bluuebunny/crossref_metadata_2025 huggingface dataset:
Socioeconomic inequalities in women´s access to health care: has Ecuadorian health reform succeeded?
Authors: Quizhpe Edy , Sebastian Miguel San , Teran Enrique , Pulkki-Brännström Anni-Maria
Published: June 2020

Background: Over the last twelve years, Ecuador has implemented a comprehensive health sector reform to ensure equitable access to health care services according to health needs. 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. This study assessed whether the health care reform implemented in the 2007 - 2017 decade contributed to reducing the socioeconomic inequalities in women´s health care access.Methods: This study was based on two waves of the Living Standards Measurement Survey conducted in Ecuador in 2006 and 2014. Data from women of reproductive age (15 to 49 years) was analysed to evaluate health care coverage in 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 inequality reductions 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 decrease by education was observed for modern contraceptive use. Conclusions: While most socioeconomic inequalities in skilled birth attendance decreased during the reform, this was not the case for inequalities in cervical cancer screening or the use of modern contraceptives. Further work is needed to address the social determinants of these health inequalities.
How we teach children with asthma to use their inhaler: A scoping review protocol
Authors: McCrossan Patrick , Mallon Orla , Shields Michael , O'Donoghue Dara
Published: June 2020

Background One reason that asthma remains poorly controlled in children is poor inhaler technique. Current guidelines recommend checking inhaler technique at each clinical visit. However, they do not specify how best to train children to mastery of correct inhaler technique. Currently many children are simply shown how to use inhalers (brief Instruction) which results in less than 50% with correct inhaler technique. The aim of this scoping review is to explore published literature on teaching methods used to train children to master correct inhaler technique. Methods This scoping review will follow the Arksey O'Malley scoping review methodology and the 2015 Joanna Briggs Institute guidelines. It will be reported using the Preferred Reporting Items for Systematic Reviews and Meta-analyses Protocols extension for Scoping Reviews. An initial pilot exercise will be undertaken using the online database MEDLINE before proceeding to a complete search using the databases Embase, Scopus, Web of Science, CINAHL and the Cochrane library. We will include studies published since the year 1956 on teaching the skill of inhaler technique to children. Due to the iterative nature of a scoping review, the research question or the search terms may alter following a piloting process. Discussion This scoping review will provide a broad overview of currently used educational techniques to improve inhaler technique in children with asthma. The analysis will allow us to refine future research in this area by focusing on the most effective techniques and optimising them. This will likely lead to a systematic review of the literature with the potential to design a randomised control trial of educational interventions to teach inhaler technique to children with asthma.
Differential diagnosis of COVID-19 from community acquired pneumonia by CT scan and follow-up
Authors: Liu Kai-Cai , Xu Ping , Lv Wei-Fu , Chen Lei , Qiu Xiao-hui , Yao Jin-Long , Gu Jin-Feng , Hu Bo , Wei Wei
Published: June 2020

Objective: Coronavirus disease-19(COVID-19) is the most serious infectious disease in the world at present. Accurate diagnosis of this disease in clinic is very important. this study aims to improve the differential ability of COVID-19 and other community acquired pneumonia(CAP) by CT,and to evaluate the short-term prognosis of patients. Methods: The clinical and imaging data of 165 COVID-19 and 118 CAP patients diagnosed in seven hospitals in Anhui Province,China from January 21,2020 to February 28, 2020 were retrospectively analyzed.Results：The sensitivity and specificity of age, white blood cell count, and ground glass shadow in the diagnosis of COVID-19 were 92.7% and 66.1%,respectively. Pulmonary consolidation,fiber cord,and bronchial wall thickening were used as indicators to exclude COVID-19.The sensitivity and specificity were 78.0% and 63.6%, respectively.The follow-up results showed that 67.8% (112/165) of the cases of COVID-19 had abnormal changes in lung residual levels,and the pulmonary sequelae of patients over 60 years of age became more severe with age.Conclusion：CT combined with clinical conditions, lung lesion density、 morphological characteristics and other associated signs, has a high accuracy for the early diagnosis of COVID-19 and the differential diagnosis of CAP.patients with COVID-19 infection over 60 years have poor prognosis.
Attendants’ experience with the Personalized citizen assistance for social participation (APIC)
Authors: Gagnon Karine , Levasseur Mélanie
Published: June 2020

Background
To promote healthy aging, the social participation needs of older adults must be better met. Previous studies have shown the benefits of the Personalized citizen assistance for social participation (APIC), but few explored its influence on attendants. This study explored the assistance experience of attendants when providing the APIC to older adults with disabilities.
Methods
A qualitative design inspired by a phenomenological approach was used with six female attendants who participated in individual interviews.
Results
The APIC attendants felt useful, developed meaningful relationships with their older adults, and improved their self-knowledge. Attendants had the opportunity to reflect on their lives and self-aging. They contributed to older adults’ functional independence, motivation, and participation in social activities. Attendants encountered challenges related to withdrawn behavior in older adults, such as refusing to participate in activities.
Conclusions
Considering the identified benefits of the APIC for attendants, further studies should explore personalized assistance to preserve older adults’ health.
NCMHap: A novel method for haplotype reconstruction based on Neutrosophic c-means clustering
Authors: Zamani Fatemeh , Olyaee Mohammad , Khanteymoori Alireza
Published: June 2020

