bluuebunny/crossref_metadata_2025 huggingface dataset:
Does sexual behaviour of people with HIV reflect antiretroviral therapy as a preventive strategy? A cross-sectional study among outpatients in Kenya
Authors: Nkhoma Kennedy , Ahmed Aabid , Alli Zipporah , Sherr Lorraine , Harding Richard
Published: September 2019

Background

The World Health Organisation (WHO) advocates early initiation of HIV treatment as a prevention strategy among people living with HIV. There is strong evidence for the effectiveness of antiretroviral therapy (ART) as a preventive tool for HIV transmission. We aimed to determine the sexual behaviour of HIV outpatients and assess if it reflects the current preventive strategy for HIV transmission.

Methods

We conducted a cross-sectional study among adult (aged at least 18 years) patients with confirmed HIV diagnosis, and aware of their diagnosis, attending HIV outpatient care in Kenya. Data were gathered through self-report (using validated questionnaires) and file extraction. Multivariate logistic regression assessed the association between sexual risk taking behaviour controlling for gender, HIV clinical stage, HIV treatment status, Tuberculosis (TB) treatment status, and CD4 count.

Results

We recruited n = 400 participants (n = 280[70%] female gender). The mean age was 39.4 (SD = 9.9) years. The mean CD4 count was 393.7 (SD = 238.2) and ranged from 2 to 1470 cells/mm3. N = 61 (15.64%) were on TB treatment. The majority (n = 366, 91.5%) were on ART. Just over half (n = 202, 50.5%) reported having a sexual partner. Of these n = 33 (16.1%) reported having unprotected sexual intercourse with a person of unknown HIV status in the previous 3 months.

Multivariate analysis showed that participants not on ART (HIV treatment) were more likely to report unprotected sexual intercourse compared to those who were on ART (odds ratio .25, 95% CI .09 to .69; P = 0.007).

Participants at early stage of HIV infection (stages 1/2) were more likely to report unprotected sexual intercourse compared to participants at advanced HIV infection (stages 3/4) (odds ratio .34, 95% CI .13 to .92; P = 0.035). Males participants were more likely to be involved in sexual risk taking behaviours compared to female participants (odds ratio .36, 95% CI .16 to .82; P = 0.015). TB treatment status, and CD4 count were not significantly associated with sexual risk taking.

Conclusion

Participants not on ART have more unprotected sexual intercourse than those who are on ART. This calls for the need to scale up coverage and early ART initiation in order to reduce transmission of HIV.
Does body mass index affect restoration of femoral offset, leg length and cup positioning after total hip arthroplasty? A prospective cohort study
Authors: Al-Amiry Bariq , Pantelakis Georgios , Mahmood Sarwar , Kadum Bakir , Brismar Torkel B. , Sayed-Noor Arkan S.
Published: September 2019

Background

In obese patients, total hip arthroplasty (THA) can be technically demanding with increased perioperative risks. The aim of this prospective cohort study is to evaluate the effect of body mass index (BMI) on radiological restoration of femoral offset (FO) and leg length as well as acetabular cup positioning.

Methods

In this prospective study, patients with unilateral primary osteoarthritis (OA) treated with THA between September 2010 and December 2013 were considered for inclusion. The perioperative plain radiographs were standardised and used to measure the preoperative degree of hip osteoarthritis, postoperative FO, leg length discrepancy (LLD), acetabular component inclination and anteversion.

Results

We included 213 patients (74.5% of those considered for inclusion) with a mean BMI of 27.7 (SD 4.5) in the final analysis. The postoperative FO was improper in 55% and the LLD in 15%, while the cup inclination and anteversion were improper in 13 and 23% of patients respectively. A multivariable logistic regression model identified BMI as the only factor that affected LLD. Increased BMI increased the risk of LLD (OR 1.14, 95% CI 1.04 to 1.25). No other factors included in the model affected any of the primary or secondary outcomes.

Conclusion

Increased BMI showed a negative effect on restoration of post-THA leg length but not on restoration of FO or positioning of the acetabular cup. Age, gender, OA duration or radiological severity and surgeon’s experience showed no relation to post-THA restoration of FO, leg length or cup positioning.
Small-cell neuroendocrine carcinoma of the ileum: case report and literature review
Authors: Lee Jong Eun , Hong Sung Hoon , Jung Hae Il , Son Myoung Won , Ahn Tae Sung , Han Sun Wook , Cho Jun Hun
Published: September 2019

Background

Poorly differentiated neuroendocrine carcinomas (NECs) originating from the gastrointestinal (GI) tract are rare and very highly malignant disease with a poor prognosis. Poorly differentiated NECs most commonly arise in the esophagus and the large bowel; however, they may occur within virtually any portion of the GI tract. It is known, however, that they do not typically occur in the small intestine.

