bluuebunny/crossref_metadata_2025 huggingface dataset:
Post-lingual non-syndromic hearing loss phenotype: a polygenic case with 2 biallelic mutations in MYO15A and MITF
Authors: Khalil Athar , Karroum Samer Bou , Barake Rana , Dunya Gabriel , Abou-Rizk Samer , Kamar Amina , Nemer Georges , Bassim Marc
Published: December 2019

Background: Hearing loss (HL) represents the most common congenital sensory impairment with an incidence of 1-5 per 1000 live births. Non-syndromic hearing loss (NSHL) is an isolated finding that is not part of any other disorder accounting for 70% of all genetic hearing loss cases.
Methods: In the current study , we reported a polygenic mode of inheritance in an NSHL consanguineous family using exome sequencing technology and we evaluated the possible effect of the detected single nucleotide variants (SNVs) using in silico methods.
Results: Two bi-allelic SNVs were detected in the affected patients; a MYO15A (. p.V485A) variant, and a novel MITF (p.P338L) variant. Along with these homozygous mutations, we detected two heterozygous variants in well described hearing loss genes ( MYO7A and MYH14 ). The novel MITF p. Pro338Leu missense mutation was predicted to change the protein structure and function.
Conclusion: A novel MITF mutation along with a previously described MYO15A mutation segregate with an autosomal recessive non-syndromic HL case with a post-lingual onset. The findings highlight the importance of carrying whole exome sequencing for a comprehensive assessment of HL genetic heterogeneity.
Does Er,Cr:YSGG reduce the microleakage of restorations when used for cavity preparation? a systematic review and meta-analysis
Authors: Zhang Yali , Chen Wenfei , Zhang Jinrui , Li Yanhui
Published: December 2019

Background: As the member of erbium laser family, Erbium, Chromium: Yttrium Scandium Gallium Garnet (Er,Cr:YSGG) has obtained the approval for caries removal and cavity preparation by Food and Drug Administration (FDA). However, there is still controversy over the beneficial effects of Er,Cr:YSGG preparations on microleakage. The present study is the first systematic review and meta-analysis to compare the microleakage of cavities prepared by Er,Cr:YSGG lasers with that by traditional burs. In addition, the effect of acid etching on the adhesive potential of self-etch and etch-and-rinse adhesives was assessed after laser preparation. Methods: An electronic search was performed in Pubmed, EBSCO, Embase, and the Cochrane Controlled Register of Trials (CENTRAL). Results: Totally, 357 articles were identified. Finally, 13 met the inclusion criteria, of which 11 were selected for meta-analysis. All the included studies exhibited a moderate risk of bias. Based on the meta-analysis, no significant difference was observed between the Er,Cr:YSGG and traditional bur groups in terms of the incidence of microleakage. Self-etch adhesives, in combination with prior acid etching, showed less microleakage than those without acid etching in the laser-prepared cavities. Conclusions: Current studies do not support the beneficial effects of Er,Cr:YSGG preparations on microleakage. Additional acid etching with self-etching adhesives is recommended after Er,Cr:YSGG preparations. Further high-quality studies are needed to draw a convincing conclusion in the future.
Utilization of dental services and associated factors among preschool children in China
Authors: Gao Xiaoli , Ding Min , Xu Mengru , Wu Huijing , Zhang Chunzi , Wang Xing , Feng Xiping , Tai Baojun , Hu Deyu , Lin Huancai , Wang Bo , Zheng Shuguo , Liu Xuenan , Rong Wensheng , Wang Weijian , Wang Chunxiao , Si Yan
Published: December 2019

Background: This study sought to evaluate dental utilization among 3-,4-, and 5-year-old children in China and to use Andersen’s behavioural model to explore influencing factors, thereby providing a reference for future policy making.
Methods: This study is a cross-sectional study. Data of 40,305 children aged 3-5 years were extracted from the Fourth National Oral Health Survey, which was performed from August 2015 to December 2016. Patient data were collected using a questionnaire, which was answered by the child’s parents, and clinical data were collected during a clinical examination. Stratification and survey weighting were incorporated into the complex survey design. Descriptive statistics, bivariate correlations and hierarchical logistic regression results were then analysed to find the factors associated with oral health service utilization.
Results : The oral health service utilization prevalence during the prior 12 months were 9.5% (95%CI: 8.1%-11.1%) among 3-year-old children, 12.1% (95%CI: 10.8%-13.5%) among 4-year-old children, and 17.5% (95%CI: 15.6%-19.4%) among 5-year-old children. “No dental diseases” (71.3%) and “dental disease was not severe” (12.4%) were the principal reasons why children had not attended a dental visit in the past 12 months. The children whose parents had a bachelor’s degree or higher(OR: 2.29, 95%CI: 1.97-2.67, p <0.001), a better oral health attitude ranging from 5 to 8(OR: 1.64, 95%CI: 1.43-1.89, p <0.001), annual per capital income more than 25,000 CNY (OR: 1.40, 95%CI: 1.18-1.65, p <0.001),think their child have worse or bad oral health(OR: 3.54, 95%CI: 2.84-4.40, p <0.001), and children who often have toothaches (OR: 9.72 , 95%CI: 7.81-12.09, p <0.001) were more likely to go to the dentist in the past year.
Conclusion: The prevalence of dental service utilization was relatively low among preschool children. It is necessary to strengthen oral health education for parents and children, thereby improving oral health knowledge as well as attitude, and promoting dental utilization.
Unique miRNAs and their targets in tomato leaf responding to combined drought and heat stress
Authors: Zhou Rong , Yu Xiaqing , Ottosen Carl-Otto , Zhang Tingling , Wu Zhen , Zhao Tongmin
Published: December 2019

