bluuebunny/crossref_metadata_2025 huggingface dataset:
A qualitative study of old patients’ experiences of the quality of the health services in hospital and 30 days after hospitalization
Authors: Lilleheie Ingvild , Debesay Jonas , Bye Asta , Bergland Astrid
Published: November 2019

Background:

The number of people aged 80 years and above is projected to triple over the next 30 years. People in this age group normally have at least two chronic conditions. The impact of multimorbidity is often significantly greater than expected from the sum of the effects of each condition. The World Health Organization has indicated that healthcare systems must prepare for a change in the focus of clinical care for older people. The World Health Organization (WHO) defines healthcare quality as care that is effective, efficient, integrated, patient centered, equitable and safe. The degree to which healthcare quality can be defined as acceptable is determined by services’ ability to meet the needs of users and adapt to patients’ expectations and perceptions.Method:

We took a phenomenological perspective to explore older patients’ subjective experiences and conducted semistructured individual interviews. Eighteen patients (aged from 82 to 100 years) were interviewed twice after discharge from hospital. The interview transcriptions were analyzed thematically.Results:

The patients found their meetings with the health service to be complex and demanding. They reported attempting to restore a sense of security and meaning in everyday life, balancing their own needs against external requirements. Five overarching themes emerged from the interviews: hospital stay and the person behind the diagnosis, poor communication and coordination, life after discharge, relationship with their next of kin, and organizational and systemic determinants.Conclusion:

According to the WHO, to deliver quality healthcare, services must include all six of the dimensions listed above. Our findings show that they do not. Healthcare focused on measurable values and biomedical inquiries. Few opportunities for participation, scant information and suboptimal care coordination left the patients with a feeling of being in limbo, where they struggled to find balance in their everyday life. Further work must be done to ensure that integrated services are provided without a financial burden, centered on the needs and rights of older people.
Transcriptomic and evolutionary analysis of the mechanisms by which P. argentatum, a rubber producing perennial, responds to drought
Authors: Nelson Andrew D. L. , Ponciano Grisel , McMahan Colleen , Ilut Daniel C. , Pugh N. Ace , Elshikha Diaa Eldin , Hunsaker Douglas J. , Pauli Duke
Published: November 2019

Background Guayule (Parthenium argentatum Gray) is a drought tolerant, rubber producing perennial shrub native to northern Mexico and the US Southwest. Hevea brasiliensis, currently the world’s only source of natural rubber, is grown as a monoculture, leaving it vulnerable to both biotic and abiotic stressors. Isolation of rubber from guayule occurs by mechanical harvesting of the entire plant. It has been reported that environmental conditions leading up to harvest have a profound impact on rubber yield. The link between rubber biosynthesis and drought, a common environmental condition in guayule’s native habitat, is currently unclear. Results We took a transcriptomic and comparative genomic approach to determine how drought impacts rubber biosynthesis in guayule. We compared transcriptional profiles of stem tissue, the location of guayule rubber biosynthesis, collected from field-grown plants subjected to water-deficit (drought) and well-watered (control) conditions. Plants subjected to the imposed drought conditions displayed an increase in production of transcripts associated with defense responses and water homeostasis, and a decrease in transcripts associated with rubber biosynthesis. An evolutionary and comparative analysis of stress-response transcripts suggests that more anciently duplicated transcripts shared among the Asteraceae, rather than recently derived duplicates, are contributing to the drought response observed in guayule. In addition, we identified several deeply conserved long non-coding RNAs (lncRNAs) containing microRNA binding motifs. One lncRNA in particular, with origins at the base of Asteraceae, may be regulating the vegetative to reproductive transition observed in water-stressed guayule by acting as a miRNA sponge for miR166. Conclusions These data represent the first genomic analyses of how guayule responds to drought like conditions in agricultural production settings. We identified an inverse relationship between stress-responsive transcripts and those associated with precursor pathways to rubber biosynthesis suggesting a physiological trade-off between maintaining homeostasis and plant productivity. We also identify a number of regulators of abiotic responses, including transcription factors and lncRNAs, that are strong candidates for future projects aimed at modulating rubber biosynthesis under water-limiting conditions common to guayules’ native production environment.
Influence of reduction quality on functional outcome and quality of life in treatment of tibial plafond fractures: a retrospective cohort study
Authors: Privalov Maxim , Euler Finn , Keil Holger , Swartman Benedict , Beisemann Nils , Franke Jochen , Grützner Paul Alfred , Vetter Sven Yves
Published: November 2019

