bluuebunny/crossref_metadata_2025 huggingface dataset:
Quantitative Analysis of Hypervascular Hepatic Metastases and Hepatocellular Carcinoma using Spectral CT Imaging
Authors: Yang Zhiqiang , Wang Xinyi , Shi Hao
Published: May 2020

Background The goal of this study is to evaluate the performance of spectral CT-based quantitative analysis in differential diagnosis of hypervascular hepatic metastasis (HVHM) and hepatocellular carcinoma (HCC). Methods Spectral CT scans were performed for 47 patients with hepatic malignant tumors, including 20 patients with HVHM and 27 patients with HCC, which generated the following sets of data: single energy images in the arterial phase; iodine and water maps; marginal areas of lesions that manifested apparent signal intensification; and energy spectral parameters of normal liver tissues and abdominal aorta. Subsequently, we calculated the normalized iodine concentrations (NIC), lesion-normal parenchyma iodine concentration ratio (LNR), iodine concentration difference (ICD) between the arterial phase and the venous phase, and the spectral curve slope. An independent samples t test and receiver operating characteristic (ROC) curve analysis were applied to examine these quantitative parameters. Results In the arterial phase, the HVHM and HCC groups displayed no differences in NIC, LNR, or spectral curve slope ( P > 0.05). In the venous phase, the two groups displayed significant differences in NIC, LNR, and spectral curve slope; the NIC was 0.59 ± 0.08 for the HVHM group and 0.4 5 ± 0.10 for the HCC group; the LNR was 1.17 ± 0.22 and 0.92 ± 0.16, respectively; the spectral curve slope was 1.85 ± 0.49 and 1.18 ± 0.34, respectively. In addition, there was no significant difference in ICD between the HVHM group (0.54 ± 0.39 g/L) and HCC group (0.45 ± 0.39 g/L) ( P > 0.05). Finally, there were no significant differences of water or iodine concentration between the arterial phase and venous phase ( P > 0.05). Taken together, the spectral curve slope in the portal venous phase had the best performance in differentiating HVHM from HCC. Conclusions HVHM and HCC have apparent differences in spectral curve and concentrations of radiocontrast agents in the portal venous phase. Hence, spectral CT imaging provides a new multiparameter quantitative approach for differentiating HVHM and HCC.
High-throughput three-dimensional visualization of root system architecture of rice using X-ray computed tomography
Authors: Teramoto Shota , Takayasu Satoko , Kitomi Yuka , Arai-Sanoh Yumiko , Tanabata Takanari , Uga Yusaku
Published: May 2020

Background: X-ray computed tomography (CT) allows us to visualize root system architecture (RSA) beneath the soil, non-destructively and in a three-dimensional (3-D) form. However, CT scanning, reconstruction processes, and root isolation from X-ray CT volumes, take considerable time. For genetic analyses, such as quantitative trait locus mapping, which require a large population size, a high-throughput RSA visualization method is required.Results: We have developed a high-throughput process flow for the 3-D visualization of rice (Oryza sativa) RSA (consisting of radicle and crown roots), using X-ray CT. The process flow includes use of a uniform particle size, calcined clay to reduce the possibility of visualizing non-root segments, use of a higher tube voltage and current in the X-ray CT scanning to increase root-to-soil contrast, and use of a 3-D median filter and edge detection algorithm to isolate root segments. Using high-performance computing technology, this analysis flow requires only 10 min (33 s, if a rough image is acceptable) for CT scanning and reconstruction, and 2 min for image processing, to visualize rice RSA. This reduced time allowed us to conduct the genetic analysis associated with 3-D RSA phenotyping. In 2-week-old seedlings, 85% and 100% of radicle and crown roots were detected, when 16 cm and 20 cm diameter pots were used, respectively. The X-ray dose per scan was estimated at < 0.09 Gy, which did not impede rice growth. Using the developed process flow, we were able to follow daily RSA development, i.e., 4-D RSA development, of an upland rice variety, over three weeks. Conclusions: We developed a high-throughput process flow for 3-D rice RSA visualization by X-ray CT. The X-ray dose assay on plant growth has shown that this methodology could be applicable for 4-D RSA phenotyping. We named the RSA visualization method ‘RSAvis3D’ and are confident that it represents a potentially efficient application for 3-D RSA phenotyping of various plant species.
Validation of the 7-item Knee Replacement Patient Education Questionnaire (KR-PEQ-7) from the 16-item Knee Osteoarthritis Patient Education Questionnaire (KOPEQ) by comparison of two measures
Authors: Huber Erika Omega , Boger Axel , Meichtry André , Bastiaenen Caroline H.
Published: May 2020

