bluuebunny/crossref_metadata_2025 huggingface dataset:
Analysis of accreditation standards for undergraduate medical studies in Serbia through the lens of the National Health Workforce Accounts
Authors: Buljugic Biljana , Milicevic Milena Santric
Published: November 2020

BackgroundUnderstanding the importance of educational accreditation standards for health and health workforce policymaking is needed more than ever given the growing circulation of physicians, cross-border care and population needs. The World Health Organization National Health Workforce Accounts (WHO/NHWA) for education and training could support the achievement of health care quality through health workforce strategies. ObjectiveTo assess the effect of the accreditation standards on the quality of undergraduate medical studies and to assess their potential to support quality improvement in health workforce education and health policy planning.MethodsStudy design is based on a multimodal approach revealing the qualitative (review of official documents, two internal reports on accreditation, literature) and quantitative data (descriptive analysis, 2010-2018) as resources for evaluation of the national accreditation standards, and mapping with WHO/NHWA indicators on education and training for medical undergraduate studies at the Faculty of Medicine University of Belgrade, Serbia (FMUB).ResultsThe mechanism of compulsory accreditation implies standards for the quality of education (except for inter-professional education). The standards partially cover social determinants and social accountability. Students participate optionally in the adoption of regulations. Like health managers who are also providers of student training during their studies, students participate in FMUB accreditation surveys. Based on the reports from two accreditation cycles, the satisfaction of graduates and employers with the quality of undergraduate medical studies has been partially improved. The downward trend in freshman enrollment has been observed for last nine years. The average duration of a six-year undergraduate study of medicine was extended to 7.2 ± 0.4 years.Conclusion Social accountability and social determinants must be taken as priority standards in the future revisions of accreditation mechanism in order to improve communication, organizational skills and independent work of medical students. Health workforce organizations, civil society and the community should participate in regulatory bodies for accreditation to establish the basis for socially accountable and inter-professional education. If applied at the institutional, local and national levels, the WHO/NHWA indicator system can support the alignment of higher education standards and plans with the standards and strategy/plan of the health care and health workforce.
Comparison of analgesic efficacy between rectus sheath bupivacaine or intrathecal morphine with bupivacaine versus intravenous patient-controlled analgesia in patients undergoing robot-assisted laparoscopic prostatectomy: a prospective, observational clinical study
Authors: Shim Jung-Woo , Cho Yun Jeong , Kim Minhee , Hong Sang Hyun , Moon Hyong Woo , Hong Sung Hoo , Chae Min Suk
Published: November 2020

Background: We explored the analgesic outcomes on postoperative day (POD) 1 in patients undergoing robot-assisted laparoscopic prostatectomy (RALP) who received intravenous patient-controlled analgesia (IV-PCA), rectus sheath bupivacaine block (RSB), or intrathecal morphine with bupivacaine block (ITMB). Methods: This was a prospective, observational clinical trial. Patients were divided into three groups: IV-PCA (n = 30), RSB (n = 30), and ITMB (n = 30). Peak pain scores at rest and with coughing, cumulative IV-PCA drug consumption, the need for IV rescue opioids, and Quality of Recovery-15 (QoR-15) questionnaire scores collected on POD 1 were compared among the groups.Results: The preoperative and intraoperative findings were comparable among the groups; the ITMB group required the least remifentanil of all groups. During POD 1, the ITMB group reported lower levels of pain at rest and with coughing, compared with the other two groups. During POD 1, incidences of severe pain at rest (10.0% vs. 23.3% vs. 40.0%) and with coughing (16.7% vs. 36.7% vs. 66.7%) were the lowest in the ITMB group compared with the RSB and IV-PCA groups, respectively. After adjustment for age, body mass index, diabetes mellitus, hypertension, and intraoperative remifentanil infusion, severe pain at rest was 0.167-fold less common in the ITMB group than in the IV-PCA group, while pain with coughing was 0.1-fold lower in the ITMB group and 0.306-fold lower in the RSB group, compared with the IV-PCA group. The ITMB group required lower cumulative IV-PCA drug infusions and less IV rescue opioids, while exhibiting a better QoR-15 global score, compared with the other two groups.Conclusion: Although ITMB induced complications of nausea and pruritus, this analgesic technique provided appropriate pain relief that enhanced patient perception related to early postoperative recovery.
Administration of Mesenchymal Stem Cells in Diabetic Kidney Disease: A Systematic Review and Meta-analysis
Authors: Lin Wenshan , Yang Qian , Chen Guangyong , Lin Shujun , Liao Chunling , Zhou Tianbiao
Published: November 2020