Background: The aim of the study was to evaluate the impact of reduction quality, using intraoperative 3D imaging, on quality of life and functional outcome in the operative treatment of tibial plafond fractures.
Methods: A group of patients with tibial plafond fractures was re-examined. The operative treatment was performed between September 2001 and October 2011. The follow-up examination was at least 2 years after the final surgical procedure. Final reduction result was assessed intraoperatively using a mobile 3D C-arm. A categorization with regard to descriptive parameters as well as type and size of joint surface irregularities was performed. Follow-up results were evaluated using: Olerud and Molander (O & M) score, Short-Form-36 (SF-36) score, movement deficit, Kellgren and Lawrence grade of osteoarthritis, and pain intensity.
Results: 34 patients with operatively treated tibial plafond fracture could be re-examined. Reduction quality had the greatest influence on functional result measured by the O & M score (p=0.001) and the PCS domain of the SF-36 score (p=0.018).
Significant differences with regard to O & M score (p=0.000), SF-36 score (p=0.001 to p=0.02; without MCS domain), movement deficit (p=0.001), grade of osteoarthritis (p=0.005) and pain (p=0.001) could be verified under consideration of the reduction quality. The group with the anatomically more accurate reduction also showed a better result for clinical follow-up and quality of life. Furthermore, it is not the type of joint surface irregularity that is always decisive, but rather the size.
Conclusions: Despite other relevant factors, it appears that reduction quality –which can be analyzed with intraoperative 3D imaging– plays the most important role in postoperative quality of life and functional outcome. Corrections should therefore be performed on joint surface irregularities with a size above 2 mm.
Influence of reduction quality on functional outcome and quality of life in treatment of tibial plafond fractures: a retrospective cohort study
Authors: Privalov Maxim , Euler Finn , Keil Holger , Swartman Benedict , Beisemann Nils , Franke Jochen , Grützner Paul Alfred , Vetter Sven Yves
Published: November 2019

Background: The aim of the study was to evaluate the impact of reduction quality, using intraoperative 3D imaging, on quality of life and functional outcome in the operative treatment of tibial plafond fractures. Methods: A group of patients with tibial plafond fractures was re-examined. The operative treatment was performed between September 2001 and October 2011. The follow-up examination was at least 2 years after the final surgical procedure. Final reduction result was assessed intraoperatively using a mobile 3D C-arm. A categorization with regard to descriptive parameters as well as type and size of joint surface irregularities was performed. Follow-up results were evaluated using: Olerud and Molander (O & M) score, Short-Form-36 (SF-36) score, movement deficit, Kellgren and Lawrence grade of osteoarthritis, and pain intensity. Results: 34 patients with operatively treated tibial plafond fracture could be re-examined. Reduction quality had the greatest influence on functional result measured by the O & M score (p=0.001) and the PCS domain of the SF-36 score (p=0.018). Significant differences with regard to O & M score (p=0.000), SF-36 score (p=0.001 to p=0.02; without MCS domain), movement deficit (p=0.001), grade of osteoarthritis (p=0.005) and pain (p=0.001) could be verified under consideration of the reduction quality. The group with the anatomically more accurate reduction also showed a better result for clinical follow-up and quality of life. Furthermore, it is not the type of joint surface irregularity that is always decisive, but rather the size. Conclusions: Despite other relevant factors, it appears that reduction quality –which can be analyzed with intraoperative 3D imaging– plays the most important role in postoperative quality of life and functional outcome. Corrections should therefore be performed on joint surface irregularities with a size above 2 mm.
Intra-abdominal infections: the role of different classifications on the selection of the best antibiotic treatment.
Authors: Nunes João Silva , Cardoso Teresa Maria Costa
Published: November 2019

Background: Intra-abdominal infections (IAIs) represent a serious cause of morbimortality. A full classification, including all facets of IAIs, does not exist. Two classifications are used to subdivide IAIs: uncomplicated or complicated, considering infection extent; and community-acquired, healthcare-associated or hospital-acquired, regarding the place of acquisition. Inadequate antibiotic therapy is associated with treatment failure and increased mortality. This study was designed to determine accuracy of different classifications of IAIs to identify infections by pathogens sensitive to current treatment guidelines helping the selection of the best antibiotic therapy.
Methods: A retrospective cohort study including all adult patients discharged from hospital with a diagnosis of IAI between 1st of January and 31st of October 2016. All variables potentially associated with pre-defined outcomes: infection by a pathogen sensitive to non-pseudomonal cephalosporin or ciprofloxacin plus metronidazole (ATB 1, primary outcome), sensitive to piperacillin-tazobactam (ATB 2) and hospital mortality (secondary outcomes) were studied through logistic regression. Accuracy of the models was assessed by area under receiver operating characteristics (AUROC) curve and calibration was tested using the Hosmer-Lemeshow goodness-of-fit test.
Results: Of 1804 patients screened 154 met inclusion criteria. Sensitivity to ATB 1 was independently associated with male gender (adjusted OR=2.612) and previous invasive procedures in the last year (adjusted OR=0.424) (AUROC curve=0,65). Sensitivity to ATB 2 was independently associated with liver disease (adjusted OR=3.580) and post-operative infections (adjusted OR=2.944) (AUROC curve=0.604). Hospital mortality was independently associated with age≥70 (adjusted OR=4.677), solid tumour (adjusted OR=3.127) and sensitivity to non-pseudomonal cephalosporin or ciprofloxacin plus metronidazole (adjusted OR=0.368).
The accuracy of pre-existing classifications to identify infection by a pathogen sensitive to ATB 1 was 0.59 considering place of acquisition, 0.61 infection extent and 0.57 local of infection, for ATB 2 it was 0.66, 0.50 and 0.57, respectively.
Conclusion: None of existing classifications had a good discriminating power to identify IAIs caused by pathogens sensitive to current antibiotic treatment recommendations. A new classification, including patients’ individual characteristics like those included in the current model, might have a higher potential to distinguish IAIs by resistant pathogens allowing a better choice of empiric antibiotic therapy.
Keywords: intra-abdominal infections; classification; antibiotic therapy; hospital mortality.
Magnitude of Intestinal Parasitic Infections and Associated Factors among Food Handlers Working at Woldia University Student’s Cafeteria, Northeastern Ethiopia: An institution based cross-sectional study
Authors: Alemnew Birhan , Belay Yalemzewud , Demis Asmamaw
Published: November 2019