Background: Single individual haplotype (SIH) problem refers to reconstructing haplotypes of an individual based on several input fragments sequenced from a specified chromosome. Solving this problem is an important task in computational biology and has many applications in the pharmaceutical industry, clinical decision-making and genetic diseases. It is known that solving the problem is NP-hard. Although several methods have been proposed to solve the problem, but it is found that most of them have low performances in dealing with noisy input fragments. Therefore, proposing a method which be accurate and scalable, is a challenging task.Results: In this paper, we introduced a method, named NCMHap, which utilizes the Neutrosophic c-means (NCM) clustering algorithm. The NCM algorithm can effectively detect the noise and outliers in the input data. In addition, it can reduce their effects in the clustering process. The proposed method has been evaluated by several benchmark datasets. Comparing with existing methods indicates that NCMHap is significantly superior in the most cases, particularly when the amount of noise increases, it outperforms the comparing methods.Conclusion: The experimental results recommend the application of the proposed method on the datasets which involve the fragments with huge amount of gaps and noise.
Sarcopenia Is Associated with the Presence of Nonalcoholic Fatty Liver Disease in Zhejiang Province, China: A Cross-Sectional Observational Study.
Authors: Wang Yu-Ming , Zhu Ke-Fu , Zhou Wen-Jing , Zhang Qin , Deng Dan-Feng , Yang Yi-Chen , Lu Wen-Wen , Xu Jia , Yang Yun-Mei
Published: June 2020

Background
Nowadays, both nonalcoholic fatty liver disease (NAFLD) and sarcopenia have attracted extensive attention in public health. However, the relationship between NAFLD and sarcopenia remains unclear. This study aimed to clarify the gender-specific association between sarcopenia and NAFLD according to the Asian Working Group for Sarcopenia (AWGS).
Methods
Dual-energy X-ray absorptiometry (DXA) and hepatic ultrasonography were measured in 578 participants (92 men and 486 women) during their annual health examinations. Multivariate logistic regression models were used to explore the association between NAFLD and sarcopenia with its two components.
Results
150 participants (30 men and 124 women) had NAFLD. The prevalence of sarcopenia was higher among the participants with NAFLD than those without (men: 20.0% vs. 9.7%, P = 0.295, women: 15.3% vs. 8.0%, P = 0.019). Low muscle mass (LMM) was independently associated with NAFLD in both men and women (men: odds ratio [OR], 2.88; 95% confidence interval [CI] 1.52–5.46; women: OR, 2.08; 95%CI 1.63–2.67). Whereas, low muscle strength (LMS) was independently associated with NAFLD only in men participants, with the OR of 1.15 (95%CI 1.02–1.28).
Conclusion
The occurrence of sarcopenia was associated with a higher risk of NAFLD, especially in men, as demonstrated by lower muscle mass and lower muscle strength.
Multi-omics data reveal genes that are relevant for muscular amino acids in the common carp
Authors: Zhu Youxiu , Zhang Hanyuan , Xu Peng , Zhao Zixia , Feng Jianxin , Wu Biyin , Jiang Yanliang , Dong Chuanju , Xu Jian
Published: June 2020

Background

Fish muscular amino acids are a series of essential nutrients that embrace essential amino acids, branched-chain amino acids and flavorous amino acids. Previous studies have found that amino acids have important physiological effects on fish growth and development, as they are involved in maintaining nitrogen balance and in the formation of enzymes and hormones. Amino acids, such as aspartic acid, glutamic acid, glycine and alanine, that can have a significant effect on fish umami taste are called flavorous amino acids. Nevertheless, the studies on the genetic mechanisms of amino acid metabolism in the common carp (Cyprinus carpio) are still limited.
Results

The purpose of this study was to examine the divergent patterns at the genomic, transcriptomic and epigenomic levels in fish with different amino acid contents. Genome-wide association analysis using 195 individuals of common carp was conducted, and 62 genes were identified to be associated with glycine, proline, and tyrosine content. RNA-Seq of samples with extreme contents of essential amino acids, branched-chain amino acids and flavorous amino acids was applied using brain, liver and muscle tissues, resulting in 1,643 differentially expressed genes. Whole-genome bisulfite sequencing identified 3,108 genes with differentially methylated promoters. Through the enrichment analysis of transcriptome and DNA methylation results, we screened out a series of enriched pathways associated with amino acid metabolism, including various categories of pathways spanning growth regulation, lipid metabolism, the citrate cycle and other signaling pathways. Integrated studies demonstrated prominent correlations between DGE and DMP for amino acid contents trait in brain and muscle tissues.
Conclusion

In summary, the multi-omics data revealed candidate genes and pathways correlated with amino acid metabolism. These results will promote the process of the genomic selection and breeding strategy in muscular amino acid contents of fish.
Clinical physiological parameters for the prediction of gram-negative bacterial infection in the emergency department
Authors: Hsu Chan-Peng , Chen Hsin-Yu , Chen Wei-Lung , Chen Jiann-Hwa , Huang Chien-Cheng , Wu Po-Han , Chung Jui-Yuan
Published: June 2020

