bluuebunny/crossref_metadata_2025 huggingface dataset:
The importance of cardiorespiratory fitness and sleep duration in early CVD prevention. BMI, resting heart rate and questions about sleep patterns are suggested in risk assessment of young adults, 18-25 years.The cross-sectional Lifestyle, biomarkers and atherosclerosis (LBA) study.
Authors: Fernström Maria , Fernberg Ulrika , Hurtig-Wennlöf Anita
Published: August 2020

Background: Cardiorespiratory fitness (CRF) and sleep habits are lifestyle factors with potential to prevent cardiovascular disease (CVD). CVD is the leading cause of death worldwide, it is therefore important to establish a healthy lifestyle at young age. In the Lifestyle, biomarkers and atherosclerosis (LBA) study we have examined 834 healthy non-smoking adults, 18-25 years. The general purpose of the LBA study was to study the effect of lifestyle on traditional biomarkers known to influence CVD risk. The aims of the present study were to evaluate sleep habits of the young adult women and men participating in the LBA study, and to compare the importance of sleep habits and other lifestyle habits on clinically relevant biomarkers for CVD. Additional aim was to find easy and reliable non-invasive biomarkers to detect young adults with increased risk to develop CVD later in life. Methods: The participants have previously been examined for lifestyle factors, biomarkers and CVD risk score. They filled in a validated computerized questionnaire about their general physical and mental health. The questionnaire included questions on sleep duration and experienced quality of sleep. Results: In total 27% of the young adult participants reported difficulties to fall asleep or experiences anxious sleep with several awakenings per night. The experienced anxious sleep was not related to higher CVD risk score, but sleep quality and sleep duration was correlated. Shorter sleep duration was significantly associated to higher body mass index (BMI), body fat %, homeostasis model assessment of insulin resistance (HOMA-IR) and CVD risk. The modifiable lifestyle factor with highest odds ratio (OR) for CVD risk was CRF. Sleep duration was the second most influential lifestyle factor, more important than moderate- and vigorous physical activity (MVPA) and food habits. Correlations between CRF and heart rate (HR) (P<0.01) and HOMA-IR and BMI (P<0.01) was observed, indicating that BMI and resting HR in combination with questions about sleep patterns are easy and reliable non-invasive biomarkers to detect young adults who needs counselling about a healthy lifestyle. Conclusion: Decreased sleep duration in combination with decreased CRF, in young adults, is a serious health issue.
Treating depression with a smartphone-delivered self-help cognitive behavioural therapy for insomnia: Study protocol for a parallel group randomized controlled trial
Authors: Hui Victoria Ka-Ying , Wong Christy Yim-Fan , Ka-Yiu Eric , Ho Fiona Yan-Yee , Chan Christian S
Published: August 2020

Background

Depression is a major public health concern. Emerging research has shown that cognitive behavioural therapy for insomnia (CBT-I) is effective in treating individuals with comorbid insomnia and depression. Traditional face-to-face CBT-I encounters many obstacles related to feasibility, accessibility, and help-seeking stigma. CBT-I delivered via smartphone application could be a potential solution. This paper aims to report a protocol designed to evaluate the efficacy of a self-help smartphone-based CBT-I, compared to a waitlist control, for people with major depression and insomnia.

Methods

A two-arm parallel randomized controlled trial is conducted in a target sample of 285 non-suicidal Hong Kong Chinese older than 17 years of age with major depression and insomnia. Participants complete an online rapid screening, followed by a telephone diagnostic interview. Those who meet the eligibility criteria are randomized in a ratio of 1:1 to receive either CBT-I immediately or to a waitlist control condition. The CBT-I consists of six weekly modules and is delivered through a smartphone application proACT-S. This smartphone app has been pilot tested and revamped to improve user experience. An online randomized algorithm is used to perform randomization to ensure allocation concealment. The primary outcomes are changes over the measurement points in sleep quality, insomnia severity, and depression severity. The secondary outcomes include changes over the measurement points in anxiety, subjective health, treatment expectancy, and acceptability of treatment. Assessments are administered at baseline, post-intervention, and 6-week follow up. The recruitment is underway. Important adverse events, if any, are documented. Multilevel linear mixed model based on intention-to-treat principle will be conducted to examine the efficacy of the CBT-I interventions.

Discussion

It is expected that proACT-S is an efficacious brief sleep-focused self-help treatment for people with major depression and insomnia. If proven efficacious, due to its self-help nature, proACT-S may be applicable as a community-based early intervention, reducing the burden of the public healthcare system in Hong Kong.
Targeting family functioning, acculturative stress, and sugar-sweetened beverage consumption for obesity prevention: Findings from the Hispanic Community Children's Health Study/Study of Latino Youth
Authors: Figueroa Roger , Isasi Carmen R , Perreira Krista M , McClain Amanda , Gallo Linda C , Sotres Daniela , Delamater Alan M , Daviglus Martha , Horn Linda Van , Mattei Josiemer
Published: August 2020

