bluuebunny/crossref_metadata_2025 huggingface dataset:
Dentin tubule obturation of a bioglass-based dentin desensitizer under repeated exposure to lactid acid and brushing
Authors: Manz Andrea S. , Attin Thomas , Sener Beatrice , Sahrmann Philipp
Published: December 2019

Background

Dentin hypersensitivity is a frequent finding especially in periodontitis patients. Conventional treatment aims for obstruction of dentin tubules by disabling liquid and osmotic fluctuation to and from the pulpal chamber. A novel bioglass-based desensitizer was shown to obstruct tubules and to resist periodic exposure to lactic acid. Whether this obstruction is resistant to brushing had not been tested so far. Accordingly, the present study aimed to assess dentin tubule obstruction after repeated acid exposure and brushing.

Methods

Sixty dentin discs were cleaned with 17% EDTA, mounted into a pulp fluid simulator and randomly divided into 3 groups: No surface treatment in Group A, Seal&Protect® in group B and DentinoCer in group C. Discs were exposed to 0.1 M non-saturated lactic acid thrice and standardized brushing twice a day for 12 days. At baseline and after 2, 4 and 12 d samples were removed from the setting and prepared for top-view SEM analysis to assess tubule obstruction using the Olley score. Discs were then vertically cut and the section surface morphologically assessed using backscatter imaging. For both vertical and sectional surfaces EDX analysis was used to characterize the surface composition in the tubular and inter-tubular area.

Results

Group A showed clean tubular lumina at all time points. From day 2 onwards dentin showed exposed collagen fibers. Group 2 initially showed a complete surface coverage that flattened out during treatment without ever exposing tubules. At baseline, samples of Group C displayed a complete homogeneous coverage. From day 2 on tubules entrances with obstructed lumen became visible. While on day 4 and 12 the dentin surface exposed collagen fibers the lumina remained closed. EDX analysis of the vertical and horizontal views showed that P and Ca were predominant elements in both the inter- and tubular dentin while Si peaks were found in the tubule plugs.

Conclusion

While group B displayed a packed layer on the surface during the whole investigation time group C samples lost their superficial layer within 48 h. Tubule plugs containing considerable Si proportions indicated previous presence of DentinoCer, while high Ca and P proportions suggest obturation by dentin-like material.
Continuous low flow ascites drainage through the urinary bladder via the Alfapump system in palliative patients with malignant ascites
Authors: Fotopoulou Christina , Berg Thomas , Hausen Annekristin , Hennig René , Jalan Rajiv , Malagó Massimo , Capel Jeroen , De Gottardi Andrea , Stirnimann Guido
Published: December 2019

Background

Malignant Ascites (MA) is a therapeutic dilemma significantly impairing patients’ quality of life (QoL). The Sequana Medical alfapump System (AP), a subcutaneous, externally rechargeable, implantable device, continually draining ascites via the urinary bladder, has been well established in liver cirrhosis, but not yet in MA. The AP-system was evaluated in cancer patients in reducing the need for large volume paracentesis (LVP).

Methods

A retrospective multicentre evaluation of all eligible patients who received an AP for MA-palliation was performed. AP was evaluated for its ability to reduce LVP and cross-correlated with adverse events (AE), survival and retrospective physician-reported QoL.

Results

Seventeen patients with median age of 63 years (range: 18–81), 70.6% female, across 7 primary tumour types were analysed. Median duration of AP-implantation was 60 min (range: 30–270) and median post-implantation hospital stay: 4 days (range: 2–24). Twelve protocol-defined AE occurred in 5 patients (29.4%): 4 kidney failures, 4 pump/catheter-related blockages, 3 infections/peritonitis and 1 wound dehiscence. Median ascitic volume (AV) pumped daily was 303.6 ml/day (range:5.6–989.3) and median total AV drained was 28 L (range: 1–638.6). Median patient post-AP-survival was 111 days (range:10–715) and median pump survival was 89 days (range: 0–715). Median number of paracenteses was 4 (range: 1–15) per patient pre-implant versus 1 (range: 0–1) post-implant (p = 0.005). 71% of patients were reported to have an improvement of at least one physician reported QoL-parameters.

Conclusions

AP appears to be effective in palliating patients with MA by an acceptable morbidity profile. Its broader implementation in oncology services should be further explored.

Trial registration

NCT03200106; June 27, 2017.
Ethno-pharmacological survey of herbal remedies used in the treatment of paediatric diseases in Buhunga parish, Rukungiri District, Uganda
Authors: Tugume Patience , Nyakoojo Clement
Published: December 2019

Background

Plants have been used as a primary source of medicine since ancient times and about 80% of the world’s population use herbal medicine to treat different ailments. Plant use knowledge differs in space and time and thus requires documentation to avoid its loss from one generation to another.

Methods

In order to accomplish the survey, semi-structured questionnaires were used. The data collected included names of plant species, parts used, ailments treated, growth habit, methods of preparation and mode of administration of the herbal remedies. Descriptive statistics were used to present the data in form of tables and a graph.

Results

Results showed that 50 plant species belonging to 26 families were utilized in the treatment of paediatric diseases of which Asteraceae and Lamiaceae were the most common. Leaves (80%) were the most commonly used and decoctions were the main method of preparation. Twenty nine health conditions were treated out of which digestive disorders, malaria and respiratory tract infections were predominant. Herbs and shrubs were equally dominant.

