bluuebunny/crossref_metadata_2025 huggingface dataset:
The prognostic value of routine preoperative blood parameters in muscle-invasive bladder cancer
Authors: zhang jingqi , Zhou Xiaozhou , Ding Hua , Wang Liwei , Liu Sha , Liu Yuting , Chen Zhiwen
Published: February 2020

Background A routine blood examination is one of the most rapid, convenient and inexpensive clinical examinations that can reflect a patient’s inflammatory status and other blood conditions, and the prognostic value of routine preoperative blood parameters in MIBC patients is still unclear, so we evaluated the prognostic value of routine preoperative blood parameters in muscle-invasive bladder cancer (MIBC) following radical cystectomy (RC). Methods Data on 202 patients with MIBC who underwent RC at our institution were retrospectively collected between October 2007 and August 2018. The median preoperative neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) and hemoglobin (HGB) values were used as cutoffs to form the low and high NLR, low and high PLR, and low and high HGB groups, respectively. The clinicopathologic characteristics of each group were compared by chi-square and t tests. Kaplan-Meier survival and multivariate Cox regression analyses were used to analyze prognosis. Results The median NLR, PLR and HGB values were 2.42, 112 and 125g/L, respectively. Kaplan-Meier results showed that the low HGB group had poor progression-free survival (PFS), cancer-specific survival (CSS) and overall survival (OS). A high NLR and high PLR groups correlated only with poor OS. Multivariate Cox analyses showed that pathological T3/4 stage, positive lymph node status and low HGB were independent risk factors for PFS, CSS and OS, and age was the only independent risk factor for OS. Conclusion Preoperative peripheral blood HGB is an independent risk factor for the prognosis of MIBC patients. These data suggest that HGB may be a useful prognostic marker for MIBC patients undergoing RC.
Epidemiology of human exposure to rabies in Nunavik: incidence, the role of dog bites and their context, and victim profiles
Authors: Mediouni Sarah , Brisson Mario , Ravel André
Published: February 2020

Background: In Nunavik, Arctic rabies is still endemic due to a spillover from wildlife to dogs. The prevention of human exposure and the management of potential exposure is a significant public health concern in this region.
Methods: This study retrospectively describes cases of potential exposure to rabies in humans as reported to the Nunavik Public Health Board through their registry of reported cases. We used multi-correspondence analysis as well as univariable and multivariable regression models to test for differences between children and adults in reported cases, and to examine to contexts of exposure to dogs and dog attacks.
Results: From 2008 to 2017, 320 cases of potential exposure to rabies were reported, 92% of which were linked to dogs. The annual incidence rate was 2.5 per 1,000 people. The incidence increased significantly during the study period, although the reasons for this are unclear. Fifteen cases of exposure were with rabid animals, mostly dogs (9 of 15). No human cases of rabies occurred thanks to adequate medical case management. Two specific profiles for potential exposure to rabies were identified based on age and gender. The first was children (<15 y/o), male or female, who were more likely to be exposed through playing with dogs and were more often injured in the head and/or neck. The second was young male adults (aged 15 to 34 y/o), who were more involved with wildlife than other age groups and mostly injured in the upper limbs and as a result of a reaction by the animal.
Conclusion: Rabies is a real public health threat in Nunavik. Potential human exposure needs to be prevented, and prevention measures should be tailored to the two risk profiles identified based on age, gender and animal species involved.
Differential protective effects of bisphosphonates and denosumab on primary breast cancer risk, potentially to be modified by statins: a retrospective study using electronic health records
Authors: Stanoyevitch Alexander , Zhang Lei , Sanz Javier , Follett Robert , Bell Douglas
Published: February 2020

Background: The risks of osteoporosis and breast cancer are increasing in elderly women, as well as hyperlipidemia. Bisphosphonates and denosumab are recommended for treatment of osteoporosis, and statins are used for hyperlipidemia. There are different and overlapping pharmacodynamics among bisphosphonates, denosumab and statins. We aim to assess effects of bisphosphonates and denosumab on breast cancer, possibly affected by statins use.Methods: This retrospective cohort is consisted of 97,671 women elder than 50 years with no previous history of malignancy and no cancer other than breast during follow-up, including 778, 2326, 15287 and 7631denosumab, bisphosphonates, statins and hormone for postmenopausal symptoms ever users. Univariate and bivariate analysis, and the Cox Proportional Hazards multi-variate model are performed.Results: Over an average of 3.6 years follow up, the breast cancer risks counted after 365 days of latency are 1.54% (12/778) for denosumab, 0.52% (12/2326) for bisphosphonates, compared to 0.65% (99/15287) in statins ever use group, 0.26% (20/7631) in hormone users for menopausal symptoms and 1.38% (1032/74867) in control group. The significant difference of breast cancer risk between denosumab and bisphosphonates group (p=0.0047) is supported by the Log-rank test (p=0.0004). The multivariate model is in partial agreement with the uni- and bivariate analysis. Further subgroup analysis revealed that concurrent use of statins in denosumab prescribers lowered the breast cancer risk to 0.89% (2/224), but with no significantly change of breast cancer risk in bisphosphonates group (7/919, 0.762%).Conclusion : Our data suggest superior protective effects of bisphosphonates over denosumab on breast cancer risk in elderly women. Statins could potentially exert breast cancer protective effect in denosumab users with no synergistic effect in patients taking bisphosphonates. A large scale study with long term follow up is needed.
Factors associated with 36-month loss to follow-up and mortality outcomes among HIV-infected adults on antiretroviral therapy in Central Kenya
Authors: Wekesa Paul , McLigeyo Angela , Owuor Kevin , Mwangi Jonathan , Nganga Evelyn , Masamaro Kenneth
Published: February 2020

Background : The scale-up of HIV treatment programs has resulted in a reduction in HIV-related morbidity and mortality. However, retention of patients in these programs remains a challenge in sub-Saharan Africa. Understanding factors associated with loss to follow-up (LTFU) and mortality outcomes is therefore important to inform targeted program interventions.

