bluuebunny/crossref_metadata_2025 huggingface dataset:
Impacts of a Comprehensive TB Control Model on the Quality of Clinical Services and the Financial Burden of Treatment for Patients with Drug-resistant Tuberculosis in China: A Mixed-methods Evaluation
Authors: Jiang Weixi , Li Zhipeng , Zhao Qi , Gao Mengqiu , Long Qian , Wang Weibing , Huang Fei , Wang Ni , Tang Shenglan
Published: December 2020

IntroductionDrug-resistant tuberculosis (DRTB) has become a critical challenge to ending TB efforts worldwide. To help address the burden in China, the China National Health Commission-Gates TB Project Phase III implemented a comprehensive TB control model which includes multiple interventions to improve the quality of clinical services and reduce the financial burden for DRTB patients.MethodsA mixed-methods approach was used to evaluate the effectiveness of interventions. The quantitative data included three sources: de-identified DRTB registered data from 2015-2018 in project provinces, medical records of DRTB patients registered in 2018 (n=106), and a structured DRTB patient survey in six sample prefectures. The quality of clinical services was evaluated using seven indicators across patient screening, diagnosis and treatment. Logistic regression was conducted to explore factors associated with the extremely high financial burden (defined as out-of-pocket medical expenditure in the first six months of treatment over 30% of annual household income). Key informant interviews with policymakers and focus group discussions with physicians and DRTB patients were conducted to understand the interventions implemented and their impacts.ResultsThe percentage of bacterially confirmed patients taking a drug susceptibility test (DST) increased significantly between 2015 and 2018: from 57.4% to 93.6% in Zhejiang, 12.5% to 86.5% in Jilin, and 29.7% to 91.4% in Ningxia. The treatment enrollment rate among diagnosed DRTB patients also increased significantly and varied from 73% to 82% in the three provinces in 2018. Over 90% of patients in Zhejiang and Jilin and 75% in Ningxia remained in treatment by the end of the first six months’ treatment. Among all survey respondents 77.5% incurred extremely high financial burden of treatment. Qualitative results showed that interventions on promoting rapid DST technologies and patient referral were successfully implemented, but the new financing policies for reducing patients’ financial burden were not implemented as planned.ConclusionsThe quality of DRTB related clinical services has been significantly improved following the comprehensive interventions, while the financial burden of DRTB patients remains high due to the delay in implementing financing policies. Stronger political commitment and leadership are required for multi-channel financing to provide additional financial support to DRTB patients.
Are Lactational Breast Abscesses caused by Methicillin-resistant Staphylococcus aureus Special?
Authors: Li Yan , Ma Xiangjun , He Xiangping
Published: December 2020

Background: This study aimed to identify the differences in clinical characteristics, puncture efficacy, antibiotic use, treatment duration, breastfeeding postillness, and recurrence of patients with breast abscesses caused by methicillin-resistant Staphylococcus aureus (MRSA) or methicillin-susceptible Staphylococcus aureus (MSSA) infection during lactation.Methods: The clinical data of patients with breast abscesses during lactation who were treated in our hospital from January 2014 to February 2017 were reviewed. According to bacterial culture results, they were divided into MRSA (n = 260) and MSSA (n = 962) groups. Hospitalization (whether or not the patients were hospitalized), postpartum time, age, location of abscess cavities, number of abscess cavities, amount of pus, frequency of needle aspiration, failure of needle aspiration, antibiotic use, treatment duration, delactation and recurrence were compared between the two groups using a t-test and a chi-squared test.Results: We noted that only delactation was statistically significantly different between the two groups (P = 0.018). Hospitalization, postpartum time, age, location of abscess cavities, number of abscess cavities, amount of pus, frequency of needle aspiration, failure of needle aspiration, antibiotic use, treatment duration and recurrence showed no statistically significant differences (P = 0.488, P = 0.328, P = 0.494, P = 0.218, P = 0.088, P = 0.102, P = 0.712, P = 0.336, P = 0.512, P = 0.386 and P = 0.359, respectively). Conclusion: Patients with breast abscesses caused by MRSA infection during lactation presented no significant differences in the clinical manifestations, needle aspiration efficacy, antibiotic use or treatment duration compare with those caused by MSSA infection. However, patients with MRSA infected were more susceptible to delectation.
FOXM1 and β-catenin are potential prognostic markers in muscle-invasive bladder carcinoma
Authors: Gui Huiming , Song Yutong , Yin Yongsheng , Rodriguez Ronald , Wang Zhiping
Published: December 2020

BackgroundForkhead box protein M1 (FOXM1) and β-catenin were confirmed to associate with numerous cancers, which attracted more attention in recent years. Our research investigated the expression of FOXM1 and β-catenin and their effects on prognosis of patients with muscle-invasive bladder cancer (MIBC). MethodsIn this study, FOXM1 and β-catenin expression was detected by immunohistochemistry in a study cohort including 121 MIBC patients. Results The results showed significant correlations of FOXM1 and β-catenin expression with tumor stage, tumor grade, and lymph node metastases in MIBC patients. Univariate analysis showed that patients with high FOXM1 (HR = 2.986; P = 0.011) and low β-catenin (HR = 2.623; P = 0.001) expression levels, advanced tumor stage (HR = 2.325; P = 0.002), advanced tumor grade (HR = 2.790; P < 0.001), tumor size (HR = 2.080; P = 0.020), lymph node metastases (HR = 3.392; P < 0.001), or recurrence status (HR = 2.016; P = 0.011) had a significantly higher risk of worse overall survival (OS). In the multivariate analysis, tumor stage (HR = 2.095; P = 0.009), tumor grade (HR = 1.962; P = 0.019), FOXM1 expression (HR = 2.196; P = 0.017) and lymph node metastases (HR = 2.136; P = 0.015) predicted worse OS. ConclusionTherefore, FOXM1 and β-catenin expression was relevant to MIBC incidence, tumor stage, tumor grade, metastasis, and survival and might be a reliable index to judge the prognosis of patients with MIBC.
Nd:YAG Laser Hyaloidotomy for Treatment of Subhyaloid Hemorrhage in Pregnancy
Authors: Abrishami Mojtaba , Shoeibi Nasser , Heidarzadeh Hamid Reza , Zamani Ghodsieh
Published: December 2020

