bluuebunny/crossref_metadata_2025 huggingface dataset:
Multimodal imaging features and genetic findings in Bietti crystalline dystrophy
Authors: Wang Wei , Chen Wei , Bai Xinyue , Chen Ling
Published: August 2020

Background

Bietti crystalline dystrophy (BCD) is a distinct entity of retinitis pigmentosa with a wide range of genotypic and phenotypic variabilities. The goal of the present study was to investigate the morphological, functional and genetic features of BCD.

Methods

A full series of multimodal imaging was performed in four Chinese patients with BCD, including fundus photography, fundus autofluorescence, fundus fluorescein angiography (FFA), indocyanine green (ICG) angiography, optical coherence tomography (OCT) and microperimetry. Electrophysiological tests including full-field electroretinography (ERG) and multifocal ERG were employed. CYP4V2 gene sequencing was performed.

Results

Intraretinal crystalline deposits were observed in fundus photographs in all patients. The crystals were better appreciated in infrared images. Autofluorescence imaging demonstrated multifocal patchy hypofluorescence, suggesting massive RPE atrophy. FFA and ICG angiography further confirmed atrophy of the RPE and the underlying choroidal vessels. OCT revealed disruption of the photoreceptors, RPE and the choroid. Outer retinal tubulations (ORTs) confining to the outer nuclear layer were detected in three out of four patients. Full-field ERG showed markedly diminished responses. Multifocal ERG displayed reduced central and peripheral responses in a patient with normal vision. Gene sequencing identified two deletion mutations in CYP4V2, c.802_807del and c.810delT. BCD complicated by choroidal neovascularization (CNV) was diagnosed in one patient, and intravitreal anti-vascular endothelial growth factor (VEGF) injection was given with favorable response.

Conclusions

Multimodal imaging features and electrophysiological findings of BCD patients were comprehensively discussed. A novel deletion mutation, c.802_807del, in the CYP4V2 gene was reported. ORTs are important changes in the outer retina of BCD patients, further investigation of this structure may provide insights into pathology of BCD. Intravitreal anti-VEGF therapy was effective for treatment of BCD complicated by CNV.
Substance P induces sympathetic immune response in the contralateral eye after the first eye cataract surgery in type 2 diabetic patients
Authors: Gong Xianhui , Ren Yueping , Fang Xiuxiu , Cai Junyong , Song E.
Published: August 2020

Background

Substance P (SP) is a nociceptive tachykinin which regulates the immune inflammatory reactions including monocyte chemoattractant protein 1 (MCP-1) production. Sequential second-eye cataract surgery patients often suffer more pain than the first one partly because of the MCP-1 increase in aqueous humor (AH). This study aims to illustrate whether SP is involved in sympathetic inflammatory responses in the contralateral eye in patients with or without type 2 diabetes.

Methods

This prospective randomized clinical study included 51 cataract patients (22 with diabetes and 29 without). Bilateral sequential cataract surgeries were conducted with 1-day or 1-week interval randomly. More than 100 μl of AH were obtained before surgery and stored for later analysis using magnetic Luminex assays to detect interleukin (IL)-1β, IL-1ra,IL-6, IL-8, IL-10, MCP-1, vascular endothelial growth factor, spinal macrophage inflammatory protein (MIP-1a), interferon-inducible protein 10 (IP-10), regulated on activation, normal T expressed and secreted (RANTES), as well as the enzyme-linked immunosorbent assay for SP.

Results

Among the 4 groups, no significant differences were found in age, sex distribution, the R/L ration of the first surgery eye, or the lens nucleus hardness (P ≥ 0.802). Over 100 μl of AH samples were collected safely in all cases without intraoperative complications. SP and MCP-1 levels were both increased significantly in the second eye of the diabetic patients with 1-day and 1-week interval (P ≤ 0.040). The SP increase in the second eye of the diabetic patients were significantly higher than that of the patients without diabetes (P ≤ 0.030) both in the groups with 1-day and 1-week interval. Similarly, the MCP-1 increase was significantly higher in the diabetic patients in the group with 1-week interval (P = 0.042).

Conclusions

Substance P and MCP-1 productions elevated in the AH of the contralateral eye after the first-eye cataract surgery in diabetic patients, indicating that SP and MCP-1 were involved in the sympathetic inflammatory responses. Diabetic patients are susceptible to noninfectious inflammation after cataract surgery, and perceive more pain in the second-eye phacoemulsification.

Trial registration

Chinese Clinical Trial Registry, ChiCTR1900028374, retrospectively registered on 20th December, 2019.
The economic burden of medical treatment of children with asthma in China
Authors: Wu Ping , Xu Baoping , Shen Adong , He Zonglin , Zhang Casper J. P. , Ming Wai-kit , Shen Kunling
Published: August 2020

Background

At present, there are few studies on the economic burden and medical treatment of children with asthma in China. Thus this study aimed to investigate the economic burden of medical treatment of children with asthma in China.

Method

The 2015 China Medical Insurance Research Association (CHIRA) database was searched for patients with asthma from 0 to 14 years old. A cross-sectional study with cost analysis was conducted.

Results

The annual per capita direct medical cost was RMB 525 (US$75) related to asthma. Totaling 58% of the medical expenditure for asthma was covered by insurance in China, the majority of which were direct medical costs. Those that have the highest rates of using antibiotics were central China (100.0%), children aged 3 years and under (63.6%), as well as fourth-tier and fifth-tier cities (77.1%). Outpatient clinics (98.58% vs 1.42%, P < 0.01), tertiary hospitals (62.08% vs 37.92%, P < 0.01), and general hospitals (72.27% vs 27.73%, P < 0.01) were more often visited than the inpatient clinics, secondary and primary as well as the specialized clinics, respectively.

