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Introduction. Ethiopia has made significant efforts to enhance family planning services despite variations in the community's use of modern contraception in different parts of the country. Various studies have reported the proportion and determinant factors of adolescents' contraceptive uptake in Ethiopia. These studies are not consistent in terms of size, scope, and geographic coverage, and the results need to be systematically collated to inform policies. Therefore, this review was aimed at analyzing the findings of those primary studies to obtain more representative evidence of adolescents' contraceptive uptake in Ethiopia. Methods. Five databases (MEDLINE via PubMed, Google Scholar, Scopus, ScienceDirect, and CINAHL) were searched for papers published from January 2000 up to June 2022 in English. Of thirty eligible studies, eight papers were included in this meta-analysis. Between-study heterogeneity was evaluated by the forest plot and inconsistency index ( I 2 ). A random-effects model was used to calculate the pooled estimates of adolescents' contraceptive uptake. Results. The overall pooled proportion of adolescents' contraceptive uptake was 40% ( I 2 = 99.70 , p ≤ 0.001 ; 95 % CI = 19 , 61). Adolescents' usage of contraception was influenced by a number of factors: individual-, sociocultural-, knowledge- (about contraceptive methods), and healthcare service-related factors. Individual-related factors include the educational status of adolescents, being of young age, and the income status of adolescents' families. Sociocultural-related factors comprise discussion with the family/relatives, parent disapproval and pressure from partners, and being married or having a partner. Healthcare service-related factors include the availability of youth clubs and inconvenient service hours for SRH services. Knowing contraceptive methods and SRH services was also positively associated with adolescents' contraceptive utilization. Conclusions. The proportion of adolescents who used contraception in Ethiopia was 40%. Adolescents' use of contraceptives was influenced by a variety of factors: individual-, sociocultural-, healthcare-, and knowledge-related factors. Hence, integrated interventions targeted at tackling barriers to contraceptive uptake may be helpful to improve adolescents' contraceptive utilization in Ethiopia. [ABSTRACT FROM AUTHOR]

Traumatic brain injury (TBI) is a brain injury caused by motor vehicle accidents, falls from heights, sports, and combat. Posttraumatic stress disorder (PTSD) is a complex mental disorder caused by physical and psychological trauma, which manifests itself with symptoms such as anxiety, depression, and cognitive dysfunction. How its symptoms arise and what factors influence it are not fully understood nor can it be predicted. In order to better understand the changes after stress disorder in TBI patients and the influencing factors of PTSD, this paper analyzed the changes and influencing factors of stress disorder in patients with mild traumatic brain injury stress disorder. In this paper, the Wechsler Memory Scale and functional magnetic resonance imaging were first used to study the memory impairment and functional changes of corresponding brain regions in patients with TBI stress disorder, and then, the Pittsburgh Sleep Quality Index Scale and the pain Visual Analogue Scale were used to study the influencing factors of PTSD. The results of the study showed that PTSD patients reduced and enhanced regional brain functional activity and impaired memory function in the resting state. Male gender, age under 45 years, no hemiplegia, and good sleep quality were protective factors for PTSD in TBI patients. The need for drug-assisted sleep, severe headache, and moderate headache was the risk factor for PTSD in TBI patients. [ABSTRACT FROM AUTHOR]

Aim. This paper investigates the risk factors preventing the reversal and nonreversal of Hartmann's procedure, as a surgical technique that has been performed in our clinic for ten years. Methods. The study involved a ten-year Hartmann's procedure followed up at our center. The patients were divided into Hartmann reversal and nonreversal groups. Groups were examined in terms of age, gender, diagnosis, stage of malignancy, ASA score, comorbidity, perioperative morbidity-mortality, and the length of the operation. Results. Age (p < 0.001), ASA score (p < 0.001), stage in case of malignancy (p = 0.002), and comorbidities (p < 0.001) were significant risk factors. The ratio of patients without any comorbidities to those with one or more comorbidities was 2.63 (95% CI 1.12–6.20). Among the malignant patients, the ratio of early-stage patients to advanced-stage patients in the group with reversal of Hartmann's colostomy was 2.82 (95% CI 1.30–6.10). In addition, the ratio of older patients to younger patients in group 2 was 0.95 (95% CI 0.92–0.98). A univariate analysis revealed that younger patients, those with lower ASA scores, those without comorbidities, and those with early-stage malignancy had a greater chance of closure of the stoma. Conclusion. Although Hartmann's procedure is performed in emergency surgery, the nonreversal of the colostomy is a problem in itself. It should be kept in mind that patients who have high risks are likely to have a permanent stoma. [ABSTRACT FROM AUTHOR]

Background and Aims. Celiac disease (CD) is possibly the most common autoimmune disorder, which may lead to dietary problems in the Arab region. This paper is aimed at exploring the epidemiology of the celiac disease in Arab countries, including its prevalence, associated risk factors, and clinical patterns. Methods. An extensive search of the literature was conducted from electronic databases such as PubMed, Embase, and Google Scholar. In total, 134 research papers were retrieved. We extracted studies published from January 1996 to December 2019. Our search was limited to studies published in English. Findings. The review included 35 studies with 22,340 participants from 12 countries and demonstrated a wide variation in the prevalence of CD. The highest prevalence among the general population (3.2%) was reported in Saudi Arabia, and the lowest (0.1%) was reported in Tunisia. Women demonstrated a higher prevalence of celiac disease relative to men. The peak age at diagnosis fell between 1 and 3 years and 9-10 years. Most studies focused on type 1 diabetes. Children with type 1 diabetes have a higher prevalence of CD (range from 5.5% to 20%), while the prevalence of CD in Down's syndrome patients was 1.1% and 10.7% in UAE and Saudi Arabia, respectively. Other autoimmune diseases associated with CD are thyroid disease and irritable bowel disease. The most widely recognized clinical presentation was an inability to flourish and poor weight gain, followed by short stature, abdominal pain, abdominal distension, bloating, and chronic diarrhea. Conclusion. The prevalence of the celiac disease in Arab countries varies with sex and age. However, we found that celiac disease presented similar clinical characteristics independent of the geographic region. Longitudinal population-based studies are needed to better identify the true burden and determinants of celiac disease. [ABSTRACT FROM AUTHOR]

Objective. This paper included a retrospective review of the effect of tranexamic acid (TXA) combined with pressure bandaging on hemostasis of patients who received a unilateral total knee arthroplasty (TKA) from 2017 to 2019. Methods. A total of 197 patients undergoing TKA were chosen to be classified into 2 groups, the compression bandage control group and compression bandage combined with TXA observation group. The patients received blood routine examination when they were in the 1st, 3rd, and 6th days of before and postoperation. Some parameters, such as hemoglobin (Hb), C-reactive protein (CRP), D-dimer value, fibrinogen, prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT), international normalized ratio (INR), and erythrocyte sedimentation rate (ESR), were also investigated. Results. In our research, the mean age was 66.54 ± 7.95 years. No difference was found in patient sex (P = 0.876) and age (P = 0.749) between groups. No differences were found in the levels of Hb, fibrinogen, TT, and INR between the 2 groups at each period (P > 0.05). The difference of PT was significantly different on the 1st day (P = 0.011), 3rd day (P = 0.010), and 6th day (P = 0.004) after surgery. Besides, the changes in APTT in observation group were clearly higher compared with the control group on the 3rd day (P = 0.001) and 6th day (P = 0.001). On the 3rd and 6th days after operation, the CRP level of the two groups increased continuously, and the CRP level was significantly higher in the observation group in comparison with the control group (P = 0.008 , P = 0.010). On 1st and 3rd days after surgery, compared to the control group, the D-dimer level of patients in the observation group was distinctly fewer (P = 0.001 , P = 0.027). Conclusion. TXA combined with compression bandage is a potential option for the reduction of bleeding after TKA. [ABSTRACT FROM AUTHOR]

Mammography remains the most prevalent imaging tool for early breast cancer screening. The language used to describe abnormalities in mammographic reports is based on the Breast Imaging Reporting and Data System (BI-RADS). Assigning a correct BI-RADS category to each examined mammogram is a strenuous and challenging task for even experts. This paper proposes a new and effective computer-aided diagnosis (CAD) system to classify mammographic masses into four assessment categories in BI-RADS. The mass regions are first enhanced by means of histogram equalization and then semiautomatically segmented based on the region growing technique. A total of 130 handcrafted BI-RADS features are then extracted from the shape, margin, and density of each mass, together with the mass size and the patient's age, as mentioned in BI-RADS mammography. Then, a modified feature selection method based on the genetic algorithm (GA) is proposed to select the most clinically significant BI-RADS features. Finally, a back-propagation neural network (BPN) is employed for classification, and its accuracy is used as the fitness in GA. A set of 500 mammogram images from the digital database for screening mammography (DDSM) is used for evaluation. Our system achieves classification accuracy, positive predictive value, negative predictive value, and Matthews correlation coefficient of 84.5%, 84.4%, 94.8%, and 79.3%, respectively. To our best knowledge, this is the best current result for BI-RADS classification of breast masses in mammography, which makes the proposed system promising to support radiologists for deciding proper patient management based on the automatically assigned BI-RADS categories. [ABSTRACT FROM AUTHOR]

Health workers are prone to burnout, which can have an adverse effect on their person and the patients to whom care is offered. The goal of this paper was to assess the levels of burnout experienced by healthcare workers in Accra, Ghana. The study was conducted using the cross-sectional study design. Questionnaires were used to obtain data from 365 respondents who worked in 12 major healthcare facilities. Data obtained were analyzed with SPSS version 23. Majority of the respondents were females (56.7%) as against males (43.3%). The total score for all burnout variables among health worker groups ranged from good (71.50%), alarming (12.60%), acute crisis (6.02%), and burnout (9.90%). Among the health worker groups, nurses had the highest percentage score values for all burnout variables. There was an association between burnout and these sociodemographic characteristics: age (p < 0.001), gender (p = 0.003), educational qualification (p < 0.001), occupation (p < 0.001), years of work experience (p < 0.001), marital status (p < 0.001), and parenthood (having children) (p < 0.001). It is recommended that measures should be put in place in Ghanaian hospitals to assess stress and burnout levels to ensure people who are going through such situations are properly cared and supported. [ABSTRACT FROM AUTHOR]