Background: Early detection and treatment of Gram-negative bacteria (GNB), major causative pathogens of sepsis, may benefit a patient’s outcome, since the mortality rate increases by 5–10% for each hour of delayed therapy. Unfortunately, GNB diagnosis is based on blood culture, which is time consuming. Therefore, an economic and effective GNB infection detection tool in the emergency department (ED) is warranted.Methods: We conducted a retrospective case control-study in the ED of a university-affiliated medical center between January 01, 2014 and December 31, 2017. The inclusion criteria were as follows: (1) age ≥ 18; (2) clinical suspicion of bacterial infection; (3) positive bacterial culture of blood or sputum or urine. Descriptive statistics was performed on patient demographic characteristics, vital signs, laboratory data, infection sites, cultured microorganisms, and clinical outcomes. The accuracy of vital signs to predict GNB infection was identified via logistic regression and receiver operating characteristic (ROC) analysis.Results: A total of 797 patients were included in this study; the mean age was 71.8 years and 51.3% were male. The results revealed that patients with body temperature ≥ 38.5°C, heart rate ≥ 110 beats per minute, respiratory rate ≥ 20 breaths per minute, and Glasgow coma scale (GCS) < 14, had a 2.3-, 1.4-, 1.9-, and 1.6-fold greater risk of GNB infection, respectively. The area under the curve values for ROC analysis of these measures were 0.70, 0.68, 0.69, and 0.67, respectively.Conclusion: The four physiological parameters were rapid and reliable independent predictors for early detection of GNB infection.
Assessing the association between periodontitis and preterm low birth weight: A case control study
Authors: UWAMBAYE Peace , MUNYANSHONGORE Cyprien , RULISA Stephen , Shiau Harlan J , NUHU Assuman , KERR Michael S
Published: June 2020

Background
Premature deliveries are the main causes of prenatal and infant mortality and morbidity in developed societies and is an important problem in obstetrics. Maternal periodontitis is a very prevalent condition that has suspected to be associated with adverse pregnancy outcomes like preterm birth and low birth weight. However, there are still conflicting results and this study have been done to determine the association between periodontitis and preterm low birth weight in order to get necessary information that will enable us to improve mothers’ and children’s health by recommending the screening tool to be used by nurses and midwives to screen for periodontal diseases during antenatal consultations.
Methods
A case control study was done on 555 women on post-partum period. This case control was in ratio of 1:2; 1 case of preterm and low birth weight to 2 controls. There were 185 cases with preterm deliveries/ gestation age < 37 weeks and low birth weight / weight < 2500 g and 370 controls with term delivery/ gestation age of above or equal to 37 weeks and normal birth weight babies 2500 g and above. Multivariate regression analysis was done and the variables were hierarchically grouped into three groups: first categories of demographic variables were put in the regression model as step 1. Second category were other potential factors were put in regression model as the second step. The third category or the third step of regression model, the researcher put periodontitis as it was hypothesized a major predictor variable.
Results
Significant association was found between periodontitis and preterm low birth weight; women who had periodontitis had 6 times the odds of giving birth to preterm low birth weight babies compared to women who had no periodontitis (p < 0.001) (95% CI 3.9, 10.4).
Conclusion
Periodontitis is a risk factor for preterm low birth weight and preventive solutions like having a periodontitis screening tool for nurses and midwives during antenatal care consultations are highly recommended.
Introduction and Feeding Practices of Solid Food in Preterm Infants born in Salzburg
Authors: Hofstätter Edda , Köttstorfer Verena , Stroicz Patricia , Schütz Sebastian , Hackenberg Lorenz Auer , Brandner Johannes , Wald Martin
Published: June 2020

Background: It is shown that meeting the increased nutritional demand of preterm infants from birth is not only important for survival but essentially contributes to the infants` overall development and long-term health. While there are established guidelines for weaning term infants, evidence regarding preterm infants is scarce and less precise. The aim of this study was to identify the current practices on introducing solids to preterm infants amongst caregivers in Salzburg and determine potential reasons for early weaning.Methods: Altogether 68 infants born between 24 0/7 and 36 6/7 weeks were recruited and detailed structured interviews with the caregivers were conducted at 17 weeks corrected age. Weight, hight and head circumference were collected. Results: 52% of the study group received solids before the recommended 17 weeks corrected age. For this group the mean age being 13.77 ± 1.11 weeks corrected age. Premature introduction of solids significantly correlates with exclusively and early formula-feeding. 34% were weaned due to recommendation by their paediatrician. 23% of the preterm infants even received solids before 12 weeks corrected age, putting them at risks for developing obesity, celiac disease and diabetes. Conclusions: This study shows the necessity for clear guidelines regarding the introduction of complementary feeding in preterm infants as well as the importance of their implementation. Caregivers should receive information on this topic early enough and they should fully understand the difference between chronological and corrected age.
Unbiased RNA-Seq-driven identification and validation of reference genes for quantitative RT-PCR analyses of cancer exosomes
Authors: Dai Yao , Cao Yumeng , Köhler Jens , Lu Aiping , Xu Shaohua , Wang Haiyun
Published: June 2020