Conclusion

Herbal remedies are an important source of treatment for paediatric diseases in Buhunga Parish. However, there is need for collaboration between herbal medicine users and scientific institutions to help in the discovery of new drugs based on indigenous knowledge. Scientists ought to explore suitable methods of preparation and dosage formulations in order to achieve the best benefits from herbal remedies.
Effects of fish oil supplement on psoriasis: a meta-analysis of randomized controlled trials
Authors: Yang Shih-Jyun , Chi Ching-Chi
Published: December 2019

Background

Fish oils, which contain omega-3 polyunsaturated fatty acids as the active ingredients, possess anti-inflammatory activities and may have therapeutic potential in diseases with an inflammatory etiology. Fish oil supplement has been advocated for treating psoriasis which is a chronic inflammatory dermatosis.

Objective

We aimed to investigate the effects of fish oil supplement on psoriasis.

Methods

We searched CENTRAL, Embase and MEDLINE on 24 January 2018 for randomized control trials (RCTs) on the effects of fish oil supplement in treating psoriasis. The Cochrane Collaboration’s tool was used to assess the risk of bias of included RCTs. We performed a random-effects model meta-analysis to obtain the pooled treatment effect estimates.

Results

We included 13 RCTs with 625 participants. Three RCTs involving 337 participants provided usable data for meta-analysis. Fish oil supplement did not significantly reduce the severity of psoriasis when assessed by Psoriasis Area and Severity Index score (mean difference − 0.28; 95% confidence interval − 1.74 to 1.19).

Conclusion

The current evidence does not support the use of fish oil supplement in treating psoriasis.
Teacher questions and student responses in case-based learning: outcomes of a video study in medical education
Authors: Gartmeier Martin , Pfurtscheller Theresa , Hapfelmeier Alexander , Grünewald Marc , Häusler Janina , Seidel Tina , Berberat Pascal O.
Published: December 2019

Background

Case-based learning (CBL) is a highly interactive instructional format widely used in medical education. One goal of CBL is to integrate basic biomedical knowledge and its application to concrete patient cases and their clinical management. In this context, we focus the role of teacher questions as triggers for reproductive vs. elaborative student responses. Specifically, our research questions concern the kinds of questions posed by clinical teachers, the kinds of responses given by students, the prediction of student responses based upon teacher questions, and the differences between the two medical disciplines in focus of our study, internal medicine and surgery.

Methods

We analyse 19 videotaped seminars (nine internal medicine, ten surgery) taught by clinicians and attended by advanced medical students. Multiple raters performed a low-inference rating process using a theory-based categorical scheme with satisfactory interrater-reliability.

Results

We found that medical teachers mostly posed initial (instead of follow-up) questions and that their questions were more often closed (instead of open). Also, more reasoning (than reproductive) questions were posed. A high rate of student non-response was observed while elaborative and reproductive student responses had a similar prevalence. In the prediction context, follow-up reasoning questions were associated with low non-response and many elaborative answers. In contrast, the highest student non-response rate followed open reproduction questions and initial reasoning questions. Most reproductive statements by students were made following closed reproduction questions.

Conclusions

These results deepen our understanding of interactive, questions-driven medical teaching and provide an empirical basis for clinical teachers to use questions in didactically fruitful ways.
Reporting of ethical approval and informed consent in clinical research published in leading nursing journals: a retrospective observational study
Authors: Wu Yanni , Howarth Michelle , Zhou Chunlan , Hu Mingyu , Cong Weilian
Published: December 2019

Background

Ethical considerations play a prominent role in the protection of human subjects in clinical research. To date the disclosure of ethical protection in clinical research published in the international nursing journals has not been explored. Our research objective was to investigate the reporting of ethical approval and informed consent in clinical research published in leading international nursing journals.

Methods

This is a retrospective observational study. All clinical research published in the five leading international nursing journals from the SCI Journal Citation Reports between 2015 and 2017 were retrieved to evaluate for evidence of ethical review.

Results

A total of 2041 citations have been identified from the contents of all the five leading nursing journals that were published between 2015 and 2017. Out of these, 1284 clinical studies have been included and text relating to ethical review has been extracted. From these, most of prospective clinical studies (87.5%) discussed informed consent. Only half of those (52.9%) reported that written informed consent had been obtained; few (3.6%) reported oral consent, and few (6.8%) used other methods such as online consent or completion and return of data collection (such as surveys) to denote assent. Notably, 36.2% of those did not describe the method used to obtain informed consent and merely described that “consent was obtained from participants or participants agreed to join in the research”. Furthermore, whilst most of clinical studies (93.7%) mentioned ethical approval; 92.5% of those stated the name of ethical committee and interestingly, only 37.1% of those mentioned the ethical approval reference. The rates of reporting ethical approval were different between different study type, country, and whether financial support was received (all P < 0.05).

