential to influence critical discourse on hearing healthcare human resource policies and planning, hearing healthcare labour market needs and capacity as well as hearing healthcare context and potential for growth in the South African context. Keywords: unemployment, human-resources, healthcare, audiology, economy
The time spent sitting does not always mean a low level of physical activity.
Authors: Matusiak-Wieczorek Ewelina , Lipert Anna , Kochan Ewa , Jegier Anna
Published: February 2020

Background: The problem of spending most of the day in a sitting position concerns all people, regardless of their age. Unfortunately, this trend is more and more often observed among young people. The aim of the study was to assess self-reported physical activity and time spent sitting among students of different fields of health related faculty.Methods: The study group included 216 students (22.3±1.8 years of age) of the Medical University of Lodz: physiotherapy students (n=101), pharmacy students (n=73), and dietetics students (n=42). The time spent sitting and physical activity level were assessed based on the International Physical Activity Questionnaire-long version. Results: The time spent sitting among health related faculty students was on average more than 46 hours a week (2781.8±1238.5 MET-minutes/week). Regarding all the students the pharmacy students spent most time sitting (3086.0±1032.1 MET-minutes/week), while the dietetics students spent the least (2215.7±1230.1 MET-minutes/week). Taking into account the physical activity level almost 65% of all the students were in a high category (mainly physiotherapy students). Only 1.4% of all the surveyed students were classified as the low physical activity category. Statistical analysis showed no significant differences ( P = 0.6880) between the time spent sitting and level of physical activity among all students.Conclusions: Students of medical universities spend too much hours on sitting, mostly 5-8 hours a day. Despite this, they undertake various activities due to which their level of physical activity is moderate or even high. Therefore, it cannot be unequivocally stated that there is a relationship between the time spent sitting and physical activity level.
Optimising medication management in children and young people with ADHD using a computerised test (QbTest): a feasibility randomised controlled trial
Authors: Williams Laura , Hall Charlotte L , Brown Sue , Guo Boliang , James Marilyn , Franceschini Matilde , Clarke Julie , Selby Kim , Vijayan Hena , Kulkarni Neeta , Brown Nikki , Sayal Kapil , Hollis Chris , Groom Madeleine J
Published: February 2020

Background: Medication for attention deficit hyperactivity disorder (ADHD) should be closely monitored to ensure optimisation. There is growing interest in using computerised assessments of ADHD symptoms to support medication monitoring. The aim of this study was to assess the feasibility and acceptability of a randomised controlled trial (RCT) to evaluate the efficacy of one such computerised assessment, the Quantified Behavior (Qb) Test, as part of medication management for ADHD.Methods: This feasibility multi-site RCT conducted in child and adolescent mental health and community paediatric settings recruited participants aged 6-15 years diagnosed with ADHD starting stimulant medication. Participants were randomised into one of two arms: Experimental (QbTest protocol); participants completed a QbTest at baseline and two follow-up QbTests on medication (2-4 weeks and 8-10 weeks later). Control; participants received treatment-as-usual, including at least two follow-up consultations. Measures of parent, teacher and clinician-rated symptoms and global functioning were completed at each time-point. Clinicians recorded treatment decision-making and health economic measures were obtained. Data were analysed using multi-level modelling and participants (children and parents) and clinicians were interviewed about their experiences, resulting data were thematically analysed.Results: Forty-four children and young people were randomised. Completion of study outcome measures by care-givers and teachers ranged from 52-78% at baseline to 47-65% at follow-up. Participants reported the questionnaires to be useful to complete. SNAP-IV inattention scores showed greater reduction in the intervention than the control group (-5.85, 95%CI -10.33, -1.36, p=0.01). Engagement with the intervention ranged from 100% at baseline, to 78% follow-up 1 and 57% follow-up 2. However, only 37% of QbTests were conducted in the correct time period. Interview data highlighted that the objectivity of the QbTest was appreciated by clinicians and parents. Clinicians commented that the additional time and resources required meant that it is not feasible to use QbTest for all cases.Conclusion: The trial design and protocol appear to be feasible and acceptable, but could be improved by modifying QbTest time periods and the method of data collection. With these changes the protocol may be appropriate for a full trial. Adding QbTest may improve symptom outcome as measured by SNAP-IV.Trial registration: Prospectively registered with Clinicaltrials.gov (NCT03368573, 11th December 2017, https://clinicaltrials.gov/ct2/show/NCT03368573) and retrospectively with ISRCTN (ISRCTN69461593, 10th April 2018, http://www.isrctn.com/ISRCTN69461593).
Prostaglandin insert Dinoprostone versus trans-cervical balloon catheter for out-patient labour induction: A randomised controlled trial of feasibility (PROBIT-F)
Authors: Bhide Amarnath , McCourt Christine , Barrett Barbara , Cupples Georgina , Coates Rose , Goode Rosie , Linton Sandra , Sedgwick Philip
Published: February 2020

