bluuebunny/crossref_metadata_2025 huggingface dataset:
Binding Heterogeneity of Plasmodium falciparum to Engineered 3D Brain Microvessels Is Mediated by EPCR and ICAM-1
Authors: Bernabeu Maria , Gunnarsson Celina , Vishnyakova Maria , Howard Caitlin C. , Nagao Ryan J. , Avril Marion , Taylor Terrie E. , Seydel Karl B. , Zheng Ying , Smith Joseph D.
Published: May 2019

Cerebral malaria research has been hindered by the inaccessibility of the brain. Here, we have developed an engineered 3D human brain microvessel model that mimics the blood flow rates and architecture of small blood vessels to study how
P. falciparum
-
infected human erythrocytes attach to brain endothelial cells. By studying parasite lines with different adhesive properties, we show that the malaria parasite binding rate is heterogeneous and strongly influenced by physiological differences in flow and whether the endothelium has been previously activated by TNF-α, a proinflammatory cytokine that is linked to malaria disease severity. We also show the importance of human EPCR and ICAM-1 in parasite binding. Our model sheds new light on how
P. falciparum
binds within brain microvessels and provides a powerful method for future investigations of recruitment of human brain pathogens to the blood vessel lining of the brain.
Antiviral Innate Responses Induced by VSV-EBOV Vaccination Contribute to Rapid Protection
Authors: Menicucci Andrea R. , Jankeel Allen , Feldmann Heinz , Marzi Andrea , Messaoudi Ilhem
Published: May 2019

Ebola virus (EBOV) is the causative agent of Ebola virus disease (EVD), a deadly disease and major public health threat worldwide. A safe and highly efficacious vesicular stomatitis virus-based vaccine against EBOV is the only platform that has successfully completed phase III clinical trials and has been used in recent and ongoing outbreaks. Earlier studies showed that antibodies are the main mode of protection when this vaccine is administered 28 days before EBOV challenge. Recently, we showed this vaccine can provide protection when administered as early as 3 days before challenge and before antibodies are detected. This study seeks to identify the mechanisms of rapid protection, which in turn will pave the way for improved vaccines and therapeutics. Additionally, this study provides insight into host gene expression signatures that could provide early biomarkers to identify infected individuals who are at highest risk of poor outcomes.
Indole Reverses Intrinsic Antibiotic Resistance by Activating a Novel Dual-Function Importer
Authors: Wang Yan , Tian Tian , Zhang Jingjing , Jin Xin , Yue Huan , Zhang Xiao-Hua , Du Liangcheng , Bai Fan
Published: May 2019

Recently, signaling molecules were found to play a role in mediating antibiotic resistance. In this study, we demonstrated that
i
ndole
r
eversed the intrinsic
a
ntibiotic
r
esistance (IRAR) of multiple bacterial species by promoting the expression of a novel dual-function importer. In addition, population-dependent behavior induced by 13-methyltetradecanoic acid, a quorum sensing signal molecule designated
Le
DSF, was involved in the IRAR process. This study highlights the dynamic regulation of bacterial antibiotic resistance by small signaling molecules and provides direction for new therapeutic strategies using traditional antibiotics in combination with signaling molecules.
The Leucine-Responsive Regulatory Protein Lrp Participates in Virulence Regulation Downstream of Small RNA ArcZ in Erwinia amylovora
Authors: Schachterle Jeffrey K. , Sundin George W.
Published: May 2019

Fire blight disease continues to plague the commercial production of apples and pears despite more than a century of research into disease epidemiology and disease control. The causative agent of fire blight,
Erwinia amylovora
coordinates turning on or off specific virulence-associated traits at the appropriate time during disease development. The development of novel control strategies requires an in-depth understanding of
E. amylovora
regulatory mechanisms, including regulatory control of virulence-associated traits. This study investigates how the small RNA ArcZ regulates motility at the transcriptional level and identifies the transcription factor Lrp as a novel participant in the regulation of several virulence-associated traits. We report that ArcZ and Lrp together affect key virulence-associated traits through integration of transcriptional and posttranscriptional mechanisms. Further understanding of the topology of virulence regulatory networks can uncover weak points that can subsequently be exploited to control
E. amylovora
.
Topological Analysis of the Type 3 Secretion System Translocon Pore Protein IpaC following Its Native Delivery to the Plasma Membrane during Infection
Authors: Russo Brian C. , Duncan Jeffrey K. , Goldberg Marcia B.
Published: May 2019

The type 3 secretion system (T3SS) is a nanomachine required for virulence of many bacterial pathogens that infect humans. The system delivers bacterial virulence proteins into the cytosol of human cells, where the virulence proteins promote bacterial infection. The T3SS forms a translocon pore in the membranes of target cells. This pore is the portal through which bacterial virulence proteins are delivered by the T3SS into the eukaryotic cytosol. The pore also regulates secretion of these virulence proteins. Our work defines the topology of translocon pore proteins in their native context during infection, resolves previously conflicting reports about the topology of the
Shigella
translocon pore protein IpaC, and provides new insights into how interactions of the pore with the T3SS likely produce signals that activate secretion of virulence proteins.
Modification of the Gastric Mucosal Microbiota by a Strain-Specific Helicobacter pylori Oncoprotein and Carcinogenic Histologic Phenotype
Authors: Noto Jennifer M. , Zackular Joseph P. , Varga Matthew G. , Delgado Alberto , Romero-Gallo Judith , Scholz Matthew B. , Piazuelo M. Blanca , Skaar Eric P. , Peek Richard M.
Published: May 2019

