bluuebunny/crossref_metadata_2025 huggingface dataset:
Determinants and aetiologies of postpartum pyrexia; a retrospective analysis in a tertiary health facility in the Littoral Region of Cameroon
Authors: Ngunyi Yannick Lechedem , Halle-Ekane Gregory , Tendongfor Nicholas , Mbivnjo Etheldreda Leinyuy , Evouna Mbarga Armel , Nembulefack Derick , Lo-oh Clifford Abonge , Egbe Thomas Obinchemti
Published: March 2020

Background

Postpartum febrile morbidity is relatively common, occurring in approximately 5–7% of births. Differentiating between potentially serious and benign causes of postpartum pyrexia (PP) is fundamental in curbing the mortality rate from sinister causes such as sepsis. The paucity of data on PP in Cameroon makes it difficult to access its actual burden. This study was aimed at determining the prevalence, risk factors and aetiologies of PP at a tertiary hospital in Douala, Cameroon.

Methods

This was a 2 – year hospital – based retrospective cohort study carried out at the Douala General Hospital (DGH), during which medical records of all postpartum admissions between January 1st 2017 and December 31st 2018 were reviewed. The review consisted of collecting data on socio-demographic characteristics, clinical profile, investigations and final diagnoses. The collected data was analysed in SPSS 23.0. Chi-squared test was used to test the association between variables and a logistic regression analysis was fitted to identify risk factors associated to PP.

Results

A total of 1520 postpartum files were reviewed. The prevalence of PP was 8.82%. The most frequent causes of PP were: malaria (46.7%), urinary tract infections (18.7%), puerperal sepsis (17.9%) and pneumonia (8.7%). E. coli was the most (49.3%) cultured germ isolated in positive cultures. Onset of PP was more common (85%) within the first 3 days postpartum and malaria (60%) was the leading aetiology within this period. Five or more vaginal examinations prior to delivery (OR 59.151, 95% CI: 21.463–163.019; p < 0.001), perineal tears (OR 45.157, 95% CI: 2.266–899.722; p < 0.001), and duration of labour > 18 h (OR 26.760, 95% CI: 7.100–100.862; p < 0.001) were the most significant risk factors associated with PP.

Conclusion

Approximately 1 in every 12 postpartum cases in the DGH presents with PP. Malaria was the leading cause of PP at DGH especially for cases registered within 3 days postpartum. The risk factors identified were mostly associated to perinatal events, such as frequent vaginal examinations, perineal tears and prolonged labour. Efforts towards preventing identified risk factors thus becomes paramount in order to curb this high rate of PP in the DGH.
Pregnancy outcomes of dichorionic triamniotic triplet pregnancies after in vitro fertilization-embryo transfer: multifoetal pregnancy reduction versus expectant management
Authors: Cai Pei , Ouyang Yan , Gong Fei , Li Xihong
Published: March 2020

Background

Trichorionic triplet pregnancy reduction to twin pregnancy is associated with a lower risk of preterm delivery but not with a lower risk of miscarriage. However, data on dichorionic triamniotic (DCTA) triplet pregnancy outcomes are lacking. This study aimed to compare the pregnancy outcomes of DCTA triplets conceived via in vitro fertilization-embryo transfer (IVF-ET) managed expectantly or reduced to a monochorionic (MC) singleton or monochorionic diamniotic (MCDA) twins at 11–13+ 6 gestational weeks.

Methods

Two hundred ninety-eight patients with DCTA triplets conceived via IVF-ET between 2012 and 2016 were retrospectively analysed. DCTA triplets with three live foetuses were reduced to a MC singleton (group A) or MCDA twins (group B) or underwent expectant management (group C). Each multifoetal pregnancy reduction (MFPR) was performed at 11–13+ 6 gestational weeks. Pregnancy outcomes in the 3 groups were compared.

Results

Eighty-four DCTA pregnancies were reduced to MC singleton pregnancies, 149 were reduced to MCDA pregnancies, and 65 were managed expectantly.

There were no significant differences among groups A, B, and C in miscarriage rate (8.3 vs. 7.4 vs. 10.8%, respectively) and live birth rate (90.5 vs. 85.2 vs. 83.1%, respectively) (P > 0.05).

Group A had significantly lower rates of preterm birth (8.3 vs. 84.6%; odds ratio (OR) 0.017, 95% confidence interval (CI) 0.006–0.046) and low birth weight (LBW; 9.2 vs. 93.2%; OR 0.007, 95% CI 0.003–0.020) than group C (P < 0.001).

Group B had significantly lower preterm birth (47.0 vs. 84.6%; OR 0.161, 95% CI 0.076–0.340) and LBW rates (58.7 vs. 93.2%; OR 0.103, 95% CI 0.053–0.200) than group C (P < 0.001).

Group A had significantly lower preterm birth (8.3 vs. 47.0%; OR 0.103, 95% CI 0.044–0.237; P < 0.001), LBW (9.2 vs. 58.7%; OR 0.071, 95% CI 0.032–0.162; P < 0.001) and perinatal death rates (1.3 vs. 9.1%; OR 0.132, 95% CI 0.018–0.991; P = 0.021) than group B.

