bluuebunny/crossref_metadata_2025 huggingface dataset:
Ketogenic diets induced glucose intolerance and lipid accumulation in mice with alterations in gut microbiota and metabolites
Authors: Li Yue , Yang Xin , Zhang Jing , Jiang Tianyi , Zhang Ziyi , Wang Zhiyi , Gong Mengxue , Zhao Liping , Zhang Chenhong
Published: November 2020

Background: A ketogenic diet (KD), which is extremely high in fat with a very low carbohydrate level and can induce changes in gut microbiota, has shown benefits for epilepsy and several neurodegenerative diseases. However, the effects of a KD on glucose and lipid metabolism remain inconclusive.Results: Using two formulas of ketogenic diets (KDR with 89.5% fat and KDH with 91.3% fat), which are commonly used in mouse trials, we found that KDR but not KDH induced insulin resistance and damaged glucose homeostasis, while KDH induced more fat accumulation in mice. In addition to the differences in the proportions of nutrients between the two kinds of KD, we found that the sources of fat in KDR were mainly trans-fatty acids. Further study showed that KD impacted glucose metabolism, which was related to the sources of fat, while both the sources and proportions of fat affected lipid metabolism. We found that both the sources and proportions of fat changed the abundance of specific bacteria in Lachnospiraceae and Oscillibacter, which positively correlated with parameters related to lipid accumulation. The abundances of specific bacteria in Bacteroides and Ruminococcaceae were only affected by the sources of fat, and specific bacteria from Lactococcus and Roseburia were only affected by the proportions of fat. Moreover, alterations in the concentrations of SCFAs and tryptophan metabolites, which were negatively correlated with parameters related to lipid accumulation, were also affected by the sources of fat. In addition, the ketogenic diet widely used in human studies still induced insulin resistance and fat accumulation in mice; enhanced Roseburia, Ruminococcaceae and Lachnospiraceae; reduced Turicibacter; increased bile acids and decreased SCFAs.Conclusions: Overall, our study demonstrated that ketogenic diets induced glucose intolerance and lipid accumulation in mice, which is closely related to the source and proportion of fat in the diet, likely due to changes in the gut microbiota and metabolites.
Satisfaction with nursing care and its related factors in patients with COVID-19: A Descriptive Correlational Study
Authors: Parizad Naser , Goli Rasoul , Arad Mansour , Mirzaee Roshanak , Baghaie Rahim , Habibzadeh Hossein
Published: November 2020

Background: Patients’ satisfaction is a fundamental factor in the quality of nursing care. The emergence of the novel coronavirus (COVID-19) and the highly contagious virus can affect nursing care by increasing the number of care-seekers. This study aimed to determine the patients’ satisfaction and related factors in patients with COVID-19 hospitalized in Taleghani Hospital, Urmia-Iran, in 2020. Methods: This descriptive correlational study was conducted on 196 patients with COVID-19 hospitalized in Taleghani Hospital, Urmia. Purposive convenient sampling was used to recruit participants. Study participants completed Patient Satisfaction Instrument (PSI) and demographics questionnaires. Data were analyzed with SPSS software version 25.0. Results: The majority of patients (68.9%) were moderately satisfied with nursing care. Based on Pearson Correlation Analysis, only residential status had a significant inverse relationship with satisfaction level in patients with COVID-19 (r = -0.0238, P=0.001).Conclusion: The patients’ satisfaction with nursing care was mostly at a moderate level. Thus, there is a need to educate health personnel and nurses in particular and motivate them to have active participation in achieving patients’ satisfaction with COVID-19. Notably, only the institutes that take patients’ satisfaction as a top priority can succeed in a competitive market of health services.
Developing a postgraduate professional education framework for emergency nursing: A co-design approach between healthcare industry and academic partners
Authors: Theobald Karen Ann , Coyer Fiona Maree , Henderson Amanda Jane , Fox Robyn , Thomson Bernadette F , McCarthy Alexandra L
Published: November 2020

Background: Hospital and university service providers invest significant but separate resources into preparing registered nurses to work in the emergency department setting. This results in the duplication of both curricula and resource investment in the health and higher education sectors. This paper describes an evidence-based co-designed study with clinical-academic stakeholders from hospital and university settings. Methods: The study was informed by evidence-based co-design, using emergency nursing as an exemplar. Eighteen hours of co-design workshops were completed with 21 key clinical-academic stakeholders from hospital and university settings. Results: Outcomes were matrices synchronising professional and regulatory imperatives of postgraduate nursing coursework; mutually-shaped curriculum content, teaching approaches and assessment strategies relevant for postgraduate education; a new University-Industry Academic Integration Framework; five agreed guiding principles of postgraduate curriculum development for university-industry curriculum co-design; and a Graduate Certificate of Emergency Nursing curriculum exemplar. Conclusion: Industry-academic service provider co-design can increase the relevance of postgraduate specialist courses in nursing, strengthening the nexus between both entities to advance learning and employability. The study developed strategies and exemplars for future use in any mutually determined academic-industry education partnership.
Comparing the effects of online teaching during the COVID-19 pandemic and traditional teaching in Surgical Nursing
Authors: Zheng Taoyun , Zhu Xinhong
Published: November 2020

