bluuebunny/crossref_metadata_2025 huggingface dataset:
Association between Economic Development Level and Tuberculosis Registered Incidence in Shandong,China
Authors: Zhang Qianyun , Yang Dongmei , Cao Linqing , Liu Jinyue , Tao Ningning , Li Yifan , Liu Yao , Song Wanmei , Xu Tingting , Li Shijin , An Qiqi , Liu Siqi , Gao Lei , Song Wanyan , Li Huaichen
Published: October 2020

Background: Tuberculosis (TB) is one of the major infectious diseases that seriously endanger people's health.In Shandong province, the relationship between the level of economic development and TB incidence has not been studied.This study aims to provide more research basis for the government to prevent and control TB by exploring the impact of different economic factors on TB incidence.Methods :By constructing threshold regression model (TRM),we described the extent to which different economic factors contribute to TB registered incidence and differences in TB registered incidence among seventeen cities with different levels of economic development in Shandong province, China, during 2006-2017. Data were retrieved from the China Information System for Disease Control and Prevention.Results: Per capita medical expenditure（regression coefficient，-0.0314462；SD，0.0079305；P>|t|，0.000）and per capita savings（regression coefficient，0.0001924；SD，0.0000566；P>|t|，0.001） passed the significance test at the level of 1%.They are the two economic indicators that have the greatest impact on TB registered incidence.Through the threshold test, we selected the per capita savings as the threshold variable.In the three stages of per capita savings(＜9772.8086 China Yuan(CNY)；9772.8086 - 33835.5391 CNY；＞33835.5391 CNY), rural per capita income always has a significant negative impact on the TB registered incidence (The regression coefficients are -0.0015682, -0.0028132 and -0.0022253 respectively.P is 0.007,0.000 and 0.000 respectively.).In cities with good economies,TB registered incidence was 38.30% in 2006 and dropped to 25.10% by 2017. In cities with moderate economies, TB registered incidence peaked in 2008 at 43.10% and dropped to 27.1% by 2017.In poorer cities, TB registered incidence peaked in 2008 at 56.30% and dropped to 28.9% in 2017.Conclusion:We found that per capita savings and per capita medical expenditure are most closely related to the TB incidence. Therefore, relevant departments should formulate a more complete medical system and medical insurance policy to effectively solve the problem of "difficult and expensive medical treatment". In order to further reduce the TB incidence, in addition to timely and accurate diagnosis and treatment, it is more important for governments to increase investment in medicine and health care.
Effect of Running with Different Intensities on Lubricin Expression of Achilles Tendon in a Rat Model
Authors: Xu Shao-Yong , Song Cheng-Xian , Deng Song-Yun , Liu Sheng-Yao , Liu Wei , He Yong-Bin , Li Shu-Fen , Ni Guo-Xin
Published: October 2020

Background: Lubricin is well known to facilitate the movement of tendon fascicles gliding and recoil against the surrounding tissues in tendons. However, little is known about its response under various mechanical loading conditions. This study was aimed to understand the effect of treadmill running with different exercise intensities on the alternations of lubricin content in rat Achilles tendon.Methods: In this study, eighteen rats were randomly divided into three groups, strenuous treadmill running (STR), moderate treadmill running (MTR), and control (CON). Rats in two running groups were subjected to treadmill running (8 weeks) protocol. Histological observation and biochemical analysis were conducted using the collected Achilles tendons.Results: After 8 weeks, the morphologies of collagen fibers are relatively parallel, crimping and elastic in the CON and MTR groups, but more ruptured in the STR group. The cell density in Achilles tendon sections markedly increased in MTR group than CON group, whereas considerably decreased in STR group than CON or MTR group. Additionally, compared to the CON group, the content of lubricin was dramatically increased in MTR group. However, the lubricin content in STR group was markedly decreased compared with that in CON or MTR group. Moreover, the TGF-β1 expression was upregulated in MTR group in contrast to CON group, while significantly downregulated in STR group than that in CON or MTR group. Conversely, the expression of IL-1 was statistically downregulated in MTR group compared with CON group, but statistically upregulated in STR group than that in CON or MTR group. Conclusions: These results suggest that moderate treadmill running might induce the increase of lubricin by the up-regulation of TGF-β1 expression to improved lubrication, and enhance the loading transmission efficiency. Whereas, strenuous treadmill running could result in the decrease of lubricin as a result of the dramatically increased expression of IL-1 to enhance interfascicular tribology, and predispose to tendinopathy even tendon rupture.
Current use of the Pelvic Organ Prolapse Quantification System in Clinical Practice Among Korean Obstetrician-gynecologists
Authors: Kim Soo Rim , Suh Dong Hoon , Jeon Myung Jae
Published: October 2020