Methods : A retrospective multi-cohort analysis of 23,890 adult patients on ART over 36 months of follow-up in Kenya was done. Multivariate logistic regression analysis was done to assess for factors associated with LTFU and mortality at 6, 12, 24, and 36 months of follow-up.
Results : Majority, 67.7%, were female. At 36 months , 27.2% were LTFU and 13.5% had died. Factors associated with mortality at 36 months included older age (51 years and above) using 20-35 years as reference [(adjusted odds ratio [aOR], 1.51, 95% confidence interval (CI) 1.23–1.86, p<0.001], being male (aOR, 1.59, 95% CI 1.39–1.83, p<0.001), divorced using married as reference (aOR, 1.86, 95% CI 1.56–2.22, p<0.001), having a body mass index (BMI) score of less than 18.5 kg/m² using 18.5-24.9 kg/m² as reference (aOR = 1.79, 95% CI 1.52–2.11, p<0.001), and, World Health Organization stage III and IV using stage I as the reference (aOR, 1.94, 95% CI 1.43–2.63 and aOR, 4.24, 95% CI 3.06–5.87, p<0.001 respectively). Factors associated with LTFU at 36 months included being young between 20-35 years (aOR, 1.49, 95% CI 1.40-1.59, p<0.001) using 36-50 years as reference, being male (aOR, 1.19, 95% CI 1.12–1.27, p<0.001), and being single or divorced using married as reference (aOR, 1.34, 95% CI 1.23–1.45 and aOR, 1.25, 95% CI 1.15–1.36, p<0.001 respectively). Patients with baseline BMI of less than 18.5 kg/m² using normal BMI as reference (aOR, 1.68, 95% CI 1.39–2.02, p<0.001) were also likely to be LTFU.

Conclusions : Factors associated with LTFU and mortality were generally similar over time. Implementation of programs in similar settings should be tailored to gender, age profiles, nutritional, and, marital status of patients to address LTFU. In addition, programs should focus on the care of older patients to reduce the risk of mortality.
Stigma and utilization of treatment for adolescent perinatal depression in Ibadan Nigeria
Authors: Kola Lola , Bennett Ian M , Bhat Amritha , Ayinde Olatunde O. , Oladeji Bibilola D. , Abiona Dolapo , Abdulmalik Jibril , Faregh Neda , Collins Pamela Y. , Gureje Oye
Published: February 2020

Background. Depression is a common and severe disorder among low-income adolescent mothers in low-and middle-income countries where resources for treatment are limited. We wished to identify factors influencing health service utilization for adolescent perinatal depression in Nigeria to inform new strategies of care delivery.Methods. Focus Group Discussions (FGDs) were conducted among purposively selected low-income young mothers (with medical histories of adolescent perinatal depression), and separately with primary care clinicians treating this condition in Ibadan, Nigeria. Participants from this community-based study were from the database of respondents who participated in a previous randomized control trial (RCT) conducted between 2014 and 2016 in 28 primary health care facilities in the 11 Local government areas in Ibadan. A semi-structured interview guide was designed according to the themes of the Behavioral Model for Vulnerable Populations to obtain views of participants on the factors that promote or hinder help-seeking and engagement. FGDs were conducted, and saturation of themes was achieved after discussions with six groups. Transcripts were analyzed using content analysis framework.Results. A total of 42 participants, 17 mothers (who were adolescents at the time of the RCT), and 25 care providers participated in 6 FGDs. The availability of care for PD at the primary care level was an important enabling factor in healthcare utilization for the adolescents. Perceived health benefits of treatment received for perinatal depression were strong motivation for service use. Significant stigma and negative stereotypes expressed by care providers towards adolescent pregnancy and perinatal depression were potential obstacles to care. However, individual patient resilience was a major enabling factor, facilitating service engagement. Providers trained in the management of perinatal depression were perceived to deliver more tolerant and supportive care that adolescent mothers valued. Conclusions. Participants identified an unsupportive and stigmatizing clinic environment as a significant potential barrier to accessing available care. Interventions to reduce stigma among healthcare providers may improve services for this vulnerable population.
Elderly patients´ perspectives on treatment, care and rehabilitation after hip fracture: A qualitative systematic review
Authors: Abrahamsen Charlotte , Nørgaard Birgitte
Published: February 2020