Objectives: the main of this study was to assess the Magnitude of intestinal parasitic infections and associated factors among food handlers working at Woldia University Student’s cafeteria, Northeastern Ethiopia. Institutional based cross-sectional study was conducted among 256 study participants in Woldia university student’s cafeteria, Northern Ethiopia. Systematic random sampling method was used to select the study participants. Data was collected using a standardized questionnaire by direct interviewing of study participants. Logistic regression was carried out to identify factors associated with intestinal parasitic infections. Results: A total of 256 food handlers were enrolled making the overall magnitude of the intestinal parasite which was stool specimens positive for different diagnostic stages of parasites was found to be 43(16.8%). Entamoeba histolytica/dispar was the most prevalent parasites 14(5.5%), followed by Giardia lamblia 10(3.9%). Lack of food safety training [AOR = 6.58; 95%CI: 2.46–17.62], no regular medical checkup [AOR=2.41; 95 %CI: 1.47-4.24], no handwashing practice after toilet by soap[AOR =3.24; 95%CI: 1.28-8.19], no handwashing practice before eating by soap [AOR =4.03; 95%CI:1.64-9.91] and haven’t food preparation license [AOR= 6.13; 95 % CI: 2.18-17.22] were significantly associated with parasitic infection among food handlers. Keywords: Intestinal parasites, Food handlers, Student cafeteria, Woldia University
The Dental Complications of Canine Tooth Bud Removal in 2-12 Years Old Children in North West Ethiopia
Authors: Teshome Amare , Assefa Berihun
Published: November 2019

Objective: Canine tooth bud removal is a process of gouging out an infant’s canine tooth buds, using unsterile tools such as Sharpe blade, garlic, or knitting needle, without anesthesia. The aim of the study was to reveal dental complications of canine tooth bud removal among children visited the dental clinic of the University of Gondar hospital. This study was an institution-based cross-sectional conducted from January 2015-September 2016 at university of Gondar hospital on 2-12 years children. The tooth was assessed for whether it had previously oral mutilated or not. In addition to this, the oral cavity was evaluated for the presence of missed, malformed or normal canine Results : A group of 355 children aged 2-12 years was examined clinically. The mean age of the children was 7.32±3.12 (SD). The prevalence of canine tooth bud removal was 86.8% which was high in 6-9 years old (54.87%) and first position children (40.26%). The most common dental complications were; malformed enamel (hypoplastic) canine (48.5%) and missed/Unerupted canine (38.6%).
Predisposing factors influencing occupational injury among frontline building construction workers in Ghana
Authors: AMISSAH JOHN , Badu Eric , Agyei-Baffour Peter , Nakua Emmanuel Kwaku , Mensah Isaac
Published: November 2019

Objective This study aims to examine the predisposing factors influencing occupational injuries among frontline construction workers in Ghana. A cross-sectional survey was carried out with 634 frontline construction workers in Kumasi metropolis of Ghana using a structured questionnaire. The study was conducted from December 2016 to June 2017 using a household-based approach. The respondents were selected through a two-stage sampling approach. A multivariate logistics regression model was employed to examine the association between risk factors and injury. Data was analyzed employing descriptive and inferential statistics with STATA version 14. Results The study found an injury prevalence of 57.91% among the workers. Open Wounds (37.29%) and fractures (6.78%) were the common and least injuries recorded respectively. The proximal factors (age, sex of worker, income) and distal factors (eg. work structure, trade specialization, working hours, job/task location, and monthly off days) were risk factors for occupational injuries among frontline construction workers. The study recommends that policymakers and occupational health experts should incorporate the proximal and distal factors in the design of injury prevention as well as management strategies.
Ultrasound Assessment of Tensile Stress in Carotid Arteries of Healthy Human Subjects with Varying Age
Authors: Luo Xianghong , Du Lianfang , Li Zhaojun
Published: November 2019

Background: Arterial remodeling is thought to reflect the adaptation of the vessel wall to mechanical and hemodynamic stimuli and contributes to the progression of cardiovascular and cerebrovascular diseases. Tensile stress (TS) is one of the mechanical properties of the artery wall. The purpose of this study was to investigate the tensile stress change (TS) of carotid artery with varying viscoelasticity in healthy subjects within two groups of different ages. Methods: Forty-five subjects were recruited and randomly assigned into the group at the age above 50 years and below 50 years. The carotid arteries were examined by ultrasonography, using the techniques of shear wave elastography (SWE), shear wave dispersion (SWD) and radiofrequency (RF) -based ultrasound. The following values, including elastic modulus (SWE R ) and viscous index (SWD R ), as well as the peak and mean TS of the left and right carotid arteries (L-PTS, R-PTS, L-MTS and R-MTS) were measured. The correlations between SWE R , SWD R and tensile stress were evaluated by using what correlation method. Results: The SWE R and SWD R of carotid arteries are lower in the subjects ≥50 years old than the subjects younger than 50 years (SWE R , 10.29±9.57 kPa VS 17.24±14.07 kPa; SWD R, 11.99±3.51 (m/s)/kHz VS 13.97±3.71 (m/s)/kHz, P < 0.05). The R-PTS was lower in the group with younger age ( P <0.05). Pearson correlation analysis showed that SWE R of carotid artery was positively correlated with the parameters of tensile stress，R-PTS, R-MTS, L-PTS and L-MTS( r =0.218, r =0.359, r =0.209 and r =0.369, respectively, P <0.05). However, SWD R of carotid arteries was not significantly associated with TS. Conclusion: Ultrasonic shear wave imaging could be used to quantitatively assess carotid viscoelasticity. The carotid TS was related to its elasticity while little related to its viscosity, suggesting that mechanical properties of the arterial wall might be better revealed.
Semi-constrained posterior stabilized total knee arthroplasty reproduces natural deep knee bending kinematics
Authors: Sumino Takanobu , Tomita Tetsuya , Sugamoto Kazuomi , Yamazaki Takaharu , Okazaki Ken
Published: November 2019

