bluuebunny/crossref_metadata_2025 huggingface dataset:
Pilot Testing of a New App for Prospective Evaluation of Health-related Quality of Life in Breast Cancer
Authors: Lund-Jacobsen Trine , Schwarz Peter
Published: December 2020

Background: Given that BC patients now live longer and have a higher survival rate, long-term side effects of primary treatment and patients' Life Quality (LQ) have become a more central issue. The purpose of this study was to investigate whether Life Quality changes after primary BC treatment.Method: A prospective cohort study was conducted including 149 Danish women with BC. Sixty had entered the date since chemotherapy termination and their daily measurement of QoL for mood in the app Bone@BC. All users can only enter the app with a Danish NemID and own mobile device. The app includes self-reported patient baseline characteristics related to BC treatment and simple self-reported data of LQ measured in mood, social life and wellbeing measured by fatigue, pain and appetite and physical activities. Results: During the pilot test period, 149 BC survivors entered baseline data. Of the 149 BC survivors 60 (40%) have entered chemotherapy history and LQ data. The mean age of the BC survivors was 58.2 ±9.6 years (range 27-78 years). Days since chemotherapy termination was with a mean of 450 days (range 54-5.175 days). In group A (n=20) 35% reported 0-365 days and in group B (n=39) 65% reported more than 365 days since chemotherapy termination. In the whole group 65% reported neutral mood. By division into group A vs. B showed that mood improve over time measured by several in group B had a neutral mood achieved. Half (53%) had a good social life. Similar changes were reported for pain with 79% reporting mild to moderate pain in the whole group, group A vs. B showed an increasing level of pain over time with 24% reporting moderate to severe pain in group B vs. 13% in group A. Finally, it was observed that 58% reported mild to moderate appetite and it is decreasing over time, 64% reported mild to moderate appetite in group B vs. 50% in group A. Conclusion: Our results indicate that BC survivors have impaired QoL up to several years after primary BC treatment but there is a trend of some improvement over time. Trial registration: ClinicalTrials.grov:NCT03784651
Validation and Factor Analysis of the Parental Bonding Instrument in Japanese Pregnant Women
Authors: Sato Maya , Okada Takashi , Morikawa Mako , Nakamura Yukako , Yamauchi Aya , Ando Masahiko , Ozaki Norio
Published: December 2020

The Parental Bonding Instrument (PBI) evaluates parental attitudes derived from an individual’s childhood experiences with their parents. The factor structure of the PBI differs depending on variables such as psychosocial factors including culture, race, sex, and psychological and social conditions of participants. Although previous studies of the relationship between perinatal depression and parenting experiences have used the factor structures of the PBI from the general population, it is unclear whether the same factor structures are appropriate in the highly variable perinatal period. In this study, complete responses to the PBI and the Edinburgh Postnatal Depression Scale (EPDS) were received from 932 primiparas at 25 weeks of gestation and at 1 month postpartum. An exploratory factor analysis was performed on half of the responses, and it was confirmed that the three factors were care, interference, and autonomy. Confirmatory factor analysis of the remaining half of the answers showed comprehensible fitness. Each factor showed a high degree of internal consistency, and each factor of the PBI correlated with the EPDS, indicating construct validity. The reliability and validity of the PBI in perinatal Japanese women were confirmed, and it was found that the PBI had a three-factor structure.
Evaluating Mental Health First Aid: an Evidence Synthesis Review of Published Empirical Studies.
Authors: Atanda Opeyemi , Callaghan Patrick , Vangeli Eleni , Reavey Paula , Carter Tim , Brown Steven D. , Durcan Graham , O'Shea Nick , White Sarah , Wood Kerry
Published: December 2020

Background: Mental Health First Aid (MHFA) has received substantial international attention since its founding in the late 1990s, with a growing evidence base relating to its nature and impact across a variety of settings. Aims: To identify the effectiveness of MHFA upon a range of outcomes, recipients, its cost-effectiveness, and the mechanisms of its effect.Method: A systematic evidence synthesisResults: Data from 65 studies show MHFA education improves trainees’ mental health literacy, their perceived confidence in helping people living with mental distress and their intentions to help such people. MHFA also raises employees’ knowledge of mental illnesses in the workplace. There was also evidence of MHFA trainees using aspects of the five-stage ALGEE MHFA approach in their helping behaviour. The quality of the studies in this review varied across different types of studies. No published studies to date have evaluated MHFA’s impact on recipient outcomes, articulated the mechanisms of its effect, its cost-effectiveness, or societal impact.Conclusions: MHFA remains popular, but evidence of its effectiveness upon those receiving it remains unknown. It is urgent to undertake studies testing the effectiveness and cost-effectiveness of MHFA upon recipients, as well as identifying, empirically, how MHFA works, for whom, under what conditions, and barriers to its implementation. Given that the enthusiasm and acceptance of MHFA appears widespread, systematic evaluations of its social impact are warranted.Registration: The review protocol has been submitted to the Open Science Framework (View-only link: https://osf.io/rj4uh/?view_only=d1f9f2ed73724b3f8075c0c4581d0d87).
Spermatogenesis Stimulation and Sperms' Activation by Direct and Gradual Electrical Shocks on Testis in Infertile Males
Authors: Hashim Hashim Talib Talib , Mostafa Morad Yaser Al , Reda Abdallah , Chowdhury Nazmus Sakib
Published: December 2020