Conclusion

The MFPR of DCTA triplets to singleton or MCDA pregnancies was associated with better pregnancy outcomes compared to expectant management. DCTA triplets reduced to singleton pregnancies had better perinatal outcomes than DCTA triplets reduced to MCDA pregnancies.
P16 as a marker of carcinoma in effusions and peritoneal washing
Authors: Carneiro Fabiana Pirani , Amorim Rivadávio Fernandes , de Vasconcelos Carneiro Marcos , de Castro Tercia Maria Mendes Lousa , de Souza Vianna Leonora Maciel , Takano Gustavo Henrique Soares , Daros Andersen Charles , Peres Isabela , Kuckelhaus Selma Aparecida Souza , Motoyama Andrea Barretto
Published: March 2020

Background

Considering the potential of p16 as a marker for diagnosis, prognosis and therapeutic response, the aim of this study was to assess its presence, via immunocytochemistry, in metastatic carcinoma of different primary sites and histological types obtained from effusions and peritoneal washings. A total of 118 samples including 85 of metastatic carcinoma and 33 samples of benign effusion/peritoneal washing were prepared by the plasma/thromboplastin method. Immunocytochemistry reactions were performed on cell block sections using antibodies against p16, claudin-4, MOC-31, calretinin, HBME and CD68.

Results

P16 overexpression was observed in 88.23% of all carcinoma samples. All cervix adenocarcinoma samples showed p16 overexpression. Overexpression in adenocarcinomas of ovary, lung and breast was observed in 93.75, 93.10 and 75% of the samples, respectively. Overexpression was observed in all different histological types analyzed: small cell carcinoma (lung), squamous cell carcinoma (cervical) and urothelial carcinoma (bladder). The specificity of p16 for carcinoma detection was of 96.96%.

Conclusion

Overexpression of p16 was observed in most metastatic carcinoma, from different primary sites and histological types, obtained from effusions and peritoneal washings. Due to its high frequency of overexpression in metastatic carcinoma, p16 may play a possible role in tumor progression and it may be considered as a complementary diagnostic marker depending on histological type and primary site of carcinoma.
A convolutional neural network-based system to classify patients using FDG PET/CT examinations
Authors: Kawauchi Keisuke , Furuya Sho , Hirata Kenji , Katoh Chietsugu , Manabe Osamu , Kobayashi Kentaro , Watanabe Shiro , Shiga Tohru
Published: March 2020

Background

As the number of PET/CT scanners increases and FDG PET/CT becomes a common imaging modality for oncology, the demands for automated detection systems on artificial intelligence (AI) to prevent human oversight and misdiagnosis are rapidly growing. We aimed to develop a convolutional neural network (CNN)-based system that can classify whole-body FDG PET as 1) benign, 2) malignant or 3) equivocal.

Methods

This retrospective study investigated 3485 sequential patients with malignant or suspected malignant disease, who underwent whole-body FDG PET/CT at our institute. All the cases were classified into the 3 categories by a nuclear medicine physician. A residual network (ResNet)-based CNN architecture was built for classifying patients into the 3 categories. In addition, we performed a region-based analysis of CNN (head-and-neck, chest, abdomen, and pelvic region).

Results

There were 1280 (37%), 1450 (42%), and 755 (22%) patients classified as benign, malignant and equivocal, respectively. In the patient-based analysis, CNN predicted benign, malignant and equivocal images with 99.4, 99.4, and 87.5% accuracy, respectively. In region-based analysis, the prediction was correct with the probability of 97.3% (head-and-neck), 96.6% (chest), 92.8% (abdomen) and 99.6% (pelvic region), respectively.

Conclusion

The CNN-based system reliably classified FDG PET images into 3 categories, indicating that it could be helpful for physicians as a double-checking system to prevent oversight and misdiagnosis.
Microvascular changes in macula and optic nerve head after femtosecond laser-assisted LASIK: an optical coherence tomography angiography study
Authors: Zhang Yan , Lan Jianqing , Cao Dan , Yang Cheng , Yang Dawei , Xie Wenjuan , Zeng Jin
Published: March 2020

Background

To measure the microcirculation change of macula and optic nerve head before and after femtosecond laser assisted laser in situ keratomileusis.

Methods

In total 45 eyes from 45 subjects, who underwent FS-LASIK during June 2017 to December 2017 in Guangdong Provincial People’s Hospital, were recruited in this study. Vessel density in macula and optic nerve head were measured by optical coherence tomography angiography before and after transient elevation in intraocular pressure caused by application of suction ring during surgery.

Results

Vessel density (VD) at superficial (SCP) plexus of macular region did not differ after surgery (F(3,132) = 1.41,P = 0.24), while the deep (DCP) plexus of macular region significantly decreased 1 day after surgery (P = 0.001) but returned to its baseline value 1 month postoperatively (P = 0.1). Vessel density of optic nerve head region had no significant changes after surgery (F(2.51,95.18) = 0.6,P = 0.59).

Conclusions

A short-term temporary decrease of vessel density at deep layer of macular region was observed in eyes undergoing FS-LASIK. However, the retinal capillary density went back to preoperative level 1 month after surgery. Therefore, transient IOP spike during FS-LASIK did not cause long-term decline of retinal microcirculation.
Development and spontaneous closure of a secondary macular hole associated with submacular hemorrhage due to polypoidal choroidal vasculopathy: a case report
Authors: Chino Minami , Yoshikawa Yuji , Kanno Junji , Nagashima Takamitsu , Sakaki Yu , Katsumoto Takeshi , Shibuya Masayuki , Shoji Takuhei , Makita Jun , Shinoda Kei
Published: March 2020

Background

Macular hole (MH) is a retinal break in the fovea involving partial or complete dehiscence of the neural retinal layers affecting the visual quality by decreasing visual acuity (VA) and visual deformation. We describe a case of secondary MH associated with submacular hemorrhage (SMH) due to polypoidal choroidal vasculopathy (PCV), which showed spontaneous closure.

