bluuebunny/crossref_metadata_2025 huggingface dataset:
Indonesian adolescents’ perspectives on smoking habits as a reference for a prevention program: a qualitative study
Authors: fithria fithria , Adlim Muhammad , Jannah Syarifah Rauzatul , Tahlil Teuku
Published: August 2020

Background: Religious factors have been used in tobacco control campaigns. However, the prevalence of smoking among adolescents is still high in some countries, especially in Indonesia. This qualitative research aimed to explore the perspectives of Muslim adolescents on smoking habits as a reference for developing effective prevention programs.Methods: Three focus group discussions involving 24 junior high school students (mean age=13.75 years) were the main source of data for this phenomenological qualitative study. The discussion guide was developed by the researchers based on the reviewed literature and validated by experts. The research findings were analyzed using an inductive content method with systematic steps based on the stages of qualitative data analysis.Results: Adolescent perspectives on smoking were grouped into two themes: (a) perception, which encompassed three sub-themes: smoking as a social habit, contradictive feelings, and the Islamic perspective; (b) smoking-related factors involving peer pressure, the parents’ smoking status, curiosity, and masculinity.Conclusion: The results indicated that adolescents consider smoking as a social habit but with contradictive feelings. From an Islamic perspective, smoking is not forbidden by the religion’s beliefs. The smoking habit was also stimulated by peer pressure, imitating parents who smoke, curiosity, and feeling masculine. We suggest that health professionals who are interested in developing smoking prevention programs should consider the adolescent perspective on smoking so that the prevention program will be more effective and appropriate for adolescents.
A rare mutation c.1663G>A (p.A555T) in the MMUT gene associated with mild clinical and biochemical phenotypes of methylmalonic acidemia in 30 Chinese patients
Authors: Liang Lili , Shuai Ruixue , Yu Yue , Qiu Wenjuan , Shen Linghua , Wu Shengnan , Wei Haiyan , Chen Yongxing , Yang Chiju , Xu Peng , Chen Xigui , Zou Hui , Feng Jizhen , Niu Tingting , Hu Haili , Ye Jun , Zhang Huiwen , Lu Deyun , Gong Zhuwen , Zhan Xia , Ji Wenjun , Yu Yongguo , Gu Xuefan , Han Lianshu
Published: August 2020

Background: Methylmalonic acidemia is an inherited organic acid metabolic disease. it involves multiple physiological systems and has variable manifestations. The primary causative gene MMUT carries wide range of mutations, and one of them, c.1663G>A (p.A555T), is considered to be of an extremely rare type. So far, little is known about the clinical features of patients carrying this mutation. In the present study, we aimed to define the clinical and biochemical features of the patients with this genotype. Methods: Among 328 mut type methylmalonic acidemia patients from multiple hospitals in China, we collected 30 compound heterozygous patients sharing the mutation c.1663G>A (p.A555T) in the MMUT gene. Their clinical characteristics and biochemical index were described in detail and compared with methylmalonic acidemia patients without this variant. Results: Most of these patients were diagnosed via newborn screening (26/30), treated in a timely manner, and kept healthy (24/30). Disease onset occurred in 7 patients. Developmental delay or intellectual impairment occurred in 4 patients. Vitamin B12 is responsive in 100% of these patients (29/29). The blood propionylcarnitine, blood propionylcarnitine/acetylcarnitine ratio, urinary methylmalonic acid, urinary methylcitric acid before and after treatment in c.1663G>A (p.A555T) carrying patients were much lower than those in non-c.1663G>A (p.A555T) carrying patients. Conclusion: Compared to patients with other mutations in the MMUT gene, patients with the c.1663G>A (p.A555T) mutation showed later onset, milder clinical phenotype, lighter biochemical abnormalities, better vitamin B12 responsiveness, lower morbidity, easier metabolic control, and thereby better prognosis. Newborn screening project plays an important role in early diagnosis, treatment, and prognosis of these patients.
Extensively drug-resistant Alcaligenes faecalis infection
Authors: Huang Chienhsiu
Published: August 2020

Background: Alcaligenes faecalis is usually opportunistic infection in humans. Alcaligenes faecalis infection is often challenging to treat due to its increased resistance to many antibiotics. The results from a clinical study of Alcaligenes faecalis infection may help improve patients’ clinical care. Methods: We conducted a retrospective analysis of all patients presenting with Alcaligenes faecalis infection from January 2014 through December 2019. The medical records of all patients were reviewed for demographic information, clinical symptoms and signs, comorbidities, use of intravenous antibiotics within the past 3 months, bacterial culture, antibiotics sensitivity test, and clinical outcomes. Results: Sixty-one cases of Alcaligenes faecalis infection were seen during the study period, including 25 cases of cystitis, 9 cases of diabetic foot ulcer with infection, 8 cases of pneumonia, 7 cases of acute pyelonephritis, 3 cases of bacteremia, 9 cases of infection at specific sites. Thirty-seven patients (60.7%) had a history of receiving intravenous antibiotics within 3 months of the diagnosis. Fifty-one (83.6%) cases were mixed with other bacterial infections. Extensively drug-resistant infections have been reported since 2018. The best sensitivity rate to A. faecalis was 66.7% for three antibiotics (imipenem, meropenem, and ceftazidime) in 2019. Two antibiotics (ciprofloxacin and piperacillin/tazobactam) sensitivity rates to A. faecalis were less than 50%. Conclusions: The most frequent Alcaligenes faecalis infection sites were in the bloodstream, urinary tract, skin and soft tissue, and middle ear. Alcaligenes faecalis showed markedly decreased sensitivity to commonly used antibiotics and, more recently, extensively drug-resistant Alcaligenes faecalis infections have emerged.
Clinical and biochemical indexes of 11 COVID-19 patients and the genome sequence analysis of the tested SARS-CoV-2
Authors: Yu Zhikang , Wu Heming , Huang Qingyan , Guo Xuemin , Zhong Zhixiong
Published: August 2020