Purpose: To report a pregnant patient with impaired vision due to macular involvement of valsalva retinopathy associated with subhyaloid hemorrhage, who was effectively treated with Nd:YAG laser hyaloidotomy and led to successful visual recovery.Case presentation: A thirty-year-old pregnant woman at 36-week gestational age was referred due to suddenly decreased visual acuity in her left eye following a severe vomiting. Left eye examination showed a dense large subhyaloid hemorrhage in front of macula extending from superior to inferior arcade with a clear media. With the diagnosis of subhyaloid hemorrhage she underwent Nd:YAG laser hyaloidotomy and visual acuity improved from hand motion to 20/20 after one week.Conclusion: In this report, Nd:YAG laser hyaloidotomy was shown to be effective and safe in treatment of dense subhyaloid hemorrhage in pregnant patients with Valsalva retinopathy.
An Assessment of Human-Livestock Predators Conflict in Central and Eastern Part of Bale Mountains National Park, Ethiopia
Authors: Tafesse Israel Sebsibe
Published: December 2020

Background: sharing of space by humans and wildlife at a time may ignite clear conflict. Populations of many species are declined due to the degradation of wildlife habitats caused by agricultural activities. Additionally, livestock may compete with wild herbivores for grazing and reduce the abundance of wild prey for carnivores. A reduction in populations of prey species of large predators might cause carnivores to be attracted towards livestock, ultimately provoke and aggravating the human-carnivores conflict. This study investigated the current status of human-predators conflict in and around the Bale Mountains National Park. Results: most (72.75%) respondents agreed on the presence of livestock predation. Major reported predators were spotted hyena (Crocuta crocuta), olive baboon (Papio anubis), African wolf (Canis lupaster), aardvark (Orycteropus afer), genet (Genetta genetta), Ethiopian wolf (Canis simensis), lion (Panthera leo), and leopard (Panthera pardus). Cattle (54.19%), sheep (70.96%), goat (32.0%), donkey (37.72%) and horse (27.54%) were mentioned as major target of predators. Within the past ten years 1623 sheep, 741 cattle, 639 goats, 193 donkeys, and 124 horses were predated. This study found an increasing trend of livestock predation. The trend was reported to be high within the Park (68%). During the past ten years, households reported killings of 3320 livestock that cost 347,460.53 USD. Loss of 8.66 USD per month constituted 27.45% of their monthly income which is expected to have a great sustenance impact. Human settlement (41%), agricultural practices (38.6%), overgrazing (25.3%), deforestation for charcoal production (25.1%), deliberate fire to free lands for agriculture (17.3%) were noticed as major causes of livestock depredation. Conclusions: the results of the present study show that there is strong human-livestock predator conflict in the study area. Therefore, the author suggested that conflict mitigation efforts focus on securing the livestock enclosure to protected areas and regular compensation fees for farmers that face great damage from wildlife. The foremost action should be awareness creation about the environmental, social, and economic importance of protected areas. Park management is also expected to promote community involvements in the future plan of mitigation strategies and practices.
The Association Between Genetic Variants in lncRNA-p53 Regulatory Network and Ischemic Stroke Prognosis
Authors: Liu Xu , wang qianwen , zhao jingjing , chang hongtao , zhu ruixia
Published: December 2020

Objective Recently, lncRNAs have been demonstrated to be associated with the p53 regulatory pathway,which serve as regulators or effectors. LncRNA-p53 regulatory network play important role in ischemia induced apoptosis and be importance for post-stroke recovery.Method Eight genetic variants in p53 related lncRNA were genotype in 940 patients to explore the association of SNPs in p53 regulatory pathway genes with ischemic stroke prognosis in a northern Chinese population. Long-term outcome and short-term outcome were respectively assessed by the stroke recurrence and modified Rankin Scale score at 3 months after stroke.Results We first identified for that p53 rs1042522 and LINC-ROR rs2027701 may be associated with the risk of IS recurrence. In our further cumulative effect analysis, we found that these two polymorphisms may jointly be associated with IS recurrence. Patients carrying 2-4 risk alleles had significantly increased risk of IS recurrence compared with those carrying 0–1 risk alleles. In contrast to rs2027701 and rs1042522, other SNP was found to be not associated with IS recurrence. Subsequently, we also found that TUG1 rs2240183 CC genotype was associated with favorable outcome of ischemic stroke after adjusting confound factors. However, the other seven genetic variants in p53 related lncRNA were not associated with functional outcome after stroke. Conclusion P53 rs1042522 and LINC-ROR rs2027701 may have combined effects on IS recurrence and TUG1 rs2240183 may be new biomarker to predict the short-term outcome of ischemic stroke through modulating p53-mediated apoptosis.
Systolic Blood Pressure is Positively Correlated With Headache Frequency: A 3-Month Follow-Up Study on 441 Migraine Patients
Authors: Wang Yen-Feng , Tzeng Yi-Shiang , Lipton Richard B. , Kuan Ai Seon , Chen Shih-Pin , Cheng Hao-min , Chen Chen-Huan , Wang Shuu-Jiun
Published: December 2020