Case presentation

A 67-year-old man developed decreased VA in his right eye due to an SMH. The VA was 20/50, and monthly intravitreal injection of aflibercept was administered three times. The SMH gradually decreased, and 10 months later the external limiting membrane was found to be perforated, resulting in MH. The old clot disappeared, and the MH remained for 10 months. Twenty-three months later, serous retinal detachment (SRD) involving the macula appeared and the MH had disappeared. SRD gradually disappeared, and macular configuration recovered. VA gradually improved and became 20/20 38 months later.

Conclusion

Dynamic change of the ultrastructure in an unusual case of secondary-developed and spontaneously closed MH was clearly observed. Although the mechanism was unknown, the small diameter size and exudative PCV are thought to have contributed to the closure.
Retinal endothelial cell phenotypic modifications during experimental autoimmune uveitis: a transcriptomic approach
Authors: Lipski Deborah A. , Foucart Vincent , Dewispelaere Rémi , Caspers Laure E. , Defrance Matthieu , Bruyns Catherine , Willermain François
Published: March 2020

Background

Blood-retinal barrier cells are known to exhibit a massive phenotypic change during experimental autoimmune uveitis (EAU) development. In an attempt to investigate the mechanisms of blood-retinal barrier (BRB) breakdown at a global level, we studied the gene regulation of total retinal cells and retinal endothelial cells during non-infectious uveitis.

Methods

Retinal endothelial cells were isolated by flow cytometry either in Tie2-GFP mice (CD31+ CD45− GFP+ cells), or in wild type C57BL/6 mice (CD31+ CD45− endoglin+ cells). EAU was induced in C57BL/6 mice by adoptive transfer of IRBP1–20-specific T cells. Total retinal cells and retinal endothelial cells from naïve and EAU mice were sorted and their gene expression compared by RNA-Seq. Protein expression of selected genes was validated by immunofluorescence on retinal wholemounts and cryosections and by flow cytometry.

Results

Retinal endothelial cell sorting in wild type C57BL/6 mice was validated by comparative transcriptome analysis with retinal endothelial cells sorted from Tie2-GFP mice, which express GFP under the control of the endothelial-specific receptor tyrosine kinase promoter Tie2. RNA-Seq analysis of total retinal cells mainly brought to light upregulation of genes involved in antigen presentation and T cell activation during EAU. Specific transcriptome analysis of retinal endothelial cells allowed us to identify 82 genes modulated in retinal endothelial cells during EAU development. Protein expression of 5 of those genes (serpina3n, lcn2, ackr1, lrg1 and lamc3) was validated at the level of inner BRB cells.

Conclusion

Those data not only confirm the involvement of known pathogenic molecules but further provide a list of new candidate genes and pathways possibly implicated in inner BRB breakdown during non-infectious posterior uveitis.
The lived experience of chronic pain and dyskinesia in children and adolescents with cerebral palsy
Authors: McKinnon Clare T. , White Jennifer H. , Morgan Prue E. , Antolovich Giuliana C. , Clancy Catherine H. , Fahey Michael C. , Harvey Adrienne R.
Published: March 2020

Background

To explore the lived experience of chronic pain and dyskinesia in children and adolescents with cerebral palsy.

Methods

A convergent parallel mixed methods design was undertaken. First, a quantitative cross-sectional study of participants able to self-report their quality of life was undertaken. This study characterised pain chronicity, intensity, body locations, and quality of life. Second, semi-structured interviews were undertaken with a subset of children and adolescents experiencing chronic pain.

Results

Twenty-five children and adolescents took part in the cross-sectional study, 23 of whom experienced chronic pain and 13 of moderate intensity. Pain was often located in multiple bodily regions (6/21), with no trends in quality of life outcomes detected. Eight participated in semi-structured interviews, which identified three key themes including ‘lives embedded with dyskinesia’, ‘real world challenges of chronic pain’, and ‘still learning strategies to manage their pain and dyskinesia’.

Conclusions

A high proportion of children and adolescents with cerebral palsy and dyskinesia who were able to self-report experienced chronic pain. The physical and emotional impacts of living with chronic pain and dyskinesia existed along a spectrum, from those with lesser to greater extent of their impacts. Children and adolescents may benefit from targeted chronic pain education and management within bio-psychosocial models.
The role of family factors in antiretroviral therapy (ART) adherence self-efficacy among HIV-infected adolescents in southern Uganda
Authors: Nabunya Proscovia , Bahar Ozge Sensoy , Chen Bin , Dvalishvili Daji , Damulira Christopher , Ssewamala Fred M.
Published: March 2020

Background

Adolescents living with HIV in sub-Saharan Africa are a vulnerable group at the intersection of poverty and health disparities. The family is a vital microsystem that provides financial and emotional support to achieve optimal antiretroviral therapy (ART) adherence. In this study, we explore the association between family factors and ART adherence self-efficacy, a significant psychological concept playing a critical role in ART adherence.

