bluuebunny/crossref_metadata_2025 huggingface dataset:
Stigma matters in ending tuberculosis: Nationwide survey of stigma in Ethiopia
Authors: Datiko Daniel G. , Jerene Degu , Suarez Pedro
Published: February 2020

Background

Tuberculosis (TB) affects, and claims the lives of, millions every year. Despite efforts to find and treat TB, about four million cases were missed globally in 2017. Barriers to accessing health care, inadequate health-seeking behavior of the community, poor socioeconomic conditions, and stigma are major determinants of this gap. Unfortunately, TB-related stigma remains unexplored in Ethiopia.

Methods

This mixed methods survey was conducted using multistage cluster sampling to identify 32 districts and 8 sub-cities, from which 40 health centers were randomly selected. Twenty-one TB patients and 21 family members were enrolled from each health center, and 11 household members from each community in the catchment population.

Results

A total of 3463 participants (844 TB patients, 836 from their families, and 1783 from the general population) were enrolled for the study. The mean age and standard deviation were 34.3 ± 12.9 years for both sexes (34.9 ± 13.2 for men and 33.8 ± 12.5 for women). Fifty percent of the study participants were women; 32.1% were illiterate; and 19.8% came from the lowest wealth quintile. The mean stigma score was 18.6 for the general population, 20.5 for families, and 21.3 for TB patients. The general population of Addis Ababa (AOR: 0.1 [95% CI: 0.06–0.17]), those educated above secondary school (AOR: 0.58 [95% CI: 0.39–0.87]), and those with a high score for knowledge about TB (AOR: 0.62 [95% CI: 0.49–0.78]) had low stigma scores. Families of TB patients who attended above secondary school (AOR: 0.37 [95% CI: 0.23–0.61]) had low stigma scores. TB patients educated above secondary school (AOR: 0.61 [95% CI: 0.38–0.97]) had lower stigma scores, while those in the first (AOR: 1.93: 95% CI 1.05–3.57) and third quintiles (AOR: 1.81: 95% CI: 1.08–3.05) had stigma scores twice as high as those in the highest quintile. Fear of job loss (32.5%), isolation (15.3%), and feeling avoided (9.3%) affected disclosure about TB.

Conclusions

More than a third of Ethiopians have high scores for TB-related stigma, which were associated with educational status, poverty, and lack of awareness about TB. Stigma matters in TB prevention, care, and treatment and warrants stigma reduction interventions.
A qualitative study of attitudes towards, typologies, and drivers of concurrent partnerships among people of black Caribbean ethnicity in England and their implications for STI prevention
Authors: Wayal Sonali , Gerressu Makeda , Weatherburn Peter , Gilbart Victoria , Hughes Gwenda , Mercer Catherine H.
Published: February 2020

Background

Partner concurrency, (having sexual partnerships overlapping in time), especially when condoms are not used, can facilitate sexually transmitted infections (STI) transmission. In Britain, STI diagnoses rates and the reporting of concurrency are higher among black Caribbeans than other ethnic groups. We explored attitudes towards, drivers, characteristics, and contexts of concurrent partnerships, and their implications for STI risk among black Caribbeans in England.

Methods

Purposive sampling, by sex and age-groups, was used to recruit participants (overalln = 59) from five sexual health clinics and community settings in London and Birmingham, England. Audio-recorded four focus group discussions (n = 28 participants), and in-depth interviews (n = 31) were conducted (June 2014–December 2015). Transcribed data were thematically analysed using Framework Analysis.

Results

‘Main plus’ and ‘non-main’ concurrency were identified in this population. Main plus concurrency involves an individual having a main partner with whom s/he has a “relationship” with, and the individual and/or their partner secretly or explicitly have other non-main partners. In contrast, non-main concurrency entails having multiple, non-committed partners overlapping in time, where concurrency is usually taken as a given, making disclosure to partners irrelevant. While main partnerships were usually long-term, non-main partnerships ranged in duration from a single event through to encounters lasting several months/years. Condomless sex was common with ex/long-term/married/cohabiting partners; whereas condoms were typically used with non-main partners. However, condom use declined with partnership duration and familiarity with partners. Awareness of partners’ concurrency facilitated condom use, STI-testing, and partner notification. While unresolved feelings, or sharing children with ex-partners, usually facilitated main plus concurrency; non-main concurrency was common among young, and single people. Gender norms, notions of masculinity, and sexual desires influenced concurrency. Black Caribbean popular music, social media, peer pressure, and relationship norms among black Caribbeans were also perceived to encourage concurrency, especially among men and young people.

Conclusions

Concurrency among black Caribbeans is shaped by a complex interaction between emotional/psychological, interpersonal, sociocultural, and structural factors. Concurrency type, its duration, and awareness influence sexual health choices, and thus STI risk in this population. Collecting these data during clinic consultations could facilitate offering partner notification methods tailored to concurrency type. Gender- and age-specific, culturally-sensitive interventions addressing STI risks associated with concurrency are needed.
Quality of medical prescriptions in diabetes and hypertension management in Kerala and its associated factors
Authors: Krishnapillai Vijayakumar , Nair Sanjeev , T. N Anand , T. P Sreelal , Soman Biju
Published: February 2020

Background

Kerala is facing challenges in the secondary prevention efforts of non-communicable diseases (NCDs). In spite of being the top performer in health parameters among Indian states, the burden of NCDs, especially diabetes mellitus (diabetes) and hypertension, is higher in Kerala. This research endeavours to identify the role of quality of medical prescriptions in secondary prevention of diabetes and hypertension and suggest corrective measures.