BackgroundHip fracture surgery is a distressing and life-changing event for patients. The treatment, care and rehabilitation of hip fracture patients governed by evidence-based recommendations, the patients’ preferences are often not represented. The aim of this systematic review is to identify what elderly hip fracture patients consider important in relation to their fracture.MethodsA qualitative approach was applied to present findings on patient perspectives. Data were extracted from the findings in the Results section of each study, categorized by similarity in meaning by both authors as either health-related factors or healthcare-related experiences. The quality of the presented evidence was evaluated, and all studies were assessed using the Critical Appraisal Skills Programme (CASP) checklist.ResultsSixteen qualitative studies met the inclusion criteria. The health-related factors category included: 1) symptoms and complications, 2) physical health, 3) mental health and 4) social relationships and 5) personal goals. Healthcare-related experiences revolved around: 1) waiting time, 2) information, , 3) participation and respect and 4) discharge.ConclusionsThis systematic review provides an overview of hip fracture patients’ perspectives on important aspects of care, treatment and training during their trajectory, thereby contributing to plan and deliver care based on what matters to patients. .
Resistance against macrocyclic lactones in Psoroptes ovis in cattle
Authors: Mol Wouter van , De Wilde Nathalie , Casaert Stijn , Chen Zhenzhen , Vanhecke Marieke , Duchateau Luc , Claerebout Edwin
Published: February 2020

Background Psoroptic mange is an important disease in beef cattle, and Belgian Blue cattle are particularly susceptible. Treatment failure of macrocyclic lactones against Psoroptes ovis has been reported, but clear evidence of in vivo resistance is still lacking. This study was conducted to investigate the efficacy of macrocyclic lactone products in 16 beef farms in Belgium and The Netherlands in vivo and in vitro . Methods On each farm a group of animals (n= 7-14) with psoroptic mange was treated with two subcutaneous injections of a macrocyclic lactone product with 7-10 days interval (15 farms) or a single injection with a long-acting macrocyclic lactone (1 farm). In vivo efficacy was assessed by the reduction in mite counts and clinical index (estimated proportion of the body surface affected by lesions), the proportion of the animals with negative mite counts after the first treatment round and the number of treatment rounds needed to obtain zero mites counts in all animals. A mite population from a given farm was categorized as sensitive when the mite count reduction after the first treatment round >95% and the lower limit of the uncertainty interval >90%. Resistance was detected when both parameters were below the threshold. Resistance was suspected when only one was below its threshold. In vitro knock-down and mortality was evaluated in a contact test. Results The proportion of the animals with negative mite counts after the first treatment round varied from 0-80%. All farms needed two or more rounds of treatments to obtain zero mite counts on all animals. Clinical index had a high variation and only started to reduce after the second treatment round. Mite populations from three farms were categorized as sensitive, one as suspected resistant and the other 12 as resistant. No correlation was found between in vitro lethal dose 50 and knock-down dose 50 values and any parameter of in vivo efficacy. Conclusions Unambiguous treatment failure was detected on 12/16 beef farms, confirming the presence of macrocyclic lactone resistance on Belgian Blue beef farms. In vitro parameters could not discriminate the farms based on their in vivo sensitivity. The mean reduction in mite counts and the lower limit of the confidence interval are proposed as most useful parameters to identify acaricide resistance.
Escherichia coli σ70 promoters allow expression rate control at the cellular level in genome-integrated expression systems
Authors: Schuller Artur , Cserjan-Puschmann Monika , Tauer Christopher , Jarmer Johanna , Wagenknecht Martin , Reinisch Daniela , Grabherr Reingard , Striedner Gerald
Published: February 2020

Background

The genome-integrated T7 expression system offers significant advantages, in terms of productivity and product quality, even when expressing the gene of interest (GOI) from a single copy of. Compared to plasmid-based expression systems, this system does not incur a plasmid-mediated metabolic load, and it does not vary the dosage of the GOI during the production process. However, long-term production with T7 expression system leads to a rapidly growing non-producing population, because the T7 RNA polymerase (RNAP) is prone to mutations. The present study aimed to investigate whether two σ 70 promoters, which were recognized by the Escherichia coli host RNAP, might be suitable in genome-integrated expression systems. We applied a promoter engineering strategy that allowed control of expressing the model protein, GFP, by introducing lac operators ( lacO ) into the constitutive T5 and A1 promoter sequences.

Results

We showed that, in genome-integrated E. coli expression systems that used σ 70 promoters, the number of lacO sites must be well balanced. Promoters containing three and two lacO sites exhibited low basal expression, but resulted in a complete stop in recombinant protein production in partially induced cultures. In contrast, expression systems regulated by a single lacO site and the lac repressor element, lacI Q , on the same chromosome caused very low basal expression, were highly efficient in recombinant protein production, and enables fine-tuning of gene expression levels on a cellular level.

Conclusions

Based on our results, we hypothesized that this phenomenon was associated with the autoregulation of the lac repressor protein, LacI. We reasoned that the affinity of LacI for the lacO sites of the GOI must be lower than the affinity of LacI to the lacO sites of the endogenous lac operon; otherwise, LacI autoregulation could not take place, and the lack of LacI autoregulation would lead to a disturbance in lac repressor-mediated regulation of transcription. By exploiting the mechanism of LacI autoregulation, we created a novel E. coli expression system for use in recombinant protein production, synthetic biology, and metabolic engineering applications.
Synthesis and biological evaluation of 4-substituted aryl-piperazine derivatives of 1,7,8,9-tetrachloro-10,10-dimethoxy-4-azatricyclo [5.2.1.02,6] dec-8-ene-3,5-dione as anti-cancer and anti-angiogenesis agents
Authors: Guo Lifang , Xu Benshan , Wan Zirui , Ren Lulu , Zhang Jie , Zhang Wen , Liu He , Liu Lihong
Published: February 2020

