bluuebunny/crossref_metadata_2025 huggingface dataset:
Prevention Services via Public Long-term Care Insurance can be Effective Among a Specific Group of Older Adults: A City Claim Data Analysis
Authors: Ito Tomoko , Mori Takahiro , Shimafuji Natsumi , Iijima Katsuya , Yoshie Satoru , Tamiya Nanako
Published: October 2020

BackgroundTo evaluate the effects of prevention services provided by long-term care insurance (LTCI) for older adults who require support from LTCI in Kashiwa City, Japan MethodsWe conducted an analysis using the following population-based longitudinal data in Kashiwa City between April 2012 and March 2015: Data of National Health Insurance and LTCI claims, the survey for certification of LTCI, the register, and premium tier classification. All data was linked using the pre-assigned anonymous identifying numbers. We analyzed the Cox regression model using the time for the deteriorations of long-term care levels as an outcome and the use of preventive care services as the primary exposure among participants aged 75 years or older, who had either support levels 1 or 2 at the beginning of this analysis. The study was further stratified by both age and initial support level. ResultsThe final analysis included 1,289 participants. The primary result showed, among all participants, that preventive service was not effective (hazard ratio 0.96, 95% confidence interval 0.78-1.19). In our sub-analysis, the preventive service was effective in avoiding deteriorations only among those aged 85 and older with support level 1 (HR 0.65, 95% CI 0.43-0.97) out of four groups.ConclusionsThe preventive services of LTCI in Kashiwa City showed a significant effect on the deterioration among subjects aged 85 or older, whose disabled level were low (support level 1). Our results suggest that the prevention services provided by LTCI may not be effective for all older individuals; to provide these services efficiently, local governments, as insurers of LTCI, will need to identify the specified groups that may benefit from the preventive services.
Serum Uric Acid Showed U-shaped Relationship with All-Cause Mortality and Cardiovascular Mortality in High Atherosclerosis Risk Patients: ASSURE Study
Authors: Cang Yan , Xu Shaojie , Zhang Jinying , Chen Zijun , Wang Keke , Ju Jingyi , Li Jue , Xu Yawei
Published: October 2020

Background: Previous studys have demonstrated association between hyperuricemia and cardiovascular disease (CVD), and Framingham study has confirmed patients with high atherosclerotic risk (HAR) had worse prognosis. But after controlling other traditional atherosclerotic risks, the association between serum uric acid (SUA) and all-cause mortality, cardiovascular mortality remains controversial, especially in HAR patients.Objective: The aim of study was to reveal the relationship with SUA and all-cause mortality, cardiovascular mortality in HAR patients.﻿Methods: The multi-center cohort study comprised 3,640 participants (1927male, 1713 female),whose mean age was 60.2±10.4 years andmean follow-uptimewere 68.85±11.37 months. Factors related to cardiovascular mortality and all-cause mortality, major adverse cardiac events in-hospital during follow-up were tested by multivariate Cox regression analysis and log-rank test. Restricted cubic splines with knots were used to explore theshape of dose-response relationship with SUA levels and Hazard risk (HR) of all-cause and CVD mortality.Results：The study showed SUA presented U-shaped relationship with all-cause and cardiovascular mortality. HR of all-cause mortality with hyperuricemia and hypouricemia was 2.11, 95% CI(1.61-3.07), and 2.05, 95% CI(1.35-2.90), respectively. HR of Cardiovascular mortality was 2.42, 95% CI (1.61-3.12), and 1.95, 95% CI(1.29-2.90), respectively. Conclusion：Abnormal SUA levels maybe significant and independent risk factors for all-cause and cardiovascular mortality. Routine SUA evaluation and intensive management are pressing needed, especially in HAR patients.
Therapeutic potential of human induced pluripotent stem cells and renal progenitor cells in experimental chronic kidney disease 
Authors: Ribeiro Patrícia de Carvalho , Lojudice Fernando Henrique , Fernandes-Charpiot Ida Maria Maximina , Baptista Maria Alice Sperto Ferreira , Araújo Stanley de Almeida , Mendes Gloria Elisa Florido , Sogayar Mari Cleide , Abbud-Filho Mario , Caldas Heloisa Cristina
Published: October 2020

BackgroundChronic Kidney Disease (CKD) is a global public health problem. Cell therapy using pluripotent stem cells represents an attractive therapeutic approach for the treatment of CKD.MethodsWe transplanted Mitomycin C (MMC)-treated human induced pluripotent stem cells (hiPSCs) and renal progenitor cells (RPCs) into a CKD rat model system. The RPCs and hiPSCs cells were characterized by immunofluorescence and qRT-PCR. Untreated 5/6 nephrectomized rats were compared to CKD animals receiving the same amount of MMC-treated hiPSCs or RPCs. Renal function, histology and immunohistochemistry were evaluated 45 days post-surgery. ResultsWe successfully generated hiPSCs from peripheral blood and differentiated them into RPCs expressing renal progenitor genes (PAX2, WT1, SIX2, and SALL1) and podocyte-related genes (SYNPO, NPHS1). RPCs also exhibited reduced OCT4 expression, confirming the loss of pluripotency. After cell transplantation into CKD rats, the body weight change was significantly increased in both hiPSC and RPC groups, in comparison with the control group. Creatinine clearance (CCr) was preserved only in the hiPSC group. Similarly, the number of macrophages in the kidneys of the hiPSC group reached a statistically significant reduction, when compared to control rats. Both treatments reduced positive staining for the marker α-smooth muscle actin. Histological features showed decreased tubulointerstitial damage (interstitial fibrosis and tubular atrophy) as well as a reduction in glomerulosclerosis in both iPSC and RPC groups.ConclusionsIn conclusion, we describe that both MMC-treated hiPSCs and RPCs exert beneficial effects in attenuating CKD progression. Both cell types were equally efficient to reduce histological damage and weight loss caused by CKD. hiPSCs seems to be more efficient than RPCs, possibly due to a paracrine effect triggered by hiPSCs. These results demonstrate that the use of MMC-treated hiPSCs and RPCs improve clinical and histological CKD parameters, avoided tumor formation, and therefore may be a promising cell therapy strategy for CKD.
Using a Physician Survey to Estimate the Economic Burden of Fibromyalgia in China
Authors: Furnback Wesley , Chen Feifei , Li Jim , Wang Bruce CM , Liang Dongfeng
Published: October 2020