Background: Mesenchymal stem cell (MSC) therapy shows great promise for diabetic kidney disease (DKD) patients. Research has been carried out on this topic in recent years. The main goal of this paper is to evaluate the therapeutic effects of MSCs on DKD through a meta-analysis and address the mechanism through a systematic review of the literature.Method: An electronic search of the Embase, Cochrane Library, ISI Web of Science, PubMed and U.S National Library of Medicine (NLM) databases was performed for all articles about MSC therapy for DKD, without species limitations, up to January 2020. Data were pooled for analysis with Stata SE 12.Result: The MSC-treated group showed a large and statistically significant hypoglycemic effect at 1 week, 2 weeks, 3 weeks, 1 month, 2 months, 3 months and 6 months. Total hypoglycemic effect was observed (SMD=-1.954, 95%CI: -2.389 to -1.519, p＜0.001). The overall effects on serum creatinine (SCr) and blood urea nitrogen (BUN) were analyzed, suggesting that MSC decreased SCr and BUN and mitigated the impairment of renal function (SCr: SMD= -4.838, 95%CI: -6.789 to -2.887, p＜0.001; BUN: SMD= -4.912, 95%CI: -6.402 to -3.422, p＜0.001). Furthermore, MSC therapy decreased the excretion of urinary albumin. Fibrosis indicators were assessed, and the results showed that transforming growth factor-β, collagen-I, fibronectin and α-smooth muscle actin were significantly decreased in the MSC-treated group compared to the control group.Conclusion: MSCs may improve glycemic control and reduce SCr, BUN, and urinary protein. MSCs can also alleviate renal fibrosis. MSC therapy is a potential treatment for DKD.
Acute pulmonary embolism in patients presenting pulmonary deterioration after admission to internal medicine wards for non-critical COVID-19.
Authors: FRIZ Hernan POLO , GELFI Elia , ORENTI Annalisa , MOTTO Elena , PRIMITZ Laura , DONZELLI Tino , INTOTERO Marcello , SCARPAZZA Paolo , VIGHI Giuseppe , CIMMINIELLO Claudio , BORACCHI Patrizia
Published: November 2020

INTRODUCTION. Emerging evidence associates COVID-19 to an increased risk of acute pulmonary embolism (APE). The present study aimed to assess the prevalence of APE in patients admitted to internal medicine department wards for non-critical COVID-19 who presented clinical deterioration, and to investigate the association of clinical and biochemical variables with a confirmed diagnosis of APE in these subjects. METHODS. All consecutive patients admitted to the internal medicine department of a general hospital with a diagnosis of non-critical COVID-19, who performed a Computer Tomography Pulmonary Angiography(CTPA) for respiratory deterioration in April 2020, were included in this retrospective cohort study. RESULTS. Study populations: 41 subjects, median(IRQ) age: 71.7(63-76) years, CPTA confirmed APE=8(19.51%,CI95%:8.82%-34.87%). Among patients with and without APE, no significant differences were found with regards symptoms, comorbidities, treatment, Wells score and outcomes. The optimal cut-off value of D-dimer for predicting APE was 2454 ng/mL, sensitivity(CI95%):63(24-91), specificity:73(54-87), Positive Predictive Value:36(13-65), Negative Predictive Value: 89(71-98) and AUC:0.62(0.38-0.85). The standard and age-adjusted D-dimer cut-offs, and the Wells score > 2 did not associate with confirmed APE, albeit a cut-off value of D-dimer=2454 ng/mL showed an RR:3.21;CI95%:0.92-13.97;p=0.073.CONCLUSION. Among patients presenting pulmonary deterioration after admission to internal medicine wards for non-critical COVID-19, the prevalence of APE was high. The traditional diagnostic tools to identify high APE pre-test probability patients does not seem to be clinically useful. These results support the use of a low threshold of suspicion for performing CTPA to exclude or confirm APE as the most appropriate diagnostic approach in this clinical setting.
Health Technology Assessment of Kidney Transplantation and Hemodialysis for the Treatment of End-Stage Kidney Disease
Authors: Widiana I Gde Raka , Marbun Maruhum Bonar H. , Ayu Nyoman Paramita , Sudhana I Wayan , Kandarini Yenny , Mahendra IB , Duarsa Renny SP , Putra Made Rama , Mahadita Gede Wira
Published: November 2020

BACKGROUNDKidney transplantation is an expensive procedure, and it is an alternative treatment of end-stage renal disease other than dialysis. Cost-Effectiveness and the cost-utility study was undertaken at Sanglah Hospital Bali Indonesia, aiming to assess whether living-related kidney transplantation is more cost-effective and cost-utility than hemodialysis in the treatment of end-stage renal disease.METHODSA health technology assessment was done in living-related kidney transplant and hemodialysis during 2018. Data search from internet resources using the electronic library and critically appraised the best evidence of the data of the best data of five-year mortality and survival of kidney transplant and hemodialysis. A preliminary study about quality of life was also done among kidney transplant and hemodialysis patients. Data about kidney transplant costs and hemodialysis for five years was taken from the Sanglah General Hospital database. RESULTSDuring the study, Fourteen living-related kidney transplant patients at Sanglah Public Hospital Denpasar Bali Indonesia consisted of 14 recipients, 12 males, and 2 females aged 27 -55 years, and 14 donors, three males and 11 females aged 24-63 years were included. Thirty HEMODIALYSIS patients at the same hospital were recruited. They consisted of 20 males and ten females, with an average age of 50.9 years. The average five-year cost of kidney transplant was 741,078 M IDR. In comparison, hemodialysis's five-year cost was 581,514 M IDR, leading to a cost difference was 159,564 M IDR. Five-year mortality of kidney transplant was 55% (survival 45%), five years survival rate was 18.9%. Five years of survival difference between kidney transplant and hemodialysis was 26.1 %. Meanwhile, QOL for a kidney transplant was 0,7063, and QOL for hemodialysis was 0,5596, leading to a QOL difference of 0.15. Kidney transplantation will spend 6.11 M IDR for every 1% increase of survival for five years with 15% better QOL. In five years, kidney transplantation produces 67% ICER. From cost-utility perspective, kidney transplantation yields 31.04 M IDR per QALY or 2,217 USD per QALY.CONCLUSIONLiving-related kidney transplantation is more cost-effective and cost-utility than hemodialysis in the treatment of end-stage renal disease.
Comparison of intravesical instillation of Bacille Calmette-Guérin and epirubicin: a randomized controlled trial
Authors: Shao Yanxiang , Yang Weixiao , Lia Thongher , Hu Xu , Yang Zhen , Ren Shangqing , Wu Kan , Liu Jianbang , Dou Weichao , Xiong Sanchao , Feng Shuyang , Wang Yaohui , Liu Yang , Li Xiang
Published: November 2020

