bluuebunny/crossref_metadata_2025 huggingface dataset:
Ureaplasma urealyticum disseminated multifocal abscesses in an immunocompromised adult patient: a case report
Authors: Diaz Pallares Carolina , Griener Thomas , Vaughan Stephen
Published: January 2020

Background

Ureaplasma urealyticum is a fastidious bacteria which lacks a cell wall. Extragenital infections are rare in immunocompetent adults. There are few literature reports of perinephric abscess. We present a case of non-resolving multifocal “culture-negative” abscesses in a hypogammaglobulinemic adult female due to U. urealyticum.

Case presentation

66-year-old female with a one-week history of fever, malaise and new right hip and leg pain. Past medical history was notable for chronic pancytopenia secondary to in remission B cell follicular lymphoma, ESRD on intermittent hemodialysis with bilateral nephrostomy tubes and Crohn’s. CT abdomen/pelvis revealed a small left perinephric hematoma and proximal right femur fluid collection. Persistent right thigh pain led to additional ultrasound with anterior thigh collection and CT revealed an irregular rim-enhancing fluid collection in the left posterior pararenal space. Antimicrobial therapy included ertapenem and vancomycin followed by meropenem, trimethoprim-sulfamethoxazole, daptomycin and metronidazole in setting of persistent culture-negative results and clinical deterioration. Following detection of U. urealyticum by 16S rDNA PCR in both left pararenal and right trochanteric bursa abscesses doxycycline was started. Despite this, the patient died four days later.

Conclusions

Disseminated infection by U. urealyticum has been documented in immunocompromised adult patients with few reports of perinephric abscess. We propose that ascending genitourinary route led to perinephric abscess. The multiple disseminated fluid collections make it highly suspicious for hematogenous spread given the lack of radiographic enhancement to suggest contiguous spread. Diagnosis and treatment of U. urealyticum-disseminated infection is extremely challenging as culture is laborious and not routinely performed. Furthermore, the lack of cell wall renders beta-lactams and vancomycin ineffective and therefore requirement for “atypical” coverage. Early diagnosis and treatment are key to prevent further complications and death.
How to estimate glomerular filtration rate in sub-Saharan Africa: design and methods of the African Research into Kidney Diseases (ARK) study
Authors: Kalyesubula Robert , Fabian June , Nakanga Wisdom , Newton Robert , Ssebunnya Billy , Prynn Josephine , George Jaya , Wade Alisha N. , Seeley Janet , Nitsch Dorothea , Hansen Christian , Nyirenda Moffat , Smeeth Liam , Naicker Saraladevi , Crampin Amelia C. , Tomlinson Laurie A.
Published: January 2020

Background

Chronic kidney disease (CKD) is a substantial cause of morbidity and mortality worldwide with disproportionate effects in sub-Saharan Africa (SSA). The optimal methods to estimate glomerular filtration rate (GFR) and therefore to determine the presence of CKD in SSA are uncertain. We plan to measure iohexol excretion to accurately determine GFR in Malawi, South Africa and Uganda. We will then assess the performance of existing equations to estimate GFR and determine whether a modified equation can better improve estimation of GFR in sub-Saharan Africa.

Methods

The African Research on Kidney Disease (ARK) study is a three-country study embedded within existing cohorts. We seek to enrol 3000 adults > 18 years based on baseline serum creatinine. Study procedures include questionnaires on socio-demographics and established risk factors for kidney disease along with anthropometry, body composition, blood pressure, blood chemistry and urine microscopy and albuminuria. We will measure GFR (mGFR) by plasma clearance of iohexol at 120, 180 and 240 min. We will compare eGFR determined by established equations with mGFR using Bland-Altman plots. We will use regression methods to estimate GFR and compare the newly derived model with existing equations.

Discussion

Through the ARK study, we aim to establish the optimal approach to estimate GFR in SSA. The study has the advantage of drawing participants from three countries, which will increase the applicability of the findings across the region. It is also embedded within established cohorts that have longitudinal information and serial measures that can be used to characterize kidney disease over a period of time. This will help to overcome the limitations of previous research, including small numbers, selected population sub-groups, and lack of data on proteinuria.

The ARK collaboration provides an opportunity for close working partnerships across different centres, using standardized protocols and measurements, and shared bio-repositories. We plan to build on the collaboration for this study for future work on kidney disease in sub-Saharan Africa, and welcome additional partners from across the continent.
“The strategies are the same, the problems may be different”: a qualitative study exploring the experiences of healthcare and service providers with medication therapy management for individuals with spinal cord injury/dysfunction
Authors: Guilcher Sara J. T. , Everall Amanda C. , Patel Tejal , Packer Tanya L. , Hitzig Sander L. , Cimino Stephanie R. , Lofters Aisha K.
Published: January 2020

Background

Persons with spinal cord injury/dysfunction (SCI/D) often take multiple medications to treat their secondary complications and chronic conditions (multimorbidity). Multiple healthcare and service providers are often involved in care, which can result in increased risk of fragmentation of care. Optimal medication therapy management (MTM) is essential to ensure therapeutic benefit from medication regimens. However, little is known about the experiences of providers in supporting persons with SCI/D with MTM.

Methods

Telephone interviews were conducted to explore healthcare and service providers’ experiences with MTM for persons with SCI/D. Participants were recruited through clinical organizations and researchers’ personal contacts. Participants were purposefully selected for diversity in profession and were required to be English speaking and to have provided care to at least one person with SCI/D. The qualitative interviews followed a semi-structured interview guide. Data display matrices were used in a constant comparative process for descriptive and interpretive analysis.