Background: To assess current use of the Pelvic Organ Prolapse Quantification (POP-Q) system in clinical practice among Korean obstetrician-gynecologists.Methods: A web-based questionnaire was sent to 780 Korean Society of Obstetrics and Gynecology members. The items evaluated in the questionnaire were demographic characteristics and current use of the POP-Q system in the evaluation of pelvic organ prolapse (POP) and surgical decision-making. Differences between POP-Q users and nonusers were analyzed by using the two-sample t-test and chi-square test.Results: One hundred twenty-six members (16%) responded to the survey. Of the respondents, 48% reported using the POP-Q system in the evaluation of POP. Members who were female, urogynecologists, or performed a high volume of prolapse surgery were more likely to use the POP-Q system (p<0.05). All but one of the POP-Q users reported using the specific criteria to determine whether each compartmental prolapse should be corrected during prolapse surgery. Most respondents used stage 2 or the hymen as a threshold for prolapse to be corrected for all compartments.Conclusions: Less than half of Korean obstetrician-gynecologists use the POP-Q system in the evaluation of POP. Almost all of POP-Q users make a surgical decision based on the results of the POP-Q examination.
Bone Bruises of the Ankle and Mid-foot Often Associate with Ankle Sprain
Authors: Koiwai Hidefumi , Kamimura Mikio , Taguchi Akira , Tensho Keiji , Nakamura Yukio , Takahashi Jun
Published: October 2020

Background: Ankle sprains are one of the most common musculoskeletal injuries. However, they may be more serious than commonly believed since many patients reportedly experience chronic problems afterwards. It is necessary to improve the treatment, such as the method and duration of fixation, of sprained ankles.Methods: Magnetic resonance imaging of 70 patients with acute moderate or advanced ankle sprains presenting consecutively between November 2014 and December 2019 were reviewed for analysis of bone bruising associated with ankle sprains. The patients were treated conservatively with a solid splint or cast until walking pain could be resolved without external fixation. In cases with pain at the time of weight bearing after solid fixation, crutches were prescribed for pain relief. The fixation period ranged from 8 days to 72 days (mean: 29.5 days). Afterwards, 54.0% of patients had walking pain and required the use of crutches. The ankle joint pain disappeared after conservative treatment in all patients.Results: The incidence of bone bruises detected by magnetic resonance imaging in the ankle and midfoot associated with ankle sprain was 81.4%. Bone bruises of the midfoot, including the tarsal bone and Chopart joint, were found in 34.3% of ankle sprains. Bone bruises of the talus were the most common, being present in 60% of ankle sprains. Bone bruises were also evident in the tibia (44.3%), the calcaneus (21.4%), and the tarsal bone (25.7%). There was a significant association between bone bruises of the talocrural joint surface and use of the crutches after fixation (P=0.041). Multiple regression analysis adjusted for age and gender revealed that bone bruises of the talocrural joint surface of the talus was a significant independent predictor of crutch use (P=0.045), with an odds ratio (95% confidence interval) of 3.03 (1.03-8.94).Conclusion: Bone bruises of the ankle and midfoot are often present in ankle sprains. In moderate or advanced cases of ankle sprain, external solid fixation of both the ankle and midfoot should be performed. In cases with pain at weight bearing following solid fixation, crutches are advised for pain relief and proper ligament and bone healing.
Prostitution Among University Students: A Case Study of Four Public Universities in Ghana
Authors: Gbagbo Fred Yao , Gbagbo Josephine Akosua
Published: October 2020

Background Despite its criminalization in Ghana, prostitution dates back to ancient societies and occurs in various forms within communities. The authors examined prostitution in selected public Universities in Ghana. Methods The study was an exploratory- mixed-method design. Respondents were identified using purposive and snowballing techniques whiles semi-structure questionnaires and in-depth interviews were used for data collection between 2017and 2019. Quantitative data were analyzed using Statistical Package for Social Sciences version 23 and qualitative data analyzed thematically. ResultsFindings show that there is a proliferation of prostitution on university campuses in Ghana for financial, material and emotional gains. Student prostitutes have devised various strategies to combine academic work and prostitution. Prospective customers are solicited by hanging out in drinking bars and night clubs in and around university campuses at night and/or leaving contact details with pimps to be contacted for services. Brothels are also springing up in and around the university campuses in the form of movie houses and student prostitutes convert their hostel rooms into brothels. Price negotiation is based on the environment, duration and styles/positions adopted for sex. ConclusionThere is a need for a multi-sectoral approach for appropriate policy and program interventions to regulate the practice on campus.
Prevention of White Flocculate Precipitation with Simethicone During Upper Gastrointestinal Endoscopy: A Double‐Blinded, Multi‐Center, Randomized Study
Authors: Chen Xueqin , Dai Ning , Deng Yanyong , Sun Xin , Zhang Mingqing , Pan Jie , Huang Zhiming , Ye Guoliang , Si Jianmin , Wang Lan , Chen Shujie
Published: October 2020

Background: The reformulated simethicone emulsion from Berlin Chemical AG might develop white flocculate precipitation covering gastric mucosa when used before esophagogastroduodenoscopy (EGD). We aim to investigate whether combining reformulated simethicone emulsion with 5% NaHCO3 solution could prevent the development of white precipitation and improve visibility during EGD. Methods: Our study involved 523 patients. They were randomly assigned to two groups: In Group A patients received a warm mixed solution containing 30 ml 5% NaHCO3 solution and 15 ml reformulated simethicone emulsion. In Group B patients received 45 ml 40℃ lukewarm water. Visibility scores were recorded and analyzed. In addition, flush times, volume of flush water, overall time taken for EGD and complications during or after procedure were also recorded. Results: We found that no white precipitation was observed during EGD in Group A. Moreover, visibility scores in Group A were significantly lower (P < 0.01). Patients in Group A had fewer flush times (P < 0.01) and smaller volumes of flush water (P < 0.01). In addition, overall time taken for EGD procedure was significantly shorter in Group A (P < 0.01). The percentage of patients who had no adverse response is significantly higher in patients in Group A compared to Group B (P < 0.01). Conclusions: Premedication with mixed solution of 15ml reformulated simethicone emulsion and 30ml 5% NaHCO3 solution can prevent the development of white precipitation, substantially enhance mucosal visibility safely.Trial registration: The registered name of the trial is “Efficacy of using premedication with reformulated simethicone emulsion during upper gastrointestinal endoscopy examination”. Current Controlled Trials ChiCTR1900021689, as well as the date of registration is 11 September 2019. Retrospectively registered, http://www.medresman.org.cn/uc/sindex.aspx.
Comparison of Three Different Screw Trajectories in Osteoporotic Vertebrae: A Biomechanical Investigation
Authors: Jarvers Jan-Sven , Schleifenbaum Stefan , Pfeifle Christian , Oefner Christoph , Edel Melanie , Höh Nicolas von der , Heyde Christoph E.
Published: October 2020