Background

The optimal regimen of instillation for patients with non-muscle invasive bladder cancer (NMIBC) and the recurrence-related factors are still needed to be clear.
Methods

The patients underwent transurethral resection of bladder tumor who diagnosed as intermediate or high risk NMIBC were randomized to receive bacillus Calmette–Guérin (BCG) 19, 15 times or epirubicin (EPI) 18 times (2:2:1). The primary end point was disease-free survival (DFS), the secondary end point was progression free survival (PFS). Associations between clinicopathological factors and prognosis were estimated, with accuracy of the prognostic models Spanish Urological Club for Oncological Treatment (CUETO) and European Organization for Research and Treatment of Cancer (EORTC) evaluated.
Results

A total of 93 patients (BCG19 for 35; BCG15 for 37 and EPI18 for 21) were included, with median follow-up time for 33.46 months. Recurrence and progression occurred in 22 and 8 of patients separately, and significant longer recurrence-free survival was noted in the BCG and primary bladder cancer groups. Higher general complication rate was seen in BCG group compared with EPI groups (83.33% and 61.90%, respectively; P = 0.022), but no grade 3–5 adverse events happened in both groups. Concordance indices for the CUETO and EORTC models were 0.766 and 0.741 for all our series and 0.812 and 0.817 for the BCG subgroup, respectively.
Conclusion

BCG instillation significantly reduced the rate of recurrence compared with epirubicin in this population. The EORTC and CUETO models exhibited high accuracies for the prediction of BCG treatment failure.
Trial registration:

This study was approved by Center for Drug Evaluation of National Medical Products Administration (CDENMPA, China) and Ethics Committee of our institute, with the whole process supervised. The registration number in CDE-NMPA was CTR20150840 (website of CDE: http://www.cde.org.cn/).
A cortical-hypothalamic circuit decodes social rank and promotes dominance behavior
Authors: Padilla-Coreano Nancy , Batra Kanha , Patarino Makenzie , Chen Zexin , Rock Rachel , Zhang Ruihan , Hausmann Sebastien , Weddington Javier , Patel Reesha , Zhang Yu , Fang Hao-Shu , Keyes Laurel , Libster Avraham , Matthews Gillian , Curley James , Fiete Ila , Lu Cewu , Tye Kay
Published: November 2020

How do we know our social rank? Most social species, from insects to humans, self-organize into social dominance hierarchies (1–4). The establishment of social ranks serves to decrease aggression, conserve energy, and maximize survival for the entire group (5–8). Despite dominance behaviors being critical for successful interactions and ultimately, survival, we have only begun to learn how the brain represents social rank (9–12) and guides behavior based on this representation. The medial prefrontal cortex (mPFC) has been implicated in the expression of social dominance in rodents (10,11), and in social rank learning in humans (13,14). Yet precisely how the mPFC encodes rank and which circuits mediate this computation is not known. We developed a trial-based social competition assay in which mice compete for rewards, as well as a computer vision tool to track multiple, unmarked animals. With the development of a deep learning computer vision tool (AlphaTracker) and wireless electrophysiology recording devices, we have established a novel platform to facilitate quantitative examination of how the brain gives rise to social behaviors. We describe nine behavioral states during social competition that were accurately decoded from mPFC ensemble activity using a hidden Markov model combined with generalized linear models (HMM-GLM). Population dynamics in the mPFC were predictive of social rank and competitive success. This population-level rank representation translated into differences in the individual cell responses to task-relevant events across ranks. Finally, we demonstrate that mPFC cells that project to the lateral hypothalamus contribute to the prediction of social rank and promote dominance behavior during the reward competition. Thus, we reveal a cortico-hypothalamic circuit by which mPFC exerts top-down modulation of social dominance.
Apelin-mediated deamidation modification of HMGA1 promotes tumorigenesis by enhancing SRBEP1 activity and Lipid Synthesis
Authors: Zhang Li , Zhu Yihan , Yang Ying , Bu Hong , Huang Hong , Ran Jingjing , Qin Liwen , Ni Yinyun , Yao Menglin , Song Tingting , Li Mufeng , Yang Yongfeng , Guo Tingting , Chao Ningning , Liu Zhiqing , Li Weiming
Published: November 2020

Apelin is a ligand of the G protein-coupled receptor that promotes tumor growth in malignant cancers. However, the molecular mechanisms through which apelin promotes tumorigenesis are unknown. Here, we confirmed that apelin promotes tumorigenesis in lung cancer cells by increasing the synthesis of fatty acids, which induces abnormal lipid metabolism. Apelin interacts with high-mobility group A HMGA1 and mediates sterol-regulatory-element-binding protein 1 (SREBP1) activity, which is required for lung tumorigenesis and lipid metabolism. Deamidation modification of HMGA1 is regulated by apelin enhanced SRBEP1 activity and lipid synthesis. Moreover, deamidated HMGA1 can enhance the formation of the apelin-HMGA1-SREBP1 complexes and increases SREBP1 activity, which induces abnormal lipid metabolism. As an energy regulator, Apelin forms a multi-protein complexes with HMGA1 to increase of lung cancer cells viability. Our results indicate that apelin is important in lipid metabolism and cancer cell proliferation.
The conserved core component EsaA mediates bacterial killing by the type VIIb secretion system
Authors: Mietrach Nicole , Damián-Aparicio Diana , Isupov Michail , Krupka Marcin , Lopez Daniel , Geibel Sebastian
Published: November 2020