Background: The Flexible Nichidai Knee Posterior Stabilized (FNK-PS) system was designed to provide relatively high varus-valgus stabilities without the stem extensions to patients with severe knee joint disorders. This is a combination of a large tibial post and high femoral cam adapted to a PS system. The aim of our study was to analyze the in vivo two-dimensional/three-dimensional registration kinematics of the FNK PS-total knee arthroplasty (TKA) system during deep knee bending. Methods: Nineteen knees from 15 total knee arthroplasty (TKA) patients who were able to squat with enough knee flexion were selected. During deep knee bending under weight bearing (WB) and non-weight bearing (NWB) conditions, we quantified range of motion, axial rotation, femoral anteroposterior translation, and post-cam engagement angle. Results: The maximum-flexion was significantly different between the two conditions. The mean axial femoral external rotation was 4.8° and 6.2° under WB and NWB conditions, respectively, at 120° flexion. Anteroposterior translation based on bicondylar posterior roll-back patterns was noted with increasing knee flexion. Both the medial and lateral femoral aspects were significantly more posterior during early to mid-flexion. Initial post-cam engagement occurred significantly earlier during flexion under NWB than under WB conditions. Under WB, the timing of the post-cam engagement correlated with the maximum flexion . Conclusions: The kinematics of the semi-constrained PS system reproducibly exhibited a mild external rotation with smooth posterior roll-back. This was assisted by the engagement of the large tibial post and high femoral cam during the early phase of flexion.
Biclique: An R package for Maximal Biclique Enumeration in Bipartite Graphs
Authors: Lu Yuping , Phillips Charles A. , Langston Michael A.
Published: November 2019

Objective

Bipartite graphs are widely used to model relationships between pairs of heterogeneous data types. Maximal bicliques are foundational structures in such graphs, and their enumeration is an important task in systems biology, epidemiology and many other problem domains. Thus, there is a need for an efficient, general purpose, publicly available tool to enumerate maximal bicliques in bipartite graphs. The statistical programming language R is a logical choice for such a tool, but until now no R package has existed for this purpose. Our objective is to provide such a package, so that the research community can more easily perform this computationally demanding task.Results

Biclique is an R package that takes as input a bipartite graph and produces a listing of all maximal bicliques in this graph. Input and output formats are straightforward, with examples provided both in this paper and in the package documentation. Biclique employs a state-of-the-art algorithm previously developed for basic research in functional genomics. This package, along with its source code and reference manual, are freely available from the CRAN public repository at https://cran.r-project.org/web/packages/biclique/index.html .
Intentional fallers with complex pelvic and acetabular fractures do not have worse radiological and functional outcomes than accidental fallers
Authors: Yu Yi-Hsun , Chou Ying-Chao , Hsu Yung-Heng , Chen I-Jung , Wei Lien-Chung
Published: November 2019

Intentional fallers with complex pelvic and acetabular fractures were thought to have a worse prognosis because of their mental disorders. We aimed to investigate the clinical outcomes of fallers with pelvic and acetabular fractures after osteosynthesis surgeries and to compare the radiological and functional outcomes between intentional and accidental fallers.Methods Between 2014 and 2017, fallers with complex pelvic and acetabular fractures who survived from resuscitation and complete surgical treatments were enrolled and investigated.Results Forty-nine fallers who underwent osteosynthesis for pelvic and acetabular fractures were included. Sixteen patients were intentional fallers, whereas the rest of the patients fell accidently. All patients who fell intentionally had pre-existing mental disorders, and the major diagnosis was adjustment disorder. Intentional fallers presented with younger age, higher injury severity score and new injury severity score, longer intensive care unit and hospital stay, early loss to follow-up, and worse functional outcomes at the 6-month follow-up. However, the radiological and functional outcomes at the 12-month follow-up did not significantly differ between the intentional and accidental fallers.Conclusion In conclusion, the intentional fallers with complex pelvic and acetabular fractures may have worse clinical presentations initially, but their radiological and functional outcomes may become comparable to those of accidental fallers after treatments.
Assessment of Health-Related Quality of Life (HRQoL) by EQ-5D in Prediabetes, Diabetes and Normal Glycaemic Population in China
Authors: Yang Nan , Long Enwu , Feng Shuang , Chen Jie , Shi Lizheng , Hu Ming
Published: November 2019