Background: Pedicle screw insertion in osteoporotic patients is challenging. Achieving more screw-cortical bone purchase and invasiveness minimization, the cortical bone trajectory and the midline cortical techniques represent alternatives to traditional pedicle screws. This study compares the fatigue behavior and fixation strength of the cement-augmented traditional trajectory (TT), the cortical bone trajectory (CBT) and the midline cortical (MC). Methods: Ten human cadaveric spine specimens (L1 - L5) were examined. The average age was 86.3 ± 7.2 years. CT scans were provided for preoperative planning. CBT and MC were implanted by using the patient-specific 3D-printed placement guide (MySpine®, Medacta International), TT were implanted freehand. All 10 cadaveric specimens were randomized to group A (CBT vs. MC) or group B (MC vs. TT). Each screw was loaded for 10,000 cycles. The failure criterion was doubling of the initial screw displacement resulting from the compressive force (60 N) at the first cycle, the stop criterion as a doubling of the initial screw displacement. After dynamic testing, screws were pulled out axially at 5 mm/min to determine their remaining fixation strength. Results: The mean pull-out forces did not differ significantly. Concerning the fatigue performance, only one out of ten MC of group A failed prematurely due to loosening after 1,500 cycles (L3). Five CBT already loosened during the first 500 cycles. The mean displacement was always lower in the MC. In group B, all TT showed no signs of failure or loosening. Three MC failed already after 26 cycles, 1,510 cycles, and 2,144 cycles, respectively. The TT showed always a lower mean displacement. In the subsequent pull-out tests, the remaining mean fixation strength of the MC (449.6 ± 298.9 N) was slightly higher compared to the mean pull-out force of the CBT (401.2 ± 261.4 N). However, MC (714.5 ± 488.0 N) were inferior to TT (990.2 ± 451.9 N).Conclusion: The current study demonstrated that cement-augmented TT have best fatigue and pull-out characteristics in osteoporotic lumbar vertebrae, followed by the MC and CBT. MC represent a promising alternative in osteoporotic bone if cement augmentation should be avoided. Using the patient-specific guide contributes to improve screws’ biomechanical properties.
Low Agricultural Potential Exacerbates the Effect of Temperature on Civil Conflicts
Authors: Goyette Jonathan , Smaoui Maroua
Published: October 2020

Using data on 172 countries from 1946 until 2014, this paper examines how time-wise variations in temperature at the country level interacted with cross-country variations in agricultural potential impact the incidence of civil conflicts. In the analysis, countries exhibiting high agricultural potential act as a control group for countries with a lower agricultural potential and variations in temperature act as a treatment from one period to the next. This allows identifying the causal impact of the interaction on conflict incidence. We find that deviations in annual or decennial temperature are conducive to a higher probability of being in conflict in countries with lower agricultural potential. The findings have important policy implications to predict, avoid or mitigate conflicts related to climate change.
Comparing the Efficacy and Side Effects of PDLASTA® (Peg-Filgrastim) with PDGRASTIM® (Filgrastim) in Breast Cancer Patients; A Non-inferiority Randomized Clinical Trial
Authors: Najafi Safa , Ansari Maryam , Kaveh Vahid , Haghighat Shahpar
Published: October 2020

Background: The objective of this study was to compare the efficacy and side effects of to evaluate the efficacy and safety of a single dose (Peg-Filgrastim or PDL) or repeated six daily injections (Filgrastim or PDG) during chemotherapy courses in breast cancer patients in a non-inferiority clinical trial.Methods: In this randomized clinical trial, 80 patients recruited and allocated randomly in two equal arms. In one group, a single subcutaneous dose of 6 mg of PDL was injected the day after receiving a chemotherapy regimen in each cycle. The second arm received a subcutaneous injection of 300 micrograms per day for six consecutive days in each course of treatment. Side effects of GCF treatment and its effect on blood parameters were compared in each cycle and during eight courses of chemotherapy.Results: hematologic parameters showed no significant difference in each course of treatment between two groups of study. The comparison of the WBC (p=0.527), Hgb (p=0.075), Platelet (p=0.819), Neutrophil (p=0.575), Lymphocyte (p=705) and ANC (p=0.675) changes during eight courses of treatment identified no statistically significant difference between two study groups. Side effects including headache, injection site reaction and muscle pain had a lower frequency in patients receiving PDL drugs.Conclusion: Regarding our results, PDL is completely non- inferior in efficacy and also less toxic compared to PDG. Prescribing in single-dose and lower expenses of PDL introduces it as a cost-effective drug in the treatment of chemotherapy-induced neutropenia. Trial registration number, date of registration: IRCT20190504043465N1, May 2019https://www.irct.ir/search/result?query=IRCT20190504043465N1
Implant Breakage Risk for Modular Fluted Tapered Stems in Revision Total Hip Arthroplasty at 5-Year Follow-Up
Authors: Lucena Thibaut , Cavaignac Etienne , Chiron Philippe , Reina Nicolas
Published: October 2020