Conclusion

The economic burden of childhood asthma in China is relatively low, and the national medical insurance reduces their economic burden to a large extent. Abuse of antibiotics in treating asthma was found in China. There remain opportunities to strengthen the hierarchical medical system, reducing hospitalization and emergency visits, and ultimately reducing the economic burden of children with asthma.
Device-assessed physical activity and sedentary behavior in a community-based cohort of older adults
Authors: Rosenberg Dori , Walker Rod , Greenwood-Hickman Mikael Anne , Bellettiere John , Xiang Yunhua , Richmire KatieRose , Higgins Michael , Wing David , Larson Eric B. , Crane Paul K. , LaCroix Andrea Z.
Published: August 2020

Background

Few studies characterize older adult physical activity and sitting patterns using accurate accelerometer and concurrent posture measures. In this descriptive paper, we report accelerometer data collection protocols, consent rates, and physical behavior measures from a population-based cohort study (Adult Changes in Thought, ACT).

Methods

The ACT study holds enrollment steady at approximately 2000 members of Kaiser Permanente Washington aged 65+ without dementia undergoing detailed biennial assessments. In 2016 the ACT-Activity Monitor (ACT-AM) sub-study was initiated to obtain data from wearing activPAL and ActiGraph devices for 7 days following regular biennial visits. We describe the methods protocol of ACT-AM and present characteristics of people who did and did not consent to wear devices. We compute inverse probability of response weights and incorporate these weights in linear regression models to estimate means and 95% confidence intervals (CI) of device-based pattern metrics, adjusted for wear time and demographic factors, and weighted to account for potential selection bias due to device-wear consent.

Results

Among 1885 eligible ACT participants, 56% agreed to wear both devices (mean age 77 years, 56% female, 89% non-Hispanic white, 91% with post-secondary education). On average, those who agreed to wear devices were younger and healthier. Estimated mean (95% CI) activPAL-derived sitting, standing, and stepping times were 10.2 h/day (603–618 min/day), 3.9 h/day (226–239 min/day), and 1.4 h/day (79–84 min/day), respectively. Estimated mean ActiGraph derived sedentary (Vector Magnitude [VM] < =18 counts/15 s), light intensity (VM 19–518 counts/15 s), and moderate-to-vigorous intensity (VM > 518 counts/15 s) physical activity durations were 9.5 h/day (565–577 min/day), 4.5 h/day (267–276 min/day), and 1.0 h/day (59–64 min/day). Participants who were older, had chronic conditions, and were unable to walk a half-mile had higher sedentary time and less physical activity.

Conclusions

Our recruitment rate demonstrates the feasibility of cohort participants to wear two devices that measure sedentary time and physical activity. Data indicate high levels of sitting time in older adults but also high levels of physical activity using cut-points developed for older adults. These data will help researchers test hypotheses related to physical behavior and health in older adults in the future.
Double anti-PL-7 and anti-MDA-5 positive Amyopathic Dermatomyositis with rapidly progressive interstitial lung disease in a Hispanic patient
Authors: Li Zi Ying , Gill Evanpaul , Mo Fan , Reyes Candice
Published: August 2020

Background

Each myositis-specific autoantibody (MSA) tends to have a distinct clinical presentation. Coexistence of MSAs do not commonly occur. If they do, it is unknown if there is an overlap of clinical features or prognostic implications. There are a few reported cases of overlap between these antibodies, mostly reported in patients with Japanese descent. Our aim for this case report is to turn more attention and interest for future MSA profile studies in the Hispanic population, which may hopefully spur better therapies if we realize the prognostic implications of certain myositis subsets including double-positive autoantibody syndromes.

Case presentation

A 27-year-old Hispanic female was admitted to the medical intensive care unit due to acute hypoxemic respiratory failure secondary to acute respiratory distress syndrome (ARDS). She had failed conventional mechanical ventilation and was cannulated for venovenous extracorporeal membrane oxygenation (VV-ECMO) to manage her respiratory failure. She had erythematous scaly plaques on bilateral 3rd metacarpophalangeal joints on examination. Her autoimmune workup revealed positivity for both anti-PL-7(threonyl) and anti-melanoma differentiation-associated gene 5 (MDA5) autoantibodies. After extensive evaluation, it was concluded that she had rapidly progressive interstitial lung disease (RPILD) due to amyopathic dermatomyositis. Despite maximal medical management, she was ultimately transitioned to comfort care measures and expired.

Conclusion

We would like to highlight the rarity of double antibody positive amyopathic dermatomyositis. This unique clinical presentation has only been reported in persons of Japanese descent. Our case is likely to be the first reported to occur in a person of Hispanic descent in the United States.

The rarity of our case could stimulate further study of overlapping MSA to understand its varied presentations and prognoses including possible tendency toward a rapidly progressive ILD phenotype. Earlier detection of these clinical syndromes can lead to better outcomes for patients with RPILD. This case report could also herald an increased recognition and understanding of MSA profile in the Hispanic population in the USA.
Combined anterior and posterior ankle impingement syndrome with nonunion of Cedell fracture in a 58-year-old female: a case report
Authors: Qin De-an , Jin Zhi-zhen , Song Jie-fu
Published: August 2020

Background

Combined anterior and posterior ankle impingement has seldom been reported. Cedell fracture, fracture of posteromedial tubercle of talus, is an uncommon and easily missed injury which may elicit posteromedial ankle impingement. The injury mechanisms and management strategies of these two lesions have been reported individually. But the concurrent lesion of both of them has not been reported.

