bluuebunny/crossref_metadata_2025 huggingface dataset:
Chronic maternal hepatitis B virus infection and pregnancy outcome- a single center study in Kunming, China
Authors: Sun Qian , Lao Terence T. , Du Mingyu , Xie Min , Sun Yonghu , Bai Bing , Ma Junnan , Zhu Tianying , Yu Shengnan , Ma Runmei
Published: March 2021

Background

Chinese population has a high prevalence of chronic hepatitis B virus (HBV) infection, the impact of which on pregnancy outcome remains controversial. A single-center retrospective cohort study was performed in Kunming, a multi-ethnic city in south-western China to examine this issue.

Methods

The singleton pregnancies delivering at ≥28 weeks gestation under our care in 2005–2017 constituted the study cohort. Maternal characteristics and pregnancy outcome were compared between mothers with and without seropositivity for hepatitis B surface antigen (HBsAg) determined at routine antenatal screening.

Results

Among the 49,479 gravidae in the cohort, the 1624 (3.3%) HBsAg seropositive gravidae had a lower incidence of nulliparity (RR 0.963, 95% CI 0.935–0.992) and having received tertiary education (RR 0.829, 95% CI 0.784–0.827). There was no significant difference in the medical history, pregnancy complications, or labor or perinatal outcome, except that HBV carriers had significantly lower incidence of labor induction (RR 0.827, 95% CI 0.714–0.958) and of small-for-gestational age (SGA) infants (RR 0.854, 95% CI 0.734–0.994). On regression analysis, maternal HBV carriage was independently associated with spontaneous labor (aRR 1.231, 95% CI 1.044–1.451) and reduced SGA infants (aRR 0.842, 95% CI 0.712–0.997).

Conclusions

Our 3.3% prevalence of maternal HBV infection was around the lower range determined in the Chinese population. The association with spontaneous labor and reduced SGA infants could have helped to promote the perpetuation of the infection through enhanced survival of the offspring infected at birth, thus explaining the high prevalence in the Chinese population.
Low-dose amikacin in the treatment of Multidrug-resistant Tuberculosis (MDR-TB)
Authors: Sabur Natasha F. , Brar Mantaj S. , Wu Lisa , Brode Sarah K.
Published: March 2021

Background

The World Health Organization recommends intravenous amikacin for the treatment of MDR-TB at a dose of 15 mg/kg. However, higher doses are associated with significant toxicity.

Methods

Patients with MDR-TB treated at our institution receive amikacin at 8–10 mg/kg, with dose adjustment based on therapeutic drug monitoring. We conducted a retrospective cohort study of patients with MDR-TB who received amikacin between 2010 and 2016.

Results

Forty-nine patients were included in the study. The median starting dose of amikacin was 8.9 mg/kg (IQR 8, 10), and target therapeutic drug levels were achieved at a median of 12 days (IQR 5, 26). The median duration of amikacin treatment was 7.2 months (IQR 5.7, 8), and median time to sputum culture conversion was 1 month (IQR 1,2). Six patients (12.2%) experienced hearing loss based on formal audiometry testing (95% CI 4.6–24.8%); 22.2% had subjective hearing loss (95% CI 11.2–37.1%) and 31.9% subjective tinnitus (95% CI 19.1–47.1%). Ten patients (23%) had a significant rise in serum creatinine (95% CI 11.8–38.6%), but only 5 patients had a GFR < 60 at treatment completion. 84% of patients had a successful treatment outcome (95% CI 84–99%).

Conclusions

Low dose amikacin is associated with relatively low rates of aminoglycoside-related adverse events. We hypothesize that low-dose amikacin can be used as a safe and effective treatment for MDR-TB in situations where an adequate regimen cannot be constructed with Group A and B drugs, and where careful monitoring for adverse events is feasible.
Eculizumab therapy on a patient with co‐existent lupus nephritis and C3 mutation‐related atypical haemolytic uremic syndrome: a case report
Authors: Kim Mi Jung , Lee Haekyung , Kim Yon Hee , Jin So Young , Kim Hee-Jin , Oh Doyeun , Jeon Jin Seok
Published: March 2021

Background

Thrombotic microangiopathy (TMA), a rare but serious complication of systemic lupus erythematosus (SLE), is associated with poor outcomes to conventional immunosuppressive therapy. Recently, eculizumab, a humanised monoclonal antibody that blocks the complement factor 5, has been known to effectively treat atypical haemolytic uremic syndrome (aHUS). Here, we report a case of aHUS co-existing with lupus nephritis that was successfully treated with eculizumab.

Case presentation

A 23-year-old man presented with abdominal pain and diarrhoea. Initial laboratory tests have shown thrombocytopaenia, microangiopathic haemolytic anaemia, and acute kidney injury. Immunologic tests were consistent with SLE. Kidney biopsy have revealed lupus nephritis class IV-G with TMA. Genetic analysis have shown complement C3 gene mutations, which hints the co-existence of lupus nephritis with aHUS, a form of complement-mediated TMA. Although initial treatment with haemodialysis, plasma exchange, and conventional immunosuppressive therapy (steroid and cyclophosphamide) did not appreciably improve kidney function and thrombocytopaenia, the patient was able to respond to eculizumab therapy.