Background: The aim of this study was to investigate the content validity, construct validity and internal consistency of an existing 16-item Knee Osteoarthritis Patient Education Questionnaire. Participants were patients with severe knee osteoarthritis who, prior to undergoing a knee replacement operation, participated routinely in a preoperative educational intervention. A mixed method design was used. Methods: The first step was directed at a reduction in the number of items on the 16-item Knee Osteoarthritis Patient Education Questionnaire. Based on a priori hypotheses, this was followed by a cross-sectional validation study, performed to compare the resulting 7-item Knee Replacement Patient Education Questionnaire to a patient-testing Interview Protocol that was tailored to the same patient educational material. Additionally, the revised questionnaire was correlated with both the Short Test of Functional Health Literacy and the Mini-Mental State Examination score. Results: A relatively high internal consistency was found for the 7-item Knee Replacement Patient Education Questionnaire, with a Cronbach’s alpha of 0.84 (SE: 0.036). Explanatory factor analysis showed no evidence against a one-factor model, with the first and second eigenvalues being 3.8 and 0.31, respectively. Bayesian Estimation of the correlation between the 7-item Knee Replacement Patient Education Questionnaire and the Interview Protocol was 0.78 (mode) (95% HPD 0.58 – 0.89). Conclusions: To more accurately reflect the content of the included items following validation, the title of the questionnaire was changed to 7-item Knee Replacement Patient Education Questionnaire. It shows good psychometric properties and could provide valuable support to health professionals. It can provide valid feedback on how patients waiting for a knee replacement operation experience an applied patient education intervention. Further investigation is needed to assess the applicability of the 7-item Knee Replacement Patient Education Questionnaire to larger samples in different hospitals and countries.
Results of Caring and Reaching for Health (CARE): A Cluster-Randomized Controlled Trial Assessing a Worksite Wellness Intervention for Child Care Staff
Authors: Linnan Laura A , Vaughn Amber E , Smith Falon , Westgate Philip , Hales Derek , Arandia Gabriela , Neshteruk Cody , Willis Erik , Ward Dianne S.
Published: May 2020

Background: Child care workers are among the lowest paid US workers and experience a wide array of health concerns. The physical and mental demands of their job and the lack of employer-provided health-insurance increase health risks. The Caring and Reaching for Health (CARE) study evaluated a 6-month Healthy Lifestyles intervention targeting child care workers’ physical activity (primary outcome), other health behaviors, and their workplace health environment. Methods: Eligible child care centers, defined as being in operation for at least two years and employing at least four staff, were enrolled into CARE’s cluster-randomized trial. Centers and their child care staff were randomly assigned to either the Healthy Lifestyles (HL) intervention arm or the Healthy Finances (HF) attention control arm using a block randomization approach. Intervention components were delivered through in-person workshops, center-level displays, informational magazines, director coaching, electronic messaging, and an interactive website. Outcome measures were collected during center visits at baseline and immediately post-intervention by trained data collectors blinded to center arm assignment. Workers’ physical activity was assessed with accelerometers, worn for seven days. Secondary outcome measures included biometric assessments of health and fitness, web-based surveys about health behaviors, and an environmental audit of workplace supports for health. Multi-level linear mixed models assessed worker- and center-level changes in these outcomes. Results: Participants included 553 child care workers representing 56 centers (HL=250 staff/28 centers, HF=303 staff/28 centers). At six months, moderate-to-vigorous physical activity declined slightly in both arms (-1.3 minutes/day, 95% CI: -3.0, 0.3 in HL; -1.9 minutes/day, 95% CI: -3.3, -0.5 in HF), but there was no significant group by time interaction. Several secondary outcomes for other health behaviors and workplace health environment showed improvements in favor of the intervention arm, yet differences did not remain statistically significant after adjustment for multiple comparisons. Conclusions: While the Healthy Lifestyles intervention did not improve health behaviors or the workplace health environment, results confirmed the pressing need to focus on the health of child care workers. Future interventions should focus on prevalent health issues (e.g., weight, stress), include both high-tech and high-touch intervention strategies, and address work conditions or other social determinants of health (e.g. wages) as a means of improving the health of these essential workers. Trial Registration: Care2BWell: Worksite Wellness for Child Care (NCT02381938)
Risk Factors of Malnutrition in Chinese Children with Congenital Heart Defect
Authors: Zhang Mingjie , Wang Liping , Huang Rui , Sun Chongrui , Bao Nan , Xu Zhuoming
Published: May 2020

Background: The study aimed to investigate the risk factors of malnutrition in children with congenital heart defect (CHD) in China. Methods: This cohort study was performed at the biggest pediatric heart center in China; 3252 patients with CHD who underwent cardiac surgeries in 2013 were included. Anthropometric measurements included weight for age Z score (WAZ), weight for height Z score (WHZ), and height for age Z score (HAZ). The patients were classified as normal nutritional status and malnutrition, based on a cut-off Z score of <-2. Factors associated with malnutrition were determined using logistic regression analysis. Results: The prevalence of preoperative WAZ <-2 (underweight), HAZ <-2 (stunting), and WHZ<-2 (wasting) was 23.3%, 23.3%, and 14.3%, respectively. The multivariable analysis of preoperative malnutrition showed that hospitalization, age at surgery, risk adjustment for congenital heart surgery-1 >3, mechanical ventilation, pulmonary hypertension, and acyanotic heart disease were associated with underweight. Parents’ height, single ventricle, and cyanotic heart disease were associated with stunting. Hospitalization and pulmonary hypertension were associated with wasting. After surgery, the patients presented a significant improvement in growth within the first year in all three parameters and grew to the normal range of WAZ (-0.3±0.9, P<0.001), HAZ (0.2±0.8, P=0.001), and WHZ (0.03±0.6, P<0.001) at two years after surgery. The prevalence of underweight, stunted, and wasting declined to 3.2%, 2.7%, and 1.9% three years after surgery. Malnutrition after surgery was associated with cardiac residual cardiac abnormalities (OR=35.3, p<0.0001), high Ross classiﬁcation of heart function (OR=27.1, p<0.0001), and long-term taking oral diuretics (OR=20.5, P=0.001).Conclusions: Malnutrition is still a problem in children with CHD in China, especially before the surgery. There is need to strengthen the nutrition support for children with CHD before surgery. Hemodynamic factors were found to be the risk factors associated with malnutrition after operation.
M1 macrophage features in severe Plasmodium falciparum malaria patients with pulmonary oedema
Authors: Klinkhamhom Aekkarin , Glaharn Supattra , Sris Charit , Ampawong Sumate , Krudsood Srivicha , Ward Stephen A. , Viriyavejakul Parnpen
Published: May 2020