For their being considered safe and as over-the-counter (OTC) drugs, proton pump inhibitors (PPI) are one of the most frequently used medicines nowadays. However, for the last couple of years, many researches analyzing PPI were conducted and these studies shed light on PPI side effects and mechanisms of these processes. Particularly, interesting is the impact of PPI on hearing loss development. However, this side effect seems to be local and its mechanisms are complex and systemic and involve changes in the whole body. This paper summarizes how through, inter alia, alterations in circulatory system, respiratory system, central nervous system, and metabolic changes PPI can cause hearing impairment, which can occur at every age and is connected with long-term use of this group of drugs. Another important finding is the role of PPI in acceleration of presbycusis development which is disturbing with regard to the fact that elders are the group who most frequently use PPI in the long term. Hearing loss is the factor which gravely decreases life quality, especially among elders who are the most afflicted group; thus, administration of PPI should be considered carefully, taking under consideration all benefits and all potential side effects. [ABSTRACT FROM AUTHOR]

Cognitive impairments (CI), associated with the consequences of Alzheimer's disease and other dementias, are increasingly prevalent among older adults, leading to deterioration in self-care, mobility, and interpersonal relationships among them. Innovative Assistive Technologies (IAT) such as electronic reminders and surveillance systems are considered as increasingly important tools to facilitate independence among this population and their caregivers. The aim of this study is to synthesise knowledge on facilitators and barriers related to acceptance of and use of IAT among people with CI and their caregivers. This systematic review includes original papers with quantitative, qualitative, or mixed methods design. Relevant peer-reviewed articles published in English between 2007 and 2017 were retrieved in the following databases: CINAHL; PubMed; Inspec; and PsycINFO. The Mixed Method Appraisal Tool (MMAT) was used for quality assessment. We retrieved thirty studies, including in total 1655 participants from Europe, USA/Canada, Australia, and Asia, enrolled in their homes, care-residences, day-care centres, or Living Labs. Two-thirds of the studies tested technologies integrating home sensors and wearable devices for care and monitoring CI symptoms. Main facilitators for acceptance and adherence to IAT were familiarity with and motivation to use technologies, immediate perception of effectiveness (e.g., increase in safety perceptions), and low technical demands. Barriers identified included older age, low maturity of the IAT, little experience with technologies in general, lack of personalization, and support. More than 2/3 of the studies met 80% of the quality criteria of the MMAT. Low acceptance and use of IAT both independently and with caregivers remains a significant concern. More knowledge on facilitators and barriers to use of IAT among clients of health care and social services is crucial for the successful implementation of innovative programmes aiming to leverage innovative technologies for the independence of older people with CI. [ABSTRACT FROM AUTHOR]

Background. Although inappropriate gestational weight gain is considered closely related to adverse maternal and birth outcomes globally, little evidence was found in low- and middle-income countries. Study Objectives. This study is aimed at identifying the determinants of gestational weight gain and examine the association between gestational weight gain and maternal and birth outcomes in the Northern Region of Ghana. Study Methods. The study used a facility-based cross-sectional study design involving 611 antenatal and delivery records in Tatale district, Tamale west, and Gushegu municipal hospitals. A two-stage sampling method involving cluster and simple random sampling was employed. Descriptive statistical analysis and measures of central tendency were used to describe the sample. The multinomial logistic regression model was used to determine the determinants of gestational weight gain and its association with maternal and birth outcomes. Results. Among the 611 women included in the study, 516 (84.45%) had inadequate gestational weight gain, and 19 (3.11%) had excessive gestational weight gain. The gestational weight gain ranged from 2 kg to 25 kg with a mean of 7.26 ± 3.70 kg. The risk factor for inadequate gestational weight gain was low prepregnancy BMI (adjusted odds ratio AOR = 1.33 , 95% CI = 1.18 − 2.57 , P = 0.002). Pregnant women who had inadequate gestational weight gain were significantly less likely to deliver through caesarean section (AOR = 0.27 , 95% CI = 0.12 − 0.61 , P = 0.002), and those who had excessive weight gain were more likely to undergo caesarean section (AOR = 19.81 , 95% CI = 5.38 − 72.91 , P = 0.001). The odds of premature delivery (birth < 37 weeks) among pregnant women with inadequate weight gain were 2.88 (95% CI = 1.27 − 6.50 , P = 0.011). Furthermore, subjects who had excessive weight gain were 43.80 times more likely to give birth to babies with macrosomia (95% CI = 7.07 − 271.23 , P = 0.001). Conclusion. Inappropriate gestational weight gain is prevalent in Ghana, which is associated with caesarean section, preterm delivery, delivery complications, and macrosomia. Urgent policy interventions are needed to improve on the frequent monitoring and management of gestational weight gain of pregnant women till term. [ABSTRACT FROM AUTHOR]

Psychosocial distress and poorer quality of life after renal transplantation are common in children and young people. This has implications for medication adherence and survival. Posttransplant psychology annual reviews were introduced in one Paediatric Renal Service in the UK as a means of measuring psychological distress and quality of life, as well as facilitating identification of patients and parents/carers who would benefit from psychological intervention. The process of completing posttransplant psychology annual reviews is discussed within this paper. The posttransplant psychology annual review appointments identified patients experiencing depression and/or anxiety and problems in quality of life. These assessments have led to appropriate referrals to, and engagement with, the renal psychology service as well as with community tier 3 child and adolescent mental health services. The posttransplant psychology annual review will continue to be completed at this UK site and discussions will be undertaken with other paediatric renal transplant services to consider whether these could be introduced at a national level to facilitate collection of longitudinal data regarding long-term psychosocial impact of paediatric renal transplantation and its effect on quality of life. [ABSTRACT FROM AUTHOR]

Prostate cancer accounts for 20.3% of all cancers in men in sub-Saharan Africa. Early screening among at-risk groups is challenging in Uganda, with limited data on prostate cancer screening uptake in most districts, including newly established ones. The purpose of this study was to determine factors influencing the uptake of prostate cancer screening among men aged ≥ 40 in Kazo Town Council, Kazo District, a newly created district. We used a descriptive cross-sectional study design that employed both quantitative and qualitative data collection methods. Participants were recruited through simple random sampling between November 2020 and January 2021. Structured questionnaires were used for quantitative data (n = 300). Statistical analyses to determine associations were carried out using inferential and chi-square tests followed by logistic regression. In-depth interviews were conducted with 10 key informants and analyzed thematically to explore a range of perceptions related to prostate cancer screening. Only 10 (3.33%; 95% CI: 0.018-0.60) respondents had ever screened for prostate cancer. Lack of privacy (p < 0.033), access to prostate cancer information (p < 0.014), and distance to health facilities (p < 0.001) were significantly associated with the uptake of prostate cancer screening. Marital status (OR = 7.93 ; 95% CI: 1.85-33.99; p = 0.005), positive health worker attitudes (OR = 0.002 ; 95% CI: 0.000-0.023, p < 0.001), and perceived affordability (OR = 0.001 ; 95% CI: 0.000-0.011, p < 0.001) were independently associated with uptake of prostate cancer screening. Key barriers included lack of information, access to screening centres, and fear of screening. The level of uptake of prostate cancer screening was considerably low among men aged 40 and above in the Kazo District. Targeted community interventions to improve access to prostate cancer information, screening, sensitization, and addressing perceived and actual barriers are needed in newly created districts to bolster the uptake of prostate cancer screening. This has implications for prioritizing research evaluating district resource allocation to support optimized and integrated evidence-based service delivery in primary healthcare centres, especially for specialized services in newly created districts. [ABSTRACT FROM AUTHOR]

Background. Typically, the idea of patient satisfaction is employed to evaluate quality. When patients enter hospitals, they have certain demands for treatment. However, patients may become dissatisfied if their requirements or expectations are not met. There is increasing agreement that evaluating hospital services should be based in part on patients' assessments of the quality of treatment they received overall. The aim of this study was to improve patient satisfaction at outpatient department. Objective. To assess improving of patient satisfaction and associated factors at outpatient department in general hospitals of central zone, Northern Ethiopia, 2019. Methods. Pre- and post-intervention study was conducted to assess the patient satisfaction at outpatient department in general hospitals of central zone, between June 2018 and April 2019 using systematic random sampling method. Two hundred seventy-five (275) participants were investigated in the preintervention and postintervention study. Data were entered to SPSS version 20. Binary logistic regression was done to test association of factors with the outcome variable with consideration of p value of less than 0.05. Result. In the preintervention period, the patient satisfaction was 54.2%; after providing intervention, the patient satisfaction was increased to 77% in postinterventional study. Respondents who paid for the medical service were 41% less likely satisfied than those who had gotten free services. Participants whose age of 18-27 years were 22% more likely satisfied than whose age were 58 and greater. Conclusion. The result in this study shows that the patient satisfaction is higher than other studies done in our country. Sex, age, and those who make payment were significantly associated with patient satisfaction. Despite the result, much things are left to be covered to increase satisfaction, so the concerned bodies, including the regional health bureau, woreda health office, and management committee and board, should mobilize the community and give training to the health professionals to make the environment smoother and more comfortable for patients. [ABSTRACT FROM AUTHOR]

Background. In recent times, cervical dysbiosis which mostly causes and aggravates infections is highlighted for its role in immune modulation in cervical dysplasia, which promotes the shifting of Th1 phenotype immunity to Th2 phenotype immunity. This study therefore estimated and compared the levels of circulatory IL-4, IL-6, IL-10, TNF-α, and IFN-γ cytokines among adult women identified to have different grades of cervical intraepithelial neoplasia (CIN) and with cervicovaginal infection. Methods. A total of 157 participants were recruited from the Akyemansa District of Ghana, and cervical swabs and blood samples were taken. The Pap smear test, microbiological culture, and ELISA were employed for cytology analysis, bacteria isolation, and identification and estimation of IL-4, IL-6, IL-10, TNF-α, and IFN-γ cytokines, respectively. Results. Overall, 14/157 (8.9%) had CIN with 7.6% having CIN 1 and 1.3% having CIN 2. The main predictor for CIN was age above 46 years (OR 11.16, 95% CI: 2.4-51.8). Bacterial vaginosis (p = 0.003) and Candida infection (p = 0.012) were significantly higher in CIN. Again, Staphylococcus aureus (60% vs. 17.6%, p = 0.005), Citrobacter sp. (40.0% vs. 13.2%, p = 0.017), and Morganella morganii (40.0% vs. 4.4%, p = 0.002) isolates were significantly higher in CIN-positive participants. IL-10 and TNF-α concentrations were elevated in participants with CIN 1+ (TNF-α NIL vs. CIN 1+ only, p < 0.05) while IL-6 was decreased among participants with CIN 1+. In the presence of vaginal infection, TNF-α decreased among CIN 1+ participants while IL-10 remained elevated. Conclusion. The findings of this study suggest that cervical dysbiosis causes immune suppression, which creates a suitable microenvironment for the development of CIN. [ABSTRACT FROM AUTHOR]

