bluuebunny/crossref_metadata_2025 huggingface dataset:
Carriage of Methicillin-resistant Staphylococcus aureus among people living with HIV-AIDS in inner São Paulo State, Brazil: molecular and spatial epidemiology
Authors: Lastória Leticia Chamma , Cunha Maria de Lourdes Ribeiro de Souza da , Souza Camila Sena Martins de , Souza Lenice do Rosário de , Victória Cassiano , Fortaleza Carlos Magno Castelo Branco
Published: January 2020

Background: Methicillin-resistant Staphylococcus aureus (MRSA) is increasingly recognized as a threat for people living with HIV/AIDS (PLWHA). However, the magnitude of asymptomatic MRSA colonization in that group varies among different countries and geographic regions. Methods: We conducted a study that aimed at identifying the prevalence, risk factors and spatial epidemiology of both overall S. aureus and MRSA colonization among PLWHA from small cities from inner São Paulo State, Brazil. MRSA isolates were characterized using Pulsed-Field Gel Electrophoresis (PFGE), and submitted to typing of the Staphylococcal Chromosome Cassete (SCC)mec. Spatial analysis was performed to search for geographical clusters and correlation with socioeconomic indicators. Results: In a first point prevalence survey, nasal and oropharyngeal swabs of 368 people were collected. Sixty-seven subjects from the city of Botucatu were surveyed for colonization in two other occasions, and had swabs collected from household members. The prevalence rates for S. aureus and MRSA in the first survey were 25.8% and 2.7%. The overall S. aureus colonization was negatively associated with the use of beta-lactams and of illicit drugs. On the other hand, MRSA colonized subjects were more likely to use crack and to have been admitted to a hospital during the past year. Repeated surveys found additional cases of MRSA colonization, but all subjects were positive in only one occasion. Four PFGE clusters were characterized, grouping subjects in household, city and region level. Of 19 total MRSA isolates, only one did not harbor SCCmec type IV. Spatial analysis of households of subjects living in the city of Botucatu found significant overdispersion of cases, but no association with socio-economic indicators. Conclusion: We found small but relevant prevalence of MRSA among PLWHA. Community and healthcare-associated risk factors were identified, so that predominant routes of transmission could not be determined on epidemiological grounds.
Descriptive Epidemiology and Outcomes of Soft Tissue Sarcomas in Adolescent and Young Adult Patients in Japan
Authors: Fukushima Takashi , Ogura Koichi , Akiyama Toru , Takeshita Katsushi , Kawai Akira
Published: January 2020

Background: Compared to young children or older adults, the prognoses of adolescent and young adult (AYA) patients with cancer, i.e., those aged from 15 to 39 years, have not improved. In this study, we focused on soft tissue sarcoma (STS) in AYA patients and aimed to determine whether there is a correlation between the AYA age group and overall poor cancer survival in STS. We further aimed to determine which histologic subtypes are more common in AYA patients and investigate the cause of poor outcomes in this group.Methods: The medical records of 5853 Japanese patients diagnosed with STS between 2006 and 2013 were accessed from the Bone and Soft Tissue Tumor registry (BSTT). We analyzed and compared the epidemiological features of AYA patients with those of other age groups. The cancer survival rates were calculated using the Kaplan-Meier method. Cox proportional hazards models were used to analyze the prognostic factors for cancer survival. The primary endpoint for prognosis was the occurrence of tumor-related death.Results: On multivariate analysis, age was not a prognostic factor for poor cancer survival among these patients. Compared to the same categories in other age groups, the proportions of myxoid/round cell liposarcomas, synovial sarcomas, malignant peripheral nerve sheath tumors (MPNST), primitive neuroectodermal tumor, and rhabdomyosarcoma in AYA patients were the highest, but none of the categories were significantly more prevalent in AYA patients. The cancer survival rates of AYA patients with MPNST were poorer than those of the other age groups; however, AYA age was not a prognostic factor on multivariate analysis in MPNST patients.Conclusions: Our study is the first to investigate STS in AYA patients using the nationwide BSTT registry. Our findings demonstrate that AYA age is not a prognostic factor for poor cancer survival among those with STS in Japan.
Pre-operative hemoglobin level and use of sedative-hypnotics are independent risk factors for post-operative delirium following total knee arthroplasty
Authors: Kijima Eiji , Kayama Tomohiro Thomas , Saito Mitsuru , Kurosaka Daisaburo , Ikeda Ryo , Hayashi Hiroteru , Kubota Daisuke , Hyakutake Takashi , Marumo Keishi
Published: January 2020

