bluuebunny/crossref_metadata_2025 huggingface dataset:
Cross-sectoral rehabilitation intervention for patients with intermittent claudication versus usual care for patients in non-operative management. - The CIPIC Rehab study: study protocol for a randomised controlled trial
Authors: Siercke Maj , Jørgensen Lise Pyndt , Missel Malene , Thygesen Lau Caspar , Blach Pernille Peppercorn , Sillesesn Henrik , Berg Selina Kikkenborg
Published: December 2019

Introduction: Intermittent claudication (IC) caused by Peripheral Artery Disease (PAD) is a common cardiovascular disease. Patients with IC have reduced walking capacity, restricted activity levels and mobility, and reduced health-related quality of life. The disease leads to social isolation, the risk of cardiovascular morbidity, and mortality. Non-operative management of IC requires exercise therapy and studies show that supervised exercise training is more effective than unsupervised training, yet many patients with IC lack motivation for changes in health behavior. No studies investigating the effects of existing cardiac rehabilitation targeted patients with IC have been published. The aim of this paper is to present the rationale and design of the CIPIC Rehab Study, which examines the effect of a cross-sectoral rehabilitation programme versus usual care for patients in non-operative management for IC. Methods and analysis: A randomised clinical trial aims to investigate whether cardiac rehabilitation for patients with IC in non-operative management versus usual care is superior to treatment as usual. The trial will allocate 118 patients, 1:1 individual randomisation to either the intervention or control group. The primary outcome is maximal walking distance measured by the standardised treadmill walking test. The secondary outcome is pain-free walking distance measured by the standardised treadmill walking test, healthy diet measured by a fat-fish-fruit-green score, and level of physical activity measured by activity score within official recommendations. Statistical analyses will be blinded. Several exploratory analyses will be performed. A mixed-method design is used to evaluate qualitative and quantitative findings. A qualitative and a survey-based complementary study will be undertaken to investigate patients’ post-discharge experiences. A qualitative post-intervention study will explore experiences of participation in rehabilitation. Discussion: The study is the first to assess the effect of a cardiac rehabilitation programme designed for patients with intermittent claudication. The study will describe how to monitor and improve rehabilitations programme for patients with intermittent claudication in a real-world setting. Mixed method strategies can allow for both exploration and generalization in the same study, but the research design is a complex intervention and any effects found can not be awarded a specific component.
Hepatic resection versus TILA-TACE in the treatment of Resectable Hepatocellular Carcinoma: study protocol for a randomized controlled trial
Authors: Feng Yangyang , Jin Yun , Jin Kai , Yu Yuanquan , Zhou Donger , Wu Jianjun , Li Bin , Zhang Guangqiang , Peng Shuyou , Qi Xiaogang , Geng Hao , Guo Yinghao , Chao Ming , Li Jiangtao
Published: December 2019

Background: Hepatic resection and transcatheter arterial chemoembolization (TACE) are common treatments for hepatocellular carcinoma (HCC). Targeting intratumoral lactic acidosis TACE (TILA-TACE) is a new therapeutic approach developed by our team that has superior response rate and effective rate than conventional TACE (cTACE). In this randomized-controlled trial, we will compare the efficacy of hepatic resection and TILA-TACE in patients clinically diagnosed with HCC to provide reliable clinical data for the subsequent effective treatment of HCC patients. Methods: A total of 230 resectable HCC patients will be given hepatic resection or TILA-TACE using a parallel-controlled approach, and the efficacy of the treatments Page 4 of 24 will be compared. The primary endpoint is the post-treatment progression-free survival (PFS) of the patients, and the secondary endpoints are the post-treatment overall survival (OS), 1-year, 3-year and 5-year survival, and the quality of life of the patients at each corresponding stage. Discussion: The aim of this study is to compare the efficacy of hepatic resection and TILA-TACE in the treatment of resectable HCC. Trial registration: ClinicalTrials.gov,NCT03314532.Registered on 19 October 2017. Keywords: Hepatocellular carcinoma, Hepatic resection, TACE, TILA-TACE, Randomized-controlled study.
Strong Families: A new family skills training programme for challenged and humanitarian settings: a single-arm intervention tested in Afghanistan
Authors: Haar Karin , El-Khani Aala , Molgaard Virginia , Maalouf Wadih
Published: December 2019

Background
Children living in challenged humanitarian settings (rural/underserved areas, displaced, refugees, conflict/post conflict) are at greater risk of mental health difficulties or behavioural problems, with caregivers acting as their main protective factors. While many family skills programmes exist, very few were developed for, or piloted in, low resource settings (settings with limited infrastructure). We designed the brief and light Strong Families (SF) programme, consisting of 5 hours contact time over 3 weeks. We conducted a pilot study aiming to test the feasibility of implementation, and preliminary effectiveness of SF, in improving child behaviour and family functioning in Afghanistan.

Methods
We recruited female caregivers and children aged 8-12 years through schools and drug treatment centres and enrolled them in the SF programme. Demographic data, emotional and behavioural difficulties of children and parental skills and family adjustment measures were collected from caregivers before, 2 and 6 weeks after the intervention. Outcome was assessed through the SDQ (Strengths and Difficulties Questionnaire), assessing children’s behavioural, emotional, and social issues, and PAFAS (Parenting and Family Adjustment Scales), measuring parenting practices and family functioning.