Background Pulmonary oedema (PE) is a serious complication of Plasmodium falciparum malaria which can lead to acute lung injury in severe cases. Lung macrophages are activated during malaria infection due to a complex host-immune response. The molecular basis for macrophage polarization is still unclear but understanding the predominant subtypes could lead to new therapeutic strategies where the diseases present with lung involvement. The present study was designed to study the polarization of lung macrophages, as M1 or M2 macrophages, in the lungs of severe P. falciparum malaria patients, with and without evidence of PE.Methods Lung tissue samples, taken from patients who died from severe P. falciparum malaria, were categorized into severe malaria with PE and without PE (non-PE). Expression of surface markers (CD68+, all macrophages; CD40+, M1 macrophage; and CD163+, M2 macrophage) on activated lung macrophages was used to quantify M1/M2 macrophage subtypes.Results Lung injury was demonstrated in malaria patients with PE. The expression of CD40 (M1 macrophage) was prominent in the group of severe P. falciparum malaria patients with PE (63.44±1.98%), compared to non-PE group (53.22±3.85%, p < 0.05), whereas there was no difference observed for CD163 (M2 macrophage) between PE and non-PE groups.Conclusions The study demonstrates M1 polarization in lung tissues from severe P. falciparum malaria infections with PE. Understanding the nature of macrophage characterization in malaria infection may provide new insights into therapeutic approaches that could be deployed to reduce lung damage in severe P. falciparum malaria.
Sentiment Analysis of Online Product Reviews Using DLMNN and Future Prediction of Online Product Using IANFIS
Authors: p Sasikala , Sheela Mary Immaculate
Published: May 2020

A major task that the NLP (Natural Language Processing) has to follow is Sentiments analysis (SA) or opinions mining (OM). For finding whether the user's attitude is positive, neutral or negative, it captures each user's opinion, belief, and feelings about the corresponding product. Through this, needed changes can well be done on the product for better customer contentment by the companies. Most of the existent techniques on SA aimed at these online products have extremely low accuracy and also encompassed more time amid training. By employing a Deep learning modified neural network (DLMNN), a technique is proposed aimed at SA of online products review; in addition, via Improved Adaptive Neuro-Fuzzy Inferences System (IANFIS), a technique is proposed aimed at future prediction of online products to trounce the above-stated issues. Firstly, the data values are separated into Contents-based (CB), Grades-based (GB), along with Collaborations based (CLB) setting as of the dataset. Then, each setting goes via review analysis (RA) by employing DLMNN, which renders the results as negative, positive, in addition to neutral reviews. IANFIS carry out a weighting factor and classification on the product for upcoming prediction. In the experimental assessment, the proposed work gave an enhanced performance compared to the existing methods.
Validity, reliability and feasibility of a new observation rating tool and a post encounter rating tool for the assessment of clinical reasoning skills of medical students during their internal medicine clerkship. A pilot study.
Authors: Haring Catharina Maria , Klaarwater Claudia , Bouwmans Geert , Cools Bernadette , Gurp Petra van , Meer Jos van der , Postma Cornelis
Published: May 2020

Background Systematic assessment of clinical reasoning skills of medical students in clinical practice is very difficult. This is partly caused by the lack of understanding of the fundamental mechanisms underlying the process of clinical reasoning. Methods We previously developed an observation tool to assess the clinical reasoning skills of medical students during clinical practice. This observation tool consists of an 11-item observation rating form (ORT). In the present study we verified the validity, reliability and feasibility of this tool and of an already existing post-encounter rating tool (PERT) in clinical practice among medical students during the internal medicine clerkshipResults Six raters each assessed the same 15 student-patient encounters. The internal consistency (Cronbach’s alfa) for the (ORT) was 0.87 (0.71-0.84) and the 5-item (PERT) was 0.81 (0.71-0.87). The intraclass-correlation coefficient for single measurements was poor for both the ORT; 0.32 (p<0.001) as well as the PERT; 0.36 (p<0.001). The Generalizability study (G-study) and decision study (D-study) showed that 6 raters are required to achieve a G-coefficient of > 0.7 for the ORT and 7 raters for the PERT. The largest sources of variance are the interaction between raters and students. There was a consistent correlation between the ORT and PERT of 0.53 (p=0.04)Conclusions The ORT and PERT are both feasible, valid and reliable instruments to assess students’ clinical reasoning skills in clinical practice.
Oil supplementation with a special combination of n-3 and n-6 long-chain polyunsaturated fatty acids does not protect for exercise induced asthma. A double-blind placebo-controlled trial.
Authors: Dreßler Melanie , Fussbroich Daniela , Böhler Lisa , Herrmann Eva , Benker Nicole , Tytyk Markus , Schulze Johannes , Schubert Ralf , Beermann Christopher , Zielen Stefan
Published: May 2020