Background: The coronavirus disease 2019 (COVID-19) pandemic has necessitated a dramatic shift in how nursing faculty and undergraduate nursing students are educated. This study aims to examine the teaching effectiveness of Surgical Nursing using both face-to-face teaching and online teaching in undergraduate nursing education. Methods: A quantitative approach was adopted. Year-3 undergraduate nursing students were recruited. face-to-face teaching was conducted in semester 1, and online teaching was conducted in semester 2 during COVID-19 pandemic. Student evaluations were collected at the beginning of semester 1 and the end of semester 1 and semester 2. Results: 162 students were recruited in the study. 45.1% students held neutral attitude towards online course of Surgical Nursing. Students were more likely to prefer unit quizzes online and mind maps as homework, task-driven learning, recording videos and online question and answer as the means of theoretical teaching online, and watching surgical nursing skills video and case-based learning in groups as the means of practical teaching online. However, nearly 62.4% students admitted the effectiveness of online teaching was worse than face-to-face teaching. During online teaching, the mean grades of student in unit quizzes were improved, but there were no differences in student evaluations of instruction mean scores for critical thinking, self-directed learning and self-efficacy in comparison with the baseline. Additionally, differences between the face-to-face and online teaching were found in terms of self-directed learning, critical thinking and self-efficacy. Conclusion: The effectiveness of online teaching was not superior to the traditional teaching. Although online teaching has advantages of convenience, speed, anytime and anywhere, face-to-face teaching in classroom and interpersonal interaction in the real situation are insurmountable limitations in online teaching.
The interaction of SAMM50-rs738491, PARVB-rs5764455 and PNPLA3-rs738409 increases the susceptibility to nonalcoholic steatohepatitis
Authors: Xu Ke , Zheng Kenneth I. , Zhu Pei-Wu , Liu Wen-Yue , Ma Hong-Lei , Li Gang , Tang Liang-Jie , Rios Rafael S. , Targher Giovanni , Byrne Christopher D. , Wang Xiao-Dong , Chen Yong-Ping , Zheng Ming-Hua
Published: November 2020

Background: Previous studies have reported that single nucleotide polymorphisms (SNPs) in SAMM50-rs738491, PARVB-rs5764455 and PNPLA3-rs738409 are associated with the development of non-alcoholic fatty liver disease (NAFLD). However, no studies have examined the effect of interactions between these three genotypes to affect liver disease severity. Objective: Our aim was to assess the effect of these three SNPs on nonalcoholic steatohepatitis (NASH) and to investigate gene-gene interactions in a Chinese cohort of patients with biopsy-proven NAFLD.Methods: 415 adult patients with biopsy-proven NAFLD were recruited to the study. Multivariable logistic regression analysis was undertaken to test associations between NASH and SNPs in SAMM50-rs738491, PARVB-rs5764455 and PNPLA3-rs738409. Gene-gene interactions were analyzed by performing a generalized multifactor dimensionality reduction (GMDR) analysis.Results: The mean age of patients was 41.3±12.5 years and 75.9% of them were men. Patients with SAMM50-rs738491 TT, PARVB-rs5764455 AA or PNPLA3-rs738409 GG genotypes had a higher risk of having NASH even after adjustment for age, sex and body mass index. Furthermore, GMDR analysis showed that the combination of all three SNPs was the best model to predict NASH. Additionally, the odds ratio of the haplotype A-G-T for predicting risk of NASH was nearly three times higher than that of the haplotype G-C-C. Conclusions: Patients with NAFLD who have SAMM50-rs738491 TT, PARVB-rs5764455 AA or PNPLA3-rs738409 GG genotypes are at higher risk of NASH. Moreover, these SNPs synergistically interact to increase the susceptibility to NASH.
The Effect of Different Ventilation Modes on the Outcomes of Patients Infected with Coronavirus Disease 2019 (COVID-19): a Protocol of Systematic Review and Network Meta-Analysis
Authors: Zhu Yihao , Wang Fei , Zhu Tao
Published: November 2020

Background: Coronavirus disease 2019 (COVID-19) outbreak has spread around the world, the high mortality rate and strong infectious cause surging global patients diagnosed patients and death while in response to the outbreak, a myriad of scientific research workers and researchers have made unremitting efforts, but effective treatments are still limited, even may say that there is no specific treatment. So a large number of patients with severe patients need treatment for respiratory support, in particular, based on various realistic factors, different way of ventilation is widely used in clinical, which kind of ventilation way is the best one of the most effective ventilation strategy is not clear, so we planned a network meta-analysis to evaluate different ventilation methods on new crown the efficacy and safety of patients, expect to find an optimal ventilation strategy.Methods and analysis: Two authors will independently search the electronic databases, preprints databases, Clinical Study Registration website and COVID-19 research related project database from December 1, 2019 to November 5, 2020. The primary outcomes are 1) All-cause mortality; 2) Transmission of COVID-19 to health care workers and other people; 3) Length of hospital stay; 4) Length of ICU stay. A systemic review and a network meta-analysis based on Bayesian framework will be performed to assess the effect of different ventilation modes on the outcomes of patients infected with COVID-19. The Grading of Recommendations Assessment, Development and Evaluation System (GRADE) will be used to evaluate the quality of evidence.Discussion: COVID-19 has spread around the world and become a global public health security problem. With limited treatment available, a large number of critically ill patients need ventilator support treatment, and the demand for ventilators has increased sharply. To our knowledge, this study will be the first systematic review and NMA to analyze the efficacy and safety of different ventilation modes in patients with COVID-19. This study expected to obtain the best choice of ventilation mode for COVID-19 patients based on high quality evidence. Ethics and dissemination: Ethical approval is not required owning to it is a literature-based study. The final conclusion will be disseminated through peer-reviewed publication. PROSPERO registration number: CRD42020219581
Effectiveness of Attachment-Based Family Therapy compared to Treatment as Usual for Depressed Adolescents in Community Mental Health Clinics 
Authors: Waraan Luxsiya , Rognli Erling W. , Czajkowski Nikolai Olavi , Aalberg Marianne , Mehlum Lars
Published: November 2020