Background. Maintaining a bond with one’s family as well coping with stress while acculturating to the US may protect Hispanic/Latino youth from increased sugar-sweetened beverages (SSB) consumption, which heightens the risk for overweight and obesity. This study aims to examine associations between acculturative stress, family functioning, and SSB consumption by acculturation status among U.S. Hispanic/Latino youth.Methods. With cross-sectional data on 1,465 youth 8-16y (49.6% females) participating in the Hispanic Community Children's Health Study/Study of Latino Youth, we classified youths into four acculturation groups – assimilated, integrated, marginalized/separated, and unclassified. SSB consumption was assessed through two 24-hour diet recalls and defined as intake frequency of soda, fruit juice, sweetened soft and fruit drinks. Multi-group path regression models were used to test associations of Hispanic/Latino youth’ acculturative stress and family functioning with SSB consumption, as well as the moderating role of acculturation status.Results. When controlling for age, sex, and study site, acculturative stress (β = -0.13, p = 0.01) was inversely associated with SSB, and poor family functioning (β = 0.11, p = 0.07) was only marginally associated with SSB consumption among youth classified as assimilated but not among youth classified as integrated, marginalized/separated, or unclassified. Conclusions. A socio-ecological perspective that incorporates the role of key acculturation-related factors across multiple levels may aid efforts to identify mechanisms that influence the relationship between acculturation status and diet among Hispanic/Latino youth and their families.
Perceptions of important outcomes of moral case deliberations: a qualitative study among healthcare professionals in childhood cancer care
Authors: Weiner Charlotte , Pergert Pernilla , Molewijk Bert , Castor Anders , Bartholdson Cecilia
Published: August 2020

BACKGROUND: In childhood cancer care, healthcare professionals must deal with several difficult moral situations in clinical practice. Previous studies show that morally difficult challenges are related to decisions on treatment limitations, infringing on the child's integrity and growing autonomy, and interprofessional conflicts. Research also shows that healthcare professionals want ethics support to help them deal with morally difficult situations. Moral case deliberations (MCDs) are one example of ethics support. The aim of this study was to describe MCD related outcomes that HCPs in childhood cancer care considered important to achieve, before MCDs were implemented, in order to support them in handling moral challenges in every day clinical practice.METHODS: This study is based on qualitative data. Healthcare professionals, mostly representing registered nurses, nursing assistants and physicians, working at childhood cancer care centres in Sweden, were invited to respond to the translated and content-validated European Moral Case Deliberation questionnaire, before participating in regular MCDs. The main open-ended question included in the questionnaire was analysed according to systematic text condensation. RESULTS: Data was collected from 161 responses from the healthcare professionals who were invited to participate. The responses included healthcare professionals’ perceptions of which MCD-related outcomes they found important for handling moral challenges. Three different themes of important outcomes from the analysis of the data are presented as follows: Inter-professional wellbeing, Being in a professional comfort zone, and Improved quality of care. The themes are related to teams, individuals and care, respectively.CONCLUSIONS: Healthcare professionals in childhood cancer care considered it important that ethics support could enhance the well-being of interprofessional teams, support healthcare professionals on an individual level and improve quality of care. The results of this study can be used for information in future training for MCD-facilitators. When knowing the context specific important MCD-outcomes, the sessions could be adapted. Managers in childhood cancer care would benefit from knowing about the specific important outcomes for their target group because they could then tailor the conditions. Finally, this study contributes to the reflection upon and evaluation of appropriate CESS outcomes in general.
Clinical physiological parameters for the prediction of gram-negative bacterial infection in the emergency department
Authors: Hsu Chan-Peng , Chen Hsin-Yu , Chen Wei-Lung , Chen Jiann-Hwa , Huang Chien-Cheng , Wu Po-Han , Chung Jui-Yuan
Published: August 2020

Background

Early detection and treatment of Gram-negative bacteria (GNB), major causative pathogens of sepsis, may benefit a patient’s outcome, since the mortality rate increases by 5–10% for each hour of delayed therapy. Unfortunately, GNB diagnosis is based on blood culture, which is time consuming. Therefore, an economic and effective GNB infection detection tool in the emergency department (ED) is warranted.

Methods

We conducted a retrospective case control-study in the ED of a university-affiliated medical center between January 01, 2014 and December 31, 2017. The inclusion criteria were as follows: (1) age ≥ 18; (2) clinical suspicion of bacterial infection; (3) positive bacterial culture of blood or sputum or urine. Descriptive statistics was performed on patient demographic characteristics, vital signs, laboratory data, infection sites, cultured microorganisms, and clinical outcomes. The accuracy of vital signs to predict GNB infection was identified via logistic regression and receiver operating characteristic (ROC) analysis.

Results

A total of 797 patients were included in this study; the mean age was 71.8 years and 51.3% were male. The results revealed that patients with body temperature ≥ 38.5°C, heart rate ≥ 110 beats per minute, respiratory rate ≥ 20 breaths per minute, and Glasgow coma scale (GCS) < 14, had a 2.3-, 1.4-, 1.9-, and 1.6-fold greater risk of GNB infection, respectively. The area under the curve values for ROC analysis of these measures were 0.70, 0.68, 0.69, and 0.67, respectively.