Methods

This cross-sectional study involved collection of prescription data and other details from consenting doctors across seven districts in Kerala. After the quality of prescription was assessed using a checklist, scores were generated, and cutoff points were used to classify the prescriptions. PASW version 18 software, was used for data analysis which included univariate and bivariate analyses and logistic regression. The proportion of quality prescriptions was estimated after adjusting for clustering, and the proportion of doctors writing quality prescriptions was also estimated. Prior to the study, ethical clearance from Independent ethics committee in Health action by People (HAP) and informed consent from all the study participants were obtained.

Results

After assessing 9199 prescriptions from 344 doctors, it was found that about 37.2% (95% CI: 34.9–39.4%) of the prescriptions were of good quality, and 48.2% (95% CI: 42.9–53.7%) of the doctors provided quality prescriptions. Factors associated with quality prescriptions were found to be knowledge about NCD guidelines, quality certifications of hospitals and usage of patient data management software.

Conclusions

In the context of rising prevalence of NCDs and the challenges in the secondary prevention efforts, this is one of the first studies in Kerala to evaluate the quality of prescriptions to manage NCDs as prescriptions often reflect the quality of medical management. The study also addresses other factors associated with quality medical management. The findings indicate that the scope for improvement is more than 50%, when considered for the overall quality of prescriptions in diabetes and hypertension management. Further, it was found that appropriate training of doctors, adherence to treatment guidelines and the use of technology may improve the overall quality of prescriptions.
Microbial contamination of home nebulizers in children with cystic fibrosis and clinical implication on the number of pulmonary exacerbations
Authors: Tabatabaii Seyed Ahmad , Khanbabaee Ghamartaj , Sadr Saeed , Farahbakhsh Nazanin , Aghdam Maryam Kazemi , Lotfollahzadeh Saran , Hosseini Amirhossein , Dara Naghi , Nanbakhsh Mohammad , Gorji Fatemeh Abdollah
Published: February 2020

Background

Early detection of pulmonary contamination in children with cystic fibrosis (CF) is essential since these children are vulnerable toPseudomonas aeruginosa(P. aeruginosa) colonization. In Iran, home nebulization of antibiotics is a widespread practice in treatment for patients with CF and, to the best our knowledge, no bacteriological surveys have been conducted till date in this regard.

Method

This observational, cross sectional study was conducted on 61 children with CF at Mofid Children’s Hospital, Tehran, from September 2017 to march 2018. The swab sampling was performed from 61 home nebulizers used by children diagnosed with CF. Contemporaneous sputum sample or deep nasopharyngeal swab was taken from each patient for bacterial and fungal testing. Medical records of the patients were reviewed and the number of exacerbations were recorded over the last 12 months prior to the study enrollment.

Results

The results of study showed that, 43 (70.5%) nebulizers were contaminated; 31 (50.8%) mouthpieces, 21 (34.4%) reservoirs, and 11 (18%) connecting tubes. The most common organism to be isolated wasP. aeruginosaand was recovered from 19 (31%) nebulizers, 16 of them belonged to patients chronically colonized withP. aeruginosa. The remaining three had at least one positive sputum culture forP. aeruginosain the past 1 year before the study. There was a significant increase in the number of CF exacerbations with an average number of exacerbation being 1.5 ± 1(SD) over last 12 months in children who had pathogenic organisms recovered from their home nebulizers compared with 0.4 ± 0.7(SD) exacerbations per year in whom non-pathogenic organisms were isolated from their nebulizers (P < 0.001).

Conclusion

The majority of domiciliary nebulizers used by children with CF were contaminated with microorganisms indicating that the nebulizers may serve as potential reservoirs of pathogens for the patients’ lung. Perpetuating colonization is a possible concern in the ones recently colonized withP. aeruginosaand, therefore, decontamination of nebulizer requires more attention to prevent ongoing infection. The negative impact of contamination of nebulizer on CF exacerbation requires serious attention and further investigations.
My joint pain, a web-based resource, effects on education and quality of care at 24 months
Authors: Wang Xia , Urban Hema , Bennell Kim L. , Dickson Chris , Dobson Fiona , Fransen Marlene , Jones Graeme , Hunter David J.
Published: February 2020

Objective

To evaluate the effects of the updated version of an evidence-based osteoarthritis (OA) resource and consumer hub, ‘My Joint Pain’ website, on health education and quality of care over 12 months.

Methods

Using a classic quasi-experimental design, participants with symptomatic hip or knee OA were recruited across Australia to evaluate the ‘My Joint Pain’ website, compared to a control group of non-users from 12 to 24 months. Outcome measures included the Health Education Impact Questionnaire (HEIQ) and the OA Quality Indicator (OAQI) questionnaire. The changes from 12 to 24 months in the HEIQ were evaluated using a generalised linear model. The differences between users and non-users in the OAQI were evaluated using a chi-square test.