Conclusion

The reporting of ethics in leading international nursing journals demonstrates progress, but improvement of the transparency and the standard of ethical reporting in nursing clinical research is required.
Improving reference prioritisation with PICO recognition
Authors: Brockmeier Austin J. , Ju Meizhi , Przybyła Piotr , Ananiadou Sophia
Published: December 2019

Background

Machine learning can assist with multiple tasks during systematic reviews to facilitate the rapid retrieval of relevant references during screening and to identify and extract information relevant to the study characteristics, which include the PICO elements of patient/population, intervention, comparator, and outcomes. The latter requires techniques for identifying and categorising fragments of text, known as named entity recognition.

Methods

A publicly available corpus of PICO annotations on biomedical abstracts is used to train a named entity recognition model, which is implemented as a recurrent neural network. This model is then applied to a separate collection of abstracts for references from systematic reviews within biomedical and health domains. The occurrences of words tagged in the context of specific PICO contexts are used as additional features for a relevancy classification model. Simulations of the machine learning-assisted screening are used to evaluate the work saved by the relevancy model with and without the PICO features. Chi-squared and statistical significance of positive predicted values are used to identify words that are more indicative of relevancy within PICO contexts.

Results

Inclusion of PICO features improves the performance metric on 15 of the 20 collections, with substantial gains on certain systematic reviews. Examples of words whose PICO context are more precise can explain this increase.

Conclusions

Words within PICO tagged segments in abstracts are predictive features for determining inclusion. Combining PICO annotation model into the relevancy classification pipeline is a promising approach. The annotations may be useful on their own to aid users in pinpointing necessary information for data extraction, or to facilitate semantic search.
Exploring the experiences of being an ethnic minority student within undergraduate nurse education: a qualitative study
Authors: Flateland Sylvi Monika , Pryce-Miller Maxine , Skisland Anne Valen-Sendstad , Tønsberg Anne Flaatten , Söderhamn Ulrika
Published: December 2019

Background

Students studying in a country where another language is spoken face multiple challenges including their ability to fully integrate with peers and academic pressures in trying to obtain an undergraduate nursing degree. The aim of the study was to explore the lived experiences of students, from varying cultural and ethnic backgrounds, undertaking an undergraduate nursing degree.

Methods

The study adopted a qualitative design and eight individual semi-structured interviews were conducted. The interviews were analysed using manifest content analysis according to Graneheim and Lundman.

Results

Students reported feelings of isolation and the lack of opportunities to integrate with native students within academia and practice. The need for personal support was a crucial factor that was independent of gender and students reported challenges related to both language and culture during the programme.

Conclusions

Suggestions arising from this study includes appropriate support systems within academia and practice. It is imperative that universities and practice settings promote and integrate cultural awareness within academia and practice in meeting the needs of students and providing culturally appropriate nursing care, thereby providing opportunities for all students to become competent and professional practitioners.
Factors associated with readmissions in women participating in screening programs and treated for breast cancer: a retrospective cohort study
Authors: Miret Carme , Domingo Laia , Louro Javier , Barata Teresa , Baré Marisa , Ferrer Joana , Carmona-García Maria Carmen , Castells Xavier , Sala Maria
Published: December 2019

Background

We aimed to identify the risk factors associated with early, late and long-term readmissions in women diagnosed with breast cancer participating in screening programs.

Methods

We performed a multicenter cohort study of 1055 women aged 50–69 years participating in Spanish screening programs, diagnosed with breast cancer between 2000 and 2009, and followed up to 2014. Readmission was defined as a hospital admission related to the disease and/or treatment complications, and was classified as early (< 30 days), late (30 days-1 year), or long-term readmission (> 1 year). We used logistic regression to estimate the adjusted odds ratios (aOR), and 95% confidence intervals (95% CI) to explore the factors associated with early, late and long-term readmissions, adjusting by women’s and tumor characteristics, detection mode, treatments received, and surgical and medical complications.

Results

Among the women included, early readmission occurred in 76 (7.2%), late readmission in 87 (8.2%), long-term readmission in 71 (6.7%), and no readmission in 821 (77.8%). Surgical complications were associated with an increased risk of early readmissions (aOR = 3.62; 95%CI: 1.27–10.29), and medical complications with late readmissions (aOR = 8.72; 95%CI: 2.83–26.86) and long-term readmissions (aOR = 4.79; 95%CI: 1.41–16.31).

Conclusion

Our results suggest that the presence of surgical or medical complications increases readmission risk, taking into account the detection mode and treatments received. Identifying early complications related to an increased risk of readmission could be useful to adapt the management of patients and reduce further readmissions.

Trial Registration

ClinicalTrials.govIdentifier: NCT03165006. Registration date: May 22, 2017 (Retrospectively registered).
Resurgence of malaria infection after mass treatment: a simulation study
Authors: Smith Thomas A. , Pemberton-Ross Peter , Penny Melissa A. , Chitnis Nakul
Published: December 2019

Background

Field studies are evaluating if mass drug administration (MDA) might shorten the time to elimination of Plasmodium falciparum malaria, when vector control measures and reactive surveillance strategies are scaled-up. A concern with this strategy is that there may be resurgence of transmission following MDA.