Background: Fibromyalgia (FM) is a chronic pain disorder with a global prevalence estimated to be between 2 and 3%. In addition to the chronic pain incurred by patients, FM is commonly associated with comorbidities and complications such as depression, anxiety, and sleep disturbances. This study estimates the economic burden of patients with FM in China using a physician survey. Methods: A burden of illness model was constructed using a micro-costing approach to estimate the direct cost associated with FM patients in China. FM-related comorbidities of anxiety, depression, and sleep disturbance were included in the model. Treatment utilization and costs for FM and FM-related comorbidities were included as well as FM-related healthcare resource utilization (physician visits, hospitalizations, blood tests, and radiologic tests). FM treatments included nonsteroidal anti-inflammatory drugs, pregabalin, duloxetine, amitriptyline, tramadol, Chinese medicine, physiotherapy, and acupuncture. The model leveraged the results of a physician survey, which targeted 6 rheumatologists and pain experts each with 5-10 FM patients per month in China. All costs are presented in Renminbi (¥) using spot exchange rates as of May 1, 2020.Results: From the physician survey, the prevalence rate of FM in China was estimated to be 2.8% with 75.8% as female. The economic model estimated the annual per patient direct medical cost of FM to be ¥17,377. Within these costs, FM-medication and treatment costs (¥11,216), healthcare resource utilization (¥4,297), and costs for medications treating FM-related comorbidities (¥1,863) were the highest contributors. Healthcare resource utilization costs were driven by physician visits (¥2,787) followed by radiographic tests (¥808), blood tests (¥508), and hospitalizations (¥194). Conclusion: The prevalence and gender distribution of FM patients in China is similar to those of other countries. The economic model estimates patients with fibromyalgia in China to incur significant economic costs.
Socio-Economic Related Inequalities in The Utilization of Family Planning Services Among Women in Zambia
Authors: Ndhlovu Simang'aliso , Bulawayo Maio , Mweemba Chris , Hangoma Peter
Published: October 2020

Background: While a large literature documents inequalities in healthcare utilization in Zambia, and the rest of sub-Saharan Africa, there has been limited focus on the examination of inequalities in family planning use and in general has increased, health inequalities persist. Similarly, despite the increase in utilization of family planning services from 15% in 1992 to 48% in 2018, the increase has not been equally shared in the population. We examine drivers of socio-economic related inequalities in utilization of family planning services among women of childbearing age in Zambia. Methods: Using secondary data from the 2014 Zambia Demographic and Health Survey (ZDHS), concentration curves and indices are applied to examine how pro-poor and pro-rich the distribution of family planning is. A Blinder-Oaxaca decomposition analysis is conducted to decompose the rural-urban differences in the utilization of family planning services among women of reproductive age. Results: Our findings show that less than half (45%) of the 12,498 respondents used family planning. Use of family planning services was unequally concentrated on the well-off (CI=0.590, P=0.055). The results are mainly driven by inequalities in rural areas (CI=0.4009, P=0.0730) as the distribution of family planning use in urban areas is more equal (CI=0.049, P=0.159). In addition to family planning use being more unequal in rural areas, the proportion of women who use family planning services is 5.16 percentage points lower than in urban areas. The factors accounting for the gap between rural and urban use of family planning, with a tendency to increase it, include wealth (54.79%), tertiary education (79.46%) and age-group of 45-49 years (53.68%). Some factors act to moderate, or reduce this gap and have negative contribution on family planning use. These include women with 7 and more children (-48.22%), being married (-43.45%), primary education (-33.93%) and middle wealth group (-43.75%). Conclusion: Despite progress in the utilisation of family planning services, socioeconomic inequalities have persisted, primarily in rural areas. Interventions to increase family planning use should aim at addressing rural socioeconomic disadvantage, with programs targeting poor women and those with low levels of education. Narrowing the rural-urban gap in family planning use should focus on improving wealth and education of rural women.
Costing the Outpatient Rehabilitation Services: Time-Driven Activity Based Costing Approach
Authors: Mohammadpour Farzaneh , Basakha Mehdi , Kamal Seyed Hossein Mohaqeqi , Azari Nadia
Published: October 2020