Background Whether blood pressure (BP) per secorrelateswith headache frequencyinmigraineis uncertain. Methods Newly diagnosed migrainepatients withoutanti-hypertensive or migraine preventive treatmentwere prospectively enrolled.Standardized BPmeasurementwas doneat each visit. Patientswere dichotomized bythe overall arithmetic mean of baseline systolic BPs (SBPs).Correlationsbetween baseline SBPs and monthly headache days (MHDs),based on prospective headache diaries,weredetermined.Participants were treated as usualfor 3 months. The associationsbetweenchanges (Δ) inBP andin MHDat 3 monthswere examined. Results In total, 441 (344F/97M, mean age 39.1±10.3 years) migraine patients were analyzed, including 197 (44.7%) with above-average SBPs, i.e. ≥120.1 mmHg. There were significant correlations between SBPs and MHDs at baseline (Spearman’s rho=0.181, p=0.012) and between ΔSBPs and ΔMHDs at3months (Spearman’s rho=0.257, p<0.001) in patients with above-average SBPs. In addition, a≥50% MHD improvement increased the odds for5-mmHgSBP reductionsat 3 months(odds ratio=1.70, 95% confidence interval=1.05-2.76, p=0.032). Conclusions SBP was associated with headache frequency in migraine patients and the association was stronger in those with higher SBP. The improvement in headache frequency paralleled that in SBP, although the underlying mechanisms remain to be determined.
Sex Difference in the Interrelationship Between TNF-α and Oxidative Stress Status in First-episode Drug-naïve Schizophrenia
Authors: Zhu Minghuan , Liu Zhenjing , Rippe Jaelin , Sultana Mst. Sadia , Wu Kang , Lang Xiaoe , Lv Qinyu , Yi Zhenghui , Li Zezhi
Published: December 2020

BackgroundIncreasing evidence indicates that dysregulated TNF-α and oxidative stress (OxS) contribute to the pathophysiology of schizophrenia. Additionally, previous evidence has demonstrated sex differences in many aspects of schizophrenia including clinical characteristics, cytokines and OxS markers. However, to the best of our knowledge, there is no study investigating sex differences in the association between TNF-α, the OxS system, and their interaction with clinical symptoms in schizophrenia patients, especially in first-episode drug-naïve (FEDN) patients. MethodsA total of 119 FEDN schizophrenia patients and 135 healthy controls were recruited for this study. Serum TNF-α, superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), catalase (CAT), and malondialdehyde (MDA) were measured. The Positive and Negative Syndrome Scale (PANSS) was applied to evaluate psychotic symptoms. Two-way ANOVA, partial correlation analysis and multivariate regression analysis were performed. ResultsA sex difference in MDA levels was demonstrated only in healthy controls (F = 7.06, p Bonferroni = 0.045) and not seen in patients. Furthermore, only male patients had higher MDA levels than male controls (F = 8.19, p Bonferroni = 0.03). Additionally, sex differences were observed in the association of TNF-α and MDA levels with psychotic symptoms (all pBonferroni<0.05). The interaction of TNF-α and MDA was only associated with general psychopathology symptom in male patients (B = -0.07, p = 0.02). ConclusionOur results demonstrate the sex difference in the relationship between TNF-α, MDA, and their interaction with psychopathological symptoms of patients with schizophrenia.
Scopolamine-induced Delirium Promotes Neuroinflammation and Neuropsychiatric Disorder in Mice
Authors: Cheon So Yeong , Koo Bon-Nyeo , Kim So Yeon , Kam Eun Hee , Nam Junhyun , Kim Eun Jung
Published: December 2020

BackgroundPostoperative delirium is a common neuropsychiatric syndrome resulting in a high postsurgical mortality rate and decline in postdischarge function. Extensive research has been performed on both human and animal delirium models due to their clinical significance, focusing on systemic inflammation and consequent neuroinflammation playing a key in the pathogenesis of postoperative cognitive dysfunctions. Since animal models are widely utilized for pathophysiological study of neuropsychiatric disorders, this study aimed at examining the validity of the scopolamine-induced delirium mice model with respect to the neuroinflammatory hypothesis of delirium. MethodsMale C57BL/6 mice were treated with intraperitoneal scopolamine (2 mg/kg). Neurobehavioural tests were performed to evaluate the changes in cognitive functions, including learning and memory, and the level of anxiety after surgery or scopolamine treatment. The levels of pro-inflammatory cytokines (IL-1ꞵ, IL-18, and TNF-α) and inflammasome components (NLRP3, ASC, and caspase-1) in different brain regions were measured. Gene expression profiles were also examined using whole-genome RNA sequencing analyses to compare gene expression patterns of different mice models.Results Scopolamine treatment showed significant increase in the level of anxiety and impairments in memory and cognitive function associated with increased level of pro-inflammatory cytokines and NLRP3 inflammasome components. Genetic analysis confirmed the different expression patterns of the genes involved in immune response and inflammation and those related with the development of the nervous system in both surgery and scopolamine-induced mice models. Conclusions The scopolamine-induced delirium mice model successfully showed that analogous neuropsychiatric changes coincide with the neuroinflammatory hypothesis for pathogenesis of delirium.
Cell Heterogeneity, Rather Than Cell Solvents Affects the Behavior of Mesenchymal Stem Cells in Vitro and Vivo
Authors: Wang Yong-Hong , Tao Ya-Chao , Wu Dong-Bo , Wang Meng-Lan , Tang Hong , Chen En‑Qiang
Published: December 2020