Background: Both drought and heat stress are serious global problems, leading to agricultural production loss. MicroRNAs (miRNAs) play important roles in plant species responding to individual drought and heat stress. However, the miRNAs and mRNAs in association with combined drought and heat in crops like tomato remains unclear. Results: We studied the crosstalk of miRNAs and their target genes in tomato plants grown under simultaneous drought and heat stress that frequently happen in field conditions. In total, 335 known miRNAs representing 55 miRNA families and 430 potential novel miRNAs were identified in Solanum lycopersicum L. using small RNA deep sequencing. Through expression analysis, miRNAs in association with drought, heat and the combination of these were investigated. In total, 61, 74 and 37 miRNAs were differentially regulated for combination (of both stresses) vs control, combination vs drought and combination vs heat, respectively. Target genes with different expression levels were found using degradome sequencing, which were mainly involved in transcription factor activity, sequence-specific DNA binding, transcription, regulation of transcription, nucleus, DNA binding etc . The quantitative real-time polymerase chain reaction (qRT-PCR) results confirmed the accuracy of sequencing. Conclusions: Our study serves as valuable knowledge on how crop adapted to combined drought and heat stress by regulating miRNAs and mRNAs, which provide information for crop improvement to deal with future climate changes. Keywords: Solanum lycopersicum L.; miRNAs; degradome; functional analysis; combined abiotic stress
Comparison of metamizole and paracetamol effects on colonic anastomosis and fibroblast activities in Wistar rats
Authors: Purnomo Eko , Nugrahaningsih Dwi Aris Agung , Agustriani Nunik , Gunadi .
Published: December 2019

Background : Leakage following colorectal anastomosis surgery causes various complications associated with high morbidity and mortality, especially in pediatric patients. It might be caused by the use of non-steroidal anti-inflammatory drugs (NSAIDs) as postoperative analgesics. This study aimed to compare the effect of metamizole and paracetamol on colonic anastomosis and fibroblast activities, including proliferation, migration, and collagen synthesis, in Wistar rats. Methods: Rats were divided into control, paracetamol and metamizole groups. The colonic anastomosis was evaluated by determining the integrity of the muscle layers, the formation of granulation tissue, and mucosal anastomosis. Fibroblast activities were analyzed by measuring the proliferation, migration, and collagen synthesis. Results: Metamizole caused more damage to muscle layer integrity, more inhibition of granulation tissue formation in the anastomosis area and lower mucosal anastomosis compared with paracetamol and control groups. Metamizole had a higher cytotoxic effect than paracetamol, which suppressed the proliferation and migration of fibroblasts. Furthermore, both drugs did not affect the synthesis of collagen. Conclusion: Metamizole shows worse effects on the integrity of muscle layers, inhibition of granulation tissue formation, mucosal anastomosis, fibroblast proliferation, and migration, but not collagen synthesis, than paracetamol in Wistar rat intestines following colonic anastomosis. These findings might indicate that paracetamol is safer than metamizole as analgesic following colonic anastomosis. Key Words: colonic anastomosis; fibroblast activities; metamizole; paracetamol; Wistar rat
Epidemiology of intestinal parasitic infections in preschool and school-aged Ethiopian children: A systematic review and meta-analysis
Authors: Chelkeba Legese , Mekonnen Zeleke , Alemu Yonas , Emana Daniel
Published: December 2019

Background : Numerous studies have been carried out on assessing the prevalence of intestinal parasites infections (IPIs) among preschool and school age children in Ethiopia, however, there was no study to gather and systematically analyze this information for policy makers.
Methods : We searched Medline via PubMed, Scopus, Science Direct, Web of Science (ISI), and Google Scholar and local peer-reviewed journals published from inception to 2019 for studies describing prevalence of IPIs among preschool and school age children. We conducted meta-regression to understand the trend and the source of heterogeneity and pooled the prevalence using ‘metaprop’ command using STATA software (Intercooled, version 14, STATA Corp, College Station, TX).
Results : Eighty three (83) studies examining 56,786 fecal specimens were included. The prevalence of IPIs was 48 %( 95%CI: 42% to 53%) and showed a gradual, but significantly decreasing trends 17% (95% CI: 2.5% to 32%) for each consecutive 6 years) and was similar in males and females. The pooled prevalence in years 1997–2002, 2003–2008, 2009–2014 and >2014 was 71% (95% CI: 57% to 86%), 42% (95% CI: 27% to 56%), 48% (95% CI: 40% to 56%) and 42% (95% CI: 34% to 49%), respectively. Poly-parasitism was observed in 16% (95% CI: 13% to 19 %,) of children while, single parasite infection was observed in 36 %( 95% CI: 30% to 41%).
Conclusion: IPIs are highly prevalent and well distributed across the regional states of Ethiopia. Southern and Amhara regional states carry the highest burden. We observed a gradual, but significant decreasing trends in prevalence of IPIs among Ethiopian children over the last two decades.
A systematic review of surgical margins utilized for removal of cutaneous mast cell tumors in dogs
Authors: Selmic Laura Elizabeth , Ruple Audrey
Published: December 2019