Background: Major Depressive Disorder (MDD) is a disabling mood disorder, profoundly affecting a large number of adolescent’s quality of life. To date, no obvious treatment of choice for MDD in adolescents is available and progress in the treatment of depressed adolescents will have important public health implications. Attachment-Based Family Therapy (ABFT), as the only empirically supported family therapy model designed to treat adolescent depression, aims to repair interpersonal ruptures and rebuild an emotionally protective parent-child relationship.Objective: To study the effectiveness of ABFT compared with treatment as usual (TAU) delivered within child- and adolescent mental health services (CAMHS) to adolescents with MDD.Method: Sixty adolescents (86.7% girls), aged 13-18 years (M = 14.9, SD = 1.35), with MDD referred to two CAMHS were randomized to 16 weeks of ABFT or TAU. ABFT consisted of weekly therapy sessions (family/individual or both) according to the treatment manual. TAU was not monitored. Primary outcomes were assessed by blinded evaluators at baseline and post-treatment with the Hamilton Depression Scale (HAMD). Self-reported (Beck Depression Inventory-II, BDI-II) depressive symptoms were assessed at baseline, and after 4, 6, 8, 10,12, 14, and 16 weeks. Analyses were performed according to intent-to-treat principles.Results: At post-treatment, clinician-rated remission rates on the HAMD (5 % in ABFT and 3.33% in TAU, p =1, OR=1.54, Fisher’s exact test) and self-reported symptoms of depression on the BDI-II did not differ significantly between groups (X2[2, N = 60] =0.06 , p = 0.97). In both treatment groups participants reported significantly reduced depressive symptoms, but the majority (63.3 %) of adolescents were still in the clinical range after 16 weeks of treatment.Conclusion: ABFT was not superior to TAU. Remission and response rates were low in both groups, suggesting none of the treatments were effective in treating MDD in adolescents. Findings must be viewed in the context of the study’s limitations and implementation challenges. Continued efforts to improve treatment for MDD in outpatient clinics are warranted . Future research should examine moderators of and mechanisms for individual differences to treatment response, as well as the feasibility and cost-effectiveness of implementing treatment models which may require extensive training and expertise to yield clinically meaningful improvements in non-research settings.Trial Registration: Clinicaltrials.gov identifier: NCT01830088https://clinicaltrials.gov/ct2/show/NCT01830088?term=Villab%C3%B8&draw=2&rank=1 Date of registration: April 12, 2013
Priority domains, aims, and testable hypotheses for implementation research: Protocol for a scoping review and evidence map
Authors: Garner Bryan R , Patel Sheila , Kirk M. Alexis
Published: November 2020

Background: The challenge of implementing evidence-based innovations within practice settings is a significant public health issue the field of implementation research (IR) is focused on addressing. Significant amounts of funding, time, and effort have been invested in IR to date, yet there remains significant room for advancement, especially regarding IR’s development of scientific theories as defined by the National Academy of Sciences (i.e., a comprehensive explanation of the relationship between variables that is supported by a vast body of evidence). Research priority setting (i.e., promoting consensus about areas where research effort will have wide benefits to society) is a key approach to helping accelerate research advancements. Thus, building upon existing IR, general principles of data reduction, and a general framework for moderated mediation, this article identifies four priority domains, three priority aims, and four testable hypotheses for IR, which we organize in the priority aims and testable hypotheses (PATH) diagram..Methods: The objective of this scoping review is to map the extent to which IR has examined the identified PATH priorities to date. Our sample will include IR published in leading implementation-focused journals (i.e., Implementation Science, Implementation Science Communications, and Implementation Research and Practice) between their inception and December 2020. The protocol for the current scoping review and evidence map has been developed in accordance with the approach developed by Arksey & O’Malley and advanced by Levac, Colquhoun, and O’Brien. Because scoping reviews seek to provide an overview of the identified evidence base rather than synthesize findings from across studies, we plan to use our data-charting form to provide a descriptive overview of implementation research to-date and summarize the research via one or more summary tables. We will use the PATH diagram to organize a map of the evidence to date.Discussion: This scoping review and evidence map is intended to help accelerate IR focused on suggested priority aims and testable hypotheses, which in turn will accelerate IR’s development of National Academy of Sciences-defined scientific theories and, subsequently, improvements in public health.Systematic review registration: Open Science Framework: https://osf.io/3vhuj/
Is post-operative non-weight-bearing necessary? Study protocol for a pragmatic randomised multicentre trial of operatively treated ankle fracture
Authors: Khojaly Ramy E , Niocaill Ruairí Mac , Shahab Muhammad , Nagle Matthew , Taylor Colm , Rowan Fiachra E. , Cleary May
Published: November 2020

