bluuebunny/crossref_metadata_2025 huggingface dataset:
Deteção da Infeção por Vírus da Imunodeficiência Humana e Outras Infeções Sexualmente Transmissíveis num Grupo de Trabalhadores/as do Sexo em Contexto Indoor na Área Metropolitana do Porto
Authors: Almeida Nilza , Melo Mariana , Soares Isabel , Carvalho Helena Moura
Published: March 2020

Introdução: O diagnóstico precoce é uma ferramenta incontornável na contenção do vírus da imunodeficiência humana e de outras infeções sexualmente transmissíveis, nomeadamente em populações-chave, das quais fazem parte os/as trabalhadores/as do sexo. Apesar da sua relevância são ainda escassos os estudos epidemiológicos e intervenções que visem a monitorização e diagnóstico das infeções sexualmente transmissíveis em Portugal. Os objetivos do presente estudo são: (i) contribuir para um conhecimento mais aprofundado da epidemiologia de infeções sexualmente transmissíveis e (ii) avaliar a adaptação de métodos de rastreio em meio clínico ao contexto de proximidade em populações ocultas como os/as trabalhadores/as do sexo.Material e Métodos: O rastreio de infeções sexualmente transmissíveis (vírus da imunodeficiência humana 1/2, vírus da hepatite B, vírus da hepatite C, sífilis, clamídia e gonorreia) foi realizado a 100 trabalhadores/as do sexo no âmbito da intervenção de proximidade realizada pelo Porto G na zona Metropolitana do Porto, entre setembro de 2015 e setembro de 2016.Resultados: Foram identificados seis casos reativos para vírus da imunodeficiência humana, cinco de sífilis, oito de clamídia e dois de gonorreia. Não foram detetados resultados positivos para vírus da hepatite B e vírus da hepatite C. Os resultados foram discutidos tendo em conta a gradação de risco e de vulnerabilidade de infeções sexualmente transmissíveis nos diferentes subgrupos de trabalhadores/as do sexo. Discussão: Os resultados deste estudo corroboram a necessidade de promover respostas integradas junto de populações mais afetadas pelo vírus da imunodeficiência humana e outras infeções sexualmente transmissíveis, como são os/as trabalhadores/as do sexo. Também neste grupo, os homens que fazem sexo com homens e as mulheres trans apresentam uma prevalência de vírus da imunodeficiência humana superior à das mulheres cis. As estratégias de intervenção devem ser informadas por estudos epidemiológicos rigorosos.Conclusão: A adaptação da metodologia de rastreio realizada em meio clínico ao contexto de proximidade demonstra ser uma resposta inovadora em território nacional, nomeadamente em populações sentinela.
Sobre a Necessidade de Promover a Prevenção Primária do Traumatismo Craniano
Authors: Mascarenhas Lino
Published: March 2020

N/A.
Mudança de Médico de Família: A Realidade de uma Unidade de Saúde
Authors: Prazeres Filipe , Passos Lígia
Published: March 2020

N/A.
Alterações Neuropsicológicas e Indicação de Cirurgia Bariátrica em Doentes Obesos Graves
Authors: Trindade Eduardo Neubarth , Trindade Manoel RM
Published: March 2020

N/A.
Ficha Técnica AMP33(3) - Março 2020
Authors: Editorial2 Departamento
Published: March 2020

N/a.
Dislipidemia Secundária a Hipotiroidismo e Colestase
Authors: Saavedra Ana , Rodrigues Elisabete , Carvalho Davide
Published: March 2020

Cerca de 28% dos doentes com dislipidemia apresentam na sua etiologia causas secundárias. A resolução de algumas destas causas pode levar à correção total da dislipidemia. Descreve-se o caso de uma doente do sexo feminino, 50 anos, com obesidade grau II e cirrose biliar primária referenciada por dislipidemia mista com mau controlo (sob estatina e fibrato) e com alterações analíticas hepáticas. No estudo efetuado constatou-se hipotiroidismo primário auto-imune. Após normalização da função tiroideia pelo tratamento com levotiroxina, além da suspensão da estatina e fibrato, verificou-se melhoria do perfil lipídico, embora mantendo hipercolesterolemia. Neste período de tempo foi-lhe diagnosticada diabetes mellitus pelo que se instituiu de novo terapêutica com estatina (atorvastatina 10 mg), com normalização do perfil lipídico. Com este caso pretende-se salientar a importância da exclusão de causas secundárias de dislipidemia, nomeadamente o hipotiroidismo, bem como discutir aspectos particulares do tratamento com estatinas na doença hepática.
The Effects of Baduanjin Exercise on BMI, Waist-Hip Ratio and Lipids Among Perimenopausal Women
Authors: Szu Li-Yun , Tsao Lee-Ing
Published: March 2020