BackgroundAt present, SARS-CoV-2 epidemic in the world rapidly spread. It is a serious global public health emergency.MethodsHere we described the clinical characteristics of 11 SARS-CoV-2 infected patients hospitalized in the Meizhou People's Hospital. And viral genome sequences of SARS-CoV-2 from these patients were analyzed.ResultsOf the 11 patients, six cases developed fever, nine cases developed cough, and two cases developed headache and chills. Four patients (36.4%) had underlying diseases. Pneumonia is the most common complication. The laboratory test results showed that there was no adult patients with increased LYM/LYM%. Most patients had normal total protein (TP) and albumin (ALB), but only two patients had decreased. Most patients had increased or normal levels of erythrocyte sedimentation rate (ESR), C reactive protein (CRP), activated partial thromboplastin time (APTT), fibrinogen (FIB), creatine kinase isoenzymes (CK-MB), and lactate dehydrogenase (LDH). Neutrophil (NEU) (r=0.664, P=0.026), CK-MB (r=0.655, P=0.029), blood urea nitrogen (BUN) (r=0.682, P=0.021) and SARS-CoV-2 virus cycle threshold (Ct) value were significantly correlated. Multiple sequence alignment (MSA) shows that we identified two different SNPs at positions 8781 and 28144, and have a completely linked genetic form of 8781C-28144T and 8781T-28144C.ConclusionsThe reports of these 11 cases in our hospital will provide useful information for the diagnosis, treatment and drug development of SARS-CoV-2.
Partnering with General Practitioners to Optimize Survivorship for Patients with Lymphoma: A phase II Randomized Controlled Trial (The GOSPEL 1 Trial)
Authors: Chan Raymond , Buhagiar Stephanie , Teleni Laisa , Simonsen Camilla , Turner Jane , Jones Lee , Gordon Louisa , Joseph Ria , Agbejule Oluwaseyifunmi Andi , Henderson Fiona , Rhee Joel , Mapp Sally
Published: August 2020

Background: Survival rates for lymphoma are highest amongst hematological malignancies. In 2019, it was estimated that over 6,400 Australians were diagnosed with lymphoma, a group of hematological malignancies with a high 5-year survival rate of ~76%. There is an increased focus on the promotion of wellness in survivorship and active approaches to reducing morbidity related to treatment; however, current models of follow-up care heavily rely on hospital-based specialist-led care.Maximizing the potential of general practitioners (GPs) in the ongoing management of cancer is consistent with the national health reform principles, and the Cancer Council Australia’s Optimal Care Pathways. GPs are well positioned to provide guideline-based follow-up care and are more likely to address comorbidities, psychosocial issues and promote healthy lifestyle behaviors. This study aims to test the feasibility of the GOSPEL 1 intervention for implementing an integrated, shared-care model in which cancer center specialists and community-based GPs collaborate to provide survivorship care for patients with lymphoma.Methods: We describe a protocol for a phase II, randomized controlled trial with two parallel arms and a 1:1 allocation. Sixty patients with Hodgkin’s and Non-Hodgkin’s lymphoma will be randomized to usual specialist-led follow-up care (as determined by the treating hematologists) or a shared follow-up care intervention (i.e., GOSPEL 1). GOSPEL 1 is a nurse-enabled, pre-specified shared-care pathway with follow-up responsibilities shared between cancer center specialists (i.e., hematologists and specialist cancer nurses) and GPs. Outcome measures assess feasibility as well as a range of patient reported outcomes including health-related quality of life as measured by the Functional Assessment of Cancer Therapy – Lymphoma, patient experience of care, symptom distress, comorbidity burden, dietary intake, physical activity behaviors, financial distress/interference and satisfaction of care. Safety indicators including hospital admission and unscheduled lymphoma clinic visits as well as process outcomes such as intervention fidelity and economic indicators will be analyzed.Discussion: This trial is designed to explore the feasibility and acceptability of a new model of shared-care for lymphoma survivors. Patient reported outcomes as well as potential barriers to implementation will be also analyzed to inform a larger definitive clinical trial testing the effects of a shared-care model on health-related quality of life of lymphoma survivors.Trial registration: Australia and New Zealand Clinical Trials Registry, Registration number: ACTRN12620000594921, Date registered: 22/05/2020, registration link: https://www.anzctr.org.au/ACTRN12620000594921.aspx
Perception and attitude of healthcare workers in Saudi Arabia with regard to Covid-19 pandemic and potential associated predictors
Authors: Abolfotouh Mostafa A. , Almutairi Adel F. , BaniMustafa Ala'a A. , Hussein Mohamed A.
Published: August 2020

Background . Healthcare workers (HCWs) face considerable mental and physical stress caring for patients with Covid-19. They are at higher risk of acquiring and transmitting this virus. Perception and attitude of HCWs in Saudi Arabia regarding Covid-19 were evaluated in comparison with MERS outbreak.

Methods. In a cross-sectional study, HCWs at three tertiary hospitals in Saudi Arabia were surveyed via email, by a concern scale about Covid-19 pandemic during 15-30 April, 2020. Concerns of disease severity, governmental efforts to contain it and disease outcomes were assessed using 32 concern-statements in five distinct domains. Multiple regression analyses were used to identify predictors of high concern scores.