Case presentation

We reported a 58-year-old female with combined anterior and posterior ankle impingement syndrome with nonunion of Cedell fracture in whom open osteophytes debridement, fracture internal fixation and posterior talotibial ligament reconstruction were performed. The AOFAS hindfoot score was 90 at 1 year follow-up. To our knowledge, this was the first reported case with anterior, posterior and posteromedial impingement which was treated operatively with an excellent short-term outcome.

Conclusions

To fully recognize this occult lesion and avoid missing is imperative for reducing the morbidities. We suggest CT and MRI as excellent imaging modalities that can help the timely diagnosis and appropriate treatment for this combined impingement with circumferential lesions.
Combined therapy of somatostatin analogues with pegvisomant for the treatment of acromegaly: a meta-analysis of prospective studies
Authors: Ma Lingyun , Luo Daohuang , Yang Ting , Wu Songtao , Li Min , Chen Chaoyang , Zhou Shuang , Ma Lingyue , Wu Ye , Zhou Ying , Cui Yimin
Published: August 2020

Background

Acromegaly is a rare, chronic and severe disease. Drug therapy including somatostatin analogues (SAs), dopamine receptor agonists and growth hormone receptor antagonists (pegvisomant, PEG) are commonly used to treat patients who do not respond to surgery. The use of combination therapy with PEG and SAs has become more common over the last decade. We performed this study to accurately evaluate the effect of combination therapy of SAs with PEG on acromegalic patients.

Methods

PubMed, EMBASE, The Cochrane Library, ClinicalTrials.gov, Scopus, Web of Science, Chinese Biomedical Literature Database and Trip databasewere searched for relevant studies. Prospective clinical trials treating acromegaly with the co-administration of SAs and PEG were included. We performed a meta-analysis by usingStata 12.1. Sensitivity analysis was conducted to explore heterogeneity.

Results

Nine studies were included in this meta-analysis. The overall rate of serum insulin-like growth factor 1 (IGF-1) normalization was 66% (95% CI: 52–78%; I2 = 62.59%). The combination therapy did not significantly change patients’ fasting plasma glucose (ES: 0.011 mmol*L− 1; 95% CI: − 0.374 to 0.397 mmol*L− 1;P = 0.954) or glycosylated haemoglobin (ES: − 0.074%; 95% CI: − 0.166 to 0.315%;P = 0.544) while decreasing the fasting plasma insulin (ES: − 21.487 pmol*L-1; 95% CI: − 35.713 to − 7.260 pmol*L-1;P = 0.003). Elevation of liver enzyme levels was found in 14% (95% CI: 8 to 21%) of the patients. There was no significant difference for serious adverse events and treatment discontinuation due to adverse event between SAs monotherapy group and combination therapy group.

Conclusions

Combined therapy of SAs and PEG effectively normalized IGF-1 levels in most of the patients whose IGF-1 level was greater than the upper limit of normal after high dose SAs monotherapy. The therapy also decreased significantly FPI levels with a neutral effect on glucose parameters in acromegaly patients. Moreover, elevated liver enzyme levels were observed in a small number of patients, which suggests a need for liver function monitoring.

Trial registration

We have our protocol registered in PROSPERO. (Registration number:CRD42019115549).
Home blood pressure data visualization for the management of hypertension: designing for patient and physician information needs
Authors: Koopman Richelle J. , Canfield Shannon M. , Belden Jeffery L. , Wegier Pete , Shaffer Victoria A. , Valentine K. D. , Jain Akshay , Steege Linsey M. , Patil Sonal J. , Popescu Mihail , LeFevre Michael L.
Published: August 2020

Background

Nearly half of US adults with diagnosed hypertension have uncontrolled blood pressure. Clinical inertia may contribute, including patient-physician uncertainty about how variability in blood pressures impacts overall control. Better information display may support clinician-patient hypertension decision making through reduced cognitive load and improved situational awareness.

Methods

A multidisciplinary team employed iterative user-centered design to create a blood pressure visualization EHR prototype that included patient-generated blood pressure data. An attitude and behavior survey and 10 focus groups with patients (N = 16) and physicians (N = 24) guided iterative design and confirmation phases. Thematic analysis of qualitative data yielded insights into patient and physician needs for hypertension management.

Results

Most patients indicated measuring home blood pressure, only half share data with physicians. When receiving home blood pressure data, 88% of physicians indicated entering gestalt averages as text into clinical notes. Qualitative findings suggest that including a data visualization that included home blood pressures brought this valued data into physician workflow and decision-making processes. Data visualization helps both patients and physicians to have a fuller understanding of the blood pressure ‘story’ and ultimately promotes the activated engaged patient and prepared proactive physician central to the Chronic Care Model. Both patients and physicians expressed concerns about workflow for entering and using home blood pressure data for clinical care.

Conclusions

Our user-centered design process with physicians and patients produced a well-received blood pressure visualization prototype that includes home blood pressures and addresses patient-physician information needs. Next steps include evaluating a recent EHR visualization implementation, designing annotation functions aligned with users’ needs, and addressing additional stakeholders’ needs (nurses, care managers, caregivers). This significant innovation has potential to improve quality of care for hypertension through better patient-physician understanding of control and goals. It also has the potential to enable remote monitoring of patient blood pressure, a newly reimbursed activity, and is a strong addition to telehealth efforts.
Defining ambulatory care sensitive conditions for adults in Portugal
Authors: Sarmento João , Rocha João Victor Muniz , Santana Rui
Published: August 2020

Background

Ambulatory Care Sensitive Conditions (ACSCs) are health conditions for which adequate management, treatment and interventions delivered in the ambulatory care setting could potentially prevent hospitalization. Which conditions are sensitive to ambulatory care varies according to the scope of health care services and the context in which the indicator is used. The need for a country-specific validated list for Portugal has already been identified, but currently no national list exists. The objective of this study was to develop a list of Ambulatory Care Sensitive Conditions for Portugal.