Conclusion

The four physiological parameters were rapid and reliable independent predictors for early detection of GNB infection.
Prevalence and associated factors of anemia among adolescent girls and boys at 10-14 years in rural western China
Authors: Zhu Zhonghai , Sudfeld Christopher R. , Cheng Yue , Qi Qi , Li Shaoru , Elhoumed Mohamed , Yang Wenfang , Chang Suying , Dibley Michael J , Zeng Lingxia , Fawzi Wafaie W.
Published: August 2020

Background: Evidence on the prevalence and associated factors of anemia among young adolescent girls and boys in rural western China is limited. Methods: We used data from a follow-up study of adolescents (10-14 years) born to women who participated in a randomized trial of antenatal micronutrient supplementation in western China. Anemia was defined by World Health Organization standards. Logistic regression was used to examine the risk factors for anemia. Results: The overall prevalence of anemia was 11.7% (178/1517). Female adolescents were 1.73 (95% CI 1.21, 2.48) times more likely to have anemia as compared to males. Adolescents whose mothers had completed high school were 65% (95% CI 7%, 87%) less likely to be anemic, compared with those of whom had <3 years. Household wealth was also inversely associated with anemia. The association of puberty status with anemia was modified by adolescent sex (p-value for interaction was 0.04): males with greater than mild puberty development had 65% (95% CI 17%, 85%) reduced odds of anemia while there was no association among females (OR: 0.72, 95% CI 0.29, 1.78). Consumption of flesh foods, eggs, and having a meal frequency of three times or more per day were associated with 42% (95% CI 11%, 62%), 40% (95% CI 7%, 62%) and 32% (95% CI 4%, 52%) reduced odds of anemia, respectively. Conclusions: Anemia is a public health problem among adolescents in rural western China. Nutritional and social determinants were identified as predictors, warranting interventions to reduce the risk of anemia among this critical age group.
Estimating the effectiveness of non-pharmaceutical interventions on COVID-19 control in South Korea
Authors: Min Kyung-Duk , Kang Heewon , Lee Ju-Yeun , Jeon Seonghee , Cho Sung-il
Published: August 2020

The authors have withdrawn this preprint due to erroneous posting.
A nomogramic model based on clinical and laboratory parameters at admission for predicting the survival of COVID-19 patients
Authors: Ma Xiaojun , Wang Huifang , Huang Junwei , Geng Yan , Jiang Shuqi , Zhou Qiuping , Chen Xuan , Hu Hongping , Li Weifeng , Zhou Chengbin , Gao Xinglin , Peng Na , Deng Yiyu
Published: August 2020

Background and AimCOVID-19 has become a major global threat. The present study aimed to develop a nomogram model to predict the survival of COVID-19 patients based on their clinical and laboratory data at admission.Methods COVID-19 patients who were admitted at Hankou Hospital and Huoshenshan Hospital in Wuhan, China from January 12, 2020 to March 20, 2020, whose outcome during the hospitalization was known, were retrospectively reviewed. The categorical variables were compared using Pearson’s χ2-test or Fisher’s exact test, and continuous variables were analyzed using Student’s t-test or Mann Whitney U-test, as appropriate. Then, variables with a P-value of ≤0.1 were included in the log-binomial model, and merely these independent risk factors were used to establish the nomogram model. The discrimination of the nomogram was evaluated using the area under the receiver operating characteristic curve (AUC), and internally verified using the Bootstrap method.Results A total of 262 patients (134 surviving and 128 non-surviving patients) were included in the analysis. Seven variables, which included age (relative risk [RR]: 0.905, 95% confidence interval [CI]: 0.868-0.944; P<0.001), chronic heart disease (CHD, RR: 0.045, 95% CI: 0.0097-0.205; P<0.001, the percentage of lymphocytes (Lym%, RR: 1.125, 95% CI: 1.041-1.216; P=0.0029), platelets (RR: 1.008, 95% CI: 1.003-1.012; P=0.001), C-reaction protein (RR: 0.982, 95% CI: 0.973-0.991; P<0.001), lactate dehydrogenase (LDH, RR: 0.993, 95% CI: 0.990-0.997; P<0.001) and D-dimer (RR: 0.734, 95% CI: 0.617-0.879; P<0.001), were identified as the independent risk factors. The nomogram model based on these factors exhibited a good discrimination, with an AUC of 0.948 (95% CI: 0.923-0.973). ConclusionA nomogram based on age, CHD, Lym%, platelets, C-reaction protein, LDH and D-dimer was established to accurately predict the prognosis of COVID-19 patients. This can be used as an alerting tool for clinicians to take early intervention measures, when necessary.
Molecular cloning and characterization of GhERF105, a gene participated in the regulation of gland formation from cotton (Gossypium hirsutum L.)
Authors: Wu Chaofeng , Cheng Hailiang , Li Shuyan , Zuo Dongyun , Lin Zhongxu , Zhang Youping , Lv Limin , Wang Qiaolian , Song Guoli
Published: August 2020

Background
Gossypium hirsutum L. (cotton) is one of the most economically important crops globally. Cottonseed is the significant source of fiber, feed, foodstuff, oil and biofuel products. However, the utilization of cottonseed was limited by the presence of small and darkly pigmented glands that contain large amounts of gossypol, which is toxic to human beings and other non-ruminant animals. To date, there has been some progress in the pigment gland formation, but the underlying molecular mechanism of pigment gland formation was still complicated and unclear.
Results
In this study, we identified an AP2/ERF transcription factor named GhERF105 (Gh_A12G1784), which was involved in the regulation of gland pigmentation, from comparative transcriptome analysis of the leaf of two pairs of glanded and glandless accessions, which are CCRI12 and CCRI12XW, L7 and L7XW. It encoded an ERF protein localized in the nucleus with transcriptional activation activity containing a conserved AP2 domain, and showed the high expression in glanded cotton accessions that contained much gossypol. Virus-induced gene silencing against GhERF105 caused the dramatic reduction in the number of glands and significantly lowered levels of gossypol in cotton leaves. GhERF105 showed the patterns of spatiotemporal and inducible expression in the glanded plants.
Conclusions
These results suggest that GhERF105 participates in the pigment gland formation and gossypol biosynthesis in partial tissue of glanded plant. It also provides a potential molecular basis to generate ‘glandless-seed’ and ‘glanded-plant’ cotton cultivar.
Preoperatively elevated RDW-SD and RDW-CV predict favorable survival in intrahepatic cholangiocarcinoma patients after curative resection
Authors: Li Xingchen , Chen Qichen , Bi Xinyu , Zhao Jianjun , Li Zhiyu , Zhou Jianguo , Huang Zhen , Zhang Yefan , Mao Rui , Zhao Hong , Cai Jianqiang
Published: August 2020