Results. A total of 844 HCW responded to the survey. Their average age was 40.4±9.5 years, 40.3% were nurses, 58.2% had direct patient contact, and 77.3% were living with family members and/or others. The majority of participants (72.1%) had an overall concern score of 55 or less out of a maximum score of 96 points. Three-fourth of respondents felt at risk of contracting Covid-19 infection at work, 69.1% felt threatened if a colleague contracted Covid-19, 69.9% felt obliged to care for patients infected with Covid-19 while 27.7% did not feel safe at work using the standard precautions. Nearly all HCWs believed that the government should isolate patients with Covid-19 in specialized hospitals (92.9%), agreed with travel restriction to/from areas affected by Covid-19 (94.7%) and felt safe government implemented curfew and movement restriction periods (93.6%). Predictors of high concern scores were; HCWs of Saudi nationality (p<0.001), younger age (p=0.003), undergraduate education (p=0.044), living with others (p=0.003) working in the western region (p=0.003) and direct contact with patients (p=0.018). In comparison with MERS outbreak, HCWs reported significantly higher mean scores about Covid-19 pandemic for overall concern (45.9 versus 40.3, p<0.001).

Conclusions. The current study highlights the high concern among HCWs about Covid-19 and identifies the predictors of those with highest concern levels. To minimize the potential negative impact of those concerns on the performance of HCWs during pandemics, measures are necessary to enhance their protection and to minimize the psychological effect of the perceived risk of infection.
Analysis of ACE2 Genetic Variants in 131 Italian SARS-CoV-2 Positive Patients
Authors: Novelli Antonio , Biancolella Michela , Borgiani Paola , Cocciadiferro Dario , Colona Vito Luigi , D’Apice Maria Rosaria , Rogliani Paola , Zaffina Salvatore , Leonardis Francesca , Campana Andrea , Raponi Massimiliano , Andreoni Massimo , Grelli Sandro , Novelli Giuseppe
Published: August 2020

Background: Coronaviruses (CoV) are a large family of viruses that are common in humans and many animal species. Animal coronaviruses rarely infect humans with the exceptions of the Middle East Respiratory Syndrome (MERS-CoV), the Severe Acute Respiratory Syndrome CoronaVirus (SARS-CoV), and now SARS-CoV-2, which is the cause of the ongoing pandemic of coronavirus disease 2019 (COVID-19). Several studies suggested that genetic variants in the ACE2 gene may influence the host susceptibility or resistance to SARS-CoV-2 infection according to the functional role of ACE2 in human pathophysiology. However, many of these studies have been conducted in silico based on epidemiological and population data. We therefore investigated the occurrence of ACE2 variants in a cohort of 131 Italian unrelated individuals clinically diagnosed with COVID-19 and in an Italian control population, to evaluate a possible allelic association with COVID-19, by direct DNA analysis.Methods: As a pilot study, we analyzed, by whole-exome sequencing, genetic variants of ACE2 gene in 131 DNA samples of COVID-19 patients hospitalized at Tor Vergata University Hospital and at Bambino Gesù Children’s Hospital, Rome. We used a large control group consisting of 1,000 individuals (500 males and 500 females).Results: We identified three different germline variants: one intronic c.439+4G>A and two missense c.1888G>C p.(Asp630His) and c.2158A>G p.(Asn720Asp) in a total of 131 patients with a similar frequency in male and female. Thus far, only the c.1888G>C p.(Asp630His) variant shows a statistically different frequency compared to the ethnically matched populations. Therefore, further studies are needed in larger cohorts, since it was found only in one heterozygous COVID-19 patient.Conclusions: Our results suggest that there is no strong evidence, in our cohort, of consistent association of ACE2 variants with COVID-19 severity. We might speculate that rare susceptibility/resistant alleles could be located in the non-coding regions of the ACE2 gene, known to play a role in regulation of the gene activity.
Minimally invasive plate osteosynthesis (MIPO) versus open reduction and internal fixation (ORIF) in the treatment of distal fibula Danis-Weber type B and C fractures
Authors: Marazzi Cesare , Wittauer Matthias , Hirschmann Michael T. , Testa Enrique A.
Published: August 2020