Methods

A modified web-based Delphi panel approach was designed, in order to determine which conditions can be considered ACSCs in the Portuguese adult population. The selected experts were general practitioners and internal medicine physicians identified by the most relevant Portuguese scientific societies. Experts were presented with previously identified ACSC and asked to select which could be accepted in the Portuguese context. They were also asked to identify other conditions they considered relevant. We estimated the number and cost of ACSC hospitalizations in 2017 in Portugal according to the identified conditions.

Results

After three rounds the experts agreed on 34 of the 45 initially proposed items. Fourteen new conditions were proposed and four achieved consensus, namely uterine cervical cancer, colorectal cancer, thromboembolic venous disease and voluntary termination of pregnancy. In 2017 133,427 hospitalizations were for ACSC (15.7% of all hospitalizations). This represents a rate of 1685 per 100,000 adults. The most frequent diagnosis were pneumonia, heart failure, chronic obstructive pulmonary disease/chronic bronchitis, urinary tract infection, colorectal cancer, hypertensive disease atrial fibrillation and complications of diabetes mellitus.

Conclusions

New ACSC were identified. It is expected that this list could be used henceforward by epidemiologic studies, health services research and for healthcare management purposes. ACSC lists should be updated frequently. Further research is necessary to increase the specificity of ACSC hospitalizations as an indicator of healthcare performance.
Boosting toxic protein biosynthesis: transient in vivo inactivation of engineered bacterial alkaline phosphatase
Authors: Krawczun Natalia , Bielawa Marta , Szemiako Kasjan , Łubkowska Beata , Sobolewski Ireneusz , Zylicz-Stachula Agnieszka , Skowron Piotr M.
Published: August 2020

Background

The biotechnology production of enzymes is often troubled by the toxicity of the recombinant products of cloned and expressed genes, which interferes with the recombinant hosts’ metabolism. Various approaches have been taken to overcome these limitations, exemplified by tight control of recombinant genes or secretion of recombinant proteins. An industrial approach to protein production demands maximum possible yields of biosynthesized proteins, balanced with the recombinant host’s viability. Bacterial alkaline phosphatase (BAP) from Escherichia coli (E. coli) is a key enzyme used in protein/antibody detection and molecular cloning. As it removes terminal phosphate from DNA, RNA and deoxyribonucleoside triphosphates, it is used to lower self-ligated vectors’ background. The precursor enzyme contains a signal peptide at the N-terminus and is secreted to the E. coli periplasm. Then, the leader is clipped off and dimers are formed upon oxidation.

Results

We present a novel approach to phoA gene cloning, engineering, expression, purification and reactivation of the transiently inactivated enzyme. The recombinant bap gene was modified by replacing a secretion leader coding section with a N-terminal His6-tag, cloned and expressed in E. coli in a PBAD promoter expression vector. The gene expression was robust, resulting in accumulation of His6-BAP in the cytoplasm, exceeding 50% of total cellular proteins. The His6-BAP protein was harmless to the cells, as its natural toxicity was inhibited by the reducing environment within the E. coli cytoplasm, preventing formation of the active enzyme. A simple protocol based on precipitation and immobilized metal affinity chromatography (IMAC) purification yielded homogeneous protein, which was reactivated by dialysis into a redox buffer containing reduced and oxidized sulfhydryl group compounds, as well as the protein structure stabilizing cofactors Zn2+, Mg2+ and phosphate. The reconstituted His6-BAP exhibited high activity and was used to develop an efficient protocol for all types of DNA termini, including problematic ones (blunt, 3′-protruding).

Conclusions

The developed method appears well suited for the industrial production of ultrapure BAP. Further, the method of transient inactivation of secreted toxic enzymes by conducting their biosynthesis in an inactive state in the cytoplasm, followed by in vitro reactivation, can be generally applied to other problematic proteins.
Accuracy of various criteria for lymph node staging in ductal adenocarcinoma of the pancreatic head by computed tomography and magnetic resonance imaging
Authors: Loch Florian N. , Asbach Patrick , Haas Matthias , Seeliger Hendrik , Beyer Katharina , Schineis Christian , Degro Claudius E. , Margonis Georgios A. , Kreis Martin E. , Kamphues Carsten
Published: August 2020

Background

Lymph node staging of ductal adenocarcinoma of the pancreatic head (PDAC) by cross-sectional imaging is limited. The aim of this study was to determine the diagnostic accuracy of expanded criteria in nodal staging in PDAC patients.

Methods

Sixty-six patients with histologically confirmed PDAC that underwent primary surgery were included in this retrospective IRB-approved study. Cross-sectional imaging studies (CT and/or MRI) were evaluated by a radiologist blinded to histopathology. Number and size of lymph nodes were measured (short-axis diameter) and characterized in terms of expanded morphological criteria of border contour (spiculated, lobulated, and indistinct) and texture (homogeneous or inhomogeneous). Sensitivities and specificities were calculated with histopathology as a reference standard.