Background: Up to 15% of couples are infertile. In up to half of these couples, male infertility plays a role. Male infertility is caused by low sperm production, irregular sperm function, or blockages preventing the sperm delivery. Illnesses, accidents, chronic health issues, lifestyle choices and other factors can play a role in causing infertility among men.Methodology: It is a randomized controlled, single-blind clinical trial was conducted among 90 participants who have been diagnosed with (Oligospermia, Hypospermia, Asthenozoospermia or Necrozoospermia). Of a sample obtained by masturbation all the participants underwent a semen examination of their semen count, volume and motility. Then they got a small device, the device gives up to 5 milliamps of electrical shock. A final checkup for all was performed after the fourth months, and the data was collected and compared between (before and after) semen analysis.Results: The findings indicate an improvement in the count, volume and motility of the sperms after being shocked electrically in comparison with the control group. By using ANOVA-test, there were a statistically significant differences between the first seminal analysis result with each of the other results independently while it was not with the control group. Conclusion: Many treatments are available for infertility and other therapies and drugs and some of them are complicated and difficult to use. This painless and healthy way of enhancing sperm movement and count can be used by the male himself conveniently and at home to improve his chance of fertilizing an ovum.Trial registration: NCT, NCT04173052. Registered 21 November 2019 - Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT04173052
Collaborative Pharmacist–physician Medication Management for the Elderly With Chronic Kidney Disease and Polypharmacy
Authors: Kim A Jeong , Lee Hayeon , Shin Eun Jeong , Cho Eun Jung , Cho Yoon Sook , Lee Hajeong , Lee Ju-Yeun
Published: December 2020

Background: Inappropriate polypharmacy is likely in older adults with chronic kidney disease owing to the considerable burden of comorbidities. We aimed to evaluate the impact of a collaborative pharmacist–physician geriatric medication management service on the quality of medication use. Methods: We retrospectively reviewed the medical records of patients who received the geriatric medication management service in ambulatory care clinic in a single tertiary-care teaching hospital from May 2019 to December 2019. The quality of medication use was evaluated based on the numbers of medications and potentially inappropriate medications. We also evaluated the types of drug-related problems identified during medication management service and pharmacists’ interventions. Results: Drug use quality was assessed in 87 of 95 patients who received the service. After the provision of medication management service, the total numbers of medications and potentially inappropriate medications decreased from 13.5 ± 4.3 to 10.9 ± 3.8 (p < 0.001) and from 1.6 ± 1.4 to 1.0 ± 1.2 (p<0.001), respectively. Furthermore, the numbers of patients who received three or more central nervous system-active drugs and strong anticholinergic drugs decreased. Among the 354 drug-related problems identified, “missing patient documentation” was the most common, followed by “adverse effect” and “drug not indicated.” The most frequent intervention was “therapy stopped” (111, 31.4%).Conclusions: Polypharmacy and potentially inappropriate medications were prevalent in older adults with chronic kidney disease, and geriatric medication management service involving a collaboration between pharmacists and physicians improved the quality of medication use in this population.
Circulating miRNA Expression in Asthmatics is Age-related and Associated with Clinical Asthma Parameters, Respiratory Function and Systemic Inflammation
Authors: Wardzyńska Aleksandra , Małgorzata Pawełczyk , Rywaniak Joanna , Makowska Joanna Samanta , Brzeska Joanna Jamroz- , Kowalski Marek Leszek
Published: December 2020

Background: Asthma in elderly asthmatics (EA) may have a different course than in non-elderly asthmatics (nEA), which may be partially associated with age-dependent aberrant immune response. The aim of the study was to assess the association of serum miRNA expression with asthma characteristics and systemic inflammation markers in EA and nEA.Methods: In 28 EA and 31 nEA patients, control and severity of asthma, pulmonary function and FeNO were assessed. The control group included 59 age-matched non-asthmatics. Expression of selected miRNAs in serum was measured with RT-PCR, and proinflammatory cytokines were assayed by ELISA or flow cytometry. Results: EA had lower serum expression of miRNA -19b and -146a, while the nEA had a higher expression of miRNA -146a than controls. EA had a higher serum expression of miRNA -106a and -126a than nEA. In all asthmatics, miRNA -106a and -126a were correlated with age. Only in nEA, the expression of selected miRNAs was associated with the level of asthma control (assessed with ACT) and with airway inflammation, measured by FeNO concentration. Elevated levels of systemic inflammation markers were associated with impaired respiratory function in all asthmatics and with worsened asthma control in the elderly patients. A significant correlation was observed between serum levels of proinflammatory cytokines and selected miRNAs.Conclusion: Serum miRNA expression was correlated with clinical characteristics of asthma and systemic inflammation in an age-dependent fashion suggesting that miRNA may differentially contribute to asthma pathogenesis in elderly and non-elderly patients.
Short-Run and Long-Run Income Elasticity of Healthcare Expenditure in India: Role of Domestic Revenue and Public Debt
Authors: Behera Deepak Kumar , Dash Umakant
Published: December 2020