Methods

A conceptual model was developed to classify possible outcomes of an initial period of MDA, followed by continuously implementing other interventions. The classification considered whether elimination or a new endemic stable state is achieved, and whether changes are rapid, transient, or gradual. These categories were informed by stability analyses of simple models of vector control, case management, and test-and-treat interventions. Individual-based stochastic models of malaria transmission (OpenMalaria) were then used to estimate the probability and likely rates of resurgence in realistic settings. Effects of concurrent interventions, including routine case management and test-and-treat strategies were investigated.

Results

Analysis of the conceptual models suggest resurgence will occur after MDA unless transmission potential is very low, or the post-MDA prevalence falls below a threshold, which depends on both transmission potential and on the induction of bistability. Importation rates are important only when this threshold is very low. In most OpenMalaria simulations the approximately stable state achieved at the end of the simulations was independent of inclusion of MDA and the final state was unaffected by importation of infections at plausible rates. Elimination occurred only with high effective coverage of case management, low initial prevalence, and high intensity test-and-treat. High coverage of case management but not by test-and-treat induced bistability. Where resurgence occurred, its rate depended mainly on transmission potential (not treatment rates).

Conclusions

A short burst of high impact MDA is likely to be followed by resurgence. To avert resurgence, concomitant interventions need either to substantially reduce average transmission potential or to be differentially effective in averting or clearing infections at low prevalence. Case management at high effective coverage has this differential effect, and should suffice to avert resurgence caused by imported cases at plausible rates of importation. Once resurgence occurs, its rate depends mainly on transmission potential, not on treatment strategies.
Does migrant background predict to what extent colorectal cancer patients want to be informed about their life expectancy? – a cross-sectional analysis
Authors: Leonhardt Marja , Aschenbrenner Katja , Kreis Martin E. , Lauscher Johannes C.
Published: December 2019

Background

Although migrant health is a topic of interest across Europe and although health care services in Germany consider migrant health issues, people with a migrant background often experience difficulties regarding health care provision. The prevalence of various cancers among migrants is lower relative to non-migrants although this equalizes with increasing duration of residence. There are documented differences in health behavior and disease-coping strategies between migrants and non-migrants, but data are scarce on this subject. This analysis investigates the extent of information migrant and non-migrant colorectal cancer (CRC) patients in Germany want about their life expectancy and the level of trust they have in their treating physician.

Method

Data from 522 CRC patients were collected through a self-reported questionnaire. Migrant background was determined by the patients’ and/or their parents’ birthplace. Bivariate analyses were applied to determine the differences between migrants and non-migrants. A multivariate analysis was used to measure the effect of migration background, demographics, and cancer stage and treatment on the preferred extent of information about life expectancy and trust in their treating physician.

Results

There were no significant differences regarding demographics or cancer stage and treatment between migrant and non-migrant CRC patients. Having a migrant background had no influence on the level of trust in the treating physician, but migrants preferred to be less informed about their life expectancy than non-migrants (21.4% vs. 13.4%, p = 0.04). The multivariate analysis showed that men (aOR = 2.102, CI: 1.123–3.932) and patients with a non-migrant background (aOR = 5.03, CI: 1.02–24.73) preferred receiving information about the approximate value of their life expectancy, rather than receiving no information.

Conclusion

The study found more similarities than discrepancies between migrant and non-migrant CRC patients regarding demographic factors and stage of disease and treatment, which may be a consequence of an increasingly homogeneous cross-cultural society. However, cultural differences between the minority and host population remain and should always be taken into account in daily clinical practice and in the communication skills training of health care professionals. The study also indicates that recording migration background into health registers would facilitate migrant-sensitive research.
Multiplex ligation reaction based on probe melting curve analysis: a pragmatic approach for the identification of 30 common Salmonella serovars
Authors: Zuo Le , Jiang Min , Jiang Yixiang , Shi Xiaolu , Li Yinghui , Lin Yiman , Qiu Yaqun , Deng Yinhua , Li Minxu , Lin Zeren , Liao Yiqun , Xie Jianbin , Li Qingge , Hu Qinghua
Published: December 2019

Background

While Salmonella serotyping is of paramount importance for the disease intervention of salmonellosis, a fast and easy-to-operate molecular serotyping solution remains elusive. We have developed a multiplex ligation reaction based on probe melting curve analysis (MLMA) for the identification of 30 common Salmonella serovars.

Methods

Serovar-specific primers and probes were designed based on a comparison of gene targets (wzx and wzy encoding for somatic antigen biosynthesis; fliC and fljB for flagellar antigens) from 5868 Salmonella genomes. The ssaR gene, a type III secretion system component, was included for the confirmation of Salmonella.

Results

All gene targets were detected and gave expected Tm values during assay evaluation. Cross reactions were not demonstrated between the 30 serovars (n = 211), or with an additional 120 serovars (n = 120) and other Enterobacteriaceae (n = 3). The limit of identification for all targets ranged from using 1.2 ng/μL to 1.56 ng/μL of DNA. The intra- and inter-assay standard deviations and the coefficients of variation were no more than 0.5 °C and less than 1% respectively, indicating high reproducibility. From consecutive outpatient stool samples (n = 3590) collected over a 10-month period at 11 sentinel hospitals in Shenzhen, China, we conducted a multicenter study using the traditional Salmonella identification workflow and the MLMA assay workflow in parallel. From Salmonella isolates (n = 496, 13.8%) derived by both workflows, total agreement (kappa = 1.0) between the MLMA assay and conventional serotyping was demonstrated.