Results

Forty-eight of 66 patients (80%) had histologically confirmed lymph node metastases (pN+). Sensitivity, specificity, and Youden’s Index for the criterion “size” were 44.2%, 82.4%, and 0.27; for “inhomogeneous signal intensity” 25.6%, 94.1%, and 0.20; and for “border contour” 62.7%, 52.9%, and 0.16, respectively. There was a significant association between the number of visible lymph nodes on preoperative CT and lymph node involvement (pN+, p = 0.031).

Conclusion

Lymph node staging in PDAC is mainly limited due to low sensitivity for detection of metastatic disease. Using expanded morphological criteria instead of size did not improve regional nodal staging due to sensitivity remaining low. Combining specific criteria yields improved sensitivity with specificity and PPV remaining high.
Clinical implications of prospective genomic profiling of metastatic breast cancer patients
Authors: van Geelen Courtney T. , Savas Peter , Teo Zhi Ling , Luen Stephen J. , Weng Chen-Fang , Ko Yi-An , Kuykhoven Keilly S. , Caramia Franco , Salgado Roberto , Francis Prudence A. , Dawson Sarah-Jane , Fox Stephen B. , Fellowes Andrew , Loi Sherene
Published: August 2020

Background

Metastatic breast cancer remains incurable. Next-generation sequencing (NGS) offers the ability to identify actionable genomic alterations in tumours which may then be matched with targeted therapies, but the implementation and utility of this approach is not well defined for patients with metastatic breast cancer.

Methods

We recruited patients with advanced breast cancer of any subtype for prospective targeted NGS of their most recent tumour samples, using a panel of 108 breast cancer-specific genes. Genes were classified as actionable or non-actionable using the European Society of Medical Oncology Scale for Clinical Actionability of Molecular Targets (ESCAT) guidelines.

Results

Between February 2014 and May 2019, 322 patients were enrolled onto the study, with 72% (n = 234) of patients successfully sequenced (n = 357 samples). The majority (74%, n = 171) of sequenced patients were found to carry a potentially actionable alteration, the most common being a PIK3CA mutation. Forty-three percent (n = 74) of patients with actionable alterations were referred for a clinical trial or referred for confirmatory germline testing or had a change in therapy outside of clinical trials. We found alterations in AKT1, BRCA2, CHEK2, ESR1, FGFR1, KMT2C, NCOR1, PIK3CA and TSC2 to be significantly enriched in our metastatic population compared with primary breast cancers. Concordance between primary and metastatic samples for key driver genes (TP53, ERBB2 amplification) was > 75%. Additionally, we found that patients with a higher number of mutations had a significantly worse overall survival.

Conclusion

Genomic profiling of patients with metastatic breast cancer can have clinical implications and should be considered in all suitable patients.
Correction to: Intercellular transmission of Seneca Valley virus mediated by exosomes
Authors: Xu Guowei , Xu Shouxing , Shi Xijuan , Shen Chaochao , Hao Junhong , Yan Minhao , Zhang Dajun , Zhu Zixiang , Zhang Keshan , Zheng Haixue , Liu Xiangtao
Published: August 2020

An amendment to this paper has been published and can be accessed via the original article.
Geographical variation in determinants of high-risk fertility behavior among reproductive age women in Ethiopia using the 2016 demographic and health survey: a geographically weighted regression analysis
Authors: Tessema Zemenu Tadesse , Azanaw Melkalem Mamuye , Bukayaw Yeaynmarnesh Asmare , Gelaye Kassahun Alemu
Published: August 2020

Background

Maternal and child mortalities are the main public health problems worldwide and both are the major health concern in developing countries such as Africa and Asia. The fertility behavior of women characterized by maternal age, birth spacing, and order, impacts the health of women and children. The aim of this study was to assess the geographically variation in risk factors of high-risk fertility behavior (HRFB) among reproductive-age women in Ethiopia using the 2016 Demographic and Health Survey.

Methods

A total of 11,022 reproductive-age women were included in this study. The data were cleaned and weighted by STATA 14.1 software. Bernoulli based spatial scan statistics was used to identify the presence of pure high-risk fertility behavior spatial clusters using Kulldorff’s SaTScan version 9.6 software. ArcGIS 10.7 was used to visualize the spatial distribution of high-risk fertility behavior. Geographically weighted regression analysis was employed by multiscale geographical using Multiscale geographical weighted regression version 2.0 software. A p-value of less than 0.05 was used to declare statistically significant predictors (at a local level).

Results

Overall, 76% with 95% confidence interval of 75.60 to 77.20 of reproductive age women were faced with high-risk fertility problems in Ethiopia. High-risk fertility behavior was highly clustered in the Somali and Afar regions of Ethiopia. SaTScan identified 385 primary spatial clusters (RR = 1.13, P <  0.001) located at Somali, Afar, and some parts of Oromia Regional Stateregional state of Ethiopia. Women who are living in primary clusters were 13% more likely venerable to high-risk fertility behavior than outside the cluster. In geographically weighted regression, not using contraceptives and home delivery were statistically significant vary risk factors affecting high- risk fertility behavior spatially. No contraceptive use and home delivery were statistically significant predictors (at the local level) in different regions of Ethiopia.