Background: The Prevalence of metabolic syndrome is increasing in perimenopausal women. BMI, waist-hip ratio (WHR) and lipids are important factors for controlling metabolic syndrome. The Baduanjin exercise is a traditional Chinese exercise that promotes the integration of physical and mental health, and it is easy to practice at home and fit for busy perimenopausal women. However, the health effects needed to be evaluated.Aim: The purpose of this quasi-experimental research was to evaluate the effects, after twelve weeks of practicing Baduanjin exercise.Methods: This study was conducted at two Buddhism painting clubs, using a parallel-design, control trial recruiting perimenopausal women. There were three instruments: (1) BMI, (2) Waist-Hip Ratio, (3) Lipids—HDL and LDL. The intervention effects from the study baseline to a twelve weeks follow-up were estimated using T-test to evaluate the effectiveness of Baduanjin exercise. The Baduanjin exercise intervention included one-on-one teaching and telephone follow-up to help women practice Baduanjin exercise of 10-15 minutes twice per day for twelve weeks at home. Result: A total of 54 women aged 40 to 60 were recruited from two Buddhism painting clubs. Twenty-seven women were in the experimental group, while 27 women were in the control group. Positive effects were found after 12 weeks doing Baduanjin exercise of 10-15 minutes twice per day at home. In the experimental group, women improved their health by significantly decreasing BMI, increasing HDL, decreasing LDL and more slowly increasing WHR compared with the control group. Conclusion: Baduanjin exercise is a good home exercise to suggest perimenopausal women to improve their BMI, waist-hip ratio and lipid
New Explanation for the Mpemba effect
Authors: Tyrovolas Ilias
Published: March 2020

The purpose of this study is to check out the involvement of entropy in Mpemba effect. Provided that preheating of the water the cooling duration is reduced, we theoretically show that water gains more entropy when warmed and re-cooled to the original temperature.
The Assessment of Carbon Dioxide Dissociation Using Single Mode Microwave Plasma Generator
Authors: Mogildea George , Mogildea Marian , Popa Cristina , Chiritoi Gabriel
Published: March 2020

The paper focuses of the interaction between tungsten (W) wire and microwave field in carbon dioxide (CO2) atmosphere. Our experimental set-up uses a microwave plasma generator in order to generate the plasma from the metallic wires. The microwave plasma generator contain a cylindrical cavity - TM_011 propagation modes, commercial source (magnetron) having the 2.45 GHz frequency at 800 W microwave and power supply. In the focal point of the cylindrical cavity we have a high energy of the electromagnetic radiation. The metallic wires from this area will be vaporized and ionized having as effect CO2 dissociation. The electron temperature regarding metallic plasma produced was estimated using the ratio of atomic emission lines acquired by a high definition of the optical multichannel spectrometer. Determination of the CO2 dissociation quantity was estimated measuring of the carbon monoxide (CO) resulting of the CO2 dissociation process. We obtained a high electron temperature of the plasma and a strong dissociation of the CO2.
Sirtuins, Mitochondria and the Melatonergic Pathway in Alzheimer’s Disease
Authors: Anderson George , Maes Michael
Published: March 2020

Alzheimer's disease (AD) has been the subject of extensive investigation as to its biological underpinnings. However, this has produced little of therapeutic benefit or indeed provided any accepted biomarkers that could tailor treatment. This chapter reviews data on the main pathophysiologic processes that have been widely shown to be altered in AD, including circadian dysregulation, mitochondrial dysfunction, gut dysbiosis, and immune-glia-platelet activation. It is proposed that alterations in the gut microbiome, including gut dysbiosis and increased gut permeability drive changes in mitochondrial function that are intimately associated with significant variations in sirtuin expression. Both mitochondria-located and nucleus/cytoplasm located sirtuins can act on mitochondrial function in different cells and body systems to co-ordinate the ageing-associated changes that underpin AD. The sirtuins are therefore key aspect to a developmental model of AD that is more 'holistic' in perspective, thereby providing a framework for the detection of earlier biomarkers and more successful treatment for the heterogenous nature of AD pathoetiology.
On Efficient Iterative Numerical Methods for Simultaneous Determination of all Roots of Non-Linear Function
Authors: Shams Mudassir , Mir Nazir , Rafiq Naila
Published: March 2020