Bachground: Considering the necessity of health services costing, the aim of this study is to calculate the cost of rehabilitation services in an outpatient rehabilitation clinic in Tehran, Iran.Methods: The data for this study were categorized as financial data and information about the process of rehabilitation services. The first category was extracted from the financial documents and the second one is obtained by observation of patient flow and interviewing the clinic staff in 2016. The cost of rehabilitation services has been estimated using the time-driven activity-based costing approach.Results: The findings show that the cost of physical occupational therapy in the Asma rehabilitation center was $18.79 per unit of service. This amount for speech therapy services was $17.23 to $19.40, taking into account the difference in the quality of the service delivered. The cost of mental health occupational therapy service was also between $19.46 and $23.57. Comparing the cost of these services with their government’s tariffs makes it clear that there is a huge gap.Conclusion: The limited number of patients referred to the center has made the cost of one unit of rehabilitation services much higher than their official tariffs. This is true for almost all similar institutions and makes the profitability of small rehabilitation institutions extremely unstable. Therefore, proper marketing for rehabilitation services by promoting patient referral links with larger healthcare centers and the formation of integrated rehabilitation complexes can play a significant role in their profitability.
Assessing the Influence of Parental Anxiety on Child Anxiety During the COVID-19 Pandemic in the United Arab Emirates
Authors: Saddik Basema , Hussein Amal , Albanna Ammar , Elbarazi Iffat , Al-Shujairi Arwa , Sharif-Askari Fatemeh S. , Temsah Mohamad Hani , Stip Emmanuel , Hamid Qutayba , Halwani Rabih
Published: October 2020

Background: Studies have investigated the psychosocial impact of infectious disease outbreaks in adults; however, there is limited information on the mental health impact of the COVID-19 pandemic on children and the general UAE community. The aim of this study was to explore anxiety levels among parents, teachers and the general community amid the COVID-19 pandemic in the UAE, as well as to identify emotional and anxiety disorders in children. Methods: Using a web-based cross-sectional survey we collected data from 2,200 self-selected, assessed volunteers. Demographic information, knowledge and beliefs about COVID-19, generalized anxiety disorder (GAD) using the (GAD-7) scale , emotional problems in children using the strengths and difficulties questionnaire (SDQ), worry and fear about COVID-19, coping mechanisms and general health information were collected. Results: The overall prevalence of GAD in the general population was 71% with younger people (59.8%) and females (51.7%) reporting highest levels of anxiety. Parents who were teachers reported the highest percentage of emotional problems in children (26.7%). Multivariate logistic regression for GAD-7 scores showed that being female, reporting high levels of worry associated with COVID-19, intention to take the COVID-19 vaccine and smoking were associated with higher levels of anxiety. Multivariate logistic regression for SDQ showed that parents with severe anxiety were seven times more likely to report emotional problems in their children than less anxious parents.Conclusions: This study is among the first to report the psychological impact of COVID-19 among adults and children in the UAE, and to highlight the significant association between parental and child anxiety. Findings suggest the urgency for policy makers to develop effective screening and coping strategies for parents and especially children.
Clinical Features Associated with the Efficacy of Chemotherapy in Patients with Glioblastoma (GBM): A Population-based Study
Authors: Wen Jieqiong , Chen Wanbin , Zhu Yayun , Zhang Pengbo
Published: October 2020

BackgroundGlioblastoma (GBM) is a highly malignant brain tumor with poor survival and prognosis. Randomized trials have demonstrated that chemotherapy improves survival in patients with GBM. This study aims to examine the clinical characteristics that are potentially associated with the efficacy of chemotherapy and the risk factors of GBM.MethodsA total of 25,698 patients diagnosed with GBM were identified between 2004 and 2015 from the Surveillance, Epidemiology, and End Results (SEER). The clinical and demographic variables between groups were examined by Student's t-test and Pearson's chi-squared test. GBM-specific survival (GBMSS) and overall survival (OS) were evaluated using the Kaplan-Meier method with the log-rank test. Univariable and multivariable analyses were also performed using the Cox proportional hazard model to identify statistically significant prognostic factors.ResultsPatients who received chemotherapy had better overall survival (median OS 13 vs. 3 months, HR=1.9224, 95%CI 1.8571-1.9900, p<0.0001) and better GBMSS (median GBMSS of 12 vs. 3 months, HR=1.9379, 95%CI 1.8632-2.0156, p<0.0001) compared with patients who did not. Further subgroup analysis revealed that among patients who underwent chemotherapy, those who were younger, with the well-differentiated tumor, with a supratentorial tumor, received surgery or radiotherapy had both improved OS and GBMSS. Age, race, tumor grade, tumor location, tumor size, and treatments were identified as independent prognostic factors by multivariable analyses for patients with glioblastoma. ConclusionPatients with GBM who were younger (<65 years), with the well-differentiated tumor, underwent surgery or radiotherapy can benefit more from chemotherapeutic regimens. Age, race, tumor size, tumor location, tumor grade, surgery, radiotherapy, and chemotherapy were factors associated with the prognosis of patients with GBM.
Efficacy and Safety of Apatinib in Patients with Recurrent or Refractory Melanoma
Authors: Yuan Shumin , Fu Qiang , Ren Yingkun , Li Zhimeng , Wang Huijuan , Zhang Xiaojie , Huang Hao , Yang Yonghao , Shang Yiman , Gao Quanli , Wang Zibing
Published: October 2020