Background Many patients suffering from exercise-induced asthma (EIA) have normal lung function at rest and show symptoms and a decline in FEV 1 when they do sports or during exercise-challenge. It has been described that long-chain polyunsaturated fatty acids (LCPUFA) could exert a protective effect on EIA. Methods In this study the protective effect of supplementation with a special combination of n-3 and n-6 LCPUFA (sc-LCPUFA) (total 1.19 g/ day) were investigated in an EIA cold air provocation model. Primary outcome measure: Decrease in FEV 1 after exercise challenge and secondary outcome measure: anti-inflammatory effects monitored by exhaled NO (eNO) before and after sc-LCPUFA supplementation versus placebo. Results 99 patients with exercise-induced symptoms aged 10 to 45 were screened by a standardized exercise challenge in a cold air chamber at 4 °C. 73 patients fulfilled the inclusion criteria of a FEV 1 decrease >15% and were treated double-blind placebo-controlled for four weeks either with sc-LCPUFA or placebo. 32 patients in each group completed the study. Mean FEV 1 decrease after cold air exercise challenge and eNO were unchanged after four weeks sc-LCPUFA supplementation. Conclusion Supplementation with sc-LCPUFA at a dose of 1.19 g/d did not have any broncho-protective ant anti-inflammatory effects on EIA.
Unraveling the Molecular Heterogeneity in type 2 Diabetes: A Potential Subtype Discovery Study Followed by Metabolic Modeling
Authors: Khoshnejat Maryam , Kavousi Kaveh , Moghaddam Ali Mohammad Banaei , Moosavi-Movahedi Ali Akbar
Published: May 2020

Background: Type 2 diabetes mellitus (T2DM) is a complex multifactorial disease with a high prevalence in the world. Insulin resistance and impaired insulin secretion are the two major abnormalities in the pathogenesis of T2DM. Skeletal muscle is responsible for over 75% of the glucose uptake, thus plays a critical role in T2DM. Here, we attempt to provide a better understanding of abnormalities in this tissue. Methods: We have explored the muscle gene expression pattern in healthy and newly-diagnosed T2DM individuals using supervised and unsupervised classification along with examining the potential of sub-typing based on the gene expression pattern in patients.Results: A machine-learning technique applied to identify a pattern of gene expression that could potentially discriminates between normoglycemic and diabetic groups. A gene set comprises of 26 genes identified which was able to discriminate healthy from diabetic individuals with the 94% accuracy after 10-fold stratified cross-validation. In addition, three distinct clusters with different dysregulated genes and metabolic pathways identified in diabetic patients. Conclusion : This study implies that it seems the disease has triggered through different cellular/molecular mechanisms and it has the potential to be sub-typing. Possibly, subtyping of T2DM patients in combination with their real clinical profiles will provide a better understanding of abnormalities in each group and lead to the recommendation of the appropriate precision therapy for each subtype in the future.
Slc6a3-dependent expression of a CAPS-associated Nlrp3 allele results in progressive behavioral abnormalities and neuroinflammation in aging mice
Authors: von Herrmann Katharine M , Anderson Faith L , Martinez Eileen M , Young Alison L , Havrda Matthew C
Published: May 2020

Background : An association between neuroinflammation and age-related neurologic disorders has been established but the molecular mechanisms and cell types involved have not been thoroughly characterized. Activity of the proinflammatory NLRP3 inflammasome is implicated in Alzheimer’s and Parkinson’s disease and our recent studies in patients suggest that dopaminergic neurons within the degenerating mesencephalon express NLRP3 throughout the progression of PD. Here, we directly test the impact of enhanced inflammasome activity in mesencephalic neurons by characterizing motor function, tissue integrity, and neuroinflammation in aging mice harboring hyper-activating mutations within the endogenous murine Nlrp3 locus, enabled only in cells expressing the dopaminergic neuron specific Slc6a3 promoter. Methods: We compared mice harboring inducible alleles encoding the cryopyrin-associated periodic syndrome activating mutations Nlrp3A350V and Nlrp3L351P inserted into the endogenous mouse Nlrp3 locus. Tissue specific expression was driven by breeding these animals with mice expressing Cre recombinase under the control of the dopaminergic neuron specific Slc6a3 promoter. The experimental mice, designed to express hyperactive NLRP3 only when the endogenous mouse Nlrp3 promotor is active in dopaminergic neurons, were analyzed throughout 18 months of aging using longitudinal motor function assessments. Biochemical and histologic analyses of mesencephalic tissues were conducted in 1- and 18-month old animals.Results : We observed progressive and significant deficits in motor function in animals expressing Nlrp3L351P, compared with animals expressing Nlrp3WT and Nlrp3A350V. Age-dependent neuroinflammatory changes in the mesencephalon were noted in all animals. Analysis of GFAP-immunoreactive astrocytes in the substantia nigra revealed a significant increase in astrocyte number in animals expressing Nlrp3L351P compared with Nlrp3WT and Nlrp3A350V. Further analysis of Nlrp3L351P striatal tissues indicated genotype specific gliosis, elevated Il1b expression, and both morphologic and gene expression indicators of proinflammatory A1 astrocytes.Conclusions : Dopaminergic neurons have the potential to accumulate NLRP3 inflammasome activators with age, including reactive oxygen species, dopamine metabolites, and misfolded proteins. Results indicate the Nlrp3 locus is active in dopaminergic neurons in aging mice, and that the hyperactive Nlrp3L351P allele can drive neuroinflammatory changes in association with progressive behavioral deficits. Findings suggest neuronal NLRP3 inflammasome activity may contribute to neuroinflammation observed during normal aging and the progression of neurologic disorders.
Primary outcome reporting in adolescent depression clinical trials needs standardization
Authors: Monsour Andrea , Mew Emma J. , Patel Sagar , Chee-a-tow Alyssandra , Saeed Leena , Santos Lucia , Courtney Darren , Watson Priya N. , Monga Suneeta , Szatmari Peter , Offringa Martin , Butcher Nancy J.
Published: May 2020