Background: Modular stems in revision total hip arthroplasties allow diaphyseal fixation and optimal restoration of the architecture of the proximal femur. Several studies report metaphyseal implant breakage in the mid- to long-term and therefore a huge impact on survivorship. We aimed to evaluate a specific design of uncemented modular fluted tapered stems (MFT) to analyze survivorship and clinical and radiological outcomes.Methods: In a retrospective study, we identified 99 patients who had surgery using the same design of MFT implant between 2012 and 2014. Patients were mainly male in 53% and mean age was 73 years. Indications were 33 aseptic loosening, 24 periprosthetic fractures, 23 periprosthetic joint infection, 1 instability and 18 were complex primary arthroplasties. Survivorship, complications and clinical outcomes, were assessed. Mean follow-up was 5 years.Results: There was no implant breakage. At 5-year follow-up, the survivorship free of revision for aseptic loosening and free of revision for any reason of the femoral stem were 100% and 99%, respectively. At last follow-up, they were 94% and 81%, respectively. Six implants were revised. A mean stem subsidence of 6 mm was noted in 9 cases; 1 was revised for aseptic loosening. The Harris hip score was 89. The risk of revision was significantly higher for shorter diaphyseal implants (p=0.026).Conclusion: At mid-term follow-up of 5 years, the MFT studied reported an excellent survivorship and clinical outcomes with no specific complications. Unlike literature reports, no specific complications occurred with this design. Satisfying clinical outcomes and limited subsidence are consistent with previous reports though.Level of evidence: IV – Case series
Clinical Outcomes of Physiotherapy for Patients with Acetabular Labral Tears: An Analysis According to Severity of Injury
Authors: Kawai Makoto , Tateda Kenji , Ikeda Yuma , Motomura Ryosuke , Kosukegawa Ima , Kaya Mitsunori , Nagoya Satoshi , Katayose Masaki
Published: October 2020

Background: Arthroscopic labral repair is an effective treatment for femoroacetabular impingement (FAI) and acetabular labral injury. However, the effectiveness of physiotherapy treatment is controversial. Previous studies that analyzed the outcome of physiotherapy for patients with FAI or acetabular labral tears did not consider damaged tissues or the severity of the acetabular labral tear. This study aimed to evaluate (1) the short-term outcome of physiotherapy in patients with acetabular labral tears confirmed by magnetic resonance imaging (MRI) and (2) the effectiveness of physiotherapy according to the severity of the labral tear.Methods: Thirty-five patients who underwent physiotherapy for symptomatic acetabular labral tears from August 2013 to July 2018 were enrolled. We evaluated the severity of the acetabular labral tears, which were classified based on the Czerny classification system using 3-T MRI. Clinical findings of microinstability and extra-articular pathologies of the hip joint were also examined. Outcome scores were evaluated using the International Hip Outcome Tool 12 (iHOT12) at pre- and post-intervention.Results: The mean iHOT12 score significantly improved from 44.0 to 73.5 in 4.7 months. The post-intervention iHOT12 scores were significantly higher than the pre-intervention scores at stages I (pre 51.0, post 74.4; P=0.004) and II (pre 44.8, post 81.2; P<0.001). However, there were no significant differences between the pre-intervention and post-intervention iHOT12 scores at stage III (pre 36.6, post 60.8; P=0.061). Furthermore, 7 patients (20.0%) had positive microinstability tests, and 22 (62.9%) had findings of extra-articular pathologies. Of 35 patients, 8 (22.9%) underwent surgical treatment after failure of conservative management, of whom 4 had Czerny stage III.Conclusions: Physiotherapy significantly improved the iHOT12 score of patients with acetabular labral tears in the short-term period. In patients with severe acetabular labral tear, improvement of clinical score by physiotherapy may be poor. Identifying the severity of acetabular labral tears can be useful in determining treatment strategies.
Preventing The Human Factor: Organisational Aspects Linked to Foetal Asphyxia.
Authors: AMADORI Roberta , GRANDIOSO Sara , OSELLA Elena , MELLUZZA Carmela , AQUINO Carmen Imma , STAMPINI Viviana , Pedrini Alberto De , TINELLI Raffaele , SURICO Daniela
Published: October 2020