Results

Thirty-two interviews were conducted from April to December 2018. Each profession had distinct views on their roles in facilitating MTM for persons with SCI/D, which aligned with their respective scopes of practice. Shared provider tasks included tailoring medications, providing education, and exploring medication alternatives. Most participants felt that the care they provided for persons with SCI/D was similar to the care that they provided to other patients, with some differences relating to the physical limitations and medical complexity associated with SCI/D. Five factors were identified that impacted participants’ abilities to provide MTM for persons with SCI/D: patient self-management skills, provider knowledge and confidence, provider-patient relationships, interprofessional collaboration, and provider funding models including the use of technology-supported consultations.

Conclusion

While participants described commonalities in the barriers and enablers associated with providing MTM to persons with SCI/D and other populations, there were unique considerations identified. These SCI/D-specific considerations resulted in recommendations for improvements in MTM for this population. Future research should include perspectives from persons with SCI/D.
Mediation and moderation analyses: exploring the complex pathways between hope and quality of life among patients with schizophrenia
Authors: Wang Wei-Liang , Zhou Yu-Qiu , Chai Nan-Nan , Li Guo-Hua , Liu Dong-Wei
Published: January 2020

Background

The underlying mechanism between hope and quality of life is as yet unknown. We aim to examine the potential mediating effect of depression and resilience and the moderated effect of sex in this well-established association.

Methods

Two hundred seven patients diagnosed with schizophrenia were administered a questionnaire battery that measured hope, depression, resilience and QOL. A multiple mediation model was used to examine the mediating effect of resilience and depression on the association between hope and QOL. A subgroup analysis was performed and a moderated mediation model was examined to find and test the moderated effect of sex on the mediation model. We used Mplus to perform moderation and mediation analyses so that the mediators and moderator could function together in the same model.

Result

Sex was the moderator on the direct path between hope and QOL. The relationship between hope and QOL was mediated by resilience and depression in both sexes. When compared with female patients, the effect of hope on QOL was completely mediated by resilience and depression in males. In female patients, the model was partially mediated, and the direct effect of hope on QOL was significantly negatively correlated with the level of hope.

Conclusion

We present a conceptual model containing the mediated effects of resilience and depression and the moderated effect of sex between hope and QOL, which we believe facilitates the understanding of these associations. This model should be useful in the formulation of strategies to improve QOL.
Men’s perspectives on HIV self-testing in sub-Saharan Africa: a systematic review and meta-synthesis
Authors: Hlongwa Mbuzeleni , Mashamba-Thompson Tivani , Makhunga Sizwe , Muraraneza Claudine , Hlongwana Khumbulani
Published: January 2020

Background

Despite the many HIV testing models implemented in Africa, the level of HIV testing uptake remains relatively poor, especially among men. The HIV self-testing (HIVST) model offers an additional approach for encouraging men to get tested. This study aimed to synthesise evidence on men’s perspectives regarding HIVST in sub-Saharan Africa (SSA).

Methods

The databases searched included PubMed/MEDLINE, American Doctoral Dissertations via EBSCO host; Union Catalogue of Theses and Dissertations; SA ePublications via SABINET Online; World Cat Dissertations; Theses via OCLC; ERIC; CINAH; PsychInfo; Embase, Sociological Abstract, Scopus; and Google Scholar. The World Health Organization (WHO) and The Joint United Nations’ Programme on HIV and AIDS (UNAIDS) websites were further searched. We only extracted qualitative information from the included studies, despite the research method used (qualitative or mixed methods). The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA), as well as the Mixed Method Appraisal Tool (MMAT) version 2018, were used to determine the methodological quality of the included studies. NVivo version 11 was used for thematic analysis.

Results

A total of 21,184 articles were identified by the initial search criteria, but only 16 articles were included in the data extraction and quality assessment stage. The following key themes emerged: knowledge of HIVST; acceptability of HIVST; need for HIVST counselling; confidentiality of HIVST; convenience of HIVST; and accuracy of HIVST. The study shows that while HIVST provides men with an alternative, confidential and convenient testing model, the potential for psychological and physical harm remains a challenge.

Conclusion

The introduction of the HIVST strategy has the potential of improving men’s uptake in HIV testing services, thereby contributing towards addressing the first cascade of the 90–90-90 strategy. While HIVST has a potential for addressing men’s barriers to attending clinic settings, such as confidentiality and convenience, it barely addresses the HIVST counselling and accuracy concerns.
Human adipose-derived Mesenchymal stem cells, low-intensity pulsed ultrasound, or their combination for the treatment of knee osteoarthritis: study protocol for a first-in-man randomized controlled trial
Authors: Nasb Mohammad , Liangjiang Huang , Gong Chenzi , Hong Chen
Published: January 2020

Background

Human adipose-derived Mesenchymal stem cells (HADMSCs) have proven their efficacy in treating osteoarthritis (OA), in earlier preclinical and clinical studies. As the tissue repairers are under the control of mechanical and biochemical signals, improving regeneration outcomes using such signals has of late been the focus of attention. Among mechanical stimuli, low-intensity pulsed ultrasound (LIPUS) has recently shown promise both in vitro and in vivo. This study will investigate the potential of LIPUS in enhancing the regeneration process of an osteoarthritic knee joint.