Background: Prognosis of patients with metastatic malignant melanoma is very poor and partly due to high resistance to conventional chemotherapies. The study’s objectives were to assess the activity and tolerability of apatinib, an oral small molecule anti-angiogenesis inhibitor, in patients with recurrent advanced melanoma.Methods: This was a single-arm, single-center phase II trial. The primary endpoint was progression-free survival (PFS) and the secondary endpoints were objective response rate (ORR), disease control rate (DCR), and overall survival (OS). Eligible patients received at least one first-line therapy for advanced melanoma and experienced recurrence. Apatinib (500 mg) was orally administered daily. Trail registration: Clinical Trials, ID: NCT03383237. Registered on 24 December 2017. URL of trail registry record: https://register.clinicaltrials.gov. Results: Fifteen patients were included in the analysis. The median PFS was 4.0 months. There were two major objective responses, for a 13.33% response rate. Eleven patients had stable disease, with a DCR of 86.67%.The median OS was 12.0 months. The most common clinically significant grade 3 or 4 toxicities included hypertension and canker sore. No treatment-related deaths occurred.Conclusions: Apatinib showed antitumor activity as a second or first-line therapy in patients with malignant melanoma. The toxicity was manageable.
Obstetric and Neonatal Outcomes in Women with Pregnancy Associated Cancer: A Population-based Study in Lombardy, Northern Italy
Authors: Esposito Giovanna , Franchi Matteo , Dalmartello Michela , Scarfone Giovanna , Negri Eva , Parazzini Fabio , Vecchia Carlo La , Corrao Giovanni
Published: October 2020

Background: Pregnancy associated cancer (PAC) may lead to adverse obstetric and neonatal outcomes. This study aims to assess the association between PACs and adverse perinatal outcomes [i.e. labor induction, iatrogenic delivery, preterm birth, small for gestational age (SGA) newborn, low Apgar score, major malformations, perinatal mortality] in Lombardy, Northern Italy. Methods: This population-based historic cohort study used the certificate of delivery assistance and the regional healthcare utilization databases of Lombardy Region to identify beneficiaries of National Health Service who delivered between 2008 and 2017. PACs were defined through oncological ICD-9-CM codes reported in the hospital discharge forms. Each woman with PAC was matched to four women randomly selected from those cancer-free (1:4). Log-binomial regression models were fitted to estimate crude and adjusted prevalence ratio (aPR) and the corresponding 95% confidence interval (CI) of each perinatal outcome among PAC and cancer-free women. Results: Out of the 657,968 deliveries, 831 PACs were identified (1.26 per 1000). PAC diagnosed during pregnancy was positively associated with labor induction or planned delivery (aPR=1.80, 95% CI: 1.57-2.07), cesarean section (aPR=1.78, 95% CI: 1.49-2.11) and premature birth (aPR=6.34, 95% CI: 4.59-8.75). No association with obstetric outcomes was found among PAC diagnosed in the post-pregnancy. No association of PAC, neither during pregnancy nor in post-pregnancy was found for SGA (aPR=0.71, 95% CI: 0.36-1.35 and aPR=1.04, 95% CI: 0.78-1.39, respectively), but newborn among PAC women had a lower birth weight (p-value<0.001). Newborns of women with PAC diagnosed during pregnancy had a higher risk of borderline significance of a low Apgar score (aPR=2.65, 95% CI: 0.96-7.33) as compared to cancer-free women. Conclusion: PAC, especially when diagnosed during pregnancy, is associated with iatrogenic preterm delivery, compromising some neonatal heath indicators.
Acute Kidney Injury in Children with COVID-19
Authors: kari Jameela A , Shalaby Mohamed , Albanna Amr S , Alahmadi Turki , Alherbish Adi , Alhasan Khalid A
Published: October 2020

Background: Acute kidney injury (AKI) is a complication of coronavirus disease 2019 (COVID-19). The reported incidence of AKI, however, varies among studies. We aimed to evaluate the incidence of AKI and its association with mortality and morbidity in children infected with severe acute respiratory distress syndrome coronavirus 2 (SARS-CoV-2) who required hospital admission.Methods: This was a multicenter retrospective cohort study from three tertiary centers, which included children with confirmed COVID-19. All children were evaluated for AKI using the Kidney Disease Improving Global Outcomes (KDIGO) definition and staging. Results: Of 89 children included, 19 (21%) developed AKI (52.6% stage I). A high renal angina index score was correlated with severity of AKI. Also, multisystem inflammatory syndrome in children (MIS-C) was increased in children with AKI compared to those with normal kidney function (15% vs 1.5%). Patients with AKI had significantly more pediatric intensive care admissions (PICU) (32% vs. 2.8%, p< 0.001) and mortality (42% vs. 0%, p< 0.001). However, AKI was not associated with prolonged hospitalization (58% vs. 40%, p=0.163) or development of MIS-C (10.5% vs. 1.4%, p=0.051). Residual renal impairment at discharge occurred in 9% of patients. This was significantly influenced by the presence of comorbidities, hypotension, hypoxia, heart failure, acute respiratory distress, hypernatremia, abnormal liver profile, high C-reactive protein, and positive blood culture.Conclusions: AKI occurred in one-fifth of children with SARS-CoV-2 infection requiring hospital admission, with one-third of those requiring PICU. AKI was associated with increased morbidity and mortality, and residual renal impairment at time of discharge.
Trichomonas Vaginalis as A Risk Factor for Human Papillomavirus: A Study With Women Undergoing Cervical Cancer Screening
Authors: Belfort Ilka Kassandra Pereira , Cunha Ana Paula Almeida , Mendes Francisco Pedro Belfort , Galvão-Moreira Leonardo Victor , Lemos Renata Gaspar , Costa Lucas Henrique de Lima , Monteiro Pablo , Ferreira Mariele Borges , Santos Gerusinete Rodrigues Bastos dos , Costa Joyce Leal , Brito Luiz Gustavo Oliveira , Brito Luciane Maria Oliveira , Vidal Flávia Castelo Branco , Monteiro Sally Cristina Moutinho
Published: October 2020

