bluuebunny/crossref_metadata_2025 huggingface dataset:
Isobaric tag for relative and absolute quantitation based quantitative proteomics reveals unique urinary protein profiles in patients with preeclampsia
Authors: Ding Wenyan , Qiu Bintao , Cram David S. , Chen Xiuting , Li Shengjie , Zhou Xiya , Liu Juntao , Wu Zhihong , Song Yijun
Published: June 2019

Preeclampsia (PE) is one of the most significant pregnancy‐related hypertensive disorders. Currently, there are no useful markers to predict the onset of the condition in pregnant women. To provide further insights into the pathogenesis of PE and identify biomarkers of the condition, we used isobaric tags for relative and absolute quantitation (iTRAQ) proteomics coupled with 2‐D LC‐MS/MS, to analyze urinary protein profiles from 7 PE patients and 7 normotensive pregnant women. A total of 294 proteins were abnormally expressed in PE patients. Of these, 233 were significantly down‐regulated and 61 proteins were significantly up‐regulated. Bioinformatics analysis using the Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) database, found that the most differentially expressed proteins (DEPs) were involved in coagulation and complement pathways, the renin‐angiotensin system and cell adhesion molecules (CAMs) pathways. We further validated three of the DEPs, including serotransferrin (TF) and complement factor B (CFB) by immunoblottingand serum paraoxonase/arylesterase 1 (PON1) by ELISA using 14 pairs of urine samples from PE patients and normal pregnant women. Taken together, our results provide the basis for further understanding the pathogenesis of PE and identifying predictive biomarkers.
Radiation‐induced cutaneous angiosarcoma of the abdomen in a patient with cervical cancer: A case report
Authors: Shin Young‐Bin , Choi Won‐Jun , Kim Chiyeon
Published: June 2019

Cutaneous angiosarcoma (CA) is a rare and aggressive malignant tumor that develops from vascular endothelium. Secondary CAs are often caused by radiotherapy and chronic lymphedema. Most radiation‐induced CAs are associated with breast or gynecologic cancer. The prognosis of CA is extremely poor, with a 5‐year survival rate ranging from 12% to 34%. Therapeutic options are limited, and surgical excision with negative margins remains the mainstay of treatment. We report a case of a 63‐year‐old woman who developed secondary CA at an irradiated site 7 years after receiving radiotherapy for cervical cancer.
Influence of simplified dietary advice combined with new complete denture fabrication on masticatory function of complete denture wearers
Authors: Suzuki Hiroyuki , Kanazawa Manabu , Komagamine Yuriko , Iwaki Maiko , Amagai Noriko , Minakuchi Shunsuke
Published: June 2019

Background

Dietary advice combined with prosthetic treatment could improve dietary intake earlier than prosthetic treatment only. This early improvement might signify early adaptation to new prostheses. Therefore, dietary advice might affect functional adaptation to new prostheses.

Objective

The aim was to clarify the influence of simple dietary advice on masticatory function of elderly individuals with new complete dentures.

Methods

A randomised controlled trial was performed on 59 edentulous elderly individuals who had received new complete dentures. Participants were randomly divided into an intervention group (received simple dietary advice: 15 men and 15 women, mean age: 74.8 ± 8.0 years) or a control group (received denture care advice: 15 men and 14 women, mean age: 78.6 ± 6.8 years). Masticatory function was assessed using colour‐changeable chewing gum for mixing ability and test gummy jelly for shearing ability. Mixing and shearing ability were assessed at pre‐treatment, and 3 and 6 months post‐treatment. At each assessment time, mixing ability was compared using Student's t test and shearing ability using Mann‐Whitney's U test. Within‐group differences in mixing ability were analysed using repeated‐measures one‐way analysis of variance and those in shearing ability were analysed using Wilcoxon signed‐rank test with Bonferroni correction.

Results

At each assessment time, there was no significant difference in mixing or shearing ability between groups. In the intervention group, mixing and shearing ability significantly increased at 3 and 6 months post‐treatment. In the control group, mixing ability significantly increased at 6 months post‐treatment.

Conclusion

Simple dietary advice might lead to relatively early improvements in masticatory function.
Lichenoid reaction with granulomatous stomatitis: A retrospective histologic study of 47 patients
Authors: Hakeem Abdulaziz , Bhattacharyya Indraneel , Aljabri Mohammed , Bindakhil Mohammed , Pachigar Krunal , Islam Mohammed N. , Cohen Donald M. , Fitzpatrick Sarah G.
Published: June 2019

Objectives

Lichenoid granulomatous reaction can be subcategorized into lichenoid granulomatous dermatitis or lichenoid granulomatous stomatitis. It is described in the literature as demonstrating a band‐like lichenoid infiltration with clusters of histiocytic or granuloma formation. In this study, we presented a large case series of lichenoid granulomatous stomatitis including demographics, histological features, and subcategories and compared findings with current literature.

Methods and materials

We retrieved all cases diagnosed with lichenoid reaction with granulomatous inflammation between January 1, 2000, and August 1, 2016, from the University of Florida Oral Pathology Biopsy Service Archives.