Case report

A 21-year-old woman visited an emergency room with acute abdominal pain that commenced 2 days prior to her presentation. Thereafter, a computed tomography (CT) scan was notable for a small-intestine perforation, and huge masses were observed in the small intestine and the mesentery. The mass that was located at the ileum site is approximately 100 cm above the ileocecal (IC) valve, and while it is located on the anti-mesenteric border and it seems that luminal narrowing had occurred, an obstruction is absent. Also, a same-nature mass is on the mesentery. The pathologic reports confirmed a small-cell-type NEC with a mass size of 7.5 × 6.5 cm. The mitotic count is up to 24/10 high-power fields (HPFs), the results of the immunohistochemical stain are positive for CD56 and synaptophysin, and the Ki-67 level is 50%. %. After the operation, she was treated with Etoposide-Cisplatin (EP) chemotheraphy. Stable disease was seen during Etoposide-Cisplatin chemotheraphy. Liver metastasis was also confirmed after chemotheraphy. Additionally, Irinotecan and cisplatin were used for 3 cycles, but progression of disease, neutropenic fever, thrombocytopenia, general weakness persisted. Eventually, she died 1 year and 6 months after surgery.

Conclusion

Ileum-located NECs are diagnosed very rarely. The most common locations for these tumors along the GI tract are the esophagus and the large intestine, but they can arise anywhere. The prognosis for NECs is poor due to the metastatic disease of most patients at the time of diagnosis. The role of adjuvant treatment requires further evaluation for the attainment of a better understanding of the overall treatment effect.
Preferred, small-scale foraging areas of two Southern Ocean fur seal species are not determined by habitat characteristics
Authors: Wege Mia , de Bruyn P. J. Nico , Hindell Mark A. , Lea Mary-Anne , Bester Marthán N.
Published: September 2019

Background

To understand and predict the distribution of foragers, it is crucial to identify the factors that affect individual movement decisions at different scales. Individuals are expected to adjust their foraging movements to the hierarchical spatial distribution of resources. At a small local scale, spatial segregation in foraging habitat happens among individuals of closely situated colonies. If foraging segregation is due to differences in distribution of resources, we would expect segregated foraging areas to have divergent habitat characteristics.

Results

We investigated how environmental characteristics of preferred foraging areas differ between two closely situated Subantarctic fur seal (Arctocephalus tropicalis) colonies and a single Antarctic fur seal (A. gazella) colony that forage in different pelagic areas even though they are located well within each other’s foraging range. We further investigated the influence of the seasonal cycle on those environmental factors. This study used tracking data from 121 adult female Subantarctic and Antarctic fur seals, collected during summer and winter (2009–2015), from three different colonies. Boosted Regression Tree species distribution models were used to determine key environmental variables associated with areas of fur seal restricted search behaviour. There were no differences in the relative influence of key environmental variables between colonies and seasons. The variables with the most influence for each colony and season were latitude, longitude and magnitude of sea-currents. The influence of latitude and longitude is a by-product of the species’ distinct foraging areas, despite the close proximity (< 25 km) of the colonies. The predicted potential foraging areas for each colony changed from summer to winter, reflecting the seasonal cycle of the Southern Ocean. The model predicted that the potential foraging areas of females from the three colonies should overlap, and the fact they do not in reality indicates that factors other than environmental are influencing the location of each colony’s foraging area.

Conclusions

The results indicated that small scale spatial segregation of foraging habitats is not driven by bottom-up processes. It is therefore important to also consider other potential drivers, e.g. competition, information transfer, and memory, to understand animal foraging decisions and movements.
Perceptions of intercultural competence and institutional intercultural inclusiveness among first year medical students: a 4-year study
Authors: Malau-Aduli Bunmi S. , Ross Simone , Adu Mary D.
Published: September 2019

Background

This study sought to examine the awareness/perception of intercultural competence and institutional intercultural inclusiveness among first year students at an Australian medical school over four consecutive years (2014–2017); to identify existing gaps in the curriculum and proffer recommendations.

Methods

The study employed an adapted 20-item questionnaire for data collection. The reliability and interrelations of the survey items were examined. Descriptive statistics was used to examine students’ perceptions, while Mann-U Whitney and Kruskal-Wallis tests were used to assess items scores in relation to participant characteristics.

Results

Over the 4 years of study, there were 520 respondents with between 53 to 69% response rates per year. Cronbach’s alpha for the instrument was 0.88 and factor analysis showed all items loading strongly on two components. Participants’ mean score on self-reported intercultural competence levels ranged from 3.8–4.6 out of 5; indicating relatively high awareness, valuing and understanding of cultural differences among this group of students. However, their mean scores (3.4–4.2) for institutional intercultural inclusiveness were slightly lower.

Conclusion

The instrument used in this study is effective in assessing level of intercultural competence among medical students. However, the results highlight the need for increased institutional support and professional development for faculty members to foster institutional intercultural inclusiveness.
Long-term retention assessment after simulation-based-training of pediatric procedural skills among adult emergency physicians: a multicenter observational study
Authors: Ansquer Raihei , Mesnier Thomas , Farampour Farnam , Oriot Denis , Ghazali Daniel Aiham
Published: September 2019

Background

One of the primary goals of simulation-based education is to enable long-term retention of training gains. However, medical literature has poorly contributed to understanding the best timing for repetition of simulation sessions. There is heterogeneity in re-training recommendations.

Objectives

This study assessed, through simulation-based training in different groups, the long-term retention of rare pediatric technical procedures.