Methods

This study involves a prospective, randomized, placebo-controlled, and single-blind trial based on the SPIRIT guidelines, and aims to recruit 96 patients initially diagnosed with knee osteoarthritis, following American College of Rheumatology criteria. Patients will be randomized in a 1:1:1 ratio to receive Intraarticular HADMSCs injection with LIPUS, Intraarticular HADMSCs injection with shame LIPUS, or Normal saline with LIPUS. The primary outcome is Western Ontario and McMaster Universities Index of OA (WOMAC) score, while the secondary outcomes will be other knee structural changes, and lower limb muscle strength such as the knee cartilage thickness measured by MRI. Blinded assessments will be performed at baseline (1 month prior to treatment), 1 month, 3 months, and 6 months following the interventions.

Discussion

This trial will be the first clinical study to comprehensively investigate the safety and efficacy of LIPUS on stem cell therapy in OA patients. The results may provide evidence of the effectiveness of LIPUS in improving stem cell therapy and deliver valuable information for the design of subsequent trials.

Trial registration

This study had been prospectively registered with the Chinese Clinical Trials Registry. registration number: ChiCTR1900025907 at September 14, 2019.
Comparison of the acute toxicity, analgesic and anti-inflammatory activities and chemical composition changes in Rhizoma anemones Raddeanae caused by vinegar processing
Authors: Wang Sha-Sha , Zhou Shao-Yan , Xie Xiao-Yan , Zhao Ling , Fu Yao , Cai Guang-Zhi , Gong Ji-Yu
Published: January 2020

Background

As the dry rhizome of Anemone raddeana Regel, Rhizoma Anemones Raddeanae (RAR), which belongs to Ranunculaceae, is usually used to treat wind and cold symptoms, hand-foot disease and spasms, joint pain and ulcer pain in China. It is well known that the efficacy of RAR can be distinctly enhanced by processing with vinegar due to the reduced toxicity and side effects. However, the entry of vinegar into liver channels can cause a series of problems. In this paper, the differences in the acute toxicity, anti-inflammatory and analgesic effects between RAR and vinegar-processed RAR were compared in detail. The changes in the chemical compositions between RAR and vinegar-processed RAR were investigated, and the mechanism of vinegar processing was also explored.

Methods

Acute toxicity experiments were used to examine the toxicity of vinegar-processed RAR. A series of studies, such as the writhing reaction, ear swelling experiment, complete Freund’s adjuvant-induced rat foot swelling experiment and cotton granuloma, in experimental mice was conducted to observe the anti-inflammatory effect of vinegar-processed RAR. The inflammatory cytokines of model rats were determined by enzyme-linked immunosorbent assay (ELISA). Liquid Chromatography-Quadrupole-Time of Flight mass spectrometer Detector (LC-Q-TOF) was used to analyse the chemical compositions of the RARs before and after vinegar processing.

Results

Neither obvious changes in mice nor death phenomena were observed as the amount of vinegar-processed RAR in crude drug was set at 2.1 g/kg. Vinegar-processed RAR could significantly prolong the latency, reduce the writhing reaction time to reduce the severity of ear swelling and foot swelling, and remarkably inhibit the secretion of Interleukin-1β(IL-1β), Interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) proinflammatory cytokines. The content of twelve saponins (e.g., Eleutheroside K) in RAR was decreased after vinegar processing, but six other types (e.g., RDA) were increased.

Conclusions

These results revealed that vinegar processing could not only improve the analgesic and anti-inflammatory effects of RAR but also reduce its own toxicity.

Trial registration

Not applicable.
Ginsenoside Rb1 can ameliorate the key inflammatory cytokines TNF-α and IL-6 in a cancer cachexia mouse model
Authors: Lu Shuai , Zhang Yubo , Li Huajun , Zhang Jing , Ci Yingqian , Han Mei
Published: January 2020

Background

Cancer cachexia is a severe condition that leads to the death of advanced cancer patients, and approximately 50~80% of cancer patients have cancer cachexia. Ginseng extract has been reported to have substantial anticancer and immune-enhancing effects; however, no study has reported the use of ginseng alone to treat cancer cachexia. Our study’s purpose was to investigate the therapeutic effects of ginseng-related monomers or mixtures on a cancer cachexia mouse model.

Methods

We selected BALB/c mice and injected the mice subcutaneously with C26 colon cancer cells to construct a cancer cachexia experimental animal model. The water extract of ginseng (WEG), two types of ginseng extracts (ginsenosides at doses of 5 mg/kg (GE5) and 50 mg/kg (GE50)) and ginsenoside Rb1 (Rb1) were used to treat cancer cachexia mice. Enzyme-linked immunosorbent assays (ELISAs) were used to analyze the inhibitory effects on two key inflammatory cytokines, tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6).

Results

Our experimental results show that GE5, GE50 and Rb1 significantly reduced the levels of TNF-α (P < 0.01) and IL-6 (P < 0.01), which are closely related to cancer cachexia; however, WEG, GE5, GE50 and Rb1 did not significantly improve the gastrocnemius muscle weight or the epididymal fat weight of mice with cancer cachexia.