Persistent low-level viremia (PLLV) of 200-999 copies/ml has been reported as a risk factor for HIV virologic failure (VF). This retrospective study was aimed at characterizing patients with PLLV, determining factors associated with VF, and determining the effect of regimen change. Data were extracted from electronic medical records for HIV care and treatment. Patients' characteristics (N = 705) were as follows: a mean age of 42 years, majority female (55%), and 51% married. A majority (78.7%) had a history of opportunistic infections in their ART lifetime. To determine factors associated with VF, 187 records on patients who maintained PLLV and 12 on deceased patients at the time of data review were eliminated from the analysis, leaving 506 patient records. Out of the 506, 89% (451/506) suppressed VL to nondetectable levels while 11% (55/506) had VF, and the difference was significant (P = 0.0001). Virologic failure was significantly associated with ages 10-30 years (P < 0.05). Baseline VL ≥ 1000 (OR 3.929; P = 0.002) and 200-999 copies/ml (OR 4.062; P = 0.004) were associated with VF. During PLLV, factors associated with VF included the following: PLLV of 200-999 copies/ml (P < 0.05), viral blips (OR 4.545; P = 0.0001), mean maximum VL (P < 0.05), and age (P = 0.043). Married marital status was inversely associated with VF (OR 0.318; P = 0.026). Regimen change was not significantly associated with virologic outcomes. However, patients who switched regimens to the second line had a high risk of VF (P = 0.028 ; OR 3.203). Regimen change was significantly high (P < 0.05) among adolescents and patients with a start regimen of 2NRTI+1NNRTI. Most of the PLLV patients (89%) achieved nondetectable VL after their continued ART monitoring for at least 12 months. Therefore, PLLV was not an indicator of VF. However, a consistent VL of ≥200-999 copies/ml at baseline and more than 12 months of ART care and treatment were significantly associated with VF. Patients with VL 200-999 copies/ml, adolescents, and young adults require intensive ART monitoring and support. [ABSTRACT FROM AUTHOR]

Objective. This study focuses on the identification of risk factors, classification of stroke level, and evaluation of the importance and interactions of various patient characteristics using cohort data from the Second Hospital of Lanzhou University. Methodology. Risk factors are identified by evaluation of the relationships between factors and response, as well as by ranking the importance of characteristics. Then, after discarding negligible factors, some well-known multicategorical classification algorithms are used to predict the level of stroke. In addition, using the Shapley additive explanation method (SHAP), factors with positive and negative effects are identified, and some important interactions for classifying the level of stroke are proposed. A waterfall plot for a specific patient is presented and used to determine the risk degree of that patient. Results and Conclusion. The results show that (1) the most important risk factors for stroke are hypertension, history of transient ischemia, and history of stroke; age and gender have a negligible impact. (2) The XGBoost model shows the best performance in predicting stroke risk; it also gives a ranking of risk factors based on their impact. (3) A combination of SHAP and XGBoost can be used to identify positive and negative factors and their interactions in stroke prediction, thereby providing helpful guidance for diagnosis. [ABSTRACT FROM AUTHOR]

Purpose. This paper aims to analyze the household financial burden and poverty impacts of cancer treatment in Vietnam. Methods. Under the “ASEAN CosTs in ONcology” study design, three major specialized cancer hospitals were employed to assemble the Vietnamese data. Factors of socioeconomic, direct, and indirect costs of healthcare were collected prospectively through both individual interviews and hospital financial records. Results. The rates of catastrophic expenditure based on the cut-off points of 20%, 30%, 40%, and 50% of household’s income were 82.6%, 73.7%, 64.7%, and 56.9%, respectively. 37.4% of the households with patient were impoverished by the treatment costs for cancer. The statistically significant correlates of the impoverishment problem were higher among older patients (40–60 years: 1.77, 95% CI 1.14–2.73; above 60 years: 1.75, 95% CI 1.03–2.98); poorer patients (less than 100% national income: 29, 95% CI 18.6–45.24; less than 200% national income: 2.89, 95% CI 1.69–4.93); patients who underwent surgery alone (receiving nonsurgery treatment: 2.46, 95% CI 1.32–4.59; receiving multiple treatments: 2.4, 95% CI 1.38–4.17). Conclusions. Lots of households were pushed into poverty due to their expenditure on cancer care; more actions are urgently needed to improve financial protection to the vulnerable groups. [ABSTRACT FROM AUTHOR]

Aging slows down the mechanisms behind skeletal muscle weakening and mobility. Increases in inflammation brought on by aging may contribute to some characteristics of sarcopenia. As a result of population aging worldwide, sarcopenia, an age-related disease, has become a huge burden on both individuals and society as a whole. The study of the morbidity mechanism and available sarcopenia treatments has received more attention. The inflammatory response may be one of the most important methods behind the pathophysiology of sarcopenia in the aged, according to the background of the study. This anti-inflammatory cytokine inhibits the ability of human monocytes and macrophages to induce inflammation as well as the production of cytokines like IL-6. Here, we investigate the association between sarcopenia and interleukin-17 (IL-17), an inflammatory cytokine in the aged. There were 262 subjects aged 61-90 years who were screened for sarcopenia in Hainan General Hospital. The subjects were divided into 45 males and 60 females aged 65-79 years (average age: 72.00 ± 4.31 years). 105 patients without sarcopenia were randomly selected among 157 participants. It included 50 males and 55 females, aged 61-76 years (mean age: 69.10 ± 4.55 years) as per the standard definition of the Asian Working Group for Sarcopenia (AWGS). The "skeletal muscle index" (SMI), "hand grip strength" (HGS), "gait speed" (GS), "biochemical indexes," "serum IL-17 level," nutritional status, and past medical history of the two groups were evaluated and compared. Compared with the participants without sarcopenia, sarcopenia patients had higher average age; less physical exercise; lower total scores of BMI, pre-ALB, IL-17, and SPPB; and a higher proportion of malnutrition risk (all P < 0.05). By "ROC curve analysis," the best critical point was IL-17 in the growth of sarcopenia. The area that comes under ROC (AUROC) value was 0.627 (95% CI = 0.552 , 0.702, P = 0.002). The ideal threshold value for IL-17 to estimate sarcopenia was 18.5 pg/mL. In the unadjusted model, IL-17 was considerably linked to sarcopenia (OR = 1.123 , 95% CI = 1.037 -1.215, P = 0.004). After the covariate adjustment observed in the complete adjustment model (OR = 1.111 , 95% CI = 1.004 -1.229, P = 0.002), this significance still exists. The results of this study suggest a strong relationship between sarcopenia and IL-17. This study will look at IL-17's potential to serve as a key sarcopenia indicator. This trial is registered with ChiCTR2200022590. [ABSTRACT FROM AUTHOR]

Background. According to American Joint Committee on Cancer (AJCC) 8th staging system, T1 intrahepatic cholangiocarcinoma (T1 ICC) is considered a tumor with no vascular invasion. However, T1 ICC usually occurs distant metastasis (DM), and the clinical features of these patients could help clinicians identify the high-risk population. Methods. We reviewed 1959 newly diagnosed patients with T1 ICC from the Surveillance, Epidemiology, and End Results (SEER) database during 2004–2018. Logistic regression models and Cox proportional hazards models were conducted to predict the risk of DM and overall survival (OS), respectively, and then, web-based nomograms were constructed. Decision curve analysis (DCA) and clinical impact curves (CIC) were used to measure the clinical utility of the models. The low-, medium-, and high-risk groups were identified by calculating the summary of the risk points. Nomograms on the web were also created to help clinicians better use these prediction models. Results. Tumor size and lymph node metastasis accounted for the first two largest proportions among the DM nomogram scores, while surgery, DM, age at diagnosis, chemotherapy, and lymph node metastasis occupied the largest percentage in OS nomogram. DM nomogram was established for these newly diagnosed patients with T1 ICC, and OS nomogram was developed to visually predict the OS rate of 3, 5, and 10 years. The calibration curves revealed a valid predictive accuracy of nomograms, of which the C-index was 0.703 and 0.740, respectively, for good discrimination. DCAs, CICs, and risk subgroups showed the clinical validity of these nomograms. Two websites were created to make it easier to use these nomograms. Conclusions. Novel web-based nomograms predicting the risk of DM and OS for T1 ICC were constructed. These predictive tools might help clinicians make precise clinical strategies for each patient with T1 ICC. [ABSTRACT FROM AUTHOR]

Background. This study is aimed at constructing a nomogram to predict the risk of clinically significant prostate cancer (csPCa) based on the aggregate index of systemic inflammation (AISI) and prostate imaging-reporting and data system version (PIRADS) score. Methods. Clinical data on patients who had undergone initial prostate biopsy from January 2019 to December 2021 were collected. Patients were randomized in a 7 : 3 ratio to the training cohort and the validation cohort. Potential risk factors for csPCa were identified by univariable and multivariate logistic regression. Nomogram was conducted with these independent risk factors, and calibration curves, the receiver operating characteristic (ROC), and decision curve analysis (DCA) were employed to assess the nomogram's ability for prediction. Results. A total of 1219 patients were enrolled in this study. Multivariate logistic regression identified that age, AISI, total prostatic specific-antigen (tPSA), free to total PSA (f/tPSA), prostate volume (PV), and PIRADS score were potential risk predictors of csPCa, and the nomogram was developed based on these factors. The area under the curve (AUC) of the training cohort and validation cohort was 0.884 (95% CI: 0.862-0.906) and 0.899 (95% CI: 0.867-0.931). The calibration curves showed that the apparent curves were closer to the ideal curves. The DCA results revealed that the nomogram model seemed to have clinical application value per DCA. Conclusion. The nomogram model can efficiently predict the risk of csPCa and may assist clinicians in determining if a prostate biopsy is necessary. [ABSTRACT FROM AUTHOR]