Methods

This multicenter observational study included 107 emergency physicians and residents. Eighty-eight were divided into four groups that were specifically trained for pediatric emergency procedures at different points in time between 2010 and 2015 (< 0.5 year prior for G1, between 0.5 and 2 years prior for G2, between 2 and 4 years prior for G3, and ≥ 4 years prior for G4). An untrained control group (C) included 19 emergency physicians. Participants were asked to manage an unconscious infant using a low-fidelity mannequin. Assessment was based on the performance at 6 specific tasks corresponding to airway (A) and ventilation (B) skills. The performance (scored on 100) was evaluated by the TAPAS scale (Team Average Performance Assessment Scale). Correlation between performance and clinical level of experience was studied.

Results

There was a significant difference in performance between groups (p < 0.0001). For G1, 89% of the expected tasks were completed but resulted in longer delays before initiating actions than for the other groups. There was no difference between G4 and C with less than half of the tasks performed (47 and 43% respectively, p = 0.57). There was no correlation between clinical level of experience and performance (p = 0.39).

Conclusion

Performance decreased at 6 months after specific training for pediatric emergency skills, with total loss at 4 years after training, irrespective of experience. Repetition of simulation sessions should be implemented frequently after training to improve long-term retention and the optimal rate of refresher courses requires further research.
Design of MARQUIS2: study protocol for a mentored implementation study of an evidence-based toolkit to improve patient safety through medication reconciliation
Authors:   the MARQUIS2 Site Leaders, Mixon Amanda S. ,   the MARQUIS2 Study Group, Smith G. Randy , Mallouk Meghan , Nieva Harry Reyes , Kripalani Sunil , Rennke Stephanie , Chu Eugene , Sridharan Anirudh , Dalal Anuj , Mueller Stephanie , Williams Mark , Wetterneck Tosha , Stein Jason M. , Stolldorf Deonni , Howell Eric , Orav John , Labonville Stephanie , Levin Brian , Yoon Catherine , Gresham Marcus , Goldstein Jenna , Platt Sara , Nyenpan Christopher , Schnipper Jeffrey L.
Published: September 2019

Background

The first Multi-center Medication Reconciliation Quality Improvement Study (MARQUIS1) demonstrated that implementation of a medication reconciliation best practices toolkit decreased total unintentional medication discrepancies in five hospitals. We sought to implement the MARQUIS toolkit in more diverse hospitals, incorporating lessons learned from MARQUIS1.

Methods

MARQUIS2 is a pragmatic, mentored implementation QI study which collected clinical and implementation outcomes. Sites implemented a revised toolkit, which included interventions from these domains: 1) best possible medication history (BPMH)-taking; 2) discharge medication reconciliation and patient/caregiver counseling; 3) identifying and defining clinician roles and responsibilities; 4) risk stratification; 5) health information technology improvements; 6) improved access to medication sources; 7) identification and correction of real-time discrepancies; and, 8) stakeholder engagement. Eight hospitalists mentored the sites via one site visit and monthly phone calls over the 18-month intervention period. Each site’s local QI team assessed opportunities to improve, implemented at least one of the 17 toolkit components, and accessed a variety of resources (e.g. implementation manual, webinars, and workshops). Outcomes to be assessed will include unintentional medication discrepancies per patient.

Discussion

A mentored multi-center medication reconciliation QI initiative using a best practices toolkit was successfully implemented across 18 medical centers. The 18 participating sites varied in size, teaching status, location, and electronic health record (EHR) platform.

We introduce barriers to implementation and lessons learned from MARQUIS1, such as the importance of utilizing dedicated, trained medication history takers, simple EHR solutions, clarifying roles and responsibilities, and the input of patients and families when improving medication reconciliation.
Development of an indirect ELISA for detecting humoral immunodominant proteins of Mycoplasma hyopneumoniae which can discriminate between inactivated bacterin-induced hyperimmune sera and convalescent sera
Authors: Ding Honglei , Zhou Yaoqin , Wang Haoju
Published: September 2019

Background

Mycoplasma hyopneumoniae(M. hyopneumoniae) is the primary pathogen of porcine enzootic pneumonia, which has been associated with economic losses due to reduced daily weight gain and feed efficiency. Although it has a small genome and no more than 1000 genes,M. hyopneumoniaecan be cultured in cell free media. However, some proteins were not expressed or were only expressed in negligible amounts under culture conditions. Nevertheless, some of these proteins can be expressed at a high level and induce a strong and rapid immune response afterM. hyopneumoniaeinfection. The unexpressed or less expressed proteins may play critical roles in pathogenesis and/or immune response. In order to find the differentially expressed proteins ofM. hyopneumoniaebetween culture condition and infected animals, we established an indirect ELISA for the detection of humoral immunodominant proteins which can discriminate between inactivated bacterin-induced hyperimmune sera and convalescent sera by using Mhp366 protein which did not react with sera from bacterin-immunized pigs, but revealed a strong immunoreaction with porcine convalescent sera.

Results

The checkerboard titration method was done by using porcine convalescent sera as positive sera and inactivated bacterin-induced hyperimmune sera as negative sera. The bacterial lysates of fusion proteins and free GST protein without dilution were the optimal coating antigens. The optimal blocking buffer was PBS with 10% FBS and 2.5% skimmed milk. In the checkboard ELISAs, when the sera were diluted at 1:500 and the HRP-labeled rabbit anti-pig IgG were diluted at 1:20000, most positive result was obtained for the assay.