Conclusions

With an assay time of 2.5 h, this simple assay has shown promising potential to provide rapid and high-throughput identification of Salmonella serovars for clinical and public health laboratories to facilitate timely surveillance of salmonellosis.
Target genes associated with lipid and glucose metabolism in non-alcoholic fatty liver disease
Authors: Li Ting , Yan Hua , Geng Yan , Shi Haitao , Li Hong , Wang Shenhao , Wang Yatao , Xu Jingyuan , Zhao Gang , Lu Xiaolan
Published: December 2019

Background

Insulin resistance (IR) and lipid peroxidation are accepted as ‘two-hit’ hypothesis of Non-alcoholic fatty liver disease (NAFLD). However, there are few published research on identifying genes which connect lipid and glucose metabolism by gene microarray.

Objective

To identify target genes related to lipid and glucose metabolism that might be responsible for the pathogenesis of NAFLD.

Methods

A rat model of NAFLD was established by feeding male rats with high-fat diet and gene expression profiles of liver tissues were determined using Agilent DNA microarray. We then investigated differentially expressed genes (DEGs) and intersection of them by using Gene Ontology (GO) and Pathway Analyses. Target genes were verified by Real-time polymerase chain reaction (RT-PCR).

Results

Compared with control, 932 genes, including 783 up-regulated and 149 down-regulated, exhibited differences in expression. The up-regulated genes were involved in biosynthesis, cell development, cell differentiation and down-regulated genes contributed to biological metabolic process, adipokine metabolic pathway and insulin signaling pathway. We identified genes involved in insulin signaling pathway, Notch signaling pathway and lipid synthetic process to be closely related to liver fat accumulation and insulin resistance. Among them, IGFBP7, Notch1 and HMGCR were up-regulated (2.85-fold, 3.22-fold, and 2.06-fold, respectively, all P < 0.05) and ACACB was down-regulated (2.08-fold, P < 0.01). These four genes supposed to connect lipid and glucose metabolism after GO and Pathway analyses.

Conclusions

These findings provide innovative information on the whole genome expression profile due to high-fat diet feeding, and bring new insight into the regulating effects of genes on the lipid and glucose metabolism of NAFLD.
Diabetes in women and health-related quality of life in the whole family: a structural equation modeling
Authors: Moeineslam Mina , Amiri Parisa , Karimi Mehrdad , Jalali-Farahani Sara , Shiva Niloofar , Azizi Fereidoun
Published: December 2019

Background

Although several studies indicate the effects of diabetes type 2 on health-related quality of life (HRQoL) in female subjects, the related impact of the disease on HRQoL in their family members has rarely been the focus of the empirical research. In this study we aim to investigate associations between diabetes in women and the HRQoL in these women and their family members, using the structural equation modeling (SEM).

Methods

This family-based study was conducted on 794 women (11.1% with diabetes) as well as their spouses and children who participated in the Tehran Lipid and Glucose Study (TLGS) from 2014 to 2016. Data on HRQoL were collected using the Iranian version of the Short-Form 12-Item Health Survey version 2 (SF-12v2) and the Pediatric Quality of Life Inventory version™ 4.0 (PedsQL). SEM was conducted to evaluate the network of associations among studied variables. Data were analyzed using IBM SPSS Statistics & AMOS version 23 software.

Results

Mean age of women was 41.37 ± 5.32 years. Diabetes in women significantly affected their mental HRQoL (β = − 0.11, P < 0.01) but showed no significant direct associations with physical and mental HRQoL in their spouses or their children. However, poor mental HRQoL in women with diabetes was associated with decrease in both physical (β = − 0.02, P = 0.013) and mental (β = − 0.03, P < 0.01) HRQoL in their spouses and total HRQoL score in children (β = − 0.02, P < 0.01).

Conclusions

Among women with diabetes type 2, beyond its effect on their mental HRQoL per se, demonstrated a negative association with the self-assessment of health status in their spouses and children. Such familial consequences are mainly attributed to the negative effect of the disease on the mental rather than the physical HRQoL in women with diabetes.
The impact of follicle-flushing during oocyte collection on embryo development of in-vitro fertilization
Authors: Zhu Li-hua , Ni Xiao-bei , Lin Fei , Xu Zhi-peng , Fang Jun-shun , Zhang Ning-yuan
Published: December 2019

Background

To evaluate the impact of follicle-flushing during oocyte collection on embryo development potential retrospectively.

Methods

A total of 1714 cases, including 133 who experienced retrieval difficulty (repeated follicle-flushing) on the day of oocyte retrieval (difficulty group) and the control 1581 cases (control group), were assessed in this retrospective study. The number of oocytes recovered, two pro-nuclei fertilization (2PN-fertilization), day 3 good-quality embryo and day 5/6 blastocyst utilization rates were compared between the difficulty group and control group correspondingly. Embryo implantation, clinical pregnancy and neonatal outcomes were further analyzed between the two groups in the fresh day− 3 embryo transfer cycles.