Results
We enrolled 72 families in the programme with a 93.1% retention rate (n=67) for data collection 6 weeks post intervention. Mean age of caregivers was 36.1 years, they had 3.8 children on average and 91.7% of them had experienced war/armed conflict in their past. The average total difficulty score of the SDQ (ranging from 0 to 40, with scores above 16 being indicative of high problems) of the 72 children reduced significantly, from 17.8 at pre-test to 12.9 at post-test and 10.6 at second follow-up, with no difference in gender and most noticeably amongst those with the highest scores at baseline. Likewise, PAFAS scores decreased significantly after the programme, again with caregivers with the highest scores at baseline improving most.

Conclusions
The implementation of a brief family skills programme was seemingly effective and feasible in a resource-limited setting and positively improved child mental health and parenting practices and family adjustment skills. These results suggest the value of such a programme and call for validation through further impact assessment and outcome evaluation.
CAPAbility: Comparison of the JOURNEY II Bi-Cruciate Stabilised and GENESIS II total knee arthroplasty in performance and functional ability: protocol of a randomised controlled trial.
Authors: Clarke Celia , Pomeroy Valerie , Clark Allan , Creelman Graham , Hancock Nicola , Horton Simon , Killett Anne , Mann Charles , Payerne Estelle , Toms Andoni , Roberts Gareth , Smith Toby , Swart Ann Marie , McNamara Iain
Published: December 2019

Background: Osteoarthritis of the knee is a common condition that is expected to rise in the next two decades leading to an associated increase in total knee replacement (TKR) surgery. Although there is little debate regarding the safety and efficacy of modern TKR, up to 20% of patients report poor functional outcomes following surgery. This study will investigate the functional outcome of two TKR; the JOURNEY II Bi Cruciate Stabilised knee, a newer prosthesis designed to provide guided motion and improve knee kinematics by more closely approximating a normal knee and the GENESIS II, a proven existing design. Aim: To compare the change in patient reported outcome scores of the JOURNEY II BCS and the GENESIS II from pre-operation to six months post-operation. Methods : CAPAbility is a pragmatic, blinded, two-arm parallel, randomised controlled trial recruiting patients with primary osteoarthritis due to have unilateral TKR surgery across two UK hospitals. Eligible participants (n=80) will be randomly allocated to receive either the JOURNEY II or the GENESIS II BCS knee prosthesis. Baseline measures will be taken prior to surgery. Patients will be followed at one week, six to eight weeks and six months post-operatively. Primary outcome is the Oxford Knee Score (OKS) at six months post-operatively. Secondary outcomes include: other patient-reported outcome measures (PROMs), biomechanical, radiological (computerised tomography, (CT)), clinical efficacy and safety outcomes. An embedded qualitative study will also investigate patients’ perspectives via interview pre- and post-surgery on variables known to affect the outcome of TKR surgery. A sub-sample (n=30) will have additional in-depth interviews to explore themes identified. The surgeons’ perspectives on the operation will be investigated by a group interview after all participants have undergone surgery. Discussion : This trial will evaluate two generations of TKR using PROMS, kinematic and radiological analyses and qualitative outcomes from the patient perspective.
A Qualitative Study of Physician Perspectives on Adaptation to Electronic Health Records
Authors: Sieck Cynthia Judine , Pearl Nicole , Bright Tiffani J. , Yen Po-Yin
Published: December 2019

Background Electronic Health Records (EHRs) have the potential to improve many aspects of care and their use has increased in the last decade. Because of this, acceptance and adoption of EHRs is less of a concern than adaptation to use. To understand this issue more deeply, we conducted a qualitative study of physician perspectives on EHR use to identify factors that facilitate adaptation.Methods We conducted semi-structured interviews with 9 physicians across a range of inpatient disciplines at a large Academic Medical Center. Interviews were conducted by phone, lasting approximately 30 minutes, and were transcribed verbatim for analysis. We utilized inductive and deductive methods in our analysis.Results We identified 4 major themes related to EHR adapation: impact of EHR changes on physicians, how physicians managed these changes, factors that facilitated adapation to using the EHR and adapting to using the EHR in the patient encounter. Within these themes, physicians felt that a positive mindset toward change, providing upgrade training that was tailored to their role, and the opportunity to learn from colleagues were important facilitators of adaption.Conclusions As EHR use moves beyond implementation, physicians continue to be required to adapt to the technology and to its frequent changes. Our study provides actionable findings that allow healthcare systems to focus on factors that facilitate the adaptation process for physicians.
Co-infection with Campylobacter and rotavirus in less than 5 year old children with acute gastroenteritis in Nepal during 2017-2018
Authors: Bhattarai Vishnu , Sharma Saroj , Author) Komal Raj Rijal(Former Corresponding , Author) Megha Raj Banjara(New Corresponding
Published: December 2019