Background Minimally invasive plate-osteosynthesis (MIPO) has been reported to be superior to open reduction and internal fixation (ORIF) in the treatment of different long bone fractures. Nevertheless, in distal fibula fractures the evidence of MIPO remains scarce. The aim of this retrospective study was to compare the clinical and radiological outcomes of the minimally invasive techniques applied to the distal fibula with open reduction and internal fixation within a 12 months follow-up.Methods A consecutive series of patients who underwent surgery using either ORIF or MIPO for the treatment of distal fibula fractures between 2010 and 2014 were retrospectively analysed. All distal fibular fractures requiring an operative treatment (Danis-Weber type B ≙ AO type 44 B1, 2, 3 and Danis-Weber type C ≙ AO type 44 C1, 2) were included (ORIF n=35, MIPO n=35). Patients were assessed for postoperative pain using a visual analogue scale (VAS) for pain (ranging from 0 to 10) and classified into 4 groups; “no pain” for VAS=0, “low” for VAS=1-3, “moderate” for VAS=3-5 and “severe” for VAS=5-10. In addition, complications of postoperative fracture-related infection, wound healing disorders, vascular and nerve injury as well as development of nonunion, were evaluated and analyzed. Radiologic outcome measures assessing the talocrural angle, lateral and medial clear space, tibiofibular overlap and talar tilt angle were evaluated postoperatively. Results The overall complication rate showed to be lower in the MIPO group compared to the ORIF group (14% vs. 37%, p=0.029). Even though not statistically significant, specific surgery related complications such as skin necrosis (3% vs. 9%, p= 0.275), nonunion (0% vs. 6%, p=0.139), infections and wound healing disorders (9% vs. 20%, p=0.141) as well as postoperative pain (17% vs. 26%, p=0.5) were found more frequently in the ORIF group. The tibiofibular overlap demonstrated to be significantly lower in the ORIF group (3.3mm vs. 2.7mm, p=0.033). The talocrural angle, talar tilt angle, lateral and medial clear space showed to be equivalent in both groups.Conclusion In this retrospective single-center consecutive series MIPO was superior to ORIF in the surgical treatment of distal fibula fractures with respect to the overall complication rate.
Does Tailor Different Educational Programs for Different Groups Might Improve Acceptance by Nursing Staff?
Authors: Chiao Li-Hua , Wu Chiu-Feng , Tzeng I-Shiang , Teng An-Na , Liao Ru-Wen , Yu Li Ying , Huang Chin Min , Pan Wei-Han , Chen Chu-Yueh , Su Tsai-Tsu
Published: August 2020

Background: Long-term shortages in the nursing workforce and high turnover rates are common in Taiwan medical industry. Little research has investigated the psychological factors associated with retention of nursing staff. However, in practice, religious hospitals often provide education in medicine or the medical humanities to enhance psychological satisfaction. The objective of this study was to explore factors influencing nursing staff’s retention with their work across different levels of demand. A further objective was to investigate whether medical humanities educations were associated with the retention of nursing staff. Methods: This study used self-administrated questionnaires to survey nurses working in northern areas of Taiwan. The questionnaire design was based on the six levels of Maslow's hierarchy of needs. Participation was voluntary and participants signed informed consent documents. Self-administrated questionnaires were administered by contacting a total of 759 participants; 729 questionnaires were returned (response rate 96.04 %). A logistic regression analysis was used to estimate the impact of seniority of nursing work on nurses reported intention to stay after adjusting for nurse characteristics (gender and age).Results: In the Pearson correlation analysis, nurses’ willingness to stay was moderately correlated with “physical needs”, “safety needs”, “love and belonging needs”, and “esteem needs” (r=0.559, P<0.001; r=0.533, P<0.001; r=0.393, P<0.001; r=0.476, P<0.001, respectively). Furthermore, nurses’ willingness to stay was highly correlated with “self-actualization needs”, “behind self-actualization needs” and “medical humanities education relevant” (r=0.707, P<0.001; r=0.728, P<0.001; r=0.678, P<0.001, respectively). We found that the odds ratio (OR) of retention of nursing staff who worked within 1 year (OR=4.511, P=0.002) and 1-3 years (OR=3.248, P=0.003) was significantly higher referred to those who worked 5-10 years.Conclusions: With regard to medical humanities education, we recommend adjusting the training as the compulsory activities under the official programs are inadequate and adjusting the required hours of medical humanities education. Tailoring different educational programs for different groups (especially for the groups of nurses who have worked 3-5 years and 5-10 years in the case study hospital) might improve acceptance by nursing staff.
The Impact of COVID-19 on Chronic Care: A Qualitative Study Among Primary Care Practices in Belgium
Authors: Danhieux Katrien , Buffel Veerle , Pairon Anthony , Benkheil Asma , Remmen Roy , Wouters Edwin , Olmen Josefien Van
Published: August 2020

Background. The COVID-19 pandemic affects the processes of routine care for chronic patients. A better understanding helps to increase resilience of the health system and prepare adequately for a second wave or flare-ups of the pandemic.Methods. A qualitative study was conducted in 16 primary care practices: 6 solo working, 4 monodisciplinary and 7 multidisciplinary. 21 people (doctors, nurses, dieticians) were interviewed, using semi-structured video interviews. A thematic analysis was done using the domains of the Chronic Care Model (CCM).Results. Three themes emerged: changes in health care organization, risk stratification and self-management support. All participating practices reported drastic changes in organization with a collective shift towards COVID-19 care, and reduction of chronic care activities, less consultations, and staff responsible for self-management support put on hold. A transition to digital support did not occur. Few practitioners had a systematic approach to identify and contact high-risk patients for early follow-up. A practice with a pre-established structured team collaboration managed to continue most chronic care elements. Generally, practitioners expected no effects of the temporary disruption for patients, although they expressed concern about patients already poorly regulated.Conclusion: Our findings show the delivery of chronic care as disrupted. It indicates that the establishment of the CCM can facilitate continuity of care in crisis times. Short term actions should be directed to facilitate identifying high-risk patients and to develop a practice organization plan to organize chronic care and use digital channels for support, especially to vulnerable patients, during a second wave or in flare-ups.
Effectiveness of technology-enhanced teaching and assessment methods of undergraduate preclinical dental skills: a systematic review of randomized controlled clinical trials
Authors: Khalaf Khaled , El-Kishawi Mohamed , Mustafa Shahd , Kawas Sausan Al
Published: August 2020