Background. We aimed to evaluate the prognostic value of E2F4 expression in oral squamous cell carcinoma (OSCC) and clarify its influence on immune cell infiltration and biological functions. Methods. The Cancer Genome Atlas (TCGA) database, the STRING database, and related online tools as well as single-sample gene set enrichment analysis (ssGSEA) were used for the analyses in our study. Results. The E2F4 expression was elevated in OSCC tumor tissue compared with paracancerous tissues. The high expression of E2F4 was closely related to the poorer overall survival, disease-free survival, and progression-free interval of OSCC. In addition, pathway enrichment analyses revealed that the top 49 genes most closely related to E2F4 were strongly associated with the cell cycle. E2F4-related proteins were closely related to the following KEGG pathways: cell cycle, cellular senescence, PI3K-Akt signaling pathway, Wnt signaling pathway, and notch signaling pathway. It was also demonstrated that the E2F4 expression was negatively correlated with immune purity and strongly related to immune cell infiltration in OSCC. Conclusions. E2F4 can be used as a novel biomarker for the diagnosis and prognosis of OSCC. [ABSTRACT FROM AUTHOR]

We aimed to determine prognostic factors and develop an effective and practical nomogram for predicting cancer-specific survival in gastrointestinal stromal tumor (GIST) patients. Postoperative data were obtained from the SEER database (2000-2018). Patients were divided into training and validation cohorts at random (7 : 3). Prognostic factors were screened, and a prognostic nomogram was established using log-rank testing and Cox regression. We used DCA, ROC curves, C-index, and calibration curves to evaluate our model's predictive performance. The clinical value of the nomogram and the modified National Institute of Health (M-NIH) classification were compared using the NRI and IDI. The Kaplan-Meier method was applied to examine survival by risk group, and log-rank tests were applied to compare variations in survival curves. Independent prognostic risk factors associated with cancer-specific survival on multivariate Cox proportional hazards regression analysis were age, race, and tumor location, size, grade, and stage. Clinically relevant variables need to be considered in addition to statistically significant variables when developing prognostic models to aid clinical decision-making. We included two additional variables (mitotic rate and chemotherapy) when constructing the prognostic model. The C-index was 0.766 (95% confidence interval (CI): 0.737-0.794) in the training cohort and 0.795 (95% CI: 0.754-0.836) in the internal validation group suggesting robustness. The areas under the ROC curve for three-year and five-year survival were >0.700, indicating satisfactory discrimination. The calibration curves showed good agreement between the predictions of the nomogram and the actual results. The NRI (0.346 for 3-year and 0.265 for 5-year cancer-specific survival for patients with GIST (GSS) prediction; validation cohort: 0.356 for 3-year and 0.246 for 5-year GSS prediction) and IDI values (0.047 for 3-year and 0.060 for 5-year GSS prediction; validation cohort: 0.071 for 3-year and 0.084 for 5-year GSS prediction) suggested that the established nomogram performed significantly better than the M-NIH classification. The DCA indicated that the nomogram was clinically useful and had a high discriminative ability in identifying patients who were at high risk of poor outcomes. According to nomogram findings, patients were divided into three groups (high, moderate, and low risk), with significantly different prognoses in both cohorts. Our nomogram satisfactorily predicted survival in postsurgical GIST patients, which may assist clinicians to evaluate the postoperative status and guide subsequent treatments. [ABSTRACT FROM AUTHOR]

Objective. This study is aimed at investigating the pattern of change occurring in respiratory pathogens before and after the outbreak of COVID-19, a type of viral pneumonia for which a pandemic was declared (March 2020). The results were analyzed by gender and age to identify the association between personal hygiene and prevention of infection by respiratory pathogens. Methods. A retrospective analysis was performed on 39,814 sputum, bronchial aspirate, and transtracheal aspirate samples obtained from 15,398 patients visiting a university hospital, located in Chungcheongnam-do, South Korea, between January 2018 and December 2021. From 4,454 patients whose samples were culture positive for bacteria, 6,389 strains were isolated and further cultured. Results. The mean age of the outpatients with respiratory pathogens was 66.2 years, and the comparison of the culture test results by gender showed that 64.9% (2,892/4,454) were male and 35.1% (1,562/4,454) were female. Compared to the pre-COVID-19 pandemic period, the number of outpatients with a request for respiratory microbial cultures after the onset of the pandemic was reduced by 20.7% and the number of outpatients with a positive culture result was reduced by 23.0%. The number of respiratory samples received was reduced by 6.7% after the pandemic, while the sample positive rate was reduced by 18.3%. Among the isolated microbial strains, there was a significant decrease of 43.1% for the Acinetobacter baumannii complex, 60.5% for Streptococcus pneumoniae, 67.2% for Haemophilus influenzae, and 78.1% for Moraxella catarrhalis when compared with pre-COVID-19 levels. The distribution of respiratory microbial strains by age group showed that the highest percentage of isolated strains was in patients in their 70s. Conclusions. The improvements in personal hygiene due to the COVID-19 pandemic exerted a substantial influence on the pattern of change in other common respiratory microorganisms, which highlights the importance of personal hygiene management in the prevention of respiratory infections. [ABSTRACT FROM AUTHOR]

Introduction. Altered ocular perfusion and vascular dysregulation have been reported in glaucoma. The aim of this paper was to evaluate the vascular response to a hypercapnic stimulus. Methods. Twenty normal tension glaucoma (NTG) patients and eighteen age- and gender-matched controls had pulsatile ocular blood flow (POBF)measurements, systemic cardiovascular assessment, and laser Doppler digital blood flow (DBF) assessed. Measurements were taken at baseline, after 10-minutes rest, in the stable sitting and supine positions and following induction and stabilization of hypercapnia, which induced a 15% increase in end-tidal pCO2. The POBF response to hypercapnia was divided into high (>20%) and low responders (<20%). Results. 65% of NTG patients had a greater than 41% increase in POBF following CO2 rebreathing (high responders). These high responders had a lower baseline POBF, lower baseline DBF, and a greater DBF response to thermal stimulus. Conclusion. NTG patients that have a greater than 20% increase in POBF after a hypercapnic stimulus have lower baseline POBF and DBF values. This suggests that there is impaired regulation of blood flow in a significant subgroup of NTG patients.This observation may reflect a generalised dysfunction of the vascular endothelium. [ABSTRACT FROM AUTHOR]

Background. The first sexual experience is the most significant event in a woman's life. Early sexual experience has short- and long-term health and behavioral risks. Studying the estimated time for a female to have her first sexual debut is important to reduce its health, demographic, and socioeconomic consequences. Thus, this study is aimed at assessing the time to first sexual experience and its determinants in Ethiopia. Methods. A survival analysis of time to first sexual experience was conducted among 6143 weighted study subjects. The data were extracted from EDHS 2016 using STATA version 16 software. A Kaplan-Meier survival curve was computed to estimate the time of first sexual experience. A log-rank test was used to compare the difference in survival curves. The Cox proportional hazard regression model was used to identify significant predictors. On multivariable analysis, variables having a p value of ≤ 0.05 are considered statically significant. Results. The overall median survival time was 16 years. The significant determinants of time to first sexual experience are educational level (no education (AHR = 2.72 , 95% CI: 2.16, 3.39), primary education (AHR = 2.17 , 95% CI: 1.79, 2.63), and secondary education (AHR = 1.47 , 95% CI: 1.21, 1.77)) and wealth index (poor (AHR = 1.15 , 95% CI: 1.00, 1.32)). Conclusion. About 50% of female youths have a sexual experience for the first time before their 16th birthday. The timing of the first sexual experience in Ethiopia was mainly influenced by educational level and wealth index. Universal access to education and poverty reduction should be the area of concern. [ABSTRACT FROM AUTHOR]

Cutaneous leishmaniasis is a continually spreading health problem in Amhara Region, Ethiopia. Despite this, up- to-date information on referral laboratory facility has been not yet reported. Therefore, this study was aimed at reporting up-to-date information about eight year's cutaneous leishmaniasis trend status. Data on referred cases from 2013 to 2020 were collected at Amhara Public Health Institute Parasitology department by reviewing log book. Of the 243 suspected cases, 114 (46.9%) were positive (confirmed) with microscope and cultured results showed that most of them were negatives. Most of the suspected cases were from 16 to 30 years and males by age and sex, respectively. Trend status by year depicted that largest numbers of suspected and confirmed cases were reported in 2013, 2015, and 2019 years. Finally, the trend status by zone showed that most cases were reported from South Gondar and Awi zones, respectively. [ABSTRACT FROM AUTHOR]

Objectives. To determine the independent prognostic factors that will influence the local tumor control/visual acuity (VA) preservation of optic pathway glioma (OPG) after Gamma Knife radiosurgery (GKS) and to optimize the treatment strategy. Methods. A cohort of 52 consecutive OPG patients who underwent GKS in our center between August 1997 and September 2020 was studied retrospectively. Risk factors such as age at GKS, gender, tumor subtype, tumor site, tumor volume, intratumoral cyst formation, and marginal dose were selected for the univariate and multivariate analysis. COX proportional hazard models were built to determine the independent prognostic factors of local tumor control/VA preservation, and the Kaplan-Meier (K-M) curves were plotted to compare the survival rate among subgroups. Results. 52 OPG patients were included in this study, with a median age of 13.8 years (2-53 years); female outnumbered male at a ratio of 30 : 22; 7 patients (13.5%) had a history of surgical resection; 14 patients (26.9%) were categorized as neurofibromatosis type I (NFI) associated OPG and the rest as sporadic OPG; there were 6 patients (11.5%) with tumors located at hypothalamus/optic chiasm and the rest located in the orbit; the mean tumor volume was 4.36 ml (0.25-11.4 ml); 49 patients (94.2%) presented with VA impairment before GKS; 28 patients (53.8%) underwent single fraction GKS, and the rest underwent fractionated GKS (2-4 fractions); the mean marginal dose (represented with biologically effective dose, BED) was 66.6 Gy (13.3-126.0 Gy); the median follow-up time was 39 months (6-147 months); 11 patients were observed with tumor relapse, 33 with stable disease, and 8 with tumor regression; tumor relapse time varied from 30 to 76 months (mean 54 months); the 1-, 3-, and 5-year progression-free survival (PFS) rates were 100%, 92%, and 78%, respectively; 30 patients were included in the visual analysis; 7 patients were observed with VA deterioration, 19 with stable VA, and 4 with VA improvement; the 1-,3-, and 5-year VA preservation rates were 92%, 84%, and 77%, respectively. COX proportional hazard risk models showed that intratumoral cyst formation and marginal dose were the only two independent prognostic factors of local tumor control/VA preservation; fractionated GKS provided a higher VA preservation rate than single fraction GKS. Four patients were observed with conjunctive edema/conjunctive hyperemia in 1-4 weeks after GKS. Conclusions. GKS is a safe and effective treatment for OPG either as initial treatment or as salvage treatment after surgical resection, it provides good local tumor control and VA preservation, and fractionated GKS could be a preference for OPG patients with baseline VA ≥ 0.2. [ABSTRACT FROM AUTHOR]