Background: Delirium is a well-known complication following surgery, especially with the increasing age of patients undergoing surgery. The increasing demands resulting from a prolonged healthy life expectancy has resulted in more arthroplasties despite their age and existing comorbidities. The purpose of this study is to explore the various risk factors that may contribute to delirium in unilateral and bilateral total knee arthroplasties in the elderly population. Methods: 170 patients who underwent unilateral or bilateral total knee arthroplasties were analyzed retrospectively for delirium. Age, sex, comorbidities, use of sedative-hypnotics, intra-operative blood loss, pre- and post-operative laboratory blood test results were investigated and analyzed. Results: The incidence of post-operative delirium was 6.5% (11 out of 170 patients) with a mean age of 79.5 (± 6.9) years, compared to 73.0 (± 9.0) years in the non-delirium group. Higher age, use of sedative-hypnotics, low pre-operative Hb and Ht, low post-operative Hb, Ht and BUN were observed in the delirium group. Multivariate logistic regression analysis identified that the use of sedative-hypnotics and pre-operative Hb level were independent risk factors for post-operative delirium after TKA. The odds ratios for the use of sedative-hypnotics and pre-operative Hb level were 4.6 and 0.53, respectively. Receiver operating characteristic curve analysis showed that pre-operative Hb of less than 11.1 g/dL was a predictor for the development of delirium, with a sensitivity of 54.6% and a specificity of 91.6%. Conclusion: Patients with a pre-operative Hb level of <11.1 g/dL or those using sedative-hypnotics have an increased risk for post-operative delirium. Peri-operative management and preventative measures are therefore needed to reduce the risks of post-operative delirium in such patients.
Cross-cultural translation, adaptation and validation of a Japanese version of the Functional Index for Hand Osteoarthritis (J-FIHOA)
Authors: Nakagawa Yasunobu , Kurimoto Shigeru , Maheu Emmanuel , Matsui Yuichiro , Kanno Yuri , Menuki Kunitaka , Hayashi Masanori , Nemoto Tetsuya , Nishizuka Takanobu , Tatebe Masahiro , Yamamoto Michiro , Iwatsuki Katsuyuki , Dreiser Renée Liliane , Hirata Hitoshi
Published: January 2020

Background: Hand osteoarthritis (OA) has a wide spectrum of clinical presentations and physical function is one of the core domains where patients suffer. The Functional Index for Hand Osteoarthritis (FIHOA) is a leading assessment tool for hand dysfunction. Our objective was to make a Japanese version of FIHOA (J-FIHOA) and validate it among Japanese hand OA patients. Methods: Forward and backward translation processes were completed to create a culturally adapted J-FIHOA. A prospective, observational multicenter study was undertaken for the validation process. Seventeen collaborating hospitals recruited Japanese hand OA patients who met the American College of Rheumatology criteria. A medical record review and responses to the following patient-rated questionnaires were collected: J-FIHOA, Hand20, Health Assessment Questionnaire (HAQ), numerical rating scale for pain (NRS pain) and Short Form 36 Health Survey (SF-36). We explored the structure of J-FIHOA using factor analysis. Cronbach’s alpha coefficients and item-total correlations were calculated. Correlations between J-FIHOA and other questionnaires were evaluated for construct validity. Participants in clinically stable conditions repeated J-FIHOA at a one- to two-week interval to assess test-retest reliability. To evaluate responsiveness, symptomatic patients who started new pharmacological treatments had a 1-month follow-up visit and completed the questionnaires twice. Effect size (ES) and standardized response mean (SRM) were calculated with pre- and post-treatment data sets. We assessed responsiveness, comparing ES and SRM of J-FIHOA with other questionnaires (construct approach). Results: A total of 210 patients participated. J-FIHOA had unidimensional structure. Cronbach’s alphas (0.914 among females and 0.929 among males) and item-total correlations (range, 0.508 to 0.881) revealed high internal consistency. Hand20, which measures upper extremity disability, was strongly correlated with J-FIHOA (r=0.82) while the mental and role-social component of SF-36 showed no correlations (r=−0.24 and −0.26, respectively). Intraclass correlation coefficient for test-retest reliability was 0.83 and satisfactory. J-FIHOA showed the highest ES and SRM (−0.68 and −0.62, respectively) among all questionnaires, except for NRS pain. Conclusions: Our results showed J-FIHOA had good measurement properties to assess physical dysfunction in Japanese patients both for ambulatory follow-up in clinical practice, and clinical research and therapeutic trials.
NEAT1 attenuates osteoarthritis development by sponging miR-424-5p and up-regulating SMAD7 expression
Authors: Zhang Dezhi , Song Lin , Wang Xiaohe
Published: January 2020

Background: Osteoarthritis is extensively accepted as a chronic joint disease primarily characterized by destruction of articular cartilage, yet with rare molecular mechanism underlying its development and limited therapeutic targets in clinic. We here to investigate the role of NEAT1 and its molecular basis in OA development. Methods: Rat tissues and chondrocytes with osteoarthritis were used to detect the mRNA level of SMAD7 and miR-424-5p in which the correlation between them was also analyzed; Overexpression and knockdown of miRNA-424-5p were implemented to detect the regulation on SMAD7; The level of inflammatory factors and cell apoptosis of chondrocytes were detected with the opposite treatment on miR-424-5p; The potential interacting lncRNA was identified through online tool and RIP was employed to demonstrate the association between them; The biological coordination between NEAT1 and miR-425-5p in osteoarthritis was explored via the effects on inflammatory factors and cell apoptosis of chondrocytes. Results: Significantly, our results showed that levels of miR-424-5p are negatively correlated to expression of SMAD7 in rat cartilage tissues and chondrocytes, and overexpression of miR-424-5p was demonstrated to down-regulate SMAD7 expression. Additionally, the results also showed that miR-424-5p regulated expression of pro-inflammatory cytokines and apoptosis in chondrocytes via a SMAD7-dependent manner. Morever, the potential interacting lncRNA of miR-424-5p was figured out, and NEAT1 was proved to inversely mediate miR-424-5p expression leading to up-regulation of SMAD7. Further, NEAT1 was also estimated to work concert with miR-424-5p orchestrating expression of pro-inflammatory cytokines and chondrocytes apoptosis to ameliorate development of OA. Conclusions: We here demonstrate that NEAT1 could attenuate OA development via sponging miR-424-5p and thus up-regulating SMAD7 expression. Our data suggest that NEAT1-miR-424-5p-SMAD7 axis might be a potential therapeutic target for OA patients.
Tissue Adhesive for Wound Closure in Fast-recovery Total Hip Arthroplasty: A Prospective, Randomized and Controlled Study
Authors: Kong Xiangpeng , Yang Minzhi , Cao Zheng , Chen Jiying , Chai Wei , Wang Yan
Published: January 2020