We construct a family of two-step optimal fourth order iterative methods for finding single root of non-linear equations. We generalize these methods to simultaneous iterative methods for determining all the distinct as well as multiple roots of single variable non-linear equations. Convergence analysis is present for both cases to show that the order of convergence is four in case of single root finding method and is twelve for simultaneous determination of all roots of non-linear equation. The computational cost, Basin of attraction, efficiency, log of residual and numerical test examples shows, the newly constructed methods are more efficient as compared to the existing methods in literature.
Sources of Salinization of Groundwater in the Lower Yarmouk Gorge, East of the River Jordan
Authors: Möller Peter , De Lucia Marco , Rosenthal Eliahu , Inbar Nimrod , Salameh Elias , Magri Fabien , Siebert Christian
Published: March 2020

In the Lower Yarmouk Gorge the chemical composition of regional, fresh to brackish, mostly thermal groundwater reveal a zonation in respect to salinization and geochemical evolution, which is seemingly controlled by the Lower Yarmouk fault (LYF) but does not strictly follow the morphological Yarmouk Gorge. South of LYF the artesian Mukeihbeh well field produces in its central segment groundwaters of almost pure basaltic-rock type with low contribution (<0.3 vol-%) of Tertiary brine, hosted in deep Cretaceous and Jurassic formations. Further distal, the contribution of limestone water increases originating from the Ajloun Mts. North of the LYF, the Mezar wells, the springs of Hammat Gader and Ain Himma produce dominantly limestone water, which contains 0.14-3 vol-% of the Tertiary brine and possess hence variable salinity. The total dissolved equivalents of solutes gained by water/rock interaction (WRI) and mixing with brine, TDE(WRI+brine), amounts to 10-70 % in the region comprising the Mukheibeh field, Ain Himma and Mezar 3 well, to 55-70 % in the springs of Hammat Gader, and to 80-90 % in wells Mezar 1 and 2. The type of salinization indicates that the Lower Yarmouk fault seemingly acts as the divide between the Ajloun and the Golan Heigths dominated groundwater.
The in vitro Efficacy of Betadine Antiseptic Solution and Colloidal Silver Gel Combination in Inhibiting the Growth of Bacterial Biofilms
Authors: Tran Phat , Luth Keaton , Dong Huy , Dev Ameesh , Mehta Dilip , Mitchell Kelly , Moeller Keith , Moeller Cameron , Reid Ted
Published: March 2020

Betadine (Providone-Iodine) solution is a topically applied antiseptic, which has been used for wound care and surgery for decades for the prevention and treatment of skin and wound infections. However, several studies have documented the ineffectiveness of Betadine solution. Other topical antimicrobial dressings, including those that contain silver, have been used in the management of infected wounds. The present study was undertaken to determine if the combination of 5% Betadine solutions and silver colloidal gel (Ag-gel), is more effective than the individual materials in inhibiting the growth of both Gram negative and Gram positive bacteria. These determinations were carried out by both the colony forming unit (CFU) assay, and confocal laser scanning microscopy (CLSM). Ag-gel showed complete inhibition on all the bacteria, except Klebsiella pneumoniae CI strain while 5% Betadine concentrations did not completely kill any of the tested bacteria. However, K. pneumoniae was completely eliminated in the presence of the combination of 5% Betadine solution plus Ag-gel. Confocal laser microscopy confirmed the CFU results. Thus this study demonstrated that while the individual treatments are not effective in killing all the bacteria tested, the combination of 5% Betadine solution and Ag-gel completely kill all bacteria tested, including K. penumoniae CI.
Fullerene Negative Ions: Formation and Catalysis
Authors: Felfli Zineb , Suggs Kelvin , Nicholas Nantambu , Msezane Alfred Z.
Published: March 2020