Results

A total of 277 eligible participants with symptomatic hip or knee OA were recruited at baseline, and 122 participants completed the 24-month surveys (users: n = 35, non-users: n = 87). There was no significant difference between users and non-users for the HEIQ scores at 24 months after adjustments for age, sex and body mass index (BMI). Users had higher emotional distress scores than non-users in univariable analysis. When compared with non-users in the OAQI, users showed favourable changes in receiving information about “self-management” and “acetaminophen” and “non-steroidal anti-inflammatory drugs (NSAIDs)” from 12 to 24 months.

Conclusion

The evaluation of the updated ‘My Joint Pain’ website didn’t find significant improvements in terms of health education, but it may help delivering useful information about self-management and appropriate use of pharmacological treatments. More strategies are needed to facilitate the uptake of evidence-based self-management and education online resources for OA consumers.
A systematic review of inflammatory cells and markers in human tendinopathy
Authors: Jomaa George , Kwan Cheuk-Kin , Fu Sai-Chuen , Ling Samuel Ka-Kin , Chan Kai-Ming , Yung Patrick Shu-Hang , Rolf Christer
Published: February 2020

Background

This article systematically reviews the current evidence regarding inflammation in Tendinopathy with the aim to increase understanding of a potential common pathophysiology.

Methods

Following the PRISMA statements, the terms: (tendinopathy OR (tendons AND rupture)) AND (inflammation OR (inflammation AND cells) OR immune system OR inflammation mediators OR bacteria) were used. One thousand four hundred thirty-one articles were identified which was screened down to 53.

Results

39/53 studies mentioned inflammatory cells but had contradicting conclusions. Macrophages were the most common cell type and inflammatory markers were detectable in all the articles which measure them.

Conclusions

The included studies show different conclusions, but this heterogeneity is not unexpected since the clinical criteria of ‘tendinopathy’ encompass a huge clinical spectrum.

Different ‘tendinopathy’ conditions may have different pathophysiology, and even the same clinical condition may be at different disease stages during sampling, which can alter the histological and biochemical picture. Control specimen sampling was suboptimal since the healthy areas of the pathological-tendon may actually be sub-clinically diseased, as could the contralateral tendon in the same subject.

Detection of inflammatory cells is most sensitive using immunohistochemistry targeting the cluster of differentiation markers, especially when compared to the conventional haematoxylin and eosin staining methods. The identified inflammatory cell types favour a chronic inflammatory process; which suggests a persistent stimulus. This means NSAID and glucocorticoids may be useful since they suppress inflammation, but it is noted that they may hinder tendon healing and cause long term problems.

This systematic review demonstrates a diversity of data and conclusions in regard to inflammation as part of the pathogenesis of Tendinopathy, ranging from ongoing or chronic inflammation to non-inflammatory degeneration and chronic infection. Whilst various inflammatory markers are present in two thirds of the reviewed articles, the heterogenicity of data and lack of comparable studies means we cannot conclude a common pathophysiology from this systematic review.
Bone transport versus acute shortening for the management of infected tibial bone defects: a meta-analysis
Authors: Wen Hongjie , Zhu Shouyan , Li Canzhang , Xu Yongqing
Published: February 2020

Background

The treatment for infected tibial bone defects can be a great challenge for the orthopaedic surgeon. This meta-analysis was conducted to compare the safety and efficacy between bone transport (BT) and the acute shortening technique (AST) in the treatment of infected tibial bone defects.

Methods

A literature survey was conducted by searching the PubMed, Web of Science, Cochrane Library, and Embase databases together with the China National Knowledge Infrastructure (CNKI) and the Wanfang database for articles published up to 9 August 2019. The modified Newcastle-Ottawa scale (NOS) was adapted to evaluate the bias and risks in each eligible study. The data of the external fixation index (EFI), bone grafting, bone and functional results, complications, bone union time and characteristics of participants were extracted. RevMan v.5.3 was used to perform relevant statistical analyses. Standard mean difference (SMD) was used for continuous variables and relative risk (RR) for the binary variables. All of the variables included its 95% confidence interval (CI).

Results

Five studies, including a total of 199 patients, were included in the study. Statistical significance was observed in the EFI (SMD = 0.63, 95% CI: 0.25, 1.01, P = 0.001) and bone grafting (RR = 0.26, 95%CI: 0.15, 0.46, P < 0.00001); however, no significance was observed in bone union time (SMD = − 0.02, 95% CI: − 0.39, 0.35, P = 0.92), bone results (RR = 0.97, 95% CI: 0.91, 1.04, P = 0.41), functional results (RR = 0.96, 95% CI: 0.86, 1.08, P = 0.50) and complications (RR = 0.76, 95% CI: 0.41, 1.39, P = 0.37).

Conclusions

AST is preferred from the aspect of minimising the treatment period, whereas BT is superior to AST for reducing bone grafting. Due to the limited number of trials, the meaning of this conclusion should be taken with caution for infected tibial bone defects.
Communication skills supervisors’ monitoring of history-taking performance: an observational study on how doctors and non-doctors use cues to prepare feedback
Authors: Wagner-Menghin Michaela , de Bruin Anique B. H. , van Merriënboer Jeroen J. G.
Published: February 2020

Background

Medical students need feedback to improve their patient-interviewing skills because self-monitoring is often inaccurate. Effective feedback should reveal any discrepancies between desired and observed performance (cognitive feedback) and indicate metacognitive cues which are diagnostic of performance (metacognitive feedback). We adapted a cue-utilization model to studying supervisors’ cue-usage when preparing feedback and compared doctors’ and non-doctors’ cue usage.