Background:Postoperative management regimes vary following open reduction and internal fixation (ORIF) of unstable ankle fractures. There is an evolving understanding that extended periods of immobilisation and limitation of weight-bearing may lead to poorer clinical outcomes. Traditional non-weight bearing cast immobilisation may prevent loss of fixation, and this practice continues in many centres. The purpose of this trial is to investigate the safety and efficacy of immediate weight-bearing (IWB) and range of motion (ROM) exercise regimes following ORIF of unstable ankle fractures with a particular focus on functional outcomes and complication rates.Methods:A pragmatic randomised controlled multicentre trial, comparing IWB in a walking boot and ROM within 24 hours versus non-weight-bearing (NWB) and immobilisation in a cast for six weeks, following ORIF of all types of unstable adult ankle fractures (lateral malleolar, bimalleolar, trimalleolar with or without syndesmotic injury) is proposed. All patients presenting to three trauma units will be included. The exclusion criteria will be skeletal immaturity and tibial plafond fractures. The three institutional review boards have granted ethical approval. The primary outcome measure will be the functional Olerud-Molander Ankle Score (OMAS). Secondary outcomes included wound infection (deep and superficial), displacement of osteosynthesis, the full arc of ankle motion (plantar flexion and dorsal flection), RAND-36 Item Short Form Survey (SF-36) scoring, time to return to work and postoperative hospital length of stay. The trial will be reported in accordance with the CONSORT statement for reporting a pragmatic trial, and this protocol will follow the SPIRIT guidance.Discussion:Traditional management of operatively treated ankle fractures includes an extended period of non-weight bearing. There is emerging evidence that earlier weight-bearing may have equivocal outcomes and favourable patient satisfaction but with higher wound-related complications. These studies often preclude more complicated fracture patterns or patient-related factors. To our knowledge, immediate weight-bearing (IWB) following ORIF of all types of unstable ankle fractures has not been investigated in a controlled prospective manner in recent decades. This pragmatic randomised-controlled multicentre trial will investigate immediate weight-bearing following ORIF of all ankle fracture patterns in the usual condition of care. It is hoped that these results will contribute to the modern management of ankle fractures.Trial registration:The trial is retrospectively registered on the 30th of June 2019, ISRCTN - ISRCTN76410775.http://www.isrctn.com/ISRCTN76410775
Effectiveness of the school-based social and behavior change communication (SBCC) interventions on insecticide-treated nets utilization among primary school children in rural Ethiopia: A quasi-experimental design
Authors: Ababulgu Fira Abamecha , Sudhakar Morankar , Gebretsadik Lakew Abebe , Lemu Yohannes Kebede , Alemayehu Guda , Koricha Zewdie Birhanu
Published: November 2020

Background: Evidence regarding the impacts of school-engaged social and behavior change communication (SBCC) interventions on malaria preventive behaviors in rural primary schools is limited. This study examined the effect of the school-based SBCC approach on the utilization of the insecticide-treated nets among primary school students in malaria-endemic settings of Ethiopia.Methods: Engaging primary schools and community; various participatory, educational, and communication interventions were implemented from 2017 to 2019 in 75 rural primary schools in Jimma to promote malaria preventive practices in target the villages. A post-intervention quasi-experimental design was conducted with randomly selected 798 students (i.e. 399 intervention and 399 control groups). Data were collected by trained interviewers using structured questionnaires. The SPSS version 26 software was used to analyze the data. Propensity score matching analysis was performed to control for possible confounding biases. The average effects of the intervention were estimated using multivariate general linear modeling and chi-square tests based on the nature of the outcome data. P-value < 5% was considered for statistical significance. Results: The result showed a significant difference of 39% in the proportion of ITN utilization between the intervention and control groups; (95% CI: 38.23% to 39.77%). The intervention also led to a significant mean differences (MD) of self-efficacy (MD=15.34; 95% CI: 13.73 to 16.95), knowledge (MD=5.83; 95% CI: 5.12 to 6.55), attitude (MD=6.01; 95% CI: 5.26 to 6.77), perceived malaria risk (MD=2.14; 95% CI: 1.53 to 2.76), and perceived family supports (MD=6.39; 95% CI: 5.57 to 7.22). Multiple logistic regression modeling results showed that knowledge (β=0.194, 95% CI: 1.09 to 1.35) and perceived family supports (β=0.165, 95% CI: 1.11 to 1.25) and self-efficacy (β=0.10, 95% CI: 1.22 to 2.32) significantly predicted the ITN utilization among the school children. Conclusion: The finding of this study suggested that the school-based SBCC approach combined with peer education activities advanced the malaria-related knowledge, attitude, self-efficacy, risk perceptions, and family supports and ultimately improved the sustained use of ITNs among school-going children. Further research should be conducted to understand the mechanism of these effects given the influences of social, health services, and school systems are considered.
Optimizing the Efficiency and Implementation of Cash Transfers to Improve Adherence to Antiretroviral Therapy: Study Protocol for A Cluster Randomized Controlled Trial
Authors: Packel Laura , Njau Prosper , Fahey Carolyn , Ramadhani Angela , Dow William H , Jewell Nicholas P , McCoy Sandra I
Published: November 2020