Microbial communities are essential for the maintenance of human health, and when these communities are altered, hosts can become susceptible to inflammation and disease. Dysbiosis contributes to gastrointestinal cancers, and specific bacterial species are associated with this phenotype. This study uses a robust and reproducible animal model to demonstrate that
H. pylori
infection induces gastric dysbiosis in a
cagA
-dependent manner and further that dysbiosis and altered microbial community structure parallel the severity of
H. pylori
-induced gastric injury. Ultimately, such models of
H. pylori
infection and cancer that can effectively evaluate multiple determinants simultaneously may yield effective strategies for manipulating the gastric microbiota to prevent the development of gastric cancer.
Neuroinflammatory Changes in Relation to Cerebrospinal Fluid Viral Load in Simian Immunodeficiency Virus Encephalitis
Authors: Hammoud Dima A. , Sinharay Sanhita , Shah Swati , Schreiber-Stainthorp William , Maric Dragan , Muthusamy Siva , Lee Dianne E. , Lee Cheri A. , Basuli Falguni , Reid William C. , Wakim Paul , Matsuda Kenta , Hirsch Vanessa , Nath Avindra , Di Mascio Michele
Published: May 2019

Neurological and cognitive problems are a common complication of HIV infection and are prevalent even in treated individuals. Although the molecular processes underlying brain involvement with HIV are not completely understood, inflammation is suspected to play a significant role. Our work presents an
in vivo
assessment of neuroinflammation in an animal model of HIV, the simian immunodeficiency virus (SIV)-infected rhesus macaque. Using positron emission tomography (PET) imaging, we identified changes in brain inflammation after inoculation with SIV over time. Interestingly, we found decreased binding of the PET ligand in the presence of very high cerebrospinal fluid (CSF) viral loads. These findings were supported by immunostaining which showed marked glial loss instead of inflammation. This study provides insight into glial and neuronal changes associated with very high CSF viral load and could reflect similar changes occurring in HIV-infected patients.
Bacteria Floc, but Do They Flock? Insights from Population Interaction Models of Quorum Sensing
Authors: Ueda Hana , Stephens Kristina , Trivisa Konstantina , Bentley William E.
Published: May 2019

Our modeling efforts show how cell density can affect chemotaxis; they help to explain the roots of subgroup formation in bacterial populations. Our work also reinforces the notion that bacterial mechanisms are at times exhibited in higher-order organisms.
Reconciling Ecological and Engineering Design Principles for Building Microbiomes
Authors: Bernstein Hans C.
Published: May 2019

Simplified microbial communities, or “benchtop microbiomes,” enable us to manage the profound complexity of microbial ecosystems. Widespread activities aiming to design and control communities result in novel resources for testing ecological theories and also for realizing new biotechnologies.
Soil Viruses: A New Hope
Authors: Emerson Joanne B.
Published: May 2019

As abundant members of microbial communities, viruses impact microbial mortality, carbon and nutrient cycling, and food web dynamics. Although most of our information about viral communities comes from marine systems, evidence is mounting to suggest that viruses are similarly important in soil.
Moving Microbiome Science from the Bench to the Bedside: a Physician-Scientist Perspective
Authors: Surana Neeraj K.
Published: May 2019

The recognition over the past decade that nearly all diseases are associated with changes in the microbiome has raised hope that microbiome-based therapeutics may cure many human ailments. Billions of dollars are being poured into microbiome-oriented biotech companies, and the coming years will undoubtedly witness the approval of the first generation of these products.
Lactate Metabolism Is Strongly Modulated by Fecal Inoculum, pH, and Retention Time in PolyFermS Continuous Colonic Fermentation Models Mimicking Young Infant Proximal Colon
Authors: Pham Van Thanh , Chassard Christophe , Rifa Etienne , Braegger Christian , Geirnaert Annelies , Rocha Martin Vanesa Natalin , Lacroix Christophe
Published: May 2019

The metabolism of lactate is important for infant gut health and may lead to acute lactate and/or H
2
accumulation, pain, and crying as observed in colicky infants. Functional human studies often faced ethical challenges due to invasive medical procedures; thus, in this study, we implemented PolyFermS fermentation models to mimic the infant proximal colon, which were inoculated with immobilized fecal microbiota of two 2-month-old infants. We investigated the impact of pH, retention time, and accumulation of
dl
-lactate on microbiota composition and metabolic activity. We found that a drop in pH from 6.0 to 5.0 led to increased LPB and decreased LUB concomitantly with lactate accumulation. Increasing the RT resulted in complete lactate consumption associated with increased LUB. Our data highlight for the first time the impact of key abiotic factors on the metabolism of lactate, which is an important intermediate product for ecology and infant health.
Glecaprevir/pibrentasvir-associated acute liver injury in non-cirrhotic, chronic HCV infection without HBV co-infection
Authors: Hammami Muhammad Baraa , Aboushaar Reem , Alsabbagh Eyad
Published: May 2019