Method

Twenty-one supervisors watched a video of a patient interview, choose scenes for feedback, and explained their selection. We applied content analysis to categorize and count cue-use frequency per communication pattern (structuring/facilitating) and scene performance rating (positive/negative) for both doctors and non-doctors.

Results

Both groups used cognitive cues more often than metacognitive cues to explain their scene selection. Both groups also used metacognitive cues such as subjective feelings and mentalizing cues, but mainly the doctors mentioned ‘missing information’ as a cue. Compared to non-doctors, the doctors described more scenes showing negative performance and fewer scenes showing positive narrative-facilitating performance.

Conclusions

Both groups are well able to communicate their observations and provide cognitive feedback on undergraduates’ interviewing skills. To improve their feedback, supervisors should be trained to also recognize metacognitive cues, such as subjective feelings and mentalizing cues, and learn how to convert both into metacognitive feedback.
Using text mining to analyze reflective essays from Japanese medical students after rural community placement
Authors: Lebowitz Adam , Kotani Kazuhiko , Matsuyama Yasushi , Matsumura Masami
Published: February 2020

Background

Following community clinical placements, medical students use reflective writing to discover the story of their journey to becoming medical professionals. However, because of assessor bias analyzing these writings qualitatively to generalize learner experiences may be problematic. This study uses a process-oriented text mining approach to better understand meanings of learner experiences by connecting key concepts in extended student reflective essays.

Methods

Text mining quantitative analysis is used on self-evaluative essays (n = 47, unique word count range 43–575) by fifth-year students at a regional quota-system university in Japan that specializes in training general practitioners for underserved communities. First, six highly-occurring key words were identified: patient, systemic treatment, locale, hospital, care, and training. Then, standardized keyword frequency analysis robust to overall essay length and keyword volume used individual keywords as “nodes” to calculate per-keyword values for each essay. Finally, Principle Components Analysis and regression were used to analyze key word relationships.

Results

Component loadings were strongest for the keyword area, indicating most shared variance. Multiply regressing three of the remaining keywords hospital, systemic treatment, and training yielded R2 = 0.45, considered high for this exploratory study. In contrast, direct patient experience for students was difficult to generalize.

Conclusions

Impressions of the practicing area environment were strongest in students, and these impressions were influenced by hospital workplace, treatment provision, and training. Text mining can extract information from larger samples of student essays in an efficient and objective manner, as well as identify patterns between learning situations to create models of the learning experience. Possible implications for community-based clinical learning may be greater understanding of student experiences for on-site precepts benefitting their roles as mentors.
Predicting patient outcomes in psychiatric hospitals with routine data: a machine learning approach
Authors: Wolff J. , Gary A. , Jung D. , Normann C. , Kaier K. , Binder H. , Domschke K. , Klimke A. , Franz M.
Published: February 2020

Background

A common problem in machine learning applications is availability of data at the point of decision making. The aim of the present study was to use routine data readily available at admission to predict aspects relevant to the organization of psychiatric hospital care. A further aim was to compare the results of a machine learning approach with those obtained through a traditional method and those obtained through a naive baseline classifier.

Methods

The study included consecutively discharged patients between 1st of January 2017 and 31st of December 2018 from nine psychiatric hospitals in Hesse, Germany. We compared the predictive performance achieved by stochastic gradient boosting (GBM) with multiple logistic regression and a naive baseline classifier. We tested the performance of our final models on unseen patients from another calendar year and from different hospitals.

Results

The study included 45,388 inpatient episodes. The models’ performance, as measured by the area under the Receiver Operating Characteristic curve, varied strongly between the predicted outcomes, with relatively high performance in the prediction of coercive treatment (area under the curve: 0.83) and 1:1 observations (0.80) and relatively poor performance in the prediction of short length of stay (0.69) and non-response to treatment (0.65). The GBM performed slightly better than logistic regression. Both approaches were substantially better than a naive prediction based solely on basic diagnostic grouping.

Conclusion

The present study has shown that administrative routine data can be used to predict aspects relevant to the organisation of psychiatric hospital care. Future research should investigate the predictive performance that is necessary to provide effective assistance in clinical practice for the benefit of both staff and patients.
Patient satisfaction with antiretroviral therapy services and associated factors at Gondar town health centers, Northwest Ethiopia: an institution-based cross-sectional study
Authors: Adissu Getaneh , Biks Gashaw Andarge , Tamirat Koku Sisay
Published: February 2020

Background

The Human Immunodeficiency Virus (HIV) with which over 37 million peoples are living is the leading cause of morbidity and mortality worldwide. The rapid expansion of antiretroviral treatment has dramatically reduced HIV related deaths and transmissions. Patient satisfaction could be an indispensable parameter used to measure patients’ desired fulfillment by the services. Hence, this study aimed to determine the level of patient satisfaction with antiretroviral therapy services and determinants at Gondar town health centers.