Background

Recent studies suggest red blood cell distribution width (RDW) was a prognostic factor in various types of cancer patients, although the results are controversial. The objective of this study was to investigate the significance of RDW in patients with Intrahepatic cholangiocarcinoma (ICC) after radical resection.
Method:

The relationship between the preoperative serum RDW value and clinic pathological characteristics was analyzed in 157 ICC patients between January 2012 and June 2018 who underwent curative resection. X-tile software was used to determine 40.2 fl, 12.6% as the optimal cut-off value for RDW-SD and RDW-CV respectively. 153 patients were classified into the low RDW-SD (≤ 40.2, n = 53) group and the high RDW-SD (> 40.2, n = 104) group, low RDW-CV (≤ 12.6, n = 94) group and the high RDW-CV (> 12.6, n = 63). Based on the RDW-SD combined with RDW-CV(SCC), classified into SCC = 0, 1 and 2 group. Kaplan-Meier survival analysis and Cox proportional hazard models were used to examine the effect of RDW on survival.
Results

Kaplan-Meier curve analysis showed that Patients with RDW-SD > 40.2 were significantly associated with better OS (P = 0.004, median OS: 68.0 months versus 17.0 months). Patients with RDW-CV > 12.6 were significantly associated with better OS (P = 0.030, median OS: not reach versus 22.0 months). Compared with a SCC = 0 or SCC = 1, SCC = 2 was significantly associated with better OS (P < 0.001, median OS: not reach versus 33.0 months versus 16, respectively). In the multivariate analysis, RDW-SD > 40.2 fl (HR = 0.446, 95% CI: 0.262–0.760, P = 0.003), RDW-CV > 12.6% (HR = 0.425, 95%CI: 0.230–0.783, P = 0.006), SCC = 2 (HR = 0.270, 95%CI: 0.133–0.549, P < 0.001) were associated with favorable OS. The multivariate analysis showed RDW-SD, RDW-CV and SCC level were not independent prognostic factors for PFS.
Conclusions

Preoperative low levels of RDW are associated with poor survival in ICC after curative resection. This provides a new way for predicting the prognosis of ICC patients and more targeted intervention measures.
Pain management in patients with end-stage renal disease and calciphylaxis- A survey among physicians and clinical practice recommendations
Authors: Chinnadurai Rajkumar , Sinha Smeeta , Lowney Aoife , Miller Mary
Published: August 2020

Background Calciphylaxis is a rare condition usually seen in patients with end-stage renal disease. Pain is a hallmark of this condition and can be extremely difficult to control. Anecdotal data suggests that pain management in calciphylaxis is challenging with variable approaches across the United Kingdom (UK) and internationally. A knowledge and practice survey was conducted to establish current practice in the management of pain in patients with calciphylaxis, in the UK. Based on the results and clinical experience the authors suggest a clinical practice guideline.Methods An online questionnaire was circulated among physicians (renal and palliative care) involved in the management of pain in calciphylaxis. The questionnaire included a mix of open-ended questions and questions with drop down options. Results One hundred and six clinicians responded to the survey of which 60 (57%) respondents were from palliative medicine; the remaining 46 (43%) were from renal medicine. 31 (30%) respondents across both specialties had not encountered any patients with a diagnosis of calciphylaxis (renal-2, palliative care-29). A referral to the palliative care team was undertaken by 18% of renal physicians, 32% referred to the pain team and 50% referred to both. Only 3% of the palliative medicine respondents indicated that they had received a referral from the renal team at the time of diagnosis. Opioids were the preferred initial drug of choice for the management of all types of pain. Paracetamol was universally selected as the preferred first-choice adjuvant agent for management of all types of pain. The importance of advance care planning was highlighted with 72% undertaking advanced care planning discussions often or most of the time.Conclusion There was wide variation in the current practice of pain management in patients with calciphylaxis, with variation between renal specialists and palliative care specialists. Referral to specialists in pain management is not universal despite the severe nature of the pain experienced by patients with calciphylaxis. The data generated has facilitated the development of a clinical practice guideline to support complex pain management in a group of patients with multiple comorbidities.
Helmet Continuous Positive Airway Pressure versus High-Flow Nasal Cannula in COVID-19: A pragmatic randomised clinical trial (COVID HELMET)
Authors: Tverring Jonas , Åkesson Anna , Nielsen Niklas
Published: August 2020