BackgroundThe aim was to assess the feasibility of conducting a randomised controlled trial (RCT) of induction of labour comparing use of two methods in the out-patient setting.MethodsAn open-label feasibility RCT was conducted in two UK maternity units from October 2017 to March 2019. Women aged ≥16 years, undergoing Induction of labour (IoL) at term, with intact membranes and deemed suitable for out-patient IoL according to local guidelines were considered eligible. They were randomised to cervical ripening balloon catheter (CRB) or vaginal Dinoprostone (Propess). The participants completed a questionnaire and a sub-group underwent detailed interview. Health economics data were collected. Women who declined to participate were also requested to complete a decliners’ questionnaire.ResultsDuring the study period 274 eligible women were identified. 230 (83.9%) were approached for participation of whom 84 (36.5%) agreed. Of these, 38 were randomised to Propess (n=20) and CRB (n=18). The intended sample size of 120 was not reached due to restrictive criteria for suitability for out-patient IoL. The intervention as randomised was received by 29/38 (76%) women. Five of the 29 participants could not go home after intervention. Spontaneous vaginal delivery was observed in 9/20 (45%) women in the Dinoprostone group, and 11/18 (61%) women in the CRB group. Severe maternal adverse events were recorded in one woman in each group. All babies were born with good condition (5-minute Apgar score >7) and all except one (37/38, 97.4%) remained with the mother after delivery. No deaths were recorded.Full health economics data were available for 36 out of the 38 participants. 21% of women in the Dinoprostone group were re-admitted prior to diagnosis of active labour compared to 12% in the CRB group. The patient questionnaire was complete and available for analysis for 37/38 (97.4%) women. Interviews were undertaken for 21/38 women.ConclusionsA third of the approached eligible women agreed for randomisation. An RCT is not feasible using existing criteria and further modifications to the eligibility criteria for out-patient IoL would be needed to reach sufficient numbers in the current service context.
Association of total bilirubin and indirect bilirubin content with metabolic syndrome among Kazakhs in Xinjiang
Authors: Hao Hao , Guo Heng , Ma Ru-lin , Yan Yi-zhong , Hu Yun-hua , Ma Jiao-long , Zhang Xiang-hui , Wang Xin-ping , Wang Kui , Mu La-ti , Song Yan-peng , Zhang Jing-yu , He Jia , Guo Shu-xia
Published: February 2020

Background: Some studies have shown that a high level of bilirubin is a protective factor against the metabolic syndrome (MS), while a high level of transaminase is a risk factor for the MS. However, the results are inconsistent, and there are few cohort studies.Methods: Using an ambispective cohort study, 565 Kazakhs from Xinjiang, China were selected as the study subjects. The serum bilirubin and transaminase levels of the subjects were divided into quartiles, and their relationships with MS and its components were analyzed. The definition of metabolic syndrome was based on the Joint Interim Statement (JIS) diagnostic criteria.Results: The average follow-up time for the subjects was 5.72 years. 204 subjects had MS, the cumulative incidence was 36.11%, and the incidence density was 63.10/1000 person-years. Multivariate Cox regression analysis showed that the levels of total bilirubin (TBIL) and indirect bilirubin (IBIL) were negatively correlated with the occurrence of MS. Compared to the lowest quartile level (Q1), the hazard ratios of MS for levels of TBIL at the Q2-Q4 quartile were: 0.408 (0.266-0.626), 0.374 (0.244-0.572), and 0.328 (0.216-0.500) while IBIL at Q2-Q4 level showed an MS hazard ratio of 0.572 (0.374-0.875), 0.432 (0.283-0.659), 0.434 (0.289-0.653), all at a 95% confidence level. In addition, TBIL and IBIL levels were negatively correlated with increased blood pressure, waist circumference, and triglyceride levels, and their highest TBIL quartile risk (Q4) was 0.479, 0.484, and 0.498 times higher than the lowest quartile (Q1).Conclusion: Serum TBIL and IBIL levels were negatively correlated with MS and its components (blood pressure, waist circumference and triglycerides).
Intensity of pyrethroid resistance in An. gambiaes.l.before and after a mass distribution of insecticide treated nets in Kinshasa and from 11 provinces of the Democratic Republic of Congo
Authors: Wat’senga Francis , Agossa Fiacre , Manzambi Emile Z. , Illombe Gillon , Mapangulu Tania , Muyembe Tamfum , Clark Tiffany , Niang Mame , Ntoya Ferdinand , Sadou Aboubacar , Plucinski Mateusz , Li Yikun , Messenger Louisa A. , Fornadel Christen , Oxborough Richard M. , Irish Seth R.
Published: February 2020