The combination of glecaprevir and pibrentasvir was recently approved for chronic hepatitis C virus (HCV) infection with recommended treatment duration of 8–12 weeks depending on previous treatments, viral genotype and cirrhosis status. Although liver injury was reported with other protease inhibitors in the presence of cirrhosis or hepatitis B virus (HBV) co-infection, glecaprevir/pibrentasvir treatment is not known to cause liver injury. We report a patient with chronic HCV infection who despite the absence of cirrhosis and HBV co-infection developed acute liver injury that completely resolved after glecaprevir/pibrentasvir withdrawal. Interestingly, sustained HCV virologic response was achieved after only 3 weeks of glecaprevir/pibrentasvir treatment.
Gemella morbillorumisolated from a pelvic abscess in an HIV-positive patient with squamous cell carcinoma of the perianal region
Authors: Ueberroth Benjamin Edward , Roxas Renato
Published: May 2019

Gemella morbillorumis a known commensal organism of the human oropharynx, gastrointestinal tract and genitourinary tract which is a rare cause of infections and even more rarely implicated in skin and soft tissue infections. We present a case of a young, HIV-positive patient with squamous cell carcinoma of the perianal region who presented with difficulty initiating urination for 1 week as well as increasing left leg swelling. His CD4 count was found to be 186, predisposing him to infection, and he had also received chemotherapy in the past year for his malignancy. He was febrile and tachycardic on presentation and admitted for further care. CT scan of the pelvis at time of admission demonstrated a pelvic abscess. Aspiration cultures ultimately grewG. morbillorum.Despite initial improvement with drainage and targeted antimicrobial therapy, the patient’s abscess recurred, and he ultimately elected transition to hospice due to worsening prognosis of malignancy.
When leucocytosis is not leukaemia
Authors: Ionescu Filip , Anusim Nwabundo , Douglas-Nikitin Vonda , Stender Michael
Published: May 2019

A female aged 84 years with a history ofClostridium difficile-associated diarrhoea presented from an extended care facility with altered mental status and respiratory distress. She was haemodynamically unstable and initial laboratory results revealed hyperleucocytosis (110.3×109/L). The presence of immature myeloid precursors, thrombocytopenia and respiratory distress, raised concern for an acute leukaemic process requiring emergent leucapheresis. However, on evaluation of the peripheral smear, prominent left shift and toxic granulation were noted, along with absence of blast cells. Considering her history ofC. difficileinfection, a CT scan of the abdomen and pelvis was obtained, which was suggestive of toxic megacolon. She was taken to the operating room for emergent colectomy. The pathology specimen showed pseudomembrane formation consistent with fulminantC. difficileinfection. She was treated with oral vancomycin and intravenous metronidazole, followed by clinical improvement and resolution of leucocytosis and thrombocytopenia.
Rapidly progressive global cerebral atrophy in the setting of anti-LGI1 encephalitis
Authors: Yelam Anudeep , Nagarajan Elanagan , Bollu Pradeep C
Published: May 2019

A 47-year-old man presented with complaints of breakthrough seizures, psychiatric and behavioural changes and catatonic features. MRI of the brain showed mild cerebral and right hippocampal atrophy, while the electroencephalogram showed intermittent right temporal slowing. With a presumed diagnosis of autoimmune encephalitis, he was treated with intravenous immunoglobulin (IVIG) and methylprednisolone, which significantly improved the symptoms. Serological testing later was positive for antileucine-rich glioma inactivated 1 antibody. Two months after the initial presentation, patient had a relapse of the symptoms without any further episodes of seizures. Repeat MRI of the brain showed a significant rapidly progressive diffuse cortical atrophy and hippocampal atrophy, more prominent on the right side along with hydrocephalus ex vacuo when compared with the initial MRI. He is currently on monthly IVIG therapy. At 4 months follow-up from the second imagining study, the patient had persistent MRI findings.
Infectious endocarditis and vertebral osteomyelitis caused byMoraxella catarrhalis
Authors: Maierean Serban M , Marinescu Daniel C , Croitoru David O , Verma Amol A
Published: May 2019

Moraxella catarrhalisfrequently colonises the oropharynges of healthy individuals. Disease is usually limited to the oropharynx, upper airways and lower airways in patients with predisposing conditions. The pathogen rarely causes more invasive disease. We present the case of a 65-year-old woman with Crohn’s disease on azathioprine, who was diagnosed with native valveM. catarrhalisendocarditis and vertebral osteomyelitis several weeks after an upper respiratory tract infection. She presented to hospital with 5 weeks of worsening malaise, nausea, relapsing fevers, weight loss, acute-on-chronic exacerbation of lower back pain and diffuse myalgia. Transoesophageal echocardiogram showed a 12 mm vegetation on her mitral valve, contrast-enhanced MRI was consistent with L4 osteomyelitis and blood cultures were persistently positive forM. catarrhalis. She was initially treated with ceftriaxone 2 g intravenously daily, and although her symptoms initially resolved, she experienced a relapse of osteomyelitis with L3 extension a few weeks after treatment discontinuation.
Henoch-Schonlein purpura associated with HLA-B27 positive axial spondyloarthritis in a young man
Authors: John Kevin John , Sadiq Mohammad , Thomas Meera , Turaka Vijay Prakash
Published: May 2019