Background:
Patients with COVID-19 and hypoxemia despite conventional low-flow oxygen therapy are often treated with High-flow Nasal Cannula (HFNC) in line with international guidelines. Oxygen delivery by Helmet Continuous Positive Airway Pressure (CPAP) is a feasible option that enables a higher positive end-expiratory pressure (PEEP) and may theoretically reduce the need for intubation compared to HFNC but direct comparative evidence is lacking.
Methods:
We plan to perform an investigator-initiated, pragmatic, randomised trial at an intermediate-level COVID-19 cohort ward in Helsingborg Hospital, southern Sweden. We have estimated a required sample size of 120 patients randomised 1:1 to HFNC or Helmet CPAP to achieve 90% power to detect superiority at a 0.05 significance level regarding the primary outcome of ventilator free days (VFD) within 28 days using a Mann-Whitney U test. Patient recruitment is planned to being June 2020 and be completed in the first half of 2021.
Discussion:
We hypothesize that the use of Helmet CPAP will reduce the need for invasive mechanical ventilation compared to the use of HFNC without having a negative effect on survival. This could have important implications during the current COVID-19 epidemic.
Trial registration:
ClinicalTrials.gov, NCT04395807, Registered 20 May 2020, https://clinicaltrials.gov/ct2/show/NCT04395807
Mental health impacts among health workers during COVID-19 in a low resource setting: a cross-sectional survey from Nepal
Authors: Khanal Pratik , Devkota Navin , Dahal Minakshi , Paudel Kiran , Joshi Devavrat
Published: August 2020

Background: Health care workers exposed to COVID-19 might be at increased risk of developing mental health problems. The study aimed to identify factors associated with anxiety, depression and insomnia among health workers involved in COVID-19 response in Nepal. Methods: This was a cross-sectional web-based survey conducted between April 26 and May 12, 2020. A total of 475 health workers participated in the study. Anxiety and depression were measured using a 14-item Hospital Anxiety and Depression Scale (HADS: 0- 21) and insomnia was measured by using a 7-item Insomnia Severity Index (ISI: 0-28). Multivariable logistic regression analysis was done to determine the risk factors of mental health outcomes. Results: Overall, 41.9% of health workers had symptoms of anxiety, 37.5% had depression symptoms and 33.9% had symptoms of insomnia. Stigma faced by health workers was significantly associated with higher odds of experiencing symptoms of anxiety (AOR: 2.47; 95% CI: 1.62-3.76), depression (AOR: 2.05; 95% CI: 1.34-3.11) and insomnia (AOR: 2.37; 95% CI: 1.46-3.84). History of medication for mental health problems was significantly associated with a higher likelihood of experiencing symptoms of anxiety (AOR: 3.40; 95% CI:1.31-8.81), depression (AOR: 3.83; 95% CI: 1.45-10.14) and insomnia (AOR: 3.82; 95% CI: 1.52-9.62) while inadequate precautionary measures in the workplace was significantly associated with higher odds of exhibiting symptoms of anxiety (AOR: 1.89; 95% CI: 1.12-3.19) and depression (AOR: 1.97; 95% CI: 1.16-3.37). Nurses (AOR: 2.33; 95% CI: 1.21-4.47) were significantly more likely to experience anxiety symptoms than other health workers. Conclusion: The study findings revealed a considerate proportion of anxiety, depression and insomnia symptoms among health workers during the early phase of the pandemic in Nepal. Health workers facing stigma, those with history of medication for mental health problems, and those reporting inadequate precautionary measures in their workplace were more at risk of developing mental health outcomes. A focus on improving mental wellbeing of health workers should be immediately initiated with attention to reduction of stigma, ensuring an adequate support system such as personal protective equipments, and family support for those with history of mental health problems.
Long Term Clinical Outcomes of Patients with Ischemic Stroke in Primary care – A 9-year Retrospective Study
Authors: Han Jinghao , Choi Yue Kwan , Leung Wing Kit , Hui Eric Ming Tung , Leung Maria Kwan Wa
Published: August 2020

Background: We aim to document the long-term outcomes of ischemic stroke patients and explore the potential risk factors for recurrent cardiovascular events and all-cause mortality in primary care.Methods: A retrospective cohort study performed at two general out-patient clinics (GOPCs) under Hospital Authority (HA) in Hong Kong (HK). Ischemic stroke patients with at least two consecutive follow-up visits during the recruitment period (1/1-30/6/2010) were enrolled. Patients were followed up regularly till the date of recurrent stroke, cardiovascular event, death or 31/12/2018. Risks of recurrent cardiovascular events and death were estimated by Cox proportional hazards model. The primary outcome was the occurrence of recurrent cerebrovascular event including transient ischemic stroke (TIA), ischemic stroke or hemorrhagic stroke. The secondary outcomes were all-cause mortality and coronary heart disease (CHD).Results: A total of 466 patients (mean age, 71.5 years) were enrolled. During a median follow-up period of 8.7 years, 158 patients (33.9%) died. Eighty patients (17.2%) had recurrent stroke and 57 (12.2%) patients developed CHD. Age was an independent risk factor for recurrent stroke, CHD and death. Statin therapy at baseline had a protective effect for recurrent stroke (hazard ratio [HR] =0.454, 95% confidence interval [CI] 0.269-0.766, P=0.003) and all-cause mortality (HR= 0.693, 95% CI 0.486-0.968, P=0.043). In addition, female sex, antiplatelet and a higher diastolic blood pressure (DBP) at baseline were also independent predictors for survival.Conclusions: Long term prognosis of ischemic stroke patients in primary care is favorable. Use of statin was associated with a significant decrease in stroke recurrence and mortality. Patients who died had a significant lower DBP at baseline, highlighted the need to consider both systolic and diastolic blood pressure in our daily practice.
Subcutaneous injection of IFN alpha-2b for COVID-19: an observational study
Authors: Wang Bo , Li Diandian , Liu Tao , Wang Haohua , Luo Fengming , Liu Yanbin
Published: August 2020