Methods

Data from an NIH-funded study called Suubi + Adherence, an economic empowerment intervention for HIV positive adolescents (average age = 12.4 years) in southern Uganda was analyzed. We conducted multilevel regression analyses to explore the protective family factors, measured by family cohesion, child-caregiver communication and perceived child-caregiver support, associated with ART adherence self-efficacy.

Results

The average age was 12.4 years and 56.4% of participants were female. The average household size was 5.7 people, with 2.3 children> 18 years. Controlling for sociodemographic and household characteristics, family cohesion (β = 0.397, p = 0.000) and child-caregiver communication (β = 0.118, p = 0.026) were significantly associated with adherence self-efficacy to ART.

Conclusion

Findings point to the need to strengthen family cohesion and communication within families if we are to enhance adherence self-efficacy among adolescents living with HIV.

Trial registration

This trial was registered with ClinicalTrials.gov (registration number: NCT01790373) on 13 February 2013.
Evidence, theory and context: using intervention mapping in the development of a community-based self-management program for chronic low back pain in a rural African primary care setting - the good back program
Authors: Igwesi-Chidobe Chinonso N. , Kitchen Sheila , Sorinola Isaac O. , Godfrey Emma L.
Published: March 2020

Background

Rural Nigeria has one of the greatest burdens of low back pain but there are no effective evidence-based interventions to manage it in this population. This paper presents the application of the intervention mapping (IM) approach in the development of a complex behavior change intervention – The Good Back program, aimed at reducing non-specific chronic low back pain (CLBP) disability in rural Nigeria.

Methods

The first four steps of IM were applied. A critical review of the literature, 2 qualitative studies and a population-based cross-sectional study in rural Nigeria helped to identify two key program objectives in order to reduce CLBP disability in this population: reduce the impact of illness perceptions, fear avoidance beliefs, catastrophising, anxiety and depression by targeting maladaptive illness perceptions about CLBP; and facilitate the adoption of exercises and good posture to limit disability. A systematic review plus these studies, identified the personal and environmental determinants of the performance objectives including health literacy, self-awareness, self-efficacy, personal preference, health professional skills, health facility structure and family/community support. The theory, techniques and strategies for modifying personal and environmental determinants were also identified from these studies. Intervention components and materials were then produced for practical application. The initial developed intervention was described.

Results

The feasibility and acceptability of the developed program was then tested using a small pragmatic non-randomised controlled study incorporating qualitative exit feedback interviews in a rural Nigerian primary health care centre. The program appeared feasible and acceptable when delivered by a highly trained physiotherapist. There were promising clinical outcomes in disability, pain intensity, illness perceptions, fear avoidance beliefs and pain medication use. Suggestions for program improvement included shorter but ongoing sessions, video demonstration of exercises/good posture, spacious exercise/demonstration rooms, and community legitimisation of exercise as treatment for back pain. Subsequent modifications to program content and delivery were then described. Theoretical modification included the addition of aspects of the social cognitive theory to the Leventhal’s self-regulatory model of illness cognitions.

Conclusions

IM appears to be a suitable framework for designing complex behavior change interventions in rural Nigeria. The need for further testing of the intervention was highlighted.
Dilation of the cystic duct confluence in laparoscopic common bile duct exploration and stone extraction in patients with secondary choledocholithiasis
Authors: Yang Xiao-Bin , Xu An-Shu , Li Jian-Gang , Xu Yong-Ping , Xu De-Song , Fu Chao-Chun , Deng Da-Bo , Li Jie , Zhang Ma-Zhong
Published: March 2020

Background

Many options exist for the management of cholelithiasis and secondary choledocholithiasis. Among them, laparoscopic common bile duct exploration (LCBDE) with choledocotomy followed by laparoscopic cholecystectomy has gained popularity. However, efforts should be made to ensure minimally invasive or noninvasive management of the common bile duct (CBD). The purpose of this study was to explore the clinical experience of non-invasive surgical modality, i.e., laparoscopic transcystic dilation of the cystic duct confluence in CBD exploration (LTD-CBDE), including feasibility, safety, adverse events, and incidence.

Methods

In this retrospective analysis, 68 patients were offered the LTD-CBDE technique from December 2015 to April 2018 based on patient’s own intention. During the surgery, the cystic duct confluence was dilated with separation forceps and/or a columnar dilation balloon. Subsequently, CBD exploration and stone extraction were performed with a choledochoscope. The entrance of the CBD was covered with a cystic duct stump wall and was subjected to primary closure at the end of surgery.

Results

Forty-nine females and 19 males with cholelithiasis and secondary choledocholithiasis were included. The mean age was 53 years old (18 to 72 year). Of these patients, 62 (91.2%) were successfully treated with the LTD-CBDE technique, and bile leakage was observed in 3 patients (4.4%). The mean operation time was 106 min, and the mean hospital stay was 5.9 days. Among the other 6 patients, 3 were converted to open cholecystectomy due to severe fibrosis, unclear anatomical structure at Calot’s triangle (n = 2) or Mirizze syndrome (n = 1); LCBDE was performed in 3 patients due to cystic duct atresia (n = 2) and low level of flow from the gallbladder duct into the CBD (n = 1). These patients had a smooth postoperative course. In total, 43/68 of the patients presented no radiological evidence of retained CBD stones at the postoperative follow-up (40 patients treated with LTD-CBDE) 1 year later.