Results

The number of oocytes recovered in the difficulty group (9.08 ± 4.65) were significantly reduced compared with the control group (12.13 ± 5.27),P < 0.001; The 2PN-fertilization, day 3 good-quality embryo and blastocyst utilization rates were significantly lower in the difficulty group compared with controls (71.7% vs. 75.7%; 52.7% vs. 56.5%; 31.9% vs. 37.0%, all P < 0.05). Embryo implantation in the difficulty group was 53.2%, which was lower than the control value of 58.7%, although not reaching statistical significance. The rate of fresh embryo transfer cycles in the difficulty group was lower than normal ones (51.88% vs. 61.99%, P = 0.026). The pregnancy and live birth rates were similar between the two groups. But the rate of spontaneous miscarriages of the difficulty group was higher than the control group, although not reaching statistical significance. The neonatal outcomes had no statistical difference between the two groups.

Conclusions

Oocyte retrieval difficulty, which include repeated flushing and the corresponded extending time required for oocyte recovery, significantly reduced day 3 good-quality embryo and blastocyst utilization rates of these patients. But the live birth rate had no difference between the difficulty group and the normal ones.
Health promoter, advocate, legitimiser — the many roles of WHO guidelines: a qualitative study
Authors: Wang Zhicheng , Grundy Quinn , Parker Lisa , Bero Lisa
Published: December 2019

Background

Properly implemented evidence-based clinical and public health guidelines can improve patient outcomes. WHO has been a major contributor to guideline development, publishing more than 250 guidelines on various topics since 2008. However, well-developed guidelines can only be effective if they are adequately and appropriately implemented. Herein, we aimed to explore whether and how WHO guidelines are implemented in local contexts to inform the success of future guideline implementation.

Methods

Seventeen interviews were carried out between March 2018 and December 2018 with WHO guideline developers, headquarter staff, and regional and country office staff. Participants were purposely sampled from a variety of WHO guidelines and snowball sampling was used to identify regional and country office staff. The deidentified transcripts were analysed through three phases of coding, using grounded theory as the analytic approach.

Results

WHO guidelines played a variety of roles in the work of WHO at all levels. WHO officers and local government officials used WHO guidelines to influence health policy. We categorised the uses of guidelines as (1) directly changing policy, (2) justifying policy change, (3) engaging stakeholders, (4) being guarantors of legitimacy, (5) being advocacy tools, and (6) intertwining with WHO’s various roles. Participants refuted the perception of the guidelines as mere lists of technical recommendations that needed to be implemented in different contexts. We found that the existence, quality and credibility, rather than the content of the guidelines, are the keys to health policy change initiatives in different local contexts.

Conclusions

Used as a guarantor of legitimacy by policy-makers, WHO guidelines can be better positioned to influence health policy and practice change. Understanding the various roles of guidelines can help WHO developers package guidelines to optimise their effective implementation.

Ethics

This project was conducted with ethics approval from The University of Sydney (Project number: 2017/723) and WHO (Protocol ID: 00001).
Action, actor, context, target, time (AACTT): a framework for specifying behaviour
Authors: Presseau Justin , McCleary Nicola , Lorencatto Fabiana , Patey Andrea M. , Grimshaw Jeremy M. , Francis Jill J.
Published: December 2019

Background

Designing implementation interventions to change the behaviour of healthcare providers and other professionals in the health system requires detailed specification of the behaviour(s) targeted for change to ensure alignment between intervention components and measured outcomes. Detailed behaviour specification can help to clarify evidence-practice gaps, clarify who needs to do what differently, identify modifiable barriers and enablers, design interventions to address these and ultimately provides an indicator of what to measure to evaluate an intervention’s effect on behaviour change. An existing behaviour specification framework proposes four domains (Target, Action, Context, Time; TACT), but insufficiently clarifies who is performing the behaviour (i.e. the Actor). Specifying the Actor is especially important in healthcare settings characterised by multiple behaviours performed by multiple different people. We propose and describe an extension and re-ordering of TACT to enhance its utility to implementation intervention designers, practitioners and trialists: the Action, Actor, Context, Target, Time (AACTT) framework. We aim to demonstrate its application across key steps of implementation research and to provide tools for its use in practice to clarify the behaviours of stakeholders across multiple levels of the healthcare system.

Methods and results

We used French et al.’s four-step implementation process model to describe the potential applications of the AACTT framework for (a) clarifying who needs to do what differently, (b) identifying barriers and enablers, (c) selecting fit-for-purpose intervention strategies and components and (d) evaluating implementation interventions.

Conclusions

Describing and detailing behaviour using the AACTT framework may help to enhance measurement of theoretical constructs, inform development of topic guides and questionnaires, enhance the design of implementation interventions and clarify outcome measurement for evaluating implementation interventions.
Anterior mitral leaflet length and mitral annulus diameter impact the echocardiographic outcome after isolated myectomy
Authors: Kuć Mateusz , Kumor Magdalena , Kłopotowski Mariusz , Dąbrowski Maciej , Kopyłowska-Kuć Natalia , Kołsut Piotr , Kuśmierczyk Mariusz
Published: December 2019

Background

Myectomy remains the standard surgical treatment of patients with hypertrophic cardiomyopathy (HOCM). New surgical methods developed in the last decades mainly address the mitral valve and are controversial because of their conflicting assumptions. This study assesses the influence of anterior mitral valve leaflet (AML) length and the anterior-posterior diameter of the mitral annulus (MAD) on dynamic left ventricle outflow tract obstruction and mitral regurgitation (MR) after extended myectomy.