Conclusions

These results indicate that GE5, GE50 and Rb1 may be useful for reducing symptoms due to inflammation by reducing the TNF-α and IL-6 cytokine levels in cancer cachexia mice, thereby ameliorating the symptoms of cancer cachexia. Our results may be beneficial for future studies on the use of Chinese herbal medicines to treat cancer cachexia.
Fostering patient-centredness by following patients outside the clinical setting: an interview study
Authors: Grau Canét-Wittkampf Christel , Eijkelboom Charlotte , Mol Saskia , Zwart Dorien , Hendriks Iris , de Groot Esther
Published: January 2020

Background

Patient-centredness is considered a core competency for health professionals. To support faculty in designing courses focused on patient-centredness, an understanding of how educational interventions lead to patient-centredness is required. This study aims to show how learning mechanisms, which potentially contribute to patient-centredness, are triggered.

Methods

Thirty-five third-year medical students at the UMC Utrecht followed four different patients for two years. The intervention took place in an out-of-hospital setting. Students visited patients in their home circumstances and accompanied them to clinical events. Twelve students were interviewed. The realist approach was used to construct configurations which relate components of the intervention to the context and learning mechanisms.

Results

Following patients in their home circumstances for a prolonged period supported the development of meaningful relationships between students and patients and provided continuity. In the context of a meaningful relationship and continuity, mechanisms contributing to learning patient-centredness were triggered. The most important learning mechanisms found in this study were: reflecting, contextualising disease in a real persons’ life, broadening perspectives and engaging with the patients.

Conclusions

Learning mechanisms are triggered by continuity and by meaningful student-patient relationships. These can be enhanced by an out-of-hospital setting and longitudinal contact. Thus, a relationship between students and patients is an important enabler for the development of patient-centredness.
Associations between red blood cell variants and malaria among children and adults from three areas of Uganda: a prospective cohort study
Authors: Kakande Elijah , Greenhouse Bryan , Bajunirwe Francis , Drakeley Chris , Nankabirwa Joaniter I. , Walakira Andrew , Nsobya Samuel L. , Katureebe Agaba , Rek John , Arinaitwe Emmanuel , Rosenthal Philip J. , Kamya Moses R. , Dorsey Grant , Rodriguez-Barraquer Isabel
Published: January 2020

Background

Multiple red blood cell (RBC) variants appear to offer protection against the most severe forms ofPlasmodium falciparummalaria. Associations between these variants and uncomplicated malaria are less clear.

Methods

Data from a longitudinal cohort study conducted in 3 sub-counties in Uganda was used to quantify associations between three red blood cell variants Hb [AA, AS, S (rs334)], alpha thalassaemia 3.7 kb deletion, and glucose-6-phosphate dehydrogenase deficiency A—(G6PD 202A genotype) and malaria incidence, parasite prevalence, parasite density (a measure of anti-parasite immunity) and body temperature adjusted for parasite density (a measure of anti-disease immunity). All analyses were adjusted for age, average household entomological inoculation rate, and study site. Results for all variants were compared to those for wild type genotypes.

Results

In children, HbAS was associated, compared to wild type, with a lower incidence of malaria (IRR = 0.78, 95% CI 0.66–0.92, p = 0.003), lower parasite density upon infection (PR = 0.66, 95% CI 0.51–0.85, p = 0.001), and lower body temperature for any given parasite density (− 0.13 ℃, 95% CI − 0.21, − 0.05, p = 0.002). In children, HbSS was associated with a lower incidence of malaria (IRR = 0.17, 95% CI 0.04–0.71, p = 0.02) and lower parasite density upon infection (PR = 0.31, 95% CI 0.18–0.54, p < 0.001). α−/αα thalassaemia, was associated with higher parasite prevalence in both children and adults (RR = 1.23, 95% CI 1.06–1.43, p = 0.008 and RR = 1.52, 95% CI 1.04–2.23, p = 0.03, respectively). G6PD deficiency was associated with lower body temperature for any given parasite density only among male hemizygote children (− 0.19 ℃, 95% CI − 0.31, − 0.06, p = 0.003).

Conclusion

RBC variants were associated with non-severe malaria outcomes. Elucidation of the mechanisms by which they confer protection will improve understanding of genetic protection against malaria.
Molecular epidemiology and antimicrobial resistance features of Acinetobacter baumannii clinical isolates from Pakistan
Authors: Karah Nabil , Khalid Fizza , Wai Sun Nyunt , Uhlin Bernt Eric , Ahmad Irfan
Published: January 2020

Background

Acinetobacter baumanniiis a Gram-negative opportunistic pathogen with a notorious reputation of being resistant to antimicrobial agents. The capability ofA. baumanniito persist and disseminate between healthcare settings has raised a major concern worldwide.

Methods

Our study investigated the antibiotic resistance features and molecular epidemiology of 52 clinical isolates ofA. baumanniicollected in Pakistan between 2013 and 2015. Antimicrobial susceptibility patterns were determined by the agar disc diffusion method. Comparative sequence analyses of theampCandblaOXA-51-likealleles were used to assign the isolates into clusters. The whole genomes of 25 representative isolates were sequenced using the MiSeq Desktop Sequencer. Free online applications were used to determine the phylogeny of genomic sequences, retrieve the multilocus sequence types (ST), and detect acquired antimicrobial resistance genes.