Conclusion

In Ethiopia, HRFB varies across regions. Statistically, a significant-high hot spot high-risk fertility behavior was identified at Somali and Afar. No contraceptive use and home delivery were statistically significant predictors (at a local level) in different regions of Ethiopia. Therefore, policymakers and health planners better to design an effective intervention program at Somali, and Afar to reduce high-risk fertility behavior and Special attention needs about health education on the advantage of contraceptive utilization and health facility delivery to reduce high-risk fertility behavior.
Decomposing socioeconomic inequality in dental caries in Iran: cross-sectional results from the PERSIAN cohort study
Authors: Najafi Farid , Rezaei Satar , Hajizadeh Mohammad , Soofi Moslem , Salimi Yahya , Kazemi Karyani Ali , Soltani Shahin , Ahmadi Sina , Homaie Rad Enayatollah , Karami Matin Behzad , Pasdar Yahya , Hamzeh Behrooz , Nazar Mehdi Moradi , Mohammadi Ali , Poustchi Hossein , Motamed-Gorji Nazgol , Moslem Alireza , Khaleghi Ali Asghar , Fatthi Mohammad Reza , Aghazadeh-Attari Javad , Ahmadi Ali , Pourfarzi Farhad , Somi Mohammad Hossein , Sohrab Mehrnoush , Ansari-Moghadam Alireza , Edjtehadi Farhad , Esmaeili Ali , Joukar Farahnaz , Lotfi Mohammad Hasan , Aghamolaei Teamur , Eslami Saied , Tabatabaee Seyed Hamid Reza , Saki Nader , Haghdost Ali Akbar
Published: August 2020

Background

The current study aimed to measure and decompose socioeconomic-related inequalities in DMFT (decayed, missing, and filled teeth) index among adults in Iran.

Methods

The study data were extracted from the adult component of Prospective Epidemiological Research Studies in IrAN (PERSIAN) from 17 centers in 14 different provinces of Iran. DMFT score was used as a measure of dental caries among adults in Iran. The concentration curve and relative concentration index (RC) was used to quantify and decompose socioeconomic-related inequalities in DMFT.

Results

A total of 128,813 adults aged 35 and older were included in the study. The mean (Standard Deviation [SD]) score of D, M, F and DMFT of the adults was 3.3 (4.6), 12.6 (10.5), 2.1 (3.4) and 18.0 (9.5), respectively. The findings suggested that DMFT was mainly concentrated among the socioeconomically disadvantaged adults (RC = − 0.064; 95% confidence interval [CI), − 0.066 to − 0.063). Socioeconomic status, being male, older age and being a widow or divorced were identified as the main factors contributing to the concentration of DMFT among the worse-off adults.

Conclusions

It is recommended to focus on the dental caries status of socioeconomically disadvantaged groups in order to reduce socioeconomic-related inequality in oral health among Iranian adults. Reducing socioeconomic-related inequalities in dental caries should be accompanied by appropriate health promotion policies that focus actions on the fundamental socioeconomic causes of dental disease.
Prostaglandin insert dinoprostone versus trans-cervical balloon catheter for outpatient labour induction: a randomised controlled trial of feasibility (PROBIT-F)
Authors: Bhide Amarnath , Sedgwick Philip , Barrett Barbara , Cupples Georgina , Coates Rose , Goode Rosie , Linton Sandra , McCourt Christine
Published: August 2020

Background

The aim was to assess the feasibility of conducting a randomised controlled trial (RCT) of induction of labour comparing use of two methods in the outpatient setting.

Methods

An open-label feasibility RCT was conducted in two UK maternity units from October 2017 to March 2019. Women aged ≥ 16 years, undergoing induction of labour (IOL) at term, with intact membranes and deemed suitable for outpatient IOL according to local guidelines were considered eligible. They were randomised to cervical ripening balloon catheter (CRB) or vaginal dinoprostone (Propess). The participants completed a questionnaire and a sub-group underwent detailed interview. Service use and cost data were collected via the Adult Service Use Schedule (AD-SUS). Women who declined to participate were requested to complete a decliners’ questionnaire.

Results

During the study period, 274 eligible women were identified. Two hundred thirty (83.9%) were approached for participation of whom 84/230 (36.5%) agreed and 146 did not. Of these, 38 were randomised to Propess (n = 20) and CRB (n = 18). Decliner data were collected for 93 women. The reasons for declining were declining IOL (n = 22), preference for inpatient IOL (n = 22) and preference for a specific method, Propess (n = 19). The intended sample size of 120 was not reached due to restrictive criteria for suitability for outpatient IOL, participant preference for Propess and shortage of research staff.

The intervention as randomised was received by 29/38 (76%) women. Spontaneous vaginal delivery was observed in 9/20 (45%) women in the dinoprostone group and 11/18 (61%) women in the CRB group. Severe maternal adverse events were recorded in one woman in each group. All babies were born with good condition and all except one (37/38, 97.4%) remained with the mother after delivery. No deaths were recorded. − 21% of women in the dinoprostone group were re-admitted prior to diagnosis of active labour compared to 12% in the CRB group.

Conclusions

A third of the approached eligible women agreed for randomisation. An RCT is not feasible in the current service context. Modifications to the eligibility criteria for outpatient IOL, better information provision and round the clock availability of research staff would be needed to reach sufficient numbers.

Trial registration

NCT03199820. Registered on June 27, 2017
Improved comprehensive analytical method for assessment of satranidazole in drug and product
Authors: Mazumder Rana , Mahanti Beduin , Majumdar Subhabrota , Pal Rabindranath , Chowdhury Ashok Dhar
Published: August 2020

Background

The aim of the present investigation was to improve comprehensive analytical method for the assessment of satranidazole in drug and product with simple, economic, sensitive, and reproducible spectrophotometric method. The drug was analyzed in three different methods by using various solvents where satranidazole (STZ) showed different absorbance maxima (s) and sharp peaks in the first order derivative spectra. Beer’s law range, correlation coefficient, apparent molar absorptivity, etc., were determined for each solvent using all the three methods.