Background We aimed to present our experience of adopting tissue adhesive as adjunct to standard wound closure in total hip arthroplasty (THA) and evaluate its role and cost performance. Methods From September 2019 to November 2019, we prospectively enrolled consecutive patients who underwent simultaneous bilateral THA in this randomized and controlled study. The allocation of tissue adhesive was randomized to either hip. The patients’ age, gender, body mass index (BMI), diagnosis, postoperative length of stay (LOS), dressing changes, wound evaluation scores, wound-related cost and complications were collected and analyzed. Results During the hospital stay, the dressing change in hips with tissue adhesive was significantly less than that in the other hips (p=0.000). However, the wound-related cost in hips with tissue adhesive was significantly higher (p=0.000). At one-month follow up, patient-reported wound measurement of hips with tissue adhesive was significantly more superior than the other hips (P=0.004). Seventeen patients preferred tissue adhesive and only five patients preferred the standard wound closure. Conclusions Tissue adhesive could significantly reduce wound drainage and increase patient satisfaction, which can be an ideal adjunct to standard wound closure in fast-recovery THA.
Measurement and Analysis of Sagittal Spinal Morphology and Function in Adolescents: A Cross-Sectional Study
Authors: Feng Qiang , Zhou Yu , Wang Fubaihui , Wang Minghao
Published: January 2020

Background: Spine health is a significant aspect of adolescent health, but few studies have focused on adolescent sagittal plane health. This study aimed to investigate the current status of sagittal spine morphology and function in adolescents. Method: This cross-sectional study analysed 1152 effective samples obtained from junior and senior high school students (543 boys and 609 girls) from demonstration, middle-level, and general schools in Beijing. Spinal sagittal morphology and function were measured by Spinal Mouse, a spine measuring instrument. The sacrum angle (SA), thoracic kyphosis angle (TKA), lumbar lordosis angle (LLA), inclination angle (INA), sacral range of motion (SROM), thoracic range of motion (TROM), lumbar range of motion (LROM), and inclination range of motion (IROM) were measured. The Matthiass test was used to measure the change in angle after external load placement on the adolescent spine. Sacral angle change (SAc), thoracic angle change (TKAc), lumbar lordosis angle change (LLAc), and inclination angle change (INAc) were also analysed. Result ： Abnormal TKA rate was 48.2% and 44.7% in the junior and senior high school. Abnormal LLA rate was 44.6% and 55.4%. In the spinal mobility test of the junior high school , SROM, TROM, LROM, and IROM were 60.6°±19.1°, 23.0°±16.6°, 23.0°±16.6°, and 136.1°±16.9°, respectively, for boys and 66.0°±34.4°, 14.0°±17.3°, 66.3°±18.6°, and 127.4°±26.8°, for girls. There were significant differences found between boys and girls (P<0.05 or P<0.01). In the Matthiass test, INAc of the junior high school was 5.7°±5.0° and 2.6°±3.7° for boys and girls, whereas INAc of the senior high school was 2.8°±3.3 and 1.6°±3.0, showing significant differences (P<0.01). The canonical correlation coefficient of SA, SROM, LROM, and IROM was 1.3877, -2.5384, -0.6625, and 1.6336. SROM and LROM were found to be negatively correlated with spinal function, whereas IROM was positively correlated with spinal function. Conclusion: Adolescents have a high incidence of thoracic kyphosis. During flexion and extension, the thoracic and lumbar vertebral activity and overall activity are better in boys. However, girls are better at maintaining the strength quality of stable muscle groups with a normal spine shape. Sacral obliquity and pelvic position greatly influence the spinal morphology of adolescents.
The influence of different hook tip depths on the treatment of acromioclavicular joint dislocation with clavicular hook plate – a retrospective study
Authors: xu ding , Luo Peng , Shi Yulong , Wang Weikang , Guo Weijun , Chen Jianming Chen
Published: January 2020

