bluuebunny/crossref_metadata_2025 huggingface dataset:
Premature aging of circulating T cells predicts all-cause mortality in hemodialysis patients
Authors: Xiang Fangfang , Chen Rongyi , Cao Xuesen , Shen Bo , Chen Xiaohong , Ding Xiaoqiang , Zou Jianzhou
Published: January 2020

Background Patients with end-stage renal disease (ESRD) exhibit a premature aging phenotype of the immune system, which is recently concerned as a significant factor for increased risk of various morbidities. Nevertheless, there are few dates explicating the relevancy of T cell senescence to mortality. In this study, we prospectively studied the predictive value of T cell senescence for mortality in hemodialysis patients. Methods Patients who had been on hemodialysis treatment for at least 6 months were enrolled. T cell senescence determined by differentiation status was evaluated by flow cytometry. Survival outcomes were estimated using the Kaplan-Meier method. Univariate and multivariate analyses were performed to evaluate the prognostic impact of T cell premature aging and other clinical factors on all-cause mortality. Results A total of 466 patients (277 man and 169 women) were enrolled in this study. Decreased number of naïve T cell, as the most prominent feature of T cell senescence, did not change in parallel with age in these patients. Decreased absolute count of T cell, naïve T cell, CD4 + naïve T cell were independently associated with all-cause mortality. Decreased percentage of T cell and increased percentage of CD8 + central-memory T cell were also independently associated with all-cause mortality. After including all the T cell parameters in one regression model, only decreased count of naïve T cell was significantly associated with increased mortality in these patients. Conclusions Aging-associated T cell changes are aggravated in ESRD patients. For the first time, our study demonstrates that naïve T cell depletion is a strong predictor of all-cause mortality in HD patients.
Potential molecular mechanism of the NPPB gene in post-ischemic heart failure with and without T2DM
Authors: Guan Yao-Zong , Yin Rui-Xing , Deng Guo-Xiong , Zheng Peng-Fei , Liu Chun-Xiao , Wei Bi-Liu
Published: January 2020

Background This study aimed to investigate natriuretic peptide B ( NPPB ) co-expression genes and the pathways involved in post-ischemic heart failure (HF) among patients both with and without type 2 diabetes mellitus (T2DM). Methods The microarray dataset of GSE26887 was examined to detect the genes that co-expressed with NPPB from 19 post-ischemic HF patients’ peripheral blood samples (7 with T2DM and 12 without T2DM). NPPB co-expression genes were then screened using the R packet. Further, using online analytical tools, we determined the Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis, Gene Ontology (GO) annotation, and protein-protein interaction (PPI) network of the co-expression genes. The modules and hub genes of the PPI network were then identified using the Cytoscape software. Results In patients with T2DM, a total of 41 biological processes (BP), 20 cellular components (CC), 13 molecular functions (MF), and 41 pathways were identified. Further, a total of 61 BPs, 16 CCs, 13 MFs, and 22 pathways in patients without T2DM were identified. In both groups of patients, 17 BPs, 10 CCs, 6 MFs, and 13 pathways were enriched. We also identified 173 intersectional co-expression genes (63 positive, 106 negative, and 4 differently co-expressed in patients with and without T2DM, respectively) in both types of patients, which enriched in 16 BPs, 8 CCs, 3 MFs, and 8 KEGG pathways. Moreover, the PPI network (contained 237 edges and 170 nodes) with the top module significantly enriched in 4 BPs (the tricarboxylic acid metabolic process, citrate metabolic process, tricarboxylic acid cycle, and aerobic respiration) and 3 pathways (the citrate cycle, malaria parasite metabolic pathway, and AGE-RAGE signaling pathway in diabetic complications) was constructed. Conclusions This study used genome-wide co-expression genes to identify the potential functions and mechanisms of the NPPB gene in post-ischemic HF with and without T2DM. Our findings may elucidate the functions and roles of NPPB in patients with post-ischemic HF and facilitate HF management.
Low-arginine and low-protein diets induce hepatic lipid accumulation through different mechanisms in growing rats
Authors: Otani Lila , Nishi Hiroki , Koyama Ayaka , Akasaka Yuta , Taguchi Yusuke , Toyoshima Yuka , Yamanaka Daisuke , Hakuno Fumihiko , Jia Huijuan , Takahashi Shin-Ichiro , Kato Hisanori
Published: January 2020

Background Dietary protein deficiency and amino acid uimbalance cause hepatic fat accumulation. We previously demonstrated that only arginine deficiency as well as total amino acid deficiency in a diet caused significant hepatic triglyceride (TG) accumulation in young Wistar rats. In this study, we explored the mechanisms of this fatty liver formation using these two models. Methods A low-total-amino acid diet (equivalent to 5% protein) and a low-arginine diet (solely the arginine content alone is as low as the low-total-amino acid diet) to the rats for 2 weeks. Results There was substantially greater hepatic TG accumulation in the low-arginine group than in the low-total-amino acid group. The low-total-amino-acid diet potentiated insulin signals in the liver and enhanced de novo lipogenesis. By contrast, the low-arginine diet inhibited hepatic very-low-density lipoprotein secretion, without affecting hepatic insulin signaling and lipogenesis. Conclusions We conclude that, although the arginine intake of the low-arginine group was as low as that of the low-total-amino-acid group, these two diets developed a fatty liver via completely different mechanisms. The potentiation of insulin signaling and resultant increases in fatty acid synthesis seem to drive the effects of a low-protein diet, whereas lower VLDL secretion may be the main causes of low-arginine diet-induced TG accumulation in the liver.
Effect of Education on Preventive Home Accident Practices by Mothers with Toddlers: Using the Theory of Planned Behavior
Authors: Amini Roya , Kalvandi Narges , Khodaveisi Masoud , Tapak Leili
Published: January 2020