Aim of the study was to describe and compare differences of health-related quality of life (HRQoL) among populations of normal glycaemic, pre-diabetics and diabetics in China.Methods A quality of life survey based on the EQ-5D-5L scale was conducted through face-to-face interviews and telephone follow-up. A total of 403 respondents with diabetes, 404 respondents with pre-diabetes, and 398 respondents with normal blood glucose were enrolled in the survey. Differences among groups were compared by chi-square test one-way analysis of variance (ANOVA), Kruskal-Wallis test or student's test after adjusting parameters of age and gender by PSM and Covariance analysis.Results In this survey, most of the diabetics were associated with circulatory system or nutritional metabolic diseases. The EQ-5D index of normal glycaemic population, pre-diabetic, and diabetic patients was 0.901, 0.948, and 0.897. And EQ-VAS scores of every groups above were 73.76, 77.45, and 68.34. HRQoL of male was higher than female in three groups of the study. In general, blood sugar control of Chinese diabetics was generally well. Results of covariance analysis and PSM were consistent with above results.Conclusion There was a general trend that patients was associated with a decline of HRQoL from pre-diabetic population, normal glycaemic population to diabetics. However, further and larger longitudinal studies are needed to confirm these findings.
Modified-ramped position: a new position for intubation of obese females: A randomized controlled study.
Authors: hasanin ahmed , Tarek Hager , Mostafa Maha MA , Arafa Amany , Safina Ahmed G , Elsherbiny Mona H , Hosny Osama , Gado Ahmed A , Almenesey Tarek , Hamden Ghada Adel , Mahmoud Mohamed , Amin Sarah
Published: November 2019

Endotracheal intubation requires optimum position of the head and neck. In obese females, the usual ramped position might not provide adequate intubating conditions. We hypothesized that a new position (modified-ramped position) during induction of anesthesia would facilitate endotracheal intubation through bringing the breasts away from the laryngoscope and would also improve the laryngeal visualization Methods Sixty obese females scheduled for general anesthesia were randomly assigned into either ramped or modified-ramped position during induction of anesthesia. In the modified-ramped position (n=30), the patient shoulders were elevated using special pillow, and the head was extended to the most possible range. Our primary outcome was incidence of failure of laryngoscope insertion in the oral cavity due to large breast with the need to repositioning “elevation of the patient’s shoulder during intubation”. Other outcomes included time till vocal cord visualization, time till successful endotracheal intubation, difficulty of mask ventilation, and Cormack-Lehane grade for laryngeal view. Results Fourteen patients (47%) in ramped group required repositioning to facilitate introduction of the laryngoscopy in comparison to one patient (3%) in the modified-ramped position (p<0.001). Modified-ramped position showed lower incidence of difficult mask ventilation, shorter time for glottic visualization, and shorter time for endotracheal tube insertion compared to the ramped position. The Cormack-Lehane grade was better in the modified-ramped position. Conclusion Modified-ramped position provided better intubating conditions, improved the laryngeal view, and eliminated the need for repositioning of obese female patients during insertion of the laryngoscope compared to ramped position
Augmented Exercise in Hospital Improves Physical Performance and Reduces Negative Post Hospitalization Events: A Randomized Controlled Trial
Authors: McCullagh Ruth , O'Connell Eimear , O'Meara Sarah , Dahly Darren , O'Reilly Eilis , O'Connor Kieran , Horgan N.Frances , Timmons Suzanne
Published: November 2019

Background: To measure the effects of an augmented prescribed exercise programme versus usual care, on physical performance, quality of life and healthcare utilisation for frail older medical patients in the acute setting. Study Design: A parallel single-blinded randomised controlled trial Methods: Within two days of admission, older medical inpatients with an anticipated length of stay ≥3 days, needing assistance/aid to walk, were blindly randomly allocated to the intervention or control group. Until discharge, both groups received twice daily, Monday-to-Friday half-hour assisted exercises, assisted by a staff physiotherapist. The intervention group completed tailored strengthening and balance exercises; the control group performed stretching and relaxation exercises. Length of stay was the primary outcome measure. Secondary measures included readmissions within three months, and physical performance (Short Physical Performance Battery) and quality of life (EuroQOL-5D-5L) measured at discharge and at three months. Time-to-event analysis was used to measure differences in length of stay, and linear regression models were used to measure differences in physical performance, quality of life, adverse events (falls, deaths) and negative events (prolonged hospitalisation, institutionalisation). Results: Of the 199 patients allocated, 190 patients’ (aged 80 ±7.5 years) data were analysed. Groups were comparable at baseline. In intention to treat analysis, length of stay did not differ between groups (HR 1.09 (95% CI, 0.77-1.56) p=0.6). Physical performance was better in the intervention group at discharge (difference 0.88 95% CI, 0.20-1.57) p=0.01), but lost at follow-up (difference 0.45 (95% CI, -0.43 – 1.33) p=0.3). An improvement in quality of life was detected at follow-up in the intervention group (difference 0.28 (95% CI, 0.9 – 0.47) p=0.004). Overall, fewer negative events occurred in the intervention group (OR 0.46 (95% CI 0.23 – 0.92) p=0.03). Conclusion: Improvements in physical performance, quality of life and fewer negative events suggest that this intervention is of value to frail medical inpatients. Its effect on length of stay remains unclear.
Haematological parameters and pathological clotting in deep vein thrombosis and patients with HIV
Authors: Jackson Brandon S , Nunes Julien , Pretorius Etheresia
Published: November 2019