Conclusions

This established indirect ELISA can be used as a tool for the detection of humoral immunodominant proteins ofM. hyopneumoniaewhich can discriminate between inactivated bacterin-induced hyperimmune sera and convalescent sera.
Post-processing radio-frequency signal based on deep learning method for ultrasonic microbubble imaging
Authors: Dai Meng , Li Shuying , Wang Yuanyuan , Zhang Qi , Yu Jinhua
Published: September 2019

Background

Improving imaging quality is a fundamental problem in ultrasound contrast agent imaging (UCAI) research. Plane wave imaging (PWI) has been deemed as a potential method for UCAI due to its’ high frame rate and low mechanical index. High frame rate can improve the temporal resolution of UCAI. Meanwhile, low mechanical index is essential to UCAI since microbubbles can be easily broken under high mechanical index conditions. However, the clinical practice of ultrasound contrast agent plane wave imaging (UCPWI) is still limited by poor imaging quality for lack of transmit focus. The purpose of this study was to propose and validate a new post-processing method that combined with deep learning to improve the imaging quality of UCPWI. The proposed method consists of three stages: (1) first, a deep learning approach based on U-net was trained to differentiate the microbubble and tissue radio frequency (RF) signals; (2) then, to eliminate the remaining tissue RF signals, the bubble approximated wavelet transform (BAWT) combined with maximum eigenvalue threshold was employed. BAWT can enhance the UCA area brightness, and eigenvalue threshold can be set to eliminate the interference areas due to the large difference of maximum eigenvalue between UCA and tissue areas; (3) finally, the accurate microbubble imaging were obtained through eigenspace-based minimum variance (ESBMV).

Results

The proposed method was validated by both phantom and in vivo rabbit experiment results. Compared with UCPWI based on delay and sum (DAS), the imaging contrast-to-tissue ratio (CTR) and contrast-to-noise ratio (CNR) was improved by 21.3 dB and 10.4 dB in the phantom experiment, and the corresponding improvements were 22.3 dB and 42.8 dB in the rabbit experiment.

Conclusions

Our method illustrates superior imaging performance and high reproducibility, and thus is promising in improving the contrast image quality and the clinical value of UCPWI.
A novel double-stranded RNA mycovirus isolated from Trichoderma harzianum
Authors: Liu Chenchen , Li Mei , Redda Estifanos Tsegaye , Mei Jie , Zhang Jiantai , Wu Beilei , Jiang Xiliang
Published: September 2019

Background

Trichoderma spp. are used extensively in agriculture as biological control agents to prevent soil-borne plant diseases. In recent years, mycoviruses from fungi have attracted increasing attention due to their effects on their hosts, but Trichoderma mycoviruses have not been the subject of extensive study. We sought to discover novel mycoviruses from Trichoderma spp. and to determine the effects of the biocontrol function of Trichoderma spp.

Methods

Mycoviruses were screened by dsRNA extraction and metagenomic analysis. RT-PCR, 5′ RACE, and 3′ RACE were used to obtain the genome sequence. MEGA software was used to classify the new mycovirus. The effects of the identified mycovirus on the biological properties of the host strain 525 were evaluated using cucumber plants and Fusarium oxysporum f. sp. cucumerinum.

Results

A novel mycovirus, Trichoderma harzianum mycovirus 1 (ThMV1) (accession number MH155602), was discovered in Trichoderma harzianum strain 525, a soil-borne fungus collected from Inner Mongolia, China. The mycovirus exhibited a double-stranded RNA (dsRNA) genome with a complete genome sequence of 3160 base pairs and two open reading frames (ORFs) on the negative strand. Phylogenetic analysis indicated that it belongs to an unclassified family of dsRNA mycoviruses. The removal of ThMV1 from the host 525 strain reduced host biomass production and improved the biocontrol capability of the host for Fusarium oxysporum f. sp. cucumerinum. At same time, the presence of ThMV1 improved the growth of cucumber.

Conclusion

ThMV1 is a new unclassified mycovirus found in T. harzianum. It not only affects the phenotype of the host strain but also reduces its biocontrol function, which sheds light on the interaction between the mycovirus and Trichoderma spp.
The efficacy and safety of core decompression for the treatment of femoral head necrosis: a systematic review and meta-analysis
Authors: Hua Kun-chi , Yang Xiong-gang , Feng Jiang-tao , Wang Feng , Yang Li , Zhang Hao , Hu Yong-cheng
Published: September 2019

Background

Core decompression (CD) is an important method for the treatment of osteonecrosis of the femoral head (ONFH). Few articles investigate the influence of core decompression on outcomes of ONFH. This study was carried out to observe the safety and effectiveness of core decompression in the treatment of ONFH.

Methods

A comprehensive literature search of databases including PubMed, Embase, and Cochrane Library was performed to collect the related studies. The medical subject headings used were “femur head necrosis” and “Core decompression.” The relevant words in title or abstract included but not limited to “Osteonecrosis of the Femoral Head,” “femoral head necrosis,” “avascular necrosis of femoral head,” and “ischemic necrosis of femoral head.” The methodological index for nonrandomized studies was adopted for assessing the studies included in this review.