Conclusions

Due to the similar features of TMA and SLE, clinical suspicion of aHUS in patients with lupus nephritis is important for early diagnosis and prompt management. Timely administration of eculizumab should be considered as a treatment option for aHUS in lupus nephritis patients to yield optimal therapeutic outcomes.
Clinical validity of the 12-item WHODAS-2.0 in a naturalistic sample of outpatients with psychotic disorders
Authors: Holmberg Christopher , Gremyr Andreas , Torgerson Jarl , Mehlig Kirsten
Published: March 2021

Background

The World Health Organization Disability Assessment Schedule 2.0 (WHODAS-2.0) is a self-administered instrument to assess functional impairment. It is used in the general population as well as different patient groups. However, its application to patients with psychotic disorders may be hampered by disease-specific difficulties of self-estimation. This study aimed to examine the psychometric properties of the short (12-item) WHODAS-2.0 in a naturalistic sample of outpatients attending a psychosis clinic in Gothenburg, Sweden.

Methods

Annual data from two outpatient clinics registered 2016–2019 were analyzed retrospectively. The assessment of the short WHODAS-2.0 was based on the first questionnaire completed by 881 patients. Confirmatory factor analysis evaluated previously validated models. Item convergent and discriminant validity as well as internal reliability were computed. Construct validity was assessed by comparing mean differences in accord with previous research regarding patients’ characteristics associated with functioning such as advanced age, diagnosed comorbidities, antipsychotic treatment status, and symptom severity measured with PANSS-8 remission items.

Results

A heterogeneous sample was obtained in terms of age (range: 20–92), various living situations, and different geographic areas of birth. Most patients (75%) had been diagnosed with psychotic disorders more than 10 years ago and the majority (89%) were on antipsychotic medication. We confirmed an adjusted two-level factor model with a single second-order disability factor and six first-order factors representing the six IFC dimensions. The WHODAS-2.0 sum score measuring general disability showed good reliability (Cronbach's alpha = 0.89). Construct validity was confirmed as older patients, patients with comorbidities, and patients in assisted living had higher WHODAS-2.0 scores. Patients with no or mild psychotic symptoms had significantly lower WHODAS-2.0 sum scores than patients with more severe symptoms.

Conclusions

The findings further validate the 12-item WHODAS-2.0 in a naturalistic sample of outpatients with psychotic disorders. This study corroborates the clinical significance of the short, 12-item WHODAS-2.0 by demonstrating consistent associations between patients’ age, medical comorbidities, living situation, antipsychotic treatment status, and psychotic symptom severity.
Prolonged apnea after ECT in organophosphorus poisoning – the need to redefine norms
Authors: Sasidharan Shibu , Dhillon Harpreet Singh
Published: March 2021

Background

Poisoning and deaths by organo-phosphorous (OP) compounds are one of the major causes of death in developing and poor countries, and a common admission in the emergency ward and the ICU. OP compounds act by irreversibly binding to pseudocholinesterase enzyme and hence prolong the apnea in patients being given suxamethonium. We present a unusual case of OP poisoning (OPP) in which prolonged apnea ensued in a patient of severe depression following MECT (modified electroconvulsive therapy) in which suxamethonium was used as muscle relaxant, in whom we were cautious of the side-effect of prior organophosphorus poisoning. Since the cases of OPP are very high worldwide, a thorough knowledge of the interaction of the action of the drug and the receptors on which it acts takes pride of place. This article highlights the nuances in the field of psychiatry and anaesthesia in diagnosis and management of prolonged apnea after ECT.

Case presentation

A 53/F patient consumed OP 38 days prior to MECT. Since existing literature recommend a delay of 4 weeks and a subminimal dose of suxamethonium to prevent prolonged apnea, both these points were taken into consideration. Despite 38 days post exposure to OP, and a dose of succinylcholine of < 0.3 mg/kg, the patient remained apneic for 3 h. Suxamethionum apnea was managed with elective ventilation. After recovery, patient had no residual effect. Subsequently her pseudocholinesterase levels were done which were found to be very low.

Conclusion

This case is being presented to emphasize that behaviour of post synaptic receptors cannot be relied upon after OP poisoning and pseudocholinesterase levels needs to be mandatorily checked, irrespective of duration post-exposure. In strong suspects dibucaine number and fluoride number also needs to be estimated.
Prevalence and factors associated with overweight and obesity in selected health areas in a rural health district in Cameroon: a cross-sectional analysis
Authors: Simo Larissa Pone , Agbor Valirie Ndip , Temgoua Francine Zeuga , Fozeu Leo Cedric Fosso , Bonghaseh Divine Tim , Mbonda Aimé Gilbert Noula , Yurika Raymond , Dotse-Gborgbortsi Winfred , Mbanya Dora
Published: March 2021

Background

Overweight and obesity are major public health problems worldwide, with projections suggesting a proportional increase in the number of affected individuals in developing countries by the year 2030. Evidence-based preventive strategies are needed to reduce the burden of overweight and obesity in developing countries. We assessed the prevalence of, and factors associated with overweight and obesity in selected health areas in West Cameroon.

Methods

Data were collected from a community-based cross-sectional study, involving the consecutive recruitment of participants aged 18 years or older. Overweight and obesity were defined according to the WHO classification. The statistical software R (version 3.5.1, The R Foundation for statistical computing, Vienna, Austria) was used for statistical analysis. Multivariable logistic regression analysis was used to assess independent factors associated with overweight and obesity, and obesity.