Methods

An institution-based cross-sectional study was conducted from November 1 to 30, 2018. The systematic random sampling technique was used to select 663 HIV/AIDS patients on antiretroviral therapy follow-ups. Data were collected using a pretested interviewer-administered questionnaire and patient medical document reviews. Summary statistics such as means, medians and proportions were calculated and presented in the form of tables, graphs, and texts. Bivariate and multivariable logistic regression analysis was fitted and adjusted odds ratio (AOR) with a 95% confidence interval (CI) was computed to assess the strength of association. Variables with p-value 0.05 at multivariable logistic regression considered significant determinants of patient satisfaction.

Results

The overall patient satisfaction with antiretroviral therapy services was 75.4% (95%CI, 71.9 to 79%). Patients’ age 38–47 years (AOR = 5.90, 95%CI: 3.38,10.31) and ≥ 48 years (AOR = 2.66, 95%CI:1.38,5.12), absence of signs and directions to ART clinic (AOR = 0.53,95%CI:0.35,0.82), Azezo health center (AOR = 2.68,95%CI:1.47,4.66) and Teda health center (AOR = 4.44,95%CI:1.73,11.30), and travel that took more than 1 h (AOR = 0.56;95% CI:0.32,0.97) were determinants of patient satisfaction with the services.

Conclusion

The overall patient satisfaction with antiretroviral therapy service was lower than the national target of 85% with the marked difference among health centers. Older age, absence of signs and directions to ART clinics, and longer travel from home to health centers were factors influencing patient satisfaction with antiretroviral treatments. This suggests that further improvement of accessibility is likely needed to increase patient satisfaction.
Experiences and challenges to cross-sectoral care reported by patients with low back pain. A qualitative interview study
Authors: Petersen Lisbeth , Birkelund Regner , Schiøttz-Christensen Berit
Published: February 2020

Background

Cross-sectoral care comprises interdisciplinary and coordinated efforts for patients with complex care needs involving various competencies and professions across the primary health care sector, hospital sector, and municipal services. Cross-sectoral care can increase the effectiveness of rehabilitation programmes, but the treatment courses often lack coherence. Establishing successful treatment pathways requires a better understanding of the health care challenges faced by patients with low back pain. The aim of this study was to explore how patients with low back pain experience cross-sectoral care.

Method

A qualitative interview study including 25 patients with low back pain. Patients were recruited in connection with their appointment at the Spine Centre of Southern Denmark. Recruitment stopped when the interviews no longer added new knowledge to the subject. The data were analysed using a systematic text condensation approach.

Results

Patients with low back pain experienced cross-sectoral care to be fragmented, with episodes lacking collaboration, information, and acknowledgement of their problem. They desired recognition of having a serious back problem and of being more than the diagnosis itself. Patients found it hard to keep track of their course of treatment due to a perceived lack of organisational support and collaboration between professionals. The patients called for more information about the treatment plan and the reasons for further referral in order to better understand and manage their treatment.

Conclusion

Patients’ experiences indicate a need for a stronger person-centred approach in cross-sectoral care, in which the individual’s experiences of living with low back pain are taken into account.
Comparison of brain connectomes by MRI and genomics and its implication in Alzheimer’s disease
Authors:   Alzheimer Disease Neuroimaging Initiative (ADNI), Woo Young Jae , Roussos Panos , Haroutunian Vahram , Katsel Pavel , Gandy Samuel , Schadt Eric E. , Zhu Jun
Published: February 2020

Background

The human brain is complex and interconnected structurally. Brain connectome change is associated with Alzheimer’s disease (AD) and other neurodegenerative diseases. Genetics and genomics studies have identified molecular changes in AD; however, the results are often limited to isolated brain regions and are difficult to interpret its findings in respect to brain connectome. The mechanisms of how one brain region impacts the molecular pathways in other regions have not been systematically studied. And how the brain regions susceptible to AD pathology interact with each other at the transcriptome level and how these interactions relate to brain connectome change are unclear.

Methods

Here, we compared structural brain connectomes defined by probabilistic tracts using diffusion magnetic resonance imaging data in Alzheimer’s Disease Neuroimaging Initiative database and a brain transcriptome dataset covering 17 brain regions.

Results

We observed that the changes in diffusion measures associated with AD diagnosis status and the associations were replicated in an independent cohort. The result suggests that disease associated white matter changes are focal. Analysis of the brain connectome by genomic data, tissue-tissue transcriptional synchronization between 17 brain regions, indicates that the regions connected by AD-associated tracts were likely connected at the transcriptome level with high number of tissue-to-tissue correlated (TTC) gene pairs (P = 0.03). And genes involved in TTC gene pairs between white matter tract connected brain regions were enriched in signaling pathways (P = 6.08 × 10−9). Further pathway interaction analysis identified ionotropic glutamate receptor pathway and Toll receptor signaling pathways to be important for tissue-tissue synchronization at the transcriptome level. Transcript profile entailing Toll receptor signaling in the blood was significantly associated with diffusion properties of white matter tracts, notable association between fractional anisotropy and bilateral cingulum angular bundles (Ppermutation = 1.0 × 10−2 and 4.9 × 10−4 for left and right respectively).