BackgroundHuman papillomavirus (HPV) and Trichomonas vaginalis (TV) infections are the most common STIs. The latter has contributed to a variety of adverse outcomes for both sexes. Moreover, in Brazil, epidemiological studies on patients with STIs are limited. Therefore, this study aimed to determine the prevalence of TV and its association with HPV in women undergoing cervical cancer screening. MethodsWomen with a normal cervix were recruited from a community-based cervical cancer screening program. Gynecological examinations were conducted and questionnaires were provided. Vaginal canal and uterine cervix samples were collected and tested for the presence of TV and HPV DNA. ResultsThe overall prevalence of HPV DNA was 45.68%; among these, 27.1% had a co-infection with TV (p = 0.001). The presence of TV was associated with an increased risk of HPV (p = 0.0001) and previously identified cytological changes (p = 0.0001). ConclusionsWe concluded that a TV infection is associated with an HPV infection of the cervix as well as with the cervical cytological abnormalities. Further studies could reveal the mechanisms by which these two organisms interact at the cellular level, with control for shared behavioral risk factors. This research is in agreement with Resolution No. 466/2012 of the National Health Council and has the Research Ethics Committee of the Hospital Universitário Presidente Dutra, from Universidade Federal do Maranhão, under opinion number 76328917.5.0000.5086.
Low pH alleviated salinity stress in ginger seedlings by enhancing light efficiency and equilibrium of mineral elements
Authors: Yin Fengman , Zhang Shanying , Cao Bili , Xu Kun
Published: October 2020

BackgroundSalt stress is one of the abiotic stresses that affect plant growth, and it mainly reduces the biomass of plants by affecting their photosynthesis. However, little is known about the mechanisms by which low pH improves plant growth under salt stress. The effects of low pH on photosynthesis, chlorophyll fluorescence and mineral content in ginger (Zingiber officinale Roscoe) leaves under salt stress were investigated.ResultsIn this study, we found that the plant height and fresh weight, photosynthesis parameter (Pn, Gs, WUE and Tr), pigment concentration, fluorescence (qP, ΦPSII, Fv/Fm), Photosynthetic enzyme (fructose 1,6-diphosphatase (FBPase), ribulose-1,5-bisphosphate carboxylase (Rubisco), fructose 1,6-bisphosphate aldolase (FBA)), sugar metabolism and mineral content were significantly decreased under salt stress, but these parameters were all recovered by low pH. Meanwhile, low pH reduced the content of Na, while enhanced the content of K, Mg, Fe, Ca and Zn in ginger seedling leaves under salt stress. The observation of the ultrastructure of ginger seedlings under salt stress also showed that low pH can alleviate the damage of ginger seedlings to the complete structure and chloroplast.ConclusionsOur results suggested that low pH could enhance salt tolerance by improving photosynthetic efficiency and promoting absorption mineral.
Analysis of the Mixed Effects Regression Model for Clustered Count Response Data
Authors: Aguade Aragaw Eshetie , Begari Muniswamy
Published: October 2020

Background

The Poisson regression model is useful to analyze count data, but, when the observations are correlated the Poisson estimate will be biased. Whereas, when the over-dispersion and heterogeneity problems occur the imposition of the Poisson model underestimate the standard error and overestimate the significance of the regression parameters. Therefore, the objective of this paper was to develop a test statistic to model and predict clustered count response data via application and simulation data.
Methods

This paper concentrated on the clustered count data model to take into account heterogeneity. Accordingly, we developed a score test based on the multilevel Poisson model for testing heterogeneity with the alternative Poisson regression model. In addition, for the model application, we used the EDHS children`s data. Therefore, to evaluate the proposed model, we used both simulation and application data.
Results

Simulation results showed that the proposed score test has high power to predict and used to control heterogeneity between groups. Oromia, Amhara, and SNNPR are among the regions with the highest child mortality rates (Table 1). The results indicated that women who made marriage a mean age of 16 years and gave birth for the first child a mean age of 18 years and 8 months. Table 1 showed that 81% of all child deaths have recorded in rural areas. 78% of child families were illiterate, as a result, 75% of children don't have access to latrines and drinking water. Rivers and open-sources waters are the common sources of drinking water which comprised 79% of the total water supply. Therefore, from the research finding, it is possible to conclude that most child mortality is due to scarcity of water.
Conclusion

The Power of test estimates indicated that the proposed method was better than the existing models. All covariant and dummy explanatory variables have a significant effect on the deaths of children. Hence, the multilevel Poisson model results indicated that there exist high variability among regions for the deaths of children. Therefore, this work suggested that the applications of the random-effects model provided a simple and robust means to predict the count response data model.
Estimation of Protein and Productive Efficiency Profile of Locally Produced Oyster Mushroom (Pleurotus Ostreatus) in Broiler
Authors: Ullah Muhammad Irfan , Ijaz Muhammad Umar , Hussain Ghulam , Faisal Muhammad Naeem , Rasul Azhar , Bukhari Shazia Anwer , Mustafa Imtiaz , Anwar Haseeb
Published: October 2020