Background The purpose of this study was to research the effect of different hook depths on the efficacy and complications of AC dislocation treatment with hook plate, and to provide valuable reference for clinical treatment.Method We retrospectively analyzed the prospectively collected data from 305 consecutive patients with AC joint dislocation between April 2013 and May 2017 at our institute. We defined〝hook tip depth〞as the position of the hook tip relative to the acromion at the coronal plane. According to the division where the tip of the hook was located, the cases were divided into Group A, Group B, Group C, and D group. All patients were required to conform to regular follow up postoperatively. Dislocation and implant maintenance are assessed by routine shoulder imaging. Functional results were evaluated using Constant-Murley criteria.Results A total of 305 cases were included in follow-up and 27 cases were lost. We used Constant-Murley criteria to evaluate functional results. The score of Group B was significantly higher than group A and group C (P<0.01). For evaluation of acromioclavicular joint reduction, we used CCD in imaging to evaluate. There was significant difference between the three groups. Joint reduction was obtained in all patients. Postoperative infection and hardware failure did not present. There were no fractures of acromion and coracoids process. There were 83 cases of shoulder pain, 93 cases of SIS and 124 cases of subacromial erosion. The incidence of complications in group A was significantly higher than group B and group C.Conclusions The relative position of the hook tip and acromion can significantly affect the efficacy and complications of the clavicular hook plate in the treatment of acromioclavicular joint dislocation. During surgery, we should control the depth of hook tip and try our best to put the tip of the hook into the area of group B to achieve an ideal postoperative effect and avoid the occurrence of various complications.
Comparative Study of the Effect of Macrolide Antibiotics Erythromycin, Clarithromycin, and Azithromycin on the ERG1 Gene Expression in H9c2 Cardiomyoblast Cells
Authors: Hajimirzaei Nima , Khalili Nazila Pour , Boroumand Behshad , Safari Fatemeh , Pourhosseini Armin , Tavakoli Fatemeh
Published: January 2020

Background: Macrolides are a clinically well-established class of antibiotics. Macrolides induce cardiotoxicity by blocking ERG potassium channels in cardiac myocytes. The aim of this study was to compare the effects of erythromycin, clarithromycin and azithromycin on cell viability and expression of ERG1 gene in H9c2 cells. Methods: Cell viability and ERG1 gene expression of H9c2 cells in 3 different concentrations, 1, 10 and 25µg/ml, after 48 and 72 hours were determined by MTT test and Real time-PCR method respectively. Results: According to the results, these antibiotics decreased cell viability in a concentration and time-dependent manner. After 48 hours, the growth of H9c2 cells treated with erythromycin and clarithromycin (at 1 and 25 μg/ml) were inhibited significantly compared to control group (p <0.05). All three groups of antibiotics showed toxic effects on cells after 72 hours in all concentrations. Azithromycin-inhibiting effects were significantly higher than two other groups after 72 hours of treatment. The expression of ERG1 gene increased in all three groups of antibiotics by increasing the concentration and duration of treatment. Azithromycin had the most pronounced effect on ERG1 expression in 48 and 72 hours. Conclusions: This study indicated that these macrolides affect ERG1 expression due to their potential cardiac adverse effects. Further investigations are required to understand the exact mechanism of cardiotoxicity associated with macrolides.
Prevalence of potential drug- drug interactions and associated factors among outpatients and inpatients in Ethiopian Hospitals: a systematic review and Meta-analysis of observational studies
Authors: Ayenew Wondim , Asmamaw Getahun , Issa Arebu
Published: January 2020

Background A very few number of studies are available regarding the evaluation of potential drug- drug interactions in Sub-Saharan Africa. This is also a problem in Ethiopian health care system. Now a days, in Ethiopia polypharmacy is increased due to comorbid conditions in the hospital health care system, a large number of patients are treated in the outpatient setting and also hospitalized and there is a high possibility for drug- drug interactions. Therefore, this study aims to summarize the prevalence of potential drug- drug interactions and associated factors in hospitals, both among hospitalized patients and outpatients in Ethiopia.Method Literature search was performed through accessing legitimate databases in PubMed/MEDLINE, Google Scholar and Research Gate for English-language publications. Advanced search strategies were applied in Science Direct and HINARI to identify any additional papers and published reviews and to retrieve relevant findings closely related to prevalence of potential drug- drug interactions and associated factors with it. The search was conducted from August 22-25, 2019 and all published and unpublished articles available online until the day of data collection were considered.Results A total of 14 studies were included for systematic review and meta-analysis. From 14 studies, 5761 patients were included and a total of 8717 potential drug- drug interactions were found in 3259 of patients. The prevalence patients with potential drug- drug interactions in Ethiopian Hospitals were found to be 72.2% (95% confidence interval: 59.1%, 85.3%). Based on severity, the prevalence of potential drug- drug interactions were 25.1%, 52.8%, 16.9% and 1.27% for major, moderate, minor potential drug- drug interactions and contraindications respectively. The factors associated with potential drug- drug interactions were related to patient characteristics such as polypharmacy, age, comorbid disease and hospital stay.Conclusion There is a high prevalence of potential drug- drug interactions in Ethiopian Hospitals. From this the most prevalent drug- drug interactions were moderate severity, 52.8%. Polypharmacy, age, comorbid disease and hospital stay were the risk factors associated with potential drug- drug interactions.
Optimal cut-off points after a daily meal corresponding to fasting goal levels of LDL-C and non-HDL-C in Chinese patients with coronary heart disease
Authors: Guo Li-Ling , Chen Yan-qiao , Lin Qiu-zhen , Tian Feng , Xiang Qun-Yan , Zhu Li-yuan , Liu Ling , Xu Jin
Published: January 2020