BackgroundBetween 2011 and 2018, an estimated 134.8 million pyrethroid-treatedlong-lasting insecticidal nets (LLINs) were distributed nationwide in the Democratic Republic of Congo (DRC) for malaria control. Pyrethroid resistance has developed in DRC in recent years, but the intensity ofresistance and impact on LLIN efficacy was not known. Therefore, the intensity of resistance of Anopheles gambiae s.l. to permethrin and deltamethrin was monitored before and after a mass distribution of LLINs in Kinshasa in December 2016, and in 7sites across the country in 2017 and 11 sites in 2018.Materials and MethodsIn Kinshasa, CDC bottle bioassays using 1, 2, 5, and 10 times the diagnostic dose of permethrin and deltamethrin were conducted using An. gambiae s.l. collected as larvae and reared to adults. Bioassays were conducted in four sites in Kinshasa province six months before a mass distribution of deltamethrin-treated ITNs and then two, six, and ten months after the distribution. One site in neighboring Kongo Central province was used as a control (no mass campaign of ITN distribution during the study). Nationwide intensity assays were conducted in six sites in 2017 using CDC bottle bioassays and in 11 sites in 2018 using WHO intensity assays. A sub-sample of An. gambiae s.l. were tested by PCR to determine species composition and frequency of kdr-1014F and 1014S alleles. ResultsIn June 2016, before LLIN distribution, permethrin resistance intensity was high in Kinshasa; the mean mortality rate was 43% at the 5× concentration and 73% at the 10× concentration. Bioassays at 3 time points after LLIN distribution showed considerable variation by site and time and there was no consistent evidence for an increase in pyrethroid resistance intensity compared to the neighboring control site. Tests of An. gambiaes.l. in 7 sites across the country in 2017 and 11 sites in 2018 showed all populations were resistant to the diagnostic doses of 3 pyrethroids.In 2018, the intensity of resistance varied by site, but was generally moderate for all three pyrethroids, with survivors at ×5 the diagnostic dose. An. gambiae s.s. was the most common species identified across 11 sites in DRC. However in Kinshasa, An. gambiae s.s.(91%) and An. coluzzii (8%) were sympatric.ConclusionsModerate or high intensity pyrethroid resistance was detected nationwide in DRC and is a serious threat to sustained malaria control with pyrethroid LLINs. Next generation nets (PBO nets or bi-treated nets) should be considered for mass distribution.
When can be safely performed total knee arthroplasty following prior arthroscopy?
Authors: Ma Jin-Ning , Li Xiao-Lin , Liang Pan , Yu Sheng-Li
Published: February 2020

Background The optimal time to perform a total knee arthroplasty (TKA) after knee arthroscopy (KA) was controversial in the literature. We aimed to 1) explore the effect of prior KA on the subsequent TKA; 2) identify who were not suitable for TKA in patients with prior KA; and 3) determine the timing of TKA following prior KA. Methods We retrospectively reviewed 87 TKAs with prior KA and 174 controls using propensity score matching in our institution. The minimum followup was 2 years. Postoperative clinical outcomes were compared between groups. Kaplan-Meier curves were created with reoperation as an end point. Multivariate Cox proportional hazards regressions were performed to identify risk factors of severe complications in the KA group. The two-piecewise linear regression analysis was performed to examine the optimal timing of TKA following prior KA. Results The all-cause reoperation, revision and complication rates of KA group were significantly higher than those of control group (p<0.05). The survivorship of KA group and control group was 92.0% and 99.4% at the 2-year followup (p=0.002), respectively. Male (HR=3.2) and prior KA for anterior cruciate ligament (ACL) injury (Hazards ratio [HR]=4.4) were associated with postoperative complications in the KA group. There was a non-liner relationship between time from prior KA to TKA and postoperative complications with the turning point at 9.4 months. Conclusion Prior KA is associated with worse outcomes following subsequent TKA, especially male patients and those with prior KA for ACL injury. The optimal timing of TKA may be 9 months after prior KA. Surgeons should keep these findings in mind when treating patients who are scheduled to undergo TKA with prior KA.
Enhanced biohydrogen production from cotton stalk hydrolysate of Enterobacter cloacae WL1318 by overexpression of the formate hydrogen lyase activator gene
Authors: Zhang Qin , You Shaolin , Li Yanbin , Qu Xiaowei , Jiang Hui
Published: February 2020