Results

Thirty-two studies included 1865 patients (2441 hips). Twenty-one studies (1301 hips) using Ficat staging standard, 7 studies (338hips) using Association Research Circulation Osseous (ARCO) staging standard, and University of Pennsylvania system for staging avascular necrosis (UPSS) staging criteria for 4 studies (802 hips). All the studies recorded the treatment, 22 studies (1379 hips) were treated with core decompression (CD) alone, and 7 studies (565 hips) were treated with core decompression combined with autologous bone (CD Autologous bone). Nine subjects (497 hips) were treated with core decompression combined with autologous bone marrow (CD Marrow). Twenty-seven studies (2120 hips) documented the number of conversion to total hip replacement (THA), and 26 studies (1752hips) documented the number of radiographic progression (RP). Twenty-one studies recorded the types of complications and the number of cases, a total of 69 cases. The random-effect model was used for meta-analysis, and the results showed that the overall success rate was 65%. The rate of success showed significant difference on the outcomes of different stages. The rate of success, conversion to THA, and radiographic progression showed significant difference on the outcomes of ONFH using different treatments.

Conclusions

Core decompression is an effective and safe method of treating ONFH. The combined use of autologous bone or bone marrow can increase the success rate. For advanced femoral head necrosis, the use of CD should be cautious. High-quality randomized controlled trials and prospective studies will be necessary to clarify the effects of different etiology factors, treatments, and postoperative rehabilitation. Until then, the surgeon can choose core decompression to treat ONFH depending on the patient’s condition.

Level of evidence

I Meta-analysis
Impact of deep water running in interval training (DWR-IT) on body composition, functional capacity, and quality of life in overweight adults: study protocol for a randomized controlled trial
Authors: Pianna Bruna , Moreno Bianca Christianini , de Souza Caroline Aquino , Bôscoa Thais Fernanda , Alcalde Guilherme Eleutério , Barrile Silvia Regina , Gimenes Camila , Martinelli Bruno , Zamunér Antonio Roberto , Pessoa-Santos Bruna Varanda , Arca Eduardo Aguilar
Published: September 2019

Background

Interval training in deep water running (DWR-IT) is a training method to improve cardiovascular fitness, functional health, and quality of life and to help control body weight. Its main advantages are the reduction of joint overload and a low risk of musculoskeletal injuries. The aim of the study is to investigate the influence of DWR-IT on functional capacity, body composition, and quality of life of overweight middle-aged adults.

Methods

This is a randomized controlled, two-arm, open, parallel clinical trial with overweight adults. Volunteers will be allocated to a water group (WG), which will be submitted to the intervention, or a control group, which will not be subjected to any kind of intervention. The evaluation will be composed of anamnesis, electrical bioimpedance, six-minute walk test (6MWT), questionnaire on the Impact of Weight on Quality of Life-lite (IWQOL-LITE), Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, chair stand test, arm curl test, and food frequency questionnaire. The DWR-IT will last for 12 weeks, systematically increasing the intensity and training volume.

Discussion

The objective of this clinical trial is to evaluate the effect of DWR-IT on overweight adults. The study is guided through practice based on scientific evidence for the use of training and aquatic rehabilitation. It is expected that after 12 weeks of aquatic intervention there will be a decrease in body fat by about 10%, evaluated by electrical bioimpedance, an increase of about 25% of cardiorespiratory endurance, evaluated by 6MWT, and an improvement of about 25% of physical function domains, self-esteem, distress in public places, and work, analyzed by IWQOL-LITE in the WG.

Trial registration

The study protocol was published in the Brazilian Registry of Clinical Trials (ReBEC) on June 16, 2016. Registration number: RBR-6dmh7d.
Multimodal cardioprotective strategy in cardiac surgery (the ProCCard trial): Study protocol for a multicenter randomized controlled trial
Authors: Chiari Pascal , Durand Michel , Desebbe Olivier , Fischer Marc-Olivier , Lena-Quintard Diane , Palao Jean-Charles , Mercier Catherine , Samson Géraldine , Varillon Yvonne , Pozzi Matteo , Mewton Nathan , Maucort-Boulch Delphine , Ovize Michel , Fellahi Jean-Luc
Published: September 2019

Background

Myocardial damage in patients undergoing cardiac surgery increases both morbidity and mortality. Different protective strategies dealing with either preconditioning or postconditioning or assessing a single aspect of cardioprotection have shown conflicting results. We tested the hypothesis that a multimodal approach would improve cardioprotection and limit myocardial damage following cardiac surgery with cardiopulmonary bypass.

