bluuebunny/crossref_metadata_2025 huggingface dataset:
Endoscopic Biopsies and Histopathological Findings in Diagnosing Chronic Gastrointestinal Disorders in Dogs and Cats
Authors: Rychlik Andrzej , Kaczmar Ewa
Published: October 2020

Nowadays, endoscopic examination is a diagnostic tool gaining popularity in the management of gastrointestinal disorders in dogs and cats. Direct accessibility of the lumen of gastrointestinal tract combined with the mucosal biopsy provides a great diagnostic potential. Using endoscopy and endoscopically guided biopsy, one can conduct both macro- and microscopic assessment of lesions and perform many specialist adjunct examinations. Histopathological examination of mucosal biopsy specimens collected from the stomach and intestines allows us to distinguish between types of inflammations and to diagnose ulcerative, polypoid, and cancerous lesions.
Experimental Investigation of the Formation of Rockburst Pits in Circular Tunnel Based on CT Scanning
Authors: Liang Peng , Zhang Yanbo , Yao Xulong , Sun Lin , Tian Baozhu
Published: October 2020

The rockburst simulation experiments of granite samples with a circular hole under biaxial loading were conducted, and the samples were scanned by computed tomography (CT) at the end of experiment. Through a series of CT images, the failure characteristics of the circular hole wall were analysed to determine the types of rockburst pits, and the detailed formation process of different types of rockburst pits was studied in combination with the crack characteristics around them. The experimental results indicate that there are mainly two types of rockburst pits, namely, pan‐shaped and V‐shaped, which can occur symmetrically or asymmetrically on the left and right sidewall of the circular hole. The formation of rockburst pits is related to the cracks parallel and perpendicular to the principal stress. Cracks parallel to the principal stress can determine the depth of the rockburst pit and affect the type of the rockburst pit, and cracks perpendicular to the principal stress determine the width of the rockburst pit. There is a correlation between the formation process of pan and V‐shaped rockburst pits. During the formation of a V‐shaped rockburst pit, several rockbursts occur, and each rockburst forms a pan‐shaped rockburst pit. In the process of developing from the tunnel wall to the deep rock, the width of the pan‐shaped rockburst pit gradually decreases and a V‐shaped rockburst with a stepped upper and lower boundary is formed.
First Trimester Ferritin Is Superior over Soluble Transferrin Receptor and Hepcidin in Predicting Anemia in the Third Trimester: Result from a Cohort Study in Indonesia
Authors: Judistiani Raden Tina Dewi , Madjid Tita Husnitawati , Handono Budi , Sukandar Hadyana , Irianti Setyorini , Gumilang Lani , Nirmala Sefita Aryuti , Setiabudiawan Budi
Published: October 2020

Introduction. Anemia in the third trimester has been identified as a risk factor for maternal and fetal morbidity that might lead to mortality. Due to its high cost, finding the best marker to predict anemia became more important to allow early prevention. Only one of ferritin, hepcidin, or soluble transferrin receptors can be picked for the prediction of anemia in the third trimester especially in low-resource setting. Objective. This study aimed at defining the best marker among ferritin, hepcidin, or soluble transferrin receptor (sTfR) in the first trimester for prediction of anemia in the third trimester. Materials, Methods, and Setting. This diagnostic study was nested on the cohort study of vitamin D and its impact during pregnancy in Indonesia. Singleton pregnant mothers with normal fetus were recruited in the first trimester from four cities in West Java, Indonesia. The 304 pregnant women were screened for hepcidin, ferritin, and sTfR level in the sera. All biomarkers were measured by ELISA. Complete blood count (CBC) was done by impedance method measurement (SysmexR). Only subjects with complete data were included in analysis for diagnostic study to compare the three markers by finding the best receiver operating curve (RoC), likelihood ratio (LR), and risk estimate (RR). Result. One-hundred and eighty-one pregnant women were eligible for analysis. The result of this study showed that the serum ferritin level in the first trimester was the best marker to predict anemia in the third trimester of pregnancy. Hepcidin and sTfR performed poorly. A new cutoff point of ferritin level ≤27.23 ng/ml yielded the best ROC with 67% area under curve (95% CI 60%–75%, p<0.0001, Youden index J 0.28), specificity 86.29% (95% CI 79.0%–91.8%), LR (+) 3.07 (95% CI 1.8–5.3), and RR 2.48 (95% CI 1.67–3.68). These last figures were better than the previously used cutoff point of ferritin level below 30 ng/ml. Conclusion. This study provided evidence that the serum ferritin level ≤27.23 ng/ml in the first trimester was the best marker to predict anemia in the third trimester. It was valuably useful for secondary screening of anemia in pregnancy, targeting subjects who may need rigorous approach for iron deficiency treatment in the prevention of anemia in pregnancy.
Development of an Integrative Care Program in a Pediatric Oncology Unit
Authors: Rutert Britta , Stritter Wiebke , Eggert Angelika , Auge Ulrike , Laengler Alfred , Seifert Georg , Holmberg Christine
Published: October 2020