Results

A total of 47 patients with tissue from 50 biopsy sites were included. The majority of the cases were noted in females (64%) with a mean age of 59 years (range 30‐88). Most patients were Caucasian, and the most common sites in descending order were: gingiva, buccal mucosa, vestibule, tongue, lip, palate, and occasional multifocal involvement. Clinical impressions by the treating clinicians included leukoplakia, dysplasia, carcinoma in situ, squamous cell carcinoma, lichen planus, vesiculobullous disease, trauma, and allergy. The histologic features of these cases ranged from lichenoid mucositis with numerous aggregates of histiocytes to well‐formed granulomas, in accordance with previous classifications of similar dermatologic lesions. All cases revealed positive CD 68 in the histiocytic infiltrates and were negative for microorganisms utilizing acid‐fast bacilli, Grocott methenamine‐silver, and periodic acid‐Schiff stains.

Conclusion

Lichenoid granulomatous disease may be more common than previously reported; however, its etiology remains unknown and patients should be kept under long‐term clinical follow‐up.
Adherence to neonatal hypoglycaemia guidelines: A retrospective cohort study
Authors: Alsweiler Jane M , Gomes Leanora , Nagy Tess , Gilchrist Catherine A , Hegarty Joanne E
Published: June 2019

Aim

To determine if the routine use of automatically calculated birthweight centiles prior to discharge from the delivery unit is associated with improved adherence to the neonatal hypoglycaemia guideline.

Methods

We conducted retrospective audits of adherence to the neonatal hypoglycaemia guideline in a tertiary maternity hospital in Auckland, New Zealand in a randomly selected cohort of newborn infants at risk of neonatal hypoglycaemia before (2011) and after (2015) the introduction of routine use of calculated birthweight centiles for all infants. The primary outcome was adherence to the guideline, defined as (i) blood glucose concentration screening in the first 48 h after birth; (ii) the initial measurement taken 1–2 h after birth; and (iii) at least three consecutive blood glucose concentrations ≥2.6 mmol/L, over 12 h, prior to cessation of screening.

Results

The audits examined the records of 400 infants (200 each in 2011 and 2015) to determine guideline adherence. Adherence improved from 2011 to 2015 (59/200 (30%) vs. 95/200 (48%), P < 0.001), with the largest improvement in large‐for‐gestational age infants (7/50 (14%) vs. 25/50 (50%), P = <0.001). Screened infants whose care was adherent to the guideline had a higher incidence of hypoglycaemia detection (adherent, 64/154 (42%) vs. non‐adherent, 34/246 (14%), P < 0.001).

Conclusions

The routine use of calculated birthweight centiles was associated with improved adherence to the neonatal hypoglycaemia guideline and increased detection of neonatal hypoglycaemia in at‐risk infants. Thus, identifying practices that improve guideline adherence may improve the detection of hypoglycaemia in asymptomatic at‐risk infants.
Molecular phylogenetic analysis resolves Trisetum (Poaceae: Pooideae: Koeleriinae) polyphyletic: Evidence for a new genus, Sibirotrisetum and resurrection of Acrospelion
Authors: Barberá Patricia , Soreng Robert J. , Peterson Paul M. , Romaschenko Konstantin , Quintanar Alejandro , Aedo Carlos
Published: June 2019

To investigate the evolutionary relationships among the species of Trisetum and other members of subtribe Koeleriinae, a phylogeny based on DNA sequences from four gene regions (ITS, rpl32‐trnL spacer, rps16‐trnK spacer, and rps16 intron) is presented. The analyses, including type species of all genera in Koeleriinae (Acrospelion, Avellinia, Cinnagrostis, Gaudinia, Koeleria, Leptophyllochloa, Limnodea, Peyritschia, Rostraria, Sphenopholis, Trisetaria, Trisetopsis, Trisetum), along with three outgroups, confirm previous indications of extensive polyphyly of Trisetum. We focus on the monophyletic Trisetum sect. Sibirica clade that we interpret here as a distinct genus, Sibirotrisetum gen. nov. We include a description of Sibirotrisetum with the following seven new combinations: Sibirotrisetum aeneum, S. bifidum, S. henryi, S. scitulum, S. sibiricum, S. sibiricum subsp. litorale, and S. turcicum; and a single new combination in Acrospelion: A. distichophyllum. Trisetum s.s. is limited to one, two or three species, pending further study.
Dynamic expressions of hypothalamic genes regulate seasonal breeding in a natural rodent population
Authors: Wang Dawei , Li Ning , Tian Lin , Ren Fei , Li Zhengguang , Chen Yan , Liu Lan , Hu Xiangfa , Zhang Xuechang , Song Ying , Hut Roelof A. , Liu Xiao‐Hui
Published: June 2019

Seasonal breeding is a universal reproductive strategy in many animals. Hypothalamic genes, especially type 2 and 3 iodothyronine deiodinases (Dio2/3), RFamide‐related peptide 3 (Rfrp‐3), kisspeptin (Kiss‐1) and gonadotropin‐releasing hormone (GnRH), are involved in a photoperiodic pathway that encodes seasonal signals from day length in many vertebrate species. However, the seasonal expression patterns of these genes in wild mammals are less studied. Here, we present a four‐year field investigation to reveal seasonal rhythm and age‐dependent reproductive activity in male Brandt's voles (Lasiopodomys brandtii) and to detect relationships among seasonal expression profiles of hypothalamic genes, testicular activity, age and annual day length. From breeding season (April) to nonbreeding season (October), adult male voles displayed a synchronous peak in gonadal activity with annual day length around summer solstice, which was jointly caused by age structure shifts and age‐dependent gonadal development patterns. Overwintered males maintained reproductive activity until late in the breeding season, whereas most newborn males terminated gonadal development completely, except for a minority of males born early in spring. Consistently, the synchronous and opposite expression profiles of Dio2/3 suggest their central function to decode photoperiodic signals and to predict the onset of the nonbreeding season. Moreover, changes in Dio2/3 signals may guide the actions of Kiss‐1 and Rfrp‐3 to regulate the age‐dependent divergence of reproductive strategy in wild Brandt's vole. Our results provide evidence on how hypothalamic photoperiod genes regulate seasonal breeding in a natural rodent population.
The effects of some soil properties (soil nitrogen forms and moisture) on community structure in Mediterranean plant communities in the Black Sea region
Authors: Elmas Emire , Kutbay Hamdi Güray
Published: June 2019