Methods

This study is a pragmatic multicenter (six French institutions), prospective, randomized, single-blinded, controlled trial. The randomization is stratified by centers. In the study, 210 patients scheduled for aortic valve surgery with or without coronary artery bypass grafting will be assigned to a control or a treatment group (105 patients in each group). In the control group, patients receive total intravenous anesthesia with propofol and liberal intraoperative blood glucose management (initiation of insulin infusion when blood glucose, measured every 60 min, is greater than 180 mg/dl), as a standard of care. The treatment group receives a bundle of care combining five techniques of cardioprotection: (1) remote ischemic preconditioning applied before aortic cross-clamping; (2) maintenance of anesthesia with sevoflurane; (3) tight intraoperative blood glucose management (initiation of insulin infusion when blood glucose, measured every 30 min, is greater than 140 mg/dl); (4) moderate respiratory acidosis (pH 7.30) at the end of cardiopulmonary bypass; and (5) a gentle reperfusion protocol following aortic unclamping. The primary outcome is myocardial damage measured by postoperative 72-h area under the curve of high-sensitivity cardiac troponin I.

Discussion

The ProCCard study will be the first multicenter randomized controlled trial aiming to assess the role of a bundle of care combining several cardioprotective strategies to reduce myocardial damage in patients undergoing cardiac surgery with cardiopulmonary bypass.

Trial registration

ClinicalTrials.gov, NCT03230136. Registered on July 26, 2017. Last updated on April 17, 2019.
Leucine-enriched essential amino acid supplementation in mechanically ventilated trauma patients: a feasibility study
Authors: Wandrag L. , Brett S. J. , Frost G. S. , To M. , Loubo E. Alves , Jackson N. C. , Umpleby A. M. , Bountziouka V. , Hickson M.
Published: September 2019

Background

Critically ill patients lose up to 2% of muscle mass per day. We assessed the feasibility of administering a leucine-enriched essential amino acid (L-EAA) supplement to mechanically ventilated trauma patients with the aim of assessing the effect on skeletal muscle mass and function.

Methods

A randomised feasibility study was performed over six months in intensive care (ICU). Patients received 5 g L-EAA five times per day in addition to standard feed (L-EAA group) or standard feed only (control group) for up to 14 days. C-reactive protein, albumin, IL-6, IL-10, urinary 3-MH, nitrogen balance, protein turnover ([1-13C] leucine infusion), muscle depth change (ultrasound), functional change (Katz and Barthel indices) and muscle strength Medical Research Council (MRC) sum score to assess ICU Acquired Weakness were measured sequentially.

Results

Eight patients (9.5% of screened patients) were recruited over six months. L-EAA doses were provided on 91/124 (73%) occasions. Inflammatory and urinary marker data were collected; serial muscle depth measurements were lacking due to short length of stay. Protein turnover studies were performed on five occasions. MRC sum score could not be performed as patients were not able to respond to the screening questions. The Katz and Barthel indices did not change. L-EAA delivery was achievable, but meaningful functional and muscle mass outcome measures require careful consideration in the design of a future randomised controlled trial.

Conclusion

L-EAA was practical to provide, but we found significant barriers to recruitment and measurement of the chosen outcomes which would need to be addressed in the design of a future, large randomised controlled trial.

Trial registration

ISRCTN Registry, ISRCTN79066838. Registered on 25 July 2012.
Detailed insight into the dynamics of the initial phases of de novo RNA-directed DNA methylation in plant cells
Authors: Přibylová Adéla , Čermák Vojtěch , Tyč Dimitrij , Fischer Lukáš
Published: September 2019

Background

Methylation of cytosines is an evolutionarily conserved epigenetic mark that is essential for the control of chromatin activity in many taxa. It acts mainly repressively, causing transcriptional gene silencing. In plants, de novo DNA methylation is established mainly by RNA-directed DNA-methylation pathway. Even though the protein machinery involved is relatively well-described, the course of the initial phases remains covert.

Results

We show the first detailed description of de novo DNA-methylation dynamics. Since prevalent plant model systems do not provide the possibility to collect homogenously responding material in time series with short intervals, we developed a convenient system based on tobacco BY-2 cell lines with inducible production of siRNAs (from an RNA hairpin) guiding the methylation machinery to theCaMV 35Spromoter controlling GFP reporter. These lines responded very synchronously, and a high level of promoter-specific siRNAs triggered rapid promoter methylation with the first increase observed already 12 h after the induction. The previous presence of CG methylation in the promoter did not affect the methylation dynamics. The individual cytosine contexts reacted differently. CHH methylation peaked at about 80% in 2 days and then declined, whereas CG and CHG methylation needed more time with CHG reaching practically 100% after 10 days. Spreading of methylation was only minimal outside the target region in accordance with the absence of transitive siRNAs. The low and stable proportion of 24-nt siRNAs suggested that Pol IV was not involved in the initial phases.

Conclusions

Our results show that de novo DNA methylation is a rapid process initiated practically immediately with the appearance of promoter-specific siRNAs and independently of the prior presence of methylcytosines at the target locus. The methylation was precisely targeted, and its dynamics varied depending on the cytosine sequence context. The progressively increasing methylation resulted in a smooth, gradual inhibition of the promoter activity, which was entirely suppressed in 2 days.
Type of bacterial isolates and antimicrobial resistance profile from different clinical samples at a Referral Hospital, Northwest Ethiopia: five years data analysis
Authors: Abebe Melkamu , Tadesse Senait , Meseret Girum , Derbie Awoke
Published: September 2019

Objective

Antimicrobial resistance (AMR) is one of the most serious global public health threats that exert a significant burden in terms of patient morbidity and mortality and financial crises in many developing countries including Ethiopia. Knowledge on the type of predominantly circulating pathogens with their respective AMR profile in a given area is essential for optimal patient care. This study was aimed at assessing the types of bacterial isolates and their AMR profile identified from a range of clinical samples at Debre Markos Referral Hospital, Northwest Ethiopia, over a period of 5 years (2013 to 2017).