Methods

We retrospectively analysed the transthoracic echocardiograms (TTE) of 36 patients. AML length and MAD were obtained from TTE performed before the operation. The greatest maximal left ventricle outflow tract (LVOT) gradient and MR registered in follow-up were analysed. After surgery, patients were divided into two groups; those with moderate or milder MR and/or an LVOT gradient < 30 mmHg (responders), and those with more than moderate MR and/or an LVOT gradient ≥30 mmHg (non-responders).

Results

Patients in responders group had significantly longer AML: 32.3 ± 2.3 mm vs 30.0 ± 3.8 mm (p = 0.03) [parasternal long axis view – PLAX view], 25.9 ± 2.3 mm vs 23.5 ± 2.7 mm (p = 0.008) [four chamber view - 4CH view] and larger anterior-posterior mitral annulus diameter 28.1 ± 2.8 mm vs 25.4 ± 3.2 mm (p = 0.011) than those in non-responders group. Among all analysed patients longer anterior mitral leaflet was correlated with lower postoperative LVOT gradient when measured in PLAX view (p = 0.02) and lower degree of MR due to systolic anterior motion (SAM) when measured in 4CH view (p = 0.009). Greater [AML x mitral annulus] ratio correlated with lower postoperative LVOT gradient in both projections: 4CH (p = 0.025), PLAX (p = 0.012). There was significant reduction in NYHA Class after surgery (p = 0.000). There were no significant differences in NYHA class after surgery (p = 0.633) neither in NYHA class reduction (p = 0.475) between patients divided into responders and non-responders group according to echocardiographic parameters.

Conclusions

Patients with a longer AML and a greater diameter of the mitral annulus are less likely to have mitral regurgitation due to residual SAM and increased LVOT gradient after an extended myectomy. Division of patients according to echocardiographic criteria into responders and non-responders was not in concordance with clinical improvement.

Trial registration

Retrospective study. Approved by ethics committee (IK-NPIA-0021-21/1763/19) at 16.01.2019.
Learning curve in minimally invasive mitral valve surgery: a single-center experience
Authors: Vo Anh Tuan , Nguyen Dinh Hoang , Van Hoang Sy , Le Khoi Minh , Nguyen Thu Trang , Nguyen Vuong Lam , Nguyen Bac Hoang , Truong Binh Quang
Published: December 2019

Background

Minimally invasive mitral valve surgery is becoming a gold standard and provides many advantages for patients. A learning curve is required for a surgeon to become proficient, and the exact number to overcome this curve is controversial. Our study aimed to define this number for mitral valve surgery in general, for replacement and repair separately.

Methods

A total of 204 mitral valve surgeries were performed via the right minithoracotomy approach from October 2014 to January 2019 by a single surgeon who isexperienced in conventional mitral valve surgery. Learning curves were analysed based on the trend of important variables (cross-clamp time, CPB time, ventilation time, ICU time, composite technical failure) over time, and the number of operations required was calculated by CUSUM method.

Results

MIMVS provided an excellent outcome in the carefully selected patients, with low mortality of 0.5% and low rate of complications. The decreasing trend of the important variables were observed over the years and as the cumulative number of procedures increased. The number of operations required to overcome the learning curve was 75 to 100 cases. When considered separately, the quantity for mitral valve replacement was 60 cases, whereas valve repair necessitated at least 90 cases to have an acceptable technical complication rate.

Conclusion

MIMVS is an excellent choice for mitral valve surgery. However, this approach required a long learning curve for a surgeon who is experienced in conventional mitral valve surgery.

Trial registration

The research was registered and approved by the ethical board of the University of Medicine and Pharmacy at Ho Chi Minh City, number 141/DHYD-HDDD, on April 11th 2018.
Expiratory flow limitation in intensive care: prevalence and risk factors
Authors: Volta Carlo Alberto , Dalla Corte Francesca , Ragazzi Riccardo , Marangoni Elisabetta , Fogagnolo Alberto , Scaramuzzo Gaetano , Grieco Domenico Luca , Alvisi Valentina , Rizzuto Chiara , Spadaro Savino
Published: December 2019

Background

Expiratory flow limitation (EFL) is characterised by a markedly reduced expiratory flow insensitive to the expiratory driving pressure. The presence of EFL can influence the respiratory and cardiovascular function and damage the small airways; its occurrence has been demonstrated in different diseases, such as COPD, asthma, obesity, cardiac failure, ARDS, and cystic fibrosis. Our aim was to evaluate the prevalence of EFL in patients requiring mechanical ventilation for acute respiratory failure and to determine the main clinical characteristics, the risk factors and clinical outcome associated with the presence of EFL.

Methods

Patients admitted to the intensive care unit (ICU) with an expected length of mechanical ventilation of 72 h were enrolled in this prospective, observational study. Patients were evaluated, within 24 h from ICU admission and for at least 72 h, in terms of respiratory mechanics, presence of EFL through the PEEP test, daily fluid balance and followed for outcome measurements.