Background: Mesenchymal stem cells (MSCs) have been approved to treat various diseases, but they have to be expanded in vitro to gain sufficient cell doses. During the process of expansion, some obstacles remain to be addressed before MSCs translation to clinic. The purpose of this study was to investigate the effects of cell solvents and cell heterogeneity on the behavior of MSCs in vitro and vivo.Methods: Human umbilical cord MSCs (UC-MSCs) were dissolved in three different solvents: phosphate buffer solution (PBS), normal saline (NS) and dulbecco's modified eagle medium (DMEM). Their ultrastructure, viability and safety were explored and compared. MSCs from other two separate donors were grouped based on their mean diameters. The ultrastructure, proliferative and hepatic differentiation potential, senescent cell ratio and safety of the two UC-MSC aggregates were investigated and compared. The reason for mice death after UC-MSCs injection was further investigated.Results: The apoptosis rates, ultrastructure analysis and survival rates of mice among UC-MSCs in DMEM, NS and PBS were similar, and no significant differences were observed. The diameters of UC-MSCs of different sizes were measured. Cells with diameter of 15.58±3.813 μm were renamed as larger UC-MSC aggregates and cells with diameter of 19.14±4.885 μm were smaller aggregates. The mean diameter of larger MSC aggregates was significantly longer than that of smaller aggregates (p<0.01). Smaller MSCs had more potent proliferation potential and higher nucleus/ cytoplasm ratio than large ones. The number of cells positive for senescence-associated β-galactosidase staining was higher in larger UC-MSC aggregates. The survival rates of mice receiving 1×106 or 2×106 smaller MSCs were 100%, both higher than that receiving larger UC-MSCs sharing same amount. Meanwhile, the reason for mice death was explored and it revealed that larger UC-MSC aggregates were accumulated and evident in the pulmonary capillary lumen in dead mice.Conclusion: Solvents showed no significant effects on cell behavior, whereas, heterogeneity is quite prevalent in MSCs populations and may limit cell application, but it is easily overlooked. Hence it is necessary to establish a more precise standardization for culture-expanded MSCs and to improve MSCs manufacturing strategies.
Network pharmacology analysis of ZiShenWan for diabetic nephropathy and experimental verification of its anti-inflammatory mechanism
Authors: Guo Xiaoyuan , Wu You , Zhang Chengfei , Wu Lili , Qin Lingling , Liu Tonghua
Published: December 2020

Background: Diabetic nephropathy (DN) is the leading cause of end-stage renal disease (ESRD). The inflammatory response plays a critical role in the process of DN. ZiShenWan (ZSW) is a classical Chinese medicinal formula with remarkable clinical therapeutic effects on DN, but its pharmacological action mechanisms remain unclear. Methods: In this study, a network pharmacology approach was applied to investigate the pharmacological mechanism of ZSW in DN therapy. The “drug-ingredient-target” network for ZSW in DN treatment was established with Cytoscape software based on candidate active components of ZSW and targets in DN treatment obtained from databases. Gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analyses were performed with the key targets. Because inflammation is important in DN, the key targets and signaling pathways associated with the anti-inflammatory, renoprotective mechanism of ZSW were partially validated in db/db mice. Results: A total of 56 active ingredients in ZSW and 166 DN-related targets were selected from databases. Various related genes and pathways participate in the inflammatory response. ZSW markedly alleviated renal injury in db/db mice by inhibiting the exaggerated release of proinflammatory cytokines such as interleukin (IL)-1β, IL-6, tumor necrosis factor -ɑ (TNF-ɑ), monocyte chemotactic protein-1 (MCP-1) and transforming growth factor-β1 (TGF-β1) and regulating the p38 mitogen-activated protein kinase (MAPK) and phosphoinositide 3-kinase-protein kinase B (PI3K-Akt) signaling pathways. Conclusions: Network pharmacology analysis demonstrated that ZSW achieved therapeutic renoprotective effects in DN by alleviating the inflammatory response via regulation of multiple targets and signaling pathways.
Prognostic Role of Matrix Metalloproteinase Expression in Meningioma: A Cross-Sectional Study.
Authors: Sharifuddin Maryam Ahmad , Sharif Sharifah Emilia Tuan , Jaafar Hasnan
Published: December 2020

Background: Meningioma is the most common intracranial tumor in adults. In addition to the extent of tumor surgical resection and WHO grade, angiogenesis is a prognostic factor that is influenced by MMP-2. Our study examined the association of these prognostic factors with MMP-2 expression in meningioma. Methods: A cross-sectional study of patients diagnosed with meningioma between January 2008 and December 2017 was conducted. All samples were re-reviewed and subjected to immunohistochemical staining for Ki67, MMP-2, and CD34. Pearson’s chi-squared test and Fisher’s exact test were used to examine the association of MMP-2 expression with the WHO grade and microvascular density (MVD). Results: The study included 99 patients aged 23–75. Most patients were female (73.7%). This study included 85 cases of low-grade meningioma (grade I) and 14 cases of high-grade meningioma (grade II, 11; grade III, 3). The most common subtypes were meningothelial, transitional, and fibroblastic. In total, 62 of 85 patients with low-grade meningioma and 10 of 14 patients with high-grade meningioma exhibited high MMP-2 expression, and the difference in the rates between the groups was not significant. Most patients in this study displayed MVD scores of 1+ (54/99) and 2+ (33/99). Of the 54 patients with an MVD score of 1+, 42 exhibited high MMP-2 expression. MMP-2 was expressed by all patients with meningioma. Conclusion: In the future, more samples are required, in high-grade tumors, to prevent bias, and more specific immunohistochemical markers should be used to evaluate angiogenesis.
miR-17-5p Combined with Epirubicin Inhibits the Progression of Breast Cancer Cells
Authors: Zhao Lingling , Zhu Zhongjian , Du Jiang , Zhao Yuanyu , Fan Dandan
Published: December 2020