Background: Antiretroviral therapy (ART) for HIV, taken daily, is an effective strategy to clinically suppress the virus, providing the dual benefit of improved survival and vastly decreasing the risk of transmission. However, this highly effective intervention has not yet reached all who could benefit. Cash transfers are increasingly recognized as an effective strategy to motivate behavior change and improve HIV care and treatment outcomes, including engagement in HIV care and adherence to ART. Despite a growing evidence base and strong theoretical foundation for the cash transfer approach, key questions remain. To address these questions and begin to bridge the “know-do gap” with respect to cash transfers, our team is employing an implementation science approach to iterative development of an incentive-based intervention to promote ART uptake and adherence among people living with HIV (PLHIV) in the Lake Zone Region, Tanzania.Methods: We will conduct a type I hybrid implementation – effectiveness trial to test the effectiveness of a cash transfer intervention on the outcome of HIV viral suppression, and concurrently examine the potential for real-world implementation with an mobile health technology (mHealth) system. Specifically, our team will expand the intervention to 32 clinics and enroll 1,984 PLHIV to (a) evaluate its effectiveness by conducting a cluster randomized controlled trial with clinics as the unit of randomization and 12-month viral suppression as the primary outcome; and (b) evaluate the implementation challenges and successes at multiple levels (patient, provider, clinic).Discussion: This trial will provide evidence about not only the real-world effectiveness of cash transfers for retention in HIV care and viral suppression, but also on the implementation challenges and successes that will facilitate or hinder wider scale-up within Tanzania and beyond.
The additional iron cable fixation between proximal patella and tibial tuberosity to treat AO/OTA 34C3 patellar fracture
Authors: Zhang Dongzheng , Shen Yong
Published: November 2020

Background:It is very difficult to deal with AO/OTA 34C3 patellar fracture. Although the modified Kirschner wire tension band, the cerclage and plate has been proposed to treat it, the result is not very good. We found that if the fixation was not firm enough after the modified Kirschner wire tension band with or without the cerclage had been carried out, the additional iron cable fixation between proximal patella and tibial tuberosity could resolve it effectively.Methods:Retrospective analysis was completed. 21 patients with AO/OTA 34C3 patellar fracture were treated in our department from January 2014 to January 2018. They were divided into 2 groups according to the operation plan. Group 1 (normal group), with 12 patients, was treated with modified Kirschner wire tension band with or without cerclage cable. Group 2 (cable group), with 9 patients, was treated with the additional iron cable fixation between proximal patella and tibial tuberosity when the fixation was not firm enough after the modified Kirschner wire tension band with or without the cerclage had been completed.Results:The two groups of the age, sex ratio, trauma mechanism, operation time, free articular fragment, comorbidity and follow-up time had no significant statistical difference (P>0.05). There was no significant statistical difference between the two groups of the clinical results. (such as Bostman total score and its specific individual score, the excellent and good ratio, the complications, and the bone union time, etc.) (P>0.05).Conclusions:To deal with AO/OTA 34C3 patellar fracture, when the fixation of modified Kirschner wire tension band with or without the cerclage cable is not firm enough, the additional iron cable fixation between proximal patella and tibial tuberosity can resolve it effectively.
Pattern-mixture model in network meta-analysis of binary missing outcome data: one-stage or two-stage approach?
Authors: Spineli Loukia Maria , Papadimitropoulou Katerina , Kalyvas Chrysostomos
Published: November 2020

Background: Trials with binary outcomes can be synthesised using within-trial exact likelihood or approximate normal likelihood in one-stage or two-stage approaches, respectively. The performance of the one-stage and the two-stage approaches has been documented extensively in the literature. However, little is known about how these approaches behave in the presence of missing outcome data (MOD), which are ubiquitous in trials. In this work, we compare the one-stage versus two-stage approach via a pattern-mixture model in the network meta-analysis using Bayesian methods to handle MOD appropriately.Methods: We used 29 published networks to empirically compare the two approaches concerning the relative treatment effects of several competing interventions and the between-trial variance ( ), while considering the extent and level of balance of MOD in the included trials. We additionally conducted a simulation study to compare the competing approaches regarding the bias and width of the 95% credible interval of the (summary) log odds ratios (OR) and in the presence of moderate and large MOD.Results: The empirical study did not reveal any systematic bias between the compared approaches regarding the log OR, but showed systematically larger uncertainty around the log OR under the one-stage approach for networks with at least one small trial or low event risk and moderate MOD. For these networks, the simulation study revealed that the bias in log OR for comparisons with the reference intervention in the network was relatively higher in the two-stage approach. Contrariwise, the bias in log OR for the remaining comparisons was relatively higher in the one-stage approach. Overall, bias increased for large MOD. For these networks, the empirical results revealed slightly higher estimates under the one-stage approach irrespective of the extent of MOD. The one-stage approach also led to less precise log OR and when compared with the two-stage approach for large MOD.Conclusions: Due to considerable bias in the log ORs overall, especially for large MOD, none of the competing approaches was superior. Until a more competent model is developed, the researchers may prefer the one-stage approach to handle MOD, while acknowledging its limitations.
A Cross-sectional, Multicenter, Observational Study to Assess the Prophylaxis of Venous Thromboembolism in Lebanese and Jordanian Hospitals
Authors: Hajj Imad , -Masri Mahmoud AL , Bashaireh Kaldoun , Hani Mohammed Bani , Hamouri Shadi , Khouzami Joe , Sabra Nisrine , Fadel Chahine
Published: November 2020