Background: Although the detection of non-fasting blood lipids has been recommended in patients with coronary heart disease (CHD), the non-fasting cut-off points corresponding to the fasting goals of LDL-C < 1.8 mmol/Land non-HDL-C < 2.6 mmol/L, respectively, have not been explored. Methods: This study enrolled 397 inpatients with CHD. One hundred and ninety-seven patients took statins for < 1 month (m) or did not take any statin before admission (i.e. CHD1 group), while 204 patients took statins for ≥ 1 m before admission (i.e. CHD2 group). Blood lipid levels were measured at 0 h, 2 h, and 4 h after a daily breakfast. Results: Non-fasting low-density lipoprotein cholesterol (LDL-C) and non-high-density lipoprotein cholesterol (non-HDL-C) levels significantly decreased after a daily meal ( P < 0.05). Both fasting and non-fasting LDL-C or non-HDL-C levels were significantly lower in the CHD2 group. The percent attainment of LDL-C < 1.8 mmol/L at 2 h or 4 h after a daily breakfast was significantly higher than that of its fasting point ( P < 0.05), whereas that of non-HDL-C < 2.6 mmol/L was significantly higher only at 4 h ( P < 0.05). Analysis of c-statistic showed that non-fasting cut-off points for LDL-C and non-HDL-C were 1.5 mmol/L and 2.4 mmol/L, corresponding to their fasting goal levels of 1.8 mmol/L and 2.6 mmol/L, respectively. When postprandial LDL-C and non-HDL-C goal attainments were re-evaluated by non-fasting cut-off points, there were no significant differences in percent attainment between fasting and non-fasting states. Conclusions: Determination ofnon-fasting cut-off points is important to evaluate the efficacy of cholesterol-lowering therapy if blood lipids are detected after a daily meal.
The Experience of Patient-Related Violence Against Emergency Department Nurses in the United States: A Phenomenological Pilot Study
Authors: Al-Qadi Mahmoud M.
Published: January 2020

Purpose This study described the experiences, thoughts, perceptions, and feelings of emergency department nurses regarding patient-related violence.Design and Methods A descriptive phenomenological research approach was adopted to collect data through unstructured interviews. Three participants were recruited via word of mouth through colleagues from two different states (North East) in the United States. Data were collected from October to November 2018. Colaizzi’s phenomenological methodology was adopted to analyze the interview content.Findings Seven themes emerged from the analysis of the data: physical violence, take care of patients regardless of their behavior, communication skills, lack of training and educational intervention, contributing factor: long waiting times, expletive forms of verbal abuse and threatening behaviors, and the impact of violent behavior on nurses led to feelings of negative emotions.Conclusions Provide training to ED nurses on how to handle violence situations and the employers has to implement policies to make the workplace safe for both nurses and patients. The findings of this study highlight the urgency of taking a realistic approach to preventing workplace violence to organizational leaders.
A dose-response study in mice of a tetravalent recombinant dengue envelope domain III protein secreted from insect cells
Authors: Shao Lijun , Pang Zheng , Bi Yu , Li Zhenhua , Lin Weiping , Li Guolei , Wang Mingling , Guo Yanming , Niu Guoyu
Published: January 2020

Background: DENV is the most globally prevalent mosquito-transmitted virus. Induction of a broadly and potently immune response is desirable for dengue vaccine development. Methods: We constructed a secreted tetravalent EDⅢ protein from eukaryotic cells and established a MAC-ELISA method for DENV diagnosis. This work aimed to evaluate the immune responses in mice of several formulations of rEDIII containing different amounts of the tetravalent protein. Results: We demonstrated that the tetravalent protein induced humoral immunity against all four serotypes of DENV, even at the lowest dose assayed. Besides, cellular immunities against DENV-1 and DENV-2 were elicited by medium dose group. Importantly, the immune responses induced by the tetravalent formulation were functional in clearing DENV-2 in circulation of mice. Conclusions: We believe that the tetravalent formulation of secreted EDⅢ protein is a potential vaccine candidate against DENV and suggest further detailed studies of this formulation in nonhuman primates. Keywords: Dengue virus; Tetravalent; Humoral immunity; Cellular immunity; Vaccine
The impact of early neuraminidase inhibitor therapy on clinical outcomes in patients hospitalised with influenza A-related pneumonia: a multicenter, retrospective study
Authors: Chen Liang , Han Xiudi , Li YanLi , Zhang Chunxiao , Xing Xiqian
Published: January 2020

Background Guidelines emphasize prompt antiviral treatment in severe influenza patients. Although nearly a 50% of severe influenza present with pneumonia, the effect of early (≤ 2 days after illness onset) neuraminidase inhibitor (NAI) use on the clinical outcomes of influenza A-related pneumonia (FluA-p) has rarely been assessed. And there is limited data about the administration of NAIs in the real-world management of Flu-p in China.Methods Data of patients hospitalised with FluA-p from five teaching hospitals in China from 1 January 2013 to 31 December 2018 were reviewed retrospectively. The impact of early NAI therapy on the outcomes in FluA-p patients, and the indications of early NAI administration by clinicians were evaluated by logistic regression analysis.Results Totally, 693 FluA-p patients were included. Of these patients, 33.5% (232/693) were treated early. After adjusting for weighted propensity scores for treatment, systemic corticosteroid and antibiotic use, a multivariate logistic regression model showed that early NAI therapy was associated with decreased risk for invasive ventilation [ odds ratio ( OR ) 0.511, 95% confidence interval (CI) 0.312–0.835, p = 0.007) and 30-day mortality ( OR 0.533, 95% CI 0.210–0.807, p < 0.001) in FluA-p patients. A multivariate logistic regression model confirmed early NAI use ( OR 0.415, 95% CI 0.195–0.858, p = 0.001) was a predictor for 30-day mortality in FluA-p patients and a positive rapid influenza diagnostic test was the only indication ( OR 3.586, 95% CI 1.259–10.219, p < 0.001) related to the prescription of early NAI by clinicians.Conclusions Early NAI therapy is associated with better outcomes in FluA-p patients. Improved education and training of clinicians on the guidelines of influenza are needed.
Molecular characterization of the viral structural gene of the first dengue virus type 2 outbreak in Hunan Province, inland China
Authors: Guan Jiaoqiong , He Zhanlong , Qin Meng , Deng Xialin , Chen Jun , Duan Suqin , Gao Xiaojun , Pan Yue , Chen Junying , Yang Yaping , Feng Shijun , Sun Qiangming
Published: January 2020