We first explore negative-ion formation in fullerenes C44, C60, C70, C98, C112, C120, C132 and C136 through low-energy electron elastic scattering total cross sections calculations using our Regge-pole methodology. Water oxidation to peroxide and water synthesis from H2 and O2 are then investigated using the anionic catalysts C44ˉ to C136ˉ. The fundamental mechanism underlying negative-ion catalysis involves hydrogen bond strength-weakening in the transition state. DFT transition state calculations found C60ˉ numerically stable for both water and peroxide synthesis, C100ˉ increases the energy barrier the most and C136ˉ the most effective catalyst in both water synthesis and oxidation to H2O2.
Fractional Partial Differential Equations associated with L$\hat{e}$vy Stable Process
Authors: Aljedhi Reem Abdullah , Kilicman Adem
Published: March 2020

In this study, we first present a time-fractional L$\hat{e}$vy diffusion equation of the exponential option pricing models of European option pricing and the risk-neutral parameter. Then, we modify a particular L$\hat{e}$vy-time fractional diffusion equation of European-style options. Introduce a more general model from the models based on the L$\hat{e}$vy-time fractional diffusion equation and review some recent findings regarding of the Europe option pricing of risk-neutral free.
Autophagy in Astrocytes: Importance for Metabolism
Authors: Ortiz-Rodriguez Ana , Arevalo Maria-Angeles
Published: March 2020

Autophagy is an essential mechanism to maintain cellular homeostasis. Besides its role in controlling the quality of cytoplasmic components, it participates in nutrient obtaining and lipid mobilization under stressful conditions. Furthermore, autophagy is involved in the regulation of systemic metabolic, a function mainly performed by neuronal populations of the arcuate nucleus of the hypothalamus. Several studies have shown that blockade of autophagy in these neurons can affect central regulation of metabolism and impact body energy balance. Moreover, hypothalamic autophagy can be altered during obesity. However, neurons are not the only cell type involved in the central regulation of metabolism. Astrocytes, essential cells for brain homeostasis, are key metabolic regulators. They can sense metabolic signals in the hypothalamus and modulate systemic functions as glucose homeostasis and feeding response. Moreover, the response of astrocytes to obesity has been widely studied. Astrocytes are important mediators of brain inflammation and can be affected by increased levels of saturated fatty acids associated to obesity. Although autophagy plays important roles for astrocyte homeostasis and functioning, the contribution of astrocyte autophagy to systemic metabolism has not been analysed. Furthermore, how obesity can impact astrocyte autophagy is poorly understood. More studies are needed in other to understand the contribution of astrocyte autophagy to metabolism.
Tuning up Transcription Factors for Therapy
Authors: Becskei Attila
Published: March 2020

The recent developments in the delivery and design of transcription factors put their therapeutic applications within reach, exemplified by cell replacement, cancer differentiation and T-cell based cancer therapies. The success of such applications depends on the efficacy and precision in the action of transcription factors. The biophysical and genetic characterization of the paradigmatic prokaryotic repressors, LacI and TetR and the designer transcription factors, TALE and CRISPR-Cas9 revealed common rules, which can help the optimization of activators and repressors. Further studies will be required to analyze the linkage between dissociation constants and enzymatic activity, the role of phase separation and squelching in activation and repression, and the long-range interaction of transcription factors with epigenetic regulators in the context of the chromosomes. Understanding these mechanisms will help to tailor systematically optimized designer transcription factors to the needs of specific applications.
Vitamin D Dietary Intake through Dairy Products to Reduce the Risk of Osteoporosis
Authors: Polzonetti Valeria , Pucciarelli Stefania , Vincenzetti Silvia , Polidori Paolo
Published: March 2020