Background: Evidence-based health care is informed by results of randomized clinical trials (RCTs) and their syntheses in meta-analyses. When the trial outcomes measured are not clearly described in trial publications, knowledge synthesis, translation, and decision-making may be impeded. While heterogeneity in outcomes measured in adolescent major depressive disorder (MDD) RCTs has been described, the comprehensiveness of outcome reporting is unknown. This study aimed to assess the reporting of primary outcomes in RCTs evaluating treatments for adolescent MDD. Methods: RCTs evaluating treatment interventions in adolescents with a diagnosis of MDD published between 2008 and 2017 specifying a single primary outcome were eligible for outcome reporting assessment. Outcome reporting assessment was done independently in duplicate using a comprehensive checklist of 58 reporting items. Primary outcome information provided in each RCT publication was scored as “fully reported”, “partially reported”, or “not reported” for each checklist item, as applicable. Results: Eighteen of 42 identified articles were found to have a discernable single primary outcome and were included for outcome reporting assessment. Most trials (72%) did not fully report on over half of the 58 checklist items. Items describing masking of outcome assessors, timing and frequency of outcome assessment, and outcome analyses were fully reported in over 70% of trials. Items less frequently reported included outcome measurement instrument properties (ranging from 6-17%), justification of timing and frequency of outcome assessment (6%), and justification of criteria used for clinically significant differences (17%). The overall comprehensiveness of reporting appeared stable over time. Conclusions: Heterogeneous reporting exists in published adolescent MDD RCTs, with frequent omissions of key details about their primary outcomes. These omissions may impair interpretability, replicability, and synthesis of RCTs that inform clinical guidelines and decision-making in this field. Consensus on the minimal criteria for outcome reporting in adolescent MDD RCTs is needed. Trial registration: Not applicable
A cross-sectional study on caregivers’ perspective of the quality of life and adherence of paediatric HIV patients to Highly Active Antiretroviral Therapy
Authors: Lahai Michael , James Peter Bai. , Wannang Noel N. , Wurie Haja R. , Conteh Sorie , Bah Abdulai Jawo , Samai Mohamed H
Published: May 2020

Background: Poor compliance to highly active antiretroviral therapy (HAART) can result in the poor quality of life in children living with HIV/AIDS because of low plasma drug concentration and the possibility of drug resistance. This study evaluates the response of caregivers for determination of adherence and the four quality of life domains in children (aged 14 years and under) on HAART.Methods: We conducted a cross-sectional study of 188 children, each accompanied by their caregivers at Ola During Children's Hospital and Makeni Government Hospital between September and November 2016. Adherence to HAART and Quality of life was assessed using the WHO Quality of life summary questionnaire (WHOQOL-BREF). We obtained ethical approval from the Sierra Leone Ethics and Scientific Review Committee. Results: The study revealed 5.9% adherence amongst paediatric patients, and a strong association of adherent patients(p=0.019*) to the physical health domain (mean=64.61 SD=8.1).Caregiver HIV status showed a strong association with the physical (mean=58.3, SD=11.7 and p=0.024*), and psychological health domains (mean=68.2, SD=14.7 and p=0.001). Caregiver type (mother/father/sibling) accompanying child to hospital also showed strong associated with the physical (mean=58.0, SD=10.6, p <0.001), psychological (mean 68.2 SD=14.81 p <0.001) and environmental health domains (mean=59.7, SD=13.47, p <0.001). Further regression analysis showed a strong association with physical health domain for HIV positive caregivers (p=0.014) and adherent paediatric patients (p=0.005). Nuclear family also showed a strong association with psychological (p<0.001) and environmental (p=0.001) health domains. Conclusion: This study showed a strong association between the quality of life domains and the involvement of nuclear family caregiver, HIV-positive caregiver and adherence to HAART. Our study suggests that the involvement of any member of the nuclear family, HIV positive parents and patient adherence to therapy can improve the quality of life of paediatric HIV/AIDS patients on highly active antiretroviral therapy in the two hospitals.
A Cost-of-Illness analysis of β-Thalassaemia major in children in Sri Lanka – Experience from a tertiary level teaching hospital
Authors: Reed-Embleton Hamish , Arambepola Savinda , Dixon Simon , Maldonado Behrouz Nezafat , Premawardhena Anuja , Arambepola Mahinda , Khan Jahangir A. M. , Allen Stephen
Published: May 2020

Background: Sri Lanka has a high prevalence of b-thalassaemia major. Clinical management is complex and long-term and includes regular blood transfusion and iron chelation therapy. The economic burden of β-thalassaemia for the Sri Lankan healthcare system and households is currently unknown.Methods: A prevalence-based, cost-of-illness study was conducted on the Thalassaemia Unit, Department of Paediatrics, Kandy Teaching Hospital, Sri Lanka. Data were collected from clinical records, consultations with the head of the blood bank and a consultant paediatrician directly involved with the care of patients, alongside structured interviews with families to gather data on the personal costs incurred such as those for travel. Results: Thirty-four children aged 2-17 years with transfusion dependent thalassaemia major and their parent/guardian were included in the study. The total average cost per patient year to the hospital was $US 2601 of which $US 2092 were direct costs and $US 509 were overhead costs. Mean household expenditure was $US 206 per year with food and transport per transfusion ($US 7.57 and $US 4.26 respectively) being the highest cost items. Nine (26.5%) families experienced catastrophic levels of healthcare expenditure (>10% of income) in the care of their affected child. The poorest households were the most likely to experience such levels of expenditure. Conclusions: β-thalassaemia major poses a significant economic burden on health services and the families of affected children in Sri Lanka. Greater support is needed for the high proportion of families that suffer catastrophic out-of-pocket costs.
Long-term survival of elderly patients after intensive care unit admission for acute respiratory infection: a population-based, propensity-score matched cohort study.
Authors: Guillon Antoine , Hermetet C. , Barker K. A. , Jouan Y. , Gaborit C. , Ehrmann S. , Manach Y. Le , Dequin P F , Grammatico-Guillon L.
Published: May 2020