Existing literature argues that income growth is an important determinant for change in healthcare expenditure in developing economies. Most of them examine the elasticity of public health expenditure concerning per capita income while the role of fiscal policies – public revenue and public debt to determine the level of spending has never been studied. Therefore, this study examines the income elasticity of public health expenditure in both short-run and long-run by controlling domestic revenue, and public debt (i.e. borrowings) in India for the period from 1980-81 to 2015-16. The study follows three steps for empirical analysis. First, we test stationarity properties of variables using the Zivot and Andrews (ZA) unit root test assuming that the Indian economy might have experienced structural breaks at different time points. Second, we examine the cointegrating relationships among variables using the Auto-Regressive Distributed Lag (ARDL) bounds testing approach. Third, we estimate both short-run and long-run elasticity by controlling structural-breaks using the unrestricted Error-Correction Term (ECT). Our result finds that domestic revenue (i.e. tax and non-tax) shows a positive and statistically significant effect while public debt (i.e. domestic and external) shows a negative and statistically significant effect on health expenditure respectively. It implies that a 1 percent increase in revenue leads to a 0.78 percent increment in public health expenditure annually while a 1 percent increase in public debt leads to an -0.51 percent reduction in public health expenditure in the long-run. Our result suggests that conducive public finance policies and alternative revenue mobilization could be a potential strategy to increase the level of health spending in India.
Implementation of a Multifactorial Fall Intervention Model in Hospital: a Longitudinal Before-and-after Controlled Study From 2015 to 2018
Authors: Liao Changju , Guo Linghong , Wang Han , Wang Tengyong , Zhang Yuyang , Zhou Yuqing , Liu Yin
Published: December 2020

Background: Falls are serious public health problems associated with irreversible health consequences and substantial economic burden. To effectively reduce the incidence of falls and mitigate fall-related injuries, we designed and verified a multifactorial fall intervention model.Methods: The current study was a longitudinal before-and-after controlled investigation including 3 phases with clinical characteristics of fall patients retrospectively identified in phase 1, a multifactorial fall intervention model designed in phase 2 and prospectively evaluated in phase 3. Phase 1 and 2 were conducted based on 153,601 hospitalized patients between January 2015 and December 2016. Phase 3 was carried out based on 171,776 hospitalized patients between January 2017 and December 2018. The Pearson Chi-squared test was used to compare categorical variables and the Mann-Whitney non-parametric test was utilized for one-way ordered data.Results: In phase 1, baseline characteristics of 491 fall patients revealed that inpatients falls were highly associated with the age, medication and disease. In phase 2, a new multifactorial fall intervention model covering measures for fall prevention, fall-onset management and continuous improvement was developed. Phase 3 recorded a total of 396 falls and demonstrated a remarkably declined fall rate (Reduction in falls by 0.09%, p<0.001) and fall rate per 1000 patient-days (Reduction in falls/1000 patient-days by 0.07‰, p<0.001) as compared with phase 1. The adjusted incident rate ratio of fall was 1.443 (95%CI: 1.263-1.647) (Phase 1 vs. Phase 3). Furthermore, the occurrence and the severity of fall injuries in phase 3 were significantly lower than that in phase 1 (Z=-4.426, p<0.001). More specifically, the number of uninjured falls accounted for 42.42% in phase 3 in comparison of 32.99% in phase 1.Conclusions: This multifactorial fall intervention model exhibited favorable effect on reducing the occurrence of fall and fall injuries.
Task-Related Brain Oscillation and Coherence Analysis Between High and Low Cognitive Proficiencies in Preschoolers With Attention Deﬁcit Hyperactivity Disorder
Authors: Chen I-Chun , Chen Chia-Ling , Chang Chih-Hao , Fan Zuo-Cian , Chang Yang , Lin Dar-Shong , Lin Cheng-Hsiu , Ko Li-Wei
Published: December 2020

BackgroundEarly diagnosis and intervention is essential for children at risk of attention deﬁcit hyperactivity disorder (ADHD). For preschool-age children with ADHD, who have heterogeneous neurobehavioral deficits, the continuous performance test and quantitative electroencephalography (EEG) can facilitate clinical diagnosis. This study investigated EEG dynamics and task-based EEG coherence in preschoolers with ADHD, who exhibited varying cognitive proficiencies.MethodsThe participants comprised 54 preschoolers (aged 5–7 years), 18 and 16 of whom exhibited high and low cognitive proficiency (ADHD-H and ADHD-L, respectively). The remaining 20 children had typical development (TD). All the children underwent the Conners’ Kiddie Continuous Performance Test and wireless EEG recording under different task conditions (rest, fast, and slow). ResultsIn the slow-rate task condition, the task-related parietal delta power of preschoolers with ADHD-L was significantly higher than that of their peers with TD. In the fast-rate condition, the preschoolers with ADHD-L exhibited higher parietal delta and theta/beta ratio as well as lower parietal beta power than those with ADHD-H. Unlike those in the TD group, the alpha power values of the participants in both the ADHD groups declined from rest to the task conditions. Task- related EEG beta coherence was decreased in both ADHD groups, which were distinct with TD groups. Conclusion﻿The aforementioned findings suggest that task-related brain oscillations were related to cognitive proficiency in preschool children with ADHD. The novel wireless EEG system used was demonstrated to be convenient and highly suitable for clinical use in preschool children. The EEG profiles in the present study may contain specific neural biomarkers that can assist early detection, diagnosis, and clinical planning for the treatment of ADHD in preschool children.
Breastfeeding Experiences of Women- The Essence of Womanhood: A Qualitative Study
Authors: Muktamath Vinutha Umesh , Itagi Sunanda Kotrabsappa , Khadi Pushpa Basavaraj
Published: December 2020