Results

From the total of 514 different clinical samples processed in the stated time frame, about 240 (46.7%) yield bacterial growth. Majority of the identified bacteria were isolated from stool culture 68 (28.3%) followed by urine 56 (23.3%), ear discharge 54 (22.5%) and wound swabs at 26 (10.8%). Most of the clinical isolates were Gram-negative at 171 (71.25%). The predominant isolate was S. aureus at 41 (17.1%) followed by Salmonella species, 40 (16.7%), Escherichia coli 36 (15%) and Pseudomonas aeruginosa at 26 (11.7%). Generally, the isolates were found resistant at (60–100%) against ampicillin, co-trimoxazole, doxycycline, gentamicin, norfloxacin and tetracycline. Gram-positive isolates were found relatively sensitive to ceftriaxone, erythromycin and vancomycin at (71–84%).
Identifying asymptomatic Leishmania infections in non-endemic villages in Gedaref state, Sudan
Authors: Mohamed Nouh Saad , Osman Hussam A. , Muneer Mohamed S. , Samy Abdallah M. , Ahmed Ayman , Mohammed Anwar O. , Siddig Emmanuel Edwar , Abdel Hamid Muzamil M. , Ali Mohamed Siralkhatim , Omer Rihab A. , Elaagip Arwa H.
Published: September 2019

Objectives

Infection with the causative agent of visceral leishmaniasis (VL) may be either symptomatic or asymptomatic. In this study we aimed at investigating the prevalence of asymptomatic infections of leishmania in non-endemic villages in Gedaref state, Sudan. A descriptive cross-sectional study conducted during September and October 2014. Blood samples were collected for serological and molecular analysis. Sticky-traps, knockdown spray and CDC-miniature light traps were used for the collection of sandflies.

Results

Ninety-Five participants were included; 52 from Abukishma, 15 Algadamblia Tirfa, 25 Abualnaja and 3 were from Algadamblia Aljabal. Females constituted 56 (58.9%) of the study participants while males were 39 (41.1%). The most frequent age group was > 40-years (54.7%). Balanites/Acacia trees were the most planted tree inside the houses; 78 (82.1%). Also, 85 (89.5%) of the participants breed animals inside the house. DAT test revealed 5 positive participants (5.2%). 4/5 DAT positive were past VL infection. PCR detected 35 (36.8%) positive participants. A total of 31/35 was considered asymptomatic infections based on PCR. Households planted Balanites/Acacia trees or breed domestic animals were found in high percentages with L. donovani PCR positive participants (60.1%, 91.4%). No statistically significant was found for VL associated risk factors and VL asymptomatic participants.
Maternal food allergy is associated with daughters’ menarche in early adolescence
Authors: Protudjer Jennifer Lisa Penner , Abrams Elissa Michelle , Kozyrskyj Anita Luba , Becker Allan Barry
Published: September 2019

Rationale

Associations between allergic disease and puberty amongst females have been widely studied. However, this association has received less attention in multigenerational populations. To this end, we sought to examine maternal allergic disease status ever, and daughters’ menarche.

Methods

In a cohort of children born in 1995, in Manitoba, Canada, we considered maternal allergic disease ever to daughters’ age 7–8 years, and daughters’ menarche at ages 12–14 years. We included all participants for whom we had information on both the exposure and the outcome of those eligible. Data were analysed using descriptive statistics and logistic regression, with adjustment for confounding variables.

Results

Overall, the prevalences of maternal allergic diseases were 28.6% for asthma 18.8% for food allergy, 27.3% for eczema and 45.5% for rhinitis. By age 12–14 years, 41.6% (64/159) girls had reached menarche. Maternal food allergy was significantly associated with daughters’ menarche (OR 4.39, 95% CI 1.51–12.73), whereas no association was found for maternal asthma, eczema or rhinitis. With consideration to comorbid disease, a combination of maternal asthma + food allergy was associated with daughters’ menarche by age 12–14 years (OR 6.41; 95% CI 1.32–31.01).

Conclusions

Maternal food allergy ever is associated with daughters’ menarche by age 12–14 years.
Comparison between silicon photomultiplier-based and conventional PET/CT in patients with suspected lung cancer—a pilot study
Authors: Economou Lundeberg Johan , Oddstig Jenny , Bitzén Ulrika , Trägårdh Elin
Published: September 2019

Background

Lung cancer is one of the most common cancers in the world. Early detection and correct staging are fundamental for treatment and prognosis. Positron emission tomography with computed tomography (PET/CT) is recommended clinically. Silicon (Si) photomultiplier (PM)-based PET technology and new reconstruction algorithms are hoped to increase the detection of small lesions and enable earlier detection of pathologies including metastatic spread. The aim of this study was to compare the diagnostic performance of a SiPM-based PET/CT (including a new block-sequential regularization expectation maximization (BSREM) reconstruction algorithm) with a conventional PM-based PET/CT including a conventional ordered subset expectation maximization (OSEM) reconstruction algorithm. The focus was patients admitted for 18F-fluorodeoxyglucose (FDG) PET/CT for initial diagnosis and staging of suspected lung cancer. Patients were scanned on both a SiPM-based PET/CT (Discovery MI; GE Healthcare, Milwaukee, MI, USA) and a PM-based PET/CT (Discovery 690; GE Healthcare, Milwaukee, MI, USA). Standardized uptake values (SUV) and image interpretation were compared between the two systems. Image interpretations were further compared with histopathology when available.