Background: Intensive care unit (ICU) hospitalisations of elderly patients with acute respiratory infection (ARI) have increased, yet the long-term effect of ICU admission among elderly individuals remain unknown. We examined differences over the two years after discharge in mortality, healthcare utilization and frailty score between elderly survivors of ARI in the ICU and an elderly control population.Methods: We used 2009-2017 data from 39 hospital discharge databases. Patients ≥80 years old discharged alive from ICU-hospitalisation for acute respiratory infection were propensity-score matched with controls (cataract surgery) discharged from the hospital at the same time and adjusted for age, sex and comorbidities present before hospitalisation. We reported 2-year mortality and compared healthcare utilization and frailty scores in the 2-year periods before and after ICU-hospitalisation.Results: 1,220 elderly survivors of acute respiratory infection in the ICU were discharged, and 988 were successfully matched with controls. After discharge, patients had a 10.1-fold [95%CI, 6.1-17.3] higher risk of death at 6 months and 3.6-fold [95%CI, 2.9-4.6] higher risk of death at 2 years compared with controls. They also had a 2-fold increase in both healthcare utilization and frailty score in the 2 years after hospital discharge, whereas healthcare utilization and frailty scores among controls were stable before and after hospitalisation.Conclusions: We observed a substantially increased rate of death in the years after ICU-hospitalisation for elderly patients along with elevated healthcare resource use and accelerated age-associated decline as assessed by frailty score. These findings provide data for better informed goals-of-care discussions and may help target post-ICU discharge services.Funding: None
Rare partial trisomy and tetrasomy of 15q11-q13 associated with developmental delay and autism spectrum disorder
Authors: Lu Yinghong , Liang Yi , Ning Sisi , Deng Guosheng , Xie Yulin , Song Jujie , Zuo Na , Feng Chunfeng , Qin Yunrong
Published: May 2020

Background: Small supernumerary marker chromosomes (sSMCs), are additional abnormal chromosomes, which can’t be detected accurately by banding cytogenetic analysis. Abnormal phenotypes were observed in about 30% of SMC carriers. Duplication of chromosome 15 and related disorders, characterized by hypotonia motor delays, autism spectrum disorder (ASD), intellectual disability, and epilepsy including infantile spasms, might be account for 50% of the total sSMCs. Case presentation: An 11-month-old infant with an sSMC fond by banding cytogenetics was referred to our clinic because of developmental retardation and autism spectrum disorder. After several months of rehabilitation treatment, the progress of motor development was obvious, but the consciousness was still far from satisfied. High-resolution karyotype analysis, multiplex ligation-dependent probe amplification and copy number variation sequencing (CNV-Seq) were conducted to confirm the identity of the sSMC. A bisatellited dicentric sSMC was observed clearly in high-resolution karyotype analysis and a 10.16-Mb duplication of 15q11.1q13.2 (3.96 copies) together with a 1.84-Mb duplication of 15q13.2q13.3 (3 copies) was showed by CNV-Seq in the proband. It suggested that the molecular cytogenetic karyotype was 47,XY,+dic(15;15)(q13.2;q13.3). Furthermore, the clinical symptoms of the proband mostly fit 15q duplication related disorders which are characterized by hypotonia motor delays, autism spectrum disorder (ASD), and intellectual disability. Conclusion: We reported for the first time using CNV-Seq to detect sSMCs and find a partial trisomy and tetrasomy of 15q11-q13 associated with developmental delay and autism spectrum disorder. Our report indicates that CNV-seq is a useful and economical way for diagnosis of dup15q and related disorders.
Correlates of Physical Activity Behavior in Adults: A Data Mining Approach
Authors: Farrahi Vahid , Niemelä Maisa , Kärmeniemi Mikko , Puhakka Soile , Kangas Maarit , Korpelainen Raija , Jämsä Timo
Published: May 2020