Background: Pleurotus ostreatus (Oyster) is a worldwide used mushroom, known to have a wide range of nutrients. Effects of the ethanolic and aqueous extracts of Oyster and its isolated proteins on the production profiles and bio health markers in broiler birds were evaluated in the present research. Methods: Four hundred and twenty, day-old Ross-308 broiler birds were distributed into seven groups with sixty number of birds in each group (N=60). Each group was divided into three subgroups with twenty number of birds in each subgroup (N=20). The first group was selected as control (CONT) with no treatment and other six groups were supplemented orally with the mushroom protein at a dose of 200 (Pr200) and 400mg/Kg BW (Pr400), an aqueous extract of mushroom at a dose of 200 (Aq200) and 400mg/Kg BW (Aq400) and ethanolic extract of mushroom at a dose of 200 (Eth200) and 400mg/Kg BW (Eth400) respectively. On day 28th of the experiment, 1st sub-group of each group was evaluated for cell-mediated immunity by assessing the lymphoproliferative reaction to Phytohemagglutinin-P (PHA-P; Toe web assay) and the humoral immune reaction was evaluated in the 2nd subgroup of each group by antibody reaction to sheep red blood cells (sRBCs; Hemagglutination assay). On day 42, serum was separated by slaughtering (decapitation) all the birds and evaluated for the oxidative stress, lipid profile, blood glucose level, and immune parameters. One-way analysis of variance (ANOVA), Tuckey range tests, and geometric mean titer (GMT) was used to statistically analyze the results. Results: The Eth400 birds showed significantly (P<0.05) higher cell-mediated immune response (1.1±0.04 mm) and humoral immune response (49.31±0.03 mm) in comparison with the control group. Birds supplemented with mushroom extracts and protein revealed significantly greater growth performance, maximum in Eth400, in terms of feed conversion ratios (FCR; 1.44±0.002) when compared with the control group (1.7±0.01). Conclusion: Different parameters to evaluate oxidative stress showed that the mushroom extracts and its protein reduced the oxidative stress in the treated groups being maximum in Eth400. Conclusively, the oyster mushroom has health promoting effects in term of production profile, as immunomodulator and antioxidant in broiler poultry.
Antimicrobial and Transconjugants Characteristics of Sul3 Positive Escherichia Coli Isolated from Animals in Nanning, Guangxi Province
Authors: Li Zheng , Chen Yunru , Zhang Geyin , Li Qingmei , Sun Junying , Yang Yunqiao , Si Hongbin
Published: October 2020

Background: Sulfonamides is the second most popular antibiotic in many countries, which leads to the widespread emergence of sulfonamides resistance. Sul3 is a late sulfanilamide resistance gene, whose research is relatively little. Result: 46 sul3 positive E. coli strains were separated. A total of 12 ST types were observed, and 1 of those was previously unknown type. The ST350 is the most numerous type. All isolates were multidrug-resistant E. coli, with high antimicrobial rates to penicillin, ceftriaxone sodium, streptomycin, tetracycline, ciprofloxacin, gatifloxacin and chloramphenicol (100%, 73.9%, 82.6%, 100%, 80.4%, 71.7% and 97.8%), and with at least 3 resistance genes in addition to sul3. The plasmids transfered from 3 sul3-positive isolates to C600, the most of which brought 7 antibiotic resistance and increased resistance genes to C600. The transferred sul3 gene and the plasmid that carries it could be stably inherited in the recipient bacteria for at least 20 days. Those plasmids had no effect on the growth of the recipient bacteria, but it would greatly reduce (at least 60 time) the in vitro competitiveness of the strains. Conclusions: In Nanning, these sul3-positive Escherichia coli have strong antimicrobial resistance, and the plasmid carrying sul3 has the ability to transfer multiple resistance genes, so long-term monitoring is necessary. Since the transferred plasmid will greatly reduce the in vitro competitiveness of the strain, we can consider limiting the spread of antimicrobial in this respect.
Evaluation of Definitive Chemoradiotherapy Versus Radical Esophagectomy in Clinical T1bN0M0 Esophageal Squamous Cell Carcinoma
Authors: Haneda Ryoma , Booka Eisuke , Ishii Kenjiro , Kikuchi Hirotoshi , Hiramatsu Yoshihiro , Kamiya Kinji , Ogawa Hirofumi , Yasui Hirofumi , Takeuchi Hiroya , Tsubosa Yasuhiro
Published: October 2020

Background: The standard treatment for patients with clinical T1bN0M0 esophageal squamous cell carcinoma is radical esophagectomy. Definitive chemoradiotherapy is regarded as a treatment option, and good clinical outcome of this treatment has been reported. This study compared the efficacy of definitive chemoradiotherapy with radical esophagectomy.Methods: From January 2011 to December 2019, this study enrolled 68 consecutive patients. Patients were classified into two groups whether treated by surgery or definitive chemoradiotherapy. Survival outcome were compared and subsequent therapies after recurrence were also investigated.Results: Surgery was performed to 39 patients, and 29 patients received definitive chemoradiotherapy. No significant difference was noted in overall survival between two groups. However, the rate of 5-year recurrence free survival was significantly lower in definitive chemoradiotherapy group than that of surgery group (91.1% vs. 62.7%, Hazard ratio 3.976, 95% Confidence interval 1.076-14.696, p = 0.039). Patients who had local recurrence after definitive chemoradiotherapy received endoscopic submucosal dissection or photodynamic therapy as salvage therapies, and resulted in no disease progression and a good prognosis.Conclusions: Definitive chemoradiotherapy may become a promising alternative therapy comparable with radical esophagectomy in patients with clinical T1bN0M0 esophageal squamous cell carcinoma. Early detection of recurrence by frequent follow-up after definitive chemoradiotherapy is important to control disease within local recurrence, and salvage therapy for local lesions could contribute to long-term survival.
Design of A Nationwide Registry-Research-Education Project for Quality Improvement: The China Heart Failure Surgery Registry (China-HFSR)
Authors: Tang Hanwei , Chen Kai , Hou Jianfeng , Huang Xiaohong , Liu Sheng , Hu Shengshou
Published: October 2020