Background Traditionally, wide lateral surgical margins of 3cm and one fascial plane deep have been recommended for resection of canine cutaneous mast cell tumor (MCT). Several studies have been published assessing surgical margins of less than this traditional recommendation. The objective of this systematic review was to determine if resection MCT with lateral surgical margins < 3cm results in low rates of incomplete resection and local tumor recurrence. Systematic searches of digital bibliographic databases were performed with two authors screening abstracts to identify relevant scientific articles. Studies regarding surgical treatment of dogs with cutaneous MCT were reviewed. Data abstraction was performed and the quality of individual studies and the strength of the body of evidence for utilization of surgical margins < 3cm for removal of MCTs was assessed.Results From the initial 78 citations identified through the database searches, four articles were retained for data abstraction after both relevance screenings were performed. Two studies were retrospective observational studies, one was a prospective case series and one was a prospective clinical trial. Assessment of the quality level of the body of evidence identified using the GRADE system was low. Excision of MCT at 2cm and 3cm was associated with comparably low rates of incomplete excision and recurrence.Conclusions Despite the low quality of the overall body of evidence, a recommendation can be made that resection of canine cutaneous MCTs (< 4cm) of Patnaik grade I and II with 2cm lateral margins and 1 fascial plane deep results in low rates of incomplete excision and local tumor recurrence.
Cardiovascular diagnostic information about blood pressure, arterial stiffness and atrial fibrillation is contained in oscillometric blood pressure profiles and is extractable by mathematical analysis
Authors: Hullender David Allan , Brown Olen R.
Published: December 2019

The authors have withdrawn this preprint from Research Square
Determining Quantitative Diagnostic Test Cut-off in G6PD Heterozygous Women for Tafenoquine Therapy
Authors: Swastika Maria , Harahap Alida R , Panggalo Lydia V , Jusman Sri Widia A , Satyagraha Ari W
Published: December 2019

Background Glucose-6-phosphate dehydrogenase (G6PD) deficiency is the most common enzyme disorder in the world. Its main function is to generate NADPH that is required for anti-oxidative pathway in the cells especially in red blood cells (RBC). G6PD deficiency is X-linked and thus subject to random X-chromosome inactivation in women giving them mosaic expression of G6PD activities in their individual cells. This phenomenon makes it difficult for diagnosis with the currently available G6PD qualitative diagnostic tests. With the rolling out of newly marketed anti-malarial drug tafenoquine which has a long half-life, screening for G6PD deficiency becomes a necessity where those with <70% G6PD activity cannot receive this drug. Thus, evidence for a quantitative cut-off for G6PD activity is needed to ensure safe drug administration.Methods RBC models were developed to analyze the effect of oxidant on RBC oxidative markers namely total glutathione (GSH) and malondialdehyde (MDA). G6PD activity was measured using quantitative assay from Trinity Biotech and was correlated with cytofluorometric assay. RBC from G6PD heterozygous women with different G6PD activities were also analyzed for comparison.Results There was a negative correlation between G6PD activity and CuCl concentration and a strong association between G6PD activities and proportion of G6PD normal RBC in CuCl-treated models and in ex vivo RBC. However, in terms of oxidative stress markers analyses, unlike the hypothesis where the lower G6PD activity, the higher MDA and the lower GSH level, our CuCl RBC model showed that in low G6PD activities (10-30%) cells, the MDA level is lower compared to the rest of the models (p<0.05). Our ex vivo model however were in line with the hypothesis, although the result was not significant (p=0.5). There was a significant difference between RBC with <60% and those with >80% G6PD activities in CuCl RBC model but not in ex vivo RBC (p=0.5). Genotyping heterozygous subjects showed G6PD Viangchan variant with 2.97 U/g Hb (33% activity) and 6.58 U/g Hb (74% activity).Conclusions The MDA and GSH analyses have pointed to the 60% G6PD activity cut-off. This provides an evidence of possible cut-off for tafenoquine administration in G6PD heterozygous women.
Opinions of key stakeholders on alternative interventions for malaria control and elimination in Tanzania
Authors: Finda Marceline Francis , Christofides Nicola , Lezaun Javier , Tarimo Brian , Chaki Prosper , Kelly Ann , Kapologwe Ntuli , Kazyoba Paul , Emidi Basiliana , Okumu Fredros O.
Published: December 2019