Mediterranean ecosystems comprise the second biodiversity hotspot area after tropical rain forests and will be most affected by global climate change. Therefore, it is important to understand community dynamics for effective conservation in this region. We investigated the relationships between soil moisture, nitrogen forms and community structuring in Quercus ilexL., Erica arborea L. and Sarcopoterium spinosum (L.) Spach communities, representing different successional stages, distributed as Mediterranean enclaves on the Sinop Peninsula (Turkey). The soil moisture, ammonium, nitrate and nitrite content were measured seasonally. Differences in these abiotic parameters within and between communities over seasons were tested. Previously collected biotic data were then used to analyze the relationship between soil parameters and community structure. Significant differences in soil parameters within and between seasons were found within and between communities. Our results show that there are different relationships between soil moisture, nitrogen forms and community structure in Mediterranean plant communities representing different successional stages. Differentiation in vegetation structure during succession cause changes especially in the water and nitrate content of the soil, and these changes in turn affect the continuity of community structure in Mediterranean plant communities.
Growth in foetal life, infancy, and early childhood and the association with ocular biometry
Authors: Tideman Jan Willem L , Polling Jan Roelof , Jaddoe Vincent W V , Vingerling Johannes R , Klaver Caroline C W
Published: June 2019

Purpose

Ocular biometry varies within groups of emmetropic, hyperopic or myopic children. The aim of this study was to quantify the effect of foetal and infant growth on ocular biometry in early childhood, to determine the most important period for this association, and to examine genetic overlap with height and birth weight.

Methods

5931 children (50.1% girls) from a population‐based prospective birth cohort study underwent intra‐uterine and infant growth measurements at second and third trimester, and from birth to 72 months. An ophthalmic examination including axial length (mm) and corneal radius of curvature (mm) was performed at 6 years of age. The associations between prenatal and postnatal growth variables and axial length and corneal radius of curvature were assessed with conditional linear regression analyses. Weighted genetic risk scores for birth weight and height were calculated and causality was tested with Mendelian randomisation.

Results

Weight and length from mid‐pregnancy to 2 years of age were most important prognostic factors for axial length and corneal radius of curvature at age 4.9–9 years (mean 6.2 years S.D. 0.5). For height (Standard deviation score), the association with axial length and corneal radius of curvature was highest for the measurement at 12 months (β 0.171 p < 0.001 and 0.070 p < 0.001). The genetic height and birth weight risk scores were both significantly associated with ocular biometry.

Conclusions

Larger neonates had longer axial length and greater corneal radius of curvature. Growth during pregnancy and 2 years postnatally is the most important period underlying this association and may be partly genetically determined by genes associated with height.
Molecular and biological properties of two putative new cytorhabdoviruses infecting Trifolium pratense
Authors: Fránová J. , Sarkisova T. , Jakešová H. , Koloniuk I.
Published: June 2019

Three pairs of generic primers designed for specific reverse transcription polymerase chain reaction amplification of part of the cytorhabdoviruses genomes were successfully tested with a number of red clover samples. Two infected plants showing irregular vein clearing, tissue necrosis and stunted growth symptoms were selected for further studies. Subsequently, two novel plant rhabdoviruses, tentatively named Trifolium pratense virus A (TpVA) and Trifolium pratense virus B (TpVB), were detected in red clover plants. Sequence analyses of nucleotide sequences of their genomic RNAs obtained after high‐throughput sequencing confirmed their affinity to members of the genus Cytorhabdovirus. While TpVA was transmitted by mechanical inoculation to Nicotiana occidentalis 37B and subtransferred to Physalis floridana plants, crude sap transmission of TpVB to a range of herbaceous host plants failed. The bacilliform shape of virions, which has a cytoplasm‐limited distribution, their sizes, and the phylogenetic relationships, support assignment of TpVA and TpVB to two distinct species of the genus Cytorhabdovirus.
Essential role of the PGC‐1α/PPARβ axis in Ucp3 gene induction
Authors: Lima Tanes I. , Guimarães Dimitrius , Sponton Carlos H. , Bajgelman Marcio C. , Palameta Soledad , Toscaro Jessica M. , Reis Osvaldo , Silveira Leonardo R.
Published: June 2019

Key points

We report that the peroxisome proliferator‐activated receptor (PPAR)γ coactivator 1‐α (PGC‐1α)/PPARβ axis is a crucial mediator of uncoupling protein 3 (UCP3) expression in skeletal muscle cells via the transactivativation of a distal PPAR response element at the Ucp3 gene promoter.

This mechanism is activated during the myogenic process and by high concentrations of fatty acids independent of PGC‐1α protein levels.