Purpose: The aim of this article is to describe what needs to be considered in implementing care practices, in this case an integrative care program consisting of anthroposophic treatments, in an intensive care unit (ICU) of a teaching hospital. Methods: We used a pediatric oncology department to implement an integrative care program. We conducted a qualitative study including participant observation and semi-structured interviews with parents, nurses, doctors, and therapists. Data analysis was based on a grounded theory approach and focused on the status quo of care in the ICU. Results: The following factors needed to be considered: the structure of the ICU, communication and information dissemination, and time constraints. This led to the following components of the integrative care program: (1) a training plan in anthroposophic treatments for all nurses that was conducted by 2 trained anthroposophic nurses, and (2) the introduction of an integrative shift that was on top of regular care at the ICU and focused on delivery of integrative care to patients. Conclusion: To add new care components to an ICU, the existing context has to be considered. Time constraints and high workload are factors that need to be recognized. In this particular context, a highly flexible program was the solution.
Clinical Effects of Xanthine Oxidase Inhibitors in Hyperuricemic Patients
Authors: Cicero Arrigo F.G. , Fogacci Federica , Cincione Raffaele Ivan , Tocci Giuliano , Borghi Claudio
Published: October 2020

This review aims to critically present the available clinical evidence supporting the treatment of chronic hyperuricemia with xanthine oxidase inhibitors. For this reason, the studies published on uric acid (UA)-lowering drugs in the English language from 2000 to August 2019 have been carefully reviewed. The terms “serum uric acid,” “xanthine oxidase,” “allopurinol,” “febuxostat,” and “topiroxostat” were incorporated into an electronic search strategy, alone and in combinations, in both MEDLINE (National Library of Medicine, Bethesda, MD) and the Cochrane Register of Controlled Trials (The Cochrane Collaboration, Oxford, UK). Even if new urate-lowering drugs seem of particular efficacy for acute treatment of refractory hyperuricemia, their use is supported by relatively small clinical evidence. On the contrary, large long-term clinical trials have demonstrated that xanthine oxidase inhibitors (XOIs, namely, allopurinol and febuxostat) are effective, safe, and relatively well-tolerated in most of the patients. They have mainly been tested in the elderly, in patients affected by chronic diseases such as heart failure and cancer, and in patients taking a large number of drugs, confirming their safety profile. Recent data also show that they could exert some positive effects on vascular health, renal function, and glucose metabolism. Their cost is also low. In conclusion, XOIs remain the first choice of UA-lowering drug for chronic treatment.
Natural History of Hemodynamics in Vertebrobasilar Disease
Authors: Amin-Hanjani Sepideh , See Alfred P. , Du Xinjian , Rose-Finnell Linda , Pandey Dilip K. , Chen Yi-Fan , Elkind Mitchell S.V. , Zipfel Gregory J. , Liebeskind David S. , Silver Frank L. , Kasner Scott E. , Gorelick Philip B. , Charbel Fady T. , Derdeyn Colin P. ,   for the VERiTAS Study Group
Published: October 2020

Background and Purpose:

The role of regional hypoperfusion as a contributor to stroke risk in atherosclerotic vertebrobasilar disease has recently been confirmed by the observational VERiTAS (Vertebrobasilar Flow Evaluation and Risk of Transient Ischemic Attack and Stroke) Study. We examined the stability of hemodynamic status over time and its relationship to stroke risk in patients from this prospective cohort.

Methods:

VERiTAS enrolled patients with recently symptomatic ≥50% atherosclerotic stenosis/occlusion of vertebral and/or basilar arteries. Large vessel flow in the vertebrobasilar territory was assessed using quantitative magnetic resonance angiography, and patients were designated as low or normal flow based on distal territory regional flow, incorporating collateral capacity. Patients underwent standard medical management and follow-up for primary outcome event of vertebrobasilar territory stroke. Quantitative magnetic resonance angiography imaging was repeated at 6, 12, and 24 months. Flow status over time was examined relative to baseline and relative to subsequent stroke risk using a cause-specific proportional hazard model, with flow status treated as a time-varying covariate. Mean blood pressure was examined to assess for association with changes in flow status.

Results:

Over 19±8 months of follow-up, 132 follow-up quantitative magnetic resonance angiography studies were performed in 58 of the 72 enrolled patients. Of the 13 patients with serial imaging who had low flow at baseline, 7 (54%) had improvement to normal flow at the last follow-up. Of the 45 patients who had normal flow at baseline, 3 (7%) converted to low flow at the last follow-up. The mean blood pressure did not differ in patients with or without changes in flow status. The time-varying flow status remained a strong predictor of subsequent stroke (hazard ratio, 10.3 [95% CI, 2.2–48.7]).

Conclusions:

There is potential both for improvement and worsening of hemodynamics in patients with atherosclerotic vertebrobasilar disease. Flow status, both at baseline and over time, is a risk factor for subsequent stroke, thus serving as an important prognostic marker.