Background: Diarrhoea, although easily curable, is a global cause of death for a half million children every year. Rotavirus and Campylobacter are the most common etiological agents of diarrhoea in children less than 5 years of age. However, in Nepal, these causative agents are not routinely examined for the diagnosis and treatment. The main objective of this study was to determine Campylobacter co-infection associated with rotavirus diarrhoea in children less than 5 years of age. Methods: A cross-sectional study was conducted at Kanti Children's Hospital (KCH), Kathmandu, Nepal from November 2017 to April 2018. A total of 303 stool specimens from children affected with diarrhoea were processed to detect rotavirus using a rapid rotavirus antigen detection test kit, and Campylobacter by microscopy, culture and biochemical tests. Antibiotic susceptibility tests of Campylobacter isolates were performed according to European Committee on Antimicrobial Susceptibility Testing (EUCAST) guidelines 2015. Results: Of 303 samples, 91 (30.0%) were positive for co-infection with rotavirus and Campylobacter. Rotavirus mono-infection was detected in 61 (20.1%), and Campylobacter mono-infection was detected in 81 (26.7%) samples. Patient’s age, month of infection, untreated water and frequent soil contact were the major risk factors for infections. Clinical features such as >9 loose motions per day, fever, vomiting, mild to moderate dehydration, diarrhea persisting 6-9 days and presence of mucus in stool were significant (p<0.05) clinical features, and were more severe in coinfection compared to mono-infections in multivariate analysis. Conclusion: The study shows a high rate of rotavirus and Campylobacter coinfection in children with diarrhoea. Diagnosis based management of diarrhoeal cases can guide the specific treatment. Keywords: Campylobacter, rotavirus, co-infection, diarrhoea, children
The Oral Microbiome and Salivary Proteins Influence Caries in Preschool Children
Authors: Chen Wang , Jiang Qian , Yan GuoWei , Yang DeQin
Published: December 2019

Background Oral microbiome and salivary proteins play a critical role in the occurrence and development of caries. In this study, we used metagenomic and metaproteomic analyses to explore the microbiological and proteinic biomarkers and investigate the etiology of caries in preschool children. Our study aims to offer a better comprehension of these factors and the relationship with caries, and these findings might facilitate caries risk assessment and provide a basis for future prevention strategies.Methods Children six to eight years old living in rural isolated areas with or without caries were recruited. Supragingival plaque and unstimulated saliva were collected for 16S rDNA pyrosequencing and isobaric tags for relative and absolute quantitation (iTRAQ)technique coupled with quantitative nano-flow liquid chromatography-tandem mass spectrometry(LC-MS/MS), respectively.Results We found the six most abundant phyla (Firmicutes, Bacteroidetes, Fusobacteria, Proteobacteria, Actinobacteria, and Candidate division TM7). The Alpha diversity analysis demonstrated that the richness and diversity of the bacterial communities were similar between children with caries-free and caries-active groups; LEfSe detected differences in the bacterial community including Dialister, Selenomonas, Actinomyces, and Mogibacterium in the caries-active group (P<0.05) and Capnocytophaga, Fusobacterium, Desulfuromonadales, Haemophilus, and Porphyromonas in the caries-free group(P<0.05). The core microbiome was defined as 18 predominant genera in preschool children with caries. The results of the salivary proteome identified 9135 unique peptides and 1662 proteins group from 20 salivary samples. Two hundred fifty-eight proteins were differentially expressed between the caries-free and caries-active groups.Conclusions The diversity of the microbial community has little effect on caries but some bacteria with different relative abundance between the caries-active and caries-free group could be considered as potential biomarkers for preschool children with caries. In addition, as a critical host factor of caries, the salivary proteins are different in caries-free and caries-active groups.
Progression of the smoking epidemic in high-income regions and its effects on male-female survival differences: a cohort-by-age analysis of 17 countries.
Authors: Wensink Maarten , Álvarez Jesús-Adrián , Rizzi Silvia , Janssen Fanny , Lindahl-Jacobsen Rune
Published: December 2019

Background Of all lifestyle behaviours, smoking caused the most deaths in the last century. Because of the time lag between the act of smoking and dying from smoking, and because males generally take up smoking before females do, male and female smoking epidemiology often follows a typical double wave pattern dubbed the ‘smoking epidemic’. How are male and female deaths from this epidemic differentially progressing in high-income regions on a cohort-by-age basis? How have they affected male-female survival differences? MethodsWe used data for the period 1950-2015 from the WHO Mortality Database and the Human Mortality Database on three geographic regions that have progressed most into the smoking epidemic: high-income North America, high-income Europe and high-income Oceania. We examined changes in smoking-attributable mortality fractions as estimated by the Preston-Glei-Wilmoth method by age (ages 50-85) across birth cohorts 1870-1965. We used these to trace sex differences with and without smoking-attributable mortality in period life expectancy between ages 50 and 85. ResultsIn all three high-income regions, smoking explained up to 50% of sex differences in period life expectancy between ages 50 and 85 over the study period. These sex differences have declined since at least 1980, driven by smoking-attributable mortality, which tended to decline in males and increase in females overall. Thus, there was a convergence between sexes across recent cohorts. While smoking-attributable mortality was still increasing for older female cohorts, it was declining for females in the more recent cohorts in the US and Europe, as well as for males in all three regions.ConclusionsThe smoking epidemic contributed substantially to the male-female survival gap and to the recent narrowing of that gap in high-income North America, high-income Europe and high-income Oceania. The precipitous decline in smoking-attributable mortality in recent cohorts bodes somewhat hopeful. Yet, smoking-attributable mortality remains high, and therefore cause for concern.
In Vitro comparison of cyclic fatigue resistance of TruNatomy in single and double curvature canals compared with different nickel-titanium rotary instruments
Authors: Elnaghy Amr M. , Elsaka Shaymaa E , Mandorah Ayman
Published: December 2019