Background Home accidents are one of the causes of death and disability in toddlers. This study aimed to determine the effect of education on preventive home accident practices by mothers with toddlers with regard to the Theory of Planned Behavior (TPB). Methods This research was a quasi-experimental study conducted on 116 mothers referred to comprehensive health centers (58 mothers per experimental and control groups), who were selected using cluster sampling method. Data were collected by a researcher-made TPB questionnaire, and then educational intervention was performed based on the TPB in four 45-60 minute sessions for the experimental group. After two months, the data were recollected from the two groups and analyzed by SPSS software version 16. Results Comparing the scores of knowledge, TPB constructs (i.e., attitude, perceived behavioral control, behavioral intention, and subjective norms), and preventive home accident practices of mothers revealed no statistically significant difference between the two groups at the beginning of the study. After having the intervention, there was a significant difference between the two groups of mothers regarding knowledge, TPB constructs (except for subjective norms), and preventive home accident practices for toddlers (p <0.001). Conclusion Preventive home accident practices adopted by mothers with toddlers enhanced after applying the TPB ; hence, this theory-based education can be used as a proper theoretical framework for toddlers’ home accident prevention.
Feeding Practices in 6-23-Month-Old Children With Chronic Cholestatic Liver Diseases: A Mixed Method Study
Authors: Zhang Yuxia , Chen Xiao , Wang Jianshe , Lu Yi , Xie Xinbao , Gu Ying , Latour Jos M.
Published: January 2020

Background Children with chronic cholestatic liver diseases have a high risk of malnutrition. However, nutritional management does not receive attention with limited evidence to improve these practices. This study aimed to evaluate feeding status of children with chronic cholestatic liver disease, aged 6-24 months, and to explore the experiences of parents’ feeding behaviors. Methods A mixed-method study was conducted among parents of 74 children with chronic cholestatic liver diseases. The Infant and young Child Feeding Index (ICFI) was used to collect quantitative data of feeding behaviors. In-depth interviews with parents were performed to generate qualitative information. Multivariate analysis was conducted to identify predictors of feeding practice. Qualitative data were analyzed using thematic analysis. Results Only 16.2% children had qualified feeding practice. In terms of dairy products, the rate of breast-feeding, medium-chain-triglyceride formula-feeding, and regular formula-feeding was 25.7%, 39.2% and 44.6% respectively. The complementary feeding rate was 68.8%, and the time of adding complementary food was 6.9±1.7 months. Consumption of food from animal sources is sub-optimal, 66.7% of children aged 6-8 months and 45.5% of children aged 9-11 months had carbohydrate as single source of complementary food and had no intake of flesh foods, eggs or bean products, while in the age group 12-24 months, 52% of children had eggs less than 2 days/week, 60% had flesh foods less than 2 days/week, and 60% had no intake of bean products. Literacy of primary care provider was significantly related with inappropriate feeding practice (Adjusted OR 5.52; 95% CI 1.29, 23.66). The result of the interviews indicated that parents generally had limited feeding knowledge and thought that the intake of animal source products such as flesh foods, eggs and oil would be a burden to the liver, and cause damage to the liver function. Conclusion Parents had limited feeding knowledge and the feeding practices in 6-24-month-old children diagnosed with chronic cholestatic liver diseases did not follow current nutritional guidelines. Appropriate intervention targeting social and cultural family circumstances should therefore be included in the disease management in order to improve children’s clinical outcomes.
Animal and Vegetarian Protein Sources in Relationship with the Risk of Biliary Stone; A Case-Control Study from Iranian Adults
Authors: Saadati Saeedeh , Hekmatdoost Azita , Asadzadeh-aghdaei Hamid , Sadeghi Amir , Sobhani Seyyed Reza , Shahrbaf Mohammad Amin , Esmailinejad Komeil , Bahrami Alireza , Rahimi-Sakak Fatemeh , Zali Mohammad Reza
Published: January 2020

Objectives Previous studies suggested that protein has a protective effect on the formation of biliary stones. The aim of the current study is the comparison between the effect of animal protein and plant protein on the formation of biliary stone. One hundred and ten cases who had the history of biliary stone disease and 230 controls who were normal in terms of biliary diseases enrolled in this study. Food frequency questionnaire was used for the nutritional assessment; moreover, demographic and anthropometric data, in addition to habitual history and comorbidities were collected by a questionnaire. Results Plant protein consumption was significantly lower in cases compared to controls (p=0.03). Furthermore, the relationship between biliary stone disease and animal protein intake was significant in crude model for men (OR: 1.03, 95% CI=1.01-1.05) and both sex together (OR: 1.01, 95% CI=1.00-1.01). In addition, the risk of biliary stone was significantly lower in patients with higher consumption of plant protein (for women: OR: 0.94, 95% CI=0.89-0.99, for both sex: OR: 0.96, 95% CI=0.93-0.99). Plant proteins have a significant negative effect on the formation of biliary stone disease compared to animal proteins.
Ionizing radiation: the silent enemy
Authors: Pires Robinson Esteves , Reis Igor Guedes Nogueira , de Faria Ângelo Ribeiro Vaz , Giordano Vincenzo , Labronici Pedro José , Belangero William Dias
Published: January 2020