Background: the aim of this study was to identify prepartum, intrapartum and organisational risk factors for foetal asphyxia. We focused on modifiable factors such as organisational factors, maternal Body Mass Index, Assisted Reproductive Technology pregnancies, smoking and number of clinical checks.Methods: This is a retrospective analytical observational study.It was carried out in a teaching hospital in Northern Italy. The data for this study was obtained from maternal and neonatal medical records,obstetric and neonatal hospital discharge summaries and birth assistance certificates.162 cases of mothers whose children experienced foetal asphyxia were compared to 162 controls where this condition did not occur. The different variables were analysed using the Fisher test, the Mann Whitney U test and logistic regression. The association probability was estimated by the odds ratio with a confidence interval of 95%. The alpha level of 0,05 was considered significant.Results: giving birth at night (p<0.001), lack of one to one assistance during labour (p <0.001), birth on a day of high volume activity(p<0.001), Assisted Reproductive Technology obtained pregnancies (p<0.001), number of clinical checks during pregnancy (p <0.001 ), smoking during pregnancy (p<0.001), high maternal body mass index (p<0.001 ), as well as other traditionally associated risk factors like shoulder distocia (p<0.001) or age>35 (p <0.001) all increased the risk in a statistically significant way.Conclusions: giving birth on a high activity day, at night or without one-to one care are organisational factors that statistically increase the risk of foetal asphxia.Our paper proposes strategies to try and modify these risk factors and therefore limit the incidence of foetal asphyxia and of its life changing consequences like cerebral palsy.
Association Between Media Use and Poor Sleep Quality Among Senior High School Students in Ratchaburi Province, Thailand: A Cross-Sectional Study
Authors: Chaveepojnkamjorn Wisit , Srik Jutiporn , Satitvipawee Pratana , Pitikultang Supachai , Khampeng Soontaree
Published: October 2020

Background: Poor sleep quality (PSQ) is an increasing health problem and adolescents also constitute risk groups. Portable mobile and media devices have become a part of children’s lives and may affect their sleep duration and quality. This study aimed to explore the prevalence of PSQ and identify the association between media use and PSQ among adolescents studying in high school grades 10-12.Methods: This cross-sectional study was conducted in Ratchaburi Province. A multi-stage sampling technique was used to enroll 777 adolescents from 8 schools from August-October 2016. The research instruments comprised factors of demographics and consumption behaviors and the questionnaire of Pittsburgh Sleep Quality Index. Multivariable logistic regression was used to calculate adjusted odds ratios (ORadj) and 95% Confidence Intervals (CI).Results: Prevalence of PSQ was 56.24%. The study subjects were mostly 16-17 years old (67.82%) and female (70.39%). Multivariable logistic regression, after controlling for possible confounders, there was an increased odds of PSQ in those who used a social media device (OR=1.34, 95%CI=0.97-1.87), and it showed a higher proportion of social media use among PSQ group.Conclusions: The surveillance system of media use and PSQ should be conducted accompanied by knowledge sharing on media use among parents, teachers and adolescents. To determine causal relationships, further longitudinal studies will be required to test for the association between media users and PSQ. This study may also provide some implications for health promotion on sleep quality of senior high school students.
Asthma-associated genetic variants induce IL33 differential expression through a novel regulatory region.
Authors: Aneas Ivy , Decker Donna , Howard Chanie , Sobreira Debora , Sakabe Noboru , Blaine Kelly , Stein Michelle , Hrusch Cara , Montefiori Lindsey , Tena Juan , Magnaye Kevin , Clay Selene , Gern James , Jackson Daniel , Altman Matthew , Naurekas Edward , Hogarth Douglas , White Steven , Gómez-Skarmeta José Luis , Schoettler Nathan , Ober Carole , Sperling Anne , Nobrega Marcelo
Published: October 2020

Genome-wide association studies (GWAS) have implicated the IL33 locus in asthma, but the underlying mechanisms remain unclear. Here, we identify a 5 kb region within the GWAS-defined segment that acts as a strong regulatory element in vivo and in vitro. Chromatin conformation capture showed that this 5 kb region loops to the IL33 promoter, potentially regulating its expression. We show that genotype at the asthma-associated SNP rs1888909, located within the 5 kb region, is associated with IL33 gene expression in human airway epithelial cells and IL-33 protein expression in human plasma, potentially through differential binding of OCT-1 (POU2F1) to the asthma-risk allele. Our data demonstrate that asthma-associated variants at the IL33 locus mediate allele-specific regulatory activity and IL33 expression, providing a novel mechanism through which a regulatory SNP contributes to genetic risk of asthma.
A Usability Study in Patients With Stroke Using MERLIN, a Robotic System Based on Serious Games for Upper Limb Rehabilitation in Home Setting
Authors: Guillén-Climent Silvia , Garzo Ainara , Muñoz-Alcaraz María Nieves , Casado-Adam Pablo , Ruiz-Ruano Javier Arcas , Mejías-Ruiz Manuela , Mayordomo-Riera Fernando Jesús
Published: October 2020