Axial spondyloarthropathies are characterised by bilateral sacroiliitis, asymmetric oligoarthritis, association with the human leucocyte antigen (HLA)-B27, enthesitis and dactylitis. Although IgA nephropathy has a well-documented association with seronegative spondyloarthropathies, the association with Henoch-Schonlein purpura (HSP) has been documented only in few case reports. The present case is that of a 26-year-old man who presented with fever, lower limb arthritis, abdominal pain, palpable purpura over the buttocks and lower limbs, and clinical features of sacroiliitis. His blood tests showed elevated inflammatory markers and rheumatoid factor was negative. CT scan of the sacroiliac joints confirmed sacroiliitis. Skin biopsy revealed neutrophilic small vessel vasculitis. HLA-B27 was positive in blood. A diagnosis of HSP with HLA-B27 positive axial spondyloarthritis was made. HSP can be associated with HLA-B27 positive axial spondyloarthritis and has to be considered while evaluating for causes of cutaneous small vessel vasculitis in such patients.
Squamous cell carcinoma of skin due to prolonged indwelling percutaneous nephrostomy catheter
Authors: Sharma Ashish , Singh Vishwajeet , Sinha Rahul Janak , Agarwal Samarth
Published: May 2019

Percutaneous nephrostomy (PCN) catheter placement is a commonly performed procedure in the urological practice for various indications like percutaneous nephrolithotomy, pyonephrosis, infected hydronephrosis and after failed attempt of ureteric stenting. The nephrostomy catheter is usually associated with low complication and morbidity rate, but prolonged indwelling nephrostomy tube may be hazardous in some cases. We hereby report a case of squamous cell carcinoma of skin around the PCN, which was attributed to chronic inflammation and persistent irritation from a long-term neglected indwelling nephrostomy catheter for last 3 years. The patient was managed with wide local excision of skin carcinoma and ureterocalicostomy for pelviureteric junction stricture. The authors report the first documented case with aforementioned presentation.
Non-occlusive mesenteric ischaemia associated with anorexia nervosa
Authors: Sakamoto Takashi , Lefor Alan Kawarai , Kubota Tadao
Published: May 2019

Non-occlusive mesenteric ischaemia (NOMI) is a life-threatening condition that requires emergent intervention and anorexia nervosa is a chronic eating disorder that requires careful medical and nutritional management. A 54-year-old woman with a history of anorexia nervosa and undergoing chronic haemodialysis developed abdominal pain and called an ambulance. On arrival, she was in shock and abdominal examination was consistent with diffuse peritonitis. Computed tomography scan suggested ischaemia from the distal ileum to the ascending colon. Emergency laparotomy revealed NOMI from the distal ileum to the transverse colon. The treatment strategy included staged operations and careful medical management to optimise nutritional support and electrolyte management with survival of the patient. NOMI and anorexia nervosa are both difficult to manage. Meticulous interdisciplinary management can result in a good outcome.
Severe acute ocular hypertension following pulsed methylprednisolone for juvenile idiopathic arthritis
Authors: Beverstock Andrew , Kelly Alison
Published: May 2019

We report the case of a 6-year-old girl with juvenile idiopathic arthritis and anterior uveitis who was treated with two doses of intravenous methylprednisolone for acute arthritis. She developed severe ocular hypertension (intraocular pressures (IOPs) of 54 mm Hg in the right eye and 61 mm Hg in the left eye) requiring inpatient therapy with intravenous acetazolamide. The normal range of values for IOP is 12–22 mm Hg. This severe case of acute intraocular hypertension due to systemic steroids highlights the need to consider monitoring of IOPs for children on high-dose topical and systemic steroids with risk factors for raised IOP.
Thrombolysis for deep venous thrombosis associated with inferior vena cava agenesis in a young patient
Authors: Raymundo Selma Regina de Oliveira , Cabral Vanessa Souza , Cavalieri Raissa Fortuna , Reis Neto Fernando
Published: May 2019

Malformations of inferior vena cava (IVC) as agenesis are a rare congenital anomaly and cause of deep venous thrombosis (DVT) of lower limbs and should be investigated in young patients of unknown aetiology. Treatment with mechanical thrombectomy and thrombolysis can be considered in certain cases of DVT, promoting rapid clot removal, and has also been shown to be an effective treatment in acute DVT. We present a case of acute lower limb DVT associated with IVC agenesis in which Alteplase thrombolysis was used and thrombus aspiration with catheter bilaterally, with subsequent angioplasty of the common and external iliac, obtaining satisfactory results.
A unique framework for the Persian clinical guidelines: addressing an evidence-based CDSS development need
Authors: Karim Hesam , Hosseini Ravandi Mohammad , Zandesh Zahra , Naserpoor Ahmad , Yasini Mobin , R Niakan Kalhori Sharareh , Mousavinasab Elham
Published: May 2019

Background and aim

One of the prerequisites to develop Computerised Decision Support Systems is Clinical Practice Guidelines (CPGs) which provide a systematic aid to make complex medical decisions. In order to provide an automated CPG, it is needed to have a unique structure for the CPGs. This study aims to propose a unique framework for the Persian guidelines.

Materials and methods

20 Persian CPGs were selected and divided into the creation and validation sets (n=10 for each). The first group was studied independently and their headings were listed; wherever possible, the headings were merged into a new heading that was applicable to all the guidelines. The developed framework was validated by the second group of the guidelines.

Results

Studied guidelines had a very heterogeneous structure. The number of original headings was 249; they were reduced to 14 main headings with 16 subheadings in a unique developed framework. The framework is able to represent and cover 100% of the guidelines.