Ucp3 is essential for PGC‐1α‐induced oxidative capacity and the adaptive mitochondrial response to fatty acid exposure.

These findings provide further evidence for the broad spectrum of the coactivator action in mitochondrial homeostasis, positioning the PGC‐1ɑ/PPARβ axis as an essential component of the molecular regulation of Ucp3 gene in skeletal muscle cells.

Uncoupling protein 3 (UCP3) has an essential role in fatty acid metabolism and mitochondrial redox regulation in skeletal muscle. However, the molecular mechanisms involved in the expression of Ucp3 are poorly known. In the present study, we show that the peroxisome proliferator‐activated receptor (PPAR)γ coactivator 1‐α (PGC‐1α)/PPARβ axis is a crucial mediator of Ucp3 expression in skeletal muscle cells. In silico analysis of the UCP3 promoter and quantitative chromatin immunoprecipitation experiments revealed that the induction of the UCP3 transcript is mediated by the transactivation of a distal PPAR response element at the Ucp3 gene promoter by the coactivator PGC‐1α. This mechanism is activated during myogenesis and during metabolic stress induced by fatty acids independent of PGC‐1α protein levels. We also provide evidence that Ucp3 is essential for PGC‐1α‐induced oxidative capacity. Taken together, our results highlight PGC‐1ɑ/PPARβ as an essential component of the molecular regulation of Ucp3 gene in skeletal muscle cells.
One-step transfer printing of patterned nanogap electrodes
Authors: Saller Kai B. , Riedl Hubert , Lugli Paolo , Koblmüller Gregor , Tornow Marc
Published: June 2019

Direct printing of nanogap-separated metallic contact pairs is described that enables novel nanoelectronic device architectures. Nanotransfer printing (nTP) stamps are grown by molecular beam epitaxy involving layered III-V semiconductors that are selectively etched. Finished stamps comprise both the nanoscale surface trench that becomes the nanogap on printing and a microscale, predetermined geometry that affords the simultaneous integration of contact pads for external electrical testing. This nTP technique is well suited for top-contacting sensitive thin films for electrical characterization; a typical electrode configuration is illustrated by transfer-printed 13 nm thin metal films that are separated by an electrically insulating gap of ca. 30 nm.
Formation of a temporary gastrostomy to aid delivery of gastric trichobezoar and decrease incidence of wound infection
Authors: Darwish Ahmed AbdElhamid , Abdelgawad Abdelghany EM , Platt Esther , Garrett-Cox Robin
Published: June 2019

Trichobezoars are relatively uncommon problems with a known female predominance. We report two female children with gastric bezoars. Main presenting symptoms were abdominal distension, weight loss and anaemia. Upper abdominal mass was palpable in both. Diagnosis was suspected on initial abdominal radiograph and ultrasound scan then confirmed by upper endoscopy. No bowel extension was recorded in either case. We report here a modification of the surgical technique in which the gastrostomy cut edges were anchored to the laparotomy skin. This modification aided easy and complete delivery of hair balls avoiding any spillage or wound contamination.
Current smoking habits in British IBD patients in the age of e-cigarettes
Authors: Chong Chui , Rahman Anisha , Loonat Khaleel , Sagar Rebecca C , Selinger Christian Philipp
Published: June 2019

Background

Smoking has a detrimental effect on Crohn’s disease (CD) while data on ulcerative colitis (UC) are conflicting. Smoking habits have changed dramatically in the UK due to a public smoking ban and the advent of e-cigarettes. We describe current smoking rates in patients with inflammatory bowel disease (IBD) and any effects on disease course.

Methods

Self-reported smoking status was elicited in outpatients with IBD, and clinical data were extracted from patient records.

Results

Of 465 patients (58% CD, 42% UC), 247 (53.1%) were ever-smokers (37.4% ex-smokers, 15.7% current smokers). Electronic cigarettes (e-cigarettes) were ever used by 28 patients (15 current users). All e-cigarette users had previously smoked cigarettes and 13 had stopped smoking completely. Patients with CD were more likely to currently smoke (21.5% vs 7.7%, p<0.001) than those with UC. Ever use of biological therapy was higher in current smokers compared with never smokers (49% vs 35%, p=0.034). The need for surgery was higher in current smokers compared with never smokers (43% vs 25%, p=0.006). The risk of CD complications during 21-month prospective follow-up was numerically higher for current smoker versus e-cigarette users (53% vs 17%, p=0.19).

Compared with the general population, the proportion of current cigarette smokers (14.9% vs 15.1%) and e-cigarette users was similar in our cohort (4.26% vs 5.5%).

Conclusions

Patients with IBD show similar smoking behaviour to the general population. E-cigarettes were used as replacement for cigarettes or by some as an intermediate step for smoking cessation. Larger, prospective studies are required to fully determine the effects of e-cigarettes on IBD.
Effect of results-based financing on facility-based maternal mortality at birth: an interrupted time-series analysis with independent controls in Malawi
Authors: De Allegri Manuela , Chase Rachel P , Lohmann Julia , Schoeps Anja , Muula Adamson S , Brenner Stephan
Published: June 2019

Introduction

The aim of this study was to assess the impact of a results-based financing (RBF) programme on the reduction of facility-based maternal mortality at birth. Malawi is a low-income country with high maternal mortality. The Results-Based Financing For Maternal and Newborn Health (RBF4MNH) Initiative was introduced at obstetric care facilities in four districts to improve quality and utilisation of maternal and newborn health services. The RBF4MNH Initiative was launched in April 2013 as a combined supply-side and demand-side RBF. Programme expansion occurred in October 2014.