Results

Overall, the isolates were grouped into 7 clusters and 3 sporadic isolates. The largest cluster, Ab-Pak-cluster-1 (blaOXA-66and ISAba1-ampC-19) included 24 isolates, belonged to ST2 and International clone (IC) II, and was distributed between two geographical far-off cities, Lahore and Peshawar. Ab-Pak-clusters-2 (blaOXA-66, ISAba1-ampC-2), and -3 (blaOXA-66, ISAba1-ampC-20) and the individual isolate Ab-Pak-Lah-01 (ISAba1-blaOXA-66, ISAba1-ampC-2) were also assigned to ST2 and IC II. On the other hand, Ab-Pak-clusters-4 (blaOXA-69,ampC-1), -5 (blaOXA-69, ISAba1-ampC-78), and -6A (blaOXA-371, ISAba1-ampC-3) belonged to ST1, while Ab-Pak-cluster-6B (blaOXA-371, ISAba1-ampC-8) belonged to ST1106, with both ST1 and ST1106 being members of IC I. Five isolates belonged to Ab-Pak-cluster-7 (blaOXA-65,ampC-43). This cluster corresponded to ST158, showed a well-delineated position on the genomic phylogenetic tree, and was equipped with several antimicrobial resistance genes includingblaOXA-23andblaGES-11.

Conclusions

Our study detected the occurrence of 7 clusters ofA. baumanniiin Pakistan. Altogether, 6/7 of the clusters and 45/52 (86.5%) of the isolates belonged to IC I (n = 9) or II (n = 36), making Pakistan no exception to the global domination of these two clones. The onset of ST158 in Pakistan marked a geographical dispersal of this clone beyond the Middle East and brought up the need for a detailed characterization.
Correlation between 12α-hydroxylated bile acids and insulin secretion during glucose tolerance tests in rats fed a high-fat and high-sucrose diet
Authors: Yoshitsugu Reika , Kikuchi Keidai , Hori Shota , Iwaya Hitoshi , Hagio Masahito , Shimizu Hidehisa , Hira Tohru , Ishizuka Satoshi
Published: January 2020

Background

Previously, we found a significant relationship in a rat study between energy intake and bile acid (BA) metabolism especially 12α-hydroxylated (12αOH) BAs. The present study was designed to reveal relationships among BA metabolism, glucose tolerance, and cecal organic acids in rats fed a high-fat and high-sucrose diet (HFS) by using multivariate and multiple regression analyses in two types of glucose tolerance tests (GTTs).

Methods

Male WKAH/HkmSlc rats were fed with a control or a HFS for 13 weeks. Oral glucose tolerance test (OGTT) and intraperitoneal glucose tolerance test (IPGTT) were performed at week 9 and 11, respectively. BAs were analyzed by using ultra high-performance liquid chromatography-mass spectrometry. Organic acid concentrations in cecal contents were analyzed by using ultra high-performance liquid chromatography with post-column pH buffered electric conductivity method.

Results

A positive correlation of aortic 12αOH BA concentration was observed with energy intake and visceral adipose tissue weight. We found that an increase of 12αOH BAs in enterohepatic circulation, intestinal contents and feces in the HFS-fed rats compared to those in control rats regardless of no significant increase of total BA concentration in the feces in the test period. Fecal 12αOH BA concentration was positively correlated with maximal insulin level in OGTT and area under curve of insulin in IPGTT. There was a positive correlation between aortic 12αOH BAs concentration and changes in plasma glucose level in both OGTT and IPGTT. In contrast, a decrease in the concentration of organic acids was observed in the cecal contents of the HFS-fed rats. Multiple linear regression analysis in the IPGTT revealed that the concentrations of aortic 12αOH BA and cecal acetic acid were the predictors of insulin secretion. Moreover, there was a positive correlation between concentration of portal 12αOH BAs and change in insulin concentration of peripheral blood in the IPGTT.

Conclusion

The distribution analysis of BA compositions accompanied by GTTs revealed a close relationship between 12αOH BA metabolism and insulin secretion in GTTs in rats.
A new model of patient-reported outcome monitoring with a clinical feedback system in ostomy care: rationale, description and evaluation protocol
Authors: Indrebø Kirsten Lerum , Aasprang Anny , Olsen Torill Elin , Andersen John Roger
Published: January 2020

Background

Living with an ostomy can be challenging and adapting to life with an ostomy can be particularly complex, with regard to both the physical and psychosocial aspects. Follow-up with a stoma care nurse (SCN) is usually performed after surgery to support the adaptation process. In the present paper, we describe a new model of ostomy care, where a clinical feedback system (CFS) is implemented in order to improve the adaption process of patients with an ostomy. We also present a plan for evaluating patients experience with the CFS and their clinical outcomes.

Methods

In this study, we include patients who had recently performed colostomy, ileostomy, or urostomy surgery. The intervention includes self-reported measures for adaptation to life with an ostomy and health-related quality of life (HRQoL), as well as patient experiences and satisfaction recorded by the clinical feedback system. The measures are electronically assessed before each clinical consultation at 3, 6, and 12 months after surgery. The scores are instantly analysed and graphically presented for use during the consultation and the patient and the SCN can discuss the findings. Patient experiences and satisfaction with care will be measured with the Generic Short Patient Experiences Questionnaire. Adaptation to the life with ostomy will be measured with the Ostomy Adjustment Scale, and HRQoL with the Short Form 36.

Discussion

This study presents a novel approach that could lead to improved consultation, more patient involvement, and better adaptation to life with an ostomy.

Trial register

ClinicalTrials.govRegistration Number: NCT03841071.