Conclusion

The heterogeneity of guidelines was high as they were not developed based on the unique framework. The proposed framework provides a layout for designing the CPGs with a homogeneous structure. Guideline developers can use this framework to develop structured CPGs. This will facilitate the integration of the guidelines into electronic medical records as well as clinical decision support systems.
Intention of German non-medical staff in preclinical emergency and rescue medicine to graduate from an academic programme in emergency paramedics: a structural equation analysis based on the theory of planned behaviour of Icek Ajzen
Authors: Koch Sebastian , Riedel Stefan , Langer Gero
Published: May 2019

According to the theory of planned behaviour, a real behaviour that a person thinks about is best predicted by a certain intention (behavioural intention). Until now there is little known about the intention of German non-medical staff in preclinical emergency and rescue medicine to study emergency paramedics. For the verification of the data of 1.585 non-medical staff in preclinical emergency and rescue medicine from all 16 federal states of Germany collected by questionnaires, a linear structural equation model (SEM) was presented by means of inference statistical quality criteria (fit model) and evaluated by IBM SPSS Amos Grad Pack V.24.0. A complete causal model (SEM) with four measurement models (four-factor solution) could be created by using a path diagram. The measurement models of the present SEM should be investigated in further studies (Quality: root mean square error of approximation 0.121 and χ
2
/df 24.273). The results obtained in this study confirm positive intention of non-medical staff in preclinical emergency and rescue medicine to graduate from an undergraduate degree course in emergency paramedics. Personal behaviour as well as management should be critically debated, as far as an intention to study to become an emergency paramedic is concerned.
Cross-sectional study of association between socioeconomic indicators and chronic kidney disease in rural–urban Ghana: the RODAM study
Authors: Adjei David N , Stronks Karien , Adu Dwomoa , Beune Erik , Meeks Karlijn , Smeeth Liam , Addo Juliet , Owusu-Dabo Ellis , Klipstein-Grobusch Kerstin , Mockenhaupt Frank P , Danquah Ina , Spranger Joachim , Bahendeka Silver , De-Graft Aikins Ama , Agyemang Charles
Published: May 2019

Objectives

Studies from high-income countries suggest higher prevalence of chronic kidney disease (CKD) among individuals in low socioeconomic groups. However, some studies from low/middle-income countries show the reverse pattern among those in high socioeconomic groups. It is unknown which pattern applies to individuals living in rural and urban Ghana. We assessed the association between socioeconomic status (SES) indicators and CKD in rural and urban Ghana and to what extent the higher SES of people in urban areas of Ghana could account for differences in CKD between rural and urban populations.

Setting

The study was conducted in Ghana (Ashanti region). We used baseline data from a multicentre Research on Obesity and Diabetes among African Migrants (RODAM) study.

Participants

The sample consisted of 2492 adults (Rural Ghana, 1043, Urban Ghana, 1449) aged 25–70 years living in Ghana.

Exposure

Educational level, occupational level and wealth index.

Outcome

Three CKD outcomes were considered using the 2012 Kidney Disease: Improving Global Outcomes severity of CKD classification: albuminuria, reduced glomerular filtration rate and high to very high CKD risk based on the combination of these two.

Results

All three SES indicators were not associated with CKD in both rural and urban Ghana after age and sex adjustment except for rural Ghana where high wealth index was significantly associated with higher odds of reduced estimated glomerular filtration rate (eGFR) (adjusted OR, 2.38; 95% CI 1.03 to 5.47). The higher rate of CKD observed in urban Ghana was not explained by the higher SES of that population.

Conclusion

SES indicators were not associated with prevalence of CKD except for wealth index and reduced eGFR in rural Ghana. Consequently, the higher SES of urban Ghana did not account for the increased rate of CKD among urban dwellers suggesting the need to identify other factors that may be driving this.
Herbal medications for anxiety, depression, pain, nausea and vomiting related to preoperative surgical patients: a systematic review and meta-analysis of randomised controlled trials
Authors: Arruda Ana Paula Nappi , Zhang Yuchen , Gomaa Huda , Bergamaschi Cristiane de Cássia , Guimaraes Caio Chaves , Righesso Leonardo A R , Paglia Mariana Del Grossi , Barberato-Filho Silvio , Lopes Luciane Cruz , Ayala Melendez Ana Patricia , de Oliveira Luciane Dias , Paula-Ramos Lucas , Johnston Bradley , El Dib Regina
Published: May 2019

Objective

To summarise the effects of herbal medications for the prevention of anxiety, depression, pain, and postoperative nausea and vomiting (PONV) in patients undergoing laparoscopic, obstetrical/gynaecological or cardiovascular surgical procedures.

Methods

Searches of MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials and LILACS up until January 2018 were performed to identify randomised controlled trials (RCTs). We included RCTs or quasi-RCTs evaluating any herbal medication among adults undergoing laparoscopic, obstetrical/gynaecological or cardiovascular surgeries. The primary outcomes were anxiety, depression, pain and PONV. We used the Grading of Recommendations Assessment, Development and Evaluation approach to rate overall certainty of the evidence for each outcome.

Results

Eleven trials including 693 patients were eligible. Results from three RCTs suggested a statistically significant reduction in vomiting (relative risk/risk ratio (RR) 0.57; 95% CI 0.38 to 0.86) and nausea (RR 0.69; 95% CI 0.50 to 0.96) with the use ofZingiber officinale(ginger) compared with placebo in both laparoscopic and obstetrical/gynaecological surgeries. Results suggested a non-statistically significantly reduction in the need for rescue medication for pain (RR 0.52; 95% CI 0.13 to 2.13) withRosa damascena(damask rose) and ginger compared with placebo in laparoscopic and obstetrical/gynaecological surgery. None of the included studies reported on adverse events (AEs).