Type VII secretion systems (T7SS) are employed by Gram-positive bacteria to infect the host or to intoxicate bacterial competitors. Bacterial killing mediated by other secretion systems involves the assembly of large, extracellular structures promoting toxin delivery into bacterial competitors. However, such extracellular structures are not known for T7SS nor is it known whether the secreted toxins have cell-penetrating properties. Here, we used a multi-drug resistant Staphylococcus aureus, one of the most relevant hospital-associated bacterial pathogens, to study the mechanism of bacterial killing by the T7SSb. We report the proteolysis-resistant, extracellular structure of the EsaA core component, which is an integral part of the membrane-embedded T7SSb secretion machine. The extracellular structure of EsaA has an elongated antenna-like shape providing an explanation how the T7SSb spans the staphylococcal cell wall. We demonstrate that the extracellular structure of EsaA has an essential function in secretion and contributes to the killing of prey bacteria. We show that the bactericidal activity of EsaA can be attributed to a membrane-damaging activity that leads to the permeabilization of phospholipid bilayers and could facilitate the delivery of antibacterial toxin into bacterial competitors. The structural similarity of the EsaA tip domain to bacterial lectins and human integrins suggests an additional function of EsaA in cell adhesion during infection or in targeting of bacterial competitors.
Designing electrolyte structure to suppress hydrogen evolution reaction in aqueous batteries
Authors: Nian Qingshun , Zhang Xiaoren , Feng Yazhi , Liu Shuang , Sun Tianjiang , Ren Xiaodi , Tao Zhanliang , Zhang Donghui , Chen Jun
Published: November 2020

Aqueous batteries (ABs) have attracted increasing attention because of their inherent safety and low cost. Nevertheless, hydrogen evolution reaction (HER) at the anode presents severe challenges for stable and safe operation of ABs. Instead of passivating the anode surface to hinder HER kinetics, a novel design strategy is proposed here to suppress the HER via alternating its thermodynamics pathway. By adding a hydrogen bond acceptor, dimethyl sulfoxide (DMSO), the onset potential of HER can be delayed by as much as 1.0 V (on titanium mesh). Spectral characterization and molecular dynamics simulation confirm that the formation of hydrogen bonds between DMSO and water molecules can reduce the water activity, thereby suppressing the HER. This strategy has proven to be universal in expanding the electrochemical window of aqueous electrolytes. For instance, unconventional V2+↔V3+ redox processes in Na3V2(PO4)3 (-1.2 V versus Ag/AgCl) and highly stable Zn plating/stripping processes can be realized in ABs.
Barriers for Early Initiation and Exclusive Breast Feeding Up to Six Months in Predominantly Rural Sri Lanka; A Need to Strengthen Policy Implementations
Authors: Agampodi Thilini Chanchala , Dharmasoma Neerodha Kithmini , Koralagedara Iresha Sandamali , Dissanayake Thushari Maduwanthi Menike , Warnasekera Janith N. , Agampodi Suneth Buddhika , Perez-Escamilla Rafael
Published: November 2020

Background Sri Lanka was named as the first-ever 'Green' breastfeeding (BF) nation status by the World Breastfeeding Trends Initiative (WBTi) in January 2020. However, capacity exists for improvement. This study aims to identify barriers and facilitators for early initiation of breastfeeding (EI) and exclusive BF (EBF) for 6 months in rural Sri Lanka. Methods We conducted in-depth interviews with 16 mothers with infants, who had been unable to practice EI and/or EBF, in six child-welfare clinics in Anuradhapura, Sri Lanka. Three focus group discussions were held with public health midwives (PHMs). Initial thematic analysis that built upon force field and social learning theories was performed. Results Main barriers for EBF were clustered at three time periods; during the first 2-3 days, 2-3rd week, and 4-5 months post-partum. Early barriers included cesarean section pain, poor latch, maternal exhaustion, Suboptimal maternity ward environment, lack of support for BF led to maternal stress. Around 2-3 weeks postpartum mothers introduced water or infant formula due to social norms and poor support. On-demand feeding was poorly practiced. Around 4 and 5 months EBF ended due to return to work. PHMs reported heavy workload impede support for BF. Conclusion Interruption of EBF are due to specific barriers corresponding to specific periods within first six months. Sri Lanka should focus on strengthening policies for reducing the excessive rates of cesarean section, better postnatal ward facilities, demand feeding, support for working mothers and reducing the work load of PHMs in order to optimize EBF.
Estimation of Non-Genetic Parameters for Reproduction and Production Traits of Holstein Friesian Dairy Herd at Elfora Cheffa Dairy Farm, Amhara Region, Ethiopia
Authors: Kassa Wubshet Woldegiorgis , Mengesha Yosef Tadesse , Gebele Aynalem Haile
Published: November 2020