Background: Neuroscience and neurotechnology are changing stroke rehabilitation. Robotic devices as well as telerehabilitation have become of great interest and are increasingly being used to train the upper extremities after stroke. Its use in home settings allows to extend institutional rehabilitation by increasing and prolonging therapy. The aim of this study is to assess the usability of MERLIN robotic system based on serious games for the upper limb rehabilitation in stroke patients in a home environment.Methods: 12 participants with a stroke in three different stages of evolution (subacute, chronic of short evolution and long-term chronic) with impaired arm/hand function were recruited to use the MERLIN system for 3 weeks: one week of training at the Maimonides Biomedical Research Institute of Cordoba (IMIBIC), and 2 weeks at patients’ home. Evaluation of usability involved System Usability Scale (SUS), Adapted Intrinsic Motivation Inventory (IMI), Quebec User Evaluation of Satisfaction with assistive Technology (QUEST), and ArmAssist Usability Assessment Questionnaire which were evaluated post-intervention. Clinical outcomes on upper extremity motor function were assessed pre- and post-intervention.Results: Finally, 9 patients participated in the study, 3 drop-off due to the COVID-19. The usability assessment reported a high level of satisfaction: mean SUS score was 71.94 % (SD=16.38), mean QUEST scale was 3.81 (SD=0.38), and mean IMI score was 6.12 (SD=1.36). The results of the ArmAssist Questionnaire was an average of 6 out of 7, which indicates that MERLIN is easy to learn, easy to use and intuitive. Regarding clinical assessment, Fugl-Meyer scores showed moderated improvements from pre- to post-intervention in the total score of motor function (p = 0.002). There were no significative changes in Modified Ashworth scale outcomes (p = 0.169) Conclusions: This usability study indicates that home-based rehabilitation for upper limb with MERLIN system is safe, useful, feasible and motivating. The telerehabilitation suppose an important step towards an intensive rehabilitation to be bring to home.Trial registration: ClinicalTrials.gov, NCT04405609. Registered 06 January 2020 - Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT04405609
Benefit of Canagliflozin In Patients With Type 2 Diabetes After Hospitalization For Acute Heart Failure
Authors: Dorado Ernesto Martin , López-Aguilera José , González Rafael , Anguita Manuel , Gutiérrez Guillermo , Luque Aurora , Paredes Nick , Oneto Jesús , Perea Jorge , Castillo Juan Carlos
Published: October 2020

BACKGROUND: Heart failure (HF) is one of the mayor contributors to cardiovascular morbidity and mortality in patients with diabetes. Sodium-glucose cotransporter 2 (SGLT2) inhibitors have demonstrated to reduce the risk of hospitalization for HF in patients with type 2 diabetes mellitus. We aimed to compare the incidence of readmission in patients who received canagliflozin at discharge after hospitalization of acute HF and changes in N-terminal pro–B-type natriuretic peptide (NT-ProBNP) concentration during follow-up. METHODS: We retrospectively included 102 consecutive patients with diabetes discharged for acute heart failure and without contraindications for SGLT2 inhibitors. We divided them in two groups: 45 patients with canagliflozin at discharge therapy and 57 without any SGLT2 inhibitors.RESULTS: Over a median follow-up of 22 months, 45 (44.1%) were hospitalized for HF. Most of the patients who were readmitted due to heart failure occurred during the first year (37.3%). HF readmission at first year occurred in 10 patients (22.2%) in canagliflozin group and 29 patients (49.1%) in control group (HR: 0.45; 95% CI: 0.21–0.96; p < 0.039) after multivariate adjustment. A composite outcome of hospitalization for HF or death for cardiovascular causes was lower in canagliflozin group (37.8%) than in the control group (70.2%) (HR: 0.51; 95% CI: 0.27–0.95; p < 0.035). Analysis of NT-ProBNP concentration showed an interaction between canagliflozin therapy and follow-up time (p=0.002).CONCLUSIONS: Canagliflozin therapy at discharge was associated with lower risk of readmission for HF and a reduction of NT-ProBNP concentration in patients with diabetes after hospitalization for HF.
Multi-View 3D Skin Feature Recognition and Localization for Patient Tracking in Spinal Surgery Applications
Authors: Manni Francesca , Mamprin Marco , Holthuizen Ronald , Shan Caifeng , Burstöm Gustav , Elmi-Terander Adrian , Edström Erik , Zinger Svitlana , de With Peter H.N.
Published: October 2020

Background: Minimally invasive spine surgery is dependent on accurate navigation. Computer-assisted navigation is increasingly used in minimally invasive surgery (MIS), but current solutions require the use of reference markers in the surgical field for both patient and instruments tracking. Purpose: To improve reliability and facilitate clinical workflow, this study proposes a new marker-free tracking framework based on skin feature recognition. Methods: Maximally Stable Extremal Regions (MSER) and Speeded Up Robust Feature (SURF) algorithms are applied for skin feature detection. The proposed tracking framework is based on a multi-camera setup for obtaining multi-view acquisitions of the surgical area. Features can then be accurately detected using MSER and SURF and afterwards localized by triangulation. The triangulation error is used for assessing the localization quality in 3D. Results: The framework was tested on a cadaver dataset and in eight clinical cases. The detected features for the entire patient datasets were found to have an overall triangulation error of 0.207 mm for MSER and 0.204 mm for SURF. The localization accuracy was compared to a system with conventional markers, serving as a ground truth. An average accuracy of 0.627 and 0.622 mm was achieved for MSER and SURF, respectively. Conclusions: This study demonstrates that skin feature localization for patient tracking in a surgical setting is feasible. The technology shows promising results in terms of detected features and localization accuracy. In the future, the framework may be further improved by exploiting extended feature processing using modern optical imaging techniques for clinical applications where patient tracking is crucial.
An Acute Viral Hepatitis Epidemic: Does Ultrasound Help the Pediatrician?
Authors: Arooj Sadaf , Mukhtar Muhammad Umer , Abbas Farnaz
Published: October 2020