Background Biohydrogen production from lignocellulose has become an important hydrogen production method due to its diversity, renewability, and cheapness. Overexpression of the formate hydrogen lyase activator ( fhlA ) gene is a promising tactic for enhancement of hydrogen production in facultative anaerobic Enterobacter . However, little work has been reported in terms of the fhlA gene cloning and expression in Enterobacter cloacae as well as the engineered strain for lignocellulose-based hydrogen production.Results The formate hydrogen lyase activator ( fhlA ) gene was cloned and overexpressed in Enterobacter cloacae WL1318, and the cumulative hydrogen production and dynamics, glucose and xylose consumption, cell growth, and soluble metabolites were analyzed in the wild and recombinant strains. The results showed that the recombinant strain significantly enhanced cumulative hydrogen production by 188% following fermentation of cotton stalk hydrolysate for 24 h, and maintained improved production above 30% throughout the fermentation process compared to the wild strain. Accordingly, overexpression of the fhlA gene resulted in an enhanced hydrogen production potential ( P ) and maximum hydrogen production rate ( R m ), as well as a shortened lag phase time ( λ ) for the recombinant strain. Additionally, the recombinant strain also displayed improved glucose (12%) and xylose (3.4%) consumption and hydrogen yield Y(H 2 /S) (37.0%) compared to the wild strain. Moreover, the metabolites and specific enzyme profiles demonstrated that reduced flux in the competitive branch, including succinic, acetic, and lactic acids, and ethanol generation, coupled with increased flux in the pyruvate node and formate splitting branch, benefited hydrogen synthesis.Conclusions The results conclusively prove that overexpression of fhlA gene in E. cloacae WL1318 can effectively enhance the hydrogen production from cotton stalk hydrolysate, and reduce the metabolic flux in the competitive branch. It’s the first attempt to engineer the fhlA gene in the hydrogen producing bacterium E. cloacae . This work provides a highly efficient engineered bacterium for biohydrogen production from fermentation of lignocellulosic hydrolysate in the future.
Incremental Prognostic Value of Echocardiography of Left Ventricular Remodeling and Diastolic Function in STICH Trial
Authors: Kim Kyung-Hee , She Lilin , Lee Kerry L. , Dabrowski Rafal , Grayburn Paul A. , Rajda Miroslaw , Prior David L. , Desvigne-Nickens Patrice , Zoghbi William A. , Senni Michele , Stefanelli Guglielmo , Beghi Cesare , Huynh Thao , Velazquez Eric J. , Oh Jae K. , Lin Grace
Published: February 2020

Aims: We sought to determine which echocardiographic markers of left ventricular (LV) remodeling and diastolic dysfunction can contribute as incremental and independent prognostic information in addition to current clinical risk markers of ischemic LV systolic dysfunction in the Surgical Treatment for Ischemic Heart Failure (STICH) trial.Methods and Results: The cohort consisted of 1511 of 2136 patients in STICH for whom baseline transmitral Doppler (E/A ratio) could be measured by an echocardiographic core laboratory blinded to treatment and outcomes, and prognostic value of echocardiographic variables was determined by a Cox regression model. E/A ratio was the most significant predictor of mortality amongst diastolic variables with lowest mortality for E/A closest 0.8, although mortality was consistently low for E/A 0.6 to 1.0. Mortality increased for E/A <0.6 and > 1.0 up to approximately 2.3, beyond which there was no further increase in risk. Larger LV end-systolic volume index (LVESVI) and E/A <0.6 and >1.0 had incremental negative effects on mortality when added to a clinical multivariable model, where creatinine, LVESVI, age, and E/A ratio accounted for 74% of the prognostic information for predicting risk. LVESVI and E/A ratio were stronger predictors of prognosis than New York Heart Association functional class, anemia, diabetes, history of atrial fibrillation, and stroke.Conclusions: Echocardiographic markers of advanced LV remodeling and diastolic dysfunction added incremental prognostic value to current clinical risk markers. LVESVI and E/A ratio outperformed other markers and should be considered as standard in assessing risks in ischemic heart failure. E/A closest to 0.8 was the most optimal filling pattern.
Hematological Inflammatory Markers in patients with clinically confirmed familial hypercholesterolemia
Authors: Vaseghi Golnaz , Heshmat-Ghahdarijani Kiyan , Shafiee Zahra , Aliyari Roghayeh , Haghjooy-Javanmard Shaghayegh , Hajian Shabnam , Sarrafzadegan Nizal
Published: February 2020

Background and aims:Familial hypercholesterolemia (FH) is an autosomal dominant genetic disorder of lipid metabolism which leads to premature cardiovascular diseases. In patients with FH, blood inflammatory markers may be disrupted; however, its extent is unclear. In this study we aimed to evaluate, the NLR: Neutrophil to lymphocyte ratio, PLR: Platelet count to lymphocyte count ratio, MPV: Mean platelet volume, RPR: Red blood cell distribution width to platelet count ratio, WBC: White blood cell, PDW: Platelet distribution width and platelets count. Methods:The study group consisted of 331 patients with FH and 260 control patients. Controls had a history of hyperlipidemia and both groups could be on pharmacotherapy or not. Results:None of the CBC inflammatory markers were not significantly difference in patients with FH than non-FH. Platelet count was significantly higher among patients with FH when compared to control patients (240.43±54.15 vs 228.52±47.37 p= 0.049*). When we used linear regression analysis, only RLR was independently associated with total cholesterol (b=0.000, p=0.13). Here we showed that CBC markers are nor different between FH and non-FH patients, however PLR is associated with cholesterol level not FH. Conclusions:Our results may show the important of high cholesterol on platelets activity and highlight the use of lipid lowering drugs in patients with hyperlipidemia.
Study of hospitalization and mortality in Korean diabetic patients using the diabetes complications severity index
Authors: Yoo Hyunju , Choo Eunjung , Lee Sukhyang
Published: February 2020