Conclusions

The current work suggests that LTD-CBDE for the management of cholelithiasis and secondary choledocholithiasis is a feasible, safe and effective technique with a low complication rate. LTD-CBDE offers another alternative for surgeons to treat patients in similar scenarios. However, additional randomized, controlled studies are needed to demonstrate its efficacy, safety, and impact on CBD stenosis.
Rectal perforation following endorectal prostate MRI: an unexpected complication
Authors: Hsu I , Lee Chia-Chen , Chen Ming-Jenn
Published: March 2020

Background

Prostate cancer is a common cancer among men in developed countries. Prostate magnetic resonance imaging (MRI) has been widely employed for early diagnosis of prostate cancer and recommending a treatment plan. The incidence of rectal perforation during endorectal prostate MRI is rare and has never been reported before. Herein, we present a case of rectal perforation after a prostate MRI examination that was subjected to emergency surgical intervention because of the acute presentation of generalized peritonitis. Patients with systemic comorbidities are reportedly at greater risks of encountering colonoscopic perforation. Endorectal prostate MRI is a safe diagnostic modality, but inadequate lubrication of the endorectal coil or over-insufflation of the balloon during the procedure may also lead to serious complications such as hollow organ perforation. Early surgery will be necessary should peritoneal symptoms persist.

Case presentation

In 2015, a 56-year-old man came to our ER due to acute abdominal pain after he finished his MRI exam. The exam indicated diffuse tenderness over his abdomen and at the ER, his abdominal CT (computerized tomography) was checked. The images revealed extraluminal air in the perirectal fat and the pneumoperitoneum. In response, exploratory laparotomy, simple closure of rectal perforation, and loop-S colostomy were performed and the patient was discharged 1 month after operation.

Conclusions

Prostate MRI is a secure procedure with few complications. Clinicians must keep in mind the possibility of perforation when using ultrasound probe. Hollow organ perforation can result in serious morbidity or death. As a result, patients need to be informed of the complications of prostate MRI. When performing the procedure, clinicians must be cautioned about the potential problems for patients with high-anesthetic risk.
The association between beverage consumption pattern and dental problems in Iranian adolescents: a cross sectional study
Authors: Hasheminejad Naimeh , Malek Mohammadi Tayebeh , Mahmoodi Mohammad Reza , Barkam Moein , Shahravan Arash
Published: March 2020

Background

With regard to the increasing consumption rates of unhealthy beverages among adolescents, the main purpose of the present study was to determine the association between beverage intake pattern and dental caries and tooth erosion in this age group.

Methods

A total sample of 600 adolescents was recruited in this study using a multistage cluster random sampling method in the city of Kerman, in the southeast of Iran, in 2017. Then, the Decayed, Missed and Filled Teeth (DMFT) index and the Tooth Wear Index (TWI) were registered for each participant. A Beverage Frequency Questionnaire was also employed to estimate typical beverage intake frequency. Correspondingly, negative binominal regression and logistic regression were performed to determine the independent variables associated with the DMFT index and the TWI.

Results

The findings revealed that the highest consumed beverage in daily living was tea in both genders, followed by sweetened soft beverages, as well as milk and kefir/yogurt drink. The results of the DMFT index were also significantly different in participants that had never consumed milk compared with those who had used milk on a daily basis. Moreover, the DMFT index in participants who had never consumed sweetened soft beverages was 39%, less than those who had had a daily intake of such beverages. Also, the chance of tooth erosion for participants who had never used sweetened soft beverages was 94%, lower than that in daily consumers.

Conclusions

The results of this study revealed that adolescents had an unhealthy beverage intake pattern. Furthermore, milk consumption was beneficial to dental caries, whereas use of soft drinks associated with more dental caries and tooth erosion.
Recommended procedures for the management of early childhood caries lesions – a scoping review by the Children Experiencing Dental Anxiety: Collaboration on Research and Education (CEDACORE)
Authors: Corrêa-Faria Patrícia , Viana Karolline Alves , Raggio Daniela Prócida , Hosey Marie Therese , Costa Luciane Rezende
Published: March 2020

Background

Early childhood caries (ECC) affects millions of children up to 6 years old. Its treatment positively impacts the quality of life of children and their families. However, there is no consensus on how to treat ECC. Thus, we performed a scoping review to identify the recommended procedures for the management of ECC lesions.

Methods

A search was performed in PubMed, Scopus, The Cochrane Library, The International Guideline Library and pediatric dentistry associations around the world were contacted by email for unpublished search documents. ECC guidelines/guidance/policies were considered eligible regardless of language and publication date.

Results

From a total of 828 references, 52 full-text articles were assessed for eligibility and 22 included in the scoping review. We found different procedures recommendations for the management of ECC lesions. For incipient lesions, minimally invasive methods such as professional fluoride and cariostatic (silver diamine) applications, as well as surveillance were recommended. If restoration was required, the recommended materials were glass ionomer cement, composite resin, amalgam and stainless-steel crown. Interim restorations and Atraumatic Restorative Treatment (ART) were also recommended. Extractions have been suggested for teeth with lesions with pulpal involvement, depending on the child’s behaviour and other clinical conditions.