Background This study aims to assessment the Brazilian orthopedic surgeon’s knowledge about ionizing radiation and its implications over the health of the surgical team and the patients. Methods A Cross-sectional study was performed using a questionnaire of fifteen questions about theoretical and practical concepts regarding ionizing radiation, during the 23 rd Brazilian Orthopaedic Trauma Association Annual meeting. The participant needed to be an orthopedic surgeon or an orthopedic surgery resident in a Brazilian institution, in order to be included in the study. The questionnaire addressed the specialty within orthopedic surgery, issues such as radiation protection use and safety concepts, participants’ children gender and exposition to radiation. Results 258 questionnaires were fully answered. Only 5.8% of the participants use the three basic radiation protection equipment (apron, thyroid shield, and radiation protection glasses); 47.3% use the dosimeter; 2.7% hit the acceptable annual maximum radiation dose; 10.5% knew the gestation period of greater risk to the fetus and 5.8%, the acceptable maximum radiation dose during pregnancy; 58.5% got right that the hands, the eyes and the thyroid are the most exposed and at greater risk of radiation related lesions; 25.2% knew that the distance of 3 meters or more from the radiation-emitting tube is safe; 44.2% knew the safest positioning of the radiation-emitting tube; 25.2% got right that smaller tubes emit greater entrance dose to magnify the image and, therefore, emit more radiation; and 55.4% knew that the surgery team receives more scattered radiation in surgical procedures performed in obese patients. Conclusion It is needed an immediate educational overall plan to orthopedic surgeons and orthopedic surgery residents, so that surgical staff and patients may be less exposed and, therefore, less vulnerable to harmful effects of ionizing radiation.
Dietary inflammatory index, risk of incident hypertension, and effect modification from BMI
Authors: MacDonald Conor-James , Laouali Nasser , Madika Anne-Laure , Mancini Francesca Romana , Boutron-Ruault Marie-Christine
Published: January 2020

Introduction Previous studies have identified a positive association between the inflammatory potential of the diet and hypertension. It is not known if BMI is an effect modifier for this association, nor if the association is dose-respondent. This study aimed to assess the association between the dietary inflammatory index (DII) and the risk of hypertension, and assess any effect modification from BMI. Methods Data from the E3N cohort study, a French prospective population-based study initiated in 1990 was used. From the women in the study, we included those who completed a detailed diet history questionnaire, and who did not have prevalent hypertension or cardiovascular disease at baseline, resulting in 46,652 women. The adapted DII was assessed with data from the dietary questionnaire. Hypertension cases were self-reported and verified through a drug-reimbursement database. Cox proportional hazard models were used to calculate hazard ratios. Spline regression was used to determine any dose-respondent relationship. Results During 884,267 person-years, 13,183 cases of incident hypertension were identified. The median DII in the population was slightly pro-inflammatory (DII = + 0.44). A highly pro-inflammatory diet (DII > 3.0) was associated with a slight increase in hypertension risk (HR Q1-Q5 = 1.07 [1.02: 1.13]). Evidence was observed for effect modification from BMI, with associations strongest amongst women in the 18.5 - 21.0 BMI range (HR Q1-Q5 = 1.17 [1.06: 1.29]). A weak dose-respondent relationship was observed. Conclusion Evidence for a weak association between DII and hypertension was observed. Associations were stronger amongst leaner women.
Real-world comparative effectiveness of second-line ipilimumab for metastatic melanoma: a population-based cohort study in Ontario, Canada
Authors: Dai Wei Fang , Beca Jaclyn , Croxford Ruth , Isaranawatchai Wanrudee , Menjak Ines B. , Petrella Teresa M. , Mittmann Nicole , Earle Craig C. , Gavura Scott , Hanna Timothy P. , Chan Kelvin K.W.
Published: January 2020

Background For novel cancer treatments, effectiveness in clinical practice is not always aligned with clinical efficacy results. As such it is important to understand a treatment’s real-world effectiveness. We examined real-world population-based comparative effectiveness of second-line ipilimumab versus non-ipilimumab treatments (chemotherapy or targeted treatments). Methods We used a cohort of melanoma patients receiving systemic treatment for advanced disease since April 2005 from Ontario, Canada. Patients were identified from provincial drug databases and the Ontario Cancer Registry who received second-line ipilimumab from 2012 to 2015 (treated) or second-line non-ipilimumab treatment prior to 2012 (historical controls). Historical controls were chosen, to permit the most direct comparison to pivotal trial findings. The cohort was linked to administrative databases to identify baseline characteristics and outcomes. Kaplan-Meier curves and multivariable Cox regression models were used to assess overall survival (OS). Observed potential confounders were adjusted for using inverse probability of treatment weighting. Results We identified 329 patients with MM who had received second-line treatments (189 treated; 140 controls). Patients receiving second-line ipilimumab were older (61.7 years vs 55.2 years) compared to historical controls. Median OS were 6.9 (95% CI: 5.4-8.3) and 4.95 (4.3-6.0) months for ipilimumab and controls, respectively. The crude 1-year, 2-year, and 3-year OS probabilities were 34.3% (27%-41%), 20.6% (15%-27%), and 15.2% (9.6%-21%) for ipilimumab and 17.1% (11%-23%), 7.1% (2.9%-11%), and 4.7% (1.2%-8.2%) for controls. Ipilimumab was associated with improved OS (IPTW HR=0.62; 95% CI: 0.49-0.78; p <0.0001). Conclusions This real-world analysis suggests second-line ipilimumab is associated with an improvement in OS for MM patients in routine practice.
Interpretable machine learning analysis of functional metagenomic profiles improves colorectal cancer prediction and reveals basic molecular mechanisms.
Authors: Casimiro-Soriguer Carlos S. , Loucera Carlos , Peña-Chilet María , Dopazo Joaquin
Published: January 2020