Results

Records of 485 participants were included for analysis. The age and sex-standardized prevalence of overweight, obesity, and overweight and obesity were 31.1% (95% CI, 27.0–35.2), 18.9% (95% CI, 14.9–22.9), and 50.1% (95% CI, 45.7–54.6), respectively. In multivariable analysis, being female (adjusted OR [aOR] = 2.79, 95% CI = 1.69–4.63), married (aOR = 3.90, 95% CI = 2.23–6.95), and having secondary or tertiary education (aOR = 3.27, 95% CI = 1.77–6.17) were associated with higher odds of overweight and obesity, while current smokers had lower odds of overweight and obesity (aOR = 0.37, 95% CI = 0.16–0.82) when compared to their respective counterpart. Compared to their respective reference categories, being female being (aOR = 3.74, 95% CI = 2.01–7.30), married (aOR = 2.58, 95% CI = 1.37–5.05) and having secondary or tertiary education (aOR = 2.03, 95% CI = 1.00–4.23) were associated with higher odds of obesity after adjustments for confounding.

Conclusion

We observed a high prevalence of overweight and obesity in this study. The odds of overweight and obesity was higher in females, married participants, and those with higher levels of education. Community-based interventions to control overweight and obesity should consider targeting these groups.
Role of temporal discounting in a conditional cash transfer (CCT) intervention to improve engagement in the prevention of mother-to-child transmission (PMTCT) cascade
Authors: Saleska Jessica Londeree , Turner Abigail Norris , Gallo Maria F. , Shoben Abigail , Kawende Bienvenu , Ravelomanana Noro Lantoniaina Rosa , Thirumurthy Harsha , Yotebieng Marcel
Published: March 2021

Background

Temporal discounting, the tendency of individuals to discount future costs and benefits relative to the present, is often associated with greater engagement in risky behaviors. Incentives such as conditional cash transfers (CCTs) have the potential to counter the effects of high discount rates on health behaviors.

Methods

With data from a randomized trial of a CCT intervention among 434 HIV-positive pregnant women in the Democratic Republic of Congo, we used binomial models to assess interactions between discount rates (measured using a delay-discounting task) and the intervention. The analysis focused on two outcomes: 1) retention in HIV care, and 2) uptake of prevention of mother-to-child transmission (PMTCT) services.

Results

The effect of high discount rates on retention was small, and we did not observe evidence of interaction between high discount rates and CCT on retention. However, our findings suggest that CCT may mitigate the negative effect of high discount rates on uptake of PMTCT services (interaction contrast (IC): 0.18, 95% CI: − 0.09, 0.44).

Conclusions

Our findings provide evidence to support the continued use of small, frequent incentives, to motivate improved uptake of PMTCT services, especially among women exhibiting high rates of temporal discounting.

Trial registration

Clinicaltrials.govnumberNCT01838005, April 23, 2013.
Feasibility and long-term safety of Ho:YAG laser lithotripsy in broncholithiasis patients
Authors: Cheng Yuan , Wang Guangfa , Zhang Wei , Zhang Hong , Wang Xi
Published: March 2021

Background

Treatment of broncholithiasis is complex, especially in the case of a large or transbronchial broncholith. Holmium-yttrium aluminum garnet (Ho:YAG) laser lithotripsy may be a useful treatment in broncholithiasis; however, as it is not yet common practice, the optimal parameters are unknown.

Methods

We performed a single-center retrospective analysis of the clinical data of 13 broncholithiasis patients who underwent Ho:YAG laser lithotripsy from May 2012 to October 2018.

Results

For the 13 patients (2 males and 11 females), Ho:YAG laser lithotripsy was performed 17 times, in total. All procedures were performed under general anesthesia with rigid bronchoscopy. We initially set the Ho:YAG laser to a pulse frequency of 5 Hz and a pulse energy of 0.8 J, gradually increasing these as required. The pulse frequency range we employed was 5–15 Hz, and the pulse energy range was 0.8–1.6 J. All broncholiths were successfully extracted after lithotripsy, and all symptoms improved. Hemoptysis, bronchial esophageal fistula, and pneumonia were the most common complications; however, there were no long-term complications.

Conclusions

Ho:YAG laser lithotripsy is an effective and safe treatment for broncholithiasis, over a long-term follow up.
Association of circulating B-type natriuretic peptide with osteoporosis in a Chinese type 2 diabetic population
Authors: Chen Pan , Yan Pijun , Wan Qin , Zhang Zhihong , Xu Yong , Miao Ying , Yang Jun
Published: March 2021

Background

Altered circulating levels and genetic variation of B-type natriuretic peptide (BNP), has been associated with lower bone mineral density (BMD) values and incidence of osteoporosis in peritoneal dialysis patients, renal transplant recipients, and postmenopausal women. The potential relationship of circulating BNP with osteoporosis in patients with type 2 diabetes mellitus (T2DM), however, has not yet been studied.

Methods

Circulating BNP levels were measured in 314 patients with T2DM, and participants were divided into normal BMD group (n = 73), osteopenia group (n = 120), and osteoporosis group (n = 121). The association of circulating BNP with diabetic osteoporosis and other parameters was analyzed.

Results

Circulating BNP was significantly higher in diabetic osteoporosis subjects than normal and osteopenia groups (P < 0.01 or P < 0.05). Circulating BNP levels correlated significantly and positively with neutrophil to lymphocyte ratio, systolic blood pressure, urinary albumin-to-creatinine ratio, and prevalence of hypertension, peripheral arterial disease, diabetic retinopathy, peripheral neuropathy, and nephropathy, and negatively with triglyceride, fasting blood glucose, lymphocyte count, hemoglobin, estimated glomerular filtration rate, bilirubin, osteoporosis self-assessment tool for Asians, BMD at different skeletal sites and corresponding T scores (P < 0.01 or P < 0.05). After multivariate adjustment, circulating BNP remained independently significantly associated with the presence of osteoporosis (odds ratio, 2.710; 95% confidence interval, 1.690–4.344; P < 0.01). BMD at the femoral neck and total hip and corresponding T scores were progressively decreased, whereas the prevalence of osteoporosis was progressively increased with increasing BNP quartiles (P for trend< 0.01). Moreover, receiver-operating characteristic analysis revealed that the optimal cutoff point of circulating BNP to indicate diabetic osteoporosis was 16.35 pg/ml.