Background: Breast cancer is the most common malignant tumor for women, which has been ranked first in women’ s cancer-related death. The objectives of the study are to uncover the underlying mechanisms of combination therapy of epirubicin with miR-17-5p in breast cancer. Methods: The expression levels of miR-17-5p were determined by quantitative RT-PCR. The survival rate of MCF-7 cell was detected respectively by MTT assay. The expression levels of miR-17-5p in MCF-7 cell was tested respectively with Ep via quantitative RT-PCR. miR-17-5p was to be transected with miR-17-5p mimic and negative control of miR-17-5p mimic (NC). Quantitative RT-PCR, MTT assay, flow cytometry assay, western blot for the proliferation and apoptosis related proteins were performed to determine the function of miR-17-5p in breast cancer cells. The bioinformatic programs TargetScan was used to predict the targets for miR-17-5p. Luciferase reporter gene assay system was used to validate and determine the targets of miR-17-5p. The relation between targets protein levels in breast cancer cells was investigated by western blot. Results: The expression levels of miR-17-5p was associated with the breast cancer tissues. The levels of miR-17-5p was down-regulated in breast cancer tissues and cells. Ep could inhibit viability of cancer cells in a concentration dependent manner and promote the expression of miR-17-5p in breast cancer cell lines. Over-expression of miR-17-5p induced cell apoptosis and upregulated the expression of p53, p21 and p27. miR-17-5p co-cultured with Ep is better than the other groups. The relative luciferase activity revealed that STAT3 was a potential target gene of miR-17-5p. Conclusions: Our work will prove that epirubicin regulated the expression of miR-17-5p to strengthen this effect of epirubicin and inhibited the progression of breast cancer.
Addressing Data and Methodological Limitations in Estimating Catastrophic Health Spending and Impoverishment in India, 2004-18
Authors: Mohanty Sanjay , Dwivedi Laxmikant
Published: December 2020

BackgroundEstimates of catastrophic health expenditure (CHE) are counterintuitive to researchers, policy makers, and developmental partners due to data and methodological limitation. While inferences drawn from use of capacity-to-pay (CTP) and budget share (BS) approaches are inconsistent, the non-availability of data on food expenditure in the health survey in India is an added limitation. MethodsUsing data from the health and consumption surveys of National Sample Surveys over 15 years, we have overcome these limitations and estimated the incidence and intensity of CHE and impoverishment using the CTP approach. ResultsThe incidence of CHE for health services in India has declined from 12.5% in 2004 to 9.1% by 2018 and that of intensity of CHE has increased from 1.25 to 1.31 during the same period. The impoverishment due to health spending was 4.8% in 2004, 5.1% in 2014 and 3.3% in 2018. The state variations in incidence and intensity of CHE and incidence of impoverishment is large. The odds of incurring CHE were lowest among the richest households [OR 0.22; 95% CI: 0.21,0.24], households with elderly members [OR 1.20; 95% CI :1.12,1.18] and households using both inpatient and outpatient services [OR 2.80, 95% CI 2.66, 2.95]. Access to health insurance reduced the chance of CHE and impoverishment among the richest households. The pattern of impoverishment was similar to that of CHE. ConclusionWe recommend the CTP approach when estimating CHE and impoverishment in low and middle-income countries.
Joint Modeling of Hypertension Measurements and Time-to-Onset of Preeclampsia Among Pregnant Women Attending Antenatal Care Service at Arerti Primary Hospital, North Shoa, Ethiopia
Authors: Haile Dawit Baye , Aguade Aragaw Eshetie , Fetene Moges Zerihun
Published: December 2020

Background: Preeclampsia is a hypertensive disorder of pregnancy that affects 2-8% of pregnant women. It is the major cause of maternal and perinatal morbidity and mortality worldwide. The purpose of this study was to identify factors associated with hypertension measurements and time-to-onset of preeclampsia among pregnant women attending antenatal care service at Arerti Primary Hospital. Methodology: A retrospective longitudinal study design was employed on a total of 201 pregnant women attending the antenatal clinic of Arerti Primary Hospital between September 2018 and June 2019. A closed-form sample size formula for estimating the effect of the longitudinal data on time-to-event was used. To analyze our data we employed descriptive method, linear mixed effect model, Cox-PH model and joint models for longitudinal and survival outcomes.Relevantdemographicandclinicalcovariateswereincludedinsubmodels. Results: This study revealed that baseline age, visiting times, weight, diabetes, history of PE and parity had significantly associated with mean change in the BP measurements. From the Cox model result, age, weight, history of PE and marital status were associated with a significant hazard of developing preeclampsia. The univariate joint models reveal that the each longitudinal BP measurements are significantly associated with hazard of developing preeclampsia. Form the bi-ariate joint model; only DBP is significantly associated with risk of developing PE. Conclusion: As the result obtained in this study, we summarized that, age, weight, history of PE and marital status had a significant effect on time to developing preeclampsia. Furthermore, due to significance of association between the longitudinal BP measurements and time to onset of preeclampsia, joint model analysis was suggested as it incorporates all information simultaneously and provides valid and efficient inferences over separate models analysis.
Feasibility of Radical Gastrointestinal Tumor Resection with Simultaneous off-Pump Coronary Artery bypass Surgery for Patients with Severe Heart Problems: A Retrospective Cohort Study from A Single Institutional Database
Authors: Jiang Rongrong , Xiao Ziying , Huang Jiechun , Sun Xiaotian , Chu Xianglin , Wang Fangrui , Wang Yiqing , Pang LieWen , Luo Fen
Published: December 2020