Background:- The study was conducted at Cheffa dairy farm with the objective of estimating the effects of none-genetic factors on Age at First Service (AFS), Age at First Calving (AFC), Calving Interval (CI), Days Open (DO), Number of Service per Conception (NSC), Lactation Length (LL) and adjusted 305 days milk yield (305-dMY). A total of 2343 records were collected from 123 cows and 13 sires' progenies having greater than 93.75 % HF blood levels through the period from 1996 to 2014 for evaluation. Independent variables were birth year and season, calving year and season and parity while AFS, AFC, CI, DO, NSC, LL and 305-dMY were dependent variables. SAS Version 9.1 software used for data analysis. Results:- The results indicated that year of birth had highly significant (p<0.01) and significant (p<0.05) effect on AFS and AFC respectively. Year of calving had highly significant (p<0.01) effect on CI and 305-dMY and significant (p<0.05) effect on DO and NSC. Season of calving had significant (p<0.05) effect on CI and 305-dMY. Longest records of CI and highest records of 305-dMY were exhibited in short rain season while, shortest and lowest records of CI and 305-dMY were recorded in dry and long rain seasons respectively. Parity had highly significant (p<0.01) effect on CI, DO, NSC and 305-dMY and significant (p<0.05) effect on LL. Longest value of CI, DO and LL were observed in 1st parity and highest value of NSC and highest value of 305-dMY were recorded in 7th and 5th parity respectively. The shortest value of CI, DO, LL and lowest value of 305-dMY was recorded in 9th parity while shortest value of NSC was recorded in 1st parity. Conclusions:- This study revealed, genetic performance of dairy breed in the study area was influenced by environment but selecting adapted animal from the herd and better management may improve all aspect of productivity. Hence, well record keeping, better management practice, non-genetic performance evaluation of economically important dairy traits and investigation of selection index were a prerequisite to improvement productivity of the herd and to run profitable dairy enterprise.
Mediterranean Natural Extracts Improved Cognitive Behavior in Zebrafish and Healthy Rats and Ameliorated LPS-induced Cognitive Impairment in a Sex Dependent Manner
Authors: Pusceddu Matteo , Hernandez-Baixauli Julia , Puiggrós Francesc , Arola Lluis , Caimari Antoni , Bas Josep M Del , Baselga Laura
Published: November 2020

Background: Several findings suggest neuroinflammation as a contributing factor for the onset of psychiatric disorders such as Alzheimer’s disease, depression, and anxiety. There is increasing evidence pointing out that the Mediterranean diet influences brain and behavior. Mediterranean herbs and spices have been shown to be within those components of the Mediterranean diet involved in cognitive enhancement. Thus, we investigated the influence of Mediterranean natural extracts (MNE), Rosemary extract (RE) and Glycyrrhiza glabra root extract (GGRE), on cognitive behavior. Results: Adult zebrafish were exposed to RE or GGRE (100 and 250 mg/L) treatments. Both MNE improved memory retention during the T-maze test, although no improvements were observed during the novel object preference. Similarly, chronic administration of RE (150 mg/Kg) and GGRE (150 mg/Kg) improved, respectively, spatial and retention memory, as assessed by the Morris Water Maze (MWM), and the Elevated Plus Maze (EPM) in healthy male rats. However, no improvements were observed during the novel object recognition. Finally, male, and female rats were chronically treated with lipopolysaccharide [(LPS) 300 ug/kg] and orally administered with RE. Interestingly, RE reversed LPS-induced cognitive deficit during the MWM and EPM in female rats. Conclusions: We found that MNE improved cognition in both zebrafish and rats. Moreover, MNE rescued LPS-induced cognitive impairment in a gender-specific manner. Therefore, our study supports the view that zebrafish represent a valuable preclinical model for drug discovery in neuroscience. These findings contribute to an exciting and growing body of research suggesting that MNE may play an important role in the prevention of cognitive impairment.
Development of a KRAS-Associated Metabolic Risk Model for Prognostic Prediction in Pancreatic Cancer
Authors: Ma Zuyi , Li Zhenchong , Zhou Zixuan , Zhuang Hongkai , Liu Chunsheng , Huang Bowen , Gong Yuanfeng , Zou Yiping , Zheng Zehao , Yang LinLing , Huang Shanzhou , Zhang Chuanzhao , Hou Baohua
Published: November 2020

Background: KRAS was reported to affect some metabolic genes and promote metabolic reprogramming in solid tumors. However, there is no comprehensive analysis to explore KRAS associated metabolic signature or risk model for Pancreatic cancer (PC).Methods: In current study, multiple bioinformatics analyses were used to identify differentially expressed metabolic genes based on KRAS mutation status in PC. Then we developed and validated a prognostic risk model based on the selected KRAS-associated metabolic genes. Besides, we explored the association of the risk model and the metabolic characteristics as well as Gemcitabine associated chemoresistance in PC.Results: 6 KRAS-associated metabolic genes (i.e. CYP2S1, GPX3, FTCD, ENPP2, UGT1A10, and XDH) were selected and were enrolled to establish a prognostic risk model. The prognostic model had a high C-index of 0.733 for overall survival (OS) in the TCGA pancreatic cancer database. The area under the curve (AUC) values of 1- and 3-year survival were both greater than 0.70. Then the risk model was validated in two GEO datasets and also presented a satisfactory discrimination and calibration performance. Further, we found that the expression of some KRAS-driven glycolysis associated genes (PKM, GLUT1, HK2, and LDHA) and Gemcitabine associated chemoresistance genes (i.e. CDA and RMM2) were significantly up-regulated in high-risk PC patients evaluated by the risk model.Conclusions: We constructed a risk model based on 6 KRAS associated metabolic genes, which predicts patients' survival with high accuracy and reflects tumor metabolic characteristics and Gemcitabine associated chemoresistance in PC.
Prognostic and Predictive Value of FCER1G in Glioma Outcomes and Response to Immunotherapy
Authors: Xu Houshi , Zhu Qingwei , Tang Lan , Jiang Junkun , Yuan Huiwen , Zhang Anke , Lou Meiqing
Published: November 2020