Registration:

URL:
https://clinicaltrials.gov
. Unique identifier: NCT00590980.
Healthcare Workers in Brazil during the COVID-19 Pandemic: A Cross-Sectional Online Survey
Authors: Cotrin Paula , Moura Wilana , Gambardela-Tkacz Caroline Martins , Pelloso Fernando Castilho , Santos Lander dos , Carvalho Maria Dalva de Barros , Pelloso Sandra Marisa , Freitas Karina Maria Salvatore
Published: October 2020

Brazil is in a critical situation due to the COVID-19 pandemic. Healthcare workers that are in the front line face challenges with a shortage of personal protective equipment, high risk of contamination, low adherence to the social distancing measures by the population, low coronavirus testing with underestimation of cases, and also financial concerns due to the economic crisis in a developing country. This study compared the impact of COVID-19 pandemic among three categories of healthcare workers in Brazil: physicians, nurses, and dentists, about workload, income, protection, training, feelings, behavior, and level of concern and anxiety. The sample was randomly selected and a Google Forms questionnaire was sent by WhatsApp messenger. The survey comprised questions about jobs, income, workload, PPE, training for COVID-19 patient care, behavior and feelings during the pandemic. The number of jobs reduced for all healthcare workers in Brazil during the pandemic, but significantly more for dentists. The workload and income reduced to all healthcare workers. Most healthcare workers did not receive proper training for treating COVID-19 infected patients. Physicians and nurses were feeling more tired than usual. Most of the healthcare workers in all groups reported difficulties in sleeping during the pandemic. The healthcare workers reported a significant impact of COVID-19 pandemic in their income, workload and anxiety, with differences among physicians, nurses and dentists.
3D Pen Tactile Pictures Generated by Individuals with Visual Impairments
Authors: Wu Chih-Fu , Wu Hsiang-Ping , Tu Yung-Hsiang , Yeh I-Ting
Published: October 2020

Introduction:

Individuals with visual impairments acquire information about objects through touch and by use of auxiliary tactile pictures. The current study introduced a new three-dimensional (3D) printing pen technology as a research tool to allow individuals with visual impairments to convert tactile experiences to convex tactile pictures.

Methods:

Participants with visual impairments used a 3D pen to draw pictures of daily necessities. The actions and time related to the entire drawing activity were recorded on video.

Results:

We noted three behaviors during the use of 3D pen: drawing, touching the trace lines, and finding location points. The object-depiction angle, component-completeness description, and drawing-line presentation differed between subjects with congenital and those with acquired blindness.

Discussion:

Individuals with congenital blindness depicted objects mainly from an operational angle, and those with acquired blindness from the angle of the object when laid flat. When the components of an object were relatively complex, the subjects with congenital blindness only drew local features in contact with their bodies and with continuous line segments, and those with acquired blindness used discontinuous line segments. Participants were satisfied that the 3D printing pen could touch the drawing path in time and that they could use the “piling” feature to create positioning marks or planar expressions.

Implications for practitioners:

Students can be instructed to use 3D pens to draw (lines, planes, and objects) to enhance the communication between teachers and students and improve teaching efficiency. Regarding the design of tactile pictures, the parts that come in contact with the body during object use can be considered the reference features of the pictures. For large pictures, attention should be paid to the size ratio between the outline and components. For small pictures, one should consider how the operational feature details should be shown at approximately the original size.
Analysis of temperature-induced deformation and stress distribution of long-span concrete truss combination arch bridge based on bridge health monitoring data and finite element simulation
Authors: Niu Yanwei , Wang Yong’e , Tang Yingying
Published: October 2020

Through decades of operation, deformation fluctuation becomes a central problem affecting the normal operating of concrete truss combination arch bridge. In order to clarify the mechanism of temperature-induced deformation and its impact on structural stress distribution, this article reports on the temperature distribution and its effect on the deformation of concrete truss combination arch bridge based on bridge health monitoring on a proto bridge with 138 m main span. The temperature distribution and deformation characteristics of the bridge structure in deep valley area are studied. Both of the daily and yearly temperature variation and structural deformation are studied based on bridge health monitoring. Using the outcome of monitoring data, three-dimensional solid finite element models are established to analyze the mechanism of temperature-induced deformation of the whole bridge under different temperature fields. The influence of temperature-induced effect is discussed on local damage based on the damage observation of the background bridge. The outcome of comparisons with field observation validates the analysis results. The relevant monitoring and simulation result can be referenced for the design and evaluation of similar bridges.
Word skipping during the lexical acquisition process
Authors: Eskenazi Michael A , Kemp Paige , Folk Jocelyn R
Published: October 2020

During reading, most words are identified in the fovea through a direct fixation; however, readers also identify some words in the parafovea without directly fixating them. This word skipping process is influenced by many lexical and visual factors including word length, launch position, frequency, and predictability. Although these factors are well understood, there is some disagreement about the process that leads to word skipping and the degree to which skipped words are processed. The purpose of this study was to investigate the word skipping process when readers are exposed to novel words in an incidental lexical acquisition paradigm. Participants read 18 three-letter novel words (i.e., pru, cho) in three different informative contexts each while their eye movements were monitored. They then completed a surprise test of their orthographic and semantic acquisition and a spelling skill assessment. Mixed-effects models indicated that participants learned spellings and meanings of words at the same rate regardless of the number of times that they were skipped. However, word skipping rates increased across the three exposures and reading times decreased. Results indicate that readers appear to process skipped words to the same degree as fixated words. However, this may be due to a more cautious skipping process used during lexical acquisition of unfamiliar words compared to processing of already known words.
Preliminary evaluation for quality of dimension lumber in four common softwoods in Mongolia
Authors: Sarkhad Murzabyek , Ishiguri Futoshi , Nezu Ikumi , Tumenjargal Bayasaa , Takahashi Yusuke , Baasan Bayartsetseg , Chultem Ganbaatar , Ohshima Jyunichi , Yokota Shinso
Published: October 2020