Background: The purpose of this study was to compare the cyclic fatigue resistance of newly developed TruNatomy instruments (TRN) in single and double (S-shaped) curvature canals with HyFlex CM (HCM), Vortex Blue (VB) and RaCe (RC) instruments. Methods: Size 20/.04 taper and size 25/0.04 of HCM, VB and RC were used. For TRN instruments, size 20/.04 taper (small) and size 26/.04 taper (prime) were used. The instruments were tested in artificial canals with double curvature (coronal curve; 60° curvature, 5 mm radius and apical curve; 70° curvature and 2 mm radius) and single curvature (60° curvature, 5 mm radius). The number of cycles to failure (NCF) was recorded. Data were statistically analyzed by Kruskal-Wallis and Dunn’s multiple comparison tests. Weibull analysis was performed on NCF data. Statistical significant was set at p < 0.05. Results: TRN and HCM revealed higher NCF compared with the other instruments for both tested sizes in single and double curvature canals (p < 0.05). TRN and HCM showed no statistically significant difference in the NCF (p > 0.05). The probability of survival was higher for HCM and TRN instruments than VB and RC instruments. Conclusions: HCM and TRN instruments were more resistant to cyclic fatigue than VB and RC instruments in single and double curvature canals. HCM and TRN instruments were anticipated to survive with higher number of cycles than the other tested instruments. RC instrument had the lowest fatigue resistance than the other instruments.
Avatar-based versus conventional vital sign display in a central monitor for monitoring multiple patients: A multicenter computer-based laboratory study.
Authors: Garot Olivier , Rössler Julian , Pfarr Juliane , Ganter Michael T. , Spahn Donat R. , Nöthiger Christoph B. , Tscholl David Werner
Published: December 2019

Background Maintaining adequate situation awareness is crucial for patient safety. Previous studies found that the use of avatar-based monitoring (Visual Patient Technology) improved the perception of vital signs compared to conventional monitoring showing numerical and waveform data; and was further associated with a reduction of perceived workload. In this study, we aimed to evaluate the effectiveness of Visual Patient Technology on perceptive performance and perceived workload when monitoring multiple patients at the same time, such as in central station monitors in intensive care units or operating rooms. Methods A prospective, within-subject, computer-based laboratory study was performed in two tertiary care hospitals in Switzerland in 2018. Thirty-eight physician and nurse anesthetists volunteered for the study. The participants were shown four different central monitor scenarios in sequence, where each scenario displayed two critical and four healthy patients simultaneously for 10 or 30 seconds. After each scenario, participants had to recall the vital signs of the critical patients. Perceived workload was assessed with the National Aeronautics and Space Administration Task-Load-Index (NASA TLX) questionnaire. Results In the 10-second scenarios, the median number of remembered vital signs significantly improved from 7 to 11 using avatar-based versus conventional monitoring with a mean of differences of 4 vital signs, 95% confidence interval (CI) 2 to 6, p < 0.001. At the same time, the median NASA TLX scores were significantly lower for avatar-based monitoring (67 vs. 77) with a mean of differences of 6 points, 95% CI 0.5 to 11, p = 0.034. In the 30-second scenarios, vital sign perception and workload did not differ significantly. Conclusions In central monitor multiple patient monitoring, we found a significant improvement of vital sign perception and reduction of perceived workload using Visual Patient Technology, compared to conventional monitoring. The technology enabled improved assessment of patient status and may, thereby, help to increase situation awareness and enhance patient safety.
Effect of pregnancy induced hypertension on adverse perinatal outcomes in Tigray regional state, Ethiopia: a prospective cohort study
Authors: Berhe Abadi Kidanemariam , ILESANMI Abiodun O. , AIMAKHU Christopher O. , Mulugeta Afework
Published: December 2019

Background: The prevalence of pregnancy-induced hypertension in Ethiopia ranges from 2.2 to 18.3%. However, so far little is known about the adverse perinatal outcomes of pregnancy-induced hypertension in Tigray regional state, Ethiopia. Therefore, the objective of this study was to assess the effect of pregnancy-induced hypertension on adverse perinatal outcomes in Tigray Regional State, Ethiopia. Methods: a prospective cohort study was conducted on a total sample of 782 pregnant women attending antenatal care in hospitals of Tigray regional state, Ethiopia. Pregnant mothers diagnosed with PIH during the data collection period in the selected hospitals were included as exposed group and normotensive women were also enrolled as a control group. Women diagnosed with pregnancy-induced hypertension between 28 and 35 weeks of gestation were enrolled for follow up to this study. Data were collected using an interviewer-administered questionnaire and review of their medical records from February 2018, to February 2019. The adverse perinatal outcome event includes low birth weight, birth asphyxia, small for gestational age, preterm delivery, admission to neonatal intensive care unit and perinatal death. A modified Poisson regression model with robust standard errors was used to analyze relative risk. Results: In this study, the overall incidence of adverse perinatal outcome was higher among women with pregnancy-induced hypertension than normotensive women (66.4% vs 22.2%). After adjusted for confounders women with pregnancy-induced hypertension were born babies with a higher risk of low birth weight (adjusted RR(95%CI)= 5.1(3.4,7.8)), birth asphyxia (aRR=2.6(1.9,3.8)), small for gestational age (aRR=3.3(2.3,4.6)), preterm delivery (aRR=5.2(3.4,7.9)), stillbirth (aRR=3.46(1.40,8.54)), admission to neonatal intensive care unit (aRR=5.1(3.1,8.4)) and perinatal death (aRR=3.6(1.8,7.4)) compared to normotensive pregnant women. Conclusions: Higher incidences of adverse perinatal outcomes occurred among women pregnancy-induced hypertension in Tigray regional state, Ethiopia. Hence health care providers should strengthen prevention, early diagnosis and prompt management of pregnancy-induced hypertension to reduce adverse perinatal outcomes of pregnancy-induced hypertension. Keywords : Adverse perinatal outcomes, pregnancy-induced hypertension, Tigray, Ethiopia
A Prospective Randomized Controlled Study of Auricular Point Acupressure to Manage Chronic Low Back Pain in Older Adults: Study Protocol
Authors: Yeh Chao Hsing , Li Cuicui , Glick Ronald , Schlenk Elizabeth A. , Albers Kathryn , Suen Lorna Kwai-Ping , Lukkahatai Nada , Salen Nicole , Pandiri Sonaali , Ma Weixia , Perrin Nancy , Morone Natalia E. , Christo Paul
Published: December 2019