The authors have requested that this preprint be removed from Research Square.
FHIR PIT: an open software application for spatiotemporal integration of clinical data and environmental exposures data
Authors: Xu Hao , Cox Steven , Stillwell Lisa , Pfaff Emily , Champion James , Ahalt Stanley C. , Fecho Karamarie
Published: February 2020

Background Informatics tools to support the integration and subsequent interrogation of spatiotemporal data such as clinical data and environmental exposures data are lacking. Such tools are needed to support research in environmental health and any biomedical field that is challenged by the need for integrated spatiotemporal data to examine individual-level determinants of health and disease. Results We have developed an open-source software application—FHIR PIT (Health Level 7 Fast Healthcare Interoperability Resources Patient data Integration Tool)—to enable studies on the impact of individual-level environmental exposures on health and disease. FHIR PIT was motivated by the need to integrate patient data derived from our institution’s clinical warehouse with a variety of public data sources on environmental exposures and then openly expose the data via ICEES (Integrated Clinical and Environmental Exposures Service). FHIR PIT consists of transformation steps or building blocks that can be chained together to form a transformation and integration workflow. Several transformation steps are generic and thus can be reused. As such, new types of data can be incorporated into the modular FHIR PIT pipeline by simply reusing generic steps or adding new ones. We have validated FHIR PIT in the context of a driving use case designed to investigate the impact of airborne pollutant exposures on asthma. Specifically, we replicated published findings demonstrating racial disparities in the impact of airborne pollutants on asthma exacerbations. Conclusions While FHIR PIT was developed to support our driving use case, the software can be used to integrate any type and number of spatiotemporal data sources at a level of granularity that enables individual-level study. We expect FHIR PIT to facilitate research in environmental health and numerous other biomedical disciplines.
Prevalence, serotypes, and antimicrobial resistance of Salmonella isolates from patients with diarrhea in Shenzhen, China
Authors: Shen Hong-wei , Chen Haochuan , Ou Yongxuan , Huang Tingting , Ma Wen , Chen Siping , Zhou Lintao , Zhang Jinjin , Hu Qinghua , Zhou Yiwen
Published: February 2020

Background : Salmonella is one of the main causative agents of diarrhea which results in substantial disease burden. To determine the prevalence, serotype distribution, and antimicrobial resistance profiles of clinical Salmonella isolates in Shenzhen, a 6-year surveillance study was conducted. Methods: Three sentinel hospitals were chosen and patients who visited the gastroenteritis clinics with acute diarrhea were enrolled. Salmonella isolates from the stool samples were subjected to serotyping, antimicrobial susceptibility testing to 24 antibiotics, and detection of resistance genes. Results: A total of 297 (5.7%) Salmonella strains were isolated from stool samples from 5,239 patients. Among the 42 serovars identified, serovar Typhimurium was the most common serotype which represented 39.7% of the isolates (118), followed by serovar Enteritidis (71, 23.9%), London (12, 4.0%), 4, 5, 12: i: - (11, 3.7%), and Senftenberg (8, 2.7%). A high frequency of resistance was found in ampicillin (70.6%), piperacillin (64.5%), tetracycline (63.5%), and streptomycin (54.3%). Resistance to ampicillin and tetracycline was observed in 95.3% of S. Typhimurium isolates; and nalidixic acid in 93.1% of S. Enteritidis isolates. Resistance to 5 or more antimicrobial agents was found in 78.8% of S. Typhimurium and 69.0% of S. Enteritidis isolates. Conclusions: Salmonella is an important cause of acute gastroenteritis and a broad range of serotypes are prevalent in Shenzhen, with Enteritidis and Typhimurium being the most common serovars. The high level of antibiotic resistance is of public health significance and ongoing monitoring combined with rational use of antibiotics are recommended.
WITHDRAWN: The effect of removable orthodontic appliances on oral microbiota: systematic review
Authors: Lucchese Alessandra , Pellegrino Marianna , Montini Eugenio , Liguori Alessandra , Manuelli Maurizio
Published: February 2020

Background
Removable orthodontic appliances may favour plaque accumulation and oral microbe colonization. This might be associated with intraoral adverse effects on enamel or periodontal tissues. The proposed systematic review was carried out to evaluate qualitatively and quantitatively the microbiological changes occurring during orthodontic therapy with removable orthodontic appliances.
Methods
PubMed, Cochrane, EMBASE, Web of Science, Scopus, Ovid Medline, Dentistry & Oral Sciences Source and Vita-Salute San Raffaele University databases were searched. The research included every article published up to December 2018 . The Preferred Reporting Items for Reporting Systematic reviews and Meta Analyses (PRISMA) protocol and the ‘Swedish Council on Technology Assessment in Health Care Criteria for Grading Assessed Studies’ (SBU) method were adopted to conduct this systematic review.
Results
The current study has a moderate evidence, demonstrating that removable appliances do influence the oral microbiota. Significant alterations occur just 15 days after the beginning of therapy, independently from the type of appliance. Furthermore, the levels of oral pathogens decrease significantly or even returned to pre-treatment levels several months later the therapy end.
Conclusions
This review suggests that orthodontic treatment with removable appliances induces changes to the oral microflora, but these alterations might not be permanent.
Protocol : PROSPERO database registration number CRD42019121762.
Keywords: Oral microbiology; Removable orthodontic appliances; Oral microflora changes; Caries bacteria.
Protein A/G-based enzyme-linked immunosorbent assay for detection of anti-Pythium insidiosum antibodies in human and animal subjects
Authors: Jaturapaktrarak Chalisa , Payattikul Penpan , Lohnoo Tassanee , Kumsang Yothin , Laikul Aree , Pathomsakulwong Watcharapol , Yurayart Chompoonek , Tonpitak Walaiporn , Krajaejun Theerapong
Published: February 2020