Objective: Acute viral hepatitis (AVH) caused by hepatitis virus A and hepatitis virus E is one of the many epidemics that plague third world countries like Pakistan. The serological tests required for the diagnosis of acute viral hepatitis may be unavailable or unaffordable to the denizens of a developing country like Pakistan. In such a scenario, the clinical manifestations and the ultrasonographic findings are the only diagnostic criteria usually present and these can be used to support a clinical diagnosis. This study aims to judge the utility of ultrasound in the diagnosis of AVH. Results:Among the forty-seven subjects of this study, gall bladder wall thickening (GWT) was the most common radiological finding seen in 39(82.9%) patients. Pericholecystic edema was the second most common finding, seen in 31(65.9%) patients. Starry sky appearance of the liver was observed in 30(63.8) patients. Hepatomegaly and ascites were seen in 28(59.5%) and 25(53.2%) of the patients, respectively. The ultrasonographic findings of GWT, pericholecystic edema, and starry sky appearance of the liver were the most common ultrasonographic findings associated with AVH.
Effect of Emergency Contraceptive Pill Use on Condom Utilization Among University Students in Nekemte Town, Western Ethiopia: A Cross-Sectional Study
Authors: Genemo Edao Sado , Korsa Ayana Tadesse , Bayisa Habte Gebeyehu
Published: October 2020

Background: Emergency contraceptive pill (ECP) is a type of hormonal contraceptives which prevents unplanned pregnancy, but not sexually transmitted infections (STIs). Besides, its impact on condom utilization is not known among female university students in Nekemte town. Thus, this study was aimed to assess the awareness and attitude of university students on the use of ECP and its impact on condom utilization. Methods: An institution-based cross-sectional study was conducted on 400 female students in three private universities in Nekemte town from February 1 to 29, 2016. A simple random sampling, after proportional size allocation to respective study settings, was used to select student participants. Among the 400 randomly selected participants, 381 have completed and returned the questionnaire with 95.25% response rate. Data were collected by using self-administered questionnaire and entered into EpiData 3.1, and analyzed by using SPSS version 20. Bivariate and multivariate analysis were performed to determine the effects of ECP use on condom utilization with statistical significance set at P-value < 0.05. Results: Nearly half (48.8%) of the students indicated that they had sexual intercourse before and heard of ECP. Moreover, 30% of the respondents reported that they used ECP. Majority (61.7%) showed willingness to use ECP. Furthermore, students who used ECP were 3 times less likely to use condoms when compared to those who never used ECP (AOR = 0.322, 95% CI 0.164, 0.632). Alternatively, students who believed ECP does not prevent STIs were 2 times more likely to use condoms when compared to those who believed ECP does prevent STIs (AOR= 2.217 95% CI 1.070, 4.593). Conclusions: our findings identified that most students lack knowledge of ECP while having positive attitude on its use. On the other hand, ECP use imposes negative impact on condom utilization so that female students could be exposed to risky STIs.
CRISPR/Cas9-Mediated Whole Genomic Wide Knockout Screening Identifies Specific Genes Related to Mineral Absorption Involving in PM2.5 Liver Toxicity
Authors: Peng Jinfu , Yi Bin , Wang Mengyao , Tan Jieqiong , Huang Zhijun
Published: October 2020

Background: PM2.5 , also known as fine particles, refers to particulate matter with a dynamic diameter of ≦ 2.5 µm in air pollutants, carrying toxic substances (e.g. heavy metals or minerals), which can pass through the alveolar epithelium and enter the bloodstream and tissues, can have more serious health problems, such as non-alcoholic fatty liver and hepatocellular carcinoma. However, the underlying mechanisms for toxic effect of PM2.5 are poorly understood. Results: Here, we subjected L02 cells to expose of PM2.5 and performed a pooled genome‐wide CRISPR (clustered regularly interspaced short palindromic repeats)/Cas9 (CRISPR-associated protein 9) loss of function screen to discover new potential targets for PM2.5. Enrichr and KEGG were employed to identify candidate genes which might involve in PM2.5 toxicity. We found that ATP1A2(ATPase Na+/K+ transporting subunit alpha 2), MT1M(metallothionein 1M), SLC6A19(solute carrier family 6 member 19) and TRPV6(transient receptor potential cation channel subfamily V member 6) genes contributed to PM2.5 toxicity involving in mineral absorption pathway. Moreover, we demonstrated that these candidate genes deficiency increased the cell viability and attenuated apoptosis in cells explored to PM2.5. Conclusions: ATP1A2, MT1M, SLC6A19 and TRPV6 contribute to PM2.5 toxicity and may be potential therapeutic targets for PM2.5 related diseases.
Breastfeeding Counseling Based on Formative Research at Primary Healthcare Services in Mexico.
Authors: Bueno-Gutiérrez Diana , Castillo Edgar Uriel Romero , Mondragón Angélica Emili Hernández
Published: October 2020