Background. Patients infected with the human immunodeficiency virus (HIV) are more prone to systemic inflammation and pathological clotting, and many may develop deep vein thrombosis (DVT) as a result of this dysregulated inflammatory profile. Coagulation tests are not routinely performed unless there is a specific reason. Methods. We recruited ten healthy control subjects, 35 HIV negative patients with deep vein thrombosis (HIV negative-DVT), and 13 HIV patients with DVT (HIV positive-DVT) on the primary antiretroviral therapy (ARV) regimen- Emtricitabine, Tenofovir and Efavirenz. Serum inflammatory markers, haematological results, viscoelastic properties (using thromboelastography-TEG) and scanning electron microscopy (SEM) of whole blood (WB) were used to compare the groups.Results. DVT patients (HIV positive and HIV negative) have anaemia with raised inflammatory markers which are more pronounced in HIV positive patients. HIV positive-DVT patients also have a microcytic hypochromic anaemia. DVT patients have a hypercoagulable profile on the TEG but no significant difference between HIV negative-DVT and HIV positive-DVT groups. The TEG analysis compared well and supported our ultrastructural results. Scanning electron microscopy of HIV positive-DVT patient’s red blood cells (RBCs) and platelets demonstrates inflammatory changes including abnormal cell shapes, irregular membranes and microparticle formation. All the ultrastructural changes were more prominent in the HIV positive-DVT patients. Conclusions. HIV positive patients have an increased hypercoagulability and DVT prevalence. Our results point to the importance of looking at the coagulation system function in HIV infected individuals with DVT. Parameters like haematological markers, coagulation tests (activated partial thromboplastin time and prothrombin time / International normalized ratio), thromboelastography and global clotting tests should be used as standard indicators of hypercoagulation and part of standard clinical practice.
A novel ABCC2 p.G693R mutation resulting in loss of function of MRP2: a recurrent cause of hyperbilirubinemia in Dubin-Johnson syndrome in China
Authors: Wu Lina , Li Yanmeng , Song Yi , Zhou Donghu , Jia Siyu , Xu Anjian , Zhang Wei , You Hong , Jia Jidong , Huang Jian , Ou Xiaojuan
Published: November 2019

Background Dubin-Johnson syndrome (DJS) is a rare autosomal recessive disorder characterized by predominantly conjugated hyperbilirubinemia that is caused by pathogenic mutations in the adenosine triphosphate-binding cassette subfamily C member 2 ( ABCC2 ) gene, which encodes multidrug resistance-associated protein 2 (MRP2). However, little is known about the causative mutation of DJS in China. Recently, we have reported a novel ABCC2 p.G693R mutation in two unrelated cases. In the present study, we investigated the pathogenicity of the ABCC2 p.G693R mutation in DJS in China.Methods Clinical and genetic analysis was conducted for the two patients with the ABCC2 p.G693R mutation. Whole exome sequencing for mutations in other known hyperbilirubinemia-related genes was conducted for the cases with ABCC2 p.G693R. Expression and cellular localization of the mutant MRP2 p.G693R were analyzed by Western blotting and immunofluorescence assay, respectively. Organic anion transport activity was evaluated by the analysis of glutathione-conjugated-monochlorobimane.Results The two DJS patients with ABCC2 p.G693R mutation, which was conserved among different species, showed typical hyperbilirubinemia phenotype. No pathogenic mutation was identified in the other known hyperbilirubinemia related genes. Functional studies in three cell lines showed that the expression, localization and the organic anion transport activity were significantly compromised by MRP2 p.G693R mutation compared with wild-type MRP2.Conclusions The ABCC2 p.G693R mutation is associated with loss of function of the MRP2 protein, which may represent one of the major etiological factors of hyperbilirubinemia in DJS in China.
Transcriptomic analysis of brain tissues identifies a role for CCAAT enhancer binding protein β in HIV-associated neurocognitive disorders
Authors: Canchi Saranya , Swinton Mary K. , Rissman Robert A. , Fields Jerel Adam
Published: November 2019

HIV-associated neurocognitive disorders (HAND) persist in the era of combined antiretroviral therapy (ART) despite reductions in viral load (VL) and overall disease severity. The mechanisms underlying HAND in ART era are not well understood but are likely multifactorial, involving alterations in common pathways such as inflammation, autophagy, neurogenesis, and mitochondrial function. Newly developed omics approaches hold potential to identify mechanisms driving neuropathogenesis of HIV in the ART era. Methods: In this study, using 33 postmortem frontal cortex (FC) tissues, neuropathological, molecular, and biochemical analyses were used to determine cellular localization and validate expression levels of the prolific transcription factor (TF), CCAAT enhancer binding protein (C/EBP) β, in brain tissues from HIV+ cognitively normal and HAND cases. Transcriptomics analyses were performed on frontal cortex tissues 24 of the FC specimens from well-characterized people with HIV that had undergone neurocognitive assessments. In vitro models for brain cells were used to investigate the role of C/EBPβ in mediating gene expression. Results:The most robust signal for TF dysregulation was observed in cases diagnosed with Minor Neurocognitive Disorders (MND) compared to cognitive normal (CN) cases. Of particular interest, due to its role in inflammation, autophagy and neurogenesis, C/EBPβ was significantly upregulated in MND compared to CN brains. C/EBPβ was increased at the protein level in HAND brains. C/EBPβ levels were significantly reduced in neurons and increased in astroglia in HAND brains compared to CN. Transfection of human astroglial cells with a plasmid (p) expressing C/EBPβ induced mRNA expression of multiple targets identified in the transcriptomic analysis of HAND brains, including dynamin-1-like protein and interleukin-1 receptor-associated kinase 1. Conclusions:These findings are the first to present transcriptomic analyses of HIV+ brain tissues, providing further evidence of altered neuroinflammation, neurogenesis, mitochondrial function, and autophagy in HAND. Interestingly, these studies confirm a role for CEBPβ in regulating inflammation, metabolism, and autophagy in astroglia. Therapeutic strategies aimed at transcriptional regulation of astroglia or downstream pathways may provide relief to HIV+ patients at risk for HAND and other neurological disorders.
Improved ascertainment of modes of HIV transmission in Ukraine indicates importance of drug injecting and homosexual risk
Authors: Dumchev Kostyantyn , Kornilova Marina , Kulchynska Roksolana , Azarskova Marianna , Vitek Charles
Published: November 2019