Purpose: Glioma is the most prevalent malignant form of brain tumors, with a dismal prognosis. Currently, cancer immunotherapy has emerged as a revolutionary treatment for patients with advanced highly aggressive therapy-resistant tumors. However, there is no effective biomarker to reflect the response to immunotherapy in glioma patient so far. So we aim to assess the clinical predictive value of FCER1G in patients with glioma. Methods: The expression level and correlation between clinical prognosis and FER1G levels were analyzed with the data from CGGA, TCGA, and GEO database. Univariate and multivariate cox regression model was built to predict the prognosis of glioma patients with multiple factors. Then the correlation between FCER1G with immune cell infiltration and activation was analyzed. At last, we predict the immunotherapeutic response in both high and low FCER1G expression subgroups.Results: FCER1G was significantly higher in glioma with greater malignancy and predicted poor prognosis. In multivariate analysis, the hazard ratio of FCER1G expression (Low versus High) was 0.66 and 95% CI is 0.54 to 0.79 (P <0.001), whereas age (HR=1.26, 95% CI=1.04-1.52), grade (HR=2.75, 95% CI=2.06-3.68), tumor recurrence (HR=2.17, 95% CI=1.81-2.62), IDH mutant (HR=2.46, 95% CI=1.97-3.01) and chemotherapeutic status (HR=1.4, 95% CI=1.20-1.80) are also included. Furthermore, we illustrated that gene FCER1G stratified glioma cases into high and low FCER1G expression subgroups that demonstrated with distinct clinical outcomes and T cell activation. At last, we demonstrated that high FCER1G levels presented great immunotherapeutic response in glioma patients.Conclusions: This study demonstrated FCER1G as a novel predictor for clinical diagnosis, prognosis, and response to immunotherapy in glioma patient. Assess expression of FCER1G is a promising method to discover patients that may benefit from immunotherapy.
Fat and Carbohydrate Distribution in Maternal Diet Programs Liver Sirtuin-1 Expression and Fatty acid Profile in Offspring
Authors: Mousavi Seyedeh Neda , Dorraji Mir Saeed Seyed , Gharacheh Sara , Koohdani Fariba
Published: November 2020

Background: Amount of fat and carbohydrate in maternal diet during gestation and lactation has permanent effects on fetal metabolism. SIRT1 is a nutrient-responsive histone deacetylase that modulates the lipid and glucose metabolism in response to energy stress and extends life span. To study the effects of carbohydrate and fat distribution in a maternal isocaloric diet on fetal gene and protein levels of SIRT1, as well as liver fatty acid profile.Methods: Twenty C57BL/6 female mice were inseminated and randomly received the AIN 93G isocaloric pair-fed LF-HC (16% and 64% of calorie as fat and carbohydrate) or HF-LC (48% and 32% of calorie as fat and carbohydrate) diet during gestation and lactation. After weaning, all offspring received LF-HC diet up to the adolescence. Liver tissue were extracted for final analysis. Results: SIRT1 gene and protein levels were lower in both sexes born from HF-LC-fed mothers than LF-HC-fed one, significant differences were only observed between males in the gene expression (p<0.001) and females in protein level (p<0.001). Saturated fatty acids and cholesterol were increased while unsaturated fatty acids decreased at the liver of male and female offspring born from HF-LC-fed mothers (p<0.001). Conclusions: Maternal dietary fat and carbohydrate distribution, regardless of calorie intake, modify the offspring hepatic fatty acid profile, as well as SIRT1 gene and protein expression which effects on life span.
Familial Hypertriglyceridemia: An Entity with Distinguishable Features from other Causes of Hypertriglyceridemia
Authors: Cruz-Bautista Ivette , Chagoya Alicia Huerta , Macias Hortencia Moreno , Rodríguez-Guillén Rosario , Ordóñez-Sánchez Maria Luisa , Segura_Kato Yayoi , Almeda-Valdez Paloma , Gomez-Munguia Liseth , De Chavez Ximena Ruiz , Rosas-Flota Ximena , Camacho Areli Andrade , Bernal-Barroeta Barbara , Guillen-Pineda Luz Elizabeth , Lopez-Carrasco Maria Guadalupe , Lopez-Estrada Angelina , Elias-Lopez Daniel , Rosado Alexandro Martagon , Gomez-Velasco Donaji , Chavolla Omar Bello- , Olvera Fabiola Del Razo , Perez Lucely Del Carmen Cetina , Rodriguez Jose Luis Acosta , Luna Maria Teresa Tusie , Aguilar-Salinas Carlos A.
Published: November 2020

BACKGROUND AND AIMS: Familial hypertriglyceridemia (FHTG) is a partially characterized primary dyslipidemia which is frequently confused with other forms hypertriglyceridemia. The aim of our study is to search for specific features that help clinicians in the recognition of FHTG. APPROACH: We included 84 FHTG cases, 728 subjects with mild-to-moderate hypertriglyceridemia (CHTG) and 609 normotriglyceridemic controls for genetic, clinical and biochemical assessment. A set of 53 SNPs previously associated to TG levels, as well as 37 rare variants within the main five genes associated to hypertriglyceridemia (i.e. LPL, APOC2, APOA5, LMF1 and GPIHBP1) were analyzed. A panel of endocrine regulatory proteins closely related to triglycerides homeostasis were compared between FHTG and CHTG.RESULTS: Compared to CHTG, FHTG subjects had higher HOMA-IR, apolipoprotein AII, FGF21, ANGPTL3 and ANGPTL4 concentrations and lower HOMA-B%, apolipoprotein B and leptin. The polygenic set of SNPs, previously associated with triglyceride levels, accounted for 1.78% of the explained variance of triglyceride levels in FHTG and 6.73% in CHTG. CONCLUSION: The clinical and genetic differences observed between FHTG and CHTG supports the notion that FHTG is a unique entity, distinguishable from other causes of hypertriglyceridemia by the higher concentrations of insulin, FGF21, ANGPTL3, apoAII and lower levels of apoB. We propose the inclusion of these analytes as useful markers to distinguish FHTG from other causes of hypertriglyceridemia.
Effects of Short Term Omega-3 Supplementation on Body Composition, Food Intake, and Lipid Proﬁle in Elite Athletes: A Double-blind Randomized Controlled Trial
Authors: Moradi Sara , Alivand Mohamadreza , Khaje-Bishak Yaser , Asghari-Jafarabadi Mohamad , Alipour Maedeh , alipour beitolah
Published: November 2020