Conclusions

Circulating BNP level may be associated with the development of osteoporosis, and may be a potential biomarker for diabetic osteoporosis.
A giant posterior mediastinal malignant peripheral nerve sheath tumor and benign neurofibroma in body surface: a case report
Authors: Zhang Yan , Cai Hongfei , Lv Guangchao , Li Yang
Published: March 2021

Background

Neurofibromatosis comprises neurofibromatosis type 1 (NF1) and type 2 (NF2). Major tumor type of NF1 are neurofibroma recognized as benign peripheral nerve tumor, malignant peripheral nerve sheath tumor (MPNST), and glioma.

Case presentation

We report a woman with a special condition, whose tumors in body surfaces were benign neurofibroma and tumors in posterior mediastinum are MPNST. The chest-enhanced CT suggested a round soft tissue density in posteriormediastium. The diagnosis was established by pathology and immunohistochemistry. A single-stage thoracoscopic mediastinal mass resection was performed. The whole operation went smoothly and the CT scan of lungs did not show relapse of tumor three months later.

Conclusions

The appearance of neurofibroma should draw particular attention to the possibility of developing MPNST. More careful imaging examinations should be carried out, and pathological examination could diagnose it.
Bilateral electrical pudendal nerve stimulation as additional therapy for lower urinary tract dysfunction when stage II sacral neuromodulator fails: a case report
Authors: Chen Shan , Wang Siyou , Gao Yunqiu , Lu Xiaolian , Yan Jiasheng , Xuan Lihua , Wang Shenhong
Published: March 2021

Background

Sacral neuromodulation (SNM) has become an effective therapy for patients with lower urinary tract dysfunction (LUTD) who do not respond to conservative treatment. However, an effective treatment strategy for patients who fail SNM has not yet been identified. An option for LUTD is needed when the clinical response to the SNM diminishes.

Case presentation

A 51-year-old Chinese man presented to an outpatient clinic complaining of difficulty in urination for > 3 years. The patient also complained of urinary frequency and urgency, accompanied by perineal discomfort. He was diagnosed with LUTD based on his symptoms and previous examinations. The patient underwent sacral neuromodulation with a permanent implantable pulse generator (IPG) (provided free of charge by Chengnuo Medical Technology Co., Ltd.; General Stim, Hangzhou, China) in the left buttock, as he participated in the company’s clinical trial to test the long-term effects of IPG. He reported loss of efficacy of the device 3 months after the implantation. We performed bilateral electrical pudendal nerve stimulation (EPNS) therapy for him. After 2 weeks of treatment, he began to report smooth voiding within 2 h after EPNS, and a moderate improvement in urinary frequency, urgency, and perineal discomfort. After 4 weeks of EPNS, the patient reported > 50% improvement in his urination, evaluated with the short form of the International Consultation on Incontinence Questionnaire for Male Lower Urinary Tract Symptoms. He reported smooth voiding, moderate improvements in urinary frequency and urgency, and the disappearance of the perineal discomfort. He also reported improved sleep and erections. The patient was discharged after 8 weeks of EPNS treatment.

Conclusion

EPNS could be an option as an additional therapy for patients with LUTD who have failed SNM.
Documented diabetes care among older people receiving home care services: a cross‐sectional study
Authors: Heimro Lovise S. , Hermann Monica , Davies Therese Thuen , Haugstvedt Anne , Haltbakk Johannes , Graue Marit
Published: March 2021

Background

Home care services plays an important role in diabetes management, and to enable older adults remain home-dwellers. Adequate follow-up and systematic nursing documentation are necessary elements in high quality diabetes care. Therefore, the purpose of this study was to examine the diabetes treatment and management for older persons with diabetes receiving home care services.

Methods

A cross-sectional study was used to assess the diabetes treatment and management in a Norwegian municipality. Demographic (age, sex, living situation) and clinical data (diabetes diagnose, type of glucose lowering treatment, diabetes-related comorbidities, functional status) were collected from electronic home care records. Also, information on diabetes management; i.e. follow-up routines on glycated haemoglobin (HbA1c), self-monitoring of blood glucose, insulin administration and risk factors (blood pressure, body mass index and nutritional status) were registered. HbA1cwas measured upon inclusion. Descriptive and inferential statistics were applied in the data analysis.

Results

A total of 92 home care records from older home-dwelling persons with diabetes, aged 66–99 years were assessed. Only 52 (57 %) of the individuals had the diabetes diagnosis documented in the home care record. A routine for self-monitoring of blood glucose was documented for 27 (29 %) of the individuals. Only 2 (2 %) had individual target for HbA1cdocumented and only 3 (3 %) had a documented routine for measuring HbA1cas recommended in international guidelines. Among 30 insulin treated older individuals, a description of the insulin regimen lacked in 4 (13 %) of the home care records. Also, documentation on who performed self-monitoring of blood glucose was unclear or lacking for 5 (17 %) individuals.