Background Malaria control in Tanzania currently relies primarily on long-lasting insecticidal nets and indoor residual spraying, alongside effective case management and behaviour change communication. This study explored opinions of key stakeholders on suitability and potential of six alternative vector control interventions for supplementing ongoing malaria control and elimination efforts in Tanzania.Methods Focus group discussions were held with policy-makers, regulators, research scientists and community members, each group having 6-10 participants. Alternative interventions discussed included: a) improved housing, b) larval source management, c) mass drug administration (MDA) with ivermectin to reduce vector densities, d) modified mosquitoes including genetically-modified or irradiated mosquitoes, e) targeted spraying of mosquito swarms, and f) spatial repellents. Discussions focused on stakeholder opinions on comparative value of these interventions for supplementing efforts towards the 2030 malaria elimination target.Results Larval source management and spatial repellents were widely supported across all stakeholder groups, while insecticide-spraying of mosquito swarms was least preferred. Support for MDA with ivermectin was high among policy makers, regulators and research scientists, but encountered opposition among community members due to perceptions that it requires significant efforts and compliance. Community members expressed strong desire and support for programmes to improve housing for poor people in high transmission areas, while policy makers challenged sustainability of this strategy given its high costs. Techniques of mosquito modification, specifically those involving gene drives, were viewed positively by community members, policy makers and regulators, but encountered high degrees of scepticism among scientists. Overall, policy-makers, regulators and community members trusted scientists to provide appropriate advice for decision making.Conclusion Stakeholder opinions regarding alternative malaria interventions were divergent, except for larval source management and spatial repellents for which there was universal support. MDA with ivermectin, house improvement and modified mosquitoes were also widely supported though each faced concerns from at least one stakeholder group. While policy-makers, regulators and community members all noted their dependence on scientists to make informed decisions, their reasoning on benefits and drawbacks of specific interventions included factors beyond technical efficiency. This study suggests the need to encourage and strengthen dialogue between scientists, policy makers, regulators and communities regarding new interventions.
Which mechanisms explain motivation of primary health workers? Insights from realist evaluation of a maternal and child health programme in Nigeria
Authors: EBENSO Bassey E. , Mbachu Chinyere , Etiaba Enyi , Huss Reinhard , Manzano Ana , Onwujekwe Obinna , Uzochukwu Benjamin , Ezumah Nkoli , Ensor Tim , Hicks Joseph Paul , Mirzoev Tolib
Published: December 2019

Background: Well-trained, adequately skilled and motivated primary healthcare (PHC) workers are essential for attaining universal health coverage and the Sustainable Development Goal 3 of ensuring healthy lives and promoting well-being for all. While there is abundant literature on drivers of workforce motivation, published knowledge on the mechanisms of how motivation works within different contexts is limited, particularly from low- and middle-income countries. This paper contributes to health workforce literature by reporting on how motivation works among PHC workers in a maternal and child health (MCH) programme in Nigeria. Methods: We adopted a realist evaluation design including scoping review of literature, document review of policies and MCH programme handbook, and in-depth interviews of PHC workers (n=25), facility managers (n=16), policymakers (n=12) and programme managers (n=10) to assess the impact of the MCH programme in Anambra State, Nigeria. A realist process of theory development, testing, verification and consolidation was used to understand how and under what circumstances the MCH programme impacted on workers’ motivation and which mechanisms helped explain how motivation works. The developed programme theory drew upon Herzberg’s two-factor and Adam’s equity theories to unpack the influences of contextual conditions on worker motivation. Results: A complex and dynamic interaction between the MCH programme and organizational, societal and policy contexts triggered five mechanisms which explain PHC worker motivation: i) feeling supported, ii) feeling valued and committed to work, iii) morale and confidence to perform tasks, iv) companionship and v) feeling comfortable with work environment. Some mechanisms were mutually reinforcing while others operated in parallel. Further analysis showed that the conditions that enabled worker motivation to occur were organisational values of fairness, recognition of health workers’ contributions and a culture of task-sharing and teamwork. Conclusions: Policy designs and management strategies for improving performance of health workers, particularly in resource-constrained settings should create working environments that foster feelings of being valued and supported while enabling workers to apply their knowledge and skills to improve healthcare delivery. Future research can test the explanatory framework generated by this study and explore differences in motivational mechanisms among different cadres of PHC workers to inform cadre-related motivational interventions.
Coordinating Health Workforce Management in a Devolved Context: Lessons from Kenya
Authors: Thuku Mathew Kariuki , Muriuki Janet , Adano Ummuro , Oyucho Linet , Nelson David
Published: December 2019

Introduction Kenya began strengthening national inter-sectoral coordination for human resources for health (HRH) planning and governance in 2010, in alignment with the World Health Organization’s Country Coordination and Facilitation approach. In 2013, however, the country fully and rapidly devolved health services to 47 county governments under Kenya’s new constitution. It soon became evident that the coordination mechanism to manage the health workforce at county level was inadequate. This case study describes how Kenya created an inter-county, multi-stakeholder HRH coordination framework that promotes consensus, commitment, and cooperation in devolved HRH management. Case Presentation Through USAID funding, IntraHealth International built the HR management capacity of county public service boards and county health departments by strengthening coordination mechanisms at national and county levels. Informed by stakeholder mapping, Kenya’s 47 counties were grouped into nine clusters with similar geographic contexts and HRH challenges. Inter-county cluster HRH stakeholder coordination forums are hosted by a rotating county-led secretariat and meet quarterly to address gaps, share successes and challenges, and track implementation of action plans. They link to the national level for capacity building, policy formulation, HRH regulation, and provision of standards. Counties have assumed ownership of the forums and contributed about US$85,000 to date toward expenses. Conclusions As a mechanism for transforming Kenya’s national HRH agenda into action at the county level, the HRH coordination framework has been instrumental in 1) expediting development, customization, and dissemination of policies, 2) enabling national HRH officers to mentor their county counterparts, and 3) providing collaborative platforms for multiple stakeholders to resolve HRH challenges and harmonize HR practices nationwide. Successes catalyzed through the inter-county forums include hiring over 20,000 health workers to address shortages; expanding the national HR information system to all 47 counties; developing guidelines for sharing specialist providers; and establishing professionalized HRH units in 43 counties. Kenya has made great strides in strengthening its health system through the HRH coordination framework, which supports standardization of county health operations with national goals while enabling national policy to address HRH gaps in the counties. Transitioning to fully local funding of inter-county forums is important for sustaining progress.
Distribution of Macrolide-Lincosamide-Streptogramin B antibiotics resistance genes in clinical isolates of Staphylococci
Authors: Nagarkoti Dharma , Prajapati Krishna , Sharma Ajay Narayan , Gyawali Arrogya , Manandhar Sarita
Published: December 2019