Results

All the results of analysis were found to be satisfactory which was validated statistically for various parameters and by performing recovery studies in accordance with international conference on harmonization (ICH) guidelines. The developed methods were also compared statistically using one way analysis of variance (ANOVA).

Conclusion

Three different spectrophotometric methods were developed for satranidazole (STZ) using various inorganic and organic solvents. The analytical methods are found to be simple, sensitive, rapid, specific, and economic, and it can be conveniently employed for the routine analysis, quality control. The sample recoveries from the formulation were in good agreement with its respective label claim.
Defining what a ‘carer’ is and the role they play in in-patient mental healthcare: A focus group study with patients, carers and clinicians
Authors: Dirik Aysegul , Kaselionyte Justina , Giacco Domenico , Priebe Stefan
Published: August 2020

Background

The value of carer involvement has been extensively researched and promoted. However, the field lacks exploration of conceptual issues, which might help to explain why there are widespread difficulties in putting policy into practice in this area, as implementation rates remain low internationally.

Aims

This qualitative study explored patients’, carers’ and clinicians’ perspectives on the role of carers in mental healthcare, particularly with regards to in-patient settings.

Method

Sixteen focus groups were conducted with patients, carers and clinicians who have current or previous experience of in-patient settings. A thematic analysis was conducted on the transcripts, exploring two key domains: (a) what a ‘carer’ is, and (b) how the ‘carer’ role is described within the context of the hospital environment.

Results

Participants diverged in their opinions of what the ‘carer’ role entails, and the perceived helpfulness of it. Issues unique to the in-patient setting were identified, such as the role of the hospital environment in enabling or being a barrier to carer involvement. These differing perspectives and contextual factors had an impact on the position of carers in the hospital setting, as they could be viewed as helpful, a hindrance or as passive visitors, depending on the perspectives of clinicians.

Conclusions

More clarity and agreement is needed between patients, carers and clinicians in terms of how the ‘carer’ role is defined. This has the potential to improve carers’ experience of involvement in hospital settings.
Validation of the Swedish Diabetes Re-Grouping Scheme in Adult-Onset Diabetes in China
Authors: Li Xia , Yang Shuting , Cao Chuqing , Yan Xiang , Zheng Lei , Zheng Lanbo , Da Jiarui , Tang Xiaohan , Ji Linong , Yang Xilin , Zhou Zhiguang
Published: August 2020

Context

This study applied the Swedish novel data-driven classification in Chinese newly diagnosed diabetic patients and validated its adoptability.

Objective

This study aimed to validate the practicality of the Swedish diabetes regrouping scheme in Chinese adults with newly diagnosed diabetes.

Design

Patients were classified into 5 subgroups by K-means and Two-Step methods according to 6 clinical parameters.

Setting

Ambulatory care.

Patients

A cross-sectional survey of 15 772 patients with adult-onset newly diagnosed diabetes was conducted in China from April 2015 to October 2017.

Intervention

None.

Main Outcome Measures

Six parameters including glutamate decarboxylase antibodies (GADA), age of onset, body mass index (BMI), glycated hemoglobin A1c (HbA1c), homoeostatic model assessment 2 estimates of β-cell function (HOMA2-B) and insulin resistance (HOMA2-IR) were measured to calculate the patient subgroups.

Results

Our patients clustered into 5 subgroups: 6.2% were in the severe autoimmune diabetes (SAID) subgroup, 24.8% were in the severe insulin-deficient diabetes (SIDD) subgroup, 16.6% were in the severe insulin-resistance diabetes (SIRD) subgroup, 21.6% were in the mild obesity-related diabetes (MOD) subgroup and 30.9% were in the mild age-related diabetes (MARD) subgroup. When compared with the Swedish population, the proportion of SIDD subgroup was higher. In general, Chinese patients had younger age, lower BMI, higher HbA1c, lower HOMA2-B and HOMA2-IR, and higher insulin use but lower metformin usage than the Swedish patients.

Conclusion

The Swedish diabetes regrouping scheme is applicable to adult-onset diabetes in China, with a high proportion of patients with the severe insulin deficient diabetes. Further validations of long-term diabetes complications remain warranted in future studies.
Maternal Thyroid Dysfunction During Pregnancy and the Risk of Adverse Outcomes in the Offspring: A Systematic Review and Meta-Analysis
Authors: Ge Grace Mengqin , Leung Miriam T Y , Man Kenneth K C , Leung Wing Cheong , Ip Patrick , Li Gloria H Y , Wong Ian C K , Kung Annie W C , Cheung Ching-Lung
Published: August 2020

Context

Previous studies suggested a potential link of maternal thyroid dysfunction with adverse neurocognitive outcomes and impaired development of internal organs in offspring.

Objective

To review the association between maternal thyroid dysfunction and the risk of adverse outcomes in offspring.

Data Sources

PubMed, EMBASE, and Cochrane Library.

Study Selections

Eligible studies reported the association between maternal thyroid hormone function and the risk of adverse outcomes in their children.

Data Extraction

Reviewers extracted data on study characteristics and results independently.

Data Synthesis

Estimates were pooled and reported as odds ratio (OR) with 95% confidence interval (CI). I2 tests were applied to assess the heterogeneity across studies.