Background There is a growing body of evidence showing substantial underuse of appropriate venous thromboembolism (VTE) prophylaxis in patients at risk. In the present study, our goal was to assess the current practices in the use rate of VTE prophylaxis among hospitalized patients in Jordan and Lebanon.Methods A cross-sectional, multicenter, observational study was conducted on 40 centers across Lebanon and Jordan. We included patients who were admitted to the participating hospitals for the treatment of a serious medical or surgical illness. The patients’ records were screened for the fulfillment of inclusion/exclusion criteria during a single assessment visit. The proportion of medical and surgical patients who were at risk of VTE and the thrombo-prophylactic measures employed by physicians for these patients were assessed according to the American College of Chest Physicians (ACCP 2016) guidelines. Results The present study included 704 patients (400 from Jordan and 304 from Lebanon) with a mean age of 54.9 ±17.5 years. Almost 59% of the patients received prophylaxis treatment in form of pharmacological anticoagulant prophylaxis and/or mechanical prophylaxis. Low molecular weight heparin was the most commonly used anticoagulant for VTE prophylaxis in 366 out of the total 704 (51.9%) patients in the analysis cohort. Two hundred and sixteen patients (52 %, 95% confidence interval [47.1% - 56.9%]) received appropriate prophylactic agents out of 415 patients who were eligible for prophylaxis according to the ACCP 2016 guidelines. On the other hand, 199 (72.1%, 95% confidence interval [66.4% – 77.3%) patients received prophylaxis out of 276 ineligible patients.. The rate of compliance to guidelines showed wide variations according to the type of hospital, specialty, and the patients’ age. The multivariate logistic regression analysis showed that only age was a significant predictor of appropriate VTE prophylaxis (odds ratio [OR] 1.05, P <0.001).Conclusion The rates of the appropriate use of VTE prophylaxis are low in Lebanon and Jordan. There is a lack of compliance to guidelines for VTE prophylaxis use for hospitalized patients in both countries.
Endoscopic ultrasound-guided fine-needle aspiration of pelvic lesions via the upper and lower gastrointestinal tract approaches
Authors: Mita Naoki , Iwashita Takuji , Senju Akihiko , Ichikawa Hironao , Iwasa Yuhei , Yasuda Ichiro , Shimizu Masahito
Published: November 2020

Background: Combining upper and lower gastrointestinal tract (GI) approaches allows expansion of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) indications for pelvic lesions. The upper GI approach has been used for pelvic lesions around the level of the aortoiliac bifurcation in our institution. The aim of this study is to evaluate the feasibility and safety of EUS-FNA for pelvic lesions via the upper and lower GI approaches. Methods: All consecutive patients who underwent EUS-FNA for the pelvic lesion between January 2008 and December 2018 were retrospectively analyzed. Pelvic lesions were defined as lesions located around and below the aortoiliac bifurcation level. The primary outcome was technical success rate, and the secondary outcomes were the diagnostic capability of EUS-FNA for malignancy and the safety.Results: EUS-FNA for pelvic lesions was performed in 49 patients: upper and lower GI approaches were used in 28 and 21 patients, respectively. The technical success rates were 91.8% (45/49) in all patients: 89.3% (25/28) and 95.2% (20/21) with the upper and lower GI approaches, respectively. Among patients who achieved technical success, the diagnostic accuracy for malignancy was 97.8% (44/45) in all patients:100% (25/25) and 95.0% (19/20) with the upper and lower GI approaches, respectively. One (2.0%) patient developed an adverse event of sigmoid colon perforation.Conclusions: EUS-FNA for pelvic lesions via the upper and lower GI approaches was a safe, feasible, and effective method, although careful endoscopic manipulation is required to avoid perforation, especially with the lower GI approach. Further large-scale, well-designed studies are needed to validate our findings.
Human Umbilical Cord Mesenchymal Stem Cell-Derived Extracellular Vesicles Ameliorate Airway Inflammation in a Rat Model of chronic obstructive pulmonary disease (COPD)
Authors: Ridzuan Noridzzaida , Zakaria Norashikin , Widera Darius , Sheard Jonathan , Morimoto Mitsuru , Kiyokawa Hirofumi , Isa Seoparjoo Azmel Mohd , Singh Gurjeet Kaur Chatar , Then Kong-Yong , Ooi Ghee-Chien , Yahaya Badrul Hisham
Published: November 2020

Background: Chronic obstructive pulmonary disease (COPD) is an incurable and debilitating chronic disease characterized by progressive airflow limitation associated with abnormal levels of tissue inflammation. Therefore, stem cell-based approaches to tackle the condition are currently a focus of regenerative therapies for COPD. Extracellular vesicles (EVs) released by all cell types are crucially involved in paracrine, extracellular communication. Recent advances in the field suggest that stem cell-derived EVs possess a therapeutic potential which is comparable to the cells of their origin.Methods: In this study, we assessed the potential anti-inflammatory effects of human umbilical cord mesenchymal stem cell (hUC-MSCs) derived EVs in a rat model of COPD. EVs were isolated from hUC-MSCs and characterized by the transmission electron microscope, western blotting, and nanoparticle tracking analysis. As a model of COPD, male Sprague Dawley rats were exposed to cigarette smoke for up to 12 weeks, followed by transplantation of hUC-MSCs or application of hUC-MSCs-derived EVs. Lung tissue was subjected to histological analysis using hematoxylin and eosin staining, alcian blue-periodic acid Schiff (AB-PAS) staining, and immunofluorescence staining. Gene expression in the lung tissue was assessed using microarray analysis. Statistical analyses were performed using GraphPad Prism 7 version 7.0 (GraphPad Software, USA). Student’s t-test was used to compare between 2 groups. Comparison among more than 2 groups was done using one-way analysis of variance (ANOVA). Data presented as median±standard deviation (SD).Results: Both, transplantation of hUC-MSCs and application of EVs resulted in a reduction of peribronchial and perivascular inflammation, alveolar septal thickening associated with mononuclear inflammation, as well as a decreased number of goblet cells. Moreover, hUC-MSCs and EVs ameliorated the loss of alveolar septa in the emphysematous lung of COPD rats and reduced the levels of NF-κB subunit p65 in the tissue. Subsequent microarray analysis revealed that both hUC-MSCs and EVs significantly regulate multiple pathways known to be associated with COPD. Conclusions: In conclusion, we show that hUC-MSCs-derived EVs effectively ameliorate by COPD-induced inflammation. Thus, EVs could serve as a new cell-free based therapy for the treatment of COPD.
Recommendation Regarding the Cranial Upper Border of Level IIb in Delineating Clinical Target Volumes (CTV) for Nasopharyngeal Carcinoma
Authors: Wang Lijun , Huang Shengfu , Zhang Lanfang , He Xia , Liu Yatian
Published: November 2020