Background: It is important to understand how HIV infection is transmitted in the population in order to guide prevention activities and properly allocate limited resources. In Ukraine and other countries where injecting drug use and homosexuality are stigmatized, the information about mode of transmission among newly registered patients is often biased. Methods: We conducted a cross-sectional survey in a random sample of patients registered at HIV clinics in seven regions of Ukraine in 2015-2017. The survey assessed behavioral risk factors and serological markers of viral hepatitis B and C. We analyzed the discrepancies between the registered mode of transmission and the survey data, and evaluated trends over three years. Results: Of 2,285 participants, 1,032 (45.2%) were females. The proportion of new HIV cases likely caused by injecting drug use based on the survey data was 59.7% compared to 33.2% in official reporting, and proportion of cases likely acquired through homosexual transmission was 3.8% compared to 2.8%. We found a significant decrease from 63.2% to 57.5% in the proportion of injecting drug use-related cases and a steep increase from 2.5 to 5.2% in homosexual transmission over three years. Conclusions: The study confirmed the significant degree of misclassification of HIV mode of transmission among newly registered cases. The role of injecting drug use in HIV transmission is gradually decreasing, but remains high. The proportion of cases related to homosexual transmission is relatively modest, but is rapidly increasing, especially in younger men. Improvements in ascertaining the risk factor information are essential to monitor the epidemic and to guide programmatic response.
Influence of COL9A1 and COL19A1 Polymorphisms on Kaschin-Beck Disease Risk
Authors: He Xue , Zheng Jianwen , Yuan Dongya , Wang Yuhe , He Yongjun , Wang Li , Bai Mei , Jin Tianbo
Published: November 2019

Objective We aimed to determine whether COL9A1 and COL19A1 polymorphisms were associated with Kaschin-Beck disease (KBD) risk.Methods Five single nucleotide polymorphisms (SNPs) in COL9A1 and COL19A1 were genotyped in 316 KBD patients and 320 healthy controls using the Agena MassARRAY platform. The association between genetic polymorphisms ( COL9A1 : rs3806093, rs603410 and rs621347; COL19A1 : rs9346371 and rs555313) and KBD risk were assessed using logistic regression model by calculating odds ratio (OR) and 95% confidence interval (CI).Results After adjustment with age and sex, the frequency distributions of genotypes in rs3806093 and rs9346371 were significantly different between cases and controls. COL9A1 rs3806093 significantly increased KBD risk in co-dominant (OR = 14.80, 95%CI = 1.42-154.80, p = 0.024) and recessive (OR = 16.39, 95%CI = 1.60-168.20, p = 0.019) models. Meanwhile, COL9A1 rs555313 was associated with KBD risk in recessive model (OR = 3.80, 95%CI = 1.01-14.27, p = 0.048). In addition, haplotype analysis revealed two blocks (block 1: rs3806093, rs603410 and rs621347; block 2: rs9346371 and rs555313).Conclusion COL9A1 and COL19A1 polymorphisms were associated with KBD risk in the Chinese Han population, suggesting roles of COL9A1 and COL19A1 in the development of KBD.
Molecular Epidemiology and Hematologic Characterizationof δβ-thalassemia and Hereditary Persistence of Fetal Hemoglobin in 125661 Families of Greater Guangzhou Area, the metropolis of Southern China
Authors: JIANG FAN , Liao Can
Published: November 2019