Background The prevalence of type 2 diabetes mellitus (T2DM) is expected to increase from 7.7% in 2017 to 8.4% in 2045 worldwide. Diabetes complications contribute to morbidity and mortality. To evaluate whether the diabetes complications severity index (DCSI) was associated with increased risks of mortality and hospitalization. Methods A retrospective cohort study was conducted using the National Health Insurance Database (NHID) sample cohort of 1,102,047 patients (2002–2015) in Korea. Diabetes complications were evaluated at 2 years after the new diagnosis of T2DM and during the follow-up period. The type and severity of complications were evaluated on the basis of the International Classification of Disease ninth (ICD-9) codes used in DCSI with 7 categories and 55 subcategories of complications. The Cox proportional hazard and Poisson regression models were used to evaluate the mortality and hospitalization rates. The incidence and relative risk of diabetes complications as well as the risk of mortality and hospitalization were the main outcome measures. Results A total of 27,871 patients were finally included and grouped into patients by the number of diabetic complications: none, one, and two or more. Out of total patients, 2,302 (8.26%) died during the follow-up period. Patients died in 490 (5.37%) of 9,130 with none, 659 (7.31%) of 9,015 with one, and 1,153 (11.85%) of 9,726 patients with two or more complications. The risks of mortality and hospitalization were related with DCSI linear [hazard ratio 1.13 (95% CI 1.11–1.16), relative risk 1.04 (95% CI 1.03–1.06)]. Conclusions The higher incidence and severity of diabetes complications have increased risks of mortality and hospitalization in patients with T2DM.
Early-stage multi-differentiated gastric carcinosarcoma and post-resection local recurrence: a case report
Authors: Shioya Akihiro , Kurose Nozomu , Mizutani Kenichi , Kumagai Motona , Kawaura Ken , Nakamura Naohiko , Kosaka Takeo , Motono Nozomu , Uramoto Hidetaka , Yamada Sohsuke
Published: February 2020

Background Carcinosarcoma is a rare neoplasm with a poor prognosis that is most often discovered at an advanced stage; a gastric carcinosarcoma is even rarer than carcinosarcomas originating in other organs, such as the uterus. We report our experience with an early-stage multi-differentiated gastric carcinosarcoma. Case presentation A 68-year-old male patient presented with anemia, and his fecal occult blood test was positive. An endoscopic examination was conducted which revealed a hemorrhagic, irregular, protruding lesion in the stomach. The lesion was diagnosed as an adenocarcinoma by histopathological examination of the biopsy specimen, and a segmental gastrectomy was performed. A 41 × 29 × 18 mm 3 protruding lesion was observed in the resection specimen, and histologically confirmed to be a gastric carcinosarcoma with mixed adenocarcinomatous and sarcomatous composition. Tumor invasion was limited to the submucosa. Besides the adenocarcinomatous portion, neuroendocrine differentiation and AFP-positive gastric carcinoma were present in the carcinomatous portion of the tumor; in the sarcomatous portion, chondrosarcomatous, leiomyosarcomatous, and rhabdomyosarcomatous components were observed in addition to the undifferentiated sarcomatous component. Furthermore, the tumor included SALL4-positive germ cell-like cells. Despite early-stage detection, the cancer recurred locally 14 months after tumor resection, which necessitated a total gastrectomy. At the 2-month follow-up after the total gastrectomy, the patient was alive. This patient had developed an esophageal squamous cell carcinoma and primary lung adenosquamous carcinoma, both of which were resected. Conclusions Few cases of early-stage gastric carcinosarcoma have been reported, but there are no reports of recurrence to date. Local recurrence as in this patient, and even in early-stage cases, requires cautious surveillance to check for post-resection recurrence and metastasis. The etiopathogenesis of carcinosarcoma has not yet been elucidated; however, in the present case, despite the tumor’s relatively small size, it exhibited various types of differentiation in both the carcinomatous and sarcomatous components and a proliferative germ cell-like portion, which suggests that the monoclonal origin hypothesis may be a valid theory for the carcinosarcoma.
Overexpression of CD155 associated with PD-1 and PD-L1 expression on immune cells, rather than tumor cells in microenvironment of breast cancer
Authors: Wang Ruibin , Li Yu-Chen , Zhou Quan , Lv Shu-Zhen , Yuan Ke-Yu , Wu Jiang-Ping , Zhao Yan-Jie , Song Qing-Kun , Zhu Bin
Published: February 2020