Date 18. February 2019 retrospectively registered.
Analysis and exploration of infertility policies in Iran: a study protocol
Authors: Morshed-Behbahani Bahar , Lamyian Minoor , Joulaei Hassan , Montazeri Ali
Published: January 2020

Background

Infertility is a complex and neglected reproductive health issue of global proportions, with varying effects on couples and their relationships. Therefore, international organisations and several countries have been compelled to consider infertility policies. In recent years, a shift in population policy trends toward increasing birth rates in Iran have set infertility policies in the health sector’s agenda. Since infertility and its associated problems are multifactorial, all health systems, including that of Iran, need to have a comprehensive policy package that covers all of its dimensions. Policy analysis is necessary to formulate such policies. This project will therefore analyse the infertility policies in Iran’s health sector and clarify the multilateral effects of their different components.

Methods

This multidisciplinary study outlines the conceptual framework of infertility policies and consists of three stages. Stage I will involve the review of infertility policies in selected countries and Iran for the operational model of infertility programmes, rules and policies. Stage II will consist of a documentary infertility policy analysis of Iran. At this stage, Iran’s infertility policies will be analysed using the Walt and Gilson framework in four areas, namely content, context, process and actors. Stage III will involve the analysis of infertility policies in Iran. At this stage, a qualitative study will be conducted to understand and provide in-depth explanations of the existing policies. Finally, the concepts and outcomes obtained from the first stage will be combined with the content of the qualitative analysis of the second and third stages for exploration of Iran’s infertility policies, and a package including a framework for infertility policies will be proposed.

Discussion

The findings of this study can be used by the Ministry of Health and public health policy-makers to determine which policies, in view of socio-cultural and economic contexts and actors’ roles in each country, can be used to reach the goals defined by international organisations, on the prevention of infertility and reproductive health.
Pediatric chronic nonbacterial osteomyelitis of the mandible: Seattle Children’s hospital 22-patient experience
Authors: Gaal Austin , Basiaga Matthew L. , Zhao Yongdong , Egbert Mark
Published: January 2020

Background

Studies evaluating treatment responses for chronic nonbacterial osteomyelitis (CNO) are lacking. We aimed to measure and compare response rates of medical treatments, time to response of medical treatments among patients with CNO of the mandible, and describe bacterial contamination rates from biopsy.

Methods

We conducted a retrospective chart review of all patients diagnosed with CNO of mandible between 2003 and 2017 and extracted demographic, clinical, laboratory, imaging and surgical data. Detailed medication use and response to medications were recorded. The primary outcome was response to medical treatments defined as improvement of presenting symptoms, inflammatory markers, and imaging if available. Medical treatments included nonsteroidal anti-inflammatory drugs (NSAIDs), glucocorticoids, disease modifying anti rheumatic drugs (DMARDs), anti-tumor necrosis factor (TNF) therapy, and pamidronate. Descriptive analysis was performed when appropriate. Multivariable logistic regression and Kaplan-Meier curves were applied to compare the responses to medical treatments and time to full response.

Results

We identified 22 patients with a median age of 11 and 36% were female. Four patients (18%) had multifocal bone lesions. CT findings (n = 21) showed lytic lesions (62%) and sclerosis (90%). MRI (n = 14) revealed hyperintensity within bone marrow (100%), soft tissue (71%) and bony expansion (71%). Non-antibiotic treatments including NSAIDs (n = 18), glucocorticoids (n = 10), DMARDs (n = 9), anti-TNF therapy (n = 5) and pamidronate (n = 6) were applied. Rates of full responses to anti-TNF therapy (60%) and pamidronate (67%) were higher than that to NSAIDs (11%) (p < 0.05). Patients receiving pamidronate responded more rapidly than those receiving anti-TNF therapy (median two vs 17 months, p = 0.01) when there was a full response. All had bone biopsies. Intraoral biopsy was performed in 12 of 13 operated in our center and the most common contaminants were Neisseria spp and Streptococcus viridians.

Conclusion

Both anti-TNF and pamidronate appeared superior to NSAIDs alone in treating mandibular CNO. Patients receiving pamidronate responded faster than those receiving anti-TNF therapy.
Group reminiscence for hope and resilience in care-seekers who have attempted suicide
Authors: Hashemi-Aliabadi Somayeh , Jalali Amir , Rahmati Mahmoud , Salari Nader
Published: January 2020

Background

The rate of attempting suicide is growing due to the increasing social and economic problems and a variety of stresses taken by individuals in their lives. Helping people, boosting hope, and improving resilience to life hardships might be helpful in this area. This paper is an attempt to determine the effects of group reminiscence on hope and resilience in care-seekers who have attempted suicide.

Method

The study was carried out as a quasi-experimental interventional study. The participants were 57 care-seekers with a history of attempting suicide who met the inclusion criteria. The sampling was done through convenience sampling and the participants were grouped into control (n = 29) and experimental (n = 28) groups randomly. The experimental group received integrated reminiscence sessions (eight sessions; 60–90 min). Hope and resilience of the subjects were measured using Schneider's Hope Scale and Connor and Davidson’s Resilience Scale. The scales were filled out by the subjects before, immediately after, and 4 weeks after the intervention.

Results

The mean scores of hope in the experimental and control groups were 34.60 and 38.04, respectively, before the intervention. These figures immediately after the intervention were 44.07 and 35.96 in the experimental and control groups, respectively. 4 weeks after the intervention, the mean scores of hope in the experimental and control groups were 44.39 and 35.79, respectively, which is a statistically significant difference (p < 0.05). In terms of resilience, the mean scores in the experimental and control groups before the intervention were 48.17 and 57.51, respectively; and immediately after the intervention, these figures were 67.71 and 52.75, respectively. 4 weeks of the intervention, the mean scores of resilience were 59.17 and 52.24, respectively, which is a statistically significant difference (p < 0.05).