Background: Chronic low back pain (cLBP) is a major health problem and the most common pain condition among those 60 years of age or older in the US. Despite the development of pharmacological and nonpharmacological interventions, cLBP outcomes have not improved and disability rates continue to rise. This study aims to test auricular point acupressure (APA) as a non-invasive, nonpharmacological self-management strategy to manage cLBP and to address current shortcomings of cLBP treatment. Methods: For this prospective randomized controlled study, participants will be randomly assigned into three groups: (1) APA (active points related to cLBP), (2) Comparison Group -1 (non-active points, unrelated to cLBP), (3) Comparison Group-2 (enhanced educational control, an educational booklet on cLBP will be given and the treatment used by participants for their cLBP will be recorded). The ecological momentary assessment smartphone app will be used to collect real-time cLBP outcomes and adherence to APA practice. Treatment and nonspecific psychological placebo effects will be measured via questionnaires for all participants. This proposed trial will evaluate the APA sustained effects for cLBP at 12-month follow-up. Monthly phone follow-up will be used to collect study outcomes. Blood will be collected during study visits at baseline, post-APA treatment, and follow-up study visits at 1-, 3-, 6-, 9- and 12-months post-completion of treatment for a total of 7 assessments. Appointments will start between 9 and 11 am to control for circadian variation in cytokine levels. Discussion: This study is expected to provide vital information on the efficacy, sustainability, and underlying mechanism of APA on cLBP necessary for APA to gain acceptance from both healthcare providers and patients, which would provide a strong impetus for including APA as part of cLBP management in clinical and home settings. Trial registration: NCT03589703, Registered on May 22, 2018 Keywords: Chronic low back pain, auricular point acupressure, older adults, cytokines
Establishment and Validation of a Nomogram with Intratumoral Heterogeneity Derived from 18F-FDG PET/CT for Predicting Individual Conditional Risk of 5-Year Recurrence before Initial Treatment of Nasopharyngeal Carcinoma
Authors: Gu Bingxin , Ma Guang , Song Shaoli , Shi Liqun , Zhang Yingjian , Zhang JianPing , Yang Zhongyi
Published: December 2019

Objectives Intratumoral heterogeneity has an enormous effect on patient treatment and outcome. The purpose of the current study was to establish and validate a nomogram with intratumoral heterogeneity derived from 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) for prognosis of 5-Year progression-free survival (PFS) of patients with nasopharyngeal carcinoma (NPC).Methods A total of 171 NPC patients who underwent pretreatment 18F-FDG PET/CT were retrospectively enrolled. Data was randomly divided into training cohort (n=101) and validation cohort (n=70). The clinicopathologic parameters and the following PET parameters were analyzed: maximum and mean standardized uptake value (SUVmax, SUVmean), metabolic tumor volume (MTV), total lesion glycolysis (TLG), and heterogeneity index (HI, SUVmax/SUVmean) for primary tumor and maximal neck lymph node. Cox analyses were performed on PFS in the training cohort. A prognostic nomogram based on this model was developed and validated.Results For the primary tumor, MTV-2.5, TLG-2.5, MTV-70%, and TLG-70% were significantly correlated with PFS. For the maximal neck lymph node, short diameter and HI were significantly correlated with PFS. Among the clinicopathologic parameters, M stage was a significant prognostic factor for recurrence. In multivariate analysis, M stage (P=0.006), TLG-T-70% (P=0.002), and HI-N (P=0.018) were independent predictors. Based on this prognostic model, a nomogram was generated. The C-index of this model was 0.74 (95% CI: 0.63-0.85). For the cross validation, the C-index for the model was 0.73 (95% CI: 0.62-0.83) with the validation cohort. Patients with a risk score of ≥111 had poorer survival outcomes than those with a risk score of 0-76 and 77-110.Conclusions Intratumoral heterogeneity derived from 18F-FDG PET/CT could predict long-term outcome in patients with primary NPC. A combination of PET parameters and the TNM stage enables better stratification of patients into subgroups with different PFS rates.
Cytological evidence of BSD2 functioning in both chloroplast division and dimorphic chloroplast formation in maize leaves
Authors: Li Heying , Bai Mei , Jiang Xingshan , Shen Rongxin , Wang Huina , Wang Haiyang , Wu Hong
Published: December 2019