The quality of dimension lumber (2 by 4 lumber) was preliminarily investigated in four common Mongolian softwoods: Pinus sylvestris L., Pinus sibirica Du Tour, Picea obovata Ledeb., and Larix sibirica Ledeb. to produce high quality dimension lumber for structural use. In total 61, 39, 67, and 37 pieces of lumber were prepared for Pinus sylvestris, Pinus sibirica, Picea obovata, and L. sibirica, respectively. The lumber was visually graded and then tested in static bending to obtain the 5% lower tolerance limits at 75% confidence level (f0.05) of the modulus of elasticity (MOE) and the modulus of rupture (MOR). In addition, the effects of sawing patterns on bending properties were also analyzed. The f0.05 of the MOE and MOR were 4.75 GPa and 15.6 MPa, 3.39 GPa and 11.0 MPa, 3.78 GPa and 11.7 MPa, and 6.07 GPa and 22.3 MPa for Pinus sylvestris, Pinus sibirica, Picea obovata, and L. sibirica, respectively. These results suggested that with a few exceptions, characteristic values of MOR in the four common Mongolian softwoods resembled those in similar commercial species already used. In visual grading, over 80% of total lumber was assigned to select structural and No. 1 grades in Pinus sylvestris and Pinus sibirica, whereas approximately 40% of total lumber in L. sibirica was No. 3 and out of grades. Sawing patterns affected bending properties in Pinus sylvestris and L. sibirica, but did not affect Pinus sibirica and Picea obovata. Dynamic Young's modulus was significantly correlated with bending properties of dimension lumber for the four species. Based on the results, it was concluded that dimension lumber for structural use can be produced from the four common Mongolian softwoods.
Genome-wide analysis of expression QTL (eQTL) and allele-specific expression (ASE) in pig muscle identifies candidate genes for meat quality traits
Authors: Liu Yan , Liu Xiaolei , Zheng Zhiwei , Ma Tingting , Liu Ying , Long Huan , Cheng Huijun , Fang Ming , Gong Jing , Li Xinyun , Zhao Shuhong , Xu Xuewen
Published: October 2020

Background

Genetic analysis of gene expression level is a promising approach for characterizing candidate genes that are involved in complex economic traits such as meat quality. In the present study, we conducted expression quantitative trait loci (eQTL) and allele-specific expression (ASE) analyses based on RNA-sequencing (RNAseq) data from the longissimus muscle of 189 Duroc × Luchuan crossed pigs in order to identify some candidate genes for meat quality traits.

Results

Using a genome-wide association study based on a mixed linear model, we identified 7192 cis-eQTL corresponding to 2098 cis-genes (p ≤ 1.33e-3, FDR ≤ 0.05) and 6400 trans-eQTL corresponding to 863 trans-genes (p ≤ 1.13e-6, FDR ≤ 0.05). ASE analysis using RNAseq SNPs identified 9815 significant ASE-SNPs in 2253 unique genes. Integrative analysis between the cis-eQTL and ASE target genes identified 540 common genes, including 33 genes with expression levels that were correlated with at least one meat quality trait. Among these 540 common genes, 63 have been reported previously as candidate genes for meat quality traits, such as PHKG1 (q-value = 1.67e-6 for the leading SNP in the cis-eQTL analysis), NUDT7 (q-value = 5.67e-13), FADS2 (q-value = 8.44e-5), and DGAT2 (q-value = 1.24e-3).

Conclusions

The present study confirmed several previously published candidate genes and identified some novel candidate genes for meat quality traits via eQTL and ASE analyses, which will be useful to prioritize candidate genes in further studies.
Genome wide analysis reveals genetic divergence between Goldsinny wrasse populations
Authors: Jansson Eeva , Besnier Francois , Malde Ketil , André Carl , Dahle Geir , Glover Kevin A.
Published: October 2020

Background

Marine fish populations are often characterized by high levels of gene flow and correspondingly low genetic divergence. This presents a challenge to define management units. Goldsinny wrasse (Ctenolabrus rupestris) is a heavily exploited species due to its importance as a cleaner-fish in commercial salmonid aquaculture. However, at the present, the population genetic structure of this species is still largely unresolved. Here, full-genome sequencing was used to produce the first genomic reference for this species, to study population-genomic divergence among four geographically distinct populations, and, to identify informative SNP markers for future studies.