Objective This study was performed to investigate the expression status of CD155 and the association with exhausted CD4 + helper and CD8 + cytotoxic tumor-infiltrating lymphocytes (TILs) and programmed cell death-ligand 1 (PD-L1) in breast cancer microenvironment. Methods 126 breast cancer patients with invasive ductal breast cancer were recruited into this study consecutively. Immunohistochemistry was used to detect the expression CD155, PD-L1 and programmed cell death protein 1 (PD-1) on tumor-infiltrating immune cells and tumor cells in the microenvironment. Results The proportion of patients with CD155 expression was higher in triple negative breast cancer (72.7%) than Luminal A patients (22.2%, p<0.05). Patients with positive CD155 expression had higher percentage of CD4 + /PD-1 + helper TILs (30%) than patients with negative CD155 expression (21%, p<0.05). Patients with positive CD155 expression also had higher cell counts of exhausted CD4+ TILs (47 vs. 20/HPF) and unexhausted CD8+ TILs (30 vs. 17/HPF) than patients with negative expression (p<0.05). CD155 expression was correlated with an increased PD-L1 expression in immune cells, 0.8% and 0.02% immune cells expressing PD-L1 in patients with positive and negative CD155 expression, respectively (p<0.05). Conclusions CD155 was related with an inhibitory immune microenvironment of breast cancer. CD155 was associated with high proportion of exhausted CD4 + and unexhausted CD8 + TILs and high PD-L1 expression in immune cells.
Intravitreal Conbercept for choroidal neovascularisation secondary to pathological myopia in real-life setting in China
Authors: Nie Xin , Wang Yulong , Yi Hong , qiao yanbin
Published: February 2020

Background: To evaluate the 12-month efficacy and safety of intravitreal conbercept for myopic choroidal neovascularization (CNV). Methods: A retrospective, observational study. Thirty-four eyes of 34 pathologic myopic patients with CNV were treated with intravitreal conbercept (IVC) 0.5 mg with a follow up of 12 months. After the first injection, administration of conbercept followed a pro re nata (PRN) regimen. Outcomes included best corrected visual acuity (BCVA), central retinal thickness (CRT), CNV size, the total number of treatments, and adverse events. Results: The mean patient age was 55.88 ± 16.17 years, and mean eye spherical equivalent was − 8.72 ± 3.75 D. The mean number of IVC over 12 months was 2.12 ± 0.69. Overall, best-corrected visual acuity（BCVA）improved from 0.86 ± 0.33 logMAR at baseline to 0.44 ± 0.32 logMAR at month 12 ( P < 0.001 ), mean improvement of vision was 4.12 ± 2.69 Snellen lines . Mean central retinal thickness reduced from 285.9 ± 104.6 μm at baseline to 192.1 ± 97.5 μm at month 12 (P < 0.001). Mean CNV size decreased from 0.52 ± 0.38 mm 2 at baseline to 0.31 ± 0.19 mm 2 at 12 months (P < 0.05). All the 34 eyes had reduced or stable size of CNV, thirty-two eyes (94.12%) showed absence of CNV leakage at the end of the study period. No severe complications were observed. Conclusion: Intravitreal conbercept 0.5mg was safe and effective for treatment of myopic CNV over 12 months in real-life setting.
Efficacy and safety of post-scleral injection of triamcinolone acetonide for macular edema in branch retinal vein occlusion: 3 month results from a prospective randomized, controlled and open label clinical trial
Authors: Lie Hongxuan , Zhu Meidong , Li Sha , Ran Li , Meng Xiaohong , Long Yanlin , Liu Yong , Wang Yi , Li Shiying
Published: February 2020

Background: To assess the safety and efficacy of post-scleral injection of triamcinolone acetonide (TA) in macular region to treat macular edema secondary to branch retinal vein occlusion (BRVO), and compare it with intravitreal injection of TA and Ranibizumab. Methods: This is a prospective, double masked and single-center study. Thirty-six eyes, one from each participant who was diagnosed with macular edema secondary to BRVO between July 2011 and December 2014, were randomised into three groups to receive post-sclera injection of 20mg/0.05ml TA (PS-TA), intravitreal injection of 2mg TA (IV-TA) and intravitreal injection of 0.5mg Ranibuzmab (IV-Ranibizumab), respectively. Changes of retinal thickness in optical coherence tomography (OCT) in foveal (zone 1) and average macular area (1-9 zones) at month 1 and 3 from baseline were the primary outcomes. The secondary study outcomes include changes of best corrected visual acuity (BCVA) and intraocular pressure (IOP) at month 1 and 3 from baseline and profile of adverse events. Results: The mean thickness changes from the baseline in macular fovea (zone 1) were statistically significant at month 1 in IV-TA and PS-TA groups, respectively (P-value < 0.0005 and P-value = 0.032), but not in Ranibizumab group (P-value = 0.083). At month 3, the mean thickness change from the baseline in macular fovea (zone 1) was statistically significant only in IV-TA group (P-value = 0.001). There was no significant difference in the mean thickness changes in macular region (zone 1-9) from baseline to month 1 or 3 in any group. No statistically significant differences were detected across the three treatment groups in mean thickness changes in macular fovea (zone 1) nor macular region (zone 1-9), over 1 and 3 months from baseline (P-values > 0.05). No Serious Adverse Event was detected in any treatment group during the study period. Two eyes in the IV-TA group had mild elevated IOP after the injection. Conclusion: PS-TA injection near macular region is safe and effective in treating macular edema secondary to BRVO. PS-TA could reduce the incidence of intraocular hypertension significantly, and thus has the advantages of safety compared to IVTA.
Topical citicoline and vitamin B12 versus placebo in the treatment of diabetes-related corneal nerve damage: a randomized double-blind controlled trial.
Authors: Fogagnolo Paolo , Melardi Ettore , Tranchina Laura , Rossetti Luca
Published: February 2020