Background: Vitamin D and calcium are the most important dietary compounds that affect bone mass, even if other minerals (potassium, zinc, etc.) and other vitamins (A, C and K) are also involved. Vitamin D, in fact, plays an important role in calcium homeostasis and calcium absorption. Talking about calcium, it is well known the “calcium paradox”: hip fractures incidence are higher in western countries, where calcium is frequently included in human diet, while the occurrence of these fractures is lower in developing countries, where diets are normally poor in calcium. This paradox may be partially understood considering vitamin D content in serum of local population; a report produced by WHO/FAO experts team investigating on diet, nutrition and the prevention of specific diseases stated that there is enough clinical data demonstrating that an intake of vitamin D and calcium together sufficient to cover dietary requirements can greatly reduce the risk of osteoporotic fracture in older people. Vitamin D can also act as a hormone; vitamin D2 (ergocalciferol) is derived from the UV-B radiation of ergosterol, the vitamin D precursor naturally found in plants, fungi, and invertebrates. Vitamin D3 (cholecalciferol) is originated by sunlight exposure from 7-dehydrocholesterol, a precursor of cholesterol that can also act as a provitamin D3. Dietary intake of vitamin D is very important when skin is exposed for short times to ultraviolet B light (UV-B) one of the three kind of invisible light rays together with UV-A and UV-C. This can be considered the usual situation in some latitude and in winter season, or the typical condition for older people and/or for people with vey white delicate skin. Actually, the recommended daily intake of dietary vitamin D is strictly correlated with age, ranging from 5 μg for infants, children, teen-agers and adults, including women during pregnancy and lactation, to 15 μg for people over 65 years.
More about the Determination of Death by Neurologic Criteria
Authors: Machado Calixto
Published: March 2020

Lewis et al. published an important and timely necessary article about the determination of death by neurological criteria, revising the Uniform Determination of Death.The acceptance of brain death (BD) has been progressively accepted beginning at the late 1950s. Nonetheless, contentious brain-death cases have recently raised new controversies about the diagnosis of BD, such as the Jahi McMath case, extensively covered by the US and international press. Jahi McMath meant a terrible tragedy for her and her family. But further than this gloomy story, the case has also raised confusion and challenging qualms about a fundamental query: how we confirm whether a person is dead or alive? Since 1981, the Uniform Determination of Death Act (UDDA) has served as the legal foundation for the medical practice of determining death. But, although death by neurologic criteria is considered legal death throughout the United States, several recent lawsuits have quizzed the rightfulness the authority of the UDDA to declare death by neurological criteria. This issue explains the importance of Lewis’s et al. paper. In this article I want to present the historical procedure for issuing a law in Cuba for the determination and certification of death. Of course, it is impossible to compare our country with USA. Cuba is a small and developing country, in which a law encompasses a national scenery, in contrast with USA, a multistate nation.
Chemical Synthesis and Characterization of Conducting Polyaniline
Authors: Et al. Hasoon
Published: March 2020

The polyaniline powder was chemically manufactured by direct oxidation of aniline. The resulting polymer was characterized by the results of optical, measurements by (FT-IR) spectroscopy, we have detected some of the absorption peaks located at 3498, 2858 cm-1, which correspond N-H vibrations, and C-H expansion of the aromatic ring respectively as well as stretching vibrations of quinoid ring have been observed. Structural properties, such as the surface topography using an atomic force microscope (AFM), and Surface composition by (SEM) have been studied. The structure of some pellets of polyaniline powder have been examined by using analytical X-ray diffraction technique, the pattern of observed lines shows a crystalline nature and three large peaks observed.
Measurement of the Radon Concentration and Annual Effective Dose in Malva sylvestris (Khabbaz) Plant Used in Traditional Medicine and Food
Authors: Et al. Mohammed
Published: March 2020

In this study, the radon gas concentration as well as the annual effective dose in leaves of the Malvasylvestris (Khabbaz) plant used in the traditional treatment and as food in Iraq, for this, it is necessary to evaluate the concentrations radon gas, which were measured using solid state nuclear track detectors (SSNTDs) CR-39 technique.  The  concentration and annual effective dose in samples were collected from Baghdad city ranged from minimum to maximum value 15.815 , 0.498 , 54.445 , 1.717  respectively, while the values of  concentration and annual effective dose in a sample collected from Karbala are 15.297 ,0.482 . These values of  concentration and annual effective dose less were compared with the samples from Baghdad.  The annual effective dose lies well within the safe limits as recommended by WHO.  So, the uses of Malvasylvestris plant are in traditional medicine and as a safe food for human consumption.
Synthesis, Characteristics and Study the Photoluminscience of the CdSxSe1-x Nanocrystaline Thin Film
Authors: Et al. Jassim
Published: March 2020