The study examined the relationship between menopausal symptoms and sleep disturbances and the related influencing factors. Methods. We recruited women aged 40-65 years who attended the menopause clinic at Shanghai Jiao Tong University's Sixth People's Hospital from February 2011 to November 2019. The Menopause Rating Scale (MRS) was used to collect women's menopausal symptoms, and the Pittsburgh Sleep Quality Index (PSQI) was used to evaluate the subjects' sleep condition. We used logistic regression models to identify the relationship between menopausal symptoms and sleep quality. Results. A total of 1341 participants were recruited in this study. The most frequent three symptoms assessed by MRS were fatigue (72.9%), sleep disturbance (67%), and hot flashes with night sweats (65%). Participants' age was significantly associated with the severity of menopausal syndrome (P < 0.01). According to the PSQI sleep evaluation, 66.9 percent of participants had sleep disturbances (PSQI > 5). Logistic regression analysis revealed that women with mild, moderate, or severe menopausal syndrome had a 3-, 7-, and 17-fold increased chance of having sleep disturbances compared to women without menopausal syndrome. Conclusion. Women aged 40–65 years were found to have a significantly higher risk of menopausal syndrome and sleep disturbances. [ABSTRACT FROM AUTHOR]

Normal aging affects the different structures of teeth, in particular, the dentine. These changes are useful in forensic disciplines as a tool for age estimation. Although multiphoton (MP) microscopy has been used to explore dental pieces, a relationship between age and MP response of the human dentine has not been proposed yet. The relationship between MP signals and natural dentine aging is investigated herein. An index of age (INAG) combining two-photon excitation fluorescence (TPEF) and second harmonic generation (SHG) images has been used to quantify these changes. The results show that the INAG significantly decreases with age. Moreover, peritubular dentine size and collagen internal properties are also modified with age. This information confirms the usefulness of this technique in forensic age estimation after disasters (natural or manmade) with a lack of comprehensive fingerprint database. Courts and other government authorities might also benefit from this tool when the official age of individuals under special circumstances is required for legal or medical reasons. [ABSTRACT FROM AUTHOR]

Objective. To analyze the therapeutic effect of oral propranolol combined with sclerotherapy of lauromacrogol and triamcinolone acetonide in the treatment of lip infantile hemangiomas (IHs). Methods. We recorded the demographic characteristics and lesions of 56 patients with lip IHs. The efficacy was evaluated by Achauer grade and VAS score in this study. Nonparametric test and Spearman correlation analysis were used to identify factors that might affect the curative effect of patients, and multivariate logistic regression analysis was used to further analyze the factors that affect the prognosis of patients with lip IH. Results. All 56 patients improved without serious complications after treatment. Univariate analysis showed that the age of the patients at the time of treatment initiation, the layer, classification, and volume of IH may influence the course and outcome of treatment. The logistic regression analysis further showed that the frequency of topical sclerotherapy was affected by the age of the months at the time of treatment initiation. The final efficacy evaluation was influenced by the age at the beginning of treatment and the layer of IH. Conclusion. Oral propranolol combined with local sclerotherapy is a safe and effective method for treating lip IH. After combination therapy, the therapeutic effect of hemangiomas located in the mucosa and submucosa is better than those located in the skin and superficial subcutaneous fascia. Patients who were younger at treatment initiation received less frequencies of topical sclerotherapy and had better therapeutic effect. [ABSTRACT FROM AUTHOR]

Our aim in this paper is to describe the results of treatment of acute lymphoblastic leukaemia (ALL) in Mexican children treated from 2006 to 2010 under the protocol from the Dana-Farber Cancer Institute (DFCI) 00-01. The children were younger than 16 years of age and had a diagnosis of ALL de novo. The patients were classified as standard risk if they were 1–9.9 years old and had a leucocyte count <50 × 109/L, precursor B cell immunophenotype, no mediastinal mass, CSF free of blasts, and a good response to prednisone. The rest of the patients were defined as high risk. Of a total of 302 children, 51.7% were at high risk. The global survival rate was 63.9%, and the event-free survival rate was 52.3% after an average follow-up of 3.9 years. The percentages of patients who died were 7% on induction and 14.2% in complete remission; death was associated mainly with infection (21.5%). The relapse rate was 26.2%. The main factor associated with the occurrence of an event was a leucocyte count >100 × 109/L. The poor outcomes were associated with toxic death during induction, complete remission, and relapse. These factors remain the main obstacles to the success of this treatment in our population. [ABSTRACT FROM AUTHOR]

Construction workers are getting older. In the European Union, the percentage of workers over 50 grew from 24.7% in 2011 to 31.5% in 2018, in Spain from 20.4% to 31.2%. Objective. Identify trends and detailed patterns of accidents of older construction workers compared to other age groups. Data and Method. We analyzed construction accidents in Spain from 2011 to 2018 (N = 455,491). The number of accidents and lost working days (LWD) were broken down by occupation, seniority, company size, temporal variables (weekday, hour), trigger, and body part injured and compared for different age groups. Results. Although older worker had fewer accidents, the consequences of accidents were more serious. Those over 50 years had 84% more lost working days (LWD) than those under 24 years, 48% more than those between 25 and 39 years, and 21% more than those between 40 and 49 years. (1) Occupation: the percentage of accidents grew with age for supervisors, lorry drivers, and bricklayers. (2) Seniority: the least experienced (less than 6 months) and the most experienced (more than 6 years) had the most LWD. (3) Company size: there are 24.5% of accidents in companies of less than four workers. (4) Trigger: older workers suffered more falls, both from height and at the same level. (5) Time: the percentage of accidents in those over 50 was higher on Thursdays and Fridays, in the afternoons from 4 to 7 p.m., and after four hours of work. (6) Injury: this shows the longest absences for shoulder injuries for those over 50 years, with an average of 70 LWD. [ABSTRACT FROM AUTHOR]

Objective. In this study, we aimed to evaluate the effect of administering lidocaine as a local anesthetic at the puncture site prior cannulation on reduction of pain during intravenous cannulation (IVC). Methods. A total of 77 patients were divided into two groups as the patients who received a local anesthetic prior IVC procedure (n = 40) and the control group (n = 37). Patients' demographic data, including age, gender, height, weight and body mass index, IV gauge, IV site, heart rate (HR), and oxygen saturation (SpO2) were recorded and analyzed. Patients in both groups scored the pain they felt during IVC through the visual analog scale (VAS) and the verbal descriptor scale (VDS). Results. No statistically significant difference was found between the two groups in terms of the demographic features. There was no significant difference between the two groups in terms of the cannula gauges and site of IVC. The mean post-IVC HR value was statistically significantly higher compared to pre-IVC in the control group (p = 0.032), while no difference was found between the mean pre- and postprocedure HR in the lidocaine group. The mean VAS score was significantly lower in the lidocaine group compared to the control group (p < 0.001). There was a significant difference between the groups in terms of the current VDSs. The rate of the patients reporting mild pain was statistically significantly higher in the lidocaine group compared to the control subjects (p < 0.001). Conclusion. According to the results of this study, lidocaine HCL-impregnated padded dressing prior IV cannulation significantly reduced pain sensation during IVC. [ABSTRACT FROM AUTHOR]

Aim. We aimed to establish a prognostic nomogram for penile cancer (PC) patients based on the Surveillance, Epidemiology, and End Results Program (SEER) database. Methods. Data from 1643 patients between 2010 and 2015 were downloaded and extracted from the SEER database. They were randomly divided into the development group (70%) and the verification group (30%), and then, univariate and multivariate Cox proportional hazards regression, respectively, was used to explore the possible risk factors of PC. The factors significantly related to overall survival (OS) and cancer-specific survival (CSS) were used to establish the nomogram, which was assessed via the concordance index (C-index), receiver operating characteristic (ROC) curve, and calibration curve. An internal validation was conducted to test the accuracy and effectiveness of the nomogram. Kaplan–Meier calculation was used to predict the further OS and CSS status of these patients. Results. On multivariate Cox proportional hazards regression, the independent prognostic risk factors associated with OS were age, race, marital status, N/M stage, surgery, surgery of lymph nodes, and histologic type, with a moderate C-index of 0.737 (95% confidence interval (CI): 0.713–0.760) and 0.766 (95% CI: 0.731–0.801) in the development and verification groups, respectively. The areas under the ROC (AUC) of 3- and 5-year OS were 0.749 and 0.770, respectively. While marital status, N/M stage, surgery, surgery of lymph nodes, and histologic type were significantly linked to PC patients' CSS, which have better C-index of 0.802 (95% confidence interval (CI): 0.771–0.833) and 0.82 (95% CI: 0.775–0.865) in the development and verification groups, and the AUC of 3- and 5-year CSS were 0.766 and 0.787. Both of the survival calibration curves of 3- and 5-year OS and CSS brought out a high consistency. Conclusion. Our study produced a satisfactory nomogram revealing the survival of PC patients, which could be helpful for clinicians to assess the situation of PC patients and to implement further treatment. [ABSTRACT FROM AUTHOR]