Purpose: A data mining approach was applied to establish a multilevel hierarchy predicting physical activity (PA) behavior, and to methodologically identify the correlates of PA behavior. Methods: Cross-sectional data from the population-based Northern Finland Birth Cohort 1966 study, collected in the most recent follow-up at age 46, were used to create a hierarchy using the chi-square automatic interaction detection (CHAID) decision tree technique for predicting PA behavior. PA behavior is defined as active or inactive depending on participants’ activity profiles, which were previously created through a multidimensional (clustering) approach on continuous accelerometer-measured activity intensities in one week. The input variables (predictors) used for decision tree fitting consisted of individual, demographical, psychological, behavioral, environmental, and physical factors. Using generalized linear mixed models, we also analyzed how factors emerging from the model were associated with three PA metrics, including daily time (minutes per day) in sedentary (SED), light PA (LPA), and moderate-to-vigorous PA (MVPA), to assure the relative importance of methodologically identified factors. Results: Of the 4,582 participants with valid accelerometer data at the latest follow-up, 2,701 and 1,881 had active and inactive profiles, respectively. We used a total of 168 factors as input variables to classify these two PA behaviors. Out of these 168 factors, the decision tree selected 36 factors of different domains from which 54 subgroups of participants were formed. The emerging factors from the model explained minutes per day in SED, LPA, and/or MVPA, including body fat percentage (SED: B=26.5, LPA: B=-16.1, and MVPA: B=-11.7), normalized heart rate recovery 60 seconds after exercise (SED: B=-16.1, LPA: B=9.9, and MVPA: B=9.6), average weekday total sitting time (SED: B=34.1, LPA: B=-25.3, and MVPA: B=-5.8), and extravagance score (SED: B=6.3 and LPA: B=-3.7). Conclusions: Using data mining, we established a data-driven model composed of 36 different factors of relative importance from empirical data. This model may be used to identify subgroups for multilevel intervention allocation and design. Additionally, this study methodologically discovered an extensive set of factors that can be a basis for additional hypothesis testing in PA correlates research.
Effect of ulinastatin on post-operative blood loss and allogeneic transfusion in patients receiving cardiac surgery with cardiopulmonary bypass: a prospective randomized controlled study with 10-year follow-up
Authors: Zhang Peng , Lv Hong , Qi Xia , Xiao Wenjing , Xue Qinghua , Zhang Lei , Li Lihuan , Shi Jia
Published: May 2020

Background: Major bleeding and allogeneic transfusion leads to negative outcomes in patients receiving cardiac surgery with cardiopulmonary bypass (CPB). Ulinastatin, a urine trypsin inhibitor, relieves systemic inflammation and improves coagulation profiles with however sparse evidence of its effects on blood loss and allogeneic transfusion in this specific population. Methods: In this prospective randomized controlled trial, 426 consecutive patients receiving open heart surgery with CPB were randomly assigned into three groups to receive ulinastatin (group U, n=142), tranexamic acid (group T, n=143) or normal saline (group C, n=141). The primary outcome was the total volume of post-operative bleeding and the secondary outcome included the volume and exposure of allogeneic transfusion, the incidence of stroke, post-operative myocardial infarction, renal failure, respiratory failure and all-cause mortality. A ten-year follow-up was carried on to evaluate long-term safety.Results: Compared with placebo, ulinastatin significantly reduced the volume of post-operative blood loss within 24 hours (688.39±393.55ml vs 854.33±434.03ml MD -165.95ml, 95%CI -262.88ml to -69.01ml, p<0.001) and the volume of allogeneic erythrocyte transfusion (2.57±3.15 unit vs 3.73±4.21 unit, MD-1.16 unit, 95%CI -2.06 units to -0.26 units, p=0.002). The bleeding and transfusion outcomes were comparable between the ulinastatin group and the tranexamic acid group. In-hospital outcomes and 10-year follow-up showed no statistical difference in mortality and major morbidity among groups. Conclusions: Ulinastatin reduced post-operative blood loss and allogeneic erythrocyte transfusion in heart surgery with CPB. The mortality and major morbidity was comparable among the groups shown by the 10-year follow-up. Trial registration: The trial was retrospectively registered on February 2, 2010. Trial registration number: https://www.clinicaltrials.gov. Identifier: NCT01060189.
Incidence of acute kidney injury and use of renal replacement therapy in intensive care unit patients in Indonesia
Authors: Jonny Jonny , Hasyim Moch , Angelia Vedora , Jahya Ayu Nursantisuryani , Hilman Lydia Permata , Kusumaningrum Venna Febrian , Srisa Nattachai
Published: May 2020

Background : Currently, there is limited epidemiology data on acute kidney injury (AKI) in Indonesia.Therefore, we assessed the incidence of AKI and the utilization of renal replacement therapy (RRT) in Indonesia. Methods : Demographic and clinical data were collected from 952 ICU participants. The participants were categorized into AKI and non-AKI groups. The participants were further classified according to the 3 different stages of AKI as per the Kidney Disease Improving Global Outcome (KDIGO) criteria. Results : Overall incidenceof AKI was 43%. The participants were divided into three groups based on the AKI stages: 18.5% had stage 1, 33% had stage 2, and 48.5% had stage 3. Primary diagnosis of renal disease and high APACHE II score were the risk factors associated with AKI (OR = 4.53, 95% CI: 1.67-12.33, p=0.003 and OR = 1.14 per 1 unit increase, 95% CI: 1.09-1.20, p<0.001, respectively).Chronic kidney disease was the risk factor for severe AKI. Sepsis was the leading cause of AKI.Among the AKI participants, 24.6% required RRT. The most common RRT modalities were intermittent hemodialysis (71.7%), followed by slow low-efficiency dialysis (22.8%), continuous renal replacement therapy (4.3%), and peritoneal dialysis (1.1%). Conclusions : This study showed that AKI was a common problem in the Indonesian ICU. We strongly believe that identification of the risk factors associated with AKI will help us develop a predictive score for AKI so we can prevent and improve AKI outcome in the future.
Impact of coronary collateralization on long-term clinical outcomes in type 2 diabetic patients after successful recanalization of chronic total occlusion
Authors: Yang Zhen Kun , Shen Ying , Dai Yang , Wang Xiao Qun , Hu Jian , Ding Feng Hua , Zhang Rui Yan , Lu Lin , Shen Wei Feng
Published: May 2020