Objectives: Pythiosis is a deadly infectious disease caused by Pythium insidiosum. Reports of both human and animal pythiosis are on the rise worldwide. Prognosis of the pythiosis patients relies on early diagnosis and prompt treatment. There are needs for an immunodiagnostic test that can detect the disease in both humans and animals. This study aims at reporting an optimized protocol for the development of a protein A/G-based enzyme-linked immunosorbent assay (ELISA) for the detection of anti- P. insidiosum antibody in multiple host species.
Results: A total of 25 pythiosis and 50 control sera, obtained from humans, horses, dogs, cats, and cows, were recruited for the assay development. With a proper ELISA cutoff point, all pythiosis sera can ultimately be distinguished from the control sera. The successfully-developed protein A/G-based ELISA can detect the anti- P. insidiosum antibodies in serum samples of both humans and animals. It is a versatile, feasible-to-develop, and functional immunodiagnostic assay for pythiosis.
Synthesis, Photophysical Property and Antibacterial Activity of Cu(II) and Co(II) Porphyrins: Role of Ligand Modification
Authors: Beyene belete , Achenef Getaneh
Published: February 2020

Many synthetic porphyrins are modified at the meso-position to achieve target properties in biomedical applications. The metalloporphyrins; CuTPP, CuTPPCOOMe, CuTPPNH 2 , CoTPPOMe and CoTPPCOOH were synthesized from their free base porphyrins and characterized by spectroscopic techniques. The Uv-Vis spectra show the decrease in number of Q bands from four to one/ two peaks and a blue shift when the metal is inserted in to the porphyrin core. They are capable of effecting bacterial and viral pathogens through the large number of different mechanisms. The antibacterial activity of the metalloporphyrins and their ligands were evaluated by using two gram positive and two gram negative bacteria by disc diffusion method. Among the complexes under study, CoTPPCOOH showed highest inhibition zone (15.5- 16.5) vs 25-28 for the famous standard antibacterial drug and therefore, highest antibacterial activities as compared to other porphyrins. The study also indicates that metalloporphyrins with electron withdrawing groups have highest inhibition zones than complexes which possess electro donating group at para position of the meso-phenyl ring.
CD59 receptor targeted delivery of miRNA-1284 and Cisplatin-loaded liposomes for effective therapeutic efficacy against cervical cancers
Authors: Wang Li , Liang Ting-Ting
Published: February 2020

Co-delivery of two different therapeutics (miRNA-1284 and cisplatin (CDDP)) into the cancer cells in a single nanocarrier provides new dimension to the cancer treatment. In this study, we have designed the CD59sp-conjugated miRNA-1284/cisplatin(CDDP)-loaded liposomes for the enhanced therapeutic effect against cervical cancers. Compared with miRNA-1284/CDDP-loaded liposomes (LP-miCDDP), CD59 antibody-conjugated LP-miCDDP (CD/LP-miCDDP) showed a significantly higher cytotoxicity in HeLa cells. Notably, MiR-1284 showed a typical concentration-dependent cell killing effect in the cervical cancer cells owing to the downregulation of HMGB1. Flow cytometer analysis showed that CD/LP-miCDDP resulted in maximum apoptosis effect (~60%) compared to CDDP (~20%) or miR-1284 (~12%) treated cells indicating the superior anticancer effect in the cancer cells. Importantly, CD/LP-miCDDP significantly prolonged the blood circulation of encapsulated drug in rats with significantly higher AUC (o-t) , t 1/2 and lower CL compared to that of free CDDP. Overall, results demonstrated that targeted and synergistic co-delivery of therapeutic components could be promising in cervical cancer therapy.
Modified trapdoor procedures using autogenous tricortical iliac graft without preserving the broken cartilage to treat osteonecrosis of the femoral head: A Prospective Cohort Study With Historical Controls
Authors: Cheng qi , zhao fengchao , Xu Shizhuang , Zheng Li , Zheng Xin
Published: February 2020