Kidney failure occurs whenever the kidney stops to operate properly and would be unable to cleanse or refine the bloodstream as it should. Chronic kidney disease (CKD) is a potentially fatal consequence. If this condition is diagnosed early, its progression can be delayed. There are various factors that increase the likelihood of developing kidney failure. As a consequence, in order to detect this potentially fatal condition early on, these risk factors must be checked on a regular basis before the individual's health deteriorates. Furthermore, it lowers the cost of therapy. The chronic kidney or renal disease will be recognized in this work utilizing fuzzy and adaptive neural fuzzy inference systems. The fundamental purpose of this initiative is to enhance the precision of medical diagnostics used to diagnose illnesses. Nephron functioning, glucose levels, systolic and diastolic blood pressure, maturity level, weight and height, and smoking are all elements to consider while developing a fuzzy and adaptable neural fuzzy inference system. The output variable describes a specific patient's stage of chronic renal disease based on input factors such as stage 1, stage 2, stage 3, stage 4, and stage 5. The outcome will show the present stage of a patient's kidney. As a result, these methods can assist specialists in determining the stage of chronic renal disease. MATLAB software is used to create the fuzzy and neural fuzzy inference systems. [ABSTRACT FROM AUTHOR]

Introduction. We aimed (1) to measure the mesiodistal and buccolingual widths of the permanent dentition in Iranian orthodontic patients, (2) to determine cut-off points for sex identification based on the mesiodistal and buccolingual diameters, and (3) to calculate Bolton indices. Methods. The mesiodistal and buccolingual dimensions of 28 maxillary and mandibular permanent teeth in 331 Iranian nonsyndromic orthodontic patients (dental casts and radiographs) aged 12 to 35 years old with fully erupted permanent dentitions (except the third molars and some sporadic cases of a few teeth missing or excluded) were measured. The anterior, posterior, and overall Bolton ratios were calculated in cases with no missing teeth in the 6-to-6 range. Potentially associated factors (the skeletal Angle classes, crowding, sex, jaws, sides, and age), as well as the value of these measurements for sex determination and cut-off points for sex identification based on these measurements were assessed using receiver-operator characteristic (ROC) curves, analysis of variance (ANOVA), Tukey, unpaired t -test, partial and Pearson correlation coefficients, and multiple linear regression (α = 0.05). Results. Sex dimorphism was very frequent (P ≤ 0.05 in 41 out of 56 measurements). Only the buccolingual widths of the maxillary lateral and the mandibular central and lateral differed across the Angle classes (ANOVA/Tukey, P < 0.05). Cut-off points were estimated for 38 dental measurements, which were proper for sex identification (P < 0.05), with 8 (2 maxillary and 6 mandibular) measurements being highly appropriate (having areas under ROC curves ≥ 64 % , P < 0.05). Both the mandibular canines were the only teeth with all four measurements highly appropriate for this purpose. Controlling for the role of sex, aging was associated negatively with several crown dimensions (the buccolingual widths of the maxillary first and second premolar and mandibular second premolar and first molar; the mesiodistal diameters of the maxillary central, canine, first premolar, and first molar, mandibular central, lateral, first premolar, and first molar, P ≤ 0.05 , partial correlation coefficient). There were significant correlations among crown sizes. All the 28 (right/left-averaged) measurements were smaller in microdontia cases (P ≤ 0.002). The anterior, posterior, and overall Bolton indices were 78.05, 105.42, and 91.87, respectively. There were correlations between the overall Bolton ratio with the other two Bolton ratios (Pearson R = 0.696 , R = 0.740 , P < 0.0005) but not between the anterior and posterior Bolton ratios (R = 0.045 , P = 0.459). The skeletal Angle classes might not be associated with the overall and anterior Bolton ratios (ANOVA, regression, Pearson, P > 0.05). However, the posterior Bolton ratio was smaller in class II cases compared to classes I or III (Tukey, P ≤ 0.045). In the whole sample, there was no sex dimorphism in Bolton ratios (t -test, P > 0.05). However, in Angle class II patients, the anterior Bolton ratio was greater in men than in women (P = 0.014). Conclusions. Sex dimorphism might be very common in the dentition of Iranians, with aging significantly reducing some measurements. The buccolingual widths of some incisors might differ across the skeletal Angle classes. Mandibular canines are the most appropriate teeth for sex identification. The Angle classes might not be associated with the anterior and overall Bolton ratios; nevertheless, the posterior Bolton ratio might be smaller in class II cases compared to others. In general, sex might not affect Bolton ratios; however, in class II patients, the anterior Bolton ratios might be larger in men. [ABSTRACT FROM AUTHOR]

Early in the COVID-19 pandemic, asymptomatic transmission represented an important challenge for controlling the spread of SARS-CoV-2 through the traditional public health strategies. Further understanding of the contribution of asymptomatic infections to SARS-CoV-2 transmission has been of crucial importance for pandemic control. We conducted a retrospective epidemiological study to characterize asymptomatic COVID-19 cases occurred in the Apulia region, Italy, during the first epidemic wave of COVID-19 outbreak (February 29-July 7, 2020). We analyzed data collected in a regional platform developed to manage surveillance activities, namely, investigation and follow-up of cases and contacts, contact tracing, and laboratory and clinical data collection. We included all asymptomatic cases that were laboratory-confirmed during the appropriate follow-up, defined as persons infected with SARS-CoV-2 who did not develop symptoms/clinical signs of the disease. Between February 29 and July 7, 2020, a total of 4,536 cases were diagnosed with COVID-19 among 193,757 tests performed. The group of persons with asymptomatic SARS-CoV-2 infection consisted of 903 cases; the asymptomatic proportion was 19.9% (95% CI: 18.8-21.1%); this decreased with increasing age (OR: 0.89, 95% CI: 0.83-0.96; p = 0.001), in individuals with underlying comorbidities (OR: 0.55, 95% CI: 0.41-0.73; p < 0.001), and in males (OR: 0.69, 95% CI: 0.54-0.87; p = 0.002). The median asymptomatic SARS-CoV-2 RNA positive period was 19 days (IQR: 14-31) and the cumulative proportion of persons with resolution of infection 14 days after the first positive PCR test was 74%. As the public health community is debating the question of whether asymptomatic and late spreaders could sustain virus transmission in the communities, such cases present unique opportunities to gain insight into SARS-CoV-2 adaptation to human host. This has important implications for future COVID-19 surveillance and prevention. [ABSTRACT FROM AUTHOR]

This study examined the mediating role of motor competence in the association between physical activity (PA) and quality of life (QoL) and the moderating role of age in the indirect relationship between PA and QoL in children with ADHD. Eighty-six children aged 6-12 years old (, SD = 1.40 , 17.4% girls) with the diagnosis of ADHD were recruited in this study. Participants wore a wGT3X-BT accelerometer on their wri M age = 8.45 st for seven consecutive days to measure PA. Motor competence was measured by the Test of Gross Motor Development-Third Edition (TGMD-3). Quality of life (QoL) was assessed by the parent-reported Chinese version of the Pediatric Quality of Life Inventory. MVPA was positively associated with object control skills but was not directly related to QoL. Using the bootstrapping method, the indirect effect of object control was found between MVPA and social functioning (0.10, 95 % CI = 0.01 , 0.21 ), school functioning (0.09, 95 % CI = 0.01 , 0.18 ), and overall QoL (0.07, 95 % CI = 0.01 , 0.16 ), supporting the full mediation effect. Moderated mediation analysis further revealed that age strengthened the indirect effect from MVPA to social and school functioning via object control. Findings of this study indicated that MVPA is positively associated with object control skills, which in turn, is related to psychological aspects of QoL in children with ADHD. Age was found to moderate the indirect mediation paths. The findings may inform future expeditions on designing an effective intervention that helps to improve MC and QoL in children with ADHD. [ABSTRACT FROM AUTHOR]

Obesity is a risk factor of cardiovascular disease-related mortality and may be associated with changes in the autonomic nerve activity. Nurses working shifts and caring for patients are under great mental and physical pressure, and research has proven that these can negatively affect the body. The objective of this study was to examine the influence of obesity in nurses on their heart rate variability (HRV) and determine whether age or shift type moderates this influence. A questionnaire survey and HRV measurements were conducted on nurses at a hospital in Taiwan during a routine employee health checkup. HRV analysis was conducted using a noninvasive HRV monitor for five minutes. A total of 242 nurses with a mean age of 28.98 ± 6.56 years were enrolled in this study. An overly large waist circumference (WC) had a negative impact on high frequency (HF), low frequency (LF), and standard deviation of normal-to-normal interval (SDNN), while an overly high body mass index (BMI) had a negative impact on very low frequency (VLF) and SDNN. The interaction term "overly large WC × age" had a negative impact on HF (β = − 0.21 , p = 0.010) and LF (β = − 0.18 , p = 0.030), whereas the interaction term "overly high BMI×age" had a negative impact on HF (β = − 0.27 , p = 0.001), LF (β = − 0.19 , p = 0.023), and VLF (β = − 0.17 , p = 0.045). The interaction terms "overly large WC × shift type" and "overly high BMI × shift type" did not influence any HRV parameters. As age increased, so did the degree to which the HF and LF of nurses with an overly large WC were lower than normal, and so did the degree to which the HF, LF, and VLF of nurses with an overly high BMI were lower than normal. [ABSTRACT FROM AUTHOR]