Conclusion

Group reminiscence has a positive effect on boosting hope and resilience in care-seekers who have attempted suicide.
Preoperative uric acid predicts in-hospital death in patients with acute type a aortic dissection
Authors: Zhang Yiran , Xu Xingjie , Lu Yuan , Guo Lei , Ma Liang
Published: January 2020

Background

The present study aimed to evaluate the value of admission serum uric acid (UA) level in predicting in-hospital risk of death in patients with acute type A aortic dissection (AAAD).

Methods

From January 2016 to June 2019, 186 consecutive patients with AAAD who underwent thoracic aortic surgery were retrospectively studied. Serum UA levels were measured on admission. Forward conditional logistic regression was performed to identify independent risk factors for in-hospital death. Receiver operating characteristic (ROC) analysis was performed to assess the most clinical useful level of serum UA for predicting postoperative in-hospital mortality.

Results

Increased level of serum UA was found in non-survivors compared with those survived (446 ± 123 vs 371 ± 111 umol/L, p < 0.001). Age (OR = 1.063, 95% CI 1.016–1.112, p = 0.009), UA (OR = 1.006, 95% CI 1.002–1.010, p = 0.002), D-dimer (OR = 1.025, 95% CI 1.005–1.013, p = 0.012), operation time (OR = 1.009, 95% CI 1.005–1.013, p < 0.001) and extent of aortic replacement (OR = 0.412, 95% CI 0.220–0.768, p = 0.005) were identified as independent risk factors of in-hospital mortality in AAAD patients. The best cut-off value of admission serum UA in predicting in-hospital mortality was determined to be 415 umol/L. Subgroup analysis showed that in the subgroup of total arch replacement, UA was significantly associated with in-hospital death (OR = 1.010, 95% CI 1.005–1.015, p < 0.001), while in patients underwent ascending aorta replacement or hemiarch replacement, the relationship was no longer significant (OR = 1.001, 95% CI 0.996–1.006, p = 0.611).

Conclusions

Elevated serum UA level on admission is an independent predictor of in-hospital mortality in patients with AAAD.
Release of coarse woody detritus-related carbon: a synthesis across forest biomes
Authors: Harmon Mark E. , Fasth Becky G. , Yatskov Misha , Kastendick Douglas , Rock Joachim , Woodall Christopher W.
Published: January 2020

Background

Recent increases in forest tree mortality should increase the abundance coarse woody detritus (CWD) and ultimately lead to increased atmospheric carbon dioxide. However, the time course of carbon release from CWD is not well understood. We compiled CWD decomposition rate-constants (i.e.,k) to examine how tree species, piece diameter, position (i.e., standing versus downed), canopy openness, and macroclimate influencedk. To illustrate their implications we modeled the effect of species and position on estimates of decomposition-related carbon flux. We examined a subset of currently used models to determine if their structure accounted for these factors.

Results

Globallykof downed CWD varied at least 244-fold with interspecies variation at individual sites up to 76-fold. Whilekgenerally decreased with increasing piece diameter, under open canopies the opposite occurred. Standing CWD sometimes exhibited little decomposition, but sometimes hadkvalues up to 3 times faster than downed CWD. There was a clear response ofkto mean annual temperature of ≈ 2.6 times per 10 ℃; however, there was considerable variation for a given mean annual temperature related to species, diameter, and position. A key feature of carbon release from CWD after disturbance was the “evolution” of the ecosystem-levelkvalue as positions and species mixtures of the remaining CWD changed. Variations in decomposition caused by disturbance (e.g., changes in species, positions, sizes, and microclimate) had the potential to cause net carbon fluxes to the atmosphere to be highly nonlinear. While several models currently being used for carbon accounting and assessing land-use/climate change would potentially capture some of these post disturbance changes in fluxes and carbon balances, many would not.

Conclusions

While much has been learned in the last 5 decades about CWD decomposition, to fully understand the time course of carbon release from increased mortality and other aspects of global change a new phase of global CWD research that is more systematic, experimental, and replicated needs to be initiated. If our findings are to be fully applied in modeling, an approach acknowledging how the rate of carbon release evolves over time should be implemented.
European lipodystrophy registry: background and structure
Authors: von Schnurbein Julia , Adams Claire , Akinci Baris , Ceccarini Giovanni , D’Apice Maria Rosaria , Gambineri Alessandra , Hennekam Raoul C. M. , Jeru Isabelle , Lattanzi Giovanna , Miehle Konstanze , Nagel Gabriele , Novelli Giuseppe , Santini Ferruccio , Santos Silva Ermelinda , Savage David B. , Sbraccia Paolo , Schaaf Jannik , Sorkina Ekaterina , Tanteles George , Vantyghem Marie-Christine , Vatier Camille , Vigouroux Corinne , Vorona Elena , Araújo-Vilar David , Wabitsch Martin
Published: January 2020

Background

Lipodystrophy syndromes comprise a group of extremely rare and heterogeneous diseases characterized by a selective loss of adipose tissue in the absence of nutritional deprivation or catabolic state. Because of the rarity of each lipodystrophy subform, research in this area is difficult and international co-operation mandatory. Therefore, in 2016, the European Consortium of Lipodystrophies (ECLip) decided to create a registry for patients with lipodystrophy.