Background: An unexpected dengue outbreak occurred in the Hunan Province in 2018. This is the first dengue outbreak in this area of inland China resulting 172 infected. Methods: To verify the causative agent of this outbreak and investigate gene characterization, the structural protein C/prM/E genes of viruses isolated from local residents were sequenced followed by mutation, phylogenetic analysis. The recombination, selection pressure, potential secondary structure and three-dimensional structure analysis were also performed. Results: Phylogenetic analysis revealed that all epidemic strains were classified as the cosmopolitan DENV-2 genotype, closest to the Zhejiang strain (MH010629, 2017) and then Malaysia strain (KJ806803, 2013). Compared with the DENV-2SS, 151 base substitutions were found in 89 sequences of isolates, resulting in 20 nonsynonymous mutations, of which 17 mutations existed among all samples (two in capsid protein, six in prM/M, and nine in envelope proteins). Moreover, amino acid substitutions at 602 th (E322:Q→H) and 670 th (E390: N→S) may result in heightened virulence of the epidemic strains. One new DNA-binding site and five new protein binding sites were observed. Two polynucleotide-binding sites and seven protein binding sites were lost compared with DENV-2SS. Meanwhile, five changes were found in helix regions. The helical transmembrane and disordered regions have minor changes. Protein tertiary structure prediction revealed the 429 th amino acid of E proteins was switch from histamine (positively charged) to asparagines (neutral) in 89 isolate strains. No recombination events or positive selection pressure sites were detected. To our knowledge, this study is the first gene analysis of epidemic strain in the first dengue outbreak in Hunan Province, inland China. Conclusions: The causative agent is likely to come from Zhejiang Province, a neighbouring Province where dengue fever broke out in 2017. This study may help understand the intrinsic geographical relatedness of DENV-2 and contributes further to research on pathogenicity and vaccine development.
Current Census of Oncology Critical Care Medicine in China
Authors: Wang Yao , Wang Changsong , Gao Yan , Hu Zhenjie , Wang Hongzhi , Ma Gang , Zhu Biao , Wang Donghao , Yu Kaijiang
Published: January 2020

Objective The purposes of this survey were to show the current situation of oncology critical care medicine in China, to understand the resource distribution of oncology critical care medicine, and to analyze and evaluate the existing resources and reserve capacity of oncology critical care medicine.Methods A general survey was conducted at the 36 member units of the Oncology Critical Care Medicine Committee of the Chinese Anti-cancer Association through e-mailed questionnaires. The census takers filled out the questionnaires with feedback. The survey covered 8 items: basic information on the hospital, basic profile of the ICU, personnel allocation, management status, technical skills, patient sources, equipment configuration and tumor- related treatment technology.Results The survey results involved information from 28 member units, all of which are tertiary hospitals, distributed in 20 provinces and 4 direct-controlled municipalities. The results are as follows. (1) The total ratio of ICU beds to hospital beds was 1.06%, and the average number of ICU beds was 16.36. (2) The ratio of ICU physicians to beds was approximately 0.62:1, and the ratio of nurses to beds was approximately 1.98:1. (3) According to the census of the population and GDP of different regions conducted by the State Statistics Bureau in 2017, the ratio of ICU beds for tumor patients to population was 4.55 beds per 10 million people, and the ratio of ICU beds to GDP was 8.00 beds per RMB 100 billion, on average. (4) The equipment configuration is relatively perfect, while the technical skills need to be improved.Conclusion The development of oncology critical care is becoming better, but there is still a certain gap compared with the ICU standards in China and the average level of the national ICU. It is urgent to develop oncology critical care medicine.
Modelling the impact of MAUP on environmental drivers for Schistosoma japonicum prevalence
Authors: Navas Andrea Araujo , Osei Frank , Magalhães Ricardo J. Soares , Leonardo Lydia R. , Stein Alfred
Published: January 2020