Background Gut microbiome is gaining interest because its links with several diseases, including colorectal cancer (CRC). Results Here we performed a meta-analysis of 851 fecal metagenomic samples from five publicly available studies. We used an interpretable machine learning approach based on functional profiles, instead of the conventional taxonomic profiles, to produce a highly accurate predictor of CRC with better precision than those of previous proposals. Moreover, this approach is also able to discriminate samples with adenoma, which makes this approach very promising for CRC prevention by detecting early stages in which intervention is easier and more effective. In addition, interpretable machine learning methods allows extracting features relevant for the classification, which reveals basic molecular mechanisms accounting for the changes underwent by the microbiome functional landscape in the transition from healthy gut to adenoma and CRC conditions. Conclusion Functional profiles provide superior accuracy in predicting CCR and adenoma conditions than taxonomic profiles and additionally, in a context of explainable machine learning, provide useful hints on the molecular mechanisms operating in the microbiota behind these conditions.
The new cultural norm: reasons why UK foundation doctors are choosing not to go straight into speciality training
Authors: Hollis Alexander Conor , Streeter Jack , Hamel Clare Van , Milburn Louise , Alberti Hugh
Published: January 2020

Background The number of UK foundation doctors choosing to go straight into speciality training has fallen drastically over the last 10 years: We sought to explore and understand the reasons for this change. Methods We undertook semi-structured interviews with 16 foundation year two doctors, who had not applied to speciality training, from two regional foundation schools. Transcripts were thematically analysed. Results The reasons that foundation doctors are choosing not to go straight into speciality training centre around the themes of feeling undervalued, career uncertainty and a new cultural norm. They report major feelings of uncertainty regarding career choice at such an early stage of their profession and this challenge was magnified by a perceived lack of flexibility of training and the growing normality of taking time out from training. Trainees feel a lack of support in planning and undertaking an “FY3” year and being helped back into the workforce. Trainees overwhelmingly reported that they feel undervalued by their employers. Importantly, however, not going into training directly was not always a reflection of dissatisfaction with training. Many trainees spoke very positively about their planned activities and often saw a break in training as an excellent way to recharge, develop skills and prepare for the rest of their careers in medicine. Conclusions Taking a year or more out of training after foundation years has become the new cultural norm for UK junior doctors and reasons for this include feeling undervalued, career uncertainty and the perception that this is now “normal”. Exploring these factors with participants has generated a number of recommendations related to improving the workplace environment, allowing more flexibility in training and supporting those who chose to take an FY3.
Evaluation of the performance and achievements of the WHO Evidence-informed Policy Network (EVIPNet) Europe
Authors: Lester Louise , Haby Michelle M , Chapman Evelina , Kuchenmüller Tanja
Published: January 2020

Background The Evidence-informed Policy Network (EVIPNet) is one of the key mechanisms introduced by the World Health Organization (WHO) to reduce the research-to-policy gap. EVIPNet Europe was launched in 2012. We evaluated the performance and achievements of EVIPNet Europe. The aims were: (1) to develop an understanding of the inputs, outputs and outcomes of EVIPNet Europe at both WHO Secretariat and country level; and (2) to contribute to the evidence base for organizational knowledge translation activities by sharing the lessons learnt. MethodsThe evaluation covered the WHO Secretariat of EVIPNet Europe and its 21 member countries, from its inception to the end of 2018. A mixed methods design was used to answer the evaluation questions, including triangulation of quantitative and qualitative methods – based on the EVIPNet Europe Monitoring & Evaluation framework. Data were collected between August and October 2018. Data collection comprised documentary review, social media analysis, online country evaluation, key informant interviews and validated tools. Two case studies were also developed.Results The evaluation showed promising results, as well as lessons to guide the future development of EVIPNet in Europe and other regions of the world. EVIPNet Europe appears to be filling a niche in promoting the capacity of Network member countries for evidence-informed policy-making. There is evidence that EVIPNet Europe’s capacity-building programme of work is improving knowledge and skills at the individual level. There has been an increase in activity and outputs since its establishment, and evidence has been used to inform new policies in some member countries. However, the speed at which member countries are developing or publishing products varies greatly and no formalized knowledge translation platforms have yet been created. Financial and human resources are limited and staff turnover is a cause for concern both at the WHO Secretariat and country team levels. ConclusionsSix years since the launch of EVIPNet Europe, the Network has grown quickly, is clearly valued and has had some successes. However, more work and support are needed if it is to achieve its vision of a Europe in which high-quality, context-sensitive evidence routinely informs health decision-making processes that ultimately serve to strengthen health outcomes across the Region.
Efficacy and Acceptability of Parent-only Group Cognitive Behavioral Intervention for Treatment of Anxiety disorder in Children and Adolescents : A Meta-analysis of Randomized Controlled Trials
Authors: Yin Bangmin , Teng Teng , Tong Lyu , Li Xuemei , Fan Li , Zhou Xinyu , Xie Peng
Published: January 2020