Qualitative Research for the Social Sciences uses a conversational writing style that draws readers into the excitement of the research process. It provides insights into behaviours, moods and interactions which would have been difficult to measure using traditional survey techniques. “Narrative Analysis” is a qualitative approach which emphasises on power of spoken word. This approach was used because of its tremendous initiative appeal and is the best approach to “restory” the breastfeeding experience of the woman –the essence of womanhood. The study participants included four mothers who breast fed their children exclusively for six months, four mothers who complementarily breast fed for first six months and four mothers who never breast fed the babies from Dharwad district of Northern Karnataka. A total of 12 mothers in the year 2017-18 were selected by purposive sampling method. The participants consent was taken for their participation in lengthy, in depth interview and to audio record their interview by assuring confidentiality. Analytical procedures like data reduction, coding and thematic development were done based on repeated readings of transcript. Based on this, five themes like Barriers vs Promoters, idealism vs realism, Knowledge vs Ignorance, Sense of Satisfaction vs Guilt and Normal Development vs Developmental delay were framed. Peer debriefing, member checking and triangulation were used as strategies of rigor. The results of qualitative analysis revealed that the support of husband, family and health personnel were the promoters and cultural beliefs, responsibilities of mothers,illness in infants and mothers were barriers of breast feeding. Conflicting advice by health personnel and elders in the family, and promotion of formula and other prelacteal feeds by popular brands were also the negative determinants of breastfeeding practices in mothers.The feeling that breastfeeding is the essence of motherhood was universal among mothers. Exclusively breastfed mothers perceived that their children had normal development while complementarily and never breastfed mothers perceived the delay in development of their children.
Photosynthetic Characteristics of Cotton Are Enhanced by Altering the Timing of Mulch Film Removal 
Authors: ZHANG Zhanqin , ZHANG Li , TIAN Haiyan , NIU Yuan , Yang Xiang kun
Published: December 2020

Background: The photosynthetic parameters of cotton plants may be modified by the timing of film-removal during their growing period. This study was undertaken during 2015–2017 in Xinjiang, China, to determine to what extent the film mulching removal time—1 and 10 days before the first irrigation and 1 day before the second irrigation after seedling emergence—influenced cotton’s photosynthetic characteristics. The control group consisted of film mulching present throughout the growing period. Results: The results suggested the following: (1) Removing mulching-film within 50 days of seedling emergence had adverse effects on soil temperature and moisture. (2) Film-removal before the first or second irrigation after emergence improved the net photosynthetic rate in cotton’s later flowering stage and its transpiration rate in mid and later flowering stages, while enhancing the actual electron transport rate (ETR) and maximum electron transfer rate (ETRmax) between cotton photosystems I and II. (3) Film-removal treatment post-emergence also increased cotton plants’ tolerance to high irradiation, a trend more pronounced in the early flowering stage in wetter years. (4) Leaf area index (LAI) of cotton was reduced in the film-removal treatment, for which the greatest maximum accumulation of dry matter occurred in a drought year (i.e., 2015). (5) Film-removal increased lint cotton yield, except in dry year (2015). Conclusions: Film-removal can improve cotton’s fiber quality to a certain extent. Collectively, our study’s experimental results indicate that applying mulch film removal at an appropriate, targeted time can improve photosynthesis and yield of cotton crops.
Real-Time Ethiopian Currency Recognition for Visually Disabled Peoples Using Convolutional Neural Network
Authors: Meharu Mekonnen Legess , Worku Hussien Seid
Published: December 2020

A survey report made by the Ethiopian Ministry of Health along with several non-governmental organizations in 2006 G.C, there were about 5.3% of the Ethiopian population lives with blindness and low vision problems. This research work aims to develop a Convolutional Neural Network-based model by using pre-trained models to enable vision-impaired peoples to recognize Ethiopian currency banknotes in real-time scenarios. The models attempt to accurately recognize Ethiopian currency banknotes even if the input images come up with partially or highly distorted and folded Birr notes. 8500 (1700 for each class) banknotes data are collected within real-life situations by using 9 blind persons. The models were evaluated with 500 real-time videos of different conditions. The whole training, classification, and detection tasks have been demonstrated by adopting Tensorflow Object Detection API and the pre-trained Faster R-CNN Inception, and SSD MobileNet models. All the codes are implemented using Python. The model tested using numerous Ethiopian currencies at different banknotes status and light conditions. In the case of Faster R-CNN Inception model an average accuracy, precision, recall, and F1-score of 91.8%, 91.8%, 92.8%, and 91.8% are obtained respectively and in the case of SSD MobileNet model an average accuracy, precision, recall, and F1-score of 79.4%, 79.4%, 93.6%, and 84.4% are obtained respectively within a real-time video. Therefore as the first research work, the model has shown good performance in both models but Faster R-CNN provides a promising result with an average accuracy of 91.8%.
Prevalence and Influencing Factors of Anxiety and Depression Symptoms Amongst Surgical Nurses During COVID-19 Pandemic: A Large-Scale Cross-Sectional Study
Authors: Ren Chun-Xia , Zhou De-Cun , Fan Yin-Guang , Li Bao-Zhu , Zhang Wan-Fei , Shen Yun , Yu Shi-Hui , Jiang Li , Yu Feng-Qiong , Duan Yong-Li , Peng De-Qing , Cheng Xue-Hong , Wu Le , Wu Chang-Hao , Ye Dong-Qing
Published: December 2020