Conclusions

Non-operative procedures, restorative and extraction were recommended for the management of ECC, depending on the extent of the lesions. There is no difference between different management guidelines/guidance/policies for ECC lesions.
Increasing preparedness for caregiving and death in family caregivers of patients with severe illness who are cared for at home – study protocol for a web-based intervention
Authors: Alvariza Anette , Häger-Tibell Louise , Holm Maja , Steineck Gunnar , Kreicbergs Ulrika
Published: March 2020

Background

Family caregivers of patients with severe illness and in need for a palliative care approach, face numerous challenges and report having insufficient preparedness for the caregiver role as well as a need for information and psychosocial support. Preparing to care for a severely ill family members also means becoming aware of death. Feelings of being prepared are associated with positive aspects and regarded protective against negative health consequences.

Methods

The study adheres to the SPIRIT-guidelines (Supplementary 1), uses a pre-post design and include a web-based intervention. Inclusion criteria are; being a family caregiver of a patient with severe illness and in need of a palliative care approach. The intervention which aims to increase preparedness for caregiving and death is grounded in theory, research and clinical experience. The topics cover: medical issues, symptoms and symptom relief; communication within the couple, how to spend the time before death, being a caregiver, planning for the moment of death and; considerations of the future. The intervention is presented through videos and informative texts. The website also holds an online peer-support discussion forum. Study aims are to: evaluate feasibility in terms of framework, content, usage and partners’ experiences; explore how the use of the website, influences family caregivers’ preparedness for caregiving and death; explore how the use of the website influences family caregivers’ knowledge about medical issues, their communication with the patient and their considerations of the future; and to investigate how the family caregivers’ preparedness for caregiving and death influences their physical and psychological health and quality of life 1 year after the patient’s death. Data will be collected through qualitative interviews and a study-specific questionnaire at four time-points.

Discussion

This project will provide information about whether support via a website has the potential to increase preparedness for caregiving and death and thereby decrease negative health consequences for family caregivers of patients affected by severe illness. It will provide new knowledge about intervention development, delivery, and evaluation in a palliative care context. Identification of factors before death and their association with family caregivers’ preparedness and long-term health may change future clinical work.

Trial registration

The study is registered atClinicalTrials.gov:NCT03676283.
Risk of hypertension in women with polycystic ovary syndrome: a systematic review, meta-analysis and meta-regression
Authors: Amiri Mina , Ramezani Tehrani Fahimeh , Behboudi-Gandevani Samira , Bidhendi-Yarandi Razieh , Carmina Enrico
Published: March 2020

Background

A limited number of publications have assessed the prevalence of hypertension (HTN) in polycystic ovary syndrome (PCOS) patients with inconclusive results. Since in general populations the occurrence of hypertension is related to age per se, we investigated the prevalence (P) / relative risk (RR) of HTN in pooled patients with PCOS, vs control population among reproductive age women with PCOS, compared to menopause/aging patients.

Methods

PubMed, Scopus, ScienceDirect, web of science, and Google scholar were systematically searched for retrieving observational studies published from inception to April 2019 investigating the HTN in patients with PCOS. The primary outcome of interest was pooled P and RR of HTN in reproductive and menopausal/aging women with PCOS compared to control population.

Results

The pooled prevalence of HTN in reproductive and menopausal/aging women with PCOS was higher than in the control population [(Pooled P: 0.15, 95% CI: 0.12–0.18 vs. Pooled P: 0.09, 95% CI: 0.08–0.10) and (Pooled P: 0.49, 95% CI: 0.28–0.70 vs. Pooled P: 0.40, 95% CI: 0.22–0.57), respectively]. Compared to the control population, pooled relative risk (RR) of HTN patients was increased only in reproductive age PCOS (1.70-fold, 95% CI: 1.43–2.07) but not in menopausal/aging patients who had PCOS during their reproductive years. The same results were obtained for subgroups of population-based studies. Meta-regression analysis of population-based studies showed that the RR of HTN in reproductive age PCOS patients was 1.76-fold than menopausal/aging PCOS patients (P = 0.262).

Conclusion

This meta-analysis confirms a greater risk of HTN in PCOS patients but demonstrates that this risk is increased only in reproductive age women with PCOS, indicating that after menopause, having a history of PCOS may not be as an important predisposing factor for developing HTN.
Utilization of non-pneumatic anti-shock garment and associated factors for postpartum hemorrhage management among health care professionals’ in public hospitals of Jimma zone, south-West Ethiopia, 2019
Authors: Bekele Gadisa , Terefe Gemechu , Sinaga Makeda , Belina Sena
Published: March 2020

Background

Non- pneumatic anti-shock garment is a unique, life -saving first -aid device made of neoprene and velcro, which is used for treatment of women with postpartum hemorrhage. Maternal mortality in the world still very high and postpartum hemorrhage is the leading cause of maternal mortality worldwide.

Objective

This study was aimed to assess the utilization of non-pneumatic anti-shock garment and associated factors for postpartum hemorrhage management.

Methods

Facility based cross-sectional studies design both quantitative and qualitative data collection methods were employed among 210 health care professionals and 10 key informants respectively. Bivariable and multivariable logistic regression was done to identify factors associated with non-pneumatic anti-shock garment utilization. Qualitative data was transcribed, translated and triangulated with quantitative findings.

Results

Seventy six (36.2%) of the respondents used non-pneumatic anti-shock garment in their hospitals for management of post-partum hemorrhage. Having good knowledge [(AOR = 3.96, 95% CI: (1.67, 9.407)], having positive attitude [(AOR = 3.54, 95% CI: (1.37, 9.13)], attending training [AOR = 13.156, 95% CI: (4.81, 36.00], having two and above non-pneumatic anti-shock garment at their hospitals [AOR = 8.7, 95% CI: (2.89, 26.20)] were significantly associated with utilization of non-pneumatic anti-shock garment. … “I didn’t use non-pneumatic anti-shock garment for the management of postpartum hemorrhage complication before because I have no training and experience how to use it.”