Background: To assess the prognostic role of coronary collaterals in patients with type 2 diabetes mellitus (T2DM) after successful percutaneous coronary intervention (PCI) for chronic total occlusion (CTO).Methods: Coronary collateralization was graded according to Rentrop scoring system in 198 type 2 diabetic patients and 335 non-diabetics with stable angina undergoing PCI for at least one CTO lesion. Left ventricular ejection fraction (LVEF) was determined and major adverse cardio-cerebral events (MACCE) were recorded during follow-up.Results: Poor collateralization was more common in patients with T2DM than in non-diabetics (40% vs 29%, p=0.008). At 13.5±4.1 months, the rate of composite MACCE (17.3% vs 27.6%, p=0.034) and repeat revascularization (15.2% vs 25.5%, p=0.026) was lower and the increase in LVEF (3.10 % vs 1.80%, p=0.024) was greater in patients with good collaterals than in those with poor collaterals for non-diabetic group. The associations were in the same direction for T2DM group (35% vs 44%; 30% vs 36%; 2.14% vs 1.65%, respectively) with a higher all-cause mortality in diabetic patients with poor collaterals (p=0.034). Multivariable Cox proportional hazards analysis showed that coronary collateralization was an independent factor for time to MACCE (HR 2.155，95%CI 1.290-3.599, P=0.003) and repeat revascularization (HR 2.326, 95%CI 1.357-3.986, p=0.002) in non-diabetic patients, but did not enter the model in those with T2DM.Conclusions: T2DM is associated with reduced coronary collateralization. The effects of the status of coronary collateralization on long-term clinical outcomes and left ventricular function appear to be similar in size in type 2 diabetic patients and non-diabetics after successful recanalization of CTO.
Muramyl dipeptide mediated immunomodulation on monocyte subsets exerts therapeutic effects in a mouse model of Alzheimer’s disease
Authors: Malekia Adham Fani , Cisbania Giulia , Plante Marie-Michèle , Préfontaine Paul , Laflamme Nataly , Gosselin Jean , Rivest Serge
Published: May 2020

Background: Muramyl dipeptide (MDP) is a component derived from minimal peptidoglycan motif from bacteria, and it is a ligand for the NOD2 receptor. Peripheral administration of MDP converts Ly6Chigh into Ly6Clow monocytes. Previously we have shown that Ly6Clow monocytes play crucial roles in the pathology of a mouse model of Alzheimer’s disease (AD). However, medications with mild immunomodulatory effects that solely target specific monocyte subsets, without triggering microglial activation are rare. Methods: 3-months old APPswe/PS1 transgenic male mice and age-matched C57BL/6J mice were used for high frequency (2-times/week) over 6-months and low frequency (once a week) over 3 months of intraperitoneally MDP (10 mg/kg) administrations. Flow cytometry analysis of monocyte subsets in blood, behavioral and postmortem analyses were performed. Results: Memory tests showed mild to a strong improvement in memory function, increased expression levels of postsynaptic density protein 95 (PSD95), and low-density lipoprotein receptor-related protein 1 (LRP1), which are involved in synaptic plasticity and amyloid-beta (Aβ) elimination, respectively. In addition, we found monocyte chemoattractant protein-1(MCP-1) levels significantly increased, whereas intercellular adhesion molecule-1(ICAM-1) significantly decreased and microglial marker (Iba1) did not change in the treatment group compared to the control. In parallel, we discovered elevated cyclooxygenase-2 (COX2) expression levels in the treated group, which might be a positive factor for synaptic activity. Conclusions: Our results demonstrate that MDP is beneficial in both the early phase and, to some extent, later phases of the pathology in the mouse model of AD. These data open the way for potential MDP-based medications for AD.
Urinary tract infection is associated with hypokalemia: a case control study
Authors: Shen Ai-Ling , Lin Hsiu-Li , Lin Hsiu-Chen , Tseng Yuan-Fu , Hsu Chien-Yeh , Chou Che-Yi
Published: May 2020

Background Hypokalemia is a common clinical problem. The association between urinary tract infection (UTI) and hypokalemia is not clear. Hypokalemia is common in patients with UTI in clinical observation. The aim of the study is to determine if UTI is associated with hypokalemia.Methods Patients hospitalized with UTI and the control group were retrieved from the Longitudinal Health Insurance Database 2005. The control group was patients hospitalized with other reasons and were matched for the confoundings of UTI and hypokalemia. We analyze the risk of hypokalemia using logistic regression and calculate the odds ratio (OR) and 95% confidence interval (CI) of OR.Results We analyzed 43719 UTI patients and control patients. Hypokalemia was found in 4540 (10.4%) patients with UTI and 1842 (4.2%) control patients. The percentage of patients with hypokalemia was higher in UTI patients (chi-square, p < 0.001). UTI was associated with hypokalemia and the odds ratio (OR) was 2.27 [95% confidence interval (CI): 2.17 - 2.41]. Cerebrovascular accident, chronic obstructive pulmonary disease, hypertension, congestive heart failure, diarrhea, medications including thiazides, sulfonamides, xanthines, and laxatives were independently associated with hypokalemia. Recurrent UTI was associated with hypokalemia in UTI patients (OR: 1.13, 95% CI: 1.05 – 1.23, p < 0.001).Conclusions Urinary tract infection is associated with hypokalemia among inpatients. The association is independent of patients’ comorbidities and medications. Recurrent UTI is associated with increased hypokalemia in UTI patients.