Results

Seventeen patients referred for suspected lung cancer were included in our single injection, dual imaging study. No statically significant differences in SUVmax of suspected malignant primary tumours were found between the two PET/CT systems. SUVmax in suspected malignant intrathoracic lymph nodes was 10% higher on the SiPM-based system (p = 0.026). Good consistency (14/17 cases) between the PET/CT systems were found when comparing simplified TNM staging. The available histology results did not find any obvious differences between the systems.

Conclusion

In a clinical setting, the new SiPM-based PET/CT system with a new BSREM reconstruction algorithm provided a higher SUVmax for suspected lymph node metastases compared to the PM-based system. However, no improvement in lung cancer detection was seen.
Texture analysis of pretreatment [18F]FDG PET/CT for the prognostic prediction of locally advanced salivary gland carcinoma treated with interstitial brachytherapy
Authors: Wu Wen-Jie , Li Zhen-Yu , Dong Shuang , Liu Shu-Ming , Zheng Lei , Huang Ming-Wei , Zhang Jian-Guo
Published: September 2019

Background

The aim of this study was to evaluate the prognostic value of positron emission tomography (PET) parameters and the PET texture features of fluorine 18-fluorodeoxyglucose ([18F]FDG) uptake on pretreatment PET/computed tomography (CT) in patients with locally advanced salivary gland carcinoma treated with interstitial brachytherapy.

Methods

Forty-three patients with locally advanced salivary gland carcinoma of the head and neck were treated with 125I interstitial brachytherapy as the sole modality and underwent [18F]FDG PET/CT scanning before treatment. Tumor segmentation and texture analysis were performed using the 3D slicer software. In total, 54 features were extracted and categorized as first-order statistics, morphology and shape, gray-level co-occurrence matrix, and gray-level run length matrix. Up to November 2018, the follow-up time ranged from 6 to 120 months (median 18 months). Cumulative survival was calculated by the Kaplan-Meier method. Factors between groups were compared by the log-rank test. Multivariate Cox regression analysis with a backward conditional method was used to predict progression-free survival (PFS).

Results

The 3- and 5-year locoregional control (LC) rates were 55.4% and 37.0%, respectively. The 3- and 5-year PFS rates were 51.2% and 34.1%, respectively. The 3- and 5-year overall survival (OS) rates were 77.0% and 77.0%, respectively. Univariate analysis revealed that minimum intensity, mean intensity, median intensity, root mean square, and long run emphasis (LRE) were significant predictors of PFS, whereas clinicopathological factors, conventional PET parameters, and PET texture features failed to show significance. Multivariate Cox regression analysis showed that minimum intensity and LRE were significant predictors of PFS.

Conclusions

The texture analysis of pretreatment [18F]FDG PET/CT provided more information than conventional PET parameters for predicting patient prognosis of locally advanced salivary gland carcinoma treated with interstitial brachytherapy. The minimum intensity was a risk factor for PFS, and LRE was a favorable factor in prognostic prediction according to the primary results.
Scientific validation of the antimicrobial and antiproliferative potential of Berberis aristata DC root bark, its phytoconstituents and their biosafety
Authors: Sood Henna , Kumar Yashwant , Gupta Vipan Kumar , Arora Daljit Singh
Published: September 2019

Berberis aristatais an important part of traditional healing system from more than 2500 years. The aqueous extract ofBerberis aristataroot bark displayed broad spectrum activity against 13 test pathogens, ranging from 12 to 25 mm. In classical optimization, 15% concentration prepared at 40 °C for 40 min was optimal and thermostable. Statistical optimization enhanced the activity by 1.13–1.30-folds. Ethyl acetate was the best organic solvent to elute out the potential compound responsible for antimicrobial activity. Diterpenes were the most abundant phytoconstituent (15.3%) and showed broad spectrum antimicrobial activity ranging from 16.66 to 42.66 mm. Ethyl acetate extract displayed the lowest minimum inhibitory concentration (0.05–1 mg/mL), followed by diterpenes (0.05–5 mg/mL) and flavonoids (0.05–10 mg/mL). The test extracts were microbicidal in nature and showed a prolonged post antibiotic effect ranging from 2 to 8 h. They were found to be biosafe as per Ames and MTT assay. The in vitro cytotoxicity evaluation of diterpenes against L20B, RD and Hep 2 cell lines revealed its IC50ranging from 245 to 473 µg/mL. Acute oral toxicity of diterpenes on Swiss albino mice did not show any changes in behavioral pattern, body weight, biochemical parameters as well as organs’ architecture. The study thus indicatesB. aristatacould be a potential candidate for development of potent drug owing to its antimicrobial potential and biosafe profile.