Purpose: To recommend a cranial border for level IIb in delineating clinical target volumes (CTV) for nasopharyngeal carcinoma (NPC) patients receiving intensity-modulated radiotherapy and to help reach a consensus on contouring level IIb in CTV.Methods: From 2012 to 2016, 331 nonmetastatic NPC patients treated with IMRT were retrospectively enrolled. Based on the AJCC 8th staging system of NPC, there were 15 stage I, 76 stage II, 103 stage III, and 137 stage IV patients. The distribution of cervical lymph nodes in NPC was assessed based on imaging. Comparisons of the safety and parotid dose parameters between patients with and without a reduction in the size of level IIb were conducted using SPSS 25.0 and R 2.14.2 software.Results: Metastasis rates in the most commonly involved lymph nodes, the lateral retropharyngeal and IIb nodes, were 82.8% and 64.0%, respectively. Among patients with level IIb involvement, the upper borders of the metastatic nodes were beyond the caudal edge of C1 in 13.7% of cases. The parotid gland D50 and V26 values were significantly reduced after modifying the upper bound of level IIb used to delineate the CTV (P = 0. 000).Conclusion: In principle, the upper bound of level IIb should reach the lateral skull base during delineation of the cervical CTV for NPC. To protect the parotid glands, however, individualized reduction of the upper bound of level IIb is recommended for patients who meet certain criteria.
Down-regulated RPS-30 in Angiostrongylus cantonensis L5 plays a defensive role against damage due to oxidative stress
Authors: Sun Wei-Wei , Yan Xiu-Mei , Shi Qing , Zhang Yuan-Jiao , Huang Jun-Ting , Huang Hui-Cong , Shi Hong-Fei , Yan Bao-Long
Published: November 2020

Background: Eosinophilic meningitis, caused by Angiostrongylus cantonensis L5, is mainly attributed to the Eosinophils, which contribute to tissue inflammatory responses in helminthic infections. Eosinophils are associated with helminthic killing, using the peroxidative oxidation and hydrogen peroxide (H2O2) generated by dismutation of superoxide produced during respiratory burst. In contrast, residing in the host with high level of eosinophils, helminthic worms have evolved to attenuate eosinophil-mediated tissue inflammatory responses for their survival in hosts. Our previous study demonstrated that the expression of Acan-rps-30 was significantly down-regulated in A. cantonensis L5 worms, which reside in the cerebrospinal fluid with high level of Eosinophils. Acan-RPS-30, a homologous protein of human Fau, which plays a pro-apoptotic regulatory role, may function in protecting worms from oxidative stress.Methods: RACE, genome Walking, bioinformatics were used to isolate and analyse the structural characterisation of Acan-RPS-30; qRT-PCR and microinjection was performed to detect the expression patterns of Acan-rps-30; feeding RNAi was used to ced-3 knock-down; microinjection was performed to construct transgenic worms; oxidative stress assay was used to determine the functions of Acan-RPS-30.Results: Our results showed that Acan-RPS-30 consisted of 130 amino acids, and was grouped into Clade V with C. elegans in phylogenetic analysis. It was expressed ubiquitously in worms and was down-regulated in both L5 and adult A. cantonensis. Worms expressing pCe-rps30::Acan-rps-30::rfp, with the refractile “button-like” apoptotic corpses, were susceptible to oxidative stress. Apoptosis genes ced-3 and ced-4 were both up-regulated in the transgenic worms. And the phenotype susceptible to oxidative stress could be converted with ced-3 defective mutation and RNAi. rps-30–/– mutant worms were resistant to oxidative stress, with ced-3 and ced-4 were both down-regulated. And the oxidative stress resistance phenotype could be rescued and inhibited by expressing pCe-rps30::Acan-rps-30::rfp in rps-30–/– mutant worms.Conclusion: In C. elegans worms, down-regulated RPS-30 plays a defensive role against damage due to oxidative stress for worm survival by regulating ced-3 down-regulated. And this might indicate the mechanism of A. cantonensis L5 worms, with Acan-RPS-30 down-regulated, surviving in the central nervous system of human from immune attack of Eosinophil.
Resuscitation fluid types in sepsis, surgical, and trauma patients: A Systematic review and sequential network meta-analyses
Authors: Tseng Chien-Hua , Chen Tzu-Tao , Wu Mei-Yi , Chan Ming-Cheng , Shih Ming-Chieh , Tu Yu-Kang
Published: November 2020