Results

The registry was build using the information technology Open Source Registry System for Rare Diseases in the EU (OSSE), an open-source software and toolbox. Lipodystrophy specific data forms were developed based on current knowledge of typical signs and symptoms of lipodystrophy. The platform complies with the new General Data Protection Regulation (EU) 2016/679 by ensuring patient pseudonymization, informational separation of powers, secure data storage and security of communication, user authentication, person specific access to data, and recording of access granted to any data. Inclusion criteria are all patients with any form of lipodystrophy (with the exception of HIV-associated lipodystrophy). So far 246 patients from nine centres (Amsterdam, Bologna, Izmir, Leipzig, Münster, Moscow, Pisa, Santiago de Compostela, Ulm) have been recruited. With the help from the six centres on the brink of recruitment (Cambridge, Lille, Nicosia, Paris, Porto, Rome) this number is expected to double within the next one or 2 years.

Conclusions

A European registry for all patients with lipodystrophy will provide a platform for improved research in the area of lipodystrophy. All physicians from Europe and neighbouring countries caring for patients with lipodystrophy are invited to participate in the ECLip Registry.

Study registration

ClinicalTrials.gov (NCT03553420). Registered 14 March 2018, retrospectively registered.
Lysine demethylase 2 (KDM2B) regulates hippo pathway via MOB1 to promote pancreatic ductal adenocarcinoma (PDAC) progression
Authors: Quan Ming , Chen Zhiqin , Jiao Feng , Xiao Xiuying , Xia Qing , Chen Jingde , Chao Qian , Li Yandong , Gao Yong , Yang Haiyan , Wang Liwei , Cui Jiujie
Published: January 2020

Background

Mps1 binding protein (MOB1) is one of the core components of the mammalian Hippo pathway and plays important roles in cancer development. However, its expression, function and regulation in pancreatic ductal adenocarcinoma (PDAC) have not been revealed yet.

Methods

The expression of MOB1 and lysine demethylase 2B (KDM2B) in PDAC and adjacent normal pancreas tissues were measured. Also, the underlying mechanisms of altered MOB1 expression and its impact on PDAC biology were investigated.

Results

We revealed for the first time that MOB1 was decreased expression in PDAC and was a statistically significant independent predictor of poor survival, and restored expression of MOB1 suppressed the proliferation, migration and invasion of PDAC cells. Further studies demonstrated that KDM2B directly bound to the promoter region of MOB1, and suppressed the promoter activity of MOB1 and transcriptionally inhibited the MOB1 expression. Furthermore, KDM2B regulated Hippo pathway and promoted PDAC proliferation, migration and invasion via MOB1.

Conclusion

This study demonstrated the mechanism and roles of a novel KDM2B/MOB1/Hippo signaling in PDAC progression.
Dose reduction and withdrawal strategy for TNF-inhibitors in psoriatic arthritis and axial spondyloarthritis: design of a pragmatic open-label, randomised, non-inferiority trial
Authors: Michielsens Celia A. J. , Boers Nadine , den Broeder Nathan , Wenink Mark H. , van der Maas Aatke , Mahler Elien A. M. , Mulder Michelle L. M. , van der Heijde Désirée , van den Hoogen Frank H. J. , Verhoef Lise M. , den Broeder Alfons A.
Published: January 2020

Background

Tumour necrosis factor inhibitors (TNFi) are effective in the treatment of patients with spondyloarthritis (SpA), including psoriatic arthritis (PsA) and axial spondyloarthritis (axSpA). However, these drugs come with some disadvantages such as adverse events, practical burden for patients and high costs. Dose optimisation of TNFi after patients have reached low disease activity (LDA) has been shown feasible and safe in rheumatoid arthritis (RA). However, data on TNFi dose optimisation in PsA and axSpA are scarce, especially pragmatic, randomised strategy studies.

Methods

We developed an investigator-driven, pragmatic, open-label, randomised, controlled, non-inferiority trial (DRESS-PS) to compare the effects of a disease activity-guided treat-to-target strategy with or without a tapering attempt in patients with SpA (PsA and axSpA combined), ≥ 16 years of age, who are being treated with TNFi, and have had at least 6 months of low disease activity. The primary outcome is the percentage of patients in LDA after 12 months of follow up. Patients are assessed at baseline, 3, 6, 9, and 12 months of follow up. Bayesian power analyses with a weakened prior based on a similar study performed in RA resulted in a sample size of 95 patients in total.

Discussion

More knowledge on disease activity-guided treatment algorithms would contribute to better treatment choices and cost savings and potentially decrease the risk of side effects. In this article we elucidate some of our design choices on TNFi dose optimisation and its clinical and methodological consequences.

Trial registration

Dutch Trial Register,NL6771. Registered on 27 November 2018 (CMO NL66181.091.18, 23 October 2018).
Some generalized Volterra–Fredholm type dynamical integral inequalities in two independent variables on time scale pairs
Authors: Liu Haidong , Yin Chuancun
Published: January 2020

In this paper, we study some new Volterra–Fredholm type dynamical integral inequalities in two independent variables on time scale pairs, which provide explicit bounds on unknown functions. These inequalities generalize and extend some known inequalities and can be used as effective tools in the qualitative theory of certain classes of partial dynamic equations on time scales. Finally, an example is provided to illustrate the usefulness of our result.