Background and Aims: animal studies consistently showed a key role for omega-3s in decreasing fat mass (FM). Also, previous studies have shown that increased omega-3 stimulates fat loss in individuals who experience obesity, diabetes and metabolic syndrome. However, it is not known whether omega-3 supplementation make similar effects in healthy individuals with low FM. This study aimed to investigate the effects of omega-3 on changes in body composition, food intake, and lipid proﬁle in healthy athletes.Methods: 36 healthy men were allocated into either the supplement or the placebo group. Dietary intake assessed by the 24-hour food recall, before and after the intervention. Anthropometric measures, blood pressure, and lipid proﬁle were measured at baseline and after 3-weeks.Results: The weight did not signiﬁcantly change at the end of the study. Body fat percent decreased signiﬁcantly at the end of the study in the omega-3 group (p= 0.003), but intergroup differences were not signiﬁcant. FM decreased but fat free mass (FFM) increased in omega-3 groups (p<0.05). In Lipid proﬁle indices just HDL-C increased (for omega-3 group p=0.001; for placebo group p=0.01; after adjustments p=0.78). Also, in the omega-3 group, energy intake (p=0.0007) and protein intake (p=0.04) after intervention increased, but after baseline adjustments they were not significant.Conclusion: 3-week omega-3 supplementation seems to be not effective in decreased FM, and increased HDL-C, and energy and protein intake in elite athletes. Further studies are recommended to determine the effect of different doses of omega-3 on adipose tissue in athletes with low FM.Clinical Trial Registration The present study was prospectively registered at the Iranian Registry of Clinical Studies on December 19, 2019 (ID: 20190625044008N1). https://en.irct.ir/trial/43332.
Providing Measurement, Evaluation, Accountability, and Leadership Support for NCDs Prevention in Ghana: Adapting the INFORMAS Approach  
Authors: Laar Amos , Kelly Bridget , Holdsworth Michelle , Quarpong Wilhemina , Aryeetey Richmond , Amevinya Gideon , Tandoh Akua , Agyemang Charles , Zotor Francis , Laar Matilda E. , Mensah Kobby , Laryea Dennis , Asiki Gershim , Pradeilles Rebecca , Sellen Daniel , L’Abbe Mary , Vandevijvere Stefanie
Published: November 2020

BackgroundLike most other countries, Ghana is experiencing an increase in obesity and nutrition-related non-communicable diseases (NR-NCDs). The need to adopt effective and comprehensive interventions/approaches to address this burden at global, regional, and national levels has been recognized. However, there is limited contextualized evidence on the implementation, and efficacy of approaches that can address NCDs in Ghana. In an earlier study, we assessed food environment priorities, and programme implementation gaps in Ghana. Building on that, this paper describes the rationale, adaptation and final protocol of a project developed to address this: The Measurement, Evaluation, Accountability, and Leadership Support for NCDs (MEALS4NCDs) project. The MEALS4NCDs project aims to measure and support public sector actions that create healthy food marketing, retail and provisioning environments for Ghanaian children, using adapted methods from the International Network for Food and Obesity/NCDs Research Monitoring and Action Support (INFORMAS). The research will facilitate understanding of the processes through which the INFORMAS approach is contextualized to a lower-middle income African context. MethodsThe protocol for this observational study draws substantially from the INFORMAS’ Food Promotion and Food Provision Modules. However, to appraise the readiness of local communities to implement interventions with strong potential to improve Ghanaian children’s food environments, the MEALS4NCDs protocol has innovatively integrated a local community participatory approach based on the Community Readiness Model (CRM) into the INFORMAS approaches. DiscussionThe study establishes a standardised approach to providing implementation science evidence for NCDs prevention in Ghana. It aims to demonstrate feasibility and innovative application of the INFORMAS expanded Food promotion and Food provision modules, together with the integration of the CRM in a lower-middle income setting. The protocol could be adapted for similar country settings to monitor relevant aspects of children’s food environments. Trial registrationNot applicable
Establishing Components of Programmes to Reduce Restrictive Practices in Adult Mental Health Inpatient Services: A Behaviour Change Technique Analysis
Authors: Berzins Kathryn , Canvin Krysia , Kendal Sarah , Benson Iris , Kellar Ian , Wright Judy , Lopez Rocio Rodriguez , Duxbury Joy , Stewart Duncan , Baker John
Published: November 2020