Background: To investigate the effectiveness of technology-enhanced teaching and assessment methods of undergraduate preclinical skills in comparison to conventional methods. Methods: A comprehensive search strategy was implemented using both manual and electronic search methods, including PubMed, Wiley, ScienceDirect, SCOPUS, and the Cochrane Central Register of Controlled Trials. The search and selection of articles that met the inclusion criteria were carried out in duplicates. A Cochrane data extraction form for RCTs was used to extract the relevant information from all included articles. Risk of bias of all included articles was assessed independently by two authors using the Cochrane risk of bias tool. Results: A total of 19 randomized controlled clinical trials met the inclusion criteria and were included in this review. The majority of the studies included in this review have a high risk of bias mainly due to incomplete data, lack of blinding of the examiners, and due to other biases, such as small sample sizes, not accounting for additional hours of training, and the lack of calibration of examiners grading the preparations. Conflicting results were reported in the included studies with regards to whether there were differences between the intervention and control groups in the outcome measure of quality of students’ performance. A meta-analysis could not be done for this study due to the heterogeneity among the included studies.Conclusions: Technology-enhanced teaching and assessment tools used in preclinical skills training of undergraduate dental students have the potential to improve students’ performance. However, due to the conflicting outcomes reported in the 19 studies included in this systematic review and their high risk of bias, better quality studies are required to find a definitive answer to the research question of this systematic review.
Evaluation of laparoscopic-assisted transanal total mesorectal excision(ta-TME) for locally advanced, distal rectal cancer in men with difficult pelvic conditions after neoadjuvant chemoradiation therapy
Authors: Li Yingjie , He Guoli , Wang Lin , Dong Qiushi , Liu Xinzhi , Leng Jiahua , Zhang Xiao , Sun Tingting , Zhang Yue , Yao Yunfeng , Wu Aiwen
Published: August 2020

BackgroundTo evaluate the use of laparoscopic-assisted transanal, total mesorectal excision (ta-TME) in men with difficult pelvic anatomy in an attempt to optimize anal sphincteric preservation, determine the completeness of TME, and determine postoperative morbidity and mortality.MethodsTwenty male patients（laparoscopic-assisted transanal total mesorectal excision, A group）with difficult pelvic anatomy (narrow pelvis) who were diagnosed as rectal cancer underwent a Ta-TME surgery from January 2017 to January 2018 at Peking University Cancer Hospital. We matched these 20 patients with 2 other groups of patients who underwent either a laparoscopic transabdominal TME （LA group）or an open transabdominal TME（OP group）according to age, sex, BMI, distance of tumor from the anal verge, and diameter of the tumor. All 3 groups of patients had undergone preoperative neoadjuvant chemoradiation therapy. The efficacy and safety of Ta-TME were evaluated according to operative time, blood loss, postoperative hospital stay, and postoperative complications. Outcomes of Ta-TME were evaluated by comparing the rate of a positive circumferential resection margin, the integrity of the TME, and the rate of sphincter preservation among the 3 groups. We also analyzed whether operative time could be shortened using a laparoscopically assisted Ta-TME through optimizing the surgical procedure.ResultsWhen comparing Ta-TME（TA group）, laparoscopic transabdominal TME(LA group), and open transabdominal TME（OP group, the respective mean blood loss(100mL, 100mL, 100mL, p=0.335),postoperative hospital stay(9 days,9 days,7 days),number of harvested lymph nodes(7, 6, 7,), positive circumferential resection margin rate(0%, 0%, 5%), rate of pathologic complete response(5%,10%,10%,), and integrity of TME showed no statistical differences across groups (p>0.5 for all). In contrast, there were significant differences in operation time(302 min, 253 min, 135 min),rate preservation of the anal sphincter(100%, 30%, 45%,), and the creation of a protective diverting ileostomy(100%, 30%, 45%, p<0.05 for all).ConclusionThe rate of anal sphincter preservation in the Ta-TME group was considerably greater than the other groups, but the safety of the operation did not differ among the 3 groups. The Ta-TME required a diverting ileostomy in all cases, and the total operation time for Ta-TME was greater than that of laparoscopic and open transabdominal TME. We believe that experience and appropriate procedure of the steps of the Ta-TME may lead to a decrease in the operation time.
Assessment of Online Patient Education Materials Designed for People with Age-Related Macular Degeneration
Authors: Fortuna Jennifer K , Riddering Anne , Shuster Linda , Lopez-Jeng Cassie
Published: August 2020

Background: Age-related macular degeneration (AMD) is a chronic eye condition that leads to permanent vision loss in the central visual field. AMD makes reading challenging and inefficient. People with AMD often find it difficult to access, process and understand written patient education materials (PEMs). To promote health literacy, the demands of written PEMs must match the literacy capacities of the target audience. This study aims to evaluate the readability (grade level) and suitability (appropriateness) of online PEMs designed for people with AMD. Methods: Online PEMs were sourced from websites of national organizations providing patient education materials designed for people with AMD. The Flesch-Kincaid Grade Level formula and the Suitability Assessment of Materials instrument were used to assess the readability and suitability of PEMs. Descriptive statistics were used to compare online PEMs by organization based on national guidelines for readability level (≤ sixth grade) and the recommended suitability score (≥ 70%) for “superior” material.Results: One hundred online PEMs were evaluated from websites of 16 professional organizations. The mean readability level was 9.3 (range 5.0-16.6). The mean suitability score was 53% (range 18%-78%). Only six (6%) of PEMs achieved the recommended guidelines for readability level and suitability score.Conclusion: The majority of online PEMs designed for people with AMD were written above the recommended readability level, and below the suggested suitability score. To promote health literacy, the demands of written health information must match the reading capacities of the target audience. Heeding to evidence-based guidelines for providing written information to patients with low health literacy and low vision is beneficial for both patients and health care providers. Future research is warranted.
Individualized hemodynamic optimization guided by indirect measurement of respiratory exchange ratio in major surgery: study protocol for a randomized controlled trial (OPHIQUE study)
Authors: BAR Stéphane , Boivin Pierre , Amine Younes El , Descamps Richard , Moussa Mouhamed , Arab Osama Abou , Fischer Marc-Olivier , Dupont Hervé , Lorne Emmanuel , Guinot Pierre-Grégoire
Published: August 2020