Results

After construction of a de novo assembly, the genome was estimated to be highly polymorphic and of ~600Mbp in size. 33,235 SNPs were thereafter selected to assess genomic diversity and differentiation among four populations collected from Scandinavia, Scotland, and Spain. Global FST among these populations was 0.015–0.092. Approximately 4% of the investigated loci were identified as putative global outliers, and ~ 1% within Scandinavia. SNPs showing large divergence (FST > 0.15) were picked as candidate diagnostic markers for population assignment. One hundred seventy-three of the most diagnostic SNPs between the two Scandinavian populations were validated by genotyping 47 individuals from each end of the species’ Scandinavian distribution range. Sixty-nine of these SNPs were significantly (p < 0.05) differentiated (mean FST_173_loci = 0.065, FST_69_loci = 0.140). Using these validated SNPs, individuals were assigned with high probability (≥ 94%) to their populations of origin.

Conclusions

Goldsinny wrasse displays a highly polymorphic genome, and substantial population genomic structure. Diversifying selection likely affects population structuring globally and within Scandinavia. The diagnostic loci identified now provide a promising and cost-efficient tool to investigate goldsinny wrasse populations further.
Assessing the effectiveness of Chagas disease education for healthcare providers in the United States
Authors: Stigler Granados Paula , Pacheco Gerardo J. , Núñez Patlán Evangelina , Betancourt Jose , Fulton Lawrence
Published: October 2020

Background

Chagas disease is a zoonotic infection caused by the parasite Trypanosoma cruzi, which affects an estimated 8–11 million people globally. Chagas disease is almost always associated with poverty in rural areas and disproportionately impacts immigrants from Latin America living in the United States. Approximately 20–30% of people who are infected with Chagas disease will develop a chronic form of the infection that can be fatal if left untreated. Chagas disease is vastly underestimated in the United States, often goes undiagnosed and is not well understood by most U.S. healthcare providers. One of the most important ways at reducing barriers to improving diagnostics of Chagas disease in the U.S. is giving healthcare providers the most up-to-date information and access to leading experts.

Methods

An online webinar was conducted for healthcare providers, veterinarians and public health professionals using Chagas disease expert panelists. Pre and post tests were administered to participants (n = 57) to determine the efficacy in raising awareness and to determine key focus areas for improving knowledge. A Wilcoxon rank-sum was used for non-parametric variables equivalent and for questions that assessed knowledge the McNemar’s Chi-Square test was used.

Results

There were statistically significant learning increases in multiple categories including transmission (p = <.001), clinical presentation (p = 0.016), diagnostics (p = <.001), and treatment (p = <.001).

Conclusion

Providing easily accessible learning opportunities using validated testing and evaluations should be further developed for rural healthcare providers in the U.S. as well as healthcare providers serving under represented populations such as immigrants. There is a clear lack of knowledge and awareness surrounding Chagas disease in the United States and just by raising awareness and providing education on the topic, lives will be saved.
Functional polymorphisms and transcriptional analysis in the 5′ region of the human serotonin receptor 1B gene (HTR1B) and their associations with psychiatric disorders
Authors: Xia Xi , Ding Mei , Xuan Jin-feng , Xing Jia-xin , Yao Jun , Wu Xue , Wang Bao-jie
Published: October 2020

Background

The 5-hydroxytryptamine 1B receptor (5-HT1B) plays an essential role in the serotonin (5-HT) system and is widely involved in a variety of brain activities.HTR1Bis the gene encoding 5-HT1B. Genome-wide association studies have shown thatHTR1Bpolymorphisms are closely related to multiple mental and behavioral disorders; however, the functional mechanisms underlying these associations are unknown. This study investigated the effect of severalHTR1Bhaplotypes on regulation of gene expression in vitro and the functional sequences in the 5′ regulatory region ofHTR1Bto determine their potential association with mental and behavioral disorders.

Methods

Six haplotypes consisting of rs4140535, rs1778258, rs17273700, rs1228814, rs11568817, and rs130058 and several truncated fragments of the 5′ regulatory region ofHTR1Bwere transfected into SK-N-SH and HEK-293 cells. The relative fluorescence intensities of the different haplotypes and truncated fragments were detected using a dual-luciferase reporter assay system.

Results

Compared to the major haplotype T-G-T-C-T-A, the relative fluorescence intensities of haplotypes C-A-T-C-T-A, C-G-T-C-T-A, C-G-C-A-G-T, and C-G-T-A-T-A were significantly lower, and that of haplotype C-G-C-A-G-A was significantly higher. Furthermore, the effects of the rs4140535T allele, the rs17273700C-rs11568817G linkage combination, and the rs1228814A allele made their relative fluorescence intensities significantly higher than their counterparts at each locus. Conversely, the rs1778258A and rs130058T alleles decreased the relative fluorescence intensities. In addition, we found that regions from − 1587 to − 1371 bp (TSS, + 1), − 1149 to − 894 bp, − 39 to + 130 bp, + 130 to + 341 bp, and + 341 to + 505 bp upregulated gene expression. In contrast, regions − 603 to − 316 bp and + 130 to + 341 bp downregulated gene expression. Region + 341 to + 505 bp played a decisive role in gene transcription.