BackgroundThe outbreak of novel 2019 coronavirus disease (COVID-19) has imposed an enormous physical and psychological pressure on people across the world. This study focused on evaluating the prevalence and influencing factors of anxiety and depression symptoms in surgical nurses during the epidemic in China. MethodA cross-sectional, multicenter quantitative study was conducted in Anhui province (China) from March 3, 2020 to March 19, 2020, with a questionnaire package which consisted of general information questionnaire，Zung's self-rating anxiety scale (SAS), Zung's self-rating Depression Scale (SDS) and social support rating scale (SSRS). A total of 3600 surgical nurses participated in the survey by Wechat and QQ. Data were analysed using multiple linear regression models. ResultsA total of 3492 surgical nurses from 12tertiary hospitals and 12 secondary hospitals in one province of mainland China completed the survey. The prevalence rates of anxiety symptoms and depressive symptoms were 24.83% and 22.39%, respectively. The average level of anxiety and depression of surgical nurses were higher than that of the Chinese norm (P< 0.05).Levels of social support for surgical nurses were significantly negatively associated with the degree of anxiety (r = -0.630, P < 0.001) and depression (r = -0.578, P < 0.001). Fertility status (β = 1.469, P = 0.003), hospital (β = -0.611, P < 0.001), participation in care for COVID-19 patients (β = 2.229, P < 0.001), likelihood of being infected with COVID-19 (β = 1.146, P < 0.001), social support (β = -0.623, P < 0.001) were significantly influencing surgical nurses’ anxiety degree. Similarly, these characteristics were significantly associated with the odds of experiencing depression symptoms in surgical nurses. Divorce and widowed surgical nurses (β = -2.654, P < 0.001) were significantly more likely to experience depressive symptoms than single nurses. ConclusionIn this survey, we found that the surgical nurses had high anxiety and depression symptoms during the COVID-19 outbreak in China. The findings suggest that targeted psychological interventions to promote the mental health of surgical nurses with psychological problems need to be immediately implemented.
Detection of Serum KL-6 and SARS-CoV-2 Antibody in Patients with Coronavirus Disease 2019 and the Diagnostic Value in Severe Disease
Authors: Wang Huiyan , Chen Lichang , Zhang Yang , Liu Long , Xu Meimei , Sun Baoqing , Gao Yong , Jin Tengchuan , Li Ming
Published: December 2020

Background: Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a significant threat to human health, but its clinical manifestations vary greatly among individuals. Early detection and treatment are important for severely ill patients to improve their prognosis and reduce the risk of death. Methods: In the present study, serum markers were detected and analyzed in moderately ill and severely ill patients. Results: The results found that there were statistically significant differences in age, serum Krebs von den Lungen-6 (KL-6) and Immunoglobulin A (IgA) levels between severely ill patients and moderately ill patients (P < 0.05). The cut-off of using KL-6 alone for the diagnosis of severely ill patients was 298.91 U/mL, with an AUC of 0.737, a sensitivity of 100%, and a specificity of 43%. When the diagnosis was performed using KL-6 in combination with Interleukin-6 (IL-6), an indicator of infection, the AUC was 0.776, with a sensitivity and specificity of 82% and 69%, respectively. When the three above were used in combination for diagnosis, the AUC was 0.785, and the sensitivity and specificity were 100% and 59%, respectively. After rehabilitation, the serum levels of KL-6, C-reactive protein (CRP), as well as antibodies, IgA, IgM and IgG, were significantly lower than those in the early stage of hospitalization. Conclusion: In the present study, KL-6 and IgA were found to have some diagnostic efficacy for severely ill patients with COVID-19, but larger cohort studies are still needed for further confirmation, which in turn improves the diagnostic and therapeutic efficiency of severely ill patients.
Adherence to Low Carbohydrate Diet in Relation to Chronic Obstructive Pulmonary Disease (COPD)
Authors: Malmir Hanieh , Onvani Shokouh , Ardestani Mohammad Emami , Feizi Awat , Azadbakht Leila , Esmaillzadeh Ahmad
Published: December 2020

Purpose: Data on the link between adherence to low-carbohydrate diet (LCD) and odds of chronic obstructive pulmonary disease (COPD) are scarce. The current study aimed to investigate the relation between adherence to LCD and COPD in Iranian adults.Methods: In this hospital-based case-control study, we enrolled 84 newly-diagnosed COPD patients and 252 age and sex matched healthy controls in Alzahra University Hospital, Isfahan, Iran. COPD was defined based on findings of spirometry test (forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC) < 70% or FEV1 < 80%). Dietary intakes of study participants were assessed using the validated Block-format 168-item FFQ. Data on potential confounders were also collected through the use of a pre-tested questionnaire. Results: Mean age of cases and controls were 57.7 and 55.07 years, respectively. Adherence to LCD was inversely associated with odds of COPD (0.35; 95% CI: 0.16-0.75). This inverse association did not alter after controlling for age, sex, and energy intake (0.42; 95% CI: 0.19-0.93). Adjustments for other potential confounders, including dietary intakes, smoking and educational status, did not affect these findings; such that those in the top quintile of LCD score were 64% less likely to have COPD than those in the bottom quintile (OR: 0.36; 95% CI: 0.13-0.99). Conclusion: We found an inverse association between adherence to LCD and odds of COPD. The association remained statistically significant even after taking other potential confounders, including socioeconomic characteristic and dietary intakes into account.
Downregulation of GLYAT facilities tumor growth and metastasis and poor clinical outcomes through the PI3K/AKT/Snail pathway in human breast cancer
Authors: Tian Xin , Wu Lina , Jiang Min , Zhang Zhenyong , Wu Rong , Miao Jianing , Liu Caigang , Gao Song
Published: December 2020

Background

The Glycine N-acyltransferase (GLYAT) gene encodes a protein that catalyzes the transfer of acyl groups from acyl CoA to glycine, resulting in acyl glycine and coenzyme A. Aberrant GLYAT expression is associated with several malignant tumors, but its clinical importance in malignant tumors, especially human breast cancer (BC), has yet to be fully addressed. This study aims to evaluate the clinical function of GLYAT in BC patients.
Methods