Background: The modifiable areal unit problem (MAUP) arises when the support size of a spatial variable affects the relationship between prevalence and environmental risk factors. Its effect on Schistosomiasis modelling studies could lead to unreliable parameter estimates. The present research aims to quantify MAUP effects on environmental drivers of Schistosoma japonicum infection by (i) bringing all covariates to the same spatial support, (ii) estimating individual-level regression parameters at 30 m, 90 m, 250 m, 500 m, and 1 km spatial supports, and (iii) quantifying the differences between parameter estimates using five models.Methods: We modelled the prevalence of Schistosoma japonicum using sub-provinces health outcome data and pixel-level environmental data. We estimated and compared regression coefficients from convolution models using Bayesian statistics. Results: Increasing the spatial support to 500 m gradually increased the parameter estimates and their associated uncertainties. Abrupt changes in the parameter estimates occur at 1 km spatial support, resulting in loss of significance of almost all the covariates. No significant differences were found between the predicted values and their uncertainties from the five models. We provide suggestions to define an appropriate spatial data structure for modelling that gives more reliable parameter estimates and a clear relationship between risk factors and the disease. Conclusions: Inclusion of quantified MAUP effects was important in this study on schistosomiasis. This will support helminth control programs by providing reliable parameter estimates at the same spatial support, and suggesting the use of an adequate spatial data structure, to generate reliable maps that could guide efficient mass drug administration campaigns.
Preventive health service coverage among infants and children at six maternal-child health clinics in western Kenya: A cross-sectional assessment
Authors: Deathe Andrew , Oyungu Eren , Ayaya Samuel O. , Ombitsa Ananda R. , McAteer Carole I. , Vreeman Rachel C. , McHenry Megan S.
Published: January 2020

BackgroundDespite the substantial reduction of child mortality in recent decades, Kenya still strives to provide universal healthcare access and to meet other international benchmarks for child health. This study aimed to describe child health service coverage among children visiting six Maternal and Child Health (MCH) clinics in western Kenya. MethodsIn a cross-sectional study of Kenyan young children (≤5 years) presenting to MCH clinics, child health records were reviewed to determine coverage of immunizations, growth monitoring, vitamin A supplementation, and deworming. Among 78 children and their caregivers, nearly 70% of children were fully vaccinated for their age. ResultsWe found a significant disparity in full vaccination coverage by gender (p = .017), as males had 3.5x higher odds of being fully vaccinated compared to females. Further, full vaccination coverage also varied across MCH clinic sites ranging from 43.8% to 92.9%. ConclusionsHealth service coverage for Kenyan children in this study is consistent with national and sub-national findings; however, our study found a significant gender equity gap in coverage at these six clinics that warrants further investigation to ensure that all children receive critical preventative services.
Tailoring the Determinants of Implementation Behaviour Questionnaire (DIBQ) to best-practice low back pain primary care program implementation: a mixed-methods validity-testing in Sweden and Denmark
Authors: Ris Inge , Schröder Karin , Kongsted Alice , Abbott Allan , Nilsen Per , Hartvigsen Jan , Öberg Birgitta
Published: January 2020

Background: Best-practice low back pain (LBP) primary care programs have been developed based on evidence-based clinical guidelines and are implemented in Sweden and Denmark. The Theoretical Domains Framework and its linkage to The Behavioural Change Wheel has been utilised in the design of the implementation object and its implementation strategy. Based on the Theoretical Domains Framework domains, the Determinants of Implementation Behaviour Questionnaire (DIBQ) has been developed to evaluate implementation determinants but its feasibility and validity needs to be tested and adapted to study specific contexts while maintaining its linkage to the Behavioural Change Wheel. The aim of this study was to tailor the DIBQ for evaluation of the implementation processes for best-practice LBP primary care programs in Sweden and Denmark. More specifically, the objectives were to i) Translate the DIBQ into Swedish and Danish, ii) Adapt the DIBQ into DIBQ-tailored (DIBQ-t) to study content validity, iii) Test the DIBQ-t for feasibility and iv) Perform initial validity testing of DIBQ-t. Methods: A mixed methods design with a four-step process was used. First, forward translation of the DIBQ, then adaptation into DIBQ-t using qualitative face validity assessed by the project group followed by quantitative content validity assessment by an expert group. Finally, primary care clinicians completed the DIBQ-t directly after participation in a 2-day educational course prior to the implementation of the program to determine feasibility and construct validity using confirmatory factor analyses. Results: In total 598 clinicians out of 609 responded, with only 2% of the items missing. The final DIBQ-t included 28 items describing 10 of the original 18 TDF domains and was considered feasible. The confirmatory factor analyses showed good fit after removing items 4 and 13 with the lowest domain loading. The DIBQ-t maintained linkage to all domains of the Capability–Opportunity-Motivation-Behaviour model within the Behavioural Change Wheel. The clinicians´ expectations according to the DIBQ-t indicate facilitating determinants outweighing barriers at the initiation of implementation processes. Conclusions: The study resulted in a tailored version of the DIBQ, DIBQ-t, which is feasible and valid for evaluating clinicians’ expectations regarding implementation determinants of best-practice LBP primary care programs.
Fenobody and RANbody-based sandwich enzyme-linked immunosorbent assay to detect Newcastle disease virus
Authors: Ji Pinpin , Zhu Jiahong , Li Xiaoxuan , Fan Wenqi , Liu Qianqian , Wang Kun , Zhao Jiakai , Sun Yani , Liu Baoyuan , Zhou En-Min , Zhao Qin
Published: January 2020