Conclusions

HTR1B5′ regulatory region polymorphisms have regulatory effects on gene expression and potential correlate with several pathology and physiology conditions. This study suggests that a crucial sequence for transcription is located in region + 341 ~ + 505 bp. Regions − 1587 to − 1371 bp, − 1149 to − 894 bp, − 603 to − 316 bp, − 39 to + 130 bp, and + 130 to + 341 bp contain functional sequences that can promote or suppress theHTR1Bgene expression.
Comorbidities associated with nontuberculous mycobacterial disease in Japanese adults: a claims-data analysis
Authors: Uno Shunsuke , Asakura Takanori , Morimoto Kozo , Yoshimura Kimio , Uwamino Yoshifumi , Nishimura Tomoyasu , Hoshino Yoshihiko , Hasegawa Naoki ,   Nontuberculous Mycobacteriosis and Bronchiectasis-Japan Research Consortium (NTM-JRC)
Published: October 2020

Background

Nontuberculous mycobacterial (NTM) lung disease is one of a growing number of chronic health problems that is difficult to cure in aging societies. While it is important to be vigilant about associated comorbidities in order to provide better patient care, data on the prevalence of comorbidities stratified by country or region are scarce. We aimed to elucidate the comorbidities associated with NTM disease based on Japanese health insurance claims data.

Methods

Cross-sectional analyses were performed using the claims data for 2014 provided by the Japan Medical Data Center Co., Ltd. Patients aged 20–75 years with ≥3 claims associated with NTM disease were identified and matched to 10 sex-and-age-matched controls that had never made a claim for NTM disease. Thirty-one comorbidities previously suspected to be associated with NTM disease were selected, and the prevalence of these comorbidities compared between cases and controls.

Result

Overall, 419 NTM patients (134 males and 285 females) and 4190 non-NTM controls were identified from the JMDC database. Aspergillosis, asthma, chronic heart failure, diffuse panbronchiolitis, gastroesophageal reflux, interstitial pneumonia, lung cancer, cancer other than breast, lung, ovary, or prostate cancer, and rheumatoid arthritis were associated with NTM disease in both males and females. Chronic obstructive pulmonary disease was associated with NTM in males while chronic kidney disease, osteoporosis, and Sjögren syndrome were associated with NTM in females.

Conclusion

NTM disease was associated with multiple comorbidities that should be considered when providing medical care to individuals with NTM disease.
The implications of the glenoid angles and rotator cuff status in patients with osteoarthritis undergoing shoulder arthroplasty
Authors: Ozel Omer , Hudek Robert , Abdrabou Mohamed S. , Werner Birgit S. , Gohlke Frank
Published: October 2020

Background

The success of shoulder arthroplasty, both reverse and anatomical, depends on correcting the underlying glenoid deformity especially in patients with an osteoarthritis. We hypothesized that the distribution of glenoid version and especially inclination are underestimated in the shoulder arthritis population, and also that superior glenoid inclination can be detected through 3-dimensional (3D) software program of computed tomography (CT) to a greater proportion in patients with rotator cuff insufficiency, but also in patients with osteoarthritis with an intact rotator cuff. Because of the influence of rotator cuff imbalance on secondary glenoid wear the values of the critical shoulder angle (CSA) and the fatty infiltration of the rotator cuff are further analyzed. The aim of our study is to determine; 1) the distribution of glenoid inclination and version; 2) the relationship between glenoid inclination, version, the critical shoulder angle (CSA) to the status of the rotator cuff; 3) the proportion of patients with both an intact rotator cuff and a superior inclination greater than 10°.

Methods

A total of 231 shoulders were evaluated with X-ray images, 3-dimentional (3D) software program of computed tomography (CT), and magnetic resonance imaging. The cohort was divided into 3 groups according to their inclination angles and also grouped as intact-rotator cuff and torn-cuff group.

Results

The median (min/max) values for the 231 shoulders were 8° (− 23°/56°) for the inclination angle, − 11°(− 55°/23°) for the version angle, and 31.5°(17.6°/61.6°) for the CSA. The majority of the glenoids were found to show posterior-superior erosion. Glenoid inclination angle and CSA were significantly higher in torn-cuff group when compared with intact-cuff group (P < 0.001, both). The rotator cuff tears were statistically significant in high inclination group than low inclination group and no inclination group (p < 0.001). In the high inclination group, 41 of 105 (39%) shoulders had an intact rotator cuff, in about 18% of all shoulders.

Conclusion

Our findings show that 3D evaluation of glenoid inclination is mandatory for preoperative planning of shoulder replacement in order to properly assess superior inclination and that reverse shoulder arthroplasty may be considered more frequently than as previously expected, even when the rotator cuff is intact.

Level of evidence

Level III.
A protocol study of participatory action research: integrated care pathway for pregnant women with heart disease in Indonesia
Authors: Yuliyanti Suryani , Utarini Adi , Trisnantoro Laksono
Published: October 2020

Background

Heart diseases are increasingly identified as an important indirect cause of maternal mortality in several cities in Indonesia. The management of pregnancy with heart diseases requires a multidisciplinary approach, and interprofessional collaboration practice (IPCP) is critical to improving the quality of patient care. To enable the effective implementation of IPCP, integrated care pathways (ICPs) are needed to define the roles and responsibilities of the health professionals involved. This study aims to examine the obstacles and enabling factors of IPCP, to develop and use ICPs in the implementation of IPCP in health care services for pregnant women with heart diseases.