Background The aim of the present study was to investigate clinical and radiological outcomes of autologous tricortical iliac graft through a window created at the femoral head, without suturing the opened articular cartilage to treat osteonecrosis of the femoral head (ONFH), called modified trapdoor procedures.Methods A total of 59 consecutive patients (67 hips; 36 males and 23 females) with ONFH were included in this study, which was conducted during the period from April 2009 to March 2012. Patient age ranged from 27 to 46 years old, with mean age of 36.3 years. Harris hip scores (HHS) were used to evaluate hip function pre- and postoperatively. Anteroposterior and frog-position X-rays and magnetic resonance imaging (MRI) were conducted to evaluate lesion location, size, and ARCO stage. Clinical failure was defined as score < 80 points or treatment by total hip arthroplasty(THA). Radiographic failure was defined as a > 3 mm of collapse in the hip. This group was retrospectively matched according to the ARCO stage, extent, location, etiology of the lesion, average age, gender, and preoperative Harris hip score to a group of 59 patients (67 hips) who underwent the“light bulb”approach during March 2007 to April 2009. Results Mean follow-up was 91.2 ± 13.6 months (range, 75–115 months). Mean HHS was 91.3 ± 4.5, compared with 83.1± 4.5 in the “light bulb” cohort at the 6 years follow-up examination (P < 0.001). At the 6 years follow-up, for modified trapdoor procedures, five hips (8.5%) were classified as clinical failure, and 3 hips underwent total hip arthroplasty; Seven hips were classified as (10.4%) radiographic failure.The clinical and radiographic failure of the hips treated with the modified trapdoor procedure was significantly lower than that of the hips treated with the “light bulb” procedure (p < 0.05). Survival of the joint was not significantly related to the location of the femoral head lesion between two groups, but there was better clinical and radiographic results in modified trapdoor procedures with Size-C and the ARCO stage III.Conclusion The study demonstrated superior medterm clinical results in ONFH with the use of autologous tricortical iliac block graft through a femoral head window, without suturing the opened articular cartilage. The results of this femoral head-preserving procedure in patients with postcollapse osteonecrosis and large lesion are superior to those of the “light bulb” procedure treatment.
A survey of Italian Physicians self-efficacy regarding communication skills and its correlation with a measure of "Burnout"
Authors: Messerotti Andrea , Banchelli Federico , Ferrari Silvia , Barbieri Emiliano , Bettelli Francesca , Bandieri Elena , Giusti Davide , Catellani Hillary , Borelli Eleonora , Colaci Elisabetta , Pioli Valeria , Morselli Monica , Forghieri Fabio , Galeazzi Gian Maria , Marasca Roberto , Bigi Sarah , D'Amico Roberto , Martin Peter , Efficace Fabio , Luppi Mario , Potenza Leonardo
Published: February 2020

Background: The majority of practising physicians experience burnout. One of the factors most frequently advocated to increase such risk is breaking bad news (BBN). Several reports, by showing alteration of physiological indices, have empirically suggested that BBN may stress physicians, ultimately contributing to burnout. However, the association between the way serious news is broken and burnout has not been explored yet. In this study we investigated the correlation between burnout and physicians' self-efficacy regarding communication to patients.
Methods: A 23-item questionnaire exploring attitudes and practice regarding BBN and the Maslach Burnout Inventory test were administered to 379 physicians from two University Hospitals. Associations were assessed by means of logistic regression models.
Results: 226 (60%) returned the questionnaires. 76% of physicians acquired communication skills by observing mentors or colleagues, 64% considered BBN as discussing a poor prognosis, 56% reported discussing prognosis as the most difficult task, 38% and 37% did not plan a BBN encounter and considered it stressful. The overall burnout rate was 59%. At the multivariable analysis considering BBN as discussing a poor prognosis and a stressful task were related to high level of burnout (OR 2.42, p=0.042; OR 3.56, p=0.005); whereas planning the encounter and mastering communication skills even by just by means of reading relevant literature were correlated to low level of burnout (OR=0.43, p=0.037; OR=0.19, p=0.034).
Conclusions: Our study identifies some physicians' BBN attitudes and knowledge of conceptual frameworks which may influence the risk of burnout and support the notion that increasing knowledge about communication skills may protect clinicians from burnout.
99m Tc-labeled Duramycin for detecting and monitoring cardiomyocyte death and assessing cardioprotection of atorvastatin in acute myocardial infarction
Authors: Tan Hui , Abudupataer Mieradilijiang , Qiu Lin , Mao Wujian , Cheng Dengfeng , Shi Hongcheng
Published: February 2020

Background: The objective of this study was to evaluate the feasibility of dynamic monitoring of myocardial cell death using 99m Tc-Duramycin single photon emission computed tomography/computed tomography (micro-SPECT/CT) imaging in a mouse model of acute myocardial infarction, and the anti-apoptosis effect of atorvastatin for cardio protection. Methods: Forty-five male Kunming mice were randomized into three groups: acute myocardial infarction (AMI) group, acute myocardial infarction with atorvastatin treatment (T-AMI) group, and the sham group. The mice of the AMI group and T-AMI group were subjected left coronary artery ligation. The T-AMI group was orally administered with atorvastatin 20 mg/ (kg day) 24 h before the surgery, the other two groups received only saline. Three groups of model mice were randomly selected at day 1 (D1), day 3 (D3), and day 7 (D7) day after surgery with 99m Tc-Duramycin micro-SPECT/CT imaging. Transthoracic echocardiography test was performed at D3 and D7 after surgery. The pathological evaluation, TUNEL assay and Western blot analysis were performed on heart specimens on D1, D3 and D7. Results: For up-taking of 99m Tc-duramycin in infarcted region, the mean value of semi-quantitative of AMI group were 2.62 on D1, 3.89 on D3 and 1.20 on D7. And for the T-AMI group, the mean value of semi-quantitative were 2.20 on D1, 2.97 on D3 and 1.30 on D7. The sham group had no positive imaging in myocardium, the mean value of semi-quantitative were 1.09, 1.14 and 1.10 on D1, D3 and D7, respectively. Meanwhile, 99m Tc-linear-duramycin imaging as control showed that there’s no radioactive uptake in the area of infarction region. But the T-AMI group imaging showed the tracer uptake decreased obviously compared to the uptake of AMI mice in infarcted region (L/N: 2.2 versus 2.62; 2.97 versus 3.89) on D3 and D7. LVEF was significantly reduced on D3 (42.67±2.51%) and D7 (27.71±2.52%) compared with the sham group (71.00±2.65%). The number of TUNEL positive cells decreased significantly on D3 (37.00±3.01 vs 51.00±3.61) and D7 (21.67±2.08 vs 27.65±2.51) post-MI after atorvastatin treatment. Additionally, the atorvastatin increased the expression level of anti-apoptotic protein BCL-2 and decreased the expression level of pro-apoptotic protein BAX. Conclusions: 99m Tc-Duramycin SPECT/CT imaging allowed to the non-invasively monitoring of myocardial cell death in a mouse model of acute myocardial infarction. Furthermore, this investigation and analysis could be used to assess and verify the anti-apoptosis effect of atorvastatin for cardio protection by in-vivo molecular imaging.
Prognostic value of a metastasis-related gene signature in hepatocellular carcinoma
Authors: Zhou Zhou , Jiang Yinan
Published: February 2020