Methods

Controlled interrupted time series was used to estimate the effect of the RBF4MNH on reducing facility-based maternal mortality at birth. The study sample consisted of all obstetric care facilities in 4 intervention and 19 control districts, which constituted all non-urban mainland districts in Malawi. Data for obstetric care facilities were extracted from the Malawi Health Management Information System. Facility-based maternal mortality at birth was calculated as the number of maternal deaths per all deliveries at a facility in a given time period.

Results

The RBF4MNH effectively reduced facility-based maternal mortality by 4.8 (−10.3 to 0.7, p<0.1) maternal deaths/100 000 facility-based deliveries/month after reaching full operational capacity in October 2014. Immediate effects (changes in level rather than slope) attributable to the RBF4MNH were not statistically significant.

Conclusion

This is the first study evaluating the effect of a combined supply-side and demand-side RBF on maternal mortality outcomes and demonstrates the positive role financial incentives can play in improving health outcomes. This study further shows that timeframes spanning several years might be necessary to fully evaluate the impact of health-financing programmes on health outcomes. Further research is needed to assess the extent to which the observed reduction in facility-based mortality at birth contributes to all-cause maternal mortality in the country.
Impact of capitation on outpatient expenses among patients with diabetes mellitus in Tianjin, China: a natural experiment
Authors: Dong Yanan , Chen Jiageng , Jing Xiyue , Shi Xinjun , Chen Yunfeng , Deng Xiaowei , Li Changping , Ma Jun
Published: June 2019

Objectives

Capitation policy, a new medical insurance settlement method implemented on 1 January 2014 in Tianjin, China, aimed to control unreasonable increases in medical costs. The goal of the current study was to evaluate the impact of capitation on outpatient expenses among patients with diabetes mellitus and provide scientific evidence for health policy-makers.

Design

A natural experiment.

Setting

The medical insurance database of Tianjin from 1 January 2010 to 31 December 2014.

Participants

In total, 35 529 records were included, comprising 9646 records in the pilot group (4907 records in 2014 and 4739 records in 2013) and 25 883 records in the control group (9814 records in 2014 and 16 069 records in 2013).

Main outcome measures

The outcome variables included annual total outpatient expenses, drug expenses, examination expenses, treatment expenses and other expenses.

Results

Capitation produced an increase in total outpatient expenses of ¥1993.76 (95% CI, ¥1643.74 to ¥2343.77) in the pilot group relative to the control group. There was also an increase in drug expenses of ¥1904.30 (95% CI, ¥1578.63 to ¥2229.96) after the implementation of capitation. An increase in examination expenses of ¥44.90 (95% CI, ¥19.11 to ¥70.68) was found in the pilot group versus the control group. Capitation also produced an increase in treatment expenses of ¥3.55 (95% CI, ¥1.01 to ¥6.09) and an increase in other expenses of ¥43.46 (95% CI, ¥26.81 to ¥60.11) in the pilot group versus the control group.

Conclusion

Compared with those who participated in the ‘control’ policy, outpatient expenses of patients enrolled in capitation increased significantly. The increases were due to the actual needs of patients, changes in drug directories, and the autonomy and independence of hospitals. It is necessary for the government, policy-makers, hospitals, doctors, patients and supervisory agencies to improve the capitation policy.
Cross-sectional investigation of household transmission ofCryptosporidiumin England and Wales: the epiCrypt study protocol
Authors: McKerr Caoimhe , Chalmers Rachel M , Vivancos Roberto , O’Brien Sarah J , Mugarza Julie , Christley Robert M
Published: June 2019

Introduction

Infection with theCryptosporidiumparasite causes over 4000 cases of diagnosed illness (cryptosporidiosis) in England and Wales each year. Risk factors are often estimated from outbreak investigations, and in the UK include ingestion of contaminated water and food, farm/animal contact and person-to-person spread in institutions. However, reported outbreaks only represent about 10% of cases and the transmission routes for sporadic disease may not be the same. Contact with other people has been highlighted as a factor in the transmission ofCryptosporidium, but the incidence of sporadic disease has not been sufficiently established, and how frequently this arises from contact with other infected people is not well documented. This project will estimate the amount of secondary spread that occurs in the home and potentially identify asymptomatic infections which might have a role in transmission. Risk factors and characteristics associated with secondary spread will be described including any differences in transmission betweenCryptosporidiumspecies.

Methods and analysis

The study will prospectively identify cryptosporidiosis cases from North West England and Wales over 1 year and invite them and their household to take part. Each household will complete a questionnaire and each household member will be asked to provide a stool sample. Clinical, demographic and home variables will be described, and further analyses undertaken to investigate associations with secondary spread in the home.Cryptosporidium-positive stool samples, identified by immunofluorescence microscopy, will be characterised using molecular methods to describe patterns of transmission. Data collection is expected to take 1 year, beginning in September 2018.

Ethics and dissemination

The study has been approved by the North West–Liverpool East NHS Research Ethics Committee (Reference: 18/NW/0300) and the Confidentiality and Advisory Group (Reference 18/CAG/0084). Outputs will include scientific conferences and peer-reviewed publications. In addition, a short, lay report of findings will be produced for participants, who can opt to receive this when they take part.