Background Staphylococci are the most commonly isolated pathogen from clinical specimen. These isolates are posing threat due to increasing trend of antimicrobial resistance particularly methicillin. Macrolide-lincosamide streptogramin B family of antibiotics is commonly used to treat such infections. This study was aimed to detect the prevalence of inducible clindamycin resistance and observation of erm and msr genes among Staphylococci isolated from tertiary care hospital of Nepal.Methods Staphylococci from different clinical specimen were identified and antibiotic susceptibility profile were determined following Kirby Bauer disc diffusion method. The double disc diffusion or D-zone test as outlined in CLSI document M100-S24 was performed to examine inducible clindamycin resistance isolates. Multiplex PCR was performed for detection of erm and msr gene in isolates using specific primers for ermA , ermB, ermC, msrA and msrB genes.Results Of the 60 Staphylococci isolates, 39 (65%) were Staphylococcus aureus ( S. aureus ) and 21 (35%) were coagulase negative Staphylococci (CNS) with 25 (64%) and 15 (71%) representing methicillin resistant S. aureus and CNS respectively. Constitutive and inducible MLS B phenotype was observed among 24 (40%) and 14 (23%) isolates respectively by D test. The most prevalent resistant gene was ermC gene (37%) followed by msr B (12%), erm B (10%) and msr A (10%). None of the isolates were found to possess erm A gene.Conclusions The resistant genes were detected more among CNS than S. aureus. The presence of constitutive and inducible MLS B as well as resistant genes among Staphylococci necessitates detection of such isolates to minimize treatment failure. The presence of resistant characteristic varies with hospital settings, geographical locations, patients’ demography etc. The result from this study may help elucidate the predominant resistant characteristics in clinical Staphylococci isolated from tertiary care hospital of Nepal.
Metagenomic Next-generation Sequencing of Cerebrospinal Fluid for the Diagnosis of Central Nervous System infections in HIV-infected patients
Authors: Zheng Nai qing , Guo Pengle , Chen Xiejie , He Haolan , Li Yueping , Li Linghua , Cai Weiping
Published: December 2019

Background HIV-infected patients have extremely low immunity and various opportunistic infections. Early diagnosis and treatment of these pathogens is critical for patients with HIV infection, especially those with central nervous system (CNS) infections. Metagenomic next generation sequencing (mNGS) has the advantage of identifying a broad range of pathogens and was suggested as a promising tool in the clinical diagnosis for infectious diseases. The clinical application of mNGS in the diagnosis of CNS infections in patients infected with HIV remains inadequately characterized.Methods We retrospectively analyzed data from 22 patients with suspected central nervous system infections who underwent both mNGS and conventional methods including culture, PCR, X-pert/RIF and antigen testing to explored the utility of mNGS in clinical diagnostic microbiology of CNS infections in HIV-infected patients.Results A total of 22 patients participated in the study between June 2018 and May 2019. The consistency of positive percentage of mNGS compared to clinical diagnosis was significantly higher than that of conventional methods (86.36% vs. 45.21%). The proportion of co-infections in mNGS positive samples was significantly higher than that in traditional methods (40.91% vs. 14.39%). Sixteen Extra Pathogens in 14 cases identified by metagenomic NGS only, 6 pathogens affected clinical reasoning and 7 pathogens guided antimicrobial therapy.Conclusions MNGS is a powerful diagnostic method for identifying pathogens in central nervous system infections and provide actionable information in some cases. MNGS technology has positive significance for the diagnosis and clinical treatment of central nervous system infection in HIV-infected patients.
Definitions of poor outcome after total knee arthroplasty: An inventory review
Authors: Molder Malou te , Smolders José M.H. , Heesterbeek Petra J.C. , Ende Cornelia H.M. van den
Published: December 2019