Purpose To evaluate the effects of topical citicoline and vitamin B12 (OMK2, Omikron Italia srl, Italy) on the corneal sub-basal plexus density (SBP) of patients with diabetes. Methods This prospective, randomized, double blind, placebo-controlled study included thirty patients with diabetic neuropathy randomised with 2:1 ratio to OMK2 or placebo 3 times daily for 18 months. At baseline and at months 4,8,12,18 patients underwent the Ocular Surface Disease Index questionnaire (OSDI), tear break-up time, evaluation of corneal and conjunctival staining, Schirmer I test, Cochet-Bonnet esthesiometry, and confocal biomicroscopy of SBP. SBP density (mm/mm2) was calculated using NeuronJ. Raw data and differences from baseline were analysed in the two groups. Results 29/30 patients concluded the study. The two groups had similar SBP at baseline; it progressively improved up to month 18 in both groups (OMK2, p<0.0001; controls, <0.0001-0.03); improvement at month 18 vs baseline was higher in OMK2 than placebo (33% vs 15%, p=0.04). A progressive amelioration of corneal sensitivity was also shown just on OMK2 group (baseline, 28±18 mm; month 18, 52±10 mm, p<0.0001). In OMK2 patients, also conjunctival staining and OSDI questionnaire improved during the study (P=0.04 and 0.05). Both treatments were well tolerated and adherence during the study was high. Conclusions OMK2 ameliorated both morphology and function of corneal nerves in patients with diabetes, thus suggesting a neuroprotective effect.
Correlation of Binocular Refractive Errors and Calculation of Intraocular Lens Power for the Second Eye
Authors: Zhang Pengcheng , Yang Yuhuan , Yan Hong , Zhang Jie , Yan Weijia
Published: February 2020

Background How to reduce the refractive error has always been a tricky problem. The aim of this study was to verify the correlation between binocular refractive errors (RE) after sequential cataract surgery and explore the individualized calculation method of intraocular lens (IOL) for the second eye. Methods This is a prospective study. One hundred eighty-eight affected eyes of 94 age-related cataract patients with sequential cataract surgery from the Department of Ophthalmology, Tangdu Hospital, china, were recruited. Complete case data of 94 patients were included for correlation analysis of binocular RE. Thereafter, data of patients with RE values greater than 0.50 diopter (D) in the first eyes were extracted and divided randomly into two groups- Group A and B. As the adjustment group, in group A we modified the IOL power for the second eyes according to 50% of the RE of the first eye, and group B was the control group without modify. The mean absolute refractive error (MARE) values of the second eyes were evaluated one month after surgery. Results The correlation coefficient of binocular RE after sequential cataract surgery was 0.760 ( P < 0.001). After the IOL power of the second eyes were adjusted, the MARE of the second eyes was 0.57±0.41 D while MARE of the first eyes was 1.18±0.85 D, and the difference was statistically significant ( P <0.001). Conclusions Binocular REs were correlated positively after sequential cataract surgery. The RE of the second eye can be reduced by adjusting the IOL power based on 50% of the postoperative RE of the first eye.
Decreased Retinal Microvasculature Densities in Pterygium
Authors: Wang¹* Feng , Ye¹²* Lin-Hong , Shi¹ Wen-Qing , Li¹ Biao , Lin¹ Qi , Min¹ You-Lan , Yuan¹ Qing , Gao Guiping , Shao¹# Yi
Published: February 2020