Background The global pandemic of coronavirus disease 2019 (COVID-19) infection is ongoing and associated with high mortality. Objective The aim of this study was to investigate the efficacy and safety of subcutaneous injection of interferon alpha-2b (IFN alpha-2b) combined with lopinavir/ritonavir (LPV/r) in the treatment of COVID-19 infection, compared with that of using LPV/r alone. Methods Patients diagnosed with laboratory-confirmed COVID-19 infection in Wuhan Red Cross hospital during the period from January 23, 2020 to March 19, 2020 were included. The length of stay, the time to viral clearance and adverse reactions during hospitalization were compared between patients using oral LPV/r and combined therapy of LPV/r and subcutaneous injection of IFN alpha-2b. Results A total of 22 patients were treated with LPV/r alone and 19 with combined therapy with subcutaneous injection of IFN alpha-2b. The average length of hospitalization in the combination group was shorter than that of LPV/r group (16±9.7 vs 23±10.5 days; P =0.028). Moreover, the days of hospitalization in early intervention group decreased from 25±8.5 days to 10±2.9 days compared with delayed intervention group (P =0.001). Combined therapy with IFN alpha-2b also significantly reduced the duration of detectable virus in the upper respiratory tract. No patient in each group was transferred to intensive care unit (ICU) or died during the treatment. There was no significant difference in the adverse effect composition between two groups. Conclusion Subcutaneous injection of IFN alpha-2b combined with LPV/r shortened the length of hospitalization and accelerated viral clearance in COVID-19 patients, which deserves further investigation in clinical practice.
Ultrapulsed CO2 Laser Combined with Long-pulsed Nd: YAG Laser for the Treatment of Oral and Maxillofacial Pyogenic Granuloma
Authors: Jiang Licheng , Zhang Di , Li Keyi , Zhang Bin , Zhang Anqi , Liu Jianlin
Published: August 2020

Background: Pyogenic granuloma is a common, benign, acquired vascular lesion involving the skin and mucous membrane. It occurs in exposed areas, such as oral and maxillofacial regions, hands and feet, which usually have aesthetic affections on the patients’ appearance. Although pyogenic granuloma is treatable by a variety of treatments, they bear defects such as high recurrence rate, multiple therapies, leaving obvious scars, hyperpigmentation, or skin atrophy. In this study, we treat pyogenic granuloma patients with both ultrapulsed CO2 laser and long-pulsed Nd: YAG laser, in order to achieve ideal effects. Methods: 20 participants with pyogenic granuloma of the oral and maxillofacial region were treated with ultrapulsed CO2 laser and long-pulsed Nd: YAG laser, reexamined one month later, and followed up for one year. Clinical characteristics and treatment effects were recorded and examined.Results: The 20 participants were all cured by one treatment with a cure rate of 100%. None of the patients had scar or recurrence during12 months of follow-up. Conclusions: Ultrapulsed CO2 laser combined with long-pulsed Nd: YAG laser is a safe and cosmetically effective solution for pyogenic granuloma of the oral and maxillofacial region.Trial registration: This research is a retrospective study.
Agnostic Evaluation of Ipilimumab and Nivolumab Association: A Metanalysis.
Authors: Marchetti Paolo , Botticelli Andrea , Ascierto Antonio Paolo , Curigliano Giuseppe , Giannarelli Diana
Published: August 2020

Background. Ipilimumab and Nivolumab, targeting the molecules CTLA-4, PD-1, respectively, have shown efficacy against several types of cancer. Despite these results, only a small percentage of patients maintain a long-lasting effect. Even Ipilimumab, in combination with nivolumab, has demonstrated a significant clinical benefit in multiple tumor types. However, no trial has been designed with the primary endpoint to compare the efficacy of nivolumab plus ipilimumab combined, compared to nivolumab alone. Hence, the added value of ipilimumab in the combination has not clearly been established yet. The aim of this study was to demonstrate the superiority of the combination strategy compared to single agent therapy.Materials and methods. We performed a meta-analysis of Phase I-II-III Clinical Trials, published from 2010 up to 2020, in which the combination of ipilimumab plus nivolumab was compared to nivolumab alone. We extracted ORR, OS and PFS HR on the basis of treatment from the subgroup analysis of each trial. Results. A total of 8 trials were included in the present meta-analysis. Overall, 1313 patients were treated with the nivolumab plus ipilimumab combination compared to 1110 patients treated with nivolumab alone. All trials reported the Objective response rate (ORR) (Table 2), no heterogeneity was found and the pooled Odds Ratio (Figure 1) was highly in favor of the nivolumab plus ipilimumab combination with respect to nivolumab alone (1.683; 95% CI: 1.407-2.012; P<0.0001). Three studies were considered for Progression free survival (PFS) analysis (Table 3), no heterogeneity was found and the pooled Hazard Ratio (Figure 2) favored the combination of nivolumab plus ipilimumab with respect to nivolumab alone (0.807; 95% CI: 0.719-0.907; P<0.0001). The Overall survival (OS) endpoint was considered only in 2 trials (Table 4), no heterogeneity was found and the pooled HR (Figure 3) favored, also in this case, the combination of nivolumab plus ipilimumab with respect to nivolumab alone (0.87; 95% CI: 0.763-0.997; P=0.045).Conclusions. The combination of ipilimumab plus nivolumab seems to be superior to nivolumab alone in cancer patients, regardless of histology.
Challenges in the management of ENT foreign bodies during COVID-19 Pandemic - Experience at a tertiary care centre.
Authors: Bellad Shama A , Hajare Priti S , Havaldar Rajesh Radhakrishna , Narasimman Dhivya Bharathi
Published: August 2020