Conclusions

The study demonstrates lack of documentation in home care records with respect to diagnosis, treatment goals and routines for monitoring of blood glucose, as well as insufficient documentation on responsibilities of diabetes management among older home-dwelling adults living with diabetes. This indicates that home care services may be suboptimal and a potential threat to patient safety.
Three case reports of patients indicating the diversity of molecular and clinical features of 16p11.2 microdeletion anomaly
Authors: Szelest Monika , Stefaniak Martyna , Ręka Gabriela , Jaszczuk Ilona , Lejman Monika
Published: March 2021

Background

16p11.2 microdeletion is a known chromosomal anomaly associated mainly with neurocognitive developmental delay, predisposition to obesity, and variable dysmorphism. Although this deletion is relatively rare among the general population, it is one of the serious known genetic aetiologies of obesity and autism spectrum disorder.

Case presentation

This study presents three cases of deletions within the 16p11.2 region. Every child had mild variable craniofacial abnormalities, hand or foot anomalies and developmental and language delays. The first proband had obesity, epilepsy, moderate intellectual disability, aphasia, motor delay, hyperinsulinism, and café au lait spots. The second proband suffered from cardiac, pulmonary, and haematological problems. The third proband had motor and language delays, bronchial asthma, and umbilical hernia. Although each patient presented some features of the syndrome, the children differed in terms of their clinical pictures. Genetic diagnosis of 16p11.2 microdeletion syndrome was made in children at different ages based on multiplex ligation probe-dependent amplification analysis and/or microarray methods.

Conclusions

Our reports allow us to analyse and better understand the biology of 16p11.2 microdeletion throughout development. However, the variability of presented cases supports the alternate conclusion to this presented in available literature regarding 16p11.2 deletion, as we observed no direct cause-and-effect genotype/phenotype relationships. The reported cases indicate the key role of the interdisciplinary approach in 16p11.2 deletion diagnostics. The care of patients with this anomaly is based on regular health assessment and adjustment of nervous system development therapy.
The diagnostic value of EBV-DNA and EBV-related antibodies detection for nasopharyngeal carcinoma: a meta-analysis
Authors: Liu Weixing , Chen Gui , Gong Xin , Wang Yingqi , Zheng Yaoming , Liao Xiao , Liao Wenjing , Song Lijuan , Xu Jun , Zhang Xiaowen
Published: March 2021

Background

Numerous individual studies have investigated the diagnostic value of EBV-DNA, EA-IgA, VCA-IgA, EBNA1-IgA and Rta-IgG detection for nasopharyngeal carcinoma (NPC), but the conclusions remain controversial. This meta-analysis aimed to determine the value of EBV-DNA, EA-IgA, VCA-IgA, EBNA1-IgA and Rta-IgG detection in the diagnosis of NPC.

Methods

PROSPERO registration number: CRD42019145532. PubMed, EMBASE, Cochrane Library, and Chinese data libraries (Wanfang, CNKI, and CBM) were searched up to January 2019. The pooled sensitivity, specificity, and positive likelihood, negative likelihood, and diagnostic odds ratios were conducted in this meta-analysis. Summary receiver operating characteristic curves evaluated the test-performance global summary. Publication bias was examined by Deek’s funnel plot asymmetry test.

Results

Forty-seven studies with 8382 NPC patients (NPC group) and 15,089 individuals without NPC (Control group) were included in this meta-analysis. The sensitivity, specificity, positive likelihood (+ LR), negative likelihood (-LR), DOR and AUC of EBV-DNA in diagnosis of NPC were: 0.76 (95% CI 0.73–0.77), 0.96 (95% CI 0.95–0.97), 14.66 (95% CI 9.97–21.55), 0.19 (95% CI 0.13–0.28), 84 (95% CI 50.45–139.88), 0.96 (SE: 0.001), and 0.55 (95% CI 0.54–0.57), 0.96 (95% CI 0.96–0.97), 12.91 (95% CI 9.55–17.45), 0.35 (95% CI 0.29–0.43), 39.57 (95% CI 26.44–59.23), 0.94 (SE: 0.002) for the EA-IgA, and 0.85 (95% CI 0.84–0.85), 0.89 (95% CI 0.88–0.89), 6.73 (95% CI5.38–8.43), 0.17 (95% CI 0.12–0.23), 43.03 (95% CI 31.51–58.76), 0.93 (SE: 0.007) for the VCA-IgA, and 0.86 (95% CI 0.85–0.88), 0.87 (95% CI 0.88–0.90), 7.55 (95% CI 5.79–9.87), 0.16 (95% CI 0.13–0.19), 50.95 (95% CI 34.35–75.57), 0.94 (SE: 0.008) for the EBNA1-IgA, and 0.70 (95% CI 0.69–0.71), 0.94 (95% CI 0.94–0.95), 9.84 (95% CI 8.40–11.54), 0.25 (95% CI 0.21–0.31), 40.59 (95% CI 32.09–51.35), 0.95 (SE: 0.005) for the Rta-IgG. The EBV-DNA had larger AUC compared with other EBV-based antibodies (P < 0.05), while the difference between EA-IgA, VCA-IgA, EBNA1-IgA and Rta-IgG was not statistically significant (P > 0.05).

Conclusions

EBV-DNA, VCA-IgA, EBNA1-IgA and Rta-IgG detection have high accuracy in early diagnosis NPC. In addition, EBV-DNA detection has the higher diagnosis accuracy in NPC. On the other hand, EA-IgA is suitable for the diagnosis but not NPC screening.
A longitudinal analysis of violence and healthcare service utilization in Mexico
Authors: Vargas Laura X. , Richmond Therese S. , Allen Heidi L. , Meisel Zachary F.
Published: March 2021

Objectives

We analyze the degree to which community violence in Mexico, largely due to organized crime violence, affects health care service utilization.