Background: Surgery is a potential curative treatment for hepatocellular carcinoma (HCC), but postoperative recurrence occurs in majority of patients. Currently, there are no robust biomarkers to predict the disease progression or recurrence. Methods: Weighted gene correlation network analysis (WGCNA) was used to construct co-expression network. The least absolute shrinkage and selection operator (LASSO) method was applied to develop prognostic model. Survival analysis, gene set variation analysis (GSVA) and gene set enrichment analysis (GSEA) were performed to assess the performance. Results: By using GSE14520 dataset, 16 hub genes associated with HCC metastasis were screened. A signature of 5 metastasis-related genes was subsequently constructed by incorporating TCGA LIHC dataset. HCC patients with high risk score have low survival rate, low disease free survival rate and high recurrence rate. The prognostic value of this 5-mRNA signature was further verified in pan-cancer datasets. A nomogram was built with excellent performance and potential clinical application for prognosis. GSVA and GSVA revealed that metabolic pathways are distinct between high- and low-risk groups. Conclusions: We have established a 5-mRNA signature and a nomogram that can efficiently predict metastasis, recurrence and patient survival in HCC.
Single-nucleotide polymorphism rs17548629 in RIPK1 gene may be associated with lung cancer in a young and middle-aged Han Chinese population
Authors: Yang Shimin , Yu Fanglin , Lin Mingyan , Sun Linyi , Wei Junjie , Lai Cheng , Cai Lin , Hu Zhijian , He Fei
Published: February 2020

Background Genetic biomarkers of lung cancer (LC) susceptibility may provide a basis for treatment and prevention. This study analyzed an association between SNPs (single nucleotide polymorphisms) in the complementary region of the 3′-UTR (3' untranslated region) of microRNAs of the gene RIPK1 (receptor-interacting serine/threonine-protein kinase 1) and LC among an adult Han Chinese population aged younger than 60 years. Also explored the effect of regulation of the RIPK1 gene via rs17548629 and microRNA-1197 on the occurrence of LC. Methods RIPK1 variants (rs17548629, rs77736895) were determined in a population of 571 adults (younger than 60 years) with LC, and 609 gender- and age-matched healthy individuals. Bioinformatics methods predicted the microRNAs bound to rs17548629. Dual luciferase reporter assay was performed to confirm the presence of both rs17548629 and the predicted microRNA. Results A mutation (T) of rs17548629 was associated with an increased risk for LC in this population under the codominant and recessive genetic models. The risk of lung adenocarcinoma in rs17548629 mutant carriers was 1.769-fold higher than that of the wildtype. In vitro , the luciferase activity of co-transfected mutant psiCHECK2- RIPK1 and microRNA-1197 mimics was less than that of the group transfected with microRNA-1197 mimics only. Factorial analysis indicated interactions between microRNA-1197 mimics and genotypes of rs17548629. Conclusion A mutation (T) of rs17548629 may increase the risk of LC/lung adenocarcinomain adult Han populations younger than 60 years. When carrying the T allele, rs17548629 may be the target of hsa-miR-1197. This mutation may affect levels of RIPK1 protein, thereby promoting the occurrence of LC.
"Knock Knock": A qualitative study exploring the experience of household contacts on home visits and their attitude towards people living with TB in South Africa
Authors: Sathar Farzana , Velen Kavindhran , Peterson Meaghan , Charalambous Salome , Chetty-Makkan Candice M
Published: February 2020