The novel coronavirus disease 2019 (COVID-19) pandemic has put unprecedented challenges on the medical community. ENT surgical procedures are associated with very high risk of transmission of the virus due to aerosol generation. Management of ENT emergencies due to foreign bodies during ongoing COVID-19 was challenging. This is a prospective study done in our tertiary care centre from March 2020 to June 2020, during COVID-19 pandemic, where patients were referred from primary health facility after unsuccessful attempt. The challenges encountered in the management of these cases, precautions taken and protocols followed are being discussed. The foreign bodies should be removed by trained personnel using Personal Protective Equipment taking all precautions to minimize aerosol generating procedures and limit the length of these procedures whenever possible. Additionally, the use of povidone-iodine in varying concentrations is emphasized in reducing the viral load in the aerodigestive tract, thus proving to be safe to both the patients and the treating doctors.
Circ_0000005 Facilitates Proliferation, Apoptosis, Migration and Invasion of Acute Myeloid Leukemia Cells via Modulating miR-139-5p/Tspan3 Axis
Authors: Tong Juan , Liu Huilan , Zheng Changcheng , Zhu Xiaoyu , Wan Xiang , Tang Baolin , Yao Wen , Zhang Lei , Song Kaidi , Sun Guangyu , Sun Zimin
Published: August 2020

Background: Accumulating circular RNAs (circRNAs) are reported to be abnormally expressed in diverse cancers, hematologic malignancies included. This study aimed to investigate the biological function and underlying mechanisms of circ_0000005 in acute myeloid leukemia (AML).Materials and methods: Bone marrow samples were enrolled from AML patients with normal samples as controls. Circ_0000005, miR-139-5p and tetraspanin 3 (Tspan3) were detected by qRT-PCR and Western blot, respectively. AML cell lines (KG1 and HL60) were used as cell models. CCK-8, Transwell and flow cytometry assays were adopted to study the biological functions of circ_0000005 on AML cells in vitro. The interrelation between circ_0000005 and miR-139-5p was detected by bioinformatics, qRT-PCR, luciferase reporter gene assay, RNA pull-down assay, and RNA-binding protein immunoprecipitation (RIP) assays. Ultimately, Western blot, qRT-PCR, luciferase reporter gene assay were adopted to corroborate the interrelation between miR-139-5p and its target Tspan3. Results: Circ_0000005 was demonstrably elevated in both AML clinical samples and cell lines. Circ_0000005 overexpression promoted the viability, migration and invasion of AML cells, and repressed the apoptosis of AML cells, while silencing circ_0000005 showed opposite biological effects. Circ_0000005 interacted with miR-139-5p and repressed its expression, and Tspan3 was proved to be negatively regulated by miR-139-5p. Circ_0000005 could promote the expression of Tspan3 via repressing miR-139-5p, and the oncogenic functions of circ_0000005 were dependent on its regulatory function on miR-139-5p/Tspan3 axis.Conclusion: Circ_0000005 facilitates the malignant phenotypes of AML cells via miR-139-5p/Tspan3 axis. Circ_0000005 may serve as a potential therapeutic target in AML.
Quantification of antibiotic resistance genes and mobile genetic elements in manure from dairy farms in California
Authors: Wang Yi , Pandey Pramod , Chiu Colleen , Jeannotte Richard , Kuppu Sundaram , Zhang Ruihong , Pereira Richard , Weimer Bart , Nitin Nitin , Aly Sharif
Published: August 2020

Antibiotic resistance genes (ARGs) are emerging environmental contaminants of concern to both human and animal health. Dairy manure is considered reservoir of ARGs. This study is focused on investigating prevalence of ARGs in California dairy farm manure under current common manure management. A total of 33 manure samples were collected from multiple manure treatment conditions: 1) flushed manure (FM), 2) fresh pile (FP), 3) compost pile (CP), 4) primary lagoon (PL), and 5) secondary lagoon (SL). After DNA extraction, all fecal samples were screened by PCR for the presence of 8 ARGs: four sulfonamide ARGs (sulI, sulII, sulIII, sulA), two tetracycline ARGs (tetW, tetO), two macrolide-lincosamide-streptogramin B (MLSB) ARGs (ermB, ermF). Samples were also screened for two mobile genetic elements (MGEs) (intI1, tnpA), which are responsible for dissemination of ARGs. Quantitative PCR was then used to screen all samples for five ARGs (sulII, tetW, ermF, tnpA and intI1). Prevalence of genes varied among sample types, but all genes were detectable in different manure types. Results showed that liquid-solid separation, piling, and lagoon conditions had limited effects on reducing ARGs and MGEs, and the effect was only found significant on tetW (p = 0.01). Besides, network analysis indicated that sulII was associated with tnpA (p < 0.05), and Psychrobacter and Pseudomonas as opportunistic human pathogens, were potential ARG/MGE hosts (p < 0.05). This research indicated current manure management practices in California dairy farms has limited effects on reducing ARGs and MGEs. Improvement of manure management in dairy farms is thus important to mitigate dissemination of ARGs into the environment.
Clinical data mining on network of symptom and index and correlation of tongue-pulse data in fatigue population
Authors: Shi yulin , Hu Xiaojuan , Ji Cui , Cui Longtao , Huang Jingbin , Ma Xuxiang , Tao Jiang , Yao Xinghua , Jun Li , Bi Zijuan , Li Jiacai , Yu Wang , Fu Hongyuan , Jue Wang , Lin Yanting , Bai Jingxuan , Guo Xiaojing , Tu Liping , Xu Jiatuo
Published: August 2020