Background: Maize bsd2 (bundle sheath defective2) is a classical C4 mutant with defective C4 photosynthesis, accompanied with reduced accumulation of Rubisco (ribulose bisphosphate carboxylase oxygenase) and aberrant mature chloroplast morphology in the bundle sheath (BS) cells. However, as a hypothetical chloroplast chaperone, the effects of BSD2 on C4 chloroplast development have not been fully examined yet, which precludes a full appreciation of BSD2 function in C4 photosynthesis. The aims of our study are to find out the role ofBSD2 in regulating chloroplasts development in maize leaves, and to add new insights into our understanding of C4 biology. Results: We found that at the chloroplast maturation stage, the thylakoid membranes of chloroplasts in the BS and mesophyll (M) cellsbecame significantly looser, and the granaof chloroplasts in the M cells became thinner stacking in the bsd2 mutant when compared with the wildtype plant. Moreover, at the early chloroplast development stage, the number of dividing chloroplasts and the chloroplast division rate are both reduced in the bsd2 mutant, compared with wild type. Quantitative reverse transcriptase-PCR analysis revealed that the expression of both thylakoid formation-related genesand chloroplast division-related genes is significantly reduced in the bsd2 mutants. Further, we showed that BSD2 interacts physically with the large submit of Rubisco (LS) in Bimolecular Fluorescence Complementation assay. Conclusions: Our combined results suggest that BSD2 plays an essential role in regulating the division and differentiation of the dimorphic BS and M chloroplasts, and that it acts at a post-transcriptional level to regulate LS stability or assembly of Rubisco.
Machine learning prediction of oncology drug targets based on protein and network properties
Authors: Dezso Zoltan , Ceccarelli Michele
Published: December 2019

Background The selection and prioritization of drug targets is a central problem in drug discovery. Computational approaches can leverage the growing number of large-scale human genomics and proteomics data to make in-silico target identification, reducing the cost and the time needed. Results We developed a machine learning approach to score proteins to generate a druggability score of novel targets. In our model we incorporated 70 protein features which included properties derived from the sequence, features characterizing protein functions as well as network properties derived from the protein-protein interaction network. The advantage of this approach is that it is unbiased and even less studied proteins with limited information about their function can score well as most of the features are independent of the accumulated literature. We build models on a training set which consist of targets with approved drugs and a negative set of non-drug targets. The machine learning techniques help to identify the most important combination of features differentiating validated targets from non-targets. We validated our predictions on an independent set of clinical trial drug targets, achieving a high accuracy characterized by an AUC of 0.89. Our most predictive features included biological function of proteins, network centrality measures, protein essentiality, tissue specificity, localization and solvent accessibility. Our predictions, based on a small set of 102 validated oncology targets, recovered the majority of known drug targets and identifies a novel set of proteins as drug target candidates. Conclusions We developed a machine learning approach to prioritize proteins according to their similarity to approved drug targets. We have shown that the method proposed is highly predictive on a validation dataset consisting of 277 targets of clinical trial drug confirming that our computational approach is an efficient and cost-effective tool for drug target discovery and prioritization. Our predictions were based on oncology targets and cancer relevant biological functions, resulting in significantly higher scores for targets of oncology clinical trial drugs compared to the scores of targets of trial drugs for other indications. Our approach can be used to make indication specific drug-target prediction by combining generic druggability features with indication specific biological functions.
Modular stem in total hip arthroplasty for patients with trochanter valgus deformity: surgical technique and case series
Authors: Kong Xiangpeng , Chai Wei , Yang Minzhi , Ong Alvin , Chen Jiying , Wang Yan , Zhou Yonggang
Published: December 2019

Background: Trochanter valgus deformity (TVD) is a rare condition of total hip arthroplasty (THA). The femoral osteotomy might be required to correct the deformity to implant the femoral stem in severe TVD. In this study, we described one unpublished technique of reverse sleeve of S-ROM to get through the complex situation. This study aimed to summarize and evaluate its technical challenges, safety and effectiveness. Methods : From January 2006 to December 2014, the patients whose sleeves were implanted towards the great trochanter rather than sitting on the calcar, to solve the TVD in THA were enrolled. Their demographics, perioperative and postoperative information were recorded. To explore its indication, we measured and analyzed the ratio of greater trochanter/lesser trochanter (G/L ratio) and trochanter valgus angle (TVA). Results : Twelve patients (1 male and 11 female, average age 42.30±10.23) who had the complete clinical data were analyzed. The survivorship of femoral prosthesis were 100% with mean follow-up of 6 years. No other complications were found, except for two patients with intraoperative fracture of femur. The Harris hip score (HHS) increased from preoperative 34.31±14.43 to postoperative 84.12±11.33. All patients’ G/L ratio were larger than 1.50. Conclusions: The reverse sleeve of S-ROM was a reliable method for the patients with severe trochanter valgus deformity, which brought satisfying clinical outcomes in mid-term follow-up. Keywords : cementless modular stem; reverse sleeve; total hip arthroplasty; trochanter valgus deformity.
Understanding parental self-medication with antibiotics for children in China: a multi-nationality analysis
Authors: Zhou Zhongliang , Zhao Dantong , Zhang Huarui , Shen Chi , Zhu Liang , Zhao Yaxin , Cao Dan , Ren Yangling , Si Yafei , Ma Siwei , Fang Yu
Published: December 2019