The present work focuses on the changing of the structural characteristics of the grown materials through different material characterization methods. Semiconductor CdSxSe 1-x nano crystallines have been synthesized by chemical vapor depostion. (X- ray Diffraction; XRD), (Field Emission Scanning Electron Microscopy; FESEM), measured the characterization of Semiconductor CdSxSe1-x nano crystallines. The optical properties of semiconductor CdSxSe1-x nanocrystallines have been studied by the photoluminescence (PL) (He-Cd pulsed ultraviolet laser at 325nm excitation wavelength) at room temperature. The results showed the change rule of photoluminsence peak at different S/Se ratios according to the photoluminsence spectral analysis technology. The photuminscence peak can be continuously modulated between (500- 650) nm, so the tunable emission of the materials in the present work have novle applications in the area of bioscience and spectroscopy, etc.
Eyewitnesses’ Visual Recollection in Suspect Identification by using Facial Appearance Model
Authors: Et al. Horkaew
Published: March 2020

Facial recognition has been an active field of imaging science. With the recent progresses in computer vision development, it is extensively applied in various areas, especially in law enforcement and security. Human face is a viable biometric that could be effectively used in both identification and verification. Thus far, regardless of a facial model and relevant metrics employed, its main shortcoming is that it requires a facial image, against which comparison is made. Therefore, closed circuit televisions and a facial database are always needed in an operational system. For the last few decades, unfortunately, we have experienced an emergence of asymmetric warfare, where acts of terrorism are often committed in secluded area with no camera installed and possibly by persons whose photos have never been kept in any official database prior to the event. During subsequent investigations, the authorities thus had to rely on traumatized and frustrated witnesses, whose testimonial accounts regarding suspect’s appearance are dubious and often misleading. To address this issue, this paper presents an application of a statistical appearance model of human face in assisting suspect identification based on witness’s visual recollection. An online prototype system was implemented to demonstrate its core functionalities. Both visual and numerical assessments reported herein evidentially indicated potential benefits of the system for the intended purpose.
Estimating Errors When Analyzing Two-Rate Flow Tests
Authors: Earlougher R. C.
Published: March 2020

Pinson1 recently described a technique for simplifying the analysis of two-rate transient flow tests. For rigorous analysis, one should plot Pwfvs (equation).

This graph will have a straight-line section with slope m, which is related to the system transmissibility (kh/µ). Pinson suggests plotting Pwf vs log Δt when the first flow rate, q1, acts over a long time. This plot should have a straight-line portion whose slope, m', is related to system transmissibility.

Pinson does not indicate how long the initial flow period must be before the simplified analysis method provides valid results. This note presents a method for estimating the error obtained in transmissibility and skin factor when the simplified analysis technique is used for a two-rate flow test. This error can be used to decide which analysis technique to use.

By combining the complete flow equations1,2 we obtain the error in calculated transmissibility when the simplified analysis technique is used.
A quantitative assessment of the parameters of the role of receptionists in modern primary care using the work design framework
Authors: Burrows Michael , Gale Nicola , Greenfield Sheila , Litchfield Ian
Published: March 2020

Background
Amidst increased pressures on General Practice across England, the receptionist continues to fulfil key administrative and clinically related tasks. The need for more robust support for these key personnel to ensure they stay focussed and motivated is apparent, however to be effective a more systematic understanding of the parameters of their work is required. Here we present a valuable insight into the tasks they fulfil their relationship with colleagues and their organisation, and their attitudes and behaviour at work collectively defined as their ‘work design’.
Methods
Our aim was to quantitatively assess the various characteristics of receptionists in primary care in England using the validated Work Design Questionnaire (a 21 point validated questionnaire, divided into four categories: task, knowledge and social characteristics and work context with a series of sub-categories within each). This was available online and in addition 500 postal questionnaire were sent to a random sample of 100 general practices across England. An online cross-sectional survey was employed with receptionists (N=54). Additionally (N=16; RR=3.1%).
Results
Seventy participants completed the WDQ; 54 completed the survey online 16 completed the postal version (response rate of 3.1%). Receptionists reported high task variety, task significance and, high level of information processing and knowledge demands, confirming the high cognitive load placed on them by performing numerous yet significant tasks. This complex role required an array of skills, to accommodate their various administrative, communicative, problem solving and decision-making duties they have, and there was a reliance on colleagues for support and feedback.
Conclusion
Research with modern GP receptionists is sparse and little is known formally regarding the parameters of the role. This research explores the work design of GP receptionists and offers clinicians in practice a practical overview of this important and essential role and its implications for the modern GP practice. We suggest a number of ways in to better support the modern receptionist, including separating complex tasks to avoid the errors involved with high cognitive load, providing informal feedback and developing training programmes.
Discontinuing statins or not in the elderly? Study protocol for a randomized controlled trial
Authors: Bonnet Fabrice , Bénard Antoine , Poulizac Pierre , Afonso Mélanie , Maillard Aline , Salvo Francesco , Berdaï Driss , Salles Nathalie , Rousselot Nicolas , Marchi Sébastien , Hayes Nathalie , Joseph Jean-Philippe
Published: March 2020