BackgroundObservational studies have suggested that a high respiratory exchange ratio (RER) is associated with the occurrence of postoperative complications. The study’s primary objective is to demonstrate that the incidence of postoperative complications is lower in an interventional group (patients monitored using a hemodynamic algorithm that incorporates the RER) than in a control group (treated according to standard practice).MethodsWe shall perform a prospective, multicenter, randomized, open-label, superiority trial of consecutive patients undergoing major non-cardiac surgery (i.e. abdominal, vascular and orthopedic surgery). The control group will be treated according to the current guidelines on standard hemodynamic care. The interventional group will be treated according an algorithm based on the RER. The primary outcome will be the occurrence of at least one complication within the 7 days following surgery. The secondary outcomes will be the length of hospital stay, the total number of complications per patient, 30-day mortality, the total intraoperative volume of fluids administered, the Sequential [sepsis-related] Organ Failure Assessment (SOFA) score, and laboratory data on postoperative days 1, 2 and 7. A total of 350 patients will be included.DiscussionIn the operating theater, the RER is potentially a continuously available, easy-to-read, indirect marker of tissue hypoperfusion and postoperative complications. If the RER predicts the occurrence of tissue hypoperfusion, it can help the physician to provide personalized hemodynamic management and limit the side effects related to excessive hemodynamic optimization (volume overload, vasoconstriction, etc.).Trial registrationClinicalTrials.gov identifier: NCT03852147. Registered on February 25th, 2019.
The cost-effectiveness of government actions to reduce sodium intake through salt substitutes in Vietnam
Authors: Taylor Colman , Hoek Annet C , Deltetto Irene , Peacock Adrian , Ha Do Thi Phuong , Sieburg Michael , Hoang Dolly , Trieu Kathy , Cobb Laura K , Jan Stephen , Webster Jacqui
Published: August 2020

Background Dietary sodium reduction is recommended to reduce the burden of cardiovascular disease. In Vietnam food products including salt, fish sauce and bot canh contribute to ~70% of dietary sodium intake. Reduced sodium versions of these products can be produced by replacing some of the sodium chloride with potassium chloride. We aimed to assess the cost-effectiveness of three alternative approaches to introducing reduced sodium products onto the market with a view to lowering population sodium intake in Vietnam.Methods The three salt substitution strategies included voluntary, subsidised and regulatory approaches targeting salt, fish sauce and bot canh products. Costs were modelled using the WHO-CHOICE methodology. A Markov cohort model was developed to evaluate the cost-effectiveness of each strategy versus no intervention from the government perspective. The model linked each intervention strategy to assumed changes in levels of sodium intake and then to systolic blood pressure. Changes in SBP were linked to a probability of ischaemic heart disease or stroke. The model followed people over their lifetime to assess average costs and quality adjusted life years (QALYs) gained for each strategy. Results The voluntary salt substitution strategy was assumed to require no investment by government. Following ramp up (years 6+), the average annual costs for the subsidised and regulatory strategies were 21,808,968,902 ₫ (US$ 977,354) and 12,949,953,247 ₫ (US$ 580,410) respectively. Relative to no intervention, all three salt substitution strategies were found to be cost-effective. Cost savings were driven by reductions in strokes (32,595; 768,384; 2,366,480) and IHD events (22,830; 537,157; 1,648,590) for the voluntary, subsidised & regulatory strategies, respectively. The voluntary strategy was least cost-effective (-3,445 ₫ US$ -0.15; 0.009 QALYs gained) followed by the subsidised strategy (-43,189 ₫ US$ -1.86; 0.022 QALYs gained) and the regulatory strategy delivered the highest cost savings and health gains (-243,530 ₫ US$ -10.49; 0.074 QALYs gained). Conclusion This research shows that all three modelled salt substitution strategies would be good value for money relative to no intervention in Vietnam. The subsidised alternative would require the highest level of government investment, however the implementation costs will be exceeded by healthcare savings assuming a reasonable time horizon is considered.
Development and Validation of a Nomogram to Predict the Mortality Risk in Elderly Patients With ARF：A Retrospective Study in the Mimic-III Database
Authors: Qin Chen , Jie Weng , Ruonan Hou , Xiaoming Zhou , Zhiliang Zhou , Ying Chen , Liang Wang , Wang Zhiyi , Junnan Xu
Published: August 2020