Methods

A participatory action study consisting of four stages (diagnostic, planning, implementation, and evaluation) will take approximately 2 years after consensus of ICPs are made. The primary data collection process will employ consensus, observations, focus group discussions, and in-depth interviews throughout the four stages, while secondary data from referral documents and medical records will be collected mainly during the diagnostic and evaluation stages. The findings are being analysed and will then be used to develop an ICPs through consensus building at the planning stage to be applied in the implementation stage. Finally, the implementation outcome, including acceptability, adoption, appropriateness, and feasibility of IPCP, will be assessed in the evaluation stage. All qualitative data will be analysed thematically by two coders using NVIVO 12 software.

Discussion

This research aims to assess the needs of IPCP, develop and use the ICPs in the implementation of IPCP in health care services for pregnant women with heart diseases. Findings from this study will be used for health service planning and policy making to strengthen practice of IPCP during the referral process. As a result, pregnant women with heart disease will have better access to high-quality services at every health care facility to reduce maternal mortality.

Trial registration

Retrospectively registered in the ISRCTN registry with study IDISRCTN82300061on Feb 6, 2019.
Lived experiences of tuberculosis patients and their implications for early tuberculosis case identification and management in pastoralist community setting: a qualitative study in Borena zone, Oromia region of Ethiopia
Authors: Megerso Abebe , Deyessa Negussie , Jarso Godana , Worku Alemayehu
Published: October 2020

Background

Ethiopia has highly diversified population with notable socioeconomic and cultural differences. Regardless of the differences, short course directly observed treatment,where patients should take drugs under direct observasion of health care providers, is uniformly applied all over the country. Evidences are scarce on how well does this uniform approach fits with the pastoral community setting. The purpose of this study was to explore lived experiences of TB patients in the pastoral community under the uniform approach, and their implications to early case identification and management.

Method

Qualitative method with phenomenological study design was undertaken to explore lived experiences of TB patients. Patients from all levels of health care (hospital, health center and health post) were included. Experience of both drug susceptible and drug resistant TB patients were documented. Twenty one patients, who consented to in the study, were selected by a convenience sampling method. In-depth interview was conducted using a semi-structured interview guide and the interview ended subsequent to information saturation. The interview was audio recorded; and field notes were also taken. Data analysis was done concurrently with the data collection using a word processor designed for qualitative text analysis. InductiveThematic analysis was undertaken to identify key themes.

Results

Twenty one patients (eight from hospitals, nine from health centers and four from health posts) were interviewed. Three of the eight hospital patients were on drug resistant tuberculosis (TB) treatment. Sixty two codes, five code categories and three themes emerged from the interviews. The three themes were health system, stigma and discrimination, and socioeconomic problem related experiences. Inaccessibility to health facilities due to scattered settlement and mobility, delay in care seeking TB symptoms, low index of suspecting TB by care providers, fear of stigma and indirect treatment related costs were some of the codes identified.

Conclusion

TB patients in the pastoral setting were experiencing multifaceted challenges with the current application of ‘one-size-fits-all’ approach which implied hampered timely case identification and compromised patient management. Therefore, designing context appropriate intervention approach is required to ensure unprejudiced services.
Comparative effectiveness of dulaglutide versus liraglutide in Asian type 2 diabetes patients: a multi-institutional cohort study and meta-analysis
Authors: Chang Kai-Cheng , Shao Shih-Chieh , Kuo Shihchen , Yang Chen-Yi , Chen Hui-Yu , Chan Yuk-Ying , Ou Huang-Tz
Published: October 2020

Background

Head-to-head comparison of clinical effectiveness between dulaglutide and liraglutide in Asia is limited. This study was aimed to assess the real-world comparative effectiveness of dulaglutide versus liraglutide.

Methods

We conducted a retrospective cohort study by utilizing multi-institutional electronic medical records to identify real-world type 2 diabetes patients treated with dulaglutide or liraglutide during 2016–2018 in Taiwan and followed up until 2019. Effectiveness outcomes were assessed at every 3 months in the 1-year follow-up. Propensity score techniques were applied to enhance between-group comparability. Significant differences in changes of effectiveness outcomes between treatment groups during the follow-up were examined and further analyzed using mixed-model repeated-measures approaches.

Results

A total of 1512 subjects receiving dulaglutide and 1513 subjects receiving liraglutide were identified. At 12 months, significant HbA1c changes from baseline were found in both treatments (dulaglutide: − 1.06%,p < 0.001; liraglutide: − 0.83%,p < 0.001), with a significant between-group difference (− 0.23%, 95% confidence interval − 0.38 to − 0.08%,p < 0.01). Both treatments yielded significant declines in weight, alanine aminotransferase level, and estimated glomerular filtration rate from baseline (dulaglutide: − 1.14 kg, − 3.08 U/L and − 2.08 mL/min/1.73 m2,p < 0.01; liraglutide: − 1.64 kg, − 3.65 U/L and − 2.33 mL/min/1.73 m2,p < 0.001), whereas only dulaglutide yielded a significant systolic blood pressure reduction (− 2.47 mmHg,p < 0.001). Between-group differences in changes of weight, blood pressure, and liver and renal functions at 12 months were not statistically significant.