Trial registration number

CPMS ID: 39458.
Associations and effects of omega-3 polyunsaturated fatty acids on cognitive function and mood in healthy adults: a protocol for a systematic review of observational and interventional studies
Authors: O' Donovan Fiona , Carney Síle , Kennedy Jean , Hayes Heather , Pender Niall , Boland Fiona , Stanton Alice
Published: June 2019

Introduction

The association between long-chain omega-3 polyunsaturated fatty acids (PUFAs), brain health, cognitive function and mood has been the subject of intensive research. Marine-derived omega-3 PUFAs, such as docosahexaenoic acid and eicosapentaenoic acid, are highly concentrated in neuronal membranes and affect brain function. Many studies have found that consumption of omega-3 PUFAs is associated with lower risk of cognitive or mood dysfunction. However, other studies have demonstrated no beneficial effects. There appears to be inconsistent findings from both epidemiological and randomised controlled trial (RCT) studies. The aim of this review is to compile the previous literature and establish the efficacy of omega-3 PUFAs in enhancing cognitive performance and mood in healthy adults.

Methods and analysis

Prospective cohort studies, RCTs, controlled clinical trials, controlled before and after studies, interrupted time series with a minimum of 3 months duration will be eligible for inclusion. Studies on healthy adults over the age of 18, where the intervention/exposure of interest is omega-3 PUFAs will be included. The outcomes of interest are cognition and mood. Studies will be eligible for inclusion if they measure changes in cognitive function or mood, or the risk of developing cognitive or mood disorders using validated tools and assessments. Relevant search terms and keywords will be used to generate a systematic search in Cochrane Library, MEDLINE, EMBASE, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, Web of Science, Scopus and the grey literature. Two independent reviewers will screen studies for eligibility. Risk of bias in cohort and non-randomised studies will be assessed using the ROBINS-I tool. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials will be used for RCTs. If there are sufficient data, a meta-analysis will be conducted.

Ethics and dissemination

This systematic review does not involve primary data collection and therefore formal ethical approval is not required. Results will be disseminated through peer reviewed publications, conference presentations and the popular press.

PROSPERO registration number

CRD42018080800.
Association of the combination of weight gain after 20 years of age and current obesity with chronic kidney disease in Japan: a cross-sectional study
Authors: Ochiai Hirotaka , Shirasawa Takako , Yoshimoto Takahiko , Nagahama Satsue , Kobayashi Mariko , Minoura Akira , Ikeda Keiichiro , Ozaki Eri , Hoshino Hiromi , Kokaze Akatsuki
Published: June 2019

Objectives

Weight gain after 20 years of age is associated with chronic kidney disease (CKD). However, the impact of weight gain on CKD might differ by current obesity status. We investigated the association of the combination of weight gain after 20 years of age and current obesity with CKD among adults in Japan.

Design

A cross-sectional study.

Setting and participants

We analysed data from 94 822 adults aged 40–64 years who had an annual health check-up in Japan from April 2013 to March 2014.

Primary outcome measure

CKD was defined as an estimated glomerular filtration rate <60 mL/min/1.73 m2and/or proteinuria.

Results

Both weight gain ≥10 kg after 20 years of age plus obesity (OR 2.21, 95% CI 2.07 to 2.36) and weight gain of ≥10 kg plus non-obesity (OR 1.31, 95% CI 1.21 to 1.42) significantly increased the OR for CKD when compared with weight gain <10 kg plus non-obesity in men. In women, weight gain ≥10 kg plus obesity (OR 2.04, 95% CI 1.84 to 2.25) and weight gain ≥10 kg plus non-obesity (OR 1.53, 95% CI 1.36 to 1.72) significantly increased the OR for CKD compared with weight gain <10 kg plus non-obesity. These results persisted even after adjustment for age, lifestyle factors, hypertension, dyslipidaemia and diabetes.

Conclusions

Weight gain ≥10 kg after 20 years of age was significantly associated with CKD in both obese and non-obese subjects. Moreover, the influence of weight gain ≥10 kg plus obesity on CKD was greater than that of weight gain ≥10 kg plus non-obesity on CKD. The present study results suggest that it is important to consider weight gain after maturity in both obese and non-obese subjects to prevent CKD among Japanese middle-aged adults.
Pre-emptive scalp infiltration with ropivacaine plus methylprednisolone versus ropivacaine alone for relief of postoperative pain after craniotomy in children (RP/MP vs RP): a study protocol for a randomised controlled trial
Authors: Zhao Chunmei , Jia Yitong , Jia Zipu , Xiao Xiong , Luo Fang
Published: June 2019

Introduction

Pre-emptive scalp infiltration with local anaesthetics is the simplest and most effective method to prevent postoperative incisional pain. However, local infiltration of an anaesthetic only provides relatively short-term pain relief. Methylprednisolone (MP) treatment, administered as an adjuvant at the wound site, has been shown to provide satisfactory pain management after lumbar laminectomy. However, there is no evidence regarding the efficacy of MP infiltration for the relief of postoperative pain after craniotomy. Currently, postoperative pain after craniotomy in children is undertreated. Therefore, we aim to investigate whether pre-emptive scalp infiltration with ropivacaine (RP) plus MP is superior to RP alone to improve postoperative pain after craniotomy in children.