Background
Exosomes are extracellular vesicles (EVs) derived from endocytic compartments of eukaryotic cells which contain various biomolecules like mRNAs or miRNAs. Exosomes influence the biologic behaviour and progression of malignancies and are promising candidates as non-invasive diagnostic biomarkers or as targets for therapeutic interventions. Usually, quantitative real-time polymerase chain reaction (qRT-PCR) is used to assess gene expression in cancer exosomes, however, the ideal reference genes for normalization yet remain to be identified.
Results
In this study, we performed an unbiased analysis of high-throughput mRNA and miRNA-sequencing data from exosomes of patients with various cancer types and identify candidate reference genes and miRNAs in cancer exosomes. The expression stability of these candidate reference genes was evaluated by the coefficient of variation “CV” and the average expression stability value “M”. We subsequently validated these candidate reference genes in exosomes from an independent cohort of ovarian cancer patients and healthy control individuals by qRT-PCR.
Conclusions
Our study identifies OAZ1 and hsa-miR-6835-3p as the most reliable individual reference genes for mRNA and miRNA quantification, respectively. For superior accuracy, we recommend the use of a combination of reference genes - OAZ1/SERF2/MPP1 for mRNA and hsa-miR-6835-3p/hsa-miR-4468-3p for miRNA analyses.
Progesterone levels predict pregnancy outcome in individuals with fallopian tube associated infertility
Authors: BO Wenjia , Zhang Ning
Published: June 2020

Background: To investigate the predictive value of human chorionic gonadotropin(HCG) and progesterone(P) levels on pregnancy outcomes in patients receiving in vitro fertilization(IVF) due to simple fallopian tube factors. METHODS:We retrospectively analyzed the clinical data of 854 cycles from the simple fallopian tube factor IVF fresh embryo transfer.The clinical data of 854 cycles from January 2010 to December 2018 was divided into 7 groups according to the P level on HCG day.Live birth rates(LBR) and observe trends were calculated. The receiver operating characteristic(ROC) curve was established to determine the optimal cutoff value for P, which was used to further divide the data into 3 groups: Group 1 (P ≦ 1.0 ng/ml), Group 2 (1.0 ng/ml ≤ P ≤ 1.25 ng/ml), and Group 3 (P≥1.25ng/ml). We then compared the ovulation results and clinical outcomes between the 3 groups. RESULTS There were no significant differences in age, infertility years, Gonadotropin(Gn)dosage, Gn days, Luteinizing hormone(LH) level on HCG day, 2pronuclear(2PN) fertilization rate, clinical pregnancy rate(CPR), LBR, full-term birth rate, and preterm birth rate among the three groups, but body mass index （BMI）(P = 0.001), basal LH (P = 0.034), estrogen peak (P = 0.000), number of eggs obtained (P = 0.000) were significantly different. CONCLUSION The level of P level on HCG day does not affect the CPR and LBR after IVF. However, P levels between 1.0-1.25ng/ml may lead to good clinical pregnancy outcomes.
Parents living with profound intellectual disabilities – how to improve the transition process from family home to independent living. A qualitative study with parents and employees
Authors: Roos Eirik , Sondenaa Erik
Published: June 2020

Background
The transition process from the family home to independent living for young adults with intellectual disability (ID) becomes delayed. Those families face challenges that exceed those of typical families such as higher objective and subjective burden, more frequent psychological distress and lower social support. The aim of this study was to explore the collaboration process between parents and employees and identify factors that improve the transition with less burden.
Methods
A descriptive qualitative study was undertaken with 18 persons (9 parents and 9 employees) interviewed individually and in groups. In accordance with the municipality`s guidelines, families with profound intellectual disability (PID) child should apply for housing, when the child turns 16. The purpose is to ensure interdisciplinary collaboration, information flow and coordinated services according to family’s needs. The main question in the interviews was ‘What was your experience with cooperation in the transition process, and what would you do to improve this process?’ The interviews were analysed with a thematic approach using systematic text condensation.
Results
The parents experienced a lack of general information about the ‘housing waiting list’, level of services, the plan for time of moving from the family home, and how to choose where and whom to live with. Parents described that they had an unsustainable burden of care during the waiting period, and a family crisis caused the allocation of an apartment in a group house. Employees shared challenges to meet families’ wishes, as there were too few group homes. They experienced good cooperation with families and said they offered respite care, due to reduce parents’ burden of care. Employees experienced that PID children developed skills, mastery and degrees of independence after completing a residency at the Folk High School.
Conclusions
To improve the collaboration process to reduce the burden of care to families, the informants highlighted the following imported factors:
Young age increases the risk of lymph-node metastasis in patients with muscle-invasive bladder urothelial carcinoma
Authors: Tian Zijian , Meng Lingfeng , Wang Xin , Diao Tongxiang , Hu Maolin , Wang Miao , Ming Liu , Wang Jianye
Published: June 2020