Background: A significant proportion of patients shows poor response (i.e. no or little improvement) after total knee arthroplasty (TKA) because of osteoarthritis. It is difficult to quantify the proportion of patients with poor response to TKA, as different definitions of, and perspectives (clinician’s and patient’s) on poor response are being used. The aim of this study was therefore to review the literature and summarize definitions of poor response to TKA. Methods: A systematic search was performed to identify and review studies that included dichotomous definitions of poor outcome after primary TKA. The type, amount and combination of domains (e.g. functioning), outcome measures, type of responses (absolute/relative, change/cut-off), values and moments of follow-up used in definitions were summarized. Results: A total of 46 different dichotomous definitions of poor response to TKA were extracted from 2163 initially identified studies. 35 definitions incorporated one domain, seven definitions comprised two domains and four definitions comprised three domains. Eight different domains were used in identified definitions: pain, function, physical functioning, quality of life (QoL), patient satisfaction, anxiety, depression and patient global assessment. The absolute cut-off value was the most common type of response, with large variety in value and timing of follow-up. Conclusions: Our inventory review shows that definitions of poor response to TKA are heterogeneous. Our findings stresses the need for an unambiguous definition of poor response to draw conclusions about the prevalence of poor-responders to TKA across hospitals and countries, and to identify patients at risk.
The effect and potential risks of using cement-augmented pedicle screw instrumentation on multiple segment fixation in osteoporotic spine with lumbar degenerative diseases
Authors: Tang Yong-chao , Guo Hui-zhi , Guo Dan-qing , Luo Pei-jie , Li Yong-xian , Mo Guo-ye , Ma Yan-huai , Peng Jian-cheng , Liang De , Zhang Shun-cong
Published: December 2019

Background: Cement-augmented pedicle screw instrumentation (CAPSI) has been found to significantly increase the pedicle screws anchorage in the osteoporotic vertebral body, however, with the increase of augmented level and bone cement dose, the incidence of cement leakage (CL) or side complication of CAPSI also increased. But the effect and potential risks of CAPSI for osteoporotic lumbar degenerative diseases (LDD) have not been investigated in the cases of multiple segment fixation. The purpose of this study was to investigate potential complications of using cement-augmented screws for multilevel fixation (three or four levels) and the effectiveness of this method for treating LDD with low bone quality.
How to improve the safety of bicortical pedicle screw insertion in the thoracolumbar veterbrae with osteoporotic: Analysis base on three-dimensional CT reconstruction of patients in prone position
Authors: Xu Chao , Hou Qingxian , Chu Yanchen , Huang Xiuling , Yang Wenjiu , Ma Jinlong , Wang Zhijie
Published: December 2019

Background: Three-dimensional CT reconstruction of prone position could measure the relative position between the Great vessels and the thoracolumbar vertebrae. The Great vessels positions of the thoracic and lumbar segments were studied to improve the accuracy of pedicle screw insertion, reduce the risk of vascular injury. Methods: Twenty-four adults participated in the present study. Three-dimensional reconstruction of thoracolumbar (T9–L3) CT was performed in the prone and supine positions. The relative distance between the arteriovenous vessels and vertebrae distance (AVD/VVD) was obtained, respectively. The relative position angle of the arteriovenous vessel and the vertebral body was calculated as ∠AOY/∠VOY. Self-controlled experiments were carried out in the prone and supine positions. The data obtained were analyzed using SPSS 22.0 statistical software. Results: With regard to AVD, The AVD of the T12 was the smallest,> 3.2 mm. The difference among the T9, T10, L2 level was statistically significant (P < 0.05). And AVD was greater in the prone position than in the supine position; while the value of ∠AOY is the descending from T9-L3 gradually, there were statistically significant differences in ∠AOY between T9-T12, L2 and L3 in prone and supine position (P < 0.05). The aorta in the prone position was closer to the midline than that of the supine position, varying from 0°to 30°near the Y axis. With regard to VVD, there was no significant difference in contrast between the prone and supine positions (P≥0.05), and the VVD was the smallest in the L3 level> 5.4 mm. Conclusion: The pre-vertebral position of the aorta may change from T9 to L3 due to changes in body position. When the T9-L3 thoracolumbar spine disease was treated with pedicle screw double cortical fixation, the screw was safe and reliable within a range of≤ 3 mm when broken the pre-cortex .The three-dimensional reconstruction of prone position CT could be used to more accurately assess the relative position of the vertebral body and the blood vessel.
The effects of Enhanced Primary Healthcare interventions on primary care providers job satisfaction
Authors: Wong Wen Jun , Norzi Aisyah Mohd , Ang Swee Hung , Chan Chee Lee , Jaafar Faeiz Syezri Adzmin , Sivasampu Sheamini
Published: December 2019