Methods and analysis

The RP/MP versus RP trial is a prospective, single-centre, randomised, parallel-group study of 100 children aged 8–18 years undergoing intracranial surgery. Participants will be randomly allocated to receive pre-emptive scalp infiltration with either RP plus MP or RP alone. The primary outcome will be the cumulative fentanyl dose administered by patient-controlled intravenous analgesia within 24 hours postoperatively. The secondary outcomes will include postoperative Numerical Rating Scale scores, pain control satisfaction scores, length of stay and adverse events. Data will be analysed by the intention-to-treat principle.

Ethical approval and dissemination

The study protocol has been approved by the Institutional Review Board of Beijing Tiantan Hospital Affiliated to Capital Medical University (Approval Number: KY 2018-066-02). The results will be disseminated in international academic meetings and published in peer-reviewed journals.

Trial registration number

NCT03636165; Pre-results.
Intermittent preventive treatment of pregnant women in Kintampo area of Ghana with sulphadoxine-pyrimethamine (SP): trends spanning 2011 and 2015
Authors: Oppong Felix Boakye , Gyaase Stephaney , Zandoh Charles , Nettey Obed Ernest A , Amenga-Etego Seeba , Anane Edward Apraku , Adda Robert , Dosoo David Kwame , Owusu-Agyei Seth , Asante Kwaku Poku
Published: June 2019

Objective

In Ghana, intermittent preventive treatment during pregnancy with sulphadoxine-pyrimethamine (IPTp-SP) is recommended for the prevention of malaria-related adverse outcomes. This study demonstrates the coverage of IPTp-SP use among pregnant women over a period (2011–2015) and the impact of various sociodemographic groups on the uptake of IPTp-SP.

Design

Retrospective analysis using data from all pregnant women in the Kintampo Health and Demographic Surveillance System area on the uptake of IPTp-SP.

Setting

Kintampo North Municipality and Kintampo South District of Ghana.

Participants

All pregnant women in the Kintampo Health and Demographic Surveillance System area.

Primary and secondary outcome measures

The number of doses of IPTp-SP taken by pregnant women were examined. Logistic regression was used to assess the determinant of uptake of IPTp-SP while adjusting for within-subject correlation from women with multiple pregnancies.

Results

Data from 2011 to 2015 with a total of 17 484 pregnant women were used. The coverage of the recommended three or more doses of IPTp-SP among all pregnant women was 40.6%, 44.0%, 45.9%, 20.9% and 32.4% in 2011, 2012, 2013, 2014 and 2015, respectively. In the adjusted analysis, age, household size, education, religion, number of antenatal care visits, ethnicity, marital status, wealth index and place of residence were significantly associated with the uptake of three or more doses of IPTp-SP. Having middle school education or higher, aged 20 years and above, visiting antenatal care five times or more (OR 2.83, 95% CI 2.64 to 3.03), being married (OR 1.10, 95% CI 1.02 to 1.19) and those in higher wealth quintiles were significantly more likely to take three or more doses of IPTp-SP.

Conclusion

The uptake of the recommended three or more doses of IPTp-SP is low in the study area. We recommend a community-based approach to identify women during early pregnancy and to administer IPTp-SP.
Prostate cancer with bone metastasis in Beijing: an observational study of prevalence, hospital visits and treatment costs using data from an administrative claims database
Authors: Zhuo Lin , Cheng Yinchu , Pan Yuting , Zong Jihong , Sun Wentao , Xu Lin , Soriano-Gabarró Montse , Song Yi , Lu Jian , Zhan Siyan
Published: June 2019

Objectives

To estimate the prevalence of prostate cancer with bone metastasis in Beijing, and to estimate hospital visits and direct treatment costs among male urban employees with the disease in Beijing.

Design

Cross-sectional observational study.

Setting and participants

Patients with prostate cancer and bone metastasis from the Urban Employee Basic Medical Insurance database covering the employed population of Beijing, China, from 2011 to 2014.

Primary and secondary outcome measures

Prevalence, treatment costs and healthcare visits of patients with prostate cancer and bone metastasis.

Results

A total of 1672 individuals were identified as having prostate cancer. Of these, 737 (44.1%) had bone metastasis, and among these, this was already present at the time of initial prostate cancer diagnosis in 27.0% (199/737). Mean age was 74.6 years (SD ±9.1). Prevalence of prostate cancer with bone metastasis increased from 5.3 per 100 000 males in 2011 to 8.3 per 100 000 males in 2014. The total annual health expenditure per patient (in 2014 American dollars) during the study period was $15 772.1 (SD=$16 942.6) ~$18 206.3 (SD=$18 700.2); 88% of these costs were reimbursed by insurance. Medication accounted for around 50% of total healthcare costs. Western drugs accounted for over 80% of medical costs with endocrine therapy being the most commonly prescribed treatment. There was an average 6.7% increase in expenditure related to diagnostical and therapeutical procedures over study years.

Conclusions

The increase in the prevalence of prostate cancer with bone metastasis and associated healthcare costs in China reveals the growing clinical and economical burden of this disease. The high prevalence of bone metastasis among patients with prostate cancer seen in our study suggests that efforts may be needed to improve symptoms awareness and promote early help-seeking behaviour among the Chinese population.
Models predicting survival to guide treatment decision-making in newly diagnosed primary non-metastatic prostate cancer: a systematic review
Authors: Thurtle David , Rossi Sabrina H , Berry Brendan , Pharoah Paul , Gnanapragasam Vincent J
Published: June 2019

Objectives

Men diagnosed with non-metastatic prostate cancer require standardised and robust long-term prognostic information to help them decide on management. Most currently-used tools use short-term and surrogate outcomes. We explored the evidence base in the literature on available pre-treatment, prognostic models built around long-term survival and assess the accuracy, generalisability and clinical availability of these models.