Conclusions

There is very low-certainty evidence regarding the efficacy of bothZingiber officinaleandRosa damascenain reducing vomiting (200 fewer cases per 1000; 288 fewer to 205 fewer), nausea (207 fewer cases per 1000; 333 fewer to 27 fewer) and the need for rescue medication for pain (666 fewer cases per 1000; 580 fewer to 752 more) in patients undergoing either laparoscopic or obstetrical/gynaecological surgeries. Among our eligible studies, there was no reported evidence on AEs.

PROSPERO registration number

CRD42016042838
Epidemiology of dengue and the effect of seasonal climate variation on its dynamics: a spatio-temporal descriptive analysis in the Chao-Shan area on China’s southeastern coast
Authors: Zhang Qin , Chen Yuliang , Fu Yu , Liu Tao , Zhang Qingying , Guo Pi , Ma Wenjun
Published: May 2019

Objective

Dengue is a mosquito-transmitted virus infection that remains rampant across the tropical and subtropical areas worldwide. However, the spatial and temporal dynamics of dengue transmission are poorly understood in Chao-Shan area, one of the most densely populated regions on China’s southeastern coast, limiting disease control efforts. We aimed to characterise the epidemiology of dengue and assessed the effect of seasonal climate variation on its dynamics in the area.

Design

A spatio-temporal descriptive analysis was performed in three cities including Shantou, Chaozhou and Jieyang in Chao-Shan area during the period of 2014–2017.

Setting

Data of dengue cases of three cities including Shantou, Chaozhou and Jieyang in Chao-Shan area during 2014–2017 were extracted. Data for climatic variables including mean temperature, relative humidity and rainfall were also compiled.

Methodology

The epidemiology and dynamics of dengue were initially depicted, and then the temporal dynamics related to climatic drivers was assessed by a wavelet analysis method. Furthermore, a generalised additive model for location, scale and shape model was performed to study the relationship between seasonal dynamics of dengue and climatic drivers.

Results

Among the cities, the number of notified dengue cases in Chaozhou was greatest, accounting for 78.3%. The median age for the notified cases was 43 years (IQR: 27.0–58.0 years). Two main regions located in Xixin and Chengxi streets of Chaozhou with a high risk of infection were observed, indicating that there was substantial spatial heterogeneity in intensity. We found an annual peak incidence occurred in autumn across the region, most markedly in 2015. This study reveals that periods of elevated temperatures can drive the occurrence of dengue epidemics across the region, and the risk of transmission is highest when the temperature is between 25°C and 28°C.

Conclusion

Our study contributes to a better understanding of dengue dynamics in Chao-Shan area.
Effectiveness of interventions for the implementation of thromboprophylaxis in hospitalised patients at risk of venous thromboembolism: an updated abridged Cochrane systematic review and meta-analysis of randomised controlled trials
Authors: Kahn Susan R , Diendéré Gisele , Morrison David R , Piché Alexandre , Filion Kristian B , Klil-Drori Adi J , Douketis James , Emed Jessica , Roussin André , Tagalakis Vicky , Morris Martin , Geerts William
Published: May 2019

Objective

To assess the effectiveness of system-wide interventions designed to increase the implementation of thromboprophylaxis and decrease the incidence of venous thromboembolism (VTE) in hospitalised medical and surgical patients at risk of VTE.

Design

Systematic review and meta-analysis of randomised controlled trials (RCTs).

Data sources

Medline, PubMed, Embase, BIOSIS, CINAHL, Web of Science, CENTRAL, DARE, EED, LILACS and clinicaltrials.gov without language restrictions from inception to 7 January 2017, as well as the reference lists of relevant review articles.

Eligibility criteria for selecting studies

RCTs that evaluated the effectiveness of system-wide interventions such as alerts, multifaceted, education, and preprinted orders when compared with no intervention, existing policy or another intervention.

Results

We included 13 RCTs involving 35 997 participants. Eleven RCTs had data available for meta-analysis. Compared with control, we found absolute increase in the prescription of prophylaxis associated with alerts (21% increase, 95% CI [15% to 275%]) and multifaceted interventions (4% increase, 95% CI [3% to 11%]), absolute increase in the prescription of appropriate prophylaxis associated with alerts (16% increase, 95% CI [12% to 20%]) and relative risk reductions (risk ratio 64%, 95% CI [47% to 86%]) in the incidence of symptomatic VTE associated with alerts. Computer alerts were found to be more effective than human alerts, and multifaceted interventions with an alert component appeared to be more effective than multifaceted interventions without, although comparative pooled analyses were not feasible. The quality of evidence for improvement in outcomes was judged to be low to moderate certainty.

Conclusions

Alerts increased the proportion of patients who received prophylaxis and appropriate prophylaxis, and decreased the incidence of symptomatic VTE. Multifaceted interventions increased the proportion of patients who received prophylaxis but were found to be less effective than alerts interventions.