Background In response to address the rising burden of cardiovascular risk factors, Malaysian government has implemented Enhanced Primary Healthcare (EnPHC) interventions in July 2017 at public clinics level. Healthcare providers (HCPs) play crucial roles in healthcare service delivery and health system reform can influence HCPs’ job satisfaction. However, studies evaluating HCPs’ job satisfaction following primary care transformation remain scarce in low- and middle-income countries. This study aims to evaluate the effects of EnPHC interventions on HCPs. Methods This is a quasi-experimental study conducted in 20 intervention and 20 matched control clinics. We surveyed all healthcare providers who were directly involved in patient management. A self-administered questionnaire which included six questions on job satisfaction were distributed at baseline (April and May 2017) and post-intervention (March and April 2019). Difference-in-differences analysis was used in the multivariable linear regression model in which we adjusted for providers and clinics characteristics to detect the changes in job satisfaction following EnPHC interventions. Results A total of 1042 and 1215 HCPs responded at baseline and post-intervention respectively. At post-intervention, the intervention group reported higher level of stress and change in score between two groups was -0.14 (β= -0.139; 95% CI -0.266,-0.012; p =0.032). In subgroup analysis, nurses from intervention group experienced increase in work stress following EnPHC interventions (β= -0.223; 95% CI -0.419,-0.026; p =0.026). Additionally, the same group also responded that they were less likely to perceive their profession as well-respected at post-intervention (β= -0.175; 95% CI -0.331,-0.019; p =0.027). Conversely, allied health professionals from intervention group were more likely to report a good balance between work and effort (β= 0.386; 95% CI 0.033,0.738; p =0.032) after implementing EnPHC interventions. Conclusions Our findings suggest that EnPHC interventions had resulted in some untoward effect on HCPs’ job satisfaction. Job dissatisfaction can have detrimental effects on the organisation and healthcare system. Therefore, provider experience and well-being should be considered before introducing healthcare delivery reforms to avoid overburdening of HCPs.
Custom selected reference genes outperform pre-defined reference genes in transcriptomic analysis
Authors: Santos Karen Cristine Gonçalves Dos , Desgagné-Penix Isabel , Germain Hugo
Published: December 2019

Background : RNA sequencing allows the measuring of gene expression at a resolution unmet by expression arrays or RT-qPCR. It is however necessary to normalize sequencing data by library size, transcript size and composition, among other factors, before comparing expression levels. The use of internal control genes or spike-ins is advocated in the literature for scaling read counts, but the methods for choosing reference genes are mostly targeted at RT-qPCR studies and require a set of pre-selected candidate controls or pre-selected target genes.
Results : Here, we report an R-based pipeline to select internal control genes based solely on read counts and gene sizes. This novel method first normalizes the read counts to Transcripts per Million (TPM) and then excludes weakly expressed genes using the DAFS script to calculate the cut-off. It then selects as references the genes with lowest TPM covariance. We used this method to pick custom reference genes for the differential expression analysis of three transcriptome sets from transgenic Arabidopsis plants expressing heterologous fungal effector proteins tagged with GFP (using GFP alone as the control). The custom reference genes showed lower covariance and fold change as well as a broader range of expression levels than commonly used reference genes. When analyzed with NormFinder, both typical and custom reference genes were considered suitable internal controls, but the expression of custom selected genes was more stable. geNorm produced a similar result in which most custom selected genes ranked higher ( i.e. expression more stable) than commonly used reference genes.
Conclusions : The proposed method is innovative, rapid and simple. Since it does not depend on genome annotation, it can be used with any organism, and does not require pre-selected reference candidates or target genes that are not always available.
TEORIA ESPECIAL DA RELATIVIDADE: 100 ANOS APÓS, COMO ENSINÁ-LA SIGNIFICATIVAMENTE USANDO O CORDEL
Authors: Guimarães Ênio José Gondim , Nobre Francisco Augusto Silva
Published: December 2019

Neste trabalho mostramos que o folheto de cordel pode ser usado como ferramenta de ensino-aprendizagem da Teoria Especial da Relatividade (TER), bem como, proporcionar aprendizagem significativa a partir de uma sequência de ensino. A aprendizagem significativa na educação e o saber produzido historicamente, são referenciados pela aprendizagem significativa (Ausubel, 2003) e com a pedagogia histórico-crítica (Saviani, 2003). Para tal, aplicamos o cordel numa turma de 30 alunos (as) do ensino médio, numa escola pública de Fortaleza. Com o uso do folheto de cordel e a sequência de ensino proposta, acarretou-se, interesse nos estudantes pela Teoria Especial da Relatividade e geraram-se indicativos de aprendizagem significativa.
Editorial- 2ª Edição Especial do Centenário do Eclipse de Sobral
Authors: Oliveira Antônio Nunes de , Da Silva George Frederick Tavares , Fraga Wilton Bezerra de , Siqueira Marcos Cirineu Aguiar , Santiago Thiago de Melo
Published: December 2019

Nesta edição o leitor encontrará textos alusivos às Teorias da Relatividade, suas sínteses, aplicações e métodos de ensino cujo objetivo é a divulgação da ciência, do interesse científico pelo tema além de ser fonte de inspiração e motivação para inúmeros outros trabalhos de pesquisa de professores, estudantes e amantes do tema como forma de inspirar e motivar novas práticas de ensino. Estão também contemplados textos que dizem respeito ao ensino da Astronomia (no Ensino Fundamental), a qual tem forte vínculo com a Física, de forma bem especial com a Teoria da Relatividade Geral.
VERTIGO IN MULTIPLE MYELOMA PATIENT: A CASE REPORT
Authors: Wardhana Rangga Wisnu
Published: December 2019