Background: Traditional sandwich enzyme-linked immunosorbent assay (ELISA) using polyclonal and monoclonal antibodies as reagents presents several drawbacks, including limited amounts, difficulty in permanent storage, and required use of a secondary antibody. Nanobodies can be easily expressed with different systems and fused with several tags in their tertiary structure by recombinant technology, thus offering an effective detection method for diagnostic purposes. Recently, the fenobody (ferritin-fused nanobody) and RANbody (nanobody-fused reporter) have been designed and derived from the nanobody for developing the diagnostic immunoassays. However, there was no report about developing the sandwich ELISA using the fenobody and RANbody as pairing reagents.Results: A platform for developing a sandwich ELISA utilizing fenobody as the capture antibody and RANbody as the detection antibody was firstly designed in the study. Newcastle disease virus (NDV) was selected as the antigen, from which 13 NDV-specific nanobodies were screened from an immunized Bactrian camel. Then, 5 nanobodies were selected to produce fenobodies and RANbodies. The best pairing of fenobodies (NDV-fenobody-4, 800 ng/well) and RANbodies (NDV-RANbody-49, 1:10) was determined to develop the sandwich ELISA for detecting NDV. The detection limits of the assay were determined to be 22 of hemagglutination (HA) titers and 10 ng of purified NDV particles. Compared with two commercial assays, the developed assay shows higher sensitivity and specificity. Meanwhile, it exhibits 98.7% agreement with the HA test and can detect the reference NDV strains belonging to Class II but not Class I. Conclusions: In the presented study, the 13 anti-NDV nanobodies binding the NDV particles were first produced. Then, for the first time, the sandwich ELISA to detect the NDV in the different samples has been developed using the fenobody and RANbody as reagents derived from the nanobodies. Considering the rapidly increasing generation of nanobodies, the platform can reduce the cost of production for the sandwich ELISA and be universally used to develop assays for detecting other antigens.
Severe infections following rituximab treatment in antineutrophil cytoplasmic antibody-associated vasculitis
Authors: Li Zhi-Ying , Chen Min , Zhao Ming-Hui
Published: January 2020

Background: Severe infections were not rare in antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) patients treated with rituximab. The current study aimed to evaluate severe infections in AAV patients received rituximab administration in a single Chinese center.Methods: Twenty-seven patients were retrospectively included in this study. Their demographic and clinical data were analyzed. Severe infections were classified as grade ≥3 as proposed by the Common Terminology Criteria for Adverse Events V.4.0.Results: Patients were followed up for 23.6±14.0 months from the time of rituximab initiation (mean rituximab dose 1270.4 mg). Ten severe infection events were recorded in 10 (37.0%) patients, corresponding to an event rate of 20.9 per 100 person-years. Pulmonary infections were the leading infectious complications (90%). Eight of the 10 infections occurred during the first 12 months of follow-up. In multivariable analysis, severe infection in the first year was independently associated with age (HR 1.121, 95% CI 1.011 to 1.243, P=0.031) and serum creatinine level (increased by per 88.4 μmol/L, HR 1.493, 95% CI 1.017 to 2.191, P=0.041).Conclusions: In AAV patients receiving rituximab, severe infections were common even with the low-dose regimen. Pulmonary infections were the leading cause, and most infections occurred during the first 12 months of follow-up. Older age and renal dysfunction were the risk factors for infection.
Classifying maternal deaths in Suriname using WHO ICD-MM: different interpretation by physicians, national and international maternal death review committees
Authors: Kodan Lachmi , Verschueren Kim J.C. , McCaw-Binns Affette M. , Fat Ray Tjon Kon , Browne Joyce L. , Rijken Marcus J. , Bloemenkamp Kitty W.M.
Published: January 2020

Background: Insight into the underlying causes of pregnancy-related deaths is essential to develop policies to avert preventable deaths. The WHO International Classification of Diseases-Maternal Mortality (ICD-MM) guidelines provide a framework for uniform classifications which enables comparison within and between countries and over time. However, despite using the guidelines, differences in classifying pregnancy-related deaths within and among countries remain. We evaluated consensus on maternal death classification using ICD-MM.Methods: Classification of the 2010-2014 pregnancy-related deaths in Suriname were compared (1) between the attending physician (death certificate/medical record) and the national maternal death review (MDR) committee; and (2) between MDR committees from Suriname, Jamaica and the Netherlands. All reviewers applied ICD-MM. The inter-rater reliability (Fleiss kappa [κ]) was used to measure agreement.Results: Nearly half (n=42) of the 89 cases reviewed by the Surinamese MDR committee were classified differently by the attending physicians. There was consensus among the three committees that 16 (18%) possible pregnancy-related deaths were not maternal, with opinions differing on 11 (15%, n=73) maternal deaths. Classification agreement into direct, indirect or unspecified (κ=0.53) and underlying cause attribution (κ=0.52) was moderate. The Dutch committee classified more maternal deaths as unspecified (19%), than the Jamaican (7%) and Surinamese MDR committees (4%). The Surinamese and Jamaican committees achieved better mutual agreement (κ=0.69) than Surinamese and the Dutch committees (κ=0.48). Agreement on the underlying cause category was best for abortive outcomes (κ=0.85) and obstetric hemorrhage (κ=0.74) and worst for unspecified (κ=0.29) and other direct causes (κ=0.32). Conclusions: Maternal death classification differs within Suriname and among MDR committees from different countries. Specific challenges applying ICD-MM included attribution of underlying cause when co-morbidities occur, inclusion of suicides, and maternal deaths occurring outside the country of residence.