Purpose To investigate the retinal vascular network alterations in eyes of patients with pterygium. Method 18 left eyes from 18 female pterygium patients and 18left eyes from 18female healthy control subjectswere enrolled.Optical coherence tomography angiography(OCTA) images were generated of the superficial retinallayer (SRL) and deeper retinal layer (DRL) of the macular retina for each eye. The microvascular(MIR) and macrovascular (MAR) densities were calculated and MIR, MAR, and total MIR (TMI) density was compared in the healthycontrol and pterygium groups. Results In pterygium group,in the SRL,the vascular density in SMIR (superficial MIR), SR(superior right), IR(inferior right), R(right), SC(superficial central annuli)1, SC2 and SC3decreased significantly in the maculararea (P<.05). Furthermore, the vascular density in all those decreased regions except R, was significantly and negatively correlated with the disease course ( r=-0.6038 to -0.7762, P=0.0008), and the area size of pterygium (r=-0.6043 to -0.9508, P<0.05). For the DRL, the densityof DTMI, DMIR (deeper MIR), SR, IR, R, DC2 and DC3 decreased significantly in macular area of pterygium patients (P<.05). Furthermore, the vascular density in all those decreased regions was significantly and negatively correlated with the disease course (r=-0.6901 to -0.7795, P=0.0015), and the area size of pterygium(r=-0.6043 to -0.9563, P<0.05). No statistically significant differences and correlation was foundin other region density (|r|＜0.47, P>0.05). Conclusion OCTA findings suggested that pterygium patients present with decreased retinal MIR density, which was negatively correlated with the disease course and the area size of pterygium.
­Description of the targeted water supply and hygiene response strategy implemented during the cholera outbreak of 2017-2018 in Kinshasa, DRC
Authors: Bompangue Didier , Moore Sandra , Taty Nadège , Impouma Benido , Sudre Bertrand , Manda Richard , Balde Thierno , Mboussou Franck , Vandevelde Thierry
Published: February 2020

Background: Rapid control of cholera outbreaks is a significant challenge in overpopulated urban areas. During late-2017, Kinshasa, the capital of the Democratic Republic of the Congo, experienced a cholera outbreak that showed potential to spread throughout the city. A novel targeted water and hygiene response strategy was implemented to quickly stem the outbreak.Methods: We describe the first implementation of the cluster grid response strategy carried out in the community during the cholera outbreak in Kinshasa, in which response activities targeted cholera case clusters using a grid approach. Interventions focused on emergency water supply, household water treatment and safe storage, home disinfection and hygiene promotion. We also performed a preliminary community trial study to assess the temporal pattern of the outbreak before and after response interventions were implemented. Cholera surveillance databases from the Ministry of Health were analyzed to assess the spatiotemporal dynamics of the outbreak using epidemic curves and maps.Results: From January 2017 to November 2018, a total of 1,712 suspected cholera cases were reported in Kinshasa. During this period, the most affected health zones included Binza Météo, Limeté, Kokolo, Kintambo and Kingabwa. Following implementation of the response strategy, the weekly cholera case numbers in Binza Météo, Kintambo and Limeté decreased by an average of 57% after two weeks and 86% after four weeks. The total weekly case numbers throughout Kinshasa Province dropped by 71% four weeks after the peak of the outbreak.Conclusion: During the 2017-2018 period, Kinshasa experienced a sharp increase in cholera case numbers. To contain the outbreak, water supply and hygiene response interventions targeted case households, nearby neighbors and public areas in case clusters using a grid approach. Following implementation of the response, the outbreak in Kinshasa was quickly brought under control. A similar approach may be adapted to quickly interrupt cholera transmission in other urban settings.
MACROECONOMIC ANALYSIS OF THE EFFECTIVENESS OF TAX ECONOMIC REFORMS IN EU COUNTRIES
Authors: Marekha I. , Myrhorodska V.
Published: February 2020

The article substantiates the necessity to introduce systematic and effective tax eco-reforms in the context of resource-oriented economic development by the European Union countries. The performance and effectiveness of the reforms are estimated in relation to the main four groups of environmental taxes: energy taxes, pollution taxes,
resource taxes and transport taxes. The macroecological policy of the European Union countries is the object of the undertaken analysis. The article examines the impact of macroeconomic factors on environmental taxes across the EU, using a correlation analysis toolkit. Four groups of macroeconomic parameters were selected for analysis:
internal macroeconomic factors (nominal GDP, real GDP, inflation, business cycle stage, budget deficit, energy consumption level); external macroeconomic factors (government debt, exports, foreign direct investments); institutional macroparameters (environmental culture, shadow economy, trust in government) and fiscal macroparameters (tax culture and fiscal freedom). The economic interpretation of the obtained correlates is given.
Based on the correlation analysis, stimulators and de-stimulators of tax environmental reforms across the EU were identified. It is established that the factors that positively influence on the tax environmental reforms are the overwhelming majority of the analyzed factors. The formation of indicators of the effectiveness of tax environmental
reforms is undertaken for six countries of the Community. In particular, the analysis covers three economic leaders (Germany, the United Kingdom and France) and three leading EU countries in the field of environmental tax collection (Latvia, Greece and Slovenia). The article presents approaches to improving the assessment of the effectiveness of tax environmental reforms based on the consideration of fiscal (budget-filling) and reproductive (multiplicative) functions of environmental taxes. In this regard, the environmental tax multiplier and accelerator, as well as the GDP elasticity coefficient for environmental taxes, were calculated for the analyzed group of countries. The criteria of economic efficiency of tax eco-reforms are proposed.
Keywords: environmental taxes, macroeconomic effect, macro-environmental policy, multiplier, accelerator,
elasticity