Background: The risk of positive lymph nodes in patients with muscle-invasive bladder urothelial carcinoma (MIBC) can be used to guide treatment recommendations. However, little is known about the effect of age on lymph node positivity (LN+). This study aimed to evaluate the effect of age on LN+ in MIBC. Methods: We analyzed patients with stage T2–T4 bladder urothelial carcinoma who had not received preoperative radiotherapy, had at least one lymph node examined, and underwent cystectomy between 1998 and 2015. The Cochran–Armitage trend test and logistic univariate and multivariate analyses were used to evaluate the effect of age on LN+ in all T stages.Results: In total, 15624 patients with MIBC were identified, including 747 patients aged ≤50 years (4.78%), 2614 patients aged 50–59 years (16.73%), 4914 patients aged 60–69 years (31.45%), 5225 patients aged 70–79 years old (33.44%), and 2124 patients aged >80 years (13.59%). In T2–T4 staging, LN+ was negatively correlated with age. After adjustment for several covariates, multivariate logistic regression analysis revealed that age was an independent risk factor for LN+.Conclusions: Young patients with MIBC have a higher risk of lymph node metastasis. More active screening and treatment strategies should be considered for young patients with MIBC, whereas overtreatment should be avoided in elderly patients to prevent unnecessary complications.
Effects of Solvents on Total Phenolic Content and Antioxidant Activity of Ginger Extracts
Authors: Ezez Dessie , Tefera Molla
Published: June 2020

Ginger (Zingiber officinale) is a popular spice which used for the treatment of different gastrointestinal and inflammatory discomfort. In the present study, the total phenolic content (TPC) and antioxidant activity of ginger extract using four solvents (ethanol, methanol, acetone and ethyl acetate) were determined. Among the four solvents, methanol extract showed that the maximum phenolic (1183.813 mg GAE/100 g at Ayikel and 1022.409 mg GAE/100 g at Mandura) and the least were found in acetone extract (748.865 mg GAE/100 g at Ayikel and 690.152 mg GAE/100 g at Mandura). In addition, the highest DPPH radical scavenging activity (84.868% at Ayikel and 82.883% at Mandura) was observed in methanol. However, acetone showed the least DPPH radical scavenging activity (73.864% at Ayikel and 70.597% at Mandura). Antioxidant activities of ginger extracts were also expressed as IC50 values and acetone extract has maximum IC50 value (0.654 and 0.812 mg/mL) followed by ethyl acetate and ethanol, while the lowest for methanol extracts (0.481 and 0.525 mg/mL). The result of this study showed that extraction solvents significantly affected the total phenolic content and antioxidant activities of ginger. Thus, ginger can be regarded as promising candidates for natural sources of antioxidants with high value of phenolic contents.
The Genome of Medicinal Leech (Whitmania pigra) for Exploration of Bioactive Ingredients
Authors: Tong Lei , Dai Shao-Xing , Kong De-Jun , Yang Peng-Peng , Tong Xin , Tong Xiang-Rong , Bi Xiao-Xu , Su Yuan , Zhao Yu-Qi , Liu Zichao
Published: June 2020

BackgroundLeeches are classic annelids that have a huge diversity and closely related to people, especially medicinal leeches. Medicinal leeches have been widely utilized in medicine based on the pharmacological activities of their bioactive ingredients. The discovery of bioactive ingredients is hindered heavily due to the lack of the genome of medicinal leeches.ResultsTo facilitate this discovery and the research of medicinal leeches, we reported the first genome of the medicinal leech (Whitmania pigra). The assembled genome size of W. pigra is 177 Mbp, close to the estimated genome. Approximately about 23% of the genome was repetitive. A total of 26,743 protein-coding genes were subsequently predicted. There are only 9799 (57%) orthologous genes between W. pigra and Helobdella robusta. And only 16% genes in W. pigra showed syntenic arrangement with H. robusta revealed by gene synteny analysis. Furthermore, W. pigra and H. robusta expanded different gene families enriched in the ‘calcium ion’ and ‘sodium ion’ related functions, respectively. By inspecting genome distribution and gene structure of hirudin, we identified a new hirudin gene g17108 (hirudin_2) with different cysteine pattern. At last, we systematically explored and compared the active substances in the genomes of two leeches. The results showed that W. pigra exceeds H. robusta in both kinds and gene number of active molecules.ConclusionsThis study reported the first genome of the medicinal leech (W. pigra), which provides an important genome resource and new insight into the exploration and development of bioactive molecules of medicinal leeches.
Assessing the Contextual Effect of Community in the Utilization of Postnatal Care Services in Ghana
Authors: Dankwah Emmanuel , Zeng Wu , Feng Cindy , Kirychuck Shelley , Lepnrum Rein , Farag Marwa
Published: June 2020