GLYAT expression was determined by immune blot and immunohistochemistry in three BC cell lines and primary cancer tissues. The MDA-MB 231 cell line was used for GLYAT gene knockdown experiments while the MCF7 cell line for overexpression experiments. Colony formation experiments, soft agar experiments, and transwell assays were utilized for further inspection of cell migration and proliferation capabilities. Immunofluorescence and western blot were used to detect markers of the epithelial-mesenchymal transition (EMT) and changes in the PI3K/AKT/Snail pathway. The role of GLYAT in tumor growth and metastasis was also assessed in nude mice in vivo. Also, a correlation analysis was performed between clinicopathological features and GLYAT expression in BC patients.
Results

GLYAT was decreased in human BC tissues and cell lines. Functional analysis showed that knockdown of GLYAT augmented BC cell proliferation in vitro and in vivo. However, this phenomenon was reversed when GLYAT was overexpressed in the transfected cells. Moreover, GLYAT inhibited the migratory properties of BC cells, likely through the activation of PI3K/ATK/Snail signaling, which subsequently induced the EMT. IHC analysis indicated that GLYAT was decreased in human BC tissues and lower GLYAT expression was correlated with histological grade, tumor TNM stage, Ki-67 status, and poorer survival in BC patients. Furthermore, lower GLYAT expression seemed as an independent risk factor related to poor prognosis in BC patients based on Cox regression analyses.
Conclusions

Our findings demonstrate that downregulation of GLYAT expression in human breast cancer is correlated with EMT via the PI3K/ATK/Snail pathway and is also associated with histological grade, tumor TNM stage, Ki-67 status, and poor survival in breast cancer patients.
Factors Associated With Influenza Vaccine Coverage Among Patients With Diabetes: Korea National Health and Nutrition Examination Survey 2016–2018
Authors: Han A Lum
Published: December 2020

Background: Although the influenza vaccine has been proven to be effective, this common disease has high morbidity and mortality rates. Moreover, adults with diabetes are at a high risk of influenza-mediated morbidity and mortality. With the increasing prevalence of diabetes and the efficacy of vaccination in preventing influenza, the aim of this study was to investigate the factors associated with influenza vaccination coverage in patients with diabetes.Methods: Cross-sectional data were obtained from the Korea National Health and Nutrition Examination Survey (2016–2018). We analyzed whether sociodemographic, health-related, and medical factors are associated with influenza vaccination coverage in patients with diabetes. A complex sample logistic regression analysis was performed and odds ratios (ORs) were estimated by adjusting for statistically significant factors.Results: The number of survey subjects was 18553. The vaccination coverage rate among patients with diabetes was 60.6%. In the univariate analysis, gender, educational level, smoking, exercise, drinking, marital status, private health insurance, activity limit, economic activity, age, and EuroQol-5 Dimension scores were associated with vaccination coverage. In the multivariate analysis, only age and economic activity were associated with vaccination coverage. The vaccination coverage rate was higher for people who did not undertake economic activities and who were older (OR 1.512 (1.087–2.105), OR 2.212 (1.822–2.686), respectively, p < 0.001).Conclusions: National interventions involving public health centers are necessary to encourage influenza immunization for patients with diabetes, especially younger patients and those who are working or undertaking economic activities.
The Temporal Pattern of Fibrinogen and Albumin Synthesis Rates Perioperatively in Major Abdominal Surgery
Authors: Dumitrescu Gabriel , Januszkiewicz Anna , Ågren Anna , Magnusson Maria , Sparrelid Ernesto , Rooyackers Olav , Wernerman Jan
Published: December 2020

Background: Plasma fibrinogen and albumin concentrations decrease initially after abdominal surgery. On postoperative days 3-5 fibrinogen concentration returns to preoperative level or even higher, while albumin stays low. Fibrinogen and albumin synthesis may be affected differently following major abdominal surgery related to injury and/or loss of liver tissue.The objective of the study was to determine fibrinogen and albumin quantitative synthesis rates in patients undergoing hepatectomies or pancreatectomies with intact liver size.Methods: Patients undergoing liver or pancreatic resection (n=9+6) were studied preoperatively, on postoperative days 1 and 3-5. De novo syntheses of fibrinogen and albumin were determined using the flooding dose technique with 2H5-phenylalanine as a tracer. In addition, several biomarkers indicative of fibrinogen utilization were monitored.Results: After hemi-hepatectomy, fibrinogen synthesis was 2-3-fold higher on postoperative day 1 than preoperatively. On postoperative days 3-5 the synthesis level was still higher than preoperatively. Following major liver resections albumin synthesis was not altered postoperatively compared to preoperative values. After pancreatic resection, on postoperative day 1 fibrinogen synthesis was 5-6-fold higher than preoperatively and albumin synthesis 1.5-fold higher. On postoperative days 3-5 the synthesis levels decreased towards the preoperative levels.Conclusions: De novo synthesis of fibrinogen was markedly stimulated on postoperative day 1 after both hepatectomies and pancreatectomies, while albumin synthesis remained grossly unchanged. The less pronounced changes seen following hepatectomies were possibly related to the loss of liver tissue.
Head-to-Head Comparison of Clinical Scores for Predicting Stroke Associated Pneumonia after Intracerebral Hemorrhage
Authors: JI RUIJUN , LIU YANFANG , LIU XINYU , WANG LINLIN , WANG DANDAN , WANG WENJUAN , ZHANG RUNHUA , JIANG RUIXUAN , JIA JIAOKUN , FENG HAO , DING ZEYU , LIU GAIFEN , LU JINGJING , JU YI , ZHAO XINGQUAN
Published: December 2020