Background: Bacterial resistance has become an important public health concern which mainly caused by irrational use and self-medication with antibiotics. This study aims to explore the association between parent's nationality and parental self-medication with antibiotics under the one Chinese health service system, and further compare differences in medical knowledge, attitudes and behaviors about antibiotics amongst nationalities. Methods: Based on a structured questionnaire survey, a cross-sectional study was designed to investigate a cluster of 310 parents in an International Department of an International School in Xi'an, Shaanxi, China, including Chinese, other Asians and Occidental. Binary Logistic Regression was used to examine the association between nationality and parental self-medication with antibiotics for children. The differences in medical knowledge, attitudes and behaviors about antibiotics were analyzed by Pearson Chi-square test. Results: The proportion of parental self-medication with antibiotics on children was 20.10%, 5.00% and 2.67% for Chinese, other Asians and Occidental, respectively ( P <0.001). Chinese parents were more likely to have self-medication with antibiotics for children compared to Occidental parents (OR=8.221, 95%CI: 1.646-41.054, P <0.01 in Model1 and OR=6.086, 95%CI: 1.012-36.594, P <0.05 in Model2). Occidental parents had higher rate of correct medical knowledge, attitudes and behaviors about antibiotics than Chinese and followed by other Asians in total ( P <0.001). Conclusions: Nationality is significantly associated with parental self-medication with antibiotics for children, showing that Chinese parents are more likely to self-medicate with antibiotics for children than Occidental parents. Occidental parents perform better in medical knowledge, attitudes and behaviors about antibiotics compared to Chinese and other Asians. This study highlights that the effectiveness of more efforts placed on health educations to parents on antibiotics use from demand side beyond the supervision and regulation on health service supplier in China. Key words: Parental self-medication with antibiotics; Nationalities; Medical knowledge; Attitudes; Behaviors
Substance P participates in periodontitis by upregulating HIF-1α and RANKL/OPG ratio
Authors: Yan Kaixian , Lin Qin , Tang Kailiang , Liu Shuang , Du Yi , Yu Xijiao , Li Shu
Published: December 2019

Background Both substance P and hypoxia-inducible factor 1 alpha (HIF-1α) are involved in inflammation and angiogenesis. However, the relationship between substance P and HIF-1α in rat periodontitis is still unknown. Methods Ligation‐induced rat periodontitis was established to observe the distribution and expression of substance P and HIF-1α by immunohistochemistry. Rat gingival fibroblasts were cultured and stimulated with Porphyromonas gingivalis lipopolysaccharide (LPS). Recombinant substance P was applied to elaborate the relationship between substance P and HIF-1α in gingival fibroblasts in vitro. Primary mouse bone marrow-derived macrophages (BMMs) were isolated and cultured to observe the effect of substance P on receptor activator of NF-κB ligand (RANKL)-induced osteoclastogenesis by TRAP staining. Western blotting was used to investigate the expression of HIF-1α, osteoprotegerin (OPG) and RANKL. Results Rat experimental periodontitis was successfully established six weeks after ligation. Gingival inflammatory infiltration and alveolar bone loss were observed. Positive expression of substance P was found in the infiltrating cells. Higher HIF-1α levels were observed in periodontitis compared to that of normal tissues. Substance P upregulated the level of HIF-1α in gingival fibroblasts with or without 1 µg/ml LPS in vitro (*P<0.05). Substance P upregulated the expression of HIF-1α in RANKL-stimulated BMMs in vitro. Substance P also increased the RANKL/OPG ratio in gingival fibroblasts (*P<0.05). Both 10 nM and 50 nM substance P promoted RANKL-induced osteoclast differentiation (*P<0.05). Conclusion Substance P participates in periodontitis by upregulating HIF-1α and the RANKL/OPG ratio.
Transcriptome analysis of lateral buds from Phyllostachys edulis rhizome during germination and early shoot stages
Authors: Shou Yuting , Zhu Yihua , Ding Yulong
Published: December 2019

The vegetative growth is an important stage for plants when they conduct photosynthesis, accumulate and collect all resources needed and prepare for reproduction stage. Bamboo is one of the fastest growing plant species. The rapid growth of Phyllostachys edulis results from the expansion of intercalary meristem at the basal part of nodes, which are differentiated from the apical meristem of rhizome lateral buds. However, little is known about the major signaling pathways and players involved during this rapid development stage of bamboo. To study this question, we adopted the high-throughput sequencing technology and compared the transcriptomes of Moso bamboo rhizome buds in germination stage and late development stage. We found that the development of Moso bamboo rhizome lateral buds was coordinated by multiple pathways, including meristem development, sugar metabolism and phytohormone signaling. Phytohormones have fundamental impacts on the plant development. We found the evidence of several major hormones participating in the development of Moso bamboo rhizome lateral bud. Furthermore, we showed direct evidence that Gibberellic Acids (GA) signaling participated in the Moso bamboo stem elongation. Together, these results expand our knowledge on the Moso bamboo internodes fast growth and provide research basis for further study.
Association between subthreshold depression and self-care behaviours in people with type 2 diabetes: a systematic review of observational studies
Authors: Shrestha Monika , Ng Ashley , Al-Ghareeb Amal , Alenazi Fatimah , Gray Richard
Published: December 2019

Background Self-care behaviours in people living with type 2 diabetes are important to achieving optimal glycemic control. Major depression in type 2 diabetes is associated with decreased adherence to self-care behaviours. The association between subthreshold depression and self-care behaviours, however, has not previously been systematically reviewed. Methods Five electronic databases were searched to identify observational studies in adults with type 2 diabetes investigating the association between subthreshold depression and self-care behaviours. Two reviewers independently completed title and abstract and full-text screening, appraised study quality, and extracted the data. Included articles were critically appraised using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist. Results A total of 6,408 articles were identified through the database searching. After the abstract and full-text review, two articles met the inclusion criteria. Due to a limited number of studies, a meta-analysis could not be done. The two studies showed inconsistent findings on the association between subthreshold depression and self-care behaviours. Important risks of bias were identified in both the included studies. Conclusions There is no clear evidence that subthreshold depression is associated with self-care behaviours in adults with type 2 diabetes. Our review established a gap in knowledge and suggests that further high-quality studies are needed to examine the association between subthreshold depression and self-care behaviours in people with type 2 diabetes. Systematic review registration: PROSPERO CRD42018116373
Antibiotic susceptibility Patterns against Upper Respiratory Tract Pathogens in Tertiary Care Hospitals of Lahore, Pakistan
Authors: Ullah Kalim , Baloch Marvi , Iqbal Javeid , Khan Ayaz Ali , Saeed Hamid , Islam Muhammad
Published: December 2019

Backgrounds In Pakistan, despite the surge in antibiotic consumption scanty of literature evidences exist regarding antibiotic susceptibility patterns in URTIs. Thus, we conducted the study to evaluate the antibiotic susceptibility patterns in URTIs.Methods A cross-sectional study was conducted by collecting 259 culture samples from tertiary care hospitals of Lahore, Pakistan. Using simple random sampling, culture reports of even numbered patient were included as per study inclusion criteria.Results Two hundred sixty samples were processed out of which only 144 (55.4%) samples yielded growth, i-e., 42.7% males and 49% females. In males, the resistance was high against ceftazidime (19.3%), ampicillin (13.1%), ciprofloxacin (11.6%) and gentamicin (10.8%), while in female samples it was significant against cefuroxime (6.9%), ampicillin (5.4%), tobramycin (4.6%) and ciprofloxacin (6.5%). Besides, males were sensitive against imepenem (25.8%), amikacin (22%), ceftazidime (19.3%), ciprofloxacin (19.3%) and piptaz (16.2%), while females were sensitive against amikacin (9.2%), imepenem (9.2%) and ciprofloxacin (6.9%). Overall, carbepenems, imipenem (35%) and meropenem (30.8%), were found highly sensitive followed by aminoglycosides (amikacin; 31.9%), quinolones (ciprofloxacin; 26.3%), piptaz (19.2%) among penicillin and cephalosporin, while resistant was maximum against cephalosporin (ceftazidime; 25.4%) followed by penicillin (ampicillin, 18.5%) and quinolones.Conclusion These data suggested that P. aeruginosa and Klebsiella , were the most frequent bacterial isolates in URTIs of Lahore, Pakistan. These isolates were resistant to ampicillin, cefuroxime and ceftazidime, but were sensitive to carbapenem and aminoglycoside class of antibiotics. Thus, health care professionals, policy makers and drug regulators must devise policies to overcome the menace of growing antimicrobial resistance.
Molecular epidemiology of Clostridioides difficile in patients with inflammatory bowel disease in China
Authors: Lv Tao , Chen Yunbo , Zheng Lisi , Wu Tao , Shen Ping , Li Lanjuan
Published: December 2019

Background: Clostridioides difficile (C. difficle) infection (CDI) in inflammatory bowel disease (IBD) patients can be recurrent, resulting in poor outcomes, but the molecular characterization of C. difficle in IBD patients remains to be well-established in China. This study aimed to investigate the molecular epidemiology of C. difficile in adult and pediatric IBD patients in China. Methods: C. difficile strains were isolated and identified from the fecal samples of adult and pediatric IBD patients. Toxigenic strains were typed using multilocus sequence typing (MLST), and susceptibility to 10 antimicrobials was evaluated using E-test.Results: Among the 838 IBD patients, 96 (11.5%) patients were positive for CDI, which comprised of 53 adult (9.6%) and 43 children (14.9%) cases. Isolates positive for both toxin A and toxin B genes (A+B+) accounted for 90.2% (74/82), while the remaining 9.8% were negative for toxin A, but positive for toxin B (A–B+). These toxigenic strains were susceptible to metronidazole and vancomycin, but highly resistant to clindamycin, levofloxacin, erythromycin and ciprofloxacin. Furthermore, the isolates obtained from pediatric patients had a significantly higher resistance rate to clindamycin, when compared to isolates obtained from adult CDI (p=0.009). In addition, these toxigenic strains were categorized as 18 sequence types (STs). The dominant types consisted of ST-35 (20.7%), ST-2 (17.1%), ST-54 (13.4%) and ST-3 (13.4%) in all patients, ST-2 (19.6%), ST-35 (15.2%) and ST-54 (13.0%) in adult patients, and ST-35 (27.8%), ST-3 (19.4%), ST-2 (13.9%), ST-54 (13.9%) and ST-37(8.3%) in pediatric patients, respectively. All isolates formed three distinct clusters in the phylogenetic analysis. Conclusions: The incidence and molecular epidemiology of C. difficile infection in adult IBD patients resembled CDI in the general inpatient population. A higher antibiotic resistance rate was identified among the C. difficile isolates obtained from pediatric IBD patients, and few STs accounted for most multidrug-resistant strains. However, the molecular genetic features of the same ST-type between these two groups remained highly correlated.