Breastfeeding rates in Mexico are among the lowest in Latin America with 14.4% for Exclusive Breastfeeding (EBF) under six months of age. It has been reported that rates has been decreasing among low-income and vulnerable population, where there is lack of healthcare assistance. Culturally appropriate counseling based on formative research has shown to be effective in improving breastfeeding. Our objective was to evaluate the effect of interpersonal counseling on EBF in a primary healthcare center in Tijuana, México. MethodsThis was a randomized controlled trial pilot with a sample of mothers with infants under 4 months of age from a Primary Care Center. Participants were randomized to a 1) Control Group, receiving counseling about immunizations as well as routine infant feeding information, and 2) Intervention Group, receiving breastfeeding counseling based on previous formative research using a socio-ecological framework. Changes in breastfeeding attitudes, self-efficacy and EBF at 2 months post-intervention were evaluated.ResultsEighty mothers were included in the study (40 in each group). The mean age was 26.4 years for mothers and 1.4 months for infants. Breastfeeding obstacles reported were breastfeeding in public discomfort (23%), infant unsatisfied (23%), pain (19%), insufficient milk (15%) and returning to work (8%). We observed a significant improvement in breastfeeding attitudes (P=0.0001), self-efficacy (P=0.018) and EBF (P=0.001). There was a 30% increase in EBF in the intervention group and 15% decrease in the control group post-intervention.ConclusionsBreastfeeding counseling based on formative research improved breastfeeding attitudes, self-efficacy and practices in this population. Breastfeeding should be promoted by well-trained health professionals with knowledge and skills to clearly communicate breastfeeding messages, and sensitivity to address women’s needs according to their sociocultural context. Since breastfeeding responds to health systems and socio-economic and cultural environments in which the mother lives; development and evaluation of programs to increase breastfeeding rates in low- and middle-income countries are necessary. Trial Registration ANZCTR ID: 380462 (Under review). Retrospectively registered.
Thirty-Day Readmission Rates After Takotsubo Syndrome With or Without Malignancy: A Nationwide Readmissions Database Analysis
Authors: Jang Sun-Joo , Yeo Ilhwan , Jonas Chanel , Goyal Parag , Cheung Jim W. , Feldman Dmitriy N. , McCullough S. Andrew , Krishnan Udhay , Narotsky David L. , Singh Harsimran S. , Minutello Robert M. , Bergman Geoffrey , Wong S. Chiu , Kim Luke K.
Published: October 2020

Background: Association of malignancy with readmission after TTS hospitalization has not been fully described. We sought to examine the rates, cause and cost of 30-day readmissions and 30-day all-cause mortality of Takotsubo syndrome (TTS) patients with or without malignancy. Methods: The Nationwide Readmissions Databases from 2010 to 2014 were queried to identify and compare baseline characteristics and outcomes of patients hospitalized for TTS with and without malignancy. Results: We identified 61,588 index hospitalizations for TTS. TTS patients with malignancy were older (70.6 ± 0.2 vs. 66.1 ± 0.1, p < 0.001), and the overall burden of comorbidities was higher than in those without malignancy. TTS patients with malignancy had significantly higher 30-day readmission rates than those without malignancy (15.9% vs. 11.0%; odds ratio [OR], 1.35; 95% confidence interval [CI], 1.18 - 1.56). Majority (75.5%) of the etiologies for readmissions were non-cardiac, with infection being most common (20.1%). The 30-day readmission rate due to the recurrent TTS was similar in both groups (0.4% and 0.5%, respectively; p = 0.47). Importantly, 30-day all-cause mortality was higher in TTS with vs. without malignancy (4.8% vs 2.5%; OR, 1.62; 95% CI, 1.25 - 2.10). The total costs (index admission + readmission) were higher by 25% (p < 0.001) in TTS patients with malignancy vs. without malignancy. Conclusions: In patients hospitalized with TTS, the presence of malignancy was associated with increased risk of 30-day readmission, mostly attributable to non-cardiac etiologies. Importantly, the 30-day all-cause mortality and cost were also significantly higher. These findings highlight the importance of optimization of treatment and follow up in patients with malignancy after hospitalizations for TTS.
Divide and Conquer: Clustering Patients With Autism by Gene Expression Profiles Using Machine Learning Algorithms
Authors: Lin Ping-I , Moni Mohammad Ali , Eapen Valsamma , Gau Susan Shur-Fen
Published: October 2020

BackgroundClinical heterogeneity in autism spectrum disorder (ASD) can complicate diagnostics and treatments. The identification of biomarkers may hold the key to the classification of ASD subgroups. Accumulating evidence suggests that genetic or genomic markers may facilitate the clustering of patients with ASD. The goal of the current study is to use machine learning algorithms to analyze microarray data to identify clusters with relatively homogeneous clinical features, such as language function.MethodsThe whole-genome gene expression microarray data were used to predict communication quotient (SCQ) scores against all probes to select differential expression regions (DERs). Gene set enrichment analysis was performed to identify hub pathways that play a role in the severity of social communication deficits inherent to ASD. We then used two machine learning methods, random forest classification (RF) combined with partition around medoids (PAM) and support vector machine (SVM), to identify two clusters using DERs. Finally, we evaluated how accurately the clusters predicted language impairment.ResultsA total of 191 DERs were identified. Cholesterol biosynthesis and metabolisms pathways appear to act as hubs that connect other trait-associated pathways to influence the severity of social communication deficits inherent to ASD. Both RF and SVM algorithms can yield a classification accuracy level greater than 90% when all 191 DERs were analyzed. LimitationsThe primary limitation of the current study is the small sample size. Nevertheless, some machine learning algorithm, such as SVM, can handle a small sample with a large number of features. Additionally, model overfitting may arise due to a lack of another independent sample for validation. Furthermore, unknown confounders may cause spurious associations between the phenotype and genomic markers. ConclusionsThe ASD subtypes defined by the presence of language impairment, a strong indicator for prognosis, can be predicted by transcriptomic profiles associated with social communication deficits and cholesterol biosynthesis and metabolism. Our proof-of-concept study suggests that both RF and SVM are acceptable options for machine learning algorithms to identify AD subgroups characterized by clinical homogeneity related to prognosis.