Background: Multiple myeloma is caused by pathological proliferation and inhibition of apoptosis of plasma cells inside bone marrow. There are several mechanisms which explains neurologic manifestations (peripheral and central) of multiple myeloma, such as neurologic infiltration, gamma globulin deposits, and metabolic changes.
Aim: To describe vertigo syndrome in a multiple myeloma patient admitted to Sardjito Hospital.
Case Description: A male, 60 years old, admitted to Sardjito hospital for severe dizziness in the past 24 hours before admission. This dizziness ameliorated after adequate rest. The patient experienced nausea and vomiting which was not worsen by positional changes. He was diagnosed with multiple myeloma since December 2015. The physical examination showed normal vital sign, without nystagmus. He showed an intentional tremor, dysdiadochokinesia, and dysmetria. The laboratory examination revealed anaemia, hypoalbuminemia, hyponatremia, and hyperglycaemia. Chest x-ray showed pulmonary infiltration on all lobes, with suspected osteoclastic bone metastases at left and right scapula, and the 11th right costae. Non-contrast head CT scan showed an osteoblastic skeletal metastatic at 3rd cervical vertebra. Audiometry with BERA indicated a bilateral peripheral lesion. The symptoms improved with flunarizine and diphenhydramine.
Conclusion: Mixed central and peripheral vertigo is one of severe systemic manifestation of multiple myeloma.
DIAGNOSTIC AND MANAGEMENT APPROACH ON ACUTE INTOXICATION PATIENTS IN EMERGENCY SETTING: A CASE REPORT
Authors: Rahmi Elfi
Published: December 2019

Background: Acute intoxication is one common cause of loss of consciousness in emergency setting. However, its diagnosis and management usually neglected. In addition, multiple toxin might make etiological diagnosis and management more difficult.
Aim: This report describes the approach to diagnose and manage acutely intoxicated patients with suspected multiple substance in emergency unit of Dr. Sardjito Hospital
Case description: A 30-year-old male was admitted to emergency unit with loss of consciousness and return of spontaneous circulation after resuscitation prior to admission. He was comatose, with miosis and decreased physiological reflex. Further laboratory examination discovered decreased renal function and high level of serum alcohol. The patient regained his consciousness after he was given naloxone, dexamethasone, mecobalamin, and pantoprazole.
Conclusion: In the future, there is a need to integrate substance intoxication management to the algorithm of loss of consciousness management to improve the quality of acute intoxication management.
THE PERCEPTION OF MEDICAL AND PHARMACY UNDERGRADUATE STUDENTS IN YOGYAKARTA ON INTERPROFESSIONAL COLLABORATION CLASS
Authors: Hapsari Saverina Nungky Dian , Triastuti Ida Ayu
Published: December 2019

Introduction: Improving the quality of health services requires collaborative work skills in managing health problems from health workers. An understanding about interdisciplinary collaboration needs to be given since students take theoretical education. Learning about interprofessional education (IPE) needs to be evaluated whether it provides benefits to students in achieving learning objectives. The purpose of this study was to determine student perceptions after participating in IPE collaborative learning.

Method: This research is a descriptive cross-sectional quantitative study. Samples from this study were students of the UKDW Medical Faculty and the USD Pharmacy Faculty who participated in the IPE Communication Clinical Skills. A total of 269 students were given the Google Questionnaire IPE questionnaire, which was adapted from the Student Perceptions of Physician-Pharmacist Interprofessional Clinical Education (SPICE). The reliability of the questionnaire measured by Cronbachâ€™s Alpha was 0.72.

Results: The number of students who filled out the questionnaire was 176 people (response rate of 65.43%), consisting of 99 undergraduate students of the UKWD Faculty of Medicine and 170 students of the Faculty of Pharmacy. Students tend to choose to agree or strongly agree from all four research scales.

Discussion: The instrument contains 10 questions and contains 3 factors that emphasize collaborative teamwork, roles and responsibilities of each profession, and patient outcomes. The total mean value of all questions shows that according to students' perceptions, interprofessional education sessions are beneficial for students in understanding these factors. The results of the study generally describe students having a positive perception about IPE learning.

Conclusion: Students consider that the management of health by the interprofessional team can improve the health and satisfaction of patients, the importance of working with other professions, and understanding roles and responsibilities in collaborative practice.
The effect of industrial revolutions on the transformation of social and economic systems
Authors: Melnyk Leonid , Kubatko Oleksandr , Dehtyarova Iryna , Matsenko Oleksandr , Rozhko Oleksandr
Published: December 2019

The development of human civilization is related to the constant change of economic formations, and the current social and economic situation is determined by such concepts as Society 5.0, Fourth, and Fifth Industrial Revolutions (FIR, FiIR). The paper aims to estimate the change of human role in each economic formation caused by industrial revolutions. A structured review methodology with a focus on biological, labor, and personal entity of human within the industrial revolutions is used. The description of the changes between the biological, labor, and personality entities of human in various socio-economic formations is discussed. The human as a biological entity is not changed in the first four industrial revolutions, while the FiIR tries to change the biological entity through augmenting the physical capacity. The human as a labor entity is not changed in the first three industrial formations, while the FIR tries to replace the majority of physical human jobs and opens the gate for creative economy and decisions-making. The direct labor participation is minimized within FIR since the economic systems move to the transition to the dominant role of cyber-physical systems. The personal human development is triggered within the FiIR, since informational diversity in economic systems is actualized, and conditions for creative jobs within the creative economy are formed. The biological, labor, and personality entities of human are sequentially actualized within the economic formation caused by industrial revolutions.