Background: Incidents that threaten service user and staff safety occur frequently in adult mental health inpatient settings, often resulting in restrictive practices such as restraint and seclusion. These carry significant risks, including physical and psychological harms to service users and staff, as well as costs to the NHS. Numerous complex interventions have been developed which aim to reduce the use of restrictive practices. Aims: The aims were to identify, standardise and report the effectiveness of components of interventions that seek to reduce restrictive practices in adult mental health inpatient settings, using the Behaviour Change Technique taxonomy. Methods: A systematic mapping review of literature identified in health and social care research databases and unpublished sources (including social media) was undertaken. Records were quality appraised using the MMAT. Records of interventions to reduce any form of restrictive practice used with adults in mental health services were included. The resulting dataset for extraction was guided by WIDER, Cochrane and theory coding guidelines. The BCT taxonomy was systematically applied to each identified intervention.Results: The final dataset comprised 175 records reporting 150 interventions, 109 of which had been formally evaluated. The most common intervention targets were seclusion and/or restraint reduction. The most common evaluation approach was a non-randomised design. There were only six randomised controlled trials. The number of BCTs identified per intervention ranged from 1-33 (mean:8). The most common strategy was staff training. BCTs from 14 of a possible 16 clusters were detected. Over two thirds of the BCTs mapped onto four of the 14 clusters: ‘Goals and planning’; ‘Antecedents’; ‘Shaping knowledge’; ‘Feedback and monitoring’. Those BCTs which were found in all the interventions were similar to those found in those interventions which demonstrated statistically significant effects. Conclusions: Studies of interventions to reduce restrictive practices appear to be diverse quality. Interventions tended to contain multiple components delivered in multiple ways. Further research could enhance the evidence base prior to future commissioning decisions. Separate testing of individual procedures, for example, audit and feedback, could ascertain the more effective intervention components and improve understanding of content and delivery. Registration: The study is registered as PROSPERO 2018 CRD42018086985 Available from: http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42018086985
Finite Element Analysis of Different Locking-Plate Fixation Methods for the Treatment of Ulna Head Fracture
Authors: Zhang Yue , Shao Qin , Yang Chensong , Ai Changqing , Zhou Di , Yu Yang , Sun Guixin
Published: November 2020

Background: Ulnar head fractures are increasingly higher with the growing proportion of the elderly in the population. Failure to achieve stable anatomic reduction of ulna head fracture may lead to the DRUJ dysfunction and nonunion of distal radius. Due to the lack of the postoperative reporting outcomes and the biomechanical studies, it has not been well established about the optimal management of the comminuted distal ulna head fracture. This study aimed to explain the advantages and disadvantages of the ulnar-side locking plate fixation, compared with the dorsal-side one, and its screws arrangement in the treatment of the ulnar head fracture by using finite element analysis. Methods: FE models of the ulnar head fracture and the models of ulnar-side locking plate and dorsal-side plate with two or three distal screws was constructed. In order to simulate forces acting on the ulnar and the osteosynthesis material during daily-life activity in subjects who underwent reconstructive surgery, we applied three loading conditions to each model, viz. axial compression 20N, 50N, and torsion moments 1Nm. Under these conditions, values of the von Mises Stress (VMS) distribution of the implant, peak VMS, and model displacement were investigated. Results: Both the stress values and model displacement of ulnar-side plate were lower than those of dorsal-side plate. When adding a screw in the middle hole of the ulnar head, the values of model displacement and the peak stress in fixation system are lower, but it may evidently concentrate the stress on the middle screw. Conclusions: In conclusion, our study indicated that plating locking plate on ulnar side had lower stress distribution on the plate and better stability than on dorsal side in ulnar head fracture fixation. Adding the additional screw on the ulnar head could reduce the displacement of the fixation system and increase the stability of the fixation system. This study requires clinical confirmation as to its practicality in the treatment of ulnar head fracture.
Family Medicine Practitioners’ Stress During the COVID-19 Pandemic: A Cross-Sectional Survey.
Authors: Dutour Marion , Kirchhoff Anna , Janssen Cécile , Meleze Sabine , Chevalier Hélène , Levy-Amon Sandrine , Detrez Marc-Antoine , Piet Emilie , Delory Tristan
Published: November 2020

Background The COVID-19 pandemic has shaken the world, but also caregiver’s practices. The World Health Organization warned about the stress it could generate for General Practitioners (GPs). In France, GPs were not involved in the decision-making process for organization of care before and during the first COVID-19 wave. Our objective was to estimate the self-perception of stress at the beginning of the pandemic in France, among GPs from the Auvergne-Rhône-Alpes (AuRA), a french administrative area severely impacted by COVID-19, and to identify which factors may have modulated this perception.Methods We conducted an online cross-sectional survey between 8th of April to 10th of May 2020. The self-perception of stress was evaluated using the 10-item Perceived Stress Score (PSS-10). An agreement score developed by the study scientific committee was measured for 31 positive assertion. Factors associated with stress were investigated using logistic regression, and triangulation based on verbatim analysis. Results Overall, 898 individual answers were collected. A total of 437 GPs (49%) were stressed (PSS≥27), and 283 GPs (32%) had a very high level of stress (PSS≥30). Perceived stress was associated with multiple components, and involved classic psychosocial risk factors such as emotional requirements: 415 GPs (49%) were affected by patient anxiety (OR=3.41, 95%CI [1.87-6.36], p<0.001). But in this context of health crisis, the main determinant of GPs’ stress appears to be the diversity and quantity of information from diverse sources (614 GPs (69%, OR=2.21, 95%CI [1.40-3.50], p<0.001). GPs felt isolated in a hospital-based model.Conclusion The first COVID-19 wave was stressful for AuRA’s GPs. One of the main determinants seems to be the diversity and quantity of information received from the health authorities.