Conclusion

The utilization of non-pneumatic anti-shock garment for the management of postpartum hemorrhage was low. Having positive attitude, having good knowledge and training on non-pneumatic anti-shock garment were statically associated with its use. The health care professionals that involved in the maternity service should be trained on how to use this important garment in the management of postpartum hemorrhage.
Comparison of two methods of locating proximal femoral nail anti-rotation in the treatment of femoral intertrochanteric fractures
Authors: Tian Rong-hua , Zhang Qin-ming , Chu Feng-long , Li Xiao-yan , Jiang Zhen , Han Liang , Sun Peng , Wang Hai-bin , Chi Yu-lei , Wu Bin
Published: March 2020

Background

To compare the efficacy of three-point locating versus routine locating techniques for implanting helical blades for proximal femoral nail anti-rotation-II in the treatment of trochanteric fractures.

Methods

From January 2010 to June 2013, 90 patients with intertrochanteric fractures were surgically treated, including 48 males and 42 females with an average age of 70.5 ± 7.2 years. According to the AO classification, there were 45 cases of A2.1, 35 cases of A2.2, and 10 cases of A2.3. Based on locating techniques, the 90 patients were divided into two groups: the three-point group and the routine group, with 45 patients in each group. All operations were performed by the same group of surgeons using proximal femoral nail anti-rotation (PFNA); the helical blade was inserted into the femoral neck with the three-point locating technique or by the usual method according to treatment group. Several figures including total operation time, elapsed time for implanting the helical blade, intraoperative blood loss, X-ray exposure time, and tip-apex distance (TAD) were measured and compared.

Results

The three-point group was significantly superior as compared to the routine group in terms of total operation time [(59.34 ± 9.42) min vs (67.61 ± 12.63) min, P < 0.01], elapsed time for implanting the helical blade [(4.58 ± 1.25) min vs (7.82 ± 2.19) min, P < 0.01], intraoperative blood loss [(92.78 ± 34.09) ml vs (154.01 ± 39.10) ml, P < 0.01], X-ray exposure time [(8.84 ± 1.45) vs (14.62 ± 2.91), P < 0.01], and tip-apex distance [(16.78 ± 1.55) mm vs (21.91 ± 3.01) mm, P < 0.01]. Among the 90 patients, 80 were followed up for an average time of 12 months (10–15 months), including 42 patients who were part of three-point group and 38 patients who were part of the routine group. No spiral blade cut was found on the femoral head in any patient in the three-point group, whereas it occurred in 2 patients in the routine group 1 month after surgery. However, there was no significant difference in the Harris score between the two groups 6 months after the operation.

Conclusion

The three-point locating method is faster and more accurate than the routine locating method.
BDNF impact on synaptic dynamics: extra or intracellular long-term release differently regulates cultured hippocampal synapses
Authors: Rauti Rossana , Cellot Giada , D’Andrea Paola , Colliva Andrea , Scaini Denis , Tongiorgi Enrico , Ballerini Laura
Published: March 2020

Brain Derived Neurotrophic Factor (BDNF) signalling contributes to the formation, maturation and plasticity of Central Nervous System (CNS) synapses. Acute exposure of cultured brain circuits to BDNF leads to up-regulation of glutamatergic neuro-transmission, by the accurate tuning of pre and post synaptic features, leading to structural and functional synaptic changes. Chronic BDNF treatment has been comparatively less investigated, besides it may represent a therapeutic option to obtain rescue of post-injury alterations of synaptic networks. In this study, we used a paradigm of BDNF long-term (4 days) incubation to assess in hippocampal neurons in culture, the ability of such a treatment to alter synapses. By patch clamp recordings we describe the augmented function of excitatory neurotransmission and we further explore by live imaging the presynaptic changes brought about by long-term BDNF. In our study, exogenous long-term BDNF exposure of post-natal neurons did not affect inhibitory neurotransmission. We further compare, by genetic manipulations of cultured neurons and BDNF release, intracellular overexpression of this neurotrophin at the same developmental age. We describe for the first-time differences in synaptic modulation by BDNF with respect to exogenous or intracellular release paradigms. Such a finding holds the potential of influencing the design of future therapeutic strategies.
Dissecting the transcriptional regulatory networks of promoter-associated noncoding RNAs in development and cancer
Authors: Chellini Lidia , Frezza Valentina , Paronetto Maria Paola
Published: March 2020

In-depth analysis of global RNA sequencing has enabled a comprehensive overview of cellular transcriptomes and revealed the pervasive transcription of divergent RNAs from promoter regions across eukaryotic genomes. These studies disclosed that genomes encode a vast repertoire of RNAs beyond the well-known protein-coding messenger RNAs. Furthermore, they have provided novel insights into the regulation of eukaryotic epigenomes, and transcriptomes, including the identification of novel classes of noncoding transcripts, such as the promoter-associated noncoding RNAs (pancRNAs).