Background: Anxiety disorder is the most prevalent mental disorder among children and adolescents, causing significant psychosocial problems and physical health conditions. Cognitive behavioral therapy (CBT) is an effective treatment for anxiety disorder in children and adolescents. As a new type of CBT, parent-only CBT has some advantages. However, it remains unclear whether parent-only CBT interventions are effective for treating children and adolescents with anxiety disorder.Methods: In this study, we evaluated the efficacy and acceptability of parent-only cognitive behavioral therapy (CBT) for children and adolescents with anxiety disorder. We searched electronic databases, including PubMed, Cochrane Library, Embase, Web of Science, ProQuest, and PsycINFO from inception to June 2019. We included randomized controlled trials (RCTs) comparing parent-only CBT either with waitlist (WL), or CBT with parents in children and adolescents with anxiety disorder.Results: Finally, six RCTs with 407 participants were included in the meta-analyses. In terms of efficacy, pooled analyses indicated that parent-only CBT was significantly more effective than WL for reducing anxiety symptoms with SMD of −0.72 (95% CI −1.41 to −0.03, p = 0.04), and more remission rate with RR of 4.33 (37.96% vs. 6.85%, 95% CI 1.82 to 10.27, p = 0.0009) at post-treatment. And our analyses showed no evidence that parent-only CBT had significantly greater efficacy than CBT with parents with SMD of 0.21 (95% CI −0.09 to 0.50, p = 0.17). Acceptability in the parent-only CBT group was not significantly different to the WL group with RR of 0.92 (95% CI 0.52 to 1.62, p = 0.77), and was significantly worse than in the CBT with parents group with RR of 1.93 (95% CI 1.05 to 3.57, p = 0.03).Conclusions: Current evidence indicates that parent-only CBT can be an effective and acceptable intervention for treating children and adolescents with anxiety disorder.
Cross-validation of the Arabic MINI, Module U, for Diagnosis of Premenstrual Dysphoric Disorder and the Arabic Premenstrual Symptoms Screening Tool
Authors: Chamali Rifka , Emam Rana , Mahfoud Ziyad , Al-Amin Hassen
Published: January 2020

Background Premenstrual dysphoric disorder (PMDD) is a severe form of premenstrual syndrome (PMS) that affects the functioning and includes various physical, depressive, and anxiety symptoms. The Mini-International Neuropsychiatric Interview, Module U (MINI-U), assesses the diagnostic criteria for probable PMDD. The Premenstrual Symptoms Screening Tool (PSST) measures the severity of these symptoms and provides scores from which we can diagnose PMS and PMDD. The purpose of this study is to obtain the cut-offs from PSST that would fit well with the diagnosis of PMDD using the MINI-U as a gold standard. Methods We administered the Arabic MINI-U and PSST independently to Arab women (N = 194) in Doha, Qatar. The Wilcoxon-Mann-Whitney test was used to compare the PSST ordinal scores between those who answered Yes vs No on the corresponding MINI-U items. These comparisons were followed by Receiver Operating Characteristics (ROC) analyses using the MINI-U answers as the gold standard to determine the cut-off scores on the PSST, in addition to their sensitivity and specificity measures Results The rating of PSST scores for participants who answered Yes in the MINI-U varied from 1.5 (not at all to mild) to 3 (moderate). Receiver Operating Characteristics (ROC) analyses showed that all areas under the curves (AUCs) were significant with the cut-off scores on the corresponding PSST items. Conclusion This cross-validation gives reassurance that the severity measures of PSST can recognize patients with moderate/severe PMS and PMDD who would benefit from immediate treatment instead of waiting another two months. Keywords Premenstrual Symptoms Screening Tool, Premenstrual Dysphoric Disorder, Arabs, cross-validation
Mir-138 plays an important role in diabetic nephropathy through SIRT1-p38-TTP regulatory axis
Authors: Liu Fengxun , Guo Jia , Qiao Yingjin , Pan Shaokang , Duan Jiayu , Liu Dongwei , Liu Zhangsuo
Published: January 2020

Background : Diabetic nephropathy (DN) is the main cause of chronic kidney disease (CKD) and is one of the most common and serious complications of diabetes mellitus (DM). SIRT1 and TTP are two important protective factors in DN, however, the regulatory relationship between SIRT1 and TTP and the underneath mechanism are interesting but still unclear. Identifying the key factors that regulate SIRT1 or TTP may be of great value to the understanding and treatment of the DN. Methods : in this study, through systematic experimental methods, we found that the expression of miR-138 was significantly up-regulated in DN clinical patients samples, and our experimental results suggested that miR-138 could bind the 3’UTR of SIRT1 and inhibit its expression in both cultured podocytes and db/db mice kidney tissues. Results : furthermore, our in vitro and in vivo date also indicated miR-138 could target SIRT1 and affect TTP through p38 pathway. And down-regulation of miR-138 attenuated podocyte injury and showed some extend of therapeutic effects in DN mice models. Conclusion : our findings reveal that the regulatory axis of miR-138-SIRT1-p38-TTP might play a key role in DN. We believe these findings may be of some value for deepening the understanding of DN and may serve as a reference for future treatment of this disease.
The 2018-19 influenza season in Afghanistan: Epidemiology and Virology
Authors: Sahak Mohammad Nadir , Arifi Fatima , Hammond Aspen A , Laurenson-Schafer Henry J , Saeedzai Sayed Ataullah , Safi Hafizullah , Abubakar Abdinasir , Elkholy Amgad , Rasooly Mohmmad Hafiz , Ikram Abdul Nasir
Published: January 2020