Design

Systematic literature review, pre-specified and registered on PROSPERO (CRD42018086394).

Data sources

MEDLINE, Embase and The Cochrane Library were searched from January 2000 through February 2018, using previously-tested search terms.

Eligibility criteria

Inclusion required a multivariable model prognostic model for non-metastatic prostate cancer, using long-term survival data (defined as ≥5 years), which was not treatment-specific and usable at the point of diagnosis.

Data extraction and synthesis

Title, abstract and full-text screening were sequentially performed by three reviewers. Data extraction was performed for items in the CHecklist for critical Appraisal and data extraction for systematic Reviews of prediction Modelling Studies checklist. Individual studies were assessed using the new Prediction model Risk Of Bias ASsessment Tool.

Results

Database searches yielded 6581 studies after deduplication. Twelve studies were included in the final review. Nine were model development studies using data from over 231 888 men. However, only six of the nine studies included any conservatively managed cases and only three of the nine included treatment as a predictor variable. Every included study had at least one parameter for which there was high risk of bias, with failure to report accuracy, and inadequate reporting of missing data common failings. Three external validation studies were included, reporting two available models: The University of California San Francisco (UCSF) Cancer of the Prostate Risk Assessment score and the Cambridge Prognostic Groups. Neither included treatment effect, and both had potential flaws in design, but represent the most robust and usable prognostic models currently available.

Conclusion

Few long-term prognostic models exist to inform decision-making at diagnosis of non-metastatic prostate cancer. Improved models are required to inform management and avoid undertreatment and overtreatment of non-metastatic prostate cancer.
Interventional bundle for venous thromboembolism prevention: ensuring quality and effectiveness
Authors: Shapiro Susan , Dunnigan Anna , Keen Sarah , Clarke Penney
Published: June 2019

Hospital-associated thromboses (HATs) are a potentially preventable cause of morbidity and mortality. Oxford University Hospitals NHS Foundation Trust was designated a Venous Thromboembolism (VTE) Exemplar Centre by NHS England in 2014. However, following delayed reporting of a potentially preventable HAT in 2015, a benchmarking exercise suggested HATs were being under-reported, and also that the established hospital-wide audits of VTE prevention had significant limitations. The aim of this interventional bundle was to ensure high-quality data for key VTE prevention measures across the hospital, to identify areas for improvement and demonstrate a reduction in the number of potentially preventable HATs over a 2-year period.

The project team engaged with hospital leadership and collaborated with hospital-wide stakeholders. A multifaceted approach was taken and ‘Plan Do Study Act’ cycles were used to test interventions with continuous evaluation of impact. The percentage of inpatients receiving appropriate thromboprophylaxis progressively increased from 94% to 98%. The project did not achieve its secondary aim of a reduction in the number of potentially preventable HATs. Revision of the HAT reporting process resulted in better detection and an initial increase in reporting of potentially preventable HATs, although data suggest that the level of harm from errors is now reducing.

The improvement in overall appropriate thromboprophylaxis is considered to be due to robust audits of appropriate thromboprophylaxis, upskilling of ward pharmacists, improved detection of potentially preventable HATs resulting in additional safety nets such as linking the ‘outcome recommendation’ of the electronic VTE risk assessment directly to electronic prescribing, and increased awareness and education. Combining low-cost actions in a coordinated interventional bundle has produced measurable improvements in our VTE management programme, enhancing patient safety. We believe the model to be sustainable and replicable in other general hospitals.
Driving stroke quality improvement at scale in EDs across a nationwide network of hospitals: strategies and interventions
Authors: Shpak Max , Korwek Kimberly , Nadasdy Zoltan , Ramakrishnan Anurekha , Cowperthwaite Matthew , Ankrom Kristen , Jennings Jon , Moody Ashley , Orndorff Kevin , Fanale Christopher
Published: June 2019

Objectives

Reducing the treatment time while increasing the proportion of eligible stroke patients who receive intravenous tissue plasminogen activator (tPA) has been a priority for many quality improvement efforts. Recent studies have primarily focused on identifying interventions that reduce door-to-needle (DTN) time, while comparatively little has been done to determine whether these interventions also improve tPA rates.

Methods

In order to investigate interventions related to process improvements, an electronic dashboard serving as a stroke performance tool was implemented to store and retrieve patient outcome data. These data were used to study the efficacy of interventions designed to facilitate triage of stroke patients in the ED, and determine the individual interventions associated with the most significant improvements in the fraction of patients receiving tPA and in reducing the DTN time. Stroke performance data from the dashboard collected over a 2-year period (2015–2017) from 89 US hospitals were analysed with respect to interventions implemented by individual facilities, as verified by a hospital survey.

Results

A statistically significant association was found between increases in the fraction of patients receiving tPA and reductions in DTN time over the study period. These improvements in outcomes were most strongly associated with process interventions that allocate stroke-specific physical and human resources in the ED, most notably a designated emergency room space for stroke, and with workflows that decrease the time to key checkpoints for determining a patient’s eligibility for tPA.

Conclusions

Data from the stroke performance tool was leveraged to identify the programmes and process interventions that lead to improved patient outcomes and allow EDs to better prioritise process interventions and resources.