Objective. This study is aimed at teasing out the correlation of plasma D-dimer (D-D) levels to age, metastasis, TNM stage (tumor-node-metastasis classification), and treatment in non-small-cell lung cancer (NSCLC) patients of different ages, to facilitate early diagnosis of hypercoagulable state, choose appropriate treatment, and use appropriate anticoagulants. Hence, thrombosis and complications caused by excessive anticoagulants can be prevented; thrombus or disseminated intravascular coagulation (DIC) and other complications in elderly patients with NSCLC can be reduced or avoided. By monitoring the level of plasma D-D in patients with NSCLC, recurrence and metastasis can be predicted in the early stage and the TNM stage can be evaluated. Methods. A total of 670 patients with NSCLC were selected in Shanxi Bethune Hospital from March 2014 to October 2020 as the experimental group, and 950 healthy people were selected from the physical examination center of the same hospital as the control group. The data of patients with NSCLC diagnosed for the first time without any treatment were collected and grouped based on metastasis, TNM stage, treatment, and pathological type, and the correlation with plasma D-D level was analyzed. Plasma D-D levels were measured by immunoturbidimetry on an ACL TOP 700 Automatic Coagulation Analyzer. The patients were further divided into two groups according to different treatment methods, and the differences in plasma D-D levels between patients receiving chemotherapy and those receiving targeted therapy in different treatment cycles were analyzed. The correlation between D-D levels and age in healthy controls was analyzed. The difference in D-D levels between NSCLC patients and healthy controls of the same age was analyzed. Results. All data of both the experimental group and the control group were normally distributed. The average age of the experimental group was 61.31 ± 6.23 (range: 36-92) years. The average age of the control group was 61.14 ± 11.12 (range: 35-85) years. There was no significant difference in gender between the experimental group and the control group (p > 0.05). The plasma D-D level of NSCLC patients was significantly higher than that of the healthy controls (p < 0.05). No significant difference in plasma D-D level was found between NSCLC patients of different genders, and the finding was similar between healthy controls of different genders (p > 0.05). Significant difference in the D-D level was found between the groups of 30-59 years and 60-69 years (p < 0.05), between groups of 60-69 years and 70-79 years (p < 0.05), and between 70-79 years and ≥80 years (p < 0.05). The plasma D-D level of patients ≤ 79 years old increased with age, but it decreased in those over 80 years old. According to Pearson correlation analysis, there was a positive correlation between the D-D level and the age of NSCLC patients under 79 years old (p < 0.05). The differences in D-D levels between the four age groups were statistically significant (p < 0.05), showing an upward trend of the D-D level in healthy controls with the increase of age. There were statistically significant differences in D-D levels between NSCLC patients and healthy controls of the matching age group (p < 0.05), suggesting that NSCLC patients had significantly higher D-D levels than healthy people of the same age group. The differences in D-D levels between NSCLC patients without metastasis, NSCLC patients with metastasis, and healthy people were statistically significant (p < 0.05). The patients with metastasis had the highest D-D level, and healthy people had the lowest D-D level. The difference in plasma D-D levels between patients of different TNM stages was statistically significant (p < 0.05). Patients with an advanced TNM stage tended to have higher D-D levels. The TNM stage and D-D level of NSCLC patients changed significantly before and after treatment. An earlier stage was related to a more obvious change in D-D levels after treatment with a statistically significant difference (p < 0.05). A more advanced stage was associated with a smaller change in the D-D level after treatment, with no statistically significant difference (p > 0.05). The plasma D-D levels before and after four cycles of chemotherapy or targeted therapy were higher than those of the healthy control group, and the differences were statistically significant (p < 0.05). The D-D level of patients after chemotherapy was significantly lower than that before chemotherapy (p < 0.05), but there was no significant difference before and after targeted therapy (p > 0.05). The D-D level after the first cycle of chemotherapy was higher than that before chemotherapy. The level of D-D after the third and fourth cycles was significantly lower than that before chemotherapy (p < 0.05). No significant difference was found between the D-D level before treatment and that after four cycles of chemotherapy (p > 0.05). Conclusion. It is suggested that coagulation test indexes should be included to evaluate the treatment regimen for NSCLC patients. Most patients with NSCLC are in a hypercoagulable state, which is related to age, tumor invasion and metastasis, recurrence, and treatment. Regular monitoring of plasma D-D levels can facilitate early diagnosis of a hypercoagulable state and timely and appropriate use of anticoagulants, to avoid or reduce complications such as venous thromboembolism in NSCLC patients and to prevent the risk of bleeding caused by excessive anticoagulants. Clinicians can choose the treatment with less harm and maximum benefit for NSCLC patients based on the plasma D-D level. When in a hypercoagulable state, the body's blood viscosity increases, making it more conducive to the growth and infiltration of tumor cells. Our study shows that the recurrence and metastasis of NSCLC are related to coagulation indexes, which provides a theoretical basis for the early diagnosis and treatment of recurrent and metastatic NSCLC. [ABSTRACT FROM AUTHOR]

Increasing statutory retirement ages around the world are forcing employees to prolong their working lives. We study the different ways in which mid- and late-career workers respond to such changes. We distinguish between negative emotions about working longer, cognitive engagement with prolonged employment, and proactive behavior to facilitate longer working lives. We analyze data from 1,351 employees aged 40-66 from the Netherlands. We estimate a structural equation model to identify in which ways experiences of age discrimination, accessibility of accommodative HR facilities, and social norms in the workers' social networks are related to the three different types of responses. Results show that when employees do not experience age discrimination, when their employer offers easily accessible accommodative HR facilities, and the social norms support prolonged employment, employees have fewer negative emotional reactions and are more likely to behaviorally respond to facilitate longer working lives. When these contexts are misaligned, the reverse is generally found. We also find socioeconomic differences in the ways employees respond to the prospect of prolonged employment. This study shows the importance of supportive contexts at different levels—societally, in organizations, and in individuals' own lives—for policy changes such as increasing statutory retirement ages to be effective. Different responses between different socioeconomic groups may lead to growing long-term inequality. [ABSTRACT FROM AUTHOR]

Primary central nervous system lymphoma (PCNSL) is a rare lymphoma, and the disease course is often aggressive with poor prognosis outcomes. PCNSL undergoes germinal center reactions and impairs B-cell maturation. However, angiogenesis is also involved in the tumorigenesis and progression of PCNSL. This study investigated the effects of the tumor microenvironment and angiogenesis-associated genomic alterations on the outcomes of PCNSL. The analysis also evaluated the influence of treatment modality and timing on PCNSL survival using partial least squares variance-based path modeling (PLS-PM). PLS-PM can be used to evaluate the complex relationship between prognostic variables and disease outcomes with a small sample of measurements and structural models. A total of 19 immunocompetent PCNSL samples were analyzed by exome sequencing. Our results suggest that the timing of radiotherapy and mutations of ROBO1 and KAT2B are potential indicators of PCNSL outcomes and may be affected by baseline characteristics such as age and sex. Our results also showed that patients with no mutations of ROBO1 and KAT2B, SubRT subgroup showed favorable survival outcomes compared with no SubRT subgroup in short-term follow-up. All SubRT patients have received high-dose methotrexate induction chemotherapy in the initial treatment. Therefore, initial induction chemotherapy combined with subsequent radiotherapy might improve survival outcomes in PCNSL patients who have no ROBO1 and KAT2B somatic mutations in short-term follow-up. The overall findings suggest that the tumor microenvironment and angiogenesis-associated genomic alterations and treatment modalities are potential indicators of overall survival and may be affected by the baseline characteristics of PCNSL patients. [ABSTRACT FROM AUTHOR]

Early sexual initiation is linked to an increased risk of HIV/AIDS and other STIs among teenagers, as well as having multiple partners, not using contraception, unintended pregnancy, and illegal abortions. Aim. To identify the correlates and psychological effects of early sexual debut among not-in-union women in Ghana. A descriptive cross-sectional survey was used for this study using data from Ghana Multiple Indicator Cluster Survey (MICS) for the year 2017/2018. SPSS software was used for data analysis, bivariate analysis for association was done using chi-square, and the prediction was done using a binary logistic regression model. The national prevalence of nonmarital early sexual initiation this current study recorded was 56.9%. Predictors variables were age, 15-24/≥35 years (AOR = 1.51 , 1.28-1.78), ever educated (AOR = 0.50 , 0.43-0.60), urban address (AOR = 0.85 , 0.74-0.98), married/single (AOR = 1.23 , 1.07-1.42), cohabitation/single (AOR = 1.43 , 1.19-1.72), Greater Accra Region/Upper West Region (AOR = 0.67 , 0.49-0.92), and health insurance (AOR = 0.89 , 0.79-0.998). As the wealth indices of the woman decrease from the richest to poorest, the likelihood of early sexual debut inversely increases: fourth/richest (AOR = 1.23 , 1.04-1.45), middle/richest (AOR = 1.31 , 1.09-1.58), second/richest (AOR = 1.38 , 1.11-1.72), and poorest/richest (AOR = 1.44 , 1.12-1.86); use of the internet (AOR = 0.58 , 0.50-068); substance use and alcohol ever use (AOR = 1.32 , 1.17-1.49); cigarette ever use (AOR = 2.58 , 1.44-4.64); contraceptive use (AOR = 1.31 , 1.16-1.49); and ever heard of HIV (AOR = 59 , 0.42-0.82). In conclusion, the prevalence of early sexual debut is still high in Ghana, especially among the northern regions. Several factors predicted early sex debut, and low life satisfaction and happiness were related to early sexual debut. [ABSTRACT FROM AUTHOR]

Background. Despite being sexually active and engaging in risky sexual behaviours similar to young adults, older adults (50 years or older) are less likely to receive HIV testing, and disaggregated data are still scarce about HIV prevention and treatment in this vulnerable population in sub-Saharan Africa (SSA). This systematic review is aimed at examining sex differences in HIV testing and counseling (HTC) among older adults in SSA. Methods. A systematic search of four databases, namely, MEDLINE (Ovid), EMBASE (Ovid), Web of Science, and Global Health, was conducted from 2000 to January 2020. The primary outcome of interest for this study was gender differences in HTC among older adults in SSA. Observational studies including cross-sectional, retrospective, and prospective cohort studies were included. Eligible studies must have reported sex differences in HIV testing uptake in a standard HTC service among older adults in SSA. Results. From the database search, 4143 articles were identified. Five studies were ultimately included in the final review. Of the 1189 participants, 606 (51.1%) and 580 (48.9%) were female and male, respectively. The review findings suggested that both men and women preferred HTC providers that are the same sex as them with women additionally preferring a provider who is also of a similar age. Men and women differed in their pathways to getting tested for HIV. The review documented mixed results with regard to the associations between sex of older adults and uptake of HTC. Older adult HTC uptake data are limited in scope and coverage in sub-Saharan Africa. Conclusion. This review revealed shortage of evidence to evaluate optimum HTC utilization among older adults. Few studies examined sex differences in HIV testing among older adults in the region. There is a need for stakeholders working in the area of HIV prevention and treatment to focus on older adult health utilization evidence organization, disaggregated by age and sex. Hence, high-quality research designs are needed on the topic in order to generate good quality evidence for targeted interventions to improve HTC among older adults in sub-Saharan Africa. [ABSTRACT FROM AUTHOR]