Background
Inequalities in the use of postnatal care services (PNC) in Ghana have been linked to poor maternal and neonatal health outcomes. This has ignited a genuine concern that PNC interventions with a focus on influencing solely individual-level risk factors do not achieve the desired results. This study aimed to examine the community-level effect on the utilization of postnatal care services. Specifically, the research explored clusters of non-utilization of PNC services as well as the effect of community-level factors on the utilization of PNC services, with the aim of informing equity-oriented policies and initiatives.
Methods
The 2014 Ghana Demographic and Health Survey GDHS dataset was used in this study. Two statistical methods were used to analyze the data; spatial scan statistics were used to identify hotspots of non-use of PNC services and second two-level mixed logistic regression modeling was used to determine community-level factors associated with PNC services usage.
Results
This study found non-use of PNC services to be especially concentrated among communities in the Northern region of Ghana. Also, the analyses revealed that community poverty level, as well as community secondary or higher education level, were significantly associated with the utilization of PNC services, independent of individual-level factors. In fact, this study identified that a woman dwelling in a community with a higher concentration of poor women is less likely to utilize of PNC services than those living in communities with a lower concentration of poor women (Adjusted odds ratio (AOR) = 0.60, 95%CI: 0.44–0.81). Finally, 24.0% of the heterogeneity in PNC services utilization was attributable to unobserved community variability.
Conclusion
The findings of this study indicate that community-level factors have an influence on women’s health-seeking behavior. Community-level factors should be taken into consideration for planning and resource allocation purposes to reduce maternal health inequities. Also, high-risk communities of non-use of obstetric services were identified in this study which highlights the need to formulate community-specific strategies that can substantially shift post-natal use in a direction leading to universal coverage.
Socioeconomic status inequity in inpatient service utilization based on need among migrants: Evidence from a national study in China
Authors: Wang Yi , Jing Zhengyue , Ding Lulu , Tang Xue , Feng Yuejing , Li Jie , Chen Zhuo , Zhou Chengchao
Published: June 2020

Background
Equity in access to healthcare is a major health policy challenge in many low- and middle- income countries. However, millions of people, especially migrants, do not have the adequate access to health care they need. Providing equal treatment for those who have the same need for healthcare, regardless of their socioeconomic and cultural background, has become a shared goal among policymakers who strive to improve healthcare. This study aims to identify the socioeconomic status (SES) inequities in inpatient service utilization based on need among migrants by using a nationally representative study in China.
Methods
The data used in this study was derived from the 2014 National Internal Migrant Population Dynamic Monitoring Survey collected by the National Health Commission of China. We used logistic regression method and Blinder-Oaxaca decomposition and calculated the concentration index to measure inequities of SES in inpatient service utilization based on need. Sample weights provided in the survey were applied in all the analysis to represent the China population.
Results
The total number of the migrants who needed inpatient service told by doctors was 7592, of which, 1667 (21.96%) did not use the inpatient services (unmet inpatient service need). Results showed that inpatient service utilization concentrated among high-SES migrants (Concentration Index: 0.041, p < 0.001) and the decomposition results suggested that about 53.76% of the total SES gap in inpatient service utilization could be attributed to the gradient effect. After adjusting for other confounding variables, the odds ratios of inpatient service utilization by internal migrants with high SES according to educational attainment, economic status, and employment status were 1.41 (95% CI 1.08–1.85, p = 0.012), 1.25 (95% CI 1.01–1.56, p = 0.046), and 1.62 (95% CI 1.12–2.36, p = 0.011), respectively.
Conclusion
This study observed an inequity in inpatient service utilization where the utilization concentrates among high SES migrants. This suggests that future policies should make the reimbursement more pro-poor among migrants in primary care and use more effective policies targeting the migrants with low educational attainment and unemployed, such as health education activities.
Evaluation of Peripheral Immune Activation in Amyotrophic Lateral Sclerosis
Authors: Wang Mengli , Liu Zhen , Du Juan , Yuan Yanchun , Jiao Bin , Zhang Xuewei , Hou Xuan , Shen Lu , Guo Jifeng , Jiang Hong , Xia Kun , Tang Beisha , Wang Junling
Published: June 2020

Background: Accumulating evidence has revealed that immunity plays an important role in amyotrophic lateral sclerosis (ALS) progression. However, the results regarding the serum levels of immunoglobulin and complement are inconsistent in patients with ALS. Although immune dysfunctions have also been reported in patients with other neurodegenerative diseases, few studies have explored whether immune dysfunction in ALS is similar to that in other neurodegenerative diseases.Methods: Serum levels of immunoglobulin and complement were measured in 245 patients with ALS, 65 patients with multiple system atrophy (MSA), 60 patients with Parkinson’s disease (PD), and 82 healthy controls (HCs). A meta-analysis including data from this study was performed to evaluate the differences in the levels of immunoglobulin and complement between ALS patients and HCs. The serum levels of immunoglobulin and complement were compared between patient groups and HCs or between ALS patient groups established by age at onset, site at onset, disease duration, or disease severity. The correlations between the levels of immunoglobulin and complement and the clinical characteristics of ALS were analysed using Spearman correlation analysis.Results: The pooled results showed that patients with ALS had higher C4 levels than did HCs, and no significant differences between these two groups in IgG, IgA, IgM, or C3 levels were found. Multiple comparisons revealed that there were no significant differences between patients with ALS and other neurodegenerative diseases in IgG, IgA, IgM, C3, or C4 levels. In addition, the IgG levels were lower in early-onset ALS patients than in late-onset ALS patients and HCs. The correlations between age at onset of ALS and IgG and IgA levels were significantly positive. Moreover, spinal-onset ALS patients had lower serum IgG levels than did HCs, but no difference was found between bulbar-onset ALS patients and HCs.Conclusions: Peripheral immunity abnormalities existed in patients with ALS, and lower IgG levels were associated with early-onset ALS.
Retraction of transporting bone segment during Ilizarov bone transport
Authors: han xiaofei , Ma Yunhong , Yin Qudong
Published: June 2020