Background: The case of cardiovascular surgeries for patients with heart failure (HF) patients is likely to increase in the future. However, little is known about its current status in the Asia Pacific Region. The China-HFSR is a national project that aims to timely obtain real-world knowledge about the cardiac surgeries in HF patients, provide the platform for clinical research, and finally properly guide the subsequent administrative measures and the effort for quality improvement efforts in China. This paper reports on the design of this database and provides an overview of the participating sites.Methods: We established a network of participating sites with an adult cardiac surgery volume of more than 100 operations per year. Heart failure patients with reduced ejection fraction (EF, <50%) are included. Clinical data, treatments, outcomes and follow up data are collected at local centers electronically, with a standardized set of variables and standard definitions, and rigorous control on data quality. Results: In total, 13,234 patient records from 94 hospitals were submitted from January 2012 to December 2016. The mean age of patients was 58.0 + 11.0 years with 26.9% female and the mean preoperative EF was 42.3 + 5.4%. Coronary artery bypass surgery is the leading procedure (61.2%, 8,090/13,234) and 90% patients (11,904/13,234) received on-pump surgery with median bypass time in 116 minutes. The overall complication rate was 10.2% (1,345/13,234) and in-hospital mortality rate was 4.1% (541/13,234). The median hospital stay was 23 days. Re-intubation (2.7%, 363/13,234), renal failure (2.2%, 294/13,234) and re-operation (3.0%, 397/13234) were the most common complications.Conclusion: China-HFSR provides a comprehensive insight into the clinical features of cardiac surgery in HF patients in China. As the database continues to expand, it will facilitate future research projects, establish benchmarking standards, and identify potential areas for prevention and quality improvements.
Impacts of interannual climate and biophysical variability on global agriculture markets
Authors: Zhao Xin , Calvin Katherine , Wise Marshall , Patel Pralit , Snyder Abigail , Waldhoff Stephanie , Hejazi Mohamad , Edmonds James
Published: October 2020

Most studies assessing climate impacts on agriculture have focused on average changes in market-mediated responses (e.g., changes in land use, production, and consumption). However, the response of global agricultural markets to interannual variability in climate and biophysical shocks is poorly understood and not well represented in global economic models. Here we show a strong transmission of interannual variations in climate-induced biophysical yield shocks to agriculture markets, which is further magnified by endogenous market fluctuations generated due to producers’ imperfect expectations of market and weather conditions. We demonstrate that the volatility of crop prices and consumption could be significantly underestimated (i.e., on average by 55% and 41%, respectively) by assuming perfect foresight, a standard assumption in the economic equilibrium modeling, compared with the relatively more realistic adaptive expectations. We also find heterogeneity in interannual variability across crops and regions, which is considerably mediated by international trade.
General Practitioner Residents and Patients End-of Life: Involvement and Consequences
Authors: Haardt Victoire , Cambriel Amélie , Hubert Sidonie , Tran Marc , Bruel Cédric , philippart francois
Published: October 2020

The ageing of the population and the increased number of chronicle diseases are associated with an increased frequency of end of life care in hospital settings. Residents rotating in hospital wards play a major part in their care, regardless of their specialty. General practitioner (GP) residents are confronted to such activities in hospital settings during their training.Our aim was to know how they feel about this kind of work, very different from the one they are training to do.MethodWe surveyed all GP trainees of “Ile de France”. The survey was made of 41 questions regarding advanced directives divided in 7 sections about patients’ care, communication, mentoring and repercussion on personal life. The survey was done one time, during two pre-specified days. Results:525 residents (53.8%) accepted to fulfill the survey. 74.1% of the residents thought that palliative care could have been better. Possible ways of improvements were unreasonable obstinacy (59.6%), patient’s (210 answers, 40%) relative’s communication (199 answers 37.9%). Residents also reported a lack of knowledge regarding end-of-life care specific treatments (411 answers, 79.3%) and 298 (47.2%) wished for better mentoring. Those difficulties were associated with repercussion on their private life (353 answers, 67.2%), particularly with their close relatives (55.4%). Finally, 56.2% of trainees thought that a systematic psychological follow up should be instituted for those working in “at risk” hospital settings. Conclusion:Self-perception management of dying patients by MG resident emphasize their lack of training and supervision. The feeling of suboptimal care is associated with consequences on personal life.
Estrogen Receptor-negative/progesterone Receptor-positive and Her-2 Negative Breast Cancer Might No Longer Be Classified as Hormone Receptor Positive Breast Cancer
Authors: Zheng Hongjuan , Ge Chenyang , Lin Haiping , Wu Lunpo , Wang Qinghua , Zhou Shishi , Tang Wanfen , Zhang Xia , Jin Xiayun , Xu Xifeng , Hong Zhongwu , Fu Jianfei , Du Jinlin
Published: October 2020

Background: The estrogen receptor (ER)-negative/progesterone receptor (PR)-positive (sPR positive) phenotype is an infrequent and independent biological entity. However, the prognosis of patients with sPR positive and her-2 negative phenotype is still controversial, and it is not always easy to decide treatment strategies for them.Methods: Patients during 2010–2014 were identified from Surveillance, Epidemiology, and End Results (SEER) database. The Kaplan-Meier method was used to evaluate cancer-specific survival (CSS). The propensity score matching (PSM) method was used to balance differences of characteristics in groups. The Life-Table method was used to calculate 5-year CSS rates and the annual hazard rate of death (HRD). Results: A total of 97,527 patients were included, and only 745 (0.76%) patients were sPR positive phenotype. The majority of sPR positive breast cancer were basal-like subtype. Survival analysis showed that the sPR positive breast cancer had similar prognosis comparing to ER-negative/PR-negative (dHR negative) breast cancer, and had the highest HRD during the initial 1-2 years of follow-up, then maintained the HRD of almost zero during the late years of follow-up. Conclusions: The patients with sPR positive and her-2 negative breast cancer, similar to dHR negative breast cancer, had a worse survival, and could benefit from chemotherapy significantly. However, the escalating endocrine therapy was not recommended for sPR positive patients. The patients with sPR positive should be excluded from future clinical trials concerning endocrine therapy.
Long non-coding RNA FTX predicts a poor prognosis of human cancers: a meta-analysis
Authors: Chen Weiwei , Li Yuting , Guo Liliangzi , Zhang Chenxing , Tang Shaohui
Published: October 2020