Background:Individuals with δβ-thalassemia/HPFH and β-thalassemia usually present with intermedia or thalassemia major. No large-scale survey on HPFH/δβ-thalassemia in southern China has been reported to date. The purpose of this study was to examine the molecular epidemiology and hematologic characteristics of these disorders in Guangzhou, the largest city in Southern China, to offer advice for thalassemia screening programs and genetic counseling. Methods: A total of 125,661 couples participated in pregestational thalassemia screening. 654 subjects with fetal hemoglobin (Hb F) level ≥5% were selected for further investigation. Gap-PCR combined with Multiplex ligation dependent probe amplification (MLPA) were used to screen for β-globin gene cluster deletions. Gene sequencing for the promoter region of HBG1 /HBG2 gene were performed for all those subjects. Results: A total of 654 individuals had hemoglobin (HbF) levels ≥5%, and 0.12% of the couples were found to be heterozygous for HPFH/δβ-thalassemia, including Chinese Gγ(Aγδβ)0-thal, Southeast Asia HPFH (SEA-HPFH), Taiwanese deletion and Hb Lepore–Boston–Washington. The highest prevalence was observed in the Huadu district and the lowest in the Nansha district. Three cases were identified as carrying β-globin gene cluster deletions, which had not been previously reported. Two at-risk couples (0.0015%) were required to receive prenatal diagnosis. We also found 53 cases of nondeletional-HPFH (nd-HPFH), including 52 with Italian nd-HPFH and one with the Aγ-197C-T heterozygous state. It is difficult to discriminate between Chinese Gγ(Aγδβ)0-thal and Italian nd-HPFH carriers using hemoglobin (Hb) analysis. Conclusions: This study is the first to describe the familial prevalence of HPFH/δβ-thalassemia and the high-risk rate in in Greater Guangzhou Area, and the findings will support the implementation of thalassemia screening for three common deletions by gap-PCR. We alsopresented a systematic description of genotype-phenotype relationships which will be useful for genetic counseling and prenatal diagnostic services for β-thalassemia intermedia.Keywords: Prevalence, δβ-thalassemia, HPFH, Guangzhou
Clinical Implications of Pachyvessels in Polypoidal Choroidal Vasculopathy
Authors: Ijuin Nobuo , Tsujinaka Hiroki , Hirai Hiromasa , Jimura Hironobu , Nakao Shigeya , Yamashita Mariko , Nishi Tomo , Ueda Tetsuo , Ogata Nahoko
Published: November 2019

Purpose: Polypoidal choroidal vasculopathy (PCV) is one of the disorders within the pachychoroid spectrum diseases. The presence of pachyvessels is one of the characteristics of pachychoroid disorders. However, the relationship between the presence of pachyvessels and the clinical characteristics of PCV eyes has not been determined. The purpose of this study was to determine the relationship between the presence of choroidal pachyvessels and the clinical characteristics of eyes with PCV.Methods: The medical records of patients who were diagnosed with PCV and were treatment-naïve were reviewed. Fluorescein and indocyanine green angiography, fundus photography, spectral domain optical coherence tomography (SD-OCT), and enhanced depth imaging OCT (EDI-OCT) were used to obtain images of the choroid. The PCV eyes were divided into two groups based on the presence or absence of pachyvessels and clinical features and subfoveal choroidal thickness (SFCT) were evaluated between the two groups.Results: Eighty-six eyes of 84 patients with PCV were evaluated. Pachyvessels were detected in 48 eyes (55.8％). The mean SFCT was 203.9 ± 83.9 μm in all 86 eyes, and it was significantly thinner in eyes with pachyvessels (+) than without pachyvessels (-) (183.2 ± 58.4 μm vs 230.2 ± 103.1 μm; P=0.01). The differences in the incidence of subretinal fluid, pigment epithelial detachments, and hemorrhages between the two groups were not significant. However, the PCV eyes in pachyvessels (+) group with hemorrhage had the thinnest choroid (P=0.047). The choroidal features of the fellow eyes were similar to those of the PCV affected eyes, that is, the fellow eyes in pachyvessels (+) group had pachyvessels and the fellow eyes in pachyvessels (-) group did not had pachyvessels. Conclusions: Pachyvessels were presented 55.8% in eyes with PCV, and these eyes had the thin SFCT. The presence of pachyvessels and attenuation of the inner choroid were probably due to the pathological changes in the eyes with PCV.
First description of increased resistance in carbapenem-susceptible Klebsiella pneumoniae with imipenem treatment driven by outer membrane remodelling in China
Authors: Tian Xuebin , Wang Qiongdan , Zheng Xiangkuo , Zhao Yajie , Fang Renchi , Li Jiahui , Wang Chong , Liu Haiyang , Cao Jianming , Zhou Tieli
Published: November 2019

The emergence of carbapenem-resistant Kelbsiella pneumoniae (CRKP) posed threats to human health. Although there are numerous studies regarding porin alteration in association with the production of ESBLs and/or AmpC β-lactamase, a systematic research about the treatment-emergence of porins alteration in antibiotic resistance does not exist yet. The aim of this study was to investigate the underlying mechanism and evolution of resistance of K. pneumoniae during carbapenem treatment. Here, we reported three strains (FK-2624, FK-2723 and FK-2820) isolated from one patient before and after imipenem treatment during hospitalization. Antibiotic susceptibility testing indicated that FK-2624 was susceptible to almost antimicrobials but fosfomycin; FK-2723 and FK-2820 were MDR. After imipenem therapy, FK-2820 was evolved to carbapenem-resistant. PCR and Whole-Genome sequencing ( WGS) indicated that resistance genes bla SHV , oqxA and fosA5 were detected in FK-2624, in addition, FK-2723 and FK-2820 harbored bla DHA , qnrB , aac (6’)-Ib . Virulence factors K57, ybtA, mrkD, entB and iroN were detected simultaneously in all of three strains. The results of pairwise comparisons , multi-locus sequencing typing (MLST) and pulsed-field gel electrophoresis (PFGE) revealed high homology among the isolates. Sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE) results showed that isolate FK-2820 lacked OmpK 36 as there was a premature stop codon of the outer membrane porin encoding gene ompk36 confirmed by sequencing. Real-time RT-PCR revealed that the expression of ompK36 in FK-2820 was 0.093 times the control isolate ATCC 13883. Our study highlighted that the alteration of outer membrane porins due to the 14-day use of imipenem clinically play a potential role in leading to the carbapenems-resistance of FK-2820.