Background: Retraction of transporting bone segment (TBS) may occur when fixator of TBS is removed before complete mineralization of the distraction callus and union of the docking site. However, there are few reports on the causes and influencing factors of the retraction of TBS.Methods: The clinical data of 37 cases with tibial bone defect treated by Ilizarov bone transport were analyzed retrospectively, in whom the fixator of TBS was removed before maturing of mineralization of the distraction callus and union of the docking site. Bivariate correlation was used to analyze relationship between retraction distance of TBS and factors including age, gender, disease course, length of bone defect, times of operation, size of TBS, transport distance, timing and time interval of removal of TBS fixator. Risk factors with significant level were further identified using multivariate linear regression. Results: Bivariate correlation analysis showed that the timing of removal was negatively correlated with the retraction distance while the time interval, transport distance were positively correlated with the transport distance（all p<0.05); the age, gender, disease course, length of bone defect, size of TBS and times of operation were not correlated with the transport distance（p>0.05). Multivariate linear regression analysis of the 3 risk factors showed that the timing of removal and time interval were the main risk factors for the retraction distance (p<0.05), of which, the timing of removal had the greatest impact, followed by the time interval, but the transport distance was not a main risk factor for the retraction distance (p>0.05).Conclusion: The TBS is subjected to distraction force from all the adherent soft tissues during Ilizarov bone transport, which has elastic properties and can make a retraction of TBS when its fixator is removed before complete mineralization of the distraction callus and union of the docking site. The timing of removal and the time interval are key factors influencing the retraction of TBS.
Is annular repair technique useful for reducing reherniation and reoperation after limited discectomy
Authors: Zhang Qiang , Tang Jilei , Jiang Yuqing , Li Haibo , Gao Gongming , Nong Luming
Published: June 2020

BackgroundThe annular defect because of the primary lumbar disc herniation (LDH) or surgical procedure is considered as a main reason for recurrent herniation and eventually reoperation. Efforts to close the defect with annular repair devices have been attempted several times but the results were controversial. The present aims to detect whether the annular repair techniques were useful for reducing the re-herniation and re-operation rate after limited discectomy for LDH patients.MethodsThe Pubmed, Cochrane library, and Embase databases were searched to retrieve relevant studies published before January 1, 2020. Continuous variables were compared by calculating the standard difference of the means (SDM), whereas categorical dichotomous variables were assessed using relative risks (RRs). A random-effects model was used if the heterogeneity statistic was significant; otherwise, a fixed-effects model was used. ResultsA total of 10 researches were suitable for the meta-analysis, including four different repair techniques and a total of 1907 participates (1203 treated and 704 control). In comparison with the control group, there was no statistical difference with the ODI, VAS-leg, and VAS-back scales for patients treated with annular repair. However, the use of an annular repair device was associated with a significant reduction in the re-herniation (p=0.004) and re-operation (0.004) rates. There was no difference between the groups with the perioperative complications, but much more device related long term complications happened in the annual repair group (p=0.031) though it still decreased the overall re-operation rate significantly (p=0.006).ConclusionOur results demonstrated that the use of an annular repair device was safe and useful for reducing re-herniation and re-operation rates.
EMCV Replication in BHK-21 in Vitro is Mediated by Caveolin-1, Actin, Dynamin-Dependent Endocytic Pathway
Authors: Li Qiongyi , Liu Yang , Xu Shujuan , Zhao Kexue , Ling Ying , Liu Rongxiu , Feng Ruofei , Bai Jialin
Published: June 2020

Background: Encephalomycarditis virus is a member of Cardiovirus, belongs to the family Picornaviridae, and can infect different domestic and wild animals. However, the endocytic pathway by which EMCV infected BHK-21 cells remains unclear. In this study, endocytic pathway used by EMCV replication in BHK-21 cells was elucidated.Methods: The function of numerous cellular key factors implicated in the various endocytic mechanisms known to date were systematic detected using chemical inhibitors. Furthermore, RNA interference (RNAi) silencing, the overexpression of dominant protein combined to virus infectivity assays, and confocal imaging to examine which cellular molecules involved in the infection process were also analyzed.Results: The results indicated that the EMCV replication was related to endocytosis. However, neither clathrin nor macropinocytosis pathway was involved in virus infection. QRT-PCR and WB analyses showed that caveolin-1 were significantly up-regulated in EMCV infected BHK-21 cells. Immune-fluorescent confocal microscopy analysis showed that caveolin-1 was temporally co-localized with EMCV VP1 at the early stage of EMCV infection. Overexpressed caveolin-1 or downregulated caveolin-1 expression influenced the EMCV infection. Furthermore, EMCV infection was found to depend on dynamin and actin by chemical inhibitors resulted in diminished of virus infection.Conclusions: EMCV replication in BHK-21 cells via caveolin-1, dynamin, and actin-dependent endocytosis pathways.
Metastasis progression through the interplay between the immune system and Epithelial-Mesenchymal-Transition in circulating breast tumor cells
Authors: Khoshbakht Samane , Jamalkandi Sadegh Azimzadeh , Masudi-Nejad Ali
Published: June 2020