Objective This paper aims to provide information on epidemiology and virology of seasonal influenza for the 2018-19 season, and build upon limited information for developing influenza vaccination policy for risk groups in Afghanistan. Methods This paper is based on a retrospective analysis of Afghanistan influenza surveillance data, both from influenza-like illness (ILI) and severe acute respiratory infection (SARI) cases during the 2018-19 season. The data for 2018-19 has also been compared to the data of the previous two seasons (2016-2017 and 2017-2018). Results During the 2018-19 season, a total number of 10,604 ILI and 5,261 SARI cases were reported to the national influenza sentinel surveillance system. From week 48 2018 to week 14 2019, a total of 713 ILI specimens were tested for influenza virus, and 10.7% were positive with majority influenza A(H1N1)pdm09 virus (57%). Similarly, a total of 1,004 SARI specimens were tested for influenza virus during this period, and 11% were positive for influenza with the majority caused by influenza A(H1N1) pdm09. Almost two-thirds (62%) of the ILI-influenza positive cases and 46% SARI-influenza positive cases aged less than five years. Also, over 50 years old patient was reported to have the second-highest proportion of SARI associated influenza (30%). Conclusion The findings indicate that the seasonal influenza virus results in considerable hospital visits, admissions, and deaths in Afghanistan. The data from this study will inform and guide policymakers in developing national influenza vaccination policies.
The role of Ulipristal Acetate in infertile women with submucous fibroids
Authors: Morgante Giuseppe , Centini Gabriele , Troìa Libera , Orvieto Raoul , Leo Vincenzo De
Published: January 2020

Background The presence of submucous fibroids strongly impacts on IVF results, therefore, this patients should be considered for surgical or medical treatment. The aim of this study was to assess the role of Ulipristal acetate (UPA), a selective progesterone receptor modulator, in restoring uterine cavity deformation due to submucous fibroids, in infertile patients attempting an IVF treatment. Methods Infertile patients with submucosal fibroid (Type 1 and Type 2 according to FIGO classification) were enrolled and received 1 to 3 treatment cycles of UPA, according to their response, as reflected by fibroid volume reduction and restoration of normal uterine cavity. Results 26 patients underwent UPA treatment revealed a mean volume reduction of their fibroids of 41%. A total of 15 (57.6%) biochemical pregnancy were obtained, resulting in 13 (50%) ongoing pregnancy and 9 (34.6%) healthy babies were already delivered. Conclusion Restoration of normal uterine cavity by UPA treatment prior to IVF treatment avoids surgery and enhances the pregnancy rate.
Early Complications of Anterior Cervical Fusion Using Zero-profile Implants: Analysis of 193 Consecutive Cases
Authors: Dantas Fernando Luiz Rolemberg , Sandes Bruno Lacerda , Dantas François , Caires Antônio Carlos Vieira , Cariri Gustavo Agra , Filho Gilberto de Almeida Fonseca , Botelho Ricardo Vieira
Published: January 2020

Background: Anterior access to the cervical spine is considered safe, with the most common complication being dysphagia. The objective of this study is to describe early complications of anterior cervical fusion using Zero-profile implants in a neurosurgery department and compare these with the literature.
Methods: In a retrospective study, we analyzed data of patients diagnosed with cervical spondylodiscoarthrosis at a single center between January 2011 and January 2017 who underwent anterior cervical fusion using Zero-profile implants. The analyzed demographic data included age, sex, symptoms, number of operated levels, time of preoperative symptoms, type of symptom and length of hospital stay. Immediate postoperative complications were noted.
Results: A total of 193 consecutively operated patients were included. Of the total, 106 patients were female (54.9%). The average age of the patients was 52.7 years. Average hospitalization was 3.20 days and the average number of levels was 1.68.
Complications were noted in 57 patients (29.5%). Older patients had more complications (mean 55.5 years versus 51.5). The average length of stay was longer for patients with complications. The average number of operated levels was 1.84 in patients with complications and 1.61 in those who did not complicate. The most common complications were dysphagia (9.32%) and dysphonia (5.69%). We had 1 case of C5 monoparesis and 1 case of epidural hematoma, considered serious complications.
Conclusions: Postoperative dysphagia and dysphonia were the most common complications in our series. Risk factors for complications were advanced age and number of operated levels.
Pregnancy risk factors and outcomes in the transition from respiratory distress syndrome (RDS) to RDS and acute respiratory distress syndrome (ARDS) in preterm infants: a retrospective cohort study
Authors: Chen Long , Xiong Jing , Guo Jingyu , Li Jie , Shi Yuan , Bao Lei
Published: January 2020