Conclusions

In summary, our study suggests that brain connectomes defined by MRI and transcriptome data overlap with each other.
Overexpression of SAPCD2 correlates with proliferation and invasion of colorectal carcinoma cells
Authors: Luo Yage , Wang Lili , Ran Wenwen , Li Guangqi , Xiao Yujing , Wang Xiaonan , Zhao Han , Xing Xiaoming
Published: February 2020

Background

Suppressor anaphase-promoting complex domain containing 2 (SAPCD2) is a novel gene playing important roles in the initiation, invasion, and metastasis of several malignancies. However, its role in colorectal carcinoma (CRC) still remains unclear.

Method

In this study, we investigated the expression and biological function of SAPCD2 in CRC. Immunohistochemistry (IHC) for SAPCD2 was performed in 410 pairs of CRC specimens and corresponding normal epithelial tissues, and in 50 adenoma tissues. Clinical pathological factors were analyzed in relation to the expression of SAPCD2. The biological functions of SAPCD2 in CRC cells and its effect on cell cycle were investigated in vitro and in vivo through gain/loss-of-function approaches.

Results

IHC showed that SAPCD2 expression was significantly higher in CRC tissues compared to adenoma and normal epithelium tissues and was correlated with tumor location (p = 0.018). SAPCD2 significantly promoted cell proliferation, migration, and invasion both in vitro and in vivo (p < 0.05). In addition, SAPCD2 knockdown in CRC cells was associated with reduced G1/S transition, while overexpression caused G2/M phase arrest (p < 0.05).

Conclusions

In sum, SAPCD2 is overexpressed in CRC tissues and plays a critical role in CRC progression. Therefore, it might represent a promising therapeutic target for CRC treatment.
Improving health equity among the African ethnic minority through health system strengthening: a narrative review of the New Zealand healthcare system
Authors: Kanengoni Blessing , Andajani-Sutjahjo Sari , Holroyd Eleanor
Published: February 2020

Background

In New Zealand, health equity is a pressing concern and reaching disadvantaged populations has become the goal to close the inequity gap. Building and strengthening health systems is one way to secure better outcomes. However, the discourse to date has predominately focussed on inequities in health outcomes for Māori. This study has interest in the African ethnic minority community in New Zealand. It undertakes a narrative review of the New Zealand health system which aims to identify literature around the attainment of health equity of African minority by: (i) providing a critical overview of the healthcare delivery system using World Health Organization’s six inter-related building blocks of health system strengthening; (ii) developing a summary and discussions of the research results and; (iii) identifying priorities and recommendations for future research.

Method

A narrative review of 27 articles published between January 2010 and June 2019 were selected from CINAHL, PubMed, Scopus, Google Scholar. Grey literature also informed the review. Articles excluded studies: (i) non-related to New Zealand; (ii) with no focus on equity on ethnic minority in the delivering of healthcare; (iii) had no full text available.

Findings

Literature on Africans health outcomes were scarce regarding the six building blocks. However, findings show inequities in accessibility of health services, a non-ethnic inclusive health workforce, a leadership and governance which lack political will on migrant health and resultantly an under-performing health information system which influences resource allocation.

Recommendation and conclusion

An improvement and well-functioning health information system is pivotal to capture the unmet needs of the African population. There is a need for research and political will to invest in African minority health and diverse workforce that understands the background of the African population; and action to address structural and institutional racism and white privilege to address root causes of inadequate access and care processes for ethnic minorities.
Telocytes inhibited inflammatory factor expression and enhanced cell migration in LPS-induced skin wound healing models in vitro and in vivo
Authors: Wang Lu , Song Dongli , Wei Chuanyuan , Chen Cheng , Yang Yanwen , Deng Xinyi , Gu Jianying
Published: February 2020

Background

Cell proliferation and death are key components of wound healing and tissue repair. Telocytes (TCs) represent a newly discovered cell type that can protect tissue from acute injury via cell–cell communication with adjacent cells. The aim of this study was to use a mouse model of skin wound healing and lipopolysaccharide (LPS)-induced cell injury to evaluate the effects of TCs on skin wound healing in vivo and in vitro.

Material/methods

Immunohistochemical staining was performed to evaluate the alteration of TCs in tissues from normal and chronic wound patients. Then, a male C57BL/6 mouse wound model of the back was established. The mice were divided randomly into three groups, and wound healing was estimated according to the wound healing rate and histology. An LPS-induced co-culture model of a mouse lung telocyte cell line (TCs) with human keratinocyte (HaCaT), human dermal microvascular endothelial cell (HDMEC) or murine fibroblast (L929) cell lines was established to analyse the effects of TCs on constitutive cell types of the skin. Cell proliferation, migration and apoptosis were examined, and reactive oxygen species (ROS) and inflammatory factors in HaCaT cells, HDMECs, and L929 cells were detected to study the mechanisms involved in TC protection in skin wounds.

Results

TCs were significantly increased in tissues from chronic wound patients compared with healthy controls. Wound healing was significantly improved in wound mouse models treated with exogenous TCs compared with LPS-induced models. TCs reversed the LPS-induced inhibition of HaCaT cells and HDMECs and reduced the LPS-induced apoptosis of HaCaT cells and the death ratios of HDMECs and L929 cells. TCs reversed LPS-induced ROS in HDMECs and L929 cells and decreased inflammatory factor mRNA levels in HaCaT cells, HDMECs and L929 cells.