Trial registration number

CD008201.
Challenges and barriers to optimising sedation in intensive care: a qualitative study in eight Scottish intensive care units
Authors: Kydonaki Kalliopi , Hanley Janet , Huby Guro , Antonelli Jean , Walsh Timothy Simon
Published: May 2019

Objectives

Various strategies to promote light sedation are highly recommended in recent guidelines, as deep sedation is associated with suboptimum patient outcomes. Yet, the challenges met by clinicians in delivering high-quality analgosedation is rarely addressed. As part of the evaluation of a cluster-randomised quality improvement trial in eight Scottish intensive care units (ICUs), we aimed to understand the challenges to optimising sedation in the Scottish ICU settings prior to the trial. This article reports on the findings.

Design

A qualitative exploratory design: We conducted focus groups (FG) with clinicians during the preintervention period.

Setting and participants: Eight Scottish ICUs. Nurses, physiotherapists and doctors working in each ICU volunteered to participate. FG were recorded and verbatim transcribed and inserted in NVivo V.10 for analysis. Qualitative thematic analysis was undertaken to develop emergent themes from the patterns identified in relation to sedation practice. Ethical approval was secured by Scotland A Research ethics committee.

Results

Three themes emerged from the inductive analysis: (a) a recent shift in sedation practice, (b) uncertainty in decision-making and (c) system-level factors including the ICU environment, organisational factors and educational gaps. Clinicians were challenged daily to manage agitated or difficult-to-sedate patients in the era of a progressive mantra of ‘just sedate less’ imposed by the pain–agitation–delirium guidelines.

Conclusions

The current implementation of guidelines does not support behaviour change strategies to allow a patient-focused approach to sedation management, which obstructs optimum sedation–analgesia management. Recognition of the various challenges when mandating less sedation needs to be considered and novel sedation–analgesia strategies should allow a system-level approach to improve sedation–analgesia quality.

DESIST registration number

NCT01634451
Night shift work, long working hours and dementia: a longitudinal study of the Danish Work Environment Cohort Study
Authors: Nabe-Nielsen Kirsten , Hansen Åse Marie , Ishtiak-Ahmed Kazi , Grynderup Matias Brødsgaard , Gyntelberg Finn , Islamoska Sabrina , Mortensen Erik Lykke , Phung Thien Kieu Thi , Rod Naja Hulvej , Waldemar Gunhild , Westendorp Rudi G J , Garde Anne Helene
Published: May 2019

Objective

Shift work and long working hours are potential risk factors for dementia, but previous studies on shift work, long working hours and dementia are sparse and their findings are conflicting. Therefore, we investigated the effect of night shift work and long working hours on dementia.

Design

A longitudinal study.

Setting

Denmark.

Participants

3435 occupationally active men and women from the general working population.

Methods

Work schedule covered day work (reference) and shift schedules without/with night work. Working hours covered <27, 28–36, 37 (reference), 38–44, and ≥45 hours/week. As the primary outcome, we used register-based information about dementia, and estimated incidence rate ratios (IRR) and 95% CI. Estimates were adjusted for gender, age, psychosocial work factors and cardiovascular risk factors.

Results

We identified 85 dementia cases during a mean of 9.8 years of follow-up. We found a positive, but statistically insignificant association between night shift work and dementia (IRR=2.01; 95% CI: 0.87-4.65). Post hoc analyses indicated that this was only due to a higher risk in permanent night workers (IRR=3.25; 95% CI: 1.35-7.83). The dementia risk was also significantly higher among participants working 38–44 hours/week (IRR=2.08; 95% CI: 1.11-3.90) compared with those working 37 hours/week. We found no indications of a higher risk of dementia in participants working <37 hours/week or ≥45 hours/week.

Conclusion

We did not find arguments that night shift work or long working hours increased dementia risk in general. However, we found a higher risk of dementia in specific subgroups, that is, permanent night workers and employees with moderately longer weekly working hours than the standard.
Predictors of placebo response to local (intra-articular) therapy in osteoarthritis: an individual patient data meta-analysis protocol
Authors: Yu Shirley Pei-Chun , Ferreira Manuela L , van Middelkoop Marienke , Bierma-Zeinstra Sita M A , Zhang Weiya , Deveza Leticia A , Hunter David J
Published: May 2019

Introduction

Osteoarthritis (OA) is a highly prevalent and disabling condition with limited safe and effective treatment options. Intra-articular therapies are increasingly being used, however whether the effect of these agents is due to active treatment or placebo remains unclear. As the placebo response can be attributed to multiple factors, assessment of the placebo response using individual patient data (IPD) meta-analysis will give insight into the different modifiers of response to placebo. The aim of this IPD meta-analysis is to investigate the predictors of placebo response in intra-articular injection trials in OA. IPD meta-analysis is considered to be superior to conventional meta-analysis, as it combines multiple trial data, facilitates the standardisation of analyses across different studies and allows measuring derivation of the desired information.

Method and analysis

A systematic literature search will be conducted for randomised clinical trials comparing corticosteroid and viscosupplementation/hyaluronic acid intra-articular injections with placebo for knee and hip OA. Pubmed (Medline), EMBASE, Web of Science, Cochrane Central and SCOPUS will be searched from inception to September 2018. Corresponding authors of the original trials will be contacted to obtain IPD. Risk of bias will be assessed using the Cochrane Collaboration’s tool. The primary outcome will be change in pain from baseline. Secondary outcomes will be change in function and patient’s global assessment. Potential predictors of placebo response assessed will include patient’s characteristics, pain mechanism characteristics, radiographic severity, pain severity, intervention characteristics and trial design characteristics. A multilevel logistic regression analyses will be applied. Results will be reported using the Preferred Reporting Items for Systematic review and Meta-Analysis -IPD guidelines.