Background: Neonatal acute respiratory distress syndrome (ARDS) has been proposed in 2017. Growing evidence suggests that pregnancy risk factors (PRF) contribute to the deterioration of respiratory distress. The present study aims to clarify PRF and outcomes in the transition from respiratory distress syndrome (RDS) to RDS and ARDS in preterm infants. Methods : A retrospective study was conducted at a tertiary neonatal intensive care unit from Jan-1, 2017 to July-30, 2018. Preterm neonates diagnosed with RDS were enrolled at baseline and followed up during hospitalization. The primary outcomes were to identify the relationships between PRF and transition from RDS to RDS and ARDS and the incidences of bronchopulmonary dysplasia (BPD). Results: A total of 269 preterm infants were included. Of them, 168 were diagnosed with both RDS and ARDS, and 101 with RDS. Comparing with preterm neonates with both RDS and ARDS, that with RDS was related to the decreased incidence of BPD (22:79 vs 61:107, 95%CI:0.27-0.85, P =0.010), especially in the subgroup of severe BPD (3:98 vs 17:151, 95%CI:0.08-0.95, P =0.032) and two or more of surfactant (14:87 vs 43:125, 95%CI:0.24-0.91, P =0.023). PRF including intrahepatic cholestasis during pregnancy (ICP), pernicious placenta previa (PPP), hypertensive disorder complicating pregnancy (HDCP) and gestational diabetes mellitus (GDM) were not shown differences between the two groups. Conclusion : Preterm infants with both RDS and ARDS were easier to convert to BPD as compared with that with RDS. Trial registration: Chinese Clinical Trial Registry, ChiCTR1900026980 Keywords: ARDS · RDS · risk factors · outcomes · neonate
Low-Value Clinical Practices In Adult Traumatic Brain Injury: An Umbrella Review
Authors: Moore Lynne , Tardif Pier-Alexandre , Lauzier François , Bérubé Mélanie , Archambault Patrick , Lamontagne François , Chassé Michael , Stelfox Henry T , Gabbe Belinda , Lecky Fiona , Kortbeek John , Lessard-Bonaventure Paule , Truchon Catherine , Turgeon Alexis
Published: January 2020

Background Despite numerous interventions and treatment options, the outcomes of traumatic brain injury (TBI) have improved little over the last three decades, which raises concern about the value of care in this patient population. We aimed to synthesize the evidence on 14 potentially low-value clinical practices in TBI care. Methods Using umbrella review methodology, we identified systematic reviews evaluating the effectiveness of 14 potentially low-value practices in adults with acute TBI. We present data on methodological quality (AMSTAR-2), reported effect sizes and credibility of evidence (I to IV). Results The only clinical practice with evidence of benefit was therapeutic hypothermia (credibility of evidence II to IV). However, the most recent meta-analysis on hypothermia based on high-quality trials suggested harm (credibility of evidence IV). Meta-analyses on platelet transfusion for patients on antiplatelet therapy were all consistent with harm but were statistically non-significant. For the following practices, effect estimates were consistently close to the null: CT in adults with mild TBI who are low-risk on a validated clinical decision rule; repeat CT in adults with mild TBI on anticoagulant therapy with no clinical deterioration; antibiotic prophylaxis for external ventricular drain placement; and decompressive craniectomy for refractory intracranial hypertension. Conclusions We identified five clinical practices with evidence of lack of benefit or harm. However, evidence could not be considered to be strong for any clinical practice as effect measures were imprecise and heterogeneous, systematic reviews were often of low quality and most included studies had a high risk of bias. Protocol registration PROSPERO: CRD42019132428
Associations among Cognitive Functions, Plasma DNA, and Diffusion tensor image along the perivascular space (DTI-ALPS) in Patients with Parkinson's Disease
Authors: Chen Hsiu-Ling , Chen Pei-Chin , Lu Cheng-Hsien , Tsai Nai-Wen , Yu Chiun-Chieh , Chou Kun-Hsien , Yun-Ru Lai , Taoka Toshiaki , Lin Wei-Che
Published: January 2020

Background Parkinson’s disease (PD) is a common neurodegenerative disease associated with accumulation of misfolding proteins and increased neuroinflammation. The purpose of this study was to utilize diffusion tensor image analysis along the perivascular space (DTI-ALPS) to evaluate glymphatic system activity, and its relationship with systemic oxidative stress status in PD patients. Methods Magnetic resonance imaging and neuropsychological tests were conducted on 25 PD patients with normal cognition (PDN), 25 PD patients with mild cognitive impairment (PD-MCI), 38 PD patients with dementia (PDD), and 47 normal controls (NC). Oxidative stress status was assessed by plasma DNA level. Differences in ALPS-index among the subgroups were assessed and further correlated with cognitive functions and plasma DNA levels. Results The PD-MCI and PDD groups showed significantly lower ALPS-index compared to normal controls. The lower ALPS-index was correlated with higher plasma nuclear DNA, mitochondrial DNA levels, and lower cognitive scores. Conclusions Lower diffusivity along the perivascular space, represented by lower ALPS-index, indicates impairment of the glymphatic system in PD patients. The correlation between elevated plasma nuclear DNA levels and lower ALPS-index support the notion that PD patients may exhibit increased oxidative stress associated with glymphatic system microstructural alterations.
A Comparison of Cylindrical and Tapered Stem Designs in Femoral Revision Hip Arthroplasty
Authors: Zhang Yu , Zhang Ye , Sun Jian-Ning , Hua Zi-Jian , Chen Xiang-Yang , Feng Shuo
Published: January 2020