Results

Among the 121 patients enrolled, 37 (31%) exhibited EFL upon admission. Flow-limited patients had higher BMI, history of pulmonary or heart disease, worse respiratory dyspnoea score, higher intrinsic positive end-expiratory pressure, flow and additional resistance. Over the course of the initial 72 h of mechanical ventilation, additional 21 patients (17%) developed EFL. New onset EFL was associated with a more positive cumulative fluid balance at day 3 (103.3 ml/kg) compared to that of patients without EFL (65.8 ml/kg). Flow-limited patients had longer duration of mechanical ventilation, longer ICU length of stay and higher in-ICU mortality.

Conclusions

EFL is common among ICU patients and correlates with adverse outcomes. The major determinant for developing EFL in patients during the first 3 days of their ICU stay is a positive fluid balance. Further studies are needed to assess if a restrictive fluid therapy might be associated with a lower incidence of EFL.
Enzymatic synthesis of l-fucose from l-fuculose using a fucose isomerase from Raoultella sp. and the biochemical and structural analyses of the enzyme
Authors: Kim In Jung , Kim Do Hyoung , Nam Ki Hyun , Kim Kyoung Heon
Published: December 2019

Background

l-Fucose is a rare sugar with potential uses in the pharmaceutical, cosmetic, and food industries. The enzymatic approach usingl-fucose isomerase, which interconvertsl-fucose andl-fuculose, can be an efficient way of producingl-fucose for industrial applications. Here, we performed biochemical and structural analyses ofl-fucose isomerase identified from a novel species ofRaoultella(RdFucI).

Results

RdFucI exhibited higher enzymatic activity forl-fuculose than forl-fucose, and the rate for the reverse reaction of convertingl-fuculose tol-fucose was higher than that for the forward reaction of convertingl-fucose tol-fuculose. In the equilibrium mixture, a much higher proportion ofl-fucose (~ ninefold) was achieved at 30 °C and pH 7, indicating that the enzyme-catalyzed reaction favors the formation ofl-fucose froml-fuculose. When biochemical analysis was conducted usingl-fuculose as the substrate, the optimal conditions forRdFucI activity were determined to be 40 °C and pH 10. However, the equilibrium composition was not affected by reaction temperature in the range of 30 to 50 °C. Furthermore,RdFucI was found to be a metalloenzyme requiring Mn2+as a cofactor. The comparative crystal structural analysis ofRdFucI revealed the distinct conformation of α7–α8 loop ofRdFucI. The loop is present at the entry of the substrate binding pocket and may affect the catalytic activity.

Conclusions

RdFucI-catalyzed isomerization favored the reaction froml-fuculose tol-fucose. The biochemical and structural data ofRdFucI will be helpful for the better understanding of the molecular mechanism ofl-FucIs and the industrial production ofl-fucose.
Toll-like receptors 2, 4 and 7, interferon-gamma and interleukin 10, and programmed death ligand 1 transcripts in skin from dogs of different clinical stages of leishmaniosis
Authors: Ordeix Laura , Montserrat-Sangrà Sara , Martínez-Orellana Pamela , Baxarias Marta , Solano-Gallego Laia
Published: December 2019

Background

Canine leishmaniosis (CanL) caused by Leishmania infantum can have several dermatological manifestations. The type of immune response elicited against the parasite appears to be at the basis for such clinical variability. Much of the work in CanL has focused on adaptive immune response and there are scarce data on the importance of the innate immune responses. Moreover, few studies have evaluated the immunological response in the cutaneous lesions in dogs naturally infected with L. infantum and with different degrees of disease severity, and no study has compared clinically-lesioned with normal-looking skin.

Methods

We determined and compared the transcription of toll like receptors (TLRs) 2, 4 and 7, interferon gamma (IFN-γ), interleukin (IL) 10 and programmed cell death protein ligand (PD-L) 1 by real-time PCR in paired clinically-lesioned and normal-looking skin from 25 diseased dogs (mild disease-stage I (n = 11) and moderate to severe disease-stages II and III (n = 14) as well as in normal-looking skin from healthy dogs (n = 10) from a non-endemic area. We also assessed the association between the transcripts in clinically-lesioned and normal-looking skin of dogs with leishmaniosis with clinicopathological, immunological and parasitological findings.

Results

Clinically-lesioned skin from mildly affected dogs was characterized by a significant upregulation of TLR2 (P < 0.0001) and IL-10 (P = 0.021) and downregulation of TLR7 (P = 0.004) when compared with more severely affected dogs. Normal-looking skin of mildly affected dogs was characterized by a significant lower expression of TLR7 (P = 0.003), IFN-γ (P < 0.0001) and PD-L1 (P = 0.001) when compared with more severely affected dogs. TLR2, TLR4, IL-10 and IFN-γ upregulation in clinically-lesioned skin was correlated with lower disease severity while TLR7 upregulation was correlated with markers of disease severity. Upregulation of TLR7, IL-10, IFN-γ and PD-L1 in normal-looking skin was correlated with disease severity.

Conclusions

This study demonstrated different expression profiles of immune genes in clinically-lesioned and normal-looking skin among mildly and more severely affected dogs. These immunological conditions might favor the maintenance and replication of the parasite in the skin of more severely affected dogs.