Methods

This study exploits temporal and geographic variation in monthly county-level homicide rates, matching outpatient service utilization from individual longitudinal measures. Sensitivity analyses test for an age specific concentration of violence, respiratory conditions that are likely unrelated to violence, insurance status and health center availability per capita. We test for distributional responses to violence by urban and rural localities.

Results

The likelihood of service utilization increases by 5.2% with each additional homicide per 100,000. When we include self-reported health conditions in the model, our main coefficient remains significant at 4.5%. We find no added effect to our results from interaction terms for age specific concentration of violence, respiratory conditions, insurance status, or health center availability. A substantial increase of 11.7% in the likelihood of service utilization occurs in localities with > = 100,000 inhabitants, suggesting that service utilization is sensitive to the location of violence.

Conclusions

Results highlight the relationship between and increase in violence at the local level and an increase in health care service utilization. This study is among the first to examine this relationship empirically in Mexico. Future research is needed to shed more light on this relationship and its mechanisms.
Psychometric properties of the Chinese version of the Trunk Impairment Scale in people with a stroke
Authors: Zhao Jie , Chau Janita Pak Chun , Zang Yuli , Choi Kai Chow , He Rong , Zhao Yali , Xiang Xiaoqi , Li Qin , Thompson David R.
Published: March 2021

Background

The Trunk Impairment Scale (TIS) has been translated into Chinese, but the psychometric properties of the Chinese version of the TIS (TIS-C) have not yet been established. We aimed to examine the reliability and validity of the TIS-C for assessing sitting balance among Chinese people with a stroke.

Methods

A descriptive, cross-sectional design was used. We recruited a convenience sample of 170 subacute stroke patients aged 18 years or over from the neurology departments of four traditional Chinese medicine hospitals in China. Patients completed the TIS-C, the Berg Balance Scale and the Modified Barthel Index. The psychometric properties of the TIS-C were examined to establish test–retest reliability, internal consistency, equivalence, and content, criterion, and construct validity.

Results

Intraclass correlation coefficients for inter-rater and intra-rater reliability ranged from 0.75 to 0.89 and from 0.90 to 0.97, respectively. The TIS-C Cronbach α was 0.86. The strong correlation between the total score of the TIS-C and the Berg Balance Scale (rs= 0.81,p < 0.001) or Modified Barthel Index (rs= 0.84,p < 0.001) suggested good concurrent and convergent validity, respectively. Known-group validity was supported by the significant difference (p < 0.001) in TIS-C scores between participants with mild and moderate stroke.

Conclusions

The TIS-C is a valid and reliable tool for assessing static and dynamic sitting balance as well as coordination of trunk movement among stroke survivors with mild and moderate stroke.
Rapid prioritisation of topics for rapid evaluation: the case of innovations in adult social care and social work
Authors: Cowan Katherine , Fulop Naomi J. , Harshfield Amelia , Ng Pei Li , Ntouva Antiopi , Sidhu Manbinder , Sussex Jon , Tomini Sonila M. , Walton Holly
Published: March 2021

Background

Prioritisation processes are widely used in healthcare research and increasingly in social care research. Previous research has recommended using consensus development methods for inclusive research agenda setting. This research has highlighted the need for transparent and systematic methods for priority setting. Yet there has been little research on how to conduct prioritisation processes using rapid methods. This is a particular concern when prioritisation needs to happen rapidly. This paper aims to describe and discuss a process of rapidly identifying and prioritising a shortlist of innovations for rapid evaluation applied in the field of adult social care and social work.

Method

We adapted the James Lind Alliance approach to priority setting for rapid use. We followed four stages: (1) Identified a long list of innovations, (2) Developed shortlisting criteria, (3) Grouped and sifted innovations, and (4) Prioritised innovations in a multi-stakeholder workshop (n = 23). Project initiation through to completion of the final report took four months.

Results

Twenty innovations were included in the final shortlist (out of 158 suggested innovations). The top five innovations for evaluation were identified and findings highlighted key themes which influenced prioritisation. The top five priorities (listed here in alphabetical order) were: Care coordination for dementia in the community, family group conferencing, Greenwich prisons social care, local area coordination and MySense.Ai. Feedback from workshop participants (n = 15) highlighted tensions from using a rapid process (e.g. challenges of reaching consensus in one workshop).

Conclusion

The method outlined in this manuscript can be used to rapidly prioritise innovations for evaluation in a feasible and robust way. We outline some implications and compromises of rapid prioritisation processes for future users of this approach to consider.
Signaling pathways in intestinal homeostasis and colorectal cancer: KRAS at centre stage
Authors: Ternet Camille , Kiel Christina
Published: March 2021