Background: Despite advances in medical knowledge, treatment for ICH remains strictly supportive with not many evidence-based interventions currently available. Stroke associated pneumonia (SAP) is a common medical complication after stroke and has significant impact on stroke outcomes. In the study, we aimed to systematically compare discrimination and calibration of clinical scores with regard to in-hospital SAP after ICH. Methods: The validation cohort was derived from the Beijing Registration of Intracerebral Hemorrhage. The SAP was diagnosed according to the criteria for hospital-acquired pneumonia of Center for Disease Control and Prevention. Five clinical scores were included in the study: the ICH-APS-A, ICH-ASP-B, ISAN, ACCD4 and PASS score. Discrimination was assessed by calculating the area under the receiver operating characteristic curve (AUROC). Pairwise AUROC was compared by using Delong’s method. Calibration was assessed by performing the Hosmer-Lemeshow goodness-of-fit test and plot of observed versus predicted risk according to 10 deciles of the predicted risk. The Cox and Snell R-square and Nagelkerke R-square of the Hosmer-Lemeshow goodness-of-fit test were calculated. Results: A total number of 1964 patients were enrolled. The mean age was 56.8±14.4 and 67.6% were male. The median admission NIHSS was 11 (IQR: 3-21). The median length of stay (LOS) was 16 days (IQR: 8-22). A total number of 575 (29.2%) patients was diagnosed with in-hospital SAP after ICH. The AUROC of five clinical scores ranged from 0.732 to 0.800. In pairwise comparison, the ICH-APS-B (0.800, 95% CI=0.780-0.820, P<0.001) showed statistically better discrimination than other risk models (all P<0.001). All clinical scores performed better among patients with LOS longer than 72 hours. The ICH-APS-B (0.827, 95% CI=0.806-0.848, P<0.001) still showed statistically better discrimination than other risk models in patients with LOS longer than 72 hours (all P<0.001). The ICH-SAP-B had the largest Cox and Snell R-square of the Hosmer-Lemeshow test for in-hospital SAP after ICH.Conclusion: Several models are externally validated to be effective for risk stratification and outcome prediction for in-hospital SAP after ICH, which would be useful tools for personalized care and clinical trials in prevention of SAP after ICH.
Association between early mobilization or rehabilitation and intensive care unit acquired weakness: A systematic review and meta-analysis of randomized controlled trials.
Authors: Li Minghang , Ding Mingyue , Shao Huanzhang , Qin Bingyu , Wang Xingwei , Zhao Xiafei , Ren Shengyong , Zhang Wenxiao , Ye Ling
Published: December 2020

Background

The prognosis of intensive care unit acquired weakness (ICUAW) is poor and the treatment effect is not ideal. At present, some effective and safe early prevention means are urgently needed to reduce its incidence.This study evaluated the effectiveness and safety of early activities or rehabilitation in the prevention of ICUAW.
Methods

We searched for articles in five electronic databases, including PubMed, EMBASE, the Cochrane Library, the China National Knowledge Infrastructure (CNKI) and Wanfang Med Online. All publications until June, 2020 were searched. We have selected trials investigating early mobilization or rehabilitation as compared to standard of care in critically ill adults.The extracted data included adverse events, the number of patients with ICUAW, the length of stay in the ICU (ICU-LOS) the length of mechanical ventilation (MV) etc.
Results

The final results showed that compared with the usual care group, early mobilization or rehabilitation reduced the prevalence of ICUAW (RR, 0.73; [0.61, 0.87]; I2 = 44%; P = 0.0006), ICU-LOS (MD, − 1.47;[2.83, 0.10]; I2 = 56%; P = 0.04), length of MV (MD, − 1.96; [2.41, 1.51]; I2 = 0%; P = 0.00001), but the mortality (RR, 0.90; [0.62, 1.32]; I2 = 3%; P = 0.60) at ICU discharge was not associated. The subgroup analysis of ICUAW prevalence and ICU-LOS based on the intervention methods showed that early combined rehabilitation could reduce the prevalence of ICUAW (RR, 0.56; [0.43, 0.74]; I2 = 34%; P = 0.0001) and shorten the ICU-LOS (MD, − 2.21; [3.28, 0.97]; I2 = 23%; P = 0.0003). EGDM was not associated with a decrease in ICUAW prevalence (RR, 0.85; [0.65, 1.09]; I2 = 26%; P = 0.20), but it reduced the ICU-LOS (MD, − 2.27; [3.86, 0.68]; I2 = 0%; P = 0.005).Early in-bed cycling was not associated with reduced ICUAW prevalence(RR, 1.25; [0.73, 2.13]; I2 = 0%; P = 0.41) and ICU-LOS(MD, 2.27; [0.27, 4.80]; I2 = 0%; P = 0.08) .
Conclusions

Early mobilization or rehabilitation was associated with a shorter length of MV and ICU-LOS, but not mortality. Of course, not all early activities or forms of rehabilitation are effective. The early combined rehabilitation model is effective for the prevention of ICUAW. However, EGDM and early in-bed cycling were not effective in preventing ICUAW.
Inhaled Bronchodilator Delivery via High-Flow Nasal Cannula for COPD and Asthma Patients: A Randomized Controlled Trial to Compare the Bronchodilation Effects of Gas Flow Rates
Authors: Li Jie , Chen Yibing , Ehrmann Stephan , Wu Jie , Xie Lixin , Fink James B
Published: December 2020