Background: Clinical treatment of gastrointestinal neoplasms in patients with severe coronary stenosis is difficult, and it remains controversial to perform staged or simultaneous surgeries. The purpose of this study was to retrospectively analyze the feasibility and indications for simultaneous gastrointestinal tumor resection and off-pump coronary artery bypass (OPCAB) graft surgery.Methods: Data collected from a total of five patients, including three patients with gastric cancer and two patients with colorectal cancer, who underwent simultaneous radical cancer resection and OPCAB between September 2010 and October 2019, were retrospectively analyzed. Among these patients, one had an incomplete colonic obstruction. All patients had severe coronary stenosis, and one experienced acute heart failure before surgery. OPCAB was performed first, followed by the radical cancer resection. Results: All five patients were discharged from hospital without perioperative death, major cardiovascular events or anastomotic leakage. The mean postoperative hospital stay was 9.4 days. One patient experienced slight gastrointestinal bleeding after surgery, which improved with conservative treatment. After a mean follow-up of 39 months, two patients with gastric cancer died from tumor metastasis at 28 months and 37 months, while the remaining three patients did not have tumor recurrence or metastasis. None of the patients experienced myocardial ischemia.Conclusion: It is safe and feasible to perform simultaneous OPCAB and gastrointestinal surgeries on the premise of strictly controlling the indications for patients with gastrointestinal tumors complicated with severe coronary artery stenosis.
Left Ventricular Free Wall Rupture as a Result of Delayed Presentation of an Inferior ST-Elevation Myocardial Infarction Due to Fear of COVID-19
Authors: Nasr George Hany , Glovaci Diana , Mikhail Andrew , Sinfield Steven , Chen Kevin , Patel Hardikkumar , Johl Michael , Chakravarthy Bharath , Singh Siddharth , Sagebin Fabio , El-Farra Ailin Barseghian
Published: December 2020

BackgroundLeft ventricular free wall rupture (LVFWR) is a rare complication after myocardial infarction and usually occurs one to four days after the infarct. Over the past decade, the overall incidence of LVFWR has decreased given the advancements in reperfusion therapies. However, during the COVID-19 pandemic, there has been a significant delay in hospital presentation of patients suffering myocardial infarctions, leading to a higher incidence of mechanical complications from myocardial infarctions such as LVFWR.Case PresentationWe present a case in which a patient suffered a LVFWR as a mechanical complication from myocardial infarction due to delay in seeking care over fear of contracting COVID-19 from the medical setting. The patient had been having chest pain for a few days but refused to seek medical care due to fear of contracting COVID-19 from within the medical setting. He eventually suffered a cardiac arrest at home from a massive inferior myocardial infarction and found to be in cardiac tamponade from a left ventricular perforation. He was emergently taken to the operating room to attempt to repair the rupture but he ultimately expired on the operating table.ConclusionsThe occurrence of LVFWR has been on a more significant rise over the course of the COVID-19 pandemic as patients delay seeking care over fear of contracting COVID-19 from within the medical setting. Clinicians should consider mechanical complications of MI when patients present as an out-of-hospital cardiac arrest, particularly during the COVID-19 pandemic, as delay in seeking care is often the exacerbating factor.
Exploring the Factors that Affect the Transition from Students to Health Professionals: An Integrative Review
Authors: Opoku Eric Nkansah , Khuabi Lee-Ann Jacobs-Nzuzi , Niekerk Lana Van
Published: December 2020

Background: The nature of a new health professional’s transition from student to health professional is a significant determinant of the ease or difficulty of the journey to professional competence. The integrative review will explore the extent of literature on the factors that impact the transition of new health professionals into practice, identify possible gaps and synthesise findings which will inform further research. The aim was to identify research conducted in the last two decades on the barriers, facilitators and coping strategies employed by new health professionals during their transition into practice.Methods: Whittemore and Knafl’s methodological framework for conducting integrative reviews was used to guide this study. Sources between 1999 and 2019 were gathered using EBSCOhost (including CINAHL, Medline, Academic Search Premier, Health Science: Nursing and Academic Edition), PubMed, Scopus, Cochrane and Web of Science, as well as hand searching and follow-up of bibliographies followed. The Covidence platform was used to manage the project. All studies were screened against a predetermined selection criteria. Relevant data was extracted from included sources and analysed using thematic analysis approach.Results: Of the 562 studies identified, relevant data was extracted from 24 studies that met the inclusion criteria, and analysed to form this review. Thematic analysis approach was used to categorise the findings into theme areas. Four overarching themes emerged namely: systems and structures, personal capacities, professional competence and mediating processes. Each theme revealed the barriers, facilitators and coping strategies of transition into practice among new health graduates.Conclusion: The transition into practice for new health practitioners has been described as complex and a period of great stress. Increasing clinical and practical experiences during education are required to support new health professionals in the process of closing the gap between learning and practice. Continued professional development activities should be readily available and attendance of these encouraged.
Multiple Lung Cancers: Independent Primary Tumors or Intrapulmonary Metastases, A Case Report
Authors: Erem Anna Sarah , Cecchini Matthew J , Boland Jennifer M.
Published: December 2020

Background

The prevalence of multiple primary lung cancers is rising, highlighting the need for tools to distinguish independent primary tumors from metastases. Molecular markers and hisopathologic comparison are useful to aid in this distinction, but they have significant limitations.
Case Presentation

A 76-year old woman presented with recurrent bronchorrhea, non-productive cough, and dyspnea upon exertion. She was a former smoker (15 pack-year history). Computerized tomography imaging revealed multiple lung masses: 1.9 × 2.3 cm nodule in the right upper lobe, and a 6.5 cm mass in the right lower lobe. Histologic examination of the tumors showed that the right lower lobe mass was an adenosquamous carcinoma with a mucinous adenocarcinoma component. This tumor showed visceral pleural invasion, and direct invasion of one intrapulmonary peribronchial lymph node. The upper lobe lesion was characterized by pure invasive mucinous adenocarcinoma with no squamous component. Abdominal and pelvic imaging was performed to rule out alternative primary sites, and no evidence of disease was identified outside of the chest. A cancer mutation and rearrangement panel on the adenosquamous carcinoma did not reveal any mutations.
Conclusions

In this interesting case, a patient presented with two lung tumors which had some morphologic similarities, but also some important differences, and no specific genetic mutations were present to establish the relationship between the tumors. Although current tools are useful, this case highlights an example of a case where it remains extremely difficult to determine whether two lung cancers are independent primary tumors or intrapulmonary metastases.
Breath Hold Breast Radiotherapy In The Era of Precision Medicine: Appropriate Selection for Left Descending Artery Sparing
Authors: Ippolito Edy , Greco Carlo , Marrocco Maristella , Gentile Silvia , Palizza Serena , Fiore Michele , Trodella Luca Eolo , D'Angelillo Rolando Maria , Ramella Sara
Published: December 2020

Background and purpose

To identify anatomical and/or preplanning characteristics correlated with left descending artery (LAD) dose and therefore provide guidance in the selection of patients with left-breast cancer that could benefit the most from the use of deep inspiration breath hold radiotherapy (DIBH-RT).
Materials and methods

We retrospectively identified patients with left-sided breast cancer who underwent whole breast radiotherapy in DIBH and extracted data from treatment plans in free-breathing (FB) and DIBH. The following anatomical parameters were obtained from the planning CTs in FB: lung volume, heart volume, breast separation, minimum distance from LAD to tangent open field. Receiving operating characteristics was also performed to define the cut-off point of parameters to use in LAD dosimetry prediction. Areas under the curve (AUCs) were calculated for all variables. Post-test probability has been calculated to evaluate advantage for parameters combination.
Results

One hundred ninety-seven patients were identified. The strongest predictor at FB CT scan of LAD maximum dose > 10 Gy and a LAD mean dose > 4 Gy was the minimum distance of LAD from tangent open fields. Adding consecutively other preplanning anatomic parameters, the positive predictive value (PPV) to identify patients at risk of higher dose to LAD was > 90%.
Conclusions

The dosimetric benefit of DIBH is valid for all patients and DIBH should be preferred for all left sided patients; however we can identify a subgroup of patients who benefit the least from DIBH. This is the group with favorable anatomy: limited breast separation, well expanded lungs, LAD distant from open tangent fields.
Transanal Proctocolectomy and Ileal Pouch-Anal Anastomosis (Taipaa) for Ulcerative Colitis: Medium Term Functional Outcomes in a Single Centre
Authors: Capolupo Gabriella Teresa , Carannante Filippo , Mascianà Gianluca , Lauricella Sara , Mazzotta Erica , Caricato Marco
Published: December 2020

Background: Transanal dissection of the rectum has been recently introduced for ileal pouch-anal anastomosis (IPAA) in UC showing promising results. Thanks to the precise identification of the rectotomy site the risk of long rectal stump is avoided, and a single stapled anastomosis is performed easily.The aim of this study is to analyze our initial experience of transanal proctocolectomy and ileal pouch-anal anastomosis (TaIPAA), considering postoperative complications and medium-term functional outcomes.Methods: Our Center has experienced the transanal approach for proctectomy and IPAA since August 2018. All patients underwent Enhanced Recovery After Surgery (ERAS) protocol. Postoperative complications occurring within 30 days after surgery were taken into consideration. Fecal continence, genito-urinary activity and global quality of life at 1 and 6 months after ileostomy reversal have been assessed.Results: Until March 2019, 8 patients underwent transanal proctocolectomy and ileal pouch-anal anastomosis (TaIPAA). In all cases the laparoscopic approach was performed during the transabdominal phase; abdominal drainage was never used. At the time of the pouch construction a defunctioning loop ileostomy was created in all patients. Stoma closure was performed in all cases at a median time of 6 months after surgery. Postoperative complications occurred in only one patient, who showed rectal bleeding, not required a re-invertation. There were no cases of anastomotic leakage.Medium-term functional outcomes were determined prospectively using previously validated quality of life questionnaires (Cleveland Global Quality of Life). Fecal incontinence for liquid or solid stool, genitourinary and sexual functions were also investigated, showing comparable results with the literature data.Conclusions: In our experience, transanal proctocolectomy and ileal pouch-anal anastomosis provided good short and medium-term functional results in UC.
Long-term radiographic outcomes and functional evaluation of ulnar shortening osteotomy in patients with ulnar impaction syndrome and reverse oblique sigmoid notch: a retrospective case series study
Authors: Huang Hui-Kuang , Lee Steve K. , Huang Yi-Chao , Yin Cheng-Yu , Chang Ming-Chau , Wang Jung-Pan
Published: December 2020