Ethics and dissemination

This study does not include identifiable data and ethical approval was obtained by the original investigators. Results of the IPD meta-analysis will be disseminated for publication in peer-reviewed journals and conference presentations.

PROSPERO registration number

CRD42018095188
Dynapaenic obesity and its association with health outcomes in older adult populations: protocol for a systematic review
Authors: Leahy Siobhan , Cassarino Marica , O' Connell Matthew DL , Glynn Liam , Galvin Rose
Published: May 2019

Introduction

Two major global health challenges are the rapidly ageing population and the high prevalence of obesity in all age groups. Older adults are also susceptible to age-related loss of muscle strength, termed dynapaenia. The co-occurrence of both obesity and dynapaenia, termed dynapaenic obesity (DO), has been associated with poorer health outcomes and increased healthcare usage compared with either state alone. The purpose of this systematic review is to quantify the prevalence and incidence of DO in older adult populations, and to explore the association between DO and health outcomes, specifically chronic disease and multimorbidity, functional disability and healthcare usage.

Methods and analysis

Using the Meta-analyses Of Observational Studies in Epidemiology guidelines, we will conduct a systematic review of cross-sectional and longitudinal observational studies of older adults, which include measures of DO and specified outcomes. Detailed literature searches of will be conducted using six electronic databases: Excerpta Medica dataBASE (EMBASE), PubMed, MEDLINE, SCOPUS, ScienceDirect and Cumulative Index of Nursing and Allied Health Complete (CINAHL), including articles published from database inception until Febuary 2019. The reference lists of included articles will also be searched. Two independent reviewers will undertake a three-step screening and review process using the Population, Risk Factor, Outcome framework to define eligibility. The Newcastle Ottawa Scale for non-randomised studies will be used to assess risk of bias and to rate study quality. The findings will be synthesised in a narrative summary, and a meta-analysis will be conducted where appropriate.

Ethics and dissemination

Ethical approval is not required for this systematic review. Findings from this research will be submitted for peer-reviewed publication in academic journals, and presented at relevant academic conferences.

PROSPERO registration number

CRD42018112471.
Statistical tools used for analyses of frequent users of emergency department: a scoping review
Authors: Chiu Yohann , Racine-Hemmings François , Dufour Isabelle , Vanasse Alain , Chouinard Maud-Christine , Bisson Mathieu , Hudon Catherine
Published: May 2019

Objective

Frequent users represent a small proportion of emergency department users, but they account for a disproportionately large number of visits. Their use of emergency departments is often considered suboptimal. It would be more efficient to identify and treat those patients earlier in their health problem trajectory. It is therefore essential to describe their characteristics and to predict their emergency department use. In order to do so, adequate statistical tools are needed. The objective of this study was to determine the statistical tools used in identifying variables associated with frequent use or predicting the risk of becoming a frequent user.

Methods

We performed a scoping review following an established 5-stage methodological framework. We searched PubMed, Scopus and CINAHL databases in February 2019 using search strategies defined with the help of an information specialist. Out of 4534 potential abstracts, we selected 114 articles based on defined criteria and presented in a content analysis.

Results

We identified four classes of statistical tools. Regression models were found to be the most common practice, followed by hypothesis testing. The logistic regression was found to be the most used statistical tool, followed by χ2 test and t-test of associations between variables. Other tools were marginally used.

Conclusions

This scoping review lists common statistical tools used for analysing frequent users in emergency departments. It highlights the fact that some are well established while others are much less so. More research is needed to apply appropriate techniques to health data or to diversify statistical point of views.
Exploring network structure and the role of key stakeholders to understand the obesity prevention system in an Australian metropolitan health service: study protocol
Authors: Jancey Jonine , Leavy Justine Elizabeth , Pollard Christina , Riley Therese , Szybiak Maria , Milligan Megan , Chamberlain Dan , Blackford Krysten
Published: May 2019

Introduction

Little progress has been made to address the increasing obesity prevalence over the past few decades, and there is growing concern about the far-reaching consequences for health and well-being related to obesity on a global scale. Systems thinking is emerging as a suitable approach for obesity prevention, as it allows health researchers, practitioners and policy-makers to systematically synthesise existing data, expose gaps, inform priority setting and identify leverage points in the system. The aim of this study is to trial a systems thinking approach to better understand the local obesity prevention system, and identify gaps and viable opportunities for health promotion activities to strengthen obesity prevention efforts in an Australian metropolitan health service.

Methods and analysis

A mixed methods design will be undertaken in a metropolitan health service area in Perth, Western Australia in 2019–2020. A systems inventory audit will be used to identify physical activity, nutrition and overweight/obesity prevention activities taking place in the study area. An organisational network survey will be administered, and a social network analysis undertaken to examine relationships between organisations in the network. The relationships and interactions will compare the level and type of interactions each organisation has within the network. Parameters including density, centrality and betweenness will be computed using UCINET and Netdraw.

Ethics and dissemination

Ethics approval has been obtained from the Curtin University Human Research Ethics Committee (approval number HRE2017-0862). Results will be reviewed with members of the advisory group, submitted to relevant journals and presented at relevant conferences to health promotion practitioners and policy-makers. The area health service, as co-producers of the research, will use findings to inform policy and strategy across the study area.