Background: To explore the risk factors of prognosis in elderly patients with acute respiratory failure (ARF), and to develop a nomogram model to predict the short-term mortality risk of ARF.Methods: A total of 1432 patients were included in this study from MIMIC-III database. 759 patients were categorized into the training set and 673 patients were categorized into the validation set. Demographical, laboratory variables, SOFA score and APS-III score were collected within the first 24 h after the ICU admission. The univariate and multivariate logistic regression were used to identify risk factors from the training data set. A nomogram model was developed to predict the mortality risk of ARF patients within 30 days according to the risk factors.Results: Multivariate logistic regression analysis showed that the heart rate, respiratory rate, systolic pressure, SPO2, albumin and 24 h urine output were independent prognostic factors for 30-day mortality in ARF patients. A nomogram was established based on above independent prognostic factors. This nomogram had C-index of 0.741 (95% CI: 0.7058–0.7766), and the C-index was 0.687 (95%CI: 0.6458-0.7272) in the validation set. The calibration curves both in training and validation set were close to the ideal model. The SOFA had a C-index of 0.653 and the APS-III had a C-index of 0.707 in predicting 30-day mortality. The predictive performance of our nomogram is better than the SOFA score and APS-III score. Conclusions: Our nomogram performed better than APS-III and SOFA scores and should be useful as decision support on the prediction of mortality risk in elderly patients with ARF.
Apical Periodontitis in Endodontically Treated Teeth: Cross-sectional Study of New Investigated Risk Factors
Authors: OUARTI IMANE EL , SANAA CHALA , SAKOUT MAJID , FAIZA ABDALLAOUI
Published: August 2020

Background: The present study aimed at investigating risk factors associated to apical periodontitis in endodontically treated teeth and highlight the potential risk of some factors not assessed before in previous studies. Methods:A total of 358 endodontically treated teeth were evaluated after more than 1-year period in a Moroccan population according to predetermined criteria. Studied parameters were assessed clinically and radiographically. The association between coronal restoration quality, cavity design, periodontal status, root canal filling quality, coronal restoration related features, presence or absence of the opposing dentition and the periapical status was determined. Data were analyzed using chi-square test, odds ratio and logistic regression.Results:The present study revealed that gingival health, coronal restoration with CL II cavity design, and root canal filling quality influenced periapical status of endodontically treated teeth. Multivariate analysis showed that this association was statistically significant for gingival inflammation (95% IC: 1.08-3.91, OR: 2.05, p=0.02), inadequate coronal restoration (95%IC: 1.16-4.04, OR: 2.16, p: 0.01), inadequate root canal filling length and homogeneity (95%IC: 1.24-3.01, OR: 1.93, P:0.004), (95%IC: 1.41-4.44, OR: 2.50, p:0.002) respectively. Conclusions:The present study revealed that inadequate coronal restorations especially with large proximal margins (CL II cavity design) and gingival inflammation increased the risk of apical periodontitis in endodontically treated teeth.
Effect of Root Canal Disinfection with 980 µm Diode Laser on Post-operative Pain after Endodontic Treatment in Teeth with Apical Periodontitis: A Randomized Clinical Trial
Authors: Kaplan Tuna , Sezgin Güzide Pelin , Kaplan Sema Sönmez
Published: August 2020

Background: This study aims to assess the effect of root canal disinfection with a 980 µm diode laser following chemomechanical root canal preparation on the severity of pain after root canal treatment (RCT).Methods: In present study, asymptomatic, single-rooted teeth with periapical index (PAI) score 3 or 4 were included. All patients were treated with two visits of root canal treatment including dressing with calcium hydroxide. Patients were randomly divided into two groups (n: 28). ‘Control (no laser)’: The final irrigation was performed using 5ml 2.5% NaOCI, followed by 5 ml 17% EDTA and 5 ml distilled water. ‘Laser Disinfection (LD)’: Root canals were irradiated with 980 µm diode laser after final irrigation at both visits. The pain levels were evaluated using visual analog scale (VAS) after 8, 24, 48 hours and 7 days. In addition, analgesic intake and time intervals were recorded by patients. The collected data were statistically analyzed with the Chi-square and Mann-Whitney U test (p<0.05).Results: The average pain level in the control group after 24 hours was significantly higher than that in the laser group after the first appointment (p<0.05). The average pain level after the second appointment was statistically higher at 24 h and 48 h in the control group (p<0.05). PP levels at 24-hs after the first appointment were higher than the second appointment only in the control group (p<0.05). After first appointment, analgesic use in the control group at 8 h (40%) and 24 h (23%) were significantly higher than LD group (p<0.05).Conclusions: Root canal disinfection with diode laser may reduce PP in single-rooted teeth with PAI score 3 or 4.Trial registration: Effect of the Diode Laser on Post-operative Pain After Endodontic Treatment in Teeth with Apical Periodontitis: NCT04486196. Registered 24 July 2020 - Retrospectively registered, http://clinicaltrials.gov/ct2/show/NCT04486196Clinical Trials ID: NCT04486196
Sestrin2 Was Involved in Airway Remodeling in COPD: A Multi-level Research
Authors: Zhang Da-Wei , Wei Yuan-Yuan , Ji Shuang , Fei Guang-He
Published: August 2020

Background. Airway remodeling is a major pathological characteristic of chronic obstructive pulmonary disease (COPD), which is greatly associated with oxidative stress. Sestrin2 has recently drawn attention as a representative antioxidant protein. However, the underlying correlation between sestrin2 and airway remodeling in COPD has not yet been clarified.Methods. A total of 124 subjects were enrolled in this study, including 62 control subjects and 62 COPD patients. The pathological changes in airway tissues were showed by different staining methods. The expression of sestrin2 and matrix metalloproteinase 9 (MMP9) in airway tissues was assessed by Immunohistochemistry staining. Enzyme-linked immunosorbent assay (ELISA) was used to detect the serum concentrations of sestrin2 and MMP9. The airway parameters on computed tomography (CT) of all participants were measured for the evaluation of airway remodeling. Serum sestrin2 concentrations' relationship with MMP9 and airway parameters on chest CT was further analyzed. Results. In patients with COPD, staining results of airway structure showed noticeable pathological changes of remodeling, including cilia cluttered, subepithelial fibrosis, and reticular basement membrane (Rbm) fragmentation. Compared with control subjects, the expression of sestrin2 and MMP9 was significantly increased in both human airway tissues and serum. Typical imaging characteristics of airway remodeling and increased airway parameters were found on chest CT. Additionally, the serum sestrin2 concentration was positively correlated with serum MMP9 concentration and airway parameters on chest CT.Conclusion. Increased expression of sestrin2 is related to airway remodeling in COPD at three levels including histology, biomarkers and imaging. It is demonstrated for the first time that sestrin2 may be a novel biomarker for airway remodeling in COPD.
Selection of surgical treatment approaches for old osteoporotic vertebral compression fractures: A Retrospective Study of 238 Cases
Authors: Xu Zhengwei , Hao Dingjun , Dong Liang , Yan Liang , He Baorong
Published: August 2020