BackgroundAerosol delivery via high-flow nasal cannula (HFNC) has attracted increasing clinician interest. In vitro studies report that the ratio of HFNC gas flow to patient inspiratory flow (GF:IF) is a key factor in the efficiency of trans-nasal aerosol delivery. This randomized controlled trial was aimed to validate this finding, and to explore the effective dose of inhaled bronchodilator to be given to patients via HFNC. Methods Patients with a history of COPD or asthma and documented positive response to inhaled bronchodilators in an outpatient pulmonary function laboratory were recruited. Subjects were randomized to receive inhalation at gas flow ratio/settings of : GF:IF=0.5, GF:IF=1.0, or GF=50L/min. Patients were assigned to inhale saline (control) followed by salbutamol via HFNC with an escalating dose sequence (0.5mg, 1.0mg, 2.0mg and 4.0mg). Spirometry was performed at baseline and after each inhalation. Results Seventy-five subjects (49 asthma and 26 COPD) demonstrating bronchodilator response (ATS/ERS) were enrolled. Using the criteria of post-bronchodilator FEV1 returning to screening post-bronchodilator FEV1 with salbutamol, a higher percentage of subjects receiving GF:IF=0.5 met criteria at cumulative dose of 1.5mg, than those receiving GF:IF=1.0, and GF=50L/min (64% vs 29% vs 27%, respectively, p=0.011). Similarly at 3.5mg (88% vs 54% vs 46%, respectively, p=0.005). The effective dose at GF:IF=0.5 was 1.5mg while for GF=50 L/min it was 3.5mg. Conclusion Dose response to salbutamol via HFNC was greater when administered with gas flow set at 50% of patient inspiratory flow, than with higher gas flow rates. Trial registration: www.clinicaltrials.gov: NCT03739359. Registered 13 November 2018, https://clinicaltrials.gov/ct2/show/NCT03739359?term=03739359&draw=2&rank=1
Machine Learning Model to Predict Hypotension After Starting Continuous Renal Replacement Therapy
Authors: Kang Min Woo , Kim Seonmi , Kim Yong Chul , Kim Dong Ki , Oh Kook-Hwan , Joo Kwon Wook , Kim Yon Su , Han Seung Seok
Published: December 2020

Background: Hypotension after starting continuous renal replacement therapy (CRRT) is associated with worse outcome, but it is difficult to predict because several factors have interactive and complex effects on the risk. The present study applied machine learning algorithms to develop models to predict hypotension after initiating CRRT.Methods: Among 2,349 adult patients who started CRRT due to acute kidney injury, 70% and 30% were randomly assigned into the training and testing sets, respectively. Hypotension was defined as a reduction in mean arterial pressure (MAP) ≥20 mmHg from the initial value within 6 hours. The area under the receiver operating characteristic curves (AUROCs) in machine learning models, such as support vector machine (SVM), deep neural network (DNN), and light gradient boosting machine (LGBM), were compared with those in disease-severity scores such as the Sequential Organ Failure Assessment and Acute Physiology and Chronic Health Evaluation II.Results: The DNN model showed the highest AUROC (0.822 [0.789–0.856]), and the LGBM and SVM models followed with AUROCs of 0.810 (0.776–0.845) and 0.807 (0.772–0.842), respectively; all machine learning AUROC values were higher than those obtained from disease-severity scores (AUROCs <0.6). Although different definitions of hypotension were used such as a reduction of MAP ≥30 mmHg or a reduction occurring within 1 hour, the AUROCs of machine learning models were higher than those of disease-severity scores. These machine learning models were well calibrated.Conclusion: Machine learning models successfully predict hypotension after starting CRRT and can serve as the basis of systems to predict hypotension before starting CRRT.
Exosomal miR-181a-5p Protects against MG Infection by Targeting PPM1B and Activating the TLR2-Mediated MyD88/NF-κB Pathway
Authors: Sun Yingfei , Zhao Yabo , Pang Huiwen , Zou Mengyun , Wang Yingjie , Peng Xiuli
Published: December 2020

BackgroundMycoplasma gallisepticum (MG) is one of the most important pathogens that causes chronic respiratory disease (CRD) in chickens. Exosomes secreted from cells have been well documented to deliver miRNAs to recipient cells to modulate cellular function. The purpose of this current study was to explore the functions of exosomal miR-181a-5p in MG infection and the underlying mechanisms. ResultsHere, we found that miR-181a-5p expression in vivo and in vitro was significantly upregulated after MG infection. Exosomes enriched in MG-infected chicken type-II pneumocytes (CP-II) could selectively load miR-181a-5p and transfer it into recipient DF-1 cells. PPM1B was further identified as the target gene of miR-181a-5p. Overexpression of miR-181a-5p and/or knockdown of PPM1B activated the TLR2-mediated MyD88/NF-κB signaling pathways, whereas inhibition of miR-181a-5p and the overexpression of PPM1B led to the opposite results. In addition, depressing miR-181a-5p significantly reduced the expression of tumor necrosis factors alpha (TNF-α) and interleukin-1β (IL-1β) by MG-induced. Upregulated miR-181a-5p promoted cell proliferation and cell cycle progression and inhibited apoptosis to resist MG infection. Moreover, overexpression of miR-181a-5p significantly depressed pMAG1.2 expression by directly inhibiting PPM1B.ConclusionsTaken together, we conclude that the newly identified primary CP-II cells exosomal miR-181a-5p activates the TLR2-mediated MyD88/NF-κB pathway by directly targeting PPM1B to promote pro-inflammatory cytokines expression for defending against MG infection in recipient DF-1 cells.