BackgroundCirculating tumor cells (CTCs) are the critical initiator of systemic dissemination of cancer, contributing to distant metastasis formation. The metastatic cascades rely on the fundamental roles of different types of CTCs. In which the dual immune responses and epithelial-mesenchymal-transition (EMT) are of two metastasis-driving phenomena and require more molecular assessments.MethodsIn this study, we investigated the transcriptomic modular pattern of single/cluster circulating tumor cells (CTCs). The co-expression analysis implemented, and we could detect two metastatic subnetworks indicating the immune responses and EMT in CTCs. Furthermore, a directed subnetwork identified in the KEGG database. The metastatic potential of subnetworks assessed and validated by classification methods on primary tumors. And, we could fit risk models to distant-metastasis survival of patients.ResultsOur results show the crosstalk among EMT, immune system, menstrual cycles, and stemness in CTCs. In which, fluctuation of menstrual cycles (hormone-related signals) is a new detected pathway in CTCs in breast cancer. The immune SVM model showed high metastatic potential in classifying patients metastatic/non-metastatic groups (accuracy, sensitivity, and specificity scores are 78%). The distant-metastasis free survival model could be used to stratify patients into low, medium, and high-risk groups. Finally, PTCRA, F13A1, LAT, ICAM2, and SNRPC are novel detected biomarkers in breast cancer.ConclusionIn conclusion, different types of CTCs, including cluster/single cells, are metastasis-leading elements in breast cancer. In which, individual assessment of their intrinsic biological properties may assist elucidating metastasis-related mechanisms. These findings may apply to develop superior treatments in the clinic.
Knowledge and Myths about Preeclampsia and Eclampsia and its influence on Antenatal Service Utilization among Expecting Couples in Mtwara Regional: A Cross Sectional Analytical Study.
Authors: Machenje Aziza Shaibu , Kibusi Stephen M. , Gibore Nyasiro , Lilungulu Athanase , Moshi Fabiola V.
Published: June 2020

Background : Hypertensive disorders of pregnancy, including preeclampsia and eclampsia are the major health problem and the main cause of the maternal and perinatal morbidity and mortality in Tanzania. The aim of this study was to assess knowledge and myths about preeclampsia and eclampsia and its influence in Antenatal Clinics (ANC) utilization among expecting couples in Mtwara region.Method : A community based cross-sectional analytical study conducted in Mtwara Region, a random sampling procedure was employed to obtain a sample size of 384 couples with a total of 768 participants (male=384 and female =384). Interviewer structured questionnaire was used for data collection and Statistical package for social science (SPSS v.20) software was used for data entry and analysis. Descriptive statistics, cross tabulation, Principal component analysis (PCA) was conducted and inferential statistics were used to test association between variables obtained.Results: Among 768 participants, only 292(38%) had adequate knowledge about preeclampsia and eclampsia. More than a half 396(51.6%) of study respondents had weak myths while 372(48.4%) had strong myths on pre-eclampsia and eclampsia. Furthermore 492(64%) had adequate antenatal care utilization. Study participants who had adequate knowledge on pre-eclampsia and eclampsia were almost 3 times more likely to utilize antenatal care services (AOR = 2.827; CI = 1.719 – 4.651; p<0.001). Study participants who had weak myth on pre-eclampsia and eclampsia were less likely to have adequate antenatal care attendance (AOR =0.370; CI = 0.0229-0.599; p< 0.001)Conclusion : The overall knowledge of preeclampsia and eclampsia was low. Majority of the female had adequate antenatal service utilization. Majority of respondents had weak myths. Government and stakeholders should ensure that community is equipped with knowledge about preeclampsia and eclampsia and the available Myths should be dispelled.
Gut Microbiome Composition and Metabolomic Profiles of Wild and Captive Chinese Monals (Lophophorus Lhuysii)
Authors: Jiang Dandan , He Xin , Valitutto Marc , Chen Li , Xu Qin , Yao Ying , Hou Rong , Wang Hairui
Published: June 2020

Background：The Chinese monal (Lophophorus lhuysii) is an endangered bird species, with a wild population restricted to the mountains of southwest China, and only one known captive population in the world. We investigated the fecal microbiota and metabolomics of wild and captive Chinese monals to explore differences and similarities in nutritional status and digestive characteristics. An integrated approach combining 16S ribosomal rRNA (16S rRNA) gene sequencing and ultra-high performance liquid chromatograph (UHPLC) based metabolomics were used to examine the fecal microbiome composition and the metabolomic profile of Chinese monals. Results: The results showed that the alpha diversity of gut microbes in the wild group were significantly higher than that in the captive group and the core bacterial species in the two groups showed remarkable differences at all levels. Metabolomic profiling revealed a concurrent difference, mainly related to galactose, starch and sucrose metabolism, fatty acid, bile acid biosynthesis and bile secretion. Furthermore, these metabolites in difference are have a strong correlation with the main microbe in genus level.Conclusions: Various factors related to diet and environmental conditions played a crucial role in shaping the gut microbiome composition and metabolomic profile. Through this study, we have established a baseline for a normal gut microbiome and metabolomic profile for wild Chinese monals, thus allowing us to evaluate if differences seen in captive specimens has an impact on their overall health and reproduction.