Background: Household contract tracing (HHCT) is an important strategy for active case finding. However, there is limited data on the patient-centered approach to HHCT. Our study aimed to describe experiences and preferences of household contacts (HHCs) for HHCT. Methods: We conducted a qualitative study in Rustenburg, South Africa from September 2013 to March 2015. Twenty-four HHCs (≥18 years) had audio-recorded in-depth interviews. We used an inductive thematic analysis approach to develop themes. We made an a priori assumption that we would reach saturation with at least 20 interviews.Results: There were 16 (66.7%) females (median age = 36 years) and eight (33.3%) males (median age = 34 years). Two themes developed: (i) Positive attitude of HHCs towards TB services provided at home and (ii) HHCs relationship to and acceptance of people living with TB (PLTB). The first main theme emphasized that HHCs appreciated the home visits. Participants preferred home visits because they had negative experiences at the clinic such as delayed waiting times and long queues. HHCs supported the screening of children for TB at home. Participants suggested that the research staff could expand their services by screening for diabetes and hypertension alongside TB screening. In the second main theme, there was a sense of responsibility from the HHCs towards accepting the diagnosis of PLTB and caring for them. A sub-theme that emerged was that as their knowledge on TB disease improved, they accepted the TB status of the PLTB empowering them to take care of the PLTB. Conclusions: HHCs are supportive of HHCT and felt empowered by receiving TB education that ultimately allowed them to better understand and care for PLTB. HHCs were supportive of screening children for TB at home. Future HHCT activities should consider raising community awareness on the benefits of TB contact tracing at households.
Measuring Antibody Avidity To Plasmodium Falciparum Merozoite Antigens Using A Multiplex Immunoassay Approach
Authors: Taylor Diane Wallace , Bobbili Naveen , Kayatani Alexander K , Tassi-Yunga Samuel , Leke Rose FG
Published: February 2020

Background: Antibodies (Ab) play a significant role in immunity to Plasmodium falciparum malaria. Usually, following repeated exposure to pathogens, affinity maturation and clonal selection take place, resulting in increased antibody avidity. However, some studies suggest affinity maturation may not take place to malaria antigens in endemic areas. Information on development of antibody avidity is confusing and conflicting, in part, because different techniques have been used to measure avidity. Today, bead-based multiplex immunoassays (MIA) are routinely used to simultaneously quantitate antibody levels to multiple antigens. This study evaluated the feasibility of developing an avidity MIA with 5 merozoite antigens (AMA1, EBA-175, MSP1-42, MSP2, MSP3) that used a single chaotropic concentration.
Methods: The most common ELISA protocols that used the chaotropic reagents guanidine HCl (GdHCl), urea, and ammonium thiocyanate (NH4SCN) were adapted to a multiplex MIA format. Then, different concentrations of chaotropes and incubation times were compared and results were expressed as an Avidity Index (AI), i.e., percentage of antibody remaining bound in the presence of chaotrope. Experiments were conducted to i) identify the assay with the widest range of AI (discriminatory power), ii) determine the amount of chaotrope needed to release 50% of bound Ab using plasma from adults and infants, and iii) evaluate assay repeatability.
Results: Overall, 4M GdHCl and 8M urea were weaker chaotropes than 3M NH4SCN. For example, they failed to release significant amounts of Ab bound to MSP1-42 in adult plasma samples; whereas, a range of AI values was obtained with NH4SCN. Titration of NH4SCN revealed that 2M urea gave the widest range of AI for the 5 antigens. Binding studies using plasma from 40 adults and 57 one-year old infants in Cameroon showed that 2.1M ± 0.32 (mean ± SD) NH4SCN (adults) and 1.8M ± 0.23M released 50% of bound Ab from the merozoite antigens. The final avidity multiplex assay was highly repeatable.
Conclusions. An avidity MIA is feasible for the 5 merozoite antigens that uses a single concentration (2M) of NH4SCN. The assay provides a simple method to quickly obtain information about Ab quantity and quality in the acquisition of immunity to malaria in endemic populations.
Dorsal approach with Glissonian approach in laparoscopic anatomic hepatectomy for right lobe
Authors: Wang Shaohe , Yue Yang , Zhang Wenjie , Liu Qiaoyu , Sun Beicheng , Sun Xitai , Yu Decai
Published: February 2020

Background: Laparoscopic anatomic hepatectomy（LAH）has gradually become the routine surgical procedure. We reported previously that Glissonian approach combined with major hepatic vein first was effective for LAH. Owing to Dorsal approach could expose the major hepatic vein effectively, we merged dorsal approach and Glissonian approach in LAH for right lobe.Methods: Twenty patients who underwent LAH from January 2017 to November 2018 were retrospectively analyzed. These comprised seven patients who underwent laparoscopic right hemihepatectomy (group LRH), seven patients who underwent laparoscopic right posterior hepatectomy (group LRPH), and six patients who underwent laparoscopic hepatectomy for segment 7 (group LS7). Firstly, the corresponding hepatic pedicles were isolated through Glissonian approach. Next, the liver parenchyma was transected by dorsal approach until the corresponding major hepatic vein was exposed. Then liver parenchyma was transected by a ventral approach. Finally, the root of the major hepatic vein was transected.Results: The mean age of the patients was 53.8 years and the male: female ratio was 8:12. The median operation time was 306.0 ± 58.2 min and the mean estimated volume of blood loss was 412.5 ± 255.4 mL. The mean duration of postoperative hospital stay was 10.2 days. The mean Pringle maneuver time was 64.8 ± 27.7 min. Five patients received transfusion of 2–4 U of red blood cells. Two patients suffered from transient hepatic dysfunction and one from pleural effusion. No patient underwent conversion to an open procedure. The operative duration, volume of the blood loss, Pringle maneuver time, and postoperative hospital stay duration did not differ significantly among groups LRH, LRPH, and LS7 (P > 0.05).Conclusion: Dorsal approach combined with Glissonian approach for right lobe in LAH is feasible and effective, though, it is essential to include more cases for further study.