Background
Several studies assessed the relationship between FTX expression level and clinicopathological features and survival outcomes in patients with cancer, but these results were conflicting. This meta-analysis aimed to synthesize existing data to clarify the association of FTX with prognosis of cancers.
Methods
Electronic databases of PubMed, Embase, Cochrane library, Web of Science, Chinese CNKI, and the Chinese WanFang databases were used to search for relevant studies. Role of FTX in cancers was evaluated by pooled odds ratios (ORs) and hazard ratios (HRs) with 95% confidence intervals (CIs).
Results
In total, 11 studies compromising 1210 participants including colorectal cancer (CRC), hepatocellular carcinoma (HCC), gastric cancer (GC), renal cell carcinoma (RCC), osteosarcoma (OSC), and glioma, were enrolled in this analysis. The meta-analysis showed that high FTX expression was associated with lymph node metastasis, distant metastasis, tumor size and TNM/clinical stage. More importantly, the pooled results from survival analysis revealed that there was a significant correlation between high FTX expression and a shorter OS in patients with HCC, CRC, GC, OSC, and glioma, and that FTX overexpression could be an independent predictive marker for shorter OS in patients with CRC, HCC, OSC, and glioma.
Conclusions
FTX may be a potential oncogene, and high FTX expression be associated with a poor prognosis in patients with CRC, HCC, OSC, and glioma.
Gastric Stump Cancer: Demanding a More Suitable Definition and TNM Staging System
Authors: Xu Jiannan , Liu Guangyao , Jin Xinghan , Wang Huijin , Zhu Lihua , Zhang Changhua , He Yulong
Published: October 2020

BackgroundThe incidence of gastric stump cancer (GSC) following resection of gastric cancer has increase. However, the definition between GSC and recurrent gastric cancer (RGC) is still being debated. This study was conducted to compare the clinicopathological characteristics and outcome for this two groups.Patients and MethodsThe investigators retrospectively reviewed patients in the Surveillance Epidemiology and End Results (SEER) databases from 1975 to 2016 to identify patients who underwent resection of gastric cancer subsequently experienced metachronous gastric cancer. GSC was defined as cancer occurring in remnant stomach of ≥10 years after gastrectomy, while RGC was defined as <10 years after gastrectomy. T-test, Pearson χ2-test and Kaplan-Meier estimator method was used in the present study.ResultsAmong the 167,747 gastric cancer patients, 1,006 (0.6%) patients were diagnosed multiple gastric cancer, 93 patients met the GSC criterion, and 282 patients met the RGC criterion. The mean time interval between the initial cancer and second cancer for GSC was 13.34 years and 4.24 years for RGC. Male gender (P=0.003), younger age (60.1 years old vs. 65.9 years old, P<0.001) developed more frequently in GSC group. The median OS in GSC group was 20.0 months compared with 16.0 months for RGC group (p=0.302). Surgery treatment or not, the median OS have statistically significant (in RGC group, 64.0 months vs. 10.0 months, P＜0.001; 33 months vs. 13 months, P=0.014 in GSC group).ConclusionIn our definition of GSC and RGC, the OS were not statistically significant and gastrectomy may be the appropriate treatment for this two groups. It may demand for a more suitable definition and TNM staging system for GSC.
Knock-Down of LRP/LR Influences Signalling Pathways in Late Stage Colorectal Carcinoma Cells
Authors: Vania Leila , Morris Gavin , Ferreira Eloise , Weiss Stefan
Published: October 2020

BackgroundThe 37kDa/67kDa laminin receptor (LRP/LR) is involved in several tumourigenic-promoting processes including cellular viability maintenance and apoptotic evasion. Thus, the aim of this study was to assess the molecular mechanism of LRP/LR on apoptotic pathways in late stage (DLD-1) colorectal cancer cells upon siRNA-mediated down-regulation of LRP/LR. MethodssiRNAs were used to down-regulate the expression of LRP/LR in DLD-1 cells which was assessed using western blotting and qPCR. To evaluate the mechanistic role of LRP/LR, proteomic analysis of pathways involved in proliferation and apoptosis were investigated. The data from the study was analysed using a one-way ANOVA, followed by a two-tailed student’s t-test with a confidence interval of 95%. ResultsHere we show that knock-down of LRP/LR led to significant changes in the proteome of DLD-1 cells, exposing new roles of the protein. Moreover, analysis showed that LRP/LR may alter components of the MAPK, p53-apoptotic and autophagic signalling pathways to aid colorectal cancer cells in continuous growth and survival. Knock-down of LRP/LR also resulted in significant decreases in telomerase activity and telomerase-related proteins in the DLD-1 cells. ConclusionsThese findings show that LRP/LR is critically implicated in apoptosis and cell viability maintenance and suggest that siRNA-mediated knock-down of LRP/LR may be a possible therapeutic strategy for the treatment of colorectal cancer.