Background
As the population ages, osteoporotic vertebral compression fractures (OVCF) are increasing, as are acute and chronic pain episodes and progressive spinal deformities. Therefore, the aim of our study was to investigate the treatment of symptomatic old osteoporotic vertebral compression fractures.
Methods
A retrospective study was designed to enroll patients with symptomatic old OVCFs from June 2013 to 2016. According to the complexity of the disease, the patients were divided into I to V grades, and the surgical methods were developed according to the grades. Postoperative visual analog score (VAS), oswestry disability index (ODI) scores, sagittal index (SI) and ASIA grades of neurological function were observed.
Results
VAS score, ODI score and SI of all patients were significantly improved as compared with that before surgery, and the results of the final follow-up were statistically significant in comparison to preoperative outcome (P˂0.05). All the 16 patients with nerve injury showed significant improvement after surgery. The AISA grade were improved from grade C (14 cases), grade D (2 case) to grade D (4 cases) and grade E (12 cases).
Conclusion
Old OVCFs are difficult to treat. Graded surgery can better restore spinal stability and improve clinical outcomes.
Optimized duration of antituberculosis treatment for managing female genital tuberculosis: real-world experience from a high prevalence region in Eastern China
Authors: Sun Jian , Wang Wenjie , Ding Jing , Cheng Yusheng , Zhou Yunfeng , Yang Jianghua
Published: August 2020

Background Duration of antituberculosis therapy (ATT) for managing female genital tuberculosis (FGTB) is controversial with the intermittent regimen no more advocated. We therefore conducted a prospective, real-world research to compare 6 months and 9 months of ATT.Methods Between 2012 and 2018, 109 drug-susceptible patients newly diagnosed with FGTB and/or tuberculous peritonitis (genital, 13; peritoneal, 34; mixed, 62) received naïve treatment for 9-12 months and further 18-month follow-up. Data on disease features at baseline and long-term outcome (intent-to-treat) were compared between group A (aged 18-35 yr) and group B (aged 36-81 yr). Efficacy and side effects of treatment were compared within each group 6 months and 9 months from ATT initiation (per-protocol), respectively. Results In contrast to group B at baseline, group A had more clinical evidence predicting active tuberculosis (P < 0.05), severer performance of genital lesions and pelvic adhensions (P < 0.05), more signs of active pulmonary tuberculosis (P < 0.01), and less performance of only TBP (P < 0.01). Intent-to-treat analysis showed higher incidence of overall single side effects and poor compliance in group B (P < 0.05), and similar recurrence rate between 2 groups. Per-protocol analysis showed increased complete response rate (P < 0.01) and similar incidence of side effects (P > 0.05) in group A, similar complete response rate (P > 0.05) and increased incidence of overall single side effects (P < 0.05) in group B at 9-month duration.Conclusions Younger females with FGTB had a greater risk of systemic infection of tuberculosis compared to older ones. Nine-month ATT using daily therapy proved to be beneficial for younger patients at reproductive age. Six-month option was suitable for older patients for reducing side effects and poor compliance in the duration of treatment.
Profiling the inhibitory receptors LAG-3, TIM-3, and TIGIT in renal cell carcinoma reveals malignancy
Authors: Takamatsu Kimiharu , Tanaka Nobuyuki , Hakozaki Kyohei , Takahashi Ryohei , Mikami Shuji , Shinojima Toshiaki , Sasaki Takashi , Sato Yusuke , Kume Haruki , Ogawa Seishi , Kakimi Kazuhiro , Kamatani Takashi , Miya Fuyuki , Tsunoda Tatsuhiko , Nishihara Hiroshi , Mizuno Ryuichi , Oya Mototsugu
Published: August 2020

A cutting edge therapy for future immuno-oncology is targeting a new series of inhibitory receptors (IRs): LAG-3, TIM-3, and TIGIT. Both immunogenomic analyses and diagnostic platforms to distinguish candidates and predict good responders to these IR-related agents are vital in clinical pathology. By applying an automated single-cell count for immunolabeled LAG-3, TIM-3, and TIGIT, we revealed that individual IR levels with exclusive domination in each tumour can be valid biomarkers for profiling human renal cell carcinoma (RCC). We uncovered the immunogenomic landscape associated with individual IR levels in human RCC tumours with metastases in various organs and histological subtypes. We then externally validated our results and devised a workflow with optimal biomarker cut-offs for discriminating the tumour profiles of LAG-3, TIM-3, and TIGIT. The discrimination of LAG-3, TIM-3, and TIGIT profiles in tumours may have a broad impact on investigations on immunotherapy responses after targeting a new series of IRs.