The intestinal epithelium acts as a physical barrier that separates the intestinal microbiota from the host and is critical for preserving intestinal homeostasis. The barrier is formed by tightly linked intestinal epithelial cells (IECs) (i.e. enterocytes, goblet cells, neuroendocrine cells, tuft cells, Paneth cells, and M cells), which constantly self-renew and shed. IECs also communicate with microbiota, coordinate innate and adaptive effector cell functions. In this review, we summarize the signaling pathways contributing to intestinal cell fates and homeostasis functions. We focus especially on intestinal stem cell proliferation, cell junction formation, remodelling, hypoxia, the impact of intestinal microbiota, the immune system, inflammation, and metabolism. Recognizing the critical role of KRAS mutants in colorectal cancer, we highlight the connections of KRAS signaling pathways in coordinating these functions. Furthermore, we review the impact of KRAS colorectal cancer mutants on pathway rewiring associated with disruption and dysfunction of the normal intestinal homeostasis. Given that KRAS is still considered undruggable and the development of treatments that directly target KRAS are unlikely, we discuss the suitability of targeting pathways downstream of KRAS as well as alterations of cell extrinsic/microenvironmental factors as possible targets for modulating signaling pathways in colorectal cancer.
Longitudinal association between an overall diet quality index and latent profiles of cardiovascular risk factors: results from a population based 13-year follow up cohort study
Authors: Nouri Fatemeh , Sadeghi Masoumeh , Mohammadifard Noushin , Roohafza Hamidreza , Feizi Awat , Sarrafzadegan Nizal
Published: March 2021

Background

Cardiovascular diseases (CVDs) are associated with an unhealthy lifestyle, including poor diet. Indices reflecting the overall quality of diets are more effective than single food or nutrient-based approaches in clarifying the diet disease relationship. The present study aims to use latent variable modeling to examine the longitudinal joint relationships between the latent profiles of CVDs risk factors and the diet quality index (DQI).

Methods

A total of 4390 Iranian adults aged 35 and older within the framework of the Isfahan Cohort Study were included in the current secondary analysis. DQI focused on food groups, including fast foods, sweets, vegetables, fruits, fats, and proteins, based on a validated food frequency questionnaire. The score of DQI has a range between 0 (indicating healthy and high diet quality) and 2 (indicating unhealthy and low diet quality). Blood pressure (BP), anthropometric measurements, blood glucose, serum lipids, and high-sensitivity C-Reactive Protein (hs-CRP) were measured according to standard protocols in 2001, 2007, and 2013 to evaluate the profiles of CVDs risk factors. A Bayesian Multidimensional Graded Responses Linear Mixed Model was used for data analysis.

Results

At baseline, the participants’ mean ± standard deviation age was 50.09 ± 11.21, and 49.5% of them were male. Three latent profiles of CVDs risk factors were derived: (1) Fit Pre-Metabolic Syndrome (FPMS) profile characterized by normal anthropometric indices and some impaired metabolic risk factors; (2) DysLipoproteinemia Central Obese (DLCO) profile with abdominal obesity and impaired low-density lipoprotein cholesterol as well as other normal risk factors; (3) Impaired Laboratory Inflammatory State (ILIS) profile with impaired high-density lipoprotein cholesterol and hs-CRP and other normal risk factors. In general, higher scores of the extracted latent profiles indicated more impaired function in the related risk factors. After controlling for various potential fixed and time-varying confounding variables, a significant positive longitudinal association was found between FPMS, DLCO, and ILIS profiles and DQI (β (95% CrI): 0.26 (0.03,0.51), 0.14 (0.01,0.27), and 0.24 (0.11,0.38), respectively), demonstrating that lower overall diet quality was associated with more impaired function of the related risk factors.

Conclusions

More adherence to a healthy quality diet is associated with lower levels of all emerging latent profiles of CVDs risk factors. Increasing the knowledge of the community about the importance of the quality of consumed foods may help to prevent CVDs. It is recommended that further investigations, particularly interventional studies, be conducted to confirm our results.
Validation and demonstration of a pericarp disc system for studying blossom-end rot of tomatoes
Authors: Reitz Nicholas F. , Mitcham Elizabeth J.
Published: March 2021

Background

Blossom-end rot in tomatoes is often used as a model system to study fruit calcium deficiency. The study of blossom-end rot development in tomatoes has been greatly impeded by the difficulty of directly studying and applying treatments to the affected cells. This manuscript presents a novel method for studying blossom-end rot development after harvest in immature whole fruit and in pericarp discs.

Results

Pericarp discs removed from the bottom pericarp of immature healthy fruit developed blossom-end rot like symptoms, corresponding to a decrease in L* value and an increase in a* value. Symptoms also developed in columella tissue, but not in stem-end pericarp tissue, similar to patterns observed during blossom-end rot development on the plant. Ascorbate oxidase and peroxidase activity, which are elevated in blossom-end rot affected fruit compared to healthy fruit, were both correlated with colorimetric measures of tissue darkening in discs. Respiration rate was higher in discs that later developed blossom-end rot symptoms, with increased respiration in asymptomatic discs on day 1 of storage being associated with symptom development on day 2. Calcium chloride and ascorbic acid treatments inhibited symptom development, demonstrating the potential of this method to provide causal evidence.

Conclusions

Results indicate that symptom development in this system is consistent with blossom-end rot development with regards to location, color change, and the activity of key enzymes. This system has the potential to be used to elucidate the cause of fruit calcium deficiency and improve knowledge of the biological basis for calcium’s diverse effects on fruit.
Growth in ataxia telangiectasia
Authors: Natale Valerie A. I. , Cole Tim J. , Rothblum-Oviatt Cynthia , Wright Jennifer , Crawford Thomas O. , Lefton-Greif Maureen A. , McGrath-Morrow Sharon A. , Schlechter Haley , Lederman Howard M.
Published: March 2021

Background

Ataxia telangiectasia (A-T) is a DNA repair disorder that affects multiple body systems. Neurological problems and immunodeficiency are two important features of this disease. At this time, two main severity groups are defined in A-T: classic (the more severe form) and mild. Poor growth is a common problem in classic A-T. An objective of this study was to develop growth references for classic A-T. Another objective was to compare growth patterns in classic A-T and mild A-T with each other and with the general population, using the CDC growth references. A final objective was to examine the effects of chronic infection on height.