Background: Crystalloids and different component colloids, used for volume resuscitation, are sometimes associated with various adverse effects. Clinical trial findings for such fluid types in different patients’ conditions are conflicting. Whether the mortality benefit of balanced crystalloid than saline can be infer from sepsis to other patient group is uncertain, and adverse effect profile is not comprehensive. This study aims to compare the survival benefits and adverse effects of seven fluid types with network meta-analysis in sepsis, surgical, trauma, and traumatic brain injury patients. Methods: Searched databases (PubMed, EMBASE, and Cochrane CENTRAL) and reference lists of relevant articles occurred from inception until January 2020. Studies on critically ill adults requiring fluid resuscitation were included. Intervention studies reported on balanced crystalloid, saline, iso-oncotic albumin, hyperoncotic albumin, low molecular weight hydroxyethyl starch (L-HES), high molecular weight HES, and gelatin. Network meta-analyses were conducted using random-effects model to calculate odds ratio (OR) and mean difference. Risk of Bias tool 2.0 was used to assess bias. CINeMA (Confidence in Network Meta-Analysis) web application was used to rate confidence in synthetic evidence. Results: Fifty-eight trials (n=26,351 patients) were identified. Seven fluid types were evaluated. Among patients with sepsis and surgery, balanced crystalloids and albumin achieved better survival, fewer acute kidney injury, and smaller blood transfusion volumes than saline and L-HES. In those with sepsis, balanced crystalloids significantly reduced mortality more than saline (OR, 0.84; 95% CI 0.74 to 0.95) and L-HES (OR, 0.81; 95% CI 0.69 to 0.95) and reduced acute kidney injury more than L-HES (OR, 0.80; 95% CI 0.65 to 0.99). However, they required the greatest resuscitation volume among all fluid types, especially in trauma patients. In patients with traumatic brain injury, saline and L-HES achieved lower mortality than albumin and balanced crystalloids; especially saline was significantly superior to iso-oncotic albumin (OR, 0.55; 95% CI 0.35 to 0.87).Conclusions: Our network meta-analysis found that balanced crystalloids and albumin decreased mortality more than L-HES and saline in sepsis patients; however, saline or L-HES, was better than iso-oncotic albumin or balanced crystalloids in traumatic brain injury patients.
The interaction of water with archaeological and ethnographic birch bark and its effects on swelling, shrinkage and deformations
Authors: Klügl Johanna , Pietro Giovanna Di
Published: November 2020

The aim of this study is to gain specific information on the water behaviour of archaeological and ethnographic birch bark. Water is involved in a number of curative and preventive conservation measurements e.g. when re-shaping or drying objects and when defining climate directives for long-term storage. We measured the sorption isotherm of archaeological, ethnographic and contemporary birch bark at different temperatures and analysed the moisture-induced size and shape changes (swelling, shrinkage, deformation) during humidification and drying. The analysis revealed that, compared to other organic materials like wood, the moisture uptake of outer birch bark is modest. This can be attributed to the cell structure and composition: outer birch bark is composed of closed cells made to a large extent of hydrophobic components (suberin, lignin). The equilibrium moisture content is higher if lenticels or inner bark are present. The extent of brittleness and delamination of the sample influences the sorption behaviour: the least brittle and delaminated archaeological birch bark is, the lower the equilibrium moisture content. As the moisture uptake is modest, the related swelling of the outer bark is also modest, but anisotropic being larger in radial direction and smaller in longitudinal and negligible in tangential direction. Water vapour can plasticize birch bark and as birch bark becomes flexible, it bends towards the outside of the bark. This deformation takes place at high moisture contents and the adsorption process is slow. Based on these results recommendations on how best to perform treatments involving moisture and on relative humidity ranges for birch bark objects are provided.
Bioinformatics analysis of autophagy-related lncRNAs in esophageal carcinoma
Authors: Wu Dan , Ding Yi , fan junbai
Published: November 2020

Background: Esophageal carcinoma (ESCA) is a malignant tumor with high invasiveness and mortality. Autophagy has multiple roles in the development of cancer; however, there are limited data on autophagy genes associated with long non-coding RNAs (lncRNAs) in ESCA. The purpose of this study was to screen potential diagnostic and prognostic molecules, and to identify gene co-expression networks associated with autophagy in ESCA. Methods: We downloaded transcriptome expression profiles from The Cancer Genome Atlas and autophagy-related gene data from the Human Autophagy Database, and analyzed the co-expression of mRNAs and lncRNAs. In addition, the diagnostic and prognostic value of autophagy-related lncRNAs was analyzed by multivariate Cox regression. Furthermore, Kyoto Encyclopedia of Genes and Genomes analysis was carried out for high-risk patients, and enriched pathways were analyzed by gene set enrichment analysis. Results: The results showed that genes of high-risk patients were enriched in protein export and spliceosome. Based on Cox stepwise regression and survival analysis, we identified seven autophagy-related lncRNAs with prognostic and diagnostic value, with the potential to be used as a combination to predict the prognosis of patients with ESCA. Finally, a co-expression network related to autophagy was constructed. Conclusion: These results suggest that autophagy-related lncRNAs and the spliceosome play important parts in the pathogenesis of ESCA. Our findings provide new insight into the molecular mechanism of ESCA and suggest a new method for improving its treatment.