Background Both cylindrical and tapered stems are commonly used in revision total hip arthroplasty, it is unclear whether the geometry of prosthesis stem has an effect on the patient's efficacy and prognosis. we assume the tapered stem is superior to the cylindrical stem for better clinical outcome. Methods A multicenter review of 120 femoral revisions with Paprosky I, II and III defects using cylindrical stem (54 hips) or tapered stem (66 hips) was performed with an average follow-up of 6 years. Demographic data was comparable between groups. Results There were no significant group differences were found in surgery time, bleeding volume and the postoperative Harris score, the level of overall satisfaction, 8-year cumulative survival. However, intraoperative fractures in the tapered group (4.5%) occurred significantly less than in the cylindrical group (14.8%), and stem subsidence was significantly less in the tapered group (2.17mm) than in the cylindrical group (4.17 mm). There was a higher ratio of bone repair and lower bone loss in the tapered group compared to the cylindrical group. The postoperative thigh pain rate was higher in the cylindrical group (12.9%) than in the tapered group (4.5%). Conclusion Both cylindrical stem and tapered stem can achieve satisfactory mid-term clinical results in revision THA; The tapered stem has better bone restoration of proximal femur, low incidence of intraoperative fracture, and low postoperative thigh pain rate compared with the cylindrical stem.
Plastic lengthening amputation with vascularized bone grafts in children with bone sarcoma: A preliminary report
Authors: Zhao Zhiqiang , Jin Qinglin , Xie Xianbiao , Wang Yongqian , Lin Tiao , Yin Junqiang , Huang Gang , Zou Changye , Shen Jingnan
Published: January 2020

Background At present, amputation was widely adopted for young patients when limb salvage is deemed risky with several surgical strategy such as rotationplasty. However, leg length discrepancies and unfavorable cosmetic results is an indispensable complication of this strategy. The purpose of this study is to demonstrate a novel reconstruction strategy and evaluate the early clinical and functional outcomes of the strategy. Methods Plastic lengthening amputation has been developed by lengthening the stump to preserve one additional distal joint for fixing the artificial limb well. The surgical technique and postoperative management were documented, and the functional outcomes were compared with those of traditional amputation. Six pairs of patients matched for age, sex, location, pathologic type and final prosthesis underwent individually designed plastic lengthening amputation with vascularized autografts or traditional amputation between January 2005 and December 2007. All patients were followed, and the locomotor index and MSTS were used to describe and quantitatively grade limb functional outcomes after amputation. The complications and functional outcomes of the two procedures were compared. Results Twelve patients with osteosarcoma or Ewing sarcoma in either the femur or tibia were included in the study. Six patients underwent plastic lengthening amputations, three of whom also underwent vascular anastomosis. All patients were followed for an average of 48.17 months; bone healing required an average of 3.3 months. No local recurrence was found. The average postoperative locomotor index functional score of the affected limb was 32.67 ± 5.89 in the plastic lengthening amputation group but was 19.50 ± 7.87 in the traditional amputation group. Conclusions Plastic lengthening amputations with vascularized autografts could preserve one additional distal joint and improve the function of the amputated limb in selected bone sarcoma patients. MSTS analysis also indicated that the patients would have better functional outcomes with plastic lengthening amputation than with traditional amputation.
Economic impact of therapies on perioperative hemodynamic optimization in surgical patients from the perspective of developing country: Economic study and Meta-analysis
Authors: Silva João M , Menezes Pedro Ferro L , Carvalho Flavia Helena S , Oliveira Mariana Augusta N , Filho Francisco Nilson F Cardoso , Fernando Bruna N , Carmona Maria Jose C , Teich Vanessa D , Lobo Suzana M , Malbouisson Luiz Marcelo S
Published: January 2020

Background: Health resources are limited and need to be rationally distributed. Studies suggest that hemodynamic optimization therapy can reduce length of hospital stay, complications and costs. However, Brazilian data are scarce. Therefore, the objective of this analysis was to evaluate whether the improvement demonstrated by hemodynamic optimization therapy in surgical patients could result in lower costs from the perspective of the Brazilian public unified health s ystem (SUS). Method: A meta-analysis was performed comparing surgical patients who underwent hemodynamic optimization therapy (intervention) with patients submitted to standard therapy (control) in terms of complications and hospital costs. The cost-effectiveness analysis evaluated the clinical and financial benefits of hemodynamic optimization protocols for surgical patients. The analysis considered the clinical outcomes of randomized studies published in the last 20 years that involved surgeries and hemodynamic optimization therapy. Indirect costs were not included in the analysis. Results: A total of 21 clinical trials with a total of 4872 surgical patients were selected. Comparison of the intervention and control groups showed lower rates of infectious (RR=0.66; 95% CI=0.58-0.74), renal (RR=0.68; 95% CI=0.54-0.87), and cardiovascular complications (RR=0.87; 95% CI=0.76-0.99) and a tendency toward lower rates of respiratory complications (RR=0.82; 95% CI=0.67-1.02). There was no difference in mortality (RR=1.02; 95% CI=0.80-1.3) between groups. In the analysis of total costs, the intervention group showed a cost reduction of R$396,024.83 for every 1000 patients treated compared to the control group. The patients in the intervention group showed greater effectiveness, with 1.0 fewer day in the ICU and hospital. In addition, there were 333 fewer patients with complications, with a consequent reduction of R$1,630,341.47 for every 1000 patients treated. Conclusions: Hemodynamic optimization therapy is cost-effective and would increase efficiency and decrease the burden of the Brazilian public health system.