Results

We found that classic A-T patients were smaller overall, and suffered from height and weight faltering that continued throughout childhood and adolescence. When compared to the CDC growth references, the median heights and weights for both male and female patients eventually fell to or below the 3rd centile on the CDC charts. Height faltering was more pronounced in females. Birthweight was lower in the classic A-T group compared to mild A-T and the general population, whereas birth length was not. Finally, we investigated height and BMI faltering in relation to number of infections and found no association.

Conclusions

Classic A-T appears to affect growth in utero. Although children appear to grow well in very early life, faltering begins early, and is unrelenting.
Reducing posttraumatic stress in parents of patients with a rare inherited metabolic disorder using eye movement desensitization and reprocessing therapy: a case study
Authors: Conijn Thirsa , Haverman Lotte , Wijburg Frits A. , De Roos Carlijn
Published: March 2021

Parents of children with severe inborn errors of metabolism frequently face stressful events related to the disease of their child and are consequently at high risk for developing parental posttraumatic stress disorder (PTSD). Assessment and subsequent treatment of PTSD in these parents is however not common in clinical practice. PTSD can be effectively treated by Eye Movement Desensitization and Reprocessing (EMDR), however no studies have been conducted yet regarding the effect of EMDR for parental PTSD. EMDR is generally offered in multiple weekly sessions which may preclude participation of parents as they are generally overburdened by the ongoing and often intensive care for their child. Therefore, we offered time-limited EMDR with a maximum of four sessions over two subsequent days to two parents of mucopolysaccharidosis type III (MPS III) patients to explore its potential effects. Both qualitative and quantitative outcomes were used to evaluate treatment effects. Both parents felt more resilient and competent to face future difficulties related to the disease of their child, and no adverse effects were reported. Quantitative outcomes showed a clinically significant decrease in post traumatic stress symptoms and comorbid psychological distress from pre- to post treatment, and these beneficial effects were maintained at follow-up. In conclusion, time-limited EMDR may be a highly relevant treatment for traumatized parents of children with MPS III, and probably also for parents of children with other rare progressive disorders. Further research is needed to validate the efficacy of EMDR in this specific population.
Impact of a diagnostic therapeutic educational pathway program for asthma management in preschool children
Authors: Guarnaccia Sebastiano , Quecchia Cristina , Festa Andrea , Magoni Michele , Zenoni Giuseppe , D’Agata Emanuele , Brivio Valentina , Zanardini Elena , Scarcella Carmelo , Gretter Valeria , Facchetti Susanna , Gasparotti Cinzia , Pluda Ada , Frassine Malica , Limina Rosa Maria , Spiazzi Raffaele , Badolato Raffaele , Bender Bruce , Donato Francesco
Published: March 2021

Background

Preschool children with clinically-diagnosed asthma have a higher rate of emergency department visits and consume more resources for management than older children. However, no clinical trials have yet been performed measuring the impact of a combined diagnostic, therapeutic and educational pathway regimen for evaluation of wheezing control in children aged less than 6 years.

The purpose of the present study was to assess the impact of a pediatric program developed in Italy, the Diagnostic Therapeutic Educational Pathway (DTEP), for asthma management in children less than 6 years old attending an asthma referral center.

Methods

This is a retrospective population-based cohort study performed in children with asthma aged 0–5 years, attending at “Io e l’Asma center”, Brescia, Italy between September 2007 and December 2014. The incidence rates (IRs) of hospitalization, emergency room visits, use of outpatient services and drug usage for dyspnea, wheezing, or respiratory symptoms were evaluated for time periods prior to and after DTEP intervention.

Results

A total of 741 patients, aged 0–5 years completed the DTEP, including 391 and 350 children aged 0–2 and 3–5 years, respectively. The percentage of children aged 0–2 and 3–5 years showing improved control of wheezing symptoms during the 1st to 3rd visit interval as a result of the DTEP intervention increased from 39.5 to 60.9% and from 25.5 to 75.5%, respectively. During these periods, the IRs showed a significant decrease for all outcomes, from-8.6% to − 80.4%. Although specific IRs for drug prescriptions declined, particularly for LABA plus corticosteroids, antibiotics, and systemic corticosteroids, they increased for SABA, inhaled corticosteroid and leukotriene receptor antagonist usage.

Conclusions

The results suggest that a real-world assessment of the integrated DTEP program for preschool children provides evidence for improved wheezing control and reduction of adverse therapeutic related outcomes.
gapseq: informed prediction of bacterial metabolic pathways and reconstruction of accurate metabolic models
Authors: Zimmermann Johannes , Kaleta Christoph , Waschina Silvio
Published: March 2021

Genome-scale metabolic models of microorganisms are powerful frameworks to predict phenotypes from an organism’s genotype. While manual reconstructions are laborious, automated reconstructions often fail to recapitulate known metabolic processes. Here we present (https://github.com/jotech/gapseq), a new tool to predict metabolic pathways and automatically reconstruct microbial metabolic models using a curated reaction database and a novel gap-filling algorithm. On the basis of scientific literature and experimental data for 14,931 bacterial phenotypes, we demonstrate that gapseq outperforms state-of-the-art tools in predicting enzyme activity, carbon source utilisation, fermentation products, and metabolic interactions within microbial communities.