Background and Purpose. There are increasing evidences that show that the prognosis of patients with acute ischemic stroke (AIS) is closely related to the inflammatory response. In the inflammation caused by AIS, plasma C-reactive protein (CRP) will increase and is associated with prognosis in these patients; few studies have looked at the relationship between CRP and large artery atherosclerosis- (LAA-) type AIS. We aim to investigate the role of CRP in predicting the functional outcome of LAA-type AIS patients. Methods. We prospectively included 200 patients with LAA-type AIS and tested their CRP levels on admission. We followed these patients consecutively. The primary outcome was an adverse event, defined as a modified Rankin Scale score of 2-6 at months 3, 6, and 12 after discharge. A logistic regression model was used to analyze the relationship between CRP and the functional outcome of LAA stroke. Results. We divided 200 patients into 3 groups evenly based on CRP level. After adjustment for gender, age, smoking history, drinking history, history of hyperlipidemia, history of diabetes, lipid levels, and blood glucose levels, logistic regression showed that the incidence of LAA-type AIS poor outcome was positively associated with CRP level at admission, whether it was 3 months, 6 months, or 12 months after discharge, respectively (OR: 2.574, 95% CI: 1.213-5.463; OR: 2.806, 95% CI: 1.298-6.065; OR: 2.492, 95% CI: 1.167-5.321. In the highest tertile vs. the lowest tertile as a reference), and both were statistically different. Conclusions. High CRP level predicts poor functional outcome in LAA-type AIS patients, which provides a strong basis for clinicians to make treatment decisions for these patients. [ABSTRACT FROM AUTHOR]

Background. Primary cutaneous lymphomas (PCLs) refer to cutaneous lymphomas that primarily develop in the skin with no evidence of extracutaneous disease at the time of diagnosis. The epidemiological and clinical data of PCLs in Thailand are lacking. Objectives. To evaluate the frequency, demographic data, and clinical characteristics of different subtypes of PCLs in a tertiary care university hospital. Methods. In total, 137 patients with PCLs diagnosed in our hospital in 2008–2017 were retrospectively reviewed. Results. Of the 137 patients, 57 (41.6%) were male and 80 (58.4%) were female (M : F = 1 : 1.4). The median age at diagnosis was 40 years. Most patients (134, 97.8%) had cutaneous T-cell lymphomas (CTCLs). Three patients (2.2%) had cutaneous B-cell lymphomas (CBCLs). The most common subtype was mycosis fungoides (MF) (67.9%), followed by subcutaneous panniculitis-like T-cell lymphoma (SPTCL) (21.2%), primary cutaneous anaplastic large cell lymphoma (pcALCL) (3.6%), lymphomatoid papulosis (LyP) (1.5%), primary cutaneous gamma/delta T-cell lymphoma (pcGDTCL) (1.5%), Sézary syndrome (SS) (0.7%), extranodal NK/T-cell lymphoma, nasal type (ENKTCL-NT) (0.7%), primary cutaneous peripheral T-cell lymphoma, not otherwise specified (pcPTCL-NOS) (0.7%), primary cutaneous diffuse large B-cell lymphoma, leg type (pcDLBCL-LT) (1.5%), and primary cutaneous follicle center lymphoma (pcFCL) (0.7%). Most patients with MF presented with early-stage disease (84.0%), with hypopigmented MF the most common variant (42.6%). Conclusions. Compared to earlier Caucasian and Asian studies, the present study revealed a higher proportion of CTCL patients with a younger age at onset and a female predominance. MF was the most common CTCL subtype, followed by SPTCL. More than 80% of MF patients were diagnosed at an early stage. [ABSTRACT FROM AUTHOR]

Purpose. To study postoperative Health-Related Quality of Life (HRQOL) after instrumented fusion for fresh subaxial cervical trauma and the effect of spinal cord injury (SCI). Methods. From a total of 65 patients, 17 (26%) patients suffered on admission from SCI. Twenty-five patients underwent anterior, 25 posterior, and 15 circumferential cervical surgery for a single cervical injury. Sagittal roentgenographic parameters were measured in 65 age-matched asymptomatic controls and in patients on admission, eight months postoperatively and at final follow-up (lower C2-C7 curvature, cervical sagittal vertical axis (cSVA), spinocranial angle (SCA), T1-slope, neck tilt (NT), thorax inlet angle (TIA), cervical tilt (CT), cranial tilt (CrT), and occiput–C2 angle (C0-C2)). In the last evaluation, SCI patients were compared with their counterparts without SCI using national validated HRQOL instruments (SF-36 and neck disability index (NDI)). Results. Fusion included an average of 3 vertebrae (range 2-4 vertebrae). All 65 patients were followed for an average of 5.5 years, (range 3-7 years) postoperatively. In the last evaluation, 10 (15.4%) patients with incomplete SCI improved postoperatively at 1-2 grades. At the last observation, patients with SCI showed poorer HRQOL scores than their counterparts without SCI. In particular, each SF-36 domain score was correlated with SCA, T1-slope, cSVA, and CT. At baseline, patients showed higher NT, CrT, and C0-C2 angle than controls. Eight months postoperatively, cSVA, NT, TIA, and cranial tilt (CrT) were increased in patients. In the last observation, there was difference in the sagittal roentgenographic parameters between patients with SCI compared to those without SCI. Patients aged ≥55 years had postoperatively increased cSVA, NT, and CrT compared to their younger counterparts. Conclusion. At the final observation, HRQOL scores were lower in patients with SCI than in their non-SCI counterparts, obviously because of the associated neurologic impairment. SF-36 scores correlated with several sagittal roentgenographic parameters. These correlations should be taken in consideration by spine surgeons when performing cervical spine surgery for fresh cervical spine injuries. [ABSTRACT FROM AUTHOR]

Background. The right to prefer mode of delivery is a crucial component of compassionate and respectful care that fosters both maternal and neonatal well-being as the failure to respect the mother's interest increases to the risk of maternal depression and posttraumatic stress. Thus, the aim of the study was to assess delivery mode preference and associated factors among pregnant women. Methods and Materials. The study was conducted in two hospitals and two health centers. We used a cross-sectional study design incorporating 398 pregnant mothers attending an antenatal care follow-up from February to May 2018. The study excluded pregnant mothers with any previous uterine surgery including caesarean delivery from participation due to their restricted chance to prefer their mode of delivery. Data were collected by using a pretested questionnaire. Data were entered to EpiData Manager version 3.1 and exported to Statistical Package for the Social Sciences version 22 for analysis. Besides, the analysis included both the bivariate and multivariable analyses to check the association between dependent and independent variables. Finally, level of statistical significance was declared at P value < 0.05. Result. The participant's level of response was 100% (398). The age of the mothers ranges from 15 to 45 years old. The delivery mode preference of the caesarean section (C/S) and spontaneous vertex delivery (SVD) was 115 (28.9%) and 283 (71.1%), respectively. The study revealed that planned 47 pregnancy [AOR, 1.76; CI: 0.89-3.47], young age [AOR, 12.9; CI: 0.23-7.1], and primigravida [AOR, 1.24; CI: 0.29-5.2] were among the variables associated with maternal preference of caesarean section. Conclusion and Recommendation. Nearly one-third of the mothers preferred caesarean delivery as their mode of delivery due to fear of labor pain and repeated vaginal examination by the care providers. This is particularly seen in women who had received higher education level, claim their pregnancy as planned, their choice of delivery at hospital, young aged, pregnant for the first time, and those who had visited antenatal care repeatedly. This implies that policy makers and stakeholders should exert due emphasis to ongoing desire of caesarean delivery as the procedure is not without risk, if it is done without indication. For researchers, we recommend to investigate the preference of mode of delivery in a much broader aspect. [ABSTRACT FROM AUTHOR]

Objectives. To compare the differences of epidemiology analysis in population birth defects (BDs) between the rural and urban areas of Hunan Province in China. Methods. The data of population-based BDs in Liuyang county (rural) and Shifeng district (urban) in Hunan Province for 2014–2018 were analyzed. BD prevalence rates, percentage change, and annual percentage change (APC) by sex and age were calculated to evaluate time trends. Risk factors associated with BDs were assessed using simple and multiple logistic regression analyses. Results. The BD prevalence rate per 10,000 perinatal infants (PIs) was 220.54 (95% CI: 211.26-230.13) in Liuyang and 181.14 (95% CI: 161.18-202.87) in Shifeng. Significant decreasing trends in BD prevalence rates were noted in the female PIs (APC = − 9.31 , P = 0.044) and the total BD prevalence rate in Shifeng (APC = − 14.14 , P = 0.039). Risk factors for BDs were as follows: rural area, male PIs, PIs with gestational age < 37 weeks, PIs with birth weight < 2500 g , and migrant pregnancies. Conclusions. We should focus on rural areas, reduce the prevalence of premature and low birth weight infants, and provide maternal healthcare services for migrant pregnancies for BD prevention from the perspective of population-based BD surveillance. [ABSTRACT FROM AUTHOR]

Objective. To establish a machine learning model for identifying patients coinfected with hepatitis B virus (HBV) and human immunodeficiency virus (HIV) through two sexual transmission routes in Jiangsu, China. Methods. A total of 14197 HIV cases transmitted by homosexual and heterosexual routes were recruited. After data processing, 12469 cases (HIV and HBV, 1033; HIV, 11436) were left for further analysis, including 7849 cases with homosexual transmission and 4620 cases with heterosexual transmission. Univariate logistic regression was used to select variables with significant P value and odds ratio for multivariable analysis. In homosexual transmission and heterosexual transmission groups, 10 and 6 variables were selected, respectively. For identifying HIV individuals coinfected with HBV, a machine learning model was constructed with four algorithms, including Decision Tree, Random Forest, AdaBoost with decision tree (AdaBoost), and extreme gradient boosting decision tree (XGBoost). The detective value of each variable was calculated using the optimal machine learning algorithm. Results. AdaBoost algorithm showed the highest efficiency in both transmission groups (homosexual transmission group: accuracy = 0.928 , precision = 0.915 , recall = 0.944 , F − 1 = 0.930 , and AUC = 0.96 ; heterosexual transmission group: accuracy = 0.892 , precision = 0.881 , recall = 0.905 , F − 1 = 0.893 , and AUC = 0.98). Calculated by AdaBoost algorithm, the detective value of PLA was the highest in homosexual transmission group, followed by CR, AST, HB, ALT, TBIL, leucocyte, age, marital status, and treatment condition; in the heterosexual transmission group, the detective value of PLA was the highest (consistent with the condition in the homosexual group), followed by ALT, AST, TBIL, leucocyte, and symptom severity. Conclusions. The univariate logistics regression combined with the AdaBoost algorithm could accurately screen the risk factors of HBV in HIV coinfection without invasive testing. Further studies are needed to evaluate the utility and feasibility of this model in various settings. [ABSTRACT FROM AUTHOR]