Background

The risk/benefit ratio of using statins for cardiovascular (CV) primary prevention in elderly people has not been established. The main objectives of the present study are to assess the cost-effectiveness of statin cessation and to examine the non-inferiority of statin cessation in terms of mortality in patients aged 75 and over treated with statins for primary prevention.

Methods

The Statins In The Elderly (SITE) Study is an ongoing 3-year follow-up, open-label comparative multi-centre randomised clinical trial that is being conducted in two parallel groups in outpatient primary care offices.

Participants meeting the following criteria are being included: people aged 75 years and older being treated with statins as primary prevention for CV events who provide informed consent. After randomisation, patients in the statin-cessation strategy are instructed to withdraw their treatment. In the comparison strategy, patients continue their statin treatment at the usual dosage.

The cost-effectiveness of the statin-cessation strategy compared to continuing statins will be estimated through the incremental cost per quality-adjusted life years (QALY) gained at 36 months based on the perspective of the French healthcare system. Overall mortality will be the primary clinical endpoint.

We assumed that the mortality rate at 3 years will be 15%. The sample size was computed to achieve 90% power in showing the non-inferiority of statin cessation, assuming a non-inferiority margin of 5% of the between-group difference in overall mortality. In total, the SITE study will include 2,430 individuals.

Discussion

There is some debate regarding the value of statins in people over 75 years old, especially for primary prevention, due to a lack of evidence of their efficacy in this population, potential compliance-related events, drug-drug interactions and side effects that could impair quality of life. Data from clinical trials guide the initiation of medication therapy for primary or secondary prevention of CV disease but do not define the timing, safety, or risks of discontinuing the agents.

The SITE study is one of the first to examine whether treatment cessation is a cost-effective strategy that has no adverse effects on the prognosis of people over 75 years old formerly treated with statins.

Trial registration

This research has been registered at clinicaltrials.gov under number NCT02547883, 11 September 2015, https://clinicaltrials.gov/ct2/show/NCT02547883
Dispensation of attention deficit hyperactivity disorder (ADHD) medications in patients receiving opioid agonist therapy; a national prospective cohort study in Norway from 2015 to 2017
Authors: Vold Jørn Henrik , Aas Christer , Skurtveit Svetlana , Odsbu Ingvild , Chalabianloo Fatemeh , Halmøy Anne , Johansson Kjell Arne , Fadnes Lars Thore
Published: March 2020

Background
It is estimated that up to a third of patients on opioid agonist therapy (OAT) have attention deficit hyperactivity disorder (ADHD). Treatment by ADHD medication, including a centrally acting stimulant (CAS) or atomoxetine is one of the essential approaches. This study evaluates the use of dispensed ADHD medications in the Norwegian OAT population in the period from 2015 to 2017. Types and doses of ADHD medications, co-dispensations of other potentially addictive drugs like benzodiazepines, z-hypnotics, gabapentinoids, and non-OAT opioids, as well as direct-acting antivirals (DAA) against hepatitis C infection, are investigated.

Methods
Information about all dispensed ADHD medication, OAT opioids, and the defined potentially addictive drugs were recorded from the Norwegian Prescription Database. Dispensation rates, the types, and the doses of dispensed ADHD medications were estimated by summarizing the number of dispensations, and the dispensed doses. Logistic regