bluuebunny/crossref_metadata_2025 huggingface dataset:
Grounding evaluation design in the socio-ecological model of health: a logic framework for the assessment of a national routine immunization communication initiative in Kyrgyzstan
Authors: Schiavo Renata , Basu Roy Upal , Faroul Latisha , Solodunova Galina
Published: May 2020

Childhood routine immunization (RI) is a highly effective public health intervention for the prevention of infectious diseases. Despite high immunization rates, a 2018 Knowledge, Attitudes, and Practices (KAP) study by the United Nations Children’s Fund (UNICEF) noted a growing practice of vaccine refusal among parents and primary caregivers as well as clusters of significantly lower immunization coverage in some provinces. Moreover, a 2018 Joint Appraisal report by GAVI (Global Vaccine Alliance) has highlighted a decrease in immunization rates among children under 1 year of age from 96.1% to 92% for some vaccines. As a result, UNICEF is spearheading a national communication initiative to increase the rates of RI in Kyrgyzstan. This initiative includes strengthening interpersonal communication skills of local healthcare workers, improving the quality and accuracy of media coverage via a tailored outreach to the Kyrgyz media, as well as fostering community engagement to give voice to local champions and engage hesitant parents and vaccine refuters. UNICEF has also partnered with a research team for the design phase of a suitable evaluation framework. Grounded in the socio-ecological model (SEM) of health, the framework recognizes the interconnection of behavioral, social, and policy change, and includes not only activity-specific indicators (process indicators) but also progress, outcome, and impact indicators to document results among key groups and stakeholders at different levels of the SEM, and, ultimately, on immunization rates in Kyrgyzstan. The framework reflects the importance of an integrated and multilevel approach to intervention and communication design, and integrates the SEM with a logic model that connects different components of the initiative. This paper introduces this evaluation framework, including implications for the evaluation of child health programs, and other public health, communication, and international development interventions.
Using photovoice to understand the context of cervical cancer screening for underserved communities in rural India
Authors: Adsul Prajakta , Nayaka Shivamma , Pramathesh Rashmi , Gowda Savitha , Jaykrishna Poornima , Srinivas Vijaya , Madhivanan Purnima
Published: May 2020

Cervical cancer is the second most common cancer diagnosed among women in India and current estimates indicate low screening rates. To implement successful population-based screening programs, there is an urgent need to explore the social and cultural beliefs among women residing in underserved communities. An innovative, community-based participatory approach called photovoice was used with 14 women aged between 30–51 years, residing in rural and tribal villages around Mysore, Karnataka, India. Each participant was trained in photovoice techniques, provided with a digital camera, and asked to photo document their everyday realities that could influence their intentions to undergo cervical cancer screening. Over 6 months, participants took a total of 136 photos and participated in 42 individual interviews and two group discussions. These data helped identify specific beliefs prevalent in the target population and were organized according to the Integrated Behavior Model. Some women reported a lack of perceived susceptibility to cervical cancer whereas others mentioned the fatal nature of cancer as a disease and believed that no screening exam could prevent death if they were destined to get cancer. Husbands, mothers-in-law, and their peers in the community had an important influence on the social identity of women and influenced their intentions to participate in the screening exams. Seeking healthcare was associated with an economic burden, not only in terms of out-of-pocket expenses for healthcare services but also in missing daily labor wages or taking unpaid leave from work to seek healthcare when they were asymptomatic. Several action steps were proposed including: identifying community liaisons or champions, repeated community activities to raise awareness of cervical cancer, and educating men and other family members about women’s health issues. Study findings can conceptually help design and develop educational efforts for mobilizing women to undergo screening and inform future research to help understand disparities.
Elective affinities between Sandinismo (as socialist idea) and liberation theology in the Nicaraguan Revolution
Authors: Reed Jean-Pierre
Published: May 2020

The history of the Nicaraguan Revolution has received considerable analytical attention. Typically, the successful overthrow of the Somoza regime in the late 1970s is associated with the Frente Sandinista de Liberación Nacional, a Marxist/socialist inspired vanguard group. While the role Christians played in the revolution is often acknowledged as a significant one, in part because many Sandinista cadres were Christian revolutionaries, little attention has been paid to the degree to which Sandinismo, as a unique perspective on socialism, shares elective affinities with liberation theology, a prophetic expression of Christianity. This manuscript sets out to explore the relationship between liberation theology and Sandinismo-as-socialism. It starts by considering the perspective of Christian revolutionaries on this relationship. It then identifies the electives affinities between the aforementioned cultural frameworks, and it evaluates the Nicaraguan Revolution in light of these elective affinities. The latter evaluation includes exploring the connection between Saint Paul and what it means to be a Sandinista revolutionary.
Commercial gaming devices for stroke upper limb rehabilitation: The stroke survivor experience
Authors: Thomson Katie , Pollock Alex , Bugge Carol , Brady Marian C
Published: May 2020

Introduction

Approximately 30% of stroke survivors experience an upper limb impairment, which impacts on participation and quality of life. Gaming devices (Nintendo Wii) are being incorporated into rehabilitation to improve function. We explored the stroke survivor experience of gaming as an upper limb intervention.

Methods

Semi-structured, individual interviews with stroke survivors living within the UK were completed. Interviews were audio-recorded, transcribed verbatim and analysed using Framework methods. Transcripts were coded and summarised into thematic charts. Thematic charts were refined during analysis until the final framework emerged.

Results

We captured experiences of 12 stroke survivors who used Nintendo Wii. Gaming devices were found to be acceptable for all ages but varying levels of enthusiasm existed. Enthusiastic players described gaming as having a positive impact on their motivation to engage in rehabilitation. For some, this became a leisure activity, encouraging self-practice. Non-enthusiastic players preferred sports to gaming.

Conclusion

An in-depth account of stroke survivor experiences of gaming within upper limb rehabilitation has been captured. Suitability of gaming should be assessed individually and stroke survivor abilities and preference for interventions should be taken into consideration. There was no indication that older stroke survivors or those with no previous experience of gaming were less likely to enjoy the activity.
The Effect of Volunteer Management on Intention to Continue Volunteering: A Mediating Role of Job Satisfaction of Volunteers
Authors: Cho Heetae , Wong Zi’En , Chiu Weisheng
Published: May 2020

The purpose of this study was to examine the relationship between volunteer management and volunteers’ intention to continue participating, based on the environmental psychology model. Moreover, this study investigated the mediating role of volunteers’ job satisfaction in this relationship. Using a sample drawn from volunteers of a cultural event in Singapore, this research conducted confirmatory factor analysis and structural equation modeling analysis. The results showed a positive relationship between volunteer management and volunteers’ intention to continue volunteering, with a full mediating effect of job satisfaction on this relationship. Also, the highest attribution of positive management practices came from reward and recognition, followed by empowerment, schedule flexibility, orientation and training, and social interaction. The findings of this study provide a perspective on how volunteer management can position itself for volunteer retention.
Space-Occupying Lesions of the Retropharyngeal Space: An Anatomical Study With Application to Postoperative Retropharyngeal Hematomas
Authors: Glinski Alexander von , Elia Christopher , Yilmaz Emre , Frieler Sven , Ishak Basem , Anand Mahindra Kumar , Iwanaga Joe , Abdul-Jabbar Amir , Oskouian Rod J. , Tubbs R. Shane , Chapman Jens R.
Published: May 2020

Study Design:

Cadaver study.

Objective:

The retropharyngeal space’s (RPS’s) clinical relevance is apparent in anterior cervical spine surgery with respect to postoperative hematoma, which can cause life-threatening airway obstruction. This cadaver study aims to establish guidance toward a better understanding of the tolerance of the RPS to accommodate fluid accumulation.

Methods:

Five fresh-frozen cadavers were dissected in the supine position. A digital manometer and a 20 Fr Foley catheter were inserted into the RPS via an anterolateral approach. While inflating the Foley catheter, the position of the esophagus/trachea was documented using fluoroscopy, and the retropharyngeal pressure was measured. We quantified the volume required to deviate the esophagus/trachea >1 cm from its original position using fluoroscopy. We also recorded the volume required to cause a visible change to the normal neck contour.

Results:

A mean volume of 12.5 mL (mean pressure 1.50 mm Hg) was needed to cause >1 cm of esophageal deviation. Tracheal deviation was encountered at a mean volume of 20.0 mL (mean pressure of 2.39 mm Hg). External visible clinical neck contour changes were apparent at a mean volume of 39 mL.

Conclusion:

A relatively small volume of fluid in the RPS can cause the esophagus/trachea to radiographically deviate. The esophagus is the structure in the RPS to be most influenced by mass effect. The mean volume of fluid required to cause clinically identifiable changes to the normal neck contour was nearly double the volume required to cause 1 cm of esophageal/tracheal deviation in a cadaver model.
COVID-19: A Socio-economic Perspective
Authors: Kanupriya
Published: May 2020

The recent outbreak of the COVID-19 or the coronavirus flu pandemic in the world threatens to derail the very existence of humankind. The planet could only ignore the challenges posed by this flu strain to its peril. This analysis seeks to locate the pandemic, its challenges and probable solutions within a socio-economic, political and medical sciences perspective. The various dimensions of the viral disease ranging from its impact on human societies, body politic, health and economic realms have been discussed and analysed. This perspective could be seen in the context of the ongoing debates on the nature and consequences of the crisis, as also the evolving dynamics of the same. The article examines the current situation and also factors in any future changes. A number of solutions have been offered for an effective tackling of this deadly disease, keeping in mind the global developments. All in all, the crisis must serve as an important experience for the entire civilization and imparts lessons in health, social, political and economic spheres.
FDI and Economic Performance of Firms in India
Authors: Bhattarai Keshab , Negi Vipin
Published: May 2020

FDI contributed positively to sales, profit, employment and wages of firms in India from 2004 to 2018. Foreign capital is complementing domestic capital well embodying technology and innovations required for expansion of domestic firms in it. Foreign promoters have played quite significant economic roles among firms across production sectors in manufacturing industry in India. Besides sales, total expenses, managerial remunerations and corporation taxes, involvement of foreign promoters are statistically significant determinants of profits, employment and wages among firms across all seven sectors of the manufacturing industry is clear from analysis of the Prowess database for years 2004, 2008, 2012 and 2014. These effects were even stronger in each of Modi–I years between 2015-2019 that followed the Make in India initiative in 2014. Reforms including the outright 100 per cent ownership provision in the automatic route in most industrial sectors have produced good outcomes that have not only raised the volume of FDI per capita from around 16 dollars in 2000 to 285 dollars in 2018 but also raised the global ranking of India to 63 out of 190 economies in 2019 on the ease of doing business, putting India 79 places above now than in 2014. Based on theoretical and empirical analysis it can be concluded that good sentiments of FDI in India in Modi–II years started in 2019 will prevent diminishing returns on capital and contribute towards sustainable growth in coming years.

JEL Codes: F21, F23, F14, J31, O53
A Rare Case of Spontaneous Bilateral Subcapsular Renal Hematoma
Authors: Bajaj Tushar , Trang Ngon , Nasrawi Faisal , Eppanapally Sabitha
Published: May 2020

Spontaneous bilateral renal subcapsular hematoma is a rare condition. On literature review, only 2 case reports have elucidated possible etiologies for such a presentation; however, no definite conclusions have been made. We present a rare case of a 52-year-old female with diabetes mellitus type 2, chronic kidney disease stage 4, hypertension, hyperlipidemia, prior traumatic brain injury via motor vehicle accident, who presented to our hospital with diabetic ketoacidosis and clinical signs of pyelonephritis; subsequently, imaging demonstrated spontaneous bilateral renal subcapsular hematoma. Risk factors for the rare presentation in this patient included pyelonephritis, history of bilateral ureteral stent placement, and a remote history of a mild unilateral renal laceration secondary to a motor vehicle accident. Typically, patients with this condition achieve spontaneous resolution with conservative management. Our patient initially presented with diabetic ketoacidosis and pyelonephritis but gradually developed retroperitoneal bleeding and hemorrhagic shock. Our patient’s critical condition required close monitoring in an intensive care unit and a more invasive approach including unilateral left renal artery embolization followed by a unilateral left nephrectomy. The patient ultimately recovered and continued to be followed outpatient without any serious long-term complications.
Reaching women with obesity to support weight loss before pregnancy: feasibility and qualitative assessment
Authors: Simon Denise , Kaimal Anjali J. , Oken Emily , Hivert Marie-France
Published: May 2020

Background:

We sought to assess attitudes toward weight and barriers to recruitment of women with obesity for a potential preconception weight-loss/lifestyle modification intervention.

Methods:

We performed a qualitative study involving women of reproductive age (18–45) with obesity (body mass index ⩾30 kg/m2) who were considering a pregnancy in the next 2 years. We evaluated four methods of recruitment. We used previously validated survey questions to evaluate risk perceptions. In a subset, we used semistructured interviews for topics that required more in-depth information: domains included attitudes toward weight-related issues, intentions, and barriers to engagement in a structured weight-loss program. We performed qualitative analyses of interview transcripts using immersion crystallization.

Results:

We recruited the majority (80/82, 98%) of women using e-recruitment strategies. Eighty-one women filled out the survey and 39 completed an interview. Three-quarters of the women surveyed (60 of 81) reported attempts to lose weight in the past year and 77% (68/81) of survey respondents cited jobs and work schedules as a barrier to adopting healthy habits. More than 87% (34 of 39) of women interviewed reported willingness to participate in a structured weight-loss program prior to getting pregnant. Of these, 74% (25 of 34) stated they would consider delaying their attempts at a future pregnancy in order to participate in such a program.

Conclusions:

E-recruitment is a promising strategy for recruitment for preconception weight-loss and lifestyle modification program. Most women state a willingness to delay pregnancy attempts to participate in a weight-loss program.
Mass spectrometry-based microbiological testing for blood stream infection
Authors: Nomura Fumio , Tsuchida Sachio , Murata Syota , Satoh Mamoru , Matsushita Kazuyuki
Published: May 2020

Background

The most successful application of mass spectrometry (MS) in laboratory medicine is identification (ID) of microorganisms using matrix-assisted laser desorption ionization–time of flight mass spectrometry (MALDI-TOF MS) in blood stream infection. We describe MALDI-TOF MS-based bacterial ID with particular emphasis on the methods so far developed to directly identify microorganisms from positive blood culture bottles with MALDI-TOF MS including our own protocols. We touch upon the increasing roles of Liquid chromatography (LC) coupled with tandem mass spectrometry (MS/MS) as well.

Main body

Because blood culture bottles contain a variety of nonbacterial proteins that may interfere with analysis and interpretation, appropriate pretreatments are prerequisites for successful ID. Pretreatments include purification of bacterial pellets and short-term subcultures to form microcolonies prior to MALDI-TOF MS analysis. Three commercial protocols are currently available: the Sepsityper® kit (Bruker Daltonics), the Vitek MS blood culture kit (bioMerieux, Inc.), and the rapid BACpro® II kit (Nittobo Medical Co., Tokyo). Because these commercially available kits are costly and bacterial ID rates using these kits are not satisfactory, particularly for Gram-positive bacteria, various home-brew protocols have been developed: 1. Stepwise differential sedimentation of blood cells and microorganisms, 2. Combination of centrifugation and lysis procedures, 3. Lysis-vacuum filtration, and 4. Centrifugation and membrane filtration technique (CMFT). We prospectively evaluated the performance of this CMFT protocol compared with that of Sepsityper® using 170 monomicrobial positive blood cultures. Although preliminary, the performance of the CMFT was significantly better than that of Sepsityper®, particularly for Gram-positive isolates. MALDI-TOF MS-based testing of polymicrobial blood specimens, however, is still challenging. Also, its contribution to assessment of susceptibility and resistance to antibiotics is still limited. For this purpose, liquid chromatography (LC) coupled with tandem mass spectrometry (MS/MS) should be more useful because this approach can identify as many as several thousand peptide sequences.

Conclusion

MALDI-TOF MS is now an essential tool for rapid bacterial ID of pathogens that cause blood stream infection. For the purpose of assessment of susceptibility and resistance to antibiotics of the pathogens, the roles of liquid chromatography (LC) coupled with tandem mass spectrometry (MS/MS) will increase in the future.
Identification of the molecular mechanism and diagnostic biomarkers in the thoracic ossification of the ligamentum flavum using metabolomics and transcriptomics
Authors: Li Jiahao , Yu Lingjia , Guo Shigong , Zhao Yu
Published: May 2020

Background

To establish a metabolite fingerprint of ossification of the thoracic ligamentum flavum (OTLF) patients using liquid chromatography-mass spectrometry (LC-MS) in combination with transcriptomic data and explore the potential molecular mechanism of pathogenesis.

Results

The study cohort was composed of 25 patients with OTLF and 23 healthy volunteers as a control group. Thirty-seven metabolites were identified out by UPLC-MS including uric acid and hypoxanthine. Nine metabolites, including uric acid and hypoxanthine, were found with a Variable Importance in Projection (VIP) score over 1 (p < 0.05). Pathway enrichment indicated that purine metabolism pathways and the other four metabolism pathways were enriched. Transcriptomic data revealed that purine metabolism have a substantial change in gene expression of OTLF and that xanthine dehydrogenase (XDH) is the key regulatory factor. Receiver operating characteristic (ROC) analysis indicated that 17 metabolites, including uric acid, were found with an AUC value of over 0.7.

Conclusion

Uric acid might be the potential biomarker for OTLF and play an important role within the detailed pathway. XDH could affect purine metabolism by suppressing the expression of hypoxanthine and xanthine leading to low serum levels of uric acid in OTLF, which could be a focal point in developing new therapeutic methods for OTLF.
Ephrin-B2 paces neuronal production in the developing neocortex
Authors: Kischel Anthony , Audouard Christophe , Fawal Mohamad-Ali , Davy Alice
Published: May 2020

Background

During mammalian cerebral cortex development, different types of projection neurons are produced in a precise temporal order and in stereotypical numbers. The mechanisms regulating timely generation of neocortex projection neurons and ensuring production in sufficient numbers of each neuronal identity are only partially understood.

Results

Here, we show that ephrin-B2, a member of the Eph:ephrin cell-to-cell communication pathway, sets the neurogenic tempo in the neocortex. Indeed, conditional mutant embryos for ephrin-B2 exhibit a transient delay in neurogenesis and acute stimulation of Eph signaling by in utero injection of synthetic ephrin-B2 led to a transient increase in neuronal production. Using genetic approaches we show that ephrin-B2 acts on neural progenitors to control their differentiation in a juxtacrine manner. Unexpectedly, we observed that perinatal neuron numbers recovered following both loss and gain of ephrin-B2, highlighting the ability of neural progenitors to adapt their behavior to the state of the system in order to produce stereotypical numbers of neurons.

Conclusions

Altogether, our data uncover a role for ephrin-B2 in embryonic neurogenesis and emphasize the plasticity of neuronal production in the neocortex.
Integrated small RNA and mRNA expression profiles reveal miRNAs and their target genes in response to Aspergillus flavus growth in peanut seeds
Authors: Zhao Chuanzhi , Li Tingting , Zhao Yuhan , Zhang Baohong , Li Aiqin , Zhao Shuzhen , Hou Lei , Xia Han , Fan Shoujin , Qiu Jingjing , Li Pengcheng , Zhang Ye , Guo Baozhu , Wang Xingjun
Published: May 2020

Background

MicroRNAs are important gene expression regulators in plants immune system. Aspergillus flavus is the most common causal agents of aflatoxin contamination in peanuts, but information on the function of miRNA in peanut-A. flavus interaction is lacking. In this study, the resistant cultivar (GT-C20) and susceptible cultivar (Tifrunner) were used to investigate regulatory roles of miRNAs in response to A. flavus growth.

Results

A total of 30 miRNAs, 447 genes and 21 potential miRNA/mRNA pairs were differentially expressed significantly when treated with A. flavus. A total of 62 miRNAs, 451 genes and 44 potential miRNA/mRNA pairs exhibited differential expression profiles between two peanut varieties. Gene Ontology (GO) analysis showed that metabolic-process related GO terms were enriched. Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analyses further supported the GO results, in which many enriched pathways were related with biosynthesis and metabolism, such as biosynthesis of secondary metabolites and metabolic pathways. Correlation analysis of small RNA, transcriptome and degradome indicated that miR156/SPL pairs might regulate the accumulation of flavonoids in resistant and susceptible genotypes. The miR482/2118 family might regulate NBS-LRR gene which had the higher expression level in resistant genotype. These results provided useful information for further understanding the roles of miR156/157/SPL and miR482/2118/NBS-LRR pairs.

Conclusions

Integration analysis of the transcriptome, miRNAome and degradome of resistant and susceptible peanut varieties were performed in this study. The knowledge gained will help to understand the roles of miRNAs of peanut in response to A. flavus.
LMA® Gastro™ Airway for endoscopic retrograde cholangiopancreatography: a retrospective observational analysis
Authors: Tran Andre , Thiruvenkatarajan Venkatesan , Wahba Medhat , Currie John , Rajbhoj Anand , van Wijk Roelof , Teo Edward , Lorenzetti Mark , Ludbrook Guy
Published: May 2020

Background

Various airway techniques have been employed for endoscopic procedures, with an aim to optimise patient outcomes by improving airway control and preventing hypoxia whilst avoiding the need for intubation. The LMA® Gastro™ Airway, a novel dual channel supraglottic airway technique, has been described as such a device. Its utility alongside sedation with low flow nasal cannula and general anaesthesia (GA) with intubation for endoscopic retrograde cholangiopancreatography (ERCP) procedures was evaluated.

Methods

Details of all the ERCPs performed in our institution from March 2017 to June 2018 were carefully recorded in the patients’ electronic case records. Data on the successful completion of ERCP through LMA® Gastro™ Airway; any difficulty encountered by the gastroenterologists; and adverse events were recorded. Episodes of hypoxia (SpO2 < 92%) and haemodynamic parameters were compared across the three groups: LMA® Gastro™ vs. sedation with low flow nasal cannula vs. GA with an endotracheal tube (ETT).

Results

One hundred seventy-seven ERCP procedures were performed during the study period. The LMA® Gastro™ Airway was employed in 64 procedures (36%) on 59 patients. Of these 64 procedures, ERCP was successfully completed with LMA® Gastro™ Airway in 63 (98%) instances, with only one case requiring conversion to an endotracheal tube. This instance followed difficulty in negotiating the endoscope through LMA® Gastro™ Airway. No episodes of hypoxia or hypercapnia were documented in both LMA® Gastro™ and GA with ETT groups. One sedation case with nasal cannula was noted to have hypoxia. Adverse intraoperative events were recognised in 2 cases of LMA® Gastro™: one had minimal blood stained secretions from the oral cavity that resolved with suctioning; the other developed mild laryngospasm which resolved spontaneously within a few minutes.

Conclusion

In patients undergoing ERCP, the LMA® Gastro™ airway demonstrated a high success rate for ERCP completion. Ventilation was well maintained with minimal intraoperative and postoperative adverse events. This technique may have a role in higher risk groups such as high ASA (American Society of Anesthesiologists) status, or those with potential airway difficulties such as high body mass index and those with known or suspected sleep apnoea.
Endovascular repair of type A aortic intramural hematoma accompanied by aberrant right subclavian artery and Kommerell’s diverticulum: a case report
Authors: Xiong Sizheng , Wang Daoquan , Li Jun
Published: May 2020

Background

The lesions of aberrant right subclavian artery, Kommerell’s diverticulum and type A aortic intramural hematoma are rare, and we usually treat them with open surgery. In some cases patients have increased risk to undergo surgery, the experiences of endovascular or medical treatment are limited.

Case presentation

Here we reported a case of a 53-year-old man with these three entities present with chest and back ache and attempted a novel approach, thoracic endovascular aortic repair, in the absence of surgical treatment. The patient lived over 5 years and this case provides initial experience and lesson about the endovascular and medical management of the uncommon and dangerous disease- type A aortic intramural hematoma with aortic congenital malformation.

Conclusion

Thoracic endovascular aortic repair with medical treatment may be a potential alternative approach for type A aortic intramural hematoma.
Association of methylenetetrahydrofolate reductase (MTHFR) variant C677T and risk of carotid atherosclerosis: a cross-sectional analysis of 730 Chinese Han adults in Chongqing
Authors: Peng Xulei , Zhou Yongli , Wu Xiaoxing , Wang Xiaolin , Bai Huili , Li Yongqiang , Wang Zhichao , Chen Xuan , Wang Yonghong
Published: May 2020

Background

Uncertainty still remains on the correlation of methylenetetrahydrofolate reductase (MTHFR) variant C677T with risk of carotid atherosclerosis (CAS), and there is a lack of reports on C677T/MTHFR in the Asian population. The association of C677T/MTHFR polymorphisms with CAS in the Chinese Han population in Chongqing was investigated in the present study.

Methods

Subjects (n = 730, 214 females and 516 males, Han ethnicity) who provided an informed consent were randomly selected from the general population of Chongqing, China. Polymerase chain reaction-restriction fragment length polymorphism and Sanger sequencing genotyping assays were used to determine the MTHFR genotypes. The atherosclerosis index of the intima-media thickness (IMT) was measured by high-resolution ultrasound to evaluate the CAS. Less than 1.0 mm was considered as normal for IMT, 1.0–1.5 mm was considered as thickening, and ≥ 1.5 mm and a local bulge thickened in the lumen was considered as CAS. According to the carotid ultrasonography results, these subjects were divided into two groups: CAS-group (IMT ≥ 1.0 mm) and control group (IMT < 1.0 mm).

Results

The frequency of C/T heterozygotes, T/T homozygotes genotype was significantly higher in the subjects with CAS (62% vs. 36.9%; 16.2% vs. 9.5%; 47.2% vs. 27.9%, P < 0.05), while the frequency of C/C homozygotes and C allele was significantly lower (21.8% vs. 53.7%; 52.8% vs. 72.1%, P < 0.05), when compared to the control group. The risk of CAS was higher for subjects with C/T heterozygotes and T/T homozygotes (OR = 4.06, 95% CI: 2.76–5.98, P < 0.001 and OR = 3.14, 95% CI: 1.73–5.69, P < 0.001, respectively), when compared to the subjects with the C/C genotype. In the model 1 (CT + TT versus CC), C677T/MTHFR was significantly associated with the prevalence of CAS, and the all adjusted OR values for CAS were 3.87 (95% CI, 2.67 to 5.62) in all, 17.18 (95% CI, 7.27 to 40.49) in women and 2.57 (95% CI, 1.65 to 3.99) in men after adjusting for potential confounding factors.

Conclusions

The present study suggests that a mutation in the methylenetetrahydrofolate reductase gene is a risk factor of CAS in the Chinese Han population.
Effectiveness of concomitant use of green tea and polyethylene glycol in bowel preparation for colonoscopy: a randomized controlled study
Authors: Hao Zong , Gong Lifeng , Shen Qiang , Wang Huipeng , Feng Shaowen , Wang Xin , Cai Yuankun , Chen Jun
Published: May 2020

Background

Polyethylene glycol solution (PEG) is widely used for bowel preparation prior to colonoscopies. However, patients often exhibited adverse events as nausea, vomit and distention due to its uncomfortable tastes and potential side affects. This study aimed to evaluate the effectiveness and safety of concomitant use of green tea (GT) with PEG in bowel preparation prior to colonoscopy.

Methods

This was a prospective, randomized controlled study. It was conducted at an outpatient setting of colorectal surgery in a tertiary hospital. Patients aged 18 through 80 who were scheduled to undergo colonoscopy between August 2015 and February 2016 were randomly assigned into two groups, admitting either 2 L-PEG solutions with 1 L GT liquids or 2 L-PEG solutions only for bowel preparation. Admitted doses of PEG solutions, taste evaluation, adverse reactions (nausea and vomiting, distention and abdominal pain) were investigated by questionnaires. The bowel cleanliness of each patient was evaluated according to the Aronchick indicators.

Results

A total of 116 patients were enrolled in this study (PEG+GT 59, PEG 57). Full compliances were achieved in 93.2% patients of group PEG+GT and 59.6% of group PEG (p < 0.001). Mean Aronchick scale between two groups were 2.0 ± 0.9 versus 2.2 ± 0.7 respectively (PEG+GT vs PEG, p = 0.296). Rates of adverse events as nausea and vomiting, abdominal pain in bowel preparation were significantly different between two groups (55.9% vs 77.2%, p = 0.015 and 13.6% vs 33.3%, p = 0.012). Patients in group PEG+GT who have probabilities to receive repeating colonoscopy had a higher willingness to accept PEG+GT again for bowel preparation, compared with PEG group (94.9% vs 57.9%, p < 0.001).

Conclusions

Concomitant use of green tea and polyethylene glycol may effectively reduce incidence of adverse events, increase compliances, with comparable bowel cleanliness in bowel preparation.

Trial registration

This trial was retrospectively registered on Feb 1st, 2019 (ChiCTR1900021178).
Subacute pericardial abscess after aortic valve replacement: a case report
Authors: Magnani Ilenia , Spadotto Alberto , Paolisso Pasquale , Foà Alberto , Savini Carlo , Pacini Davide , Pizzi Carmine , Galiè Nazzareno
Published: May 2020

Background

Purulent pericarditis is an infectious disease, frequently caused by gram-positive bacteria, that is rarely observed in healthy individuals, and is often associated with predisposing conditions.

Case presentation

Here, we present the case of an Escherichia coli post-surgical localized purulent pericarditis complicated by transient constrictive pericarditis and its diagnostic and therapeutic management.

Conclusions

Our case report focuses on the importance of imaging-guided treatment of purulent pericardial diseases, in particular on the emerging role of 18 F-labelled 2-fluoro-2-deoxy-D-glucose Positron Emission Tomography/Computed Tomography in pericardial diseases and on the management of transient constrictive pericarditis, often seen after thoracic surgery.
Low-dose alemtuzumab induction in a tailored immunosuppression protocol for sensitized kidney transplant recipients
Authors: Guthoff Martina , Berger Kilian , Althaus Karina , Mühlbacher Thomas , Bakchoul Tamam , Steurer Wolfgang , Nadalin Silvio , Königsrainer Alfred , Heyne Nils
Published: May 2020

Background

Induction therapy is crucial in kidney transplantation and constitutes an important cornerstone for long-term allograft survival. Alemtuzumab is a depleting CD52-specific antibody with T- and B-cell activity, leading to prolonged lymphocyte depletion for up to 12 months, with profound immunosuppression and an associated risk of serious infections. Current concepts aim to optimize dosing strategies to reduce side effects. Here we present data from an ongoing centre protocol consisting of low-dose alemtuzumab induction and tailored immunosuppression in sensitized patients undergoing kidney transplantation.

Methods

10-year results of the protocol were analysed. Low-dose alemtuzumab induction consisted of a single dose of 20 mg intraoperatively, followed by tacrolimus and corticosteroids for initial immunosuppression, with mycophenolate mofetil suspended until a total lymphocyte count (TLC) >5% or 200/μl was reached.

Results

Between 01/2007 and 04/2017, 46 patients were treated in accordance with the protocol in 48 kidney transplantations. Median PRAmaxwas 43 [22-76; IQR] %; all patients had negative CDC-crossmatch prior to transplantation. Low-dose alemtuzumab was well tolerated. Median time to TLC recovery was 77 [62-127; IQR] d. Within a median follow-up of 3.3 [1.5-5.6; IQR] years, 12 (25%) patients developed BPAR, 10 of which were antibody-mediated (3 acute, 7 chronic ABMR). Death-censored 5-year allograft survival was 79.2%, with an excellent allograft function at the end of follow-up. There was no increased rate of infections, in particular viral infections.

Conclusions

Our protocol, comprising low-dose alemtuzumab induction, initial suspension of mycophenolate mofetil and triple maintenance immunosuppression, provides excellent patient and allograft outcome in sensitized renal allograft recipients.
Intrathecal blood injection: a case report of a rare complication of an epidural blood patch
Authors: Seemiller Joseph , Challagundla Sankeerth , Taylor Travis , Zand Ramin
Published: May 2020

Background

Intrathecal injection is a rare complication of spinal anesthesia and an underreported complication of epidural blood patches. Although there are other reported cases of intrathecal blood injection, these cases lack confirmatory imaging and others report injection of mixed blood with other agents.

Case presentation

We present a case report of post-laminectomy cerebrospinal fluid leak who underwent epidural blood patch placement. CT and MRI brain imaging was obtained, depicting intrathecal blood products. The patient had subsequent seizures and respiratory distress, received supportive care, and returned to baseline after several days.

Conclusion

The patient’s clinical course illustrates the potential complications of blood products within CSF, including seizures and respiratory distress, which improved with supportive care in this case. Importantly, to our knowledge, this is the only report that clearly depicts injection of purely blood products, without other confounding agents (such as gadolinium), into intrathecal space and with diffuse spread through the CSF as visualized on CT and MRI imaging.
Pisa syndrome induced by switching of a choline-esterase inhibitor treatment from donepezil to galantamine: a case report
Authors: Mimura Yu , Kurose Shin , Takata Taketo , Tabuchi Hajime , Mimura Masaru , Funayama Michitaka
Published: May 2020

Background

Pisa syndrome (PS) is characterized by an abnormally sustained posture, with flexion of the body and head to one side and slight rotation of the trunk. Although PS most commonly arises as an adverse effect of antipsychotic drugs, choline-esterase inhibitors (ChEIs) are also sometimes known to induce PS. Despite the fact that the precise mechanism remains unclear, cholinergic-dopaminergic imbalance has been considered as a possible pathophysiologic mechanism underlying the genesis of PS.

Case presentation

We hereby report the case of a 60-year-old woman with Alzheimer’s disease who presented with the signs of PS after her treatment was switched to galantamine, a type of ChEI, even though she had received donepezil, another type of ChEI, for 5 years without any complications. To the best of our knowledge, this is the first report of PS associated with treatment switch from one to another type of ChEI. Galantamine, but not other ChEIs, can enhance striatal dopamine release through allosteric modulation of the nicotinic acetylcholine receptor, and has weaker muscarinic effects than donepezil. Therefore, we propose two novel hypotheses to explain the development of PS, as follows; galantamine, which enhances dopamine release, can induce imbalance of dopamine levels in the striatum of patients with dementia, resulting in PS, and the weaker muscarinic effects of the drug could be one of the factors predisposing to the development of PS.

Conclusion

The present case suggests that treatment with galantamine is associated with a higher risk of development of PS than that with other ChEIs, such as donepezil, despite the pharmacological profile of galantamine as a dopamine modulator. Also, this report provides novel insight into another plausible mechanism underlying the development of PS, besides cholinergic-dopaminergic imbalance, namely, dopamine imbalance in the striatum with muscarinic-nicotinic imbalance.
The effect of hyoscine n- butylbromide on labor progress: A systematic review
Authors: Mohaghegh Zaynab , Abedi Parvin , Faal Shahla , Jahanfar Shayesteh , Surdock Alayna , Sharifipour Foruzan , Zahedian Maryam
Published: May 2020

Background

The objective of this systematic review and meta-analysis was to assess the effectiveness of hyoscine n-butylbromide in labor progress.

Methods

The databases including PubMed, the Cochrane Library, Science-Direct, Scopus and Web of Science were searched for studies published up to December 2019. Articles that published as randomized controlled trials (RCTs), and full-text articles published in English or other languages were included and participants were primi or multigravida women who were in active phase of labor. The intervention included HBB compared to placebo (normal saline) that was used during active phase of labor. Pooled estimates were measured using the fixed or random effect model, while the overall effect was reported in a mean difference (MD). All data were analyzed using Review Manager 5.3.

Results

Twenty studies involving 3108 women were included in meta-analysis. Based on subgroup analysis by parity, use of HBB significantly reduced the duration of the first stage of labor in primigravida women (MD = − 57.73; 95% CI: [− 61.48, − 53.60]) and in multigravida women (MD = − 90.74; 95% CI: [− 97.24, − 84.24]). Administering HBB could reduce the second stages of labor in primigravidas and multigravidas about 6 min and 4 min respectively. Also, HBB reduced the duration of the third stage of labor in multigravidas about 3 min. APGAR score at one and 5 min after birth was not affected. The main maternal adverse effect was tachycardia and dry mouth. Labor duration in studies in which the participants were primi-and multigravida was not presented based on separate parities except for four papers, and the route of HBB administration was not the same across all studies.

Conclusions

Although, the effect of HBB was minimal when multigravidas and primigravidas women were considered together, the HBB was clinically effective in primigravida and multigravida women for shortening the first and the second stages of labor. Also, HBB could reduce the length of the third stage of labor in multigravidas.
Role of the initial degree of anaemia and treatment model in the prognosis of gastric cancer patients treated by chemotherapy: a retrospective analysis
Authors: Li Wen-Huan , Zhang Ji-Yu , Liu Wen-Hui , Chen Xian-Xian
Published: May 2020

Background

Anaemia is highly prevalent in gastric cancer (GC) patients. The role of initial haemoglobin levels in predicting the prognosis of GC patients treated by chemotherapy has not been well determined. Our present study aims to evaluate the relationship between the degree of anaemia and the overall survival (OS) and progression-free survival (PFS) of patients with GC.

Methods

Our retrospective study enrolled 598 patients who were treated with chemotherapy when the recurrent or metastatic GCs were unsuitable for surgical resection. Univariate and multivariate analyses were performed to identify risk factors that had the potential to affect patient prognosis. Additionally, the relationship between clinicopathological characteristics, including treatment method, and degree of cancer-related reduction in haemoglobin was further analysed.

Results

Our results revealed that patients with HBini level ≤ 80 g/L had a trend toward a shortened median OS and PFS (p = 0.009 and p = 0.049, respectively). Interestingly, we also found that HBdec ≥ 30 g/L was associated with a significantly shortened median OS and PFS (p = 0.039 and p = 0.001, respectively). Multivariate analysis showed that HBini levels ≤80 g/L could be used as an independent prognostic factor for recurrent and metastatic GC. More importantly, HBdec ≥ 30 g/L and treatment response were also significantly associated with OS and PFS. Furthermore, the degree of haemoglobin decrease was associated with chemotherapy including platinum and the number of chemotherapy cycles.

Conclusion

Our study concludes that the initial degree of anaemia and a decrease in haemoglobin of ≥30 g/L can serve as biomarkers to predict prognosis in recurrent or metastatic GC patients, while chemotherapy treatment rather than red blood cell (RBC) transfusion can improve their prognosis. Additionally, platinum should not be recommended for treating severely anaemic GC patients.
Dynamic alterations of genome and transcriptome in KRAS G13D mutant CRC PDX model treated with cetuximab
Authors: Zhang Hangyu , Yuan Liyun , Liu Lulu , Yan Cong , Cheng Jinming , Fu Qihan , Tong Zhou , Jiang Weiqin , Zheng Yi , Zhao Peng , Zhang Guoqing , Fang Weijia
Published: May 2020

Background

KRAS mutations have been characterized as the major predictive biomarkers for resistance to cetuximab treatment. However, studies indicate that not all KRAS mutations are associated with equivalent treatment outcomes. KRAS G13D mutations were observed to account for approximately 16% of all KRAS mutations in advanced colorectal cancer patients, and whether these patients can benefit from cetuximab has not been determined.

Methods

An established KRAS G13D mutant colorectal cancer (CRC) patient-derived xenograft (PDX) model was treated with cetuximab. After repeated use of cetuximab, treatment-resistant PDX models were established. Tissue samples were collected before and during treatment, and multiomics data were subsequently sequenced and processed, including whole-exome, mRNA and miRNA data, to explore potential dynamic changes.

Results

Cetuximab treatment initially slowed tumor growth, but resistance developed not long after treatment. WES (whole-exome sequencing) and RNA sequencing found that 145 genes had low P values (< 0.01) when analyzed between the locus genotype and its related gene expression level. Among these genes, SWAP70 was believed to be a probable cause of acquired resistance. JAK2, PRKAA1, FGFR2 and RALBP1, as well as 10 filtered immune-related genes, also exhibited dynamic changes during the treatment.

Conclusions

Cetuximab may be effective in KRAS G13D mutation patients. Dynamic changes in transcription, as determined by WES and RNA sequencing, occurred after repeated drug exposure, and these changes were believed to be the most likely cause of drug resistance.
Novel methods for in vitro modeling of pancreatic cancer reveal important aspects for successful primary cell culture
Authors: Ehlen L. , Arndt J. , Treue D. , Bischoff P. , Loch F. N. , Hahn E. M. , Kotsch K. , Klauschen F. , Beyer K. , Margonis G. A. , Kreis M. E. , Kamphues C.
Published: May 2020

Background

Pancreatic cancer remains a fatal disease. Experimental systems are needed for personalized treatment strategies, drug testing and to further understand tumor biology. Cell cultures can serve as an excellent preclinical platform, but their generation remains challenging.

Methods

Tumor cells from surgically removed pancreatic ductal adenocarcinoma (PDAC) specimens were cultured under novel protocols. Cellular growth and composition were analyzed and culture conditions were continuously optimized. Characterization of cell cultures and primary tumors was performed via hematoxylin and eosin (HE) and immunofluorescence (IF) staining.

Results

Protocols for two- and three-dimensional PDAC primary cell cultures could successfully be established. Primary cell culture depended on dissociation techniques, growth factor supplementation and extracellular matrix components containing Matrigel being crucial for the transformation to three-dimensional PDAC organoids. The generated cultures showed to be highly resemblant to established PDAC primary cell cultures. HE and IF staining for cell culture and corresponding primary tumor characterization could successfully be performed.

Conclusions

The work presented herein shows novel and effective methods to successfully establish primary PDAC cell cultures in a distinct time frame. Factors contributing to cell growth and differentiation could be identified with important implications for further primary cell culture protocols. The established protocols might serve as novel tools in personalized tumor therapy.