Results

We identified 29 eligible articles and found an association between maternal hyperthyroidism and attention deficit hyperactivity disorder (ADHD) (OR: 1.18, 95% CI: 1.04-1.34, I2 = 0%) and epilepsy (OR: 1.19, 95% CI: 1.08-1.31, I2 = 0%) in offspring; as well as an association of maternal hypothyroidism with increased risk of ADHD (OR: 1.14, 95% CI: 1.03-1.26, I2 = 25%), autism spectrum disorder (OR: 1.41, 95% CI: 1.05-1.90, I2 = 63%), and epilepsy (OR: 1.21, 95% CI: 1.06-1.39, I2 = 0%) in offspring.

Conclusion

Routine measurement and timely treatment on thyroid function should be considered for pregnant women.
Differentiation of PTH-Expressing Cells From Human Pluripotent Stem Cells
Authors: Lawton Betty R , Martineau Corine , Sosa Julie Ann , Roman Sanziana , Gibson Courtney E , Levine Michael A , Krause Diane S
Published: August 2020

Differentiation of pluripotent stem cells into functional parathyroid-like cells would accelerate development of important therapeutic options for subjects with parathyroid-related disorders, from the design and screening of novel pharmaceutical agents to the development of durable cellular therapies. We have established a highly reproducible directed differentiation approach leading to PTH-expressing cells from human embryonic stem cells and induced pluripotent stem cells. We accomplished this through the comparison of multiple different basal media, the inclusion of the CDK inhibitor PD0332991 in both definitive endoderm and anterior foregut endoderm stages, and a 2-stage pharyngeal endoderm series. This is the first protocol to reproducibly establish PTH-expressing cells from human pluripotent stem cells and represents a first step toward the development of functional parathyroid cells with broad applicability for medicinal and scientific investigation.
Acetyl-CoA Regulation, OXPHOS Integrity and Leptin Levels Are Different in Females With Childhood vs Adulthood Onset of Obesity
Authors: Tam Bjorn T , Murphy Jessica , Khor Natalie , Morais Jose A , Santosa Sylvia
Published: August 2020

Although childhood-onset obesity (CO) and adulthood-onset obesity (AO) are known to lead to distinctive clinical manifestations and disease risks, the fundamental differences between them are largely unclear. The aim of the current study is to investigate the fundamental differences between subcutaneous adipose tissue from CO and AO and to identify metabolic differences between abdominal (abSAT) and femoral subcutaneous adipose tissues (feSAT). Total and regional body composition was assessed using dual-energy x-ray absorptiometry (DXA) and computed tomography. Levels of acetyl-CoA, NAD+/NADH, acetyl-CoA network genes, mitochondrial complex abundance, H3 acetylation were determined in biopsied abSAT and feSAT. Serum leptin and adiponectin were measured. Our results showed that acetyl-CoA was higher in subcutaneous adipose tissue from subjects with AO compared with CO. Multiple linear regression revealed that ATP citrate lyase was the only main effect affecting the level of acetyl-CoA. Circulating leptin concentrations was higher in AO. The increased level of acetyl-CoA was strongly associated with histone H3 acetylation, LEP expression in adipose tissue, and circulating leptin in AO. NAD+/NADH was higher in CO; however, abundance of mitochondrial complexes, the complex II:complex V ratio, and the complex IV:complex V ratio were lower in CO, reflecting compromised mitochondrial function in subcutaneous adipose tissue from CO. Moreover, we identified differences in the level of acetyl-CoA and NAD+/NADH ratio between abSAT and feSAT, suggesting that these fat depots may possess different metabolic properties. The fundamental difference in the important metabolic intermediate acetyl-CoA between CO and AO may help us better understand the development of obesity and the pathogenesis of different obesity-related diseases in humans.
Diagnostic performance of chest CT in screening patients with suspected COVID-19 infection in a Western population
Authors: Krdzalic Jasenko , de Jaegere Tom M.H. , Kwee Robert M.
Published: August 2020

Objective:

To investigate the diagnostic performance of chest CT in screening patients suspected of Coronavirus disease 2019 (COVID-19) in a Western population.

Methods:

Consecutive patients who underwent chest CT because of clinical suspicion of COVID-19 were included. CT scans were prospectively evaluated by frontline general radiologists who were on duty at the time when the CT scan was performed and retrospectively assessed by a chest radiologist in an independent and blinded manner. Real-time reverse transcriptase–polymerase chain reaction was used as reference standard. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. Sensitivity and specificity of the frontline general radiologists were compared to those of the chest radiologist using the McNemar test.

Results:

56 patients were included. Sensitivity, specificity, PPV, and NPV for the frontline general radiologists were 89.3% [95% confidence interval (CI): 71.8%, 97.7%], 32.1% (95% CI: 15.9%, 52.4%), 56.8% (95% CI: 41.0%, 71.7%), and 75.0% (95% CI: 42.8%, 94.5%), respectively. Sensitivity, specificity, PPV, and NPV for the chest radiologist were 89.3% (95% CI: 71.8%, 97.7%), 75.0% (95% CI: 55.1%, 89.3%), 78.1% (95% CI: 60.0%, 90.7%), and 87.5% (95% CI: 67.6%, 97.3%), respectively. Sensitivity was not significantly different (p = 1.000), but specificity was significantly higher for the chest radiologist (p = 0.001).

Conclusion:

Chest CT interpreted by frontline general radiologists achieves insufficient screening performance. Although specificity of a chest radiologist appears to be significantly higher, sensitivity did not improve. A negative chest CT result does not exclude COVID-19.

Advances in knowledge:

Our study shows that chest CT interpreted by frontline general radiologists achieves insufficient diagnostic performance to use it as an independent screening tool for COVID-19. Although specificity of a chest radiologist appears to be significantly higher, sensitivity is still insufficiently high.