Conclusions

TCs reduce wound healing delay, and inflammatory responses caused by LPS might be mediated by inflammatory inhibition, thus restricting apoptosis and promoting migration of the main component cell types in the skin.
Metabolic classification of circulating tumor cells as a biomarker for metastasis and prognosis in breast cancer
Authors: Chen Jing , Ye Changsheng , Dong Jianyu , Cao Shunwang , Hu Yanwei , Situ Bo , Xi Xiaoxue , Qin Sihua , Xu Jiasen , Cai Zhen , Zheng Lei , Wang Qian
Published: February 2020

Background

Circulating tumor cells (CTCs) has been demonstrated as a promising liquid biopsy marker for breast cancer (BC). However, the intra-patient heterogeneity of CTCs remains a challenge to clinical application. We aim at profiling aggressive CTCs subpopulation in BC utilizing the distinctive metabolic reprogramming which is a hallmark of metastatic tumor cells.

Methods

Oncomine, TCGA and Kaplan–Meier plotter databases were utilized to analyze expression and survival relevance of the previously screened metastasis-promoting metabolic markers (PGK1/G6PD) in BC patients. CTCs detection and metabolic classification were performed through micro-filtration and multiple RNA in situ hybridization using CD45 and PGK1/G6PD probes. Blood samples were collected from 64 BC patients before treatment for CTCs analysis. Patient characteristics were recorded to evaluate clinical applications of CTCs metabolic subtypes, as well as morphological EMT subtypes classified by epithelial (EpCAM/CKs) and mesenchymal (Vimentin/Twist) markers.

Results

PGK1 and G6PD expressions were up-regulated in invasive BC tissues compared with normal mammary tissues. Increased tissue expressions of PGK1 or G6PD indicated shortened overall and relapse-free survival of BC patients (P < 0.001). Blood GM+CTCs (DAPI+CD45−PGK1/G6PD+) was detectable (range 0–54 cells/5 mL) in 61.8% of tCTCs > 0 patients. Increased GM+CTCs number and positive rate were correlated with tumor metastasis and progression (P < 0.05). The GM+CTCs ≥ 2/5 mL level presented superior AUC of ROC at 0.854 (95% CI 0.741–0.968) in the diagnosis of BC metastasis (sensitivity/specificity: 66.7%/91.3%), compared with that of tCTCs (0.779) and CTCs-EMT subtypes (E-CTCs 0.645, H-CTCs 0.727 and M-CTCs 0.697). Moreover, GM+CTCs+ group had inferior survival with decreased 2 years-PFS proportion (18.5%) than GM+CTCs− group (87.9%; P = 0.001).

Conclusions

This work establishes a PGK1/G6PD-based method for CTCs metabolic classification to identify the aggressive CTCs subpopulation. Metabolically active GM+CTCs subtype is suggested a favorable biomarker of distant metastasis and prognosis in BC patients.
Outcomes following resuscitative thoracotomy for abdominal exsanguination, a systematic review
Authors: Hughes Michael , Perkins Zane
Published: February 2020

Background

Resuscitative thoracotomy is a damage control procedure with an established role in the immediate treatment of patients in extremis or cardiac arrest secondary to cardiac tamponade however Its role in resuscitation of patients with abdominal exsanguination is uncertain.

Objective

The primary objective of this systematic review was to estimate mortality based on survival to discharge in patients with exsanguinating haemorrhage from abdominal trauma in cardiac arrest or a peri arrest clinical condition following a resuscitative thoracotomy.

Methods

A systematic literature search was performed to identify original research that reported outcomes in resuscitative thoracotomy either in the emergency department or pre-hospital environment in patients suffering or suspected of suffering from intra-abdominal injuries. The primary outcome was to assess survival to discharge. The secondary outcomes assessed were neurological function post procedure and the role of timing of intervention on survival.

Results

Seventeen retrospective case series were reviewed by a single author which described 584 patients with isolated abdominal trauma and an additional 1745 suffering from polytrauma including abdominal injuries. Isolated abdominal trauma survival to discharge ranged from 0 to 18% with polytrauma survival of 0–9.7% with the majority below 1%. Survival following a thoracotomy for abdominal trauma varied between studies and with no comparison non-intervention group no definitive conclusions could be drawn.

Timing of thoracotomy was important with improved mortality in patients not in cardiac arrest or having the procedure performed just after a loss of signs of life. Normal neurological function at discharge ranged from 100 to 28.5% with the presence of a head injury having a negative impact on both survival and long-term morbidity.

Conclusions

Pre-theatre thoracotomy may have a role in peri-arrest or arrested patient with abdominal trauma. The best outcomes are achieved with patients not in cardiac arrest or who have recently arrested and with no head injury present. The earlier the intervention can be performed, the better the outcome for patients, with survival figures of up to 18% following a resuscitative thoracotomy. More high-quality evidence is required to demonstrate a definitive mortality benefit for patients.
Machine learning algorithm to predict mortality in patients undergoing continuous renal replacement therapy
Authors: Kang Min Woo , Kim Jayoun , Kim Dong Ki , Oh Kook-Hwan , Joo Kwon Wook , Kim Yon Su , Han Seung Seok
Published: February 2020

Background

Previous scoring models such as the Acute Physiologic Assessment and Chronic Health Evaluation II (APACHE II) and the Sequential Organ Failure Assessment (SOFA) scoring systems do not adequately predict mortality of patients undergoing continuous renal replacement therapy (CRRT) for severe acute kidney injury. Accordingly, the present study applies machine learning algorithms to improve prediction accuracy for this patient subset.

Methods

We randomly divided a total of 1571 adult patients who started CRRT for acute kidney injury into training (70%, n = 1094) and test (30%, n = 477) sets. The primary output consisted of the probability of mortality during admission to the intensive care unit (ICU) or hospital. We compared the area under the receiver operating characteristic curves (AUCs) of several machine learning algorithms with that of the APACHE II, SOFA, and the new abbreviated mortality scoring system for acute kidney injury with CRRT (MOSAIC model) results.

Results

For the ICU mortality, the random forest model showed the highest AUC (0.784 [0.744–0.825]), and the artificial neural network and extreme gradient boost models demonstrated the next best results (0.776 [0.735–0.818]). The AUC of the random forest model was higher than 0.611 (0.583–0.640), 0.677 (0.651–0.703), and 0.722 (0.677–0.767), as achieved by APACHE II, SOFA, and MOSAIC, respectively. The machine learning models also predicted in-hospital mortality better than APACHE II, SOFA, and MOSAIC.

Conclusion

Machine learning algorithms increase the accuracy of mortality prediction for patients undergoing CRRT for acute kidney injury compared with previous scoring models.
Short postsurgical antibiotic therapy for spinal infections: protocol of prospective, randomized, unblinded, noninferiority trials (SASI trials)
Authors: Betz Michael , Uçkay Ilker , Schüpbach Regula , Gröber Tanja , Botter Sander M. , Burkhard Jan , Holy Dominique , Achermann Yvonne , Farshad Mazda
Published: February 2020

Background

There are several open scientific questions regarding the optimal antibiotic treatment of spinal infections (SIs) with or without an implant. The duration of postsurgical antibiotic therapy is debated.

Methods

We will perform two unblinded randomized controlled trials (RCTs). We hypothesize that shorter durations of systemic antibiotic therapy after surgery for SI are noninferior (10% margin, 80% power, α = 5%) to existing (long) treatment durations. The RCTs allocate the participants to two arms of 2 × 59 episodes each: 3 vs. 6 weeks of targeted postsurgical systemic antibiotic therapy for implant-free SIs or 6 vs. 12 weeks for implant-related SIs. This equals a total of 236 adult SI episodes (randomization scheme 1:1) with a minimal follow-up of 12 months. All participants receive concomitant multidisciplinary surgical, re-educational, internist, and infectious disease care. We will perform three interim analyses that are evaluated, in a blinded analysis, by an independent study data monitoring committee. Besides the primary outcome of remission, we will also assess adverse events of antibiotic therapy, changes of the patient’s nutritional status, the influence of immune suppression, total costs, functional scores, and the timely evolution of the (surgical) wounds. We define infection as the presence of local signs of inflammation (pus, wound discharge, calor, and rubor) together with microbiological evidence of the same pathogen(s) in at least two intraoperative samples, and we define remission as the absence of clinical, laboratory, and/or radiological evidence of (former or new) infection.

Discussion

Provided that there is adequate surgical debridement, both RCTs will potentially enable prescription of less antibiotics during the therapy of SI, with potentially less adverse events and reduced overall costs.

Trial registration

ClinicalTrials.gov, NCT04048304. Registered on 5 August 2019.

Protocol version

2, 5 July 2019.
Integrative prediction of gene expression with chromatin accessibility and conformation data
Authors: Schmidt Florian , Kern Fabian , Schulz Marcel H.
Published: February 2020

Background

Enhancers play a fundamental role in orchestrating cell state and development. Although several methods have been developed to identify enhancers, linking them to their target genes is still an open problem. Several theories have been proposed on the functional mechanisms of enhancers, which triggered the development of various methods to infer promoter–enhancer interactions (PEIs). The advancement of high-throughput techniques describing the three-dimensional organization of the chromatin, paved the way to pinpoint long-range PEIs. Here we investigated whether including PEIs in computational models for the prediction of gene expression improves performance and interpretability.

Results

We have extended our $$\textsc{TEPIC}$$TEPIC framework to include DNA contacts deduced from chromatin conformation capture experiments and compared various methods to determine PEIs using predictive modelling of gene expression from chromatin accessibility data and predicted transcription factor (TF) motif data. We designed a novel machine learning approach that allows the prioritization of TFs binding to distal loop and promoter regions with respect to their importance for gene expression regulation. Our analysis revealed a set of core TFs that are part of enhancer–promoter loops involving YY1 in different cell lines.

Conclusion

We present a novel approach that can be used to prioritize TFs involved in distal and promoter-proximal regulatory events by integrating chromatin accessibility, conformation, and gene expression data. We show that the integration of chromatin conformation data can improve gene expression prediction and aids model interpretability.