Background: Ulnar shortening osteotomy (USO) is an effective treatment for ulnar impaction syndrome. However, there has been a concern of osteoarthritis (OA) developing at the distal radioulnar joint (DRUJ) if USO is performed on patients with a reverse oblique sigmoid notch. This study aimed to evaluate the radiographic and functional outcomes following USO in patients with a reverse oblique sigmoid notch.Methods: We retrospectively reviewed our patients with a reverse oblique sigmoid notch who underwent USO to treat ulnar impaction syndrome between 2002 and 2013. We evaluated the radiographic changes of the DRUJ and the patients’ functional outcomes.Results: We enrolled 22 patients (22 wrists) with an average age at operation of 49.6 years and mean follow-up of 93.2 (range, 36 - 179; SD 38.2) months. We found that there were changes in the inclination angle of the sigmoid notch, from an average of reverse oblique 14.9o (range, 11o - 23o; SD 3.4o) preoperatively to a more parallel 5.1o (range, 0o - 11o; SD 3.2o) at the final follow-ups. The functional results at the final follow-ups were good with a mean VAS for pain of 0.2 (range, 0 - 1; SD 0.4) at rest and 1.3 (range, 0 - 3; SD 0.9) during activity, QuickDASH of 15.1 (range, 2.3 - 34.1; SD 8.8), and modified Mayo Wrist Score of 91.6 (range, 70-100; SD 6.4). Seven wrists (31.8%) were noted to have OA changes, but the wrists did not exhibit a significantly worse function when compared to wrists without OA changes, except for supination motion and grip strength.Conclusions: For those patients with a reverse oblique sigmoid inclination following USO, we observed that the inclination angle would have a tendency to become more parallel and some patients would develop OA changes at the DRUJ, but the functional outcomes could still be good in the long term. The reverse oblique sigmoid inclination seems not to be an absolute contraindication for USO.
Reduced translation efficiency due to novel splicing variants in 5′ untranslated region and identification of novel cis-regulatory elements in canine and human BRCA2
Authors: Yoshikawa Yasunaga , Kozuma Hajime , Morimatsu Masami , Sugawara Kaori , Orino Koichi
Published: December 2020

Background: Breast cancer 2, early onset (BRCA2) is a tumor suppressor gene. The protein encoded by this gene plays an important role in homologous recombination (HR)-mediated DNA repair. Deleterious mutations in BRCA2 and downregulation of its expression have been associated with tumorigenesis in dogs and humans. Thus, regulation of BRCA2 expression level is important for maintaining homeostasis in homologous recombination.Results: In this study, the mechanisms that regulate the expression of BRCA2 were proposed. Novel splicing variants were identified in the 5′ untranslated region (UTR) of canine and human BRCA2 in canine testis, canine ovary, and canine and human cultured cell lines. In cultured cells, the ratio of BRCA2 splicing variants at the 5′ UTR was altered by serum starvation. These novel splicing variants, excluding one of the canine splicing variants, were found to reduce the translational efficiency. Additionally, the DNA sequence in human BRCA2 intron 1 harbored novel cis-regulatory elements. Three silencer and two enhancer cis-regulatory elements were identified in human BRCA2 intron 1.Conclusions: This study demonstrates that BRCA2 expression level is regulated via 5′ UTR splicing variants and that the BRCA2 intron 1 region harbors cis-regulatory elements.
Multiple Sclerosis incidence rate in southern Iran: A Bayesian epidemiological study
Authors: Asmarian Naeimehossadat , Sharafi Zahra , Mousavi Amin , Jacques Reis , Tamayo Ibon , Bind Marie-Abèle , abutorabi-zarchi Marzie , Moradian Mohammad Javad , Izadi Sadegh
Published: December 2020

Background: Multiple Sclerosis (MS) remains to be a public health challenge, due to its unknown biological mechanisms and clinical impacts on young people. The prevalence of this disease in Iran is reported to be 5.30 to 74.28 per 100,000-person. Because of high prevalence of this disease in Fars province, the purpose of this study was to assess the spatial pattern of MS incidence rate by modeling both the effects of spatial dependence between neighboring regions and risk factors in a Bayesian Poisson model, which can lead to the improvement of health resource allocation decisions.Method: Data from 5,468 patients diagnosed with MS were collected, according to the McDonald’s criteria. New cases of MS were reported by the MS Society of Fars province from 1991 until 2016. The association between the percentage of people with low vitamin D intake, smoking, abnormal BMI and alcohol consumption in addition to spatial structure in a Bayesian spatio-temporal hierarchical model were used to determine the relative risk and trend of MS incidence rate in 29 counties of Fars province. Results: County-level crude incidence rates ranged from 0.22 to 11.31 cases per 100,000-person population. The highest relative risk was estimated at 1.80 in the county of Shiraz, the capital of Fars province, while the lowest relative risk was estimated at 0.11 in Zarindasht county in southern of Fars. The percentages of vitamin D supplementation intake and smoking were significantly associated with the incidence rate of MS. The results showed that 1% increase in vitamin D supplementation intake is associated with 2% decrease in the risk of MS and 1% increase in smoking is associated with 16% increase in the risk of MS.Conclusion: Bayesian spatio-temporal analysis of MS incidence rate revealed that the trend in the south and south east of Fars province is less steep than the mean trend of this disease. The lower incidence rate was associated with a higher percentage of vitamin D supplementation intake and a lower percentage of smoking. Previous studies have also shown that smoking and low vitamin D, among all covariates or risk factors, might be associated with high incidence of MS.