BackgroundFatigue is a kind of non-specific symptom, which is widely found in sub-health and various diseases. It is closely related to people's physical and mental health.Due to lack of objective evidence, it is often neglected in clinical diagnosis,especially in the early stage of disease.A large number of clinical practices and studies have shown that tongue and pulse image are reflection of overall state of the body.Establishing an objective evaluation method for diagnosis of disease fatigue and non-disease fatigue by combining clinical symptom and index and tongue and pulse data is of great significance for timely and effective clinical treatment.MethodsIn this study, 2362 physical examination subjects were divided into healthy control, the group of sub-health fatigue and disease fatigue ,used complex network technology to screen out the core symptoms and western medicine indexes of fatigue,respectively. Constructed the core symptom network and the core symptom-index network. At the same time, used canonical correlation analysis to get the associated relationship of tongue and pulse, and analyzed the characteristic of the tongue and pulse data.ResultsThere were some similarities between the core symptoms of sub-health fatigue and disease fatigue,as well as differences. Symptom-index associated analysis of disease fatigue showed that the core indexes in the group of disease fatigue group had a significant canonical correlation, with the canonical correlation coefficient was 0.42 (P < 0.05). There was no statistically significant correlation between the tongue and pulse data in sub-health fatigue group.ConclusionsThe complex network technology was suitable for the correlation analysis of symptoms and indexes in the fatigue population, and the tongue and pulse objective data had certain diagnostic contribution to the classification of fatigue population.Name of the registry: Chinese Clinical Trial RegistryTrial registration number: ChiCTR-IOR-15006502; ChiCTR1900026008Date of registration: Jun. 04th, 2015URL of trial registry record:http://www.chictr.org.cn/showprojen.aspx?proj=11119;http://www.chictr.org.cn/edit.aspx?pid=38828&htm=4 (This is a retrospective registration)
Socioeconomic inequality in intermittent preventive treatment using Sulphadoxine pyrimethamine among pregnant women in Nigeria: A Decomposition analysis
Authors: Mahmud Fatima Muhammad , Majdzadeh Reza , Nedjat Saharnaz , Sajadi Haniye Sadat , Parsaeian Mahboubeh
Published: August 2020

Background: Sulphadoxine pyrimethamine using intermittent preventive treatment (IPTp-SP) for malaria prevention is recommended for all pregnant women at malaria endemic areas. However, there is limited evidence on the level of socioeconomic inequality in IPTp-SP use to prevent malaria in pregnant women in Nigeria. Thus, this study aimed to determine the level of socioeconomic inequality in IPTp-SP use among pregnant women and to decompose it into its contributing factors.Methods: A secondary data analysis of Nigerian demographic and health survey of 2018 was conducted. A sample of 2,162 pregnant women aged between 15-49 years and had live birth in the past 2 years before the survey were included to this analysis. Participants were recruited based on two-stage cluster sampling method. Socioeconomic inequality was decomposed into its contributing factors by concentration index.Result: The pregnant women who took at least one or more IPTp was 63.4%, while those who took two or more doses were 40.0 % and those who took three or more doses were 17%. Based on concentration index of 0.180 (p-value= <0.001, 95% CI: 0.176 to 0.183) and the Erreyger’s normalization concentration index 0.280 (p-value=<0.001, 95% CI: 0.251 to 0.309 IPTp utilization was pro-rich. The largest contributors to the inequality in IPTp uptake were wealth index (47.81%) and educational status (28.66%).Conclusion: Our findings showed that IPTp use was pro-rich in Nigeria. Wealth index and educational status were the factors that significantly contributed to the inequality. The disparities could be reduced through IPTp service expansion by targeting pregnant women from low socioeconomic status.
Explosion disaster distribution characteristics and outlet open-close effect of turning roadway
Authors: Lv Pengfei , Ju Minghua , Zhang Jiaxu , Pang Lei , Yang Kai
Published: August 2020

In this study, under the open-close conditions of a roadway outlet, the nonlinear dynamic analysis finite element program ANSYS/LS-DYNA was used to build models of explosions on roadways with 0˚ and 90˚ bending angles, to compare and analyse the shock wave propagation characteristics and variation laws. Moreover, the destructive effect of the explosion on the partition was analysed based on the level of damage caused to the human body by shock wave overpressure. The results show that the bending angle has an impact on the space-time distribution law of the explosion shock waves on the roadway. As the bending angle increases, the peak overpressure attenuation of the shock waves becomes prominent, and the arrival time for the same distance increases. The closure of the roadway outlet has a distance effect on the peak overpressure of the shock waves. The explosion shock waves cause the peak overpressure to rise sharply owing to the reflection and stacking effects near the closure. In the far zone of the outlet, the attenuation of the shock waves is too fast and has minimal impact on the peak overpressure. Additionally, overall, the closure of the roadway outlet increases the damage range of the explosion shock waves and the severity of their effect on the human body. With an increase in the bending angle, the damage range and severity decrease. These results can provide a reference for explosion disaster evaluation and prevention.