Conclusions

In real-world T2D patients, dulaglutide versus liraglutide was associated with better glycemic control and comparable effects on changes of weight, blood pressure, and liver and renal functions.
Advancement in research and therapy of NF1 mutant malignant tumors
Authors: Tao Junyan , Sun Dantong , Dong Lina , Zhu Hua , Hou Helei
Published: October 2020

The NF1 gene encodes neurofibromin, which is one of the primary negative regulatory factors of the Ras protein. Neurofibromin stimulates the GTPase activity of Ras to convert it from an active GTP-bound form to its inactive GDP-bound form through its GTPase activating protein-related domain (GRD). Therefore, neurofibromin serves as a shutdown signal for all vertebrate RAS GTPases. NF1 mutations cause a resultant decrease in neurofibromin expression, which has been detected in many human malignancies, including NSCLC, breast cancer and so on. NF1 mutations are associated with the underlying mechanisms of treatment resistance discovered in multiple malignancies. This paper reviews the possible mechanisms of NF1 mutation-induced therapeutic resistance to chemotherapy, endocrine therapy and targeted therapy in malignancies. Then, we further discuss advancements in targeted therapy for NF1-mutated malignant tumors. In addition, therapies targeting the downstream molecules of NF1 might be potential novel strategies for the treatment of advanced malignancies.
Socioeconomic inequalities in women’s access to health care: has Ecuadorian health reform been successful?
Authors: Quizhpe Edy , Sebastian Miguel San , Teran Enrique , Pulkki-Brännström Anni-Maria
Published: October 2020

Background

Over the last 12 years, Ecuador has implemented comprehensive health sector reform to ensure equitable access to health care services according to need. While there have been important achievements in terms of health care coverage, the effects of these reforms on socioeconomic inequalities in health care have not been analysed. The present study assesses whether the health care reforms implemented in the decade between 2007 and 2017 have contributed to reducing the socioeconomic inequalities in women’s health care access.

Methods

The present study was based on two waves (2006 and 2014) of the Living Standards Measurement Survey conducted in Ecuador. Data from women of reproductive age (15 to 49 years) were analysed to evaluate health care coverage across three indicators: skilled birth attendance, cervical cancer screening, and the use of modern contraceptives. Absolute risk differences were calculated between the heath care indicators and the socioeconomic variables using binomial regression analysis for each time period. The Slope Index of Inequality (SII) was also calculated for each socioeconomic variable and period. A multiplicative interaction term between the socioeconomic variables and period was included to assess the changes in socioeconomic inequalities in health care over time.

Results

Access to health care increased in the three studied outcomes during the health sector reform. Significant reductions in inequality in skilled birth attendance were observed in all socioeconomic variables except in the occupational class. Cervical cancer screening inequalities increased according to education and occupation, but decreased by wealth. Only a poorer education was observed for modern contraceptive use.

Conclusions

While most socioeconomic inequalities in skilled birth attendance decreased during the reform period, this was not the case for inequalities in cervical cancer screening or the use of modern contraceptives. Further studies are needed to address the social determinants of these health inequalities.
Bridging the research–practice gap in healthcare: a rapid review of research translation centres in England and Australia
Authors: Robinson Tracy , Bailey Cate , Morris Heather , Burns Prue , Melder Angela , Croft Charlotte , Spyridonidis Dmitrios , Bismantara Halyo , Skouteris Helen , Teede Helena
Published: October 2020

Background

Large-scale partnerships between universities and health services are widely seen as vehicles for bridging the evidence–practice gap and for accelerating the adoption of new evidence in healthcare. Recently, different versions of these partnerships – often called academic health science centres – have been established across the globe. Although they differ in structure and processes, all aim to improve the integration of research and education with health services. Collectively, these entities are often referred to as Research Translation Centres (RTCs) and both England and Australia have developed relatively new and funded examples of these collaborative centres.

Methods

This paper presents findings from a rapid review of RTCs in Australia and England that aimed to identify their structures, leadership, workforce development and strategies for involving communities and service users. The review included published academic and grey literature with a customised search of the Google search engine and RTC websites.

Results

RTCs are complex system-level interventions that will need to disrupt the current paradigms and silos inherent in healthcare, education and research in order to meet their aims. This will require vision, leadership, collaborations and shared learnings, alongside structures, processes and strategies to deliver impact in the face of complexity. The impact of RTCs in overcoming the deeply entrenched silos across organisations, disciplines and sectors needs to be captured at the systems, organisation and individual levels. This includes workforce capacity and public and patient involvement that are vital to understanding the evolution of RTCs. In addition, new models of leadership are needed to support the brokering and mobilisation of knowledge in complex organisations.

Conclusions

The development and funding of RTCs represents one of the most significant shifts in the health research landscape and it is imperative that we continue to explore how we can progress the integration of research and healthcare and ensure research meets stakeholder needs and is translated via the collaborations supported by these organisations. Because RTCs are a recent addition to the healthcare landscape in Australia, it is instructive to review the processes and infrastructure needed to support their implementation and applied health research in England.