PancRNAs are defined as transcripts transcribed within few hundred bases from the transcription start sites (TSSs) of protein-coding or non-coding genes. Unlike the long trans-acting ncRNAs that regulate expression of target genes located in different chromosomal domains and displaying their function both in the nucleus and in the cytoplasm, the pancRNAs operate as cis-acting elements in the transcriptional regulation of neighboring genes. PancRNAs are very recently emerging as key players in the epigenetic regulation of gene expression programs in development and diseases.

Herein, we review the complex epigenetic network driven by pancRNAs in eukaryotic cells, their impact on physiological and pathological states, which render them promising targets for novel therapeutic strategies.
Cerebrospinal fluid phospho-tau T217 outperforms T181 as a biomarker for the differential diagnosis of Alzheimer’s disease and PET amyloid-positive patient identification
Authors: Barthélemy Nicolas R. , Bateman Randall J. , Hirtz Christophe , Marin Philippe , Becher François , Sato Chihiro , Gabelle Audrey , Lehmann Sylvain
Published: March 2020

Background

Cerebrospinal fluid biomarker profiles characterized by decreased amyloid-beta peptide levels and increased total and phosphorylated tau levels at threonine 181 (pT181) are currently used to discriminate between Alzheimer’s disease and other neurodegenerative diseases. However, these changes are not entirely specific to Alzheimer’s disease, and it is noteworthy that other phosphorylated isoforms of tau, possibly more specific for the disease process, have been described in the brain parenchyma of patients. The precise detection of these isoforms in biological fluids remains however a challenge.

Methods

In the present study, we used the latest quantitative mass spectrometry approach, which achieves a sensitive detection in cerebrospinal fluid biomarker of two phosphorylated tau isoforms, pT181 and pT217, and first analyzed a cohort of probable Alzheimer’s disease patients and patients with other neurological disorders, including tauopathies, and a set of cognitively normal controls. We then checked the validity of our results on a second cohort comprising cognitively normal individuals and patients with mild cognitive impairments and AD stratified in terms of their amyloid status based on PiB-PET imaging methods.

Results

In the first cohort, pT217 but not pT181 differentiated between Alzheimer’s disease patients and those with other neurodegenerative diseases and control subjects much more specificity and sensitivity than pT181. T217 phosphorylation was increased by 6.0-fold in patients with Alzheimer’s disease whereas T181 phosphorylation was only increased by 1.3-fold, when compared with control subjects. These results were confirmed in the case of a second cohort, in which the pT217 cerebrospinal fluid levels marked out amyloid-positive patients with a sensitivity and a specificity of more than 90% (AUC 0.961; CI 0.874 to 0.995). The pT217 concentrations were also highly correlated with the PiB-PET values (correlation coefficient 0.72; P < 0.001).

Conclusions

Increased cerebrospinal fluid pT217 levels, more than those of pT181, are highly specific biomarkers for detecting both the preclinical and advanced forms of Alzheimer’s disease. This finding should greatly improve the diagnosis of Alzheimer’s disease, along with the correlations found to exist between pT217 levels and PiB-PET data. It also suggests that pT217 is a promising potential target for therapeutic applications and that a link exists between amyloid and tau pathology.
Tumor necrosis factor α in aGVHD patients contributed to the impairment of recipient bone marrow MSC stemness and deficiency of their hematopoiesis-promotion capacity
Authors: Ding Li , Ning Hong-Mei , Li Pei-Lin , Yan Hong-Min , Han Dong-Mei , Zheng Xiao-Li , Liu Jing , Zhu Ling , Xue Mei , Mao Ning , Guo Zi-Kuan , Zhu Heng , Wang Heng-Xiang
Published: March 2020

Background

Though accumulated evidence has demonstrated visceral organ involvement in acute graft-versus-host disease (aGVHD), how aGVHD influences the bone marrow (BM) niche and the reconstitution of hematopoiesis post-hematopoietic stem cell transplantation remains largely unknown.

Methods

In the current study, the cell morphology, immunophenotype, multi-differentiation capacity, self-renewal capacity, and hematopoiesis promotion of the MSCs from aGVHD and non-aGVHD patients were investigated. Additionally, the stemness and hematopoiesis-promoting property of healthy donor-derived MSCs were evaluated in the presence of BM supernatant from aGVHD patients. Mechanistically, antibodies targeting inflammatory cytokines involved in aGVHD were added into the MSC culture. Furthermore, a recombinant human tumor necrosis factor (TNF-α) receptor-Ig fusion protein (rhTNFR:Fc) was used to protect healthy donor-derived MSCs. Moreover, mRNA sequencing was performed to explore the underlying mechanisms.

Results

The aGVHD MSCs exhibited morphological and immunophenotypic characteristics that were similar to those of the non-aGVHD MSCs. However, the osteogenic and adipogenic activities of the aGVHD MSCs significantly decreased. Additionally, the colony formation capacity and the expression of self-renewal-related genes remarkably decreased in aGVHD MSCs. Further, the hematopoiesis-supporting capacity of aGVHD MSCs significantly reduced. The antibody neutralization results showed that TNF-α contributed to the impairment of MSC properties. Moreover, rhTNFR:Fc exhibited notable protective effects on MSCs in the aGVHD BM supernatants. The mRNA sequencing results indicated that the TNF-α pathway and the Toll-like receptor pathway may be activated by TNF-α.

Conclusions

Thus, our data demonstrate MSCs as cellular targets of aGVHD and suggest a potential role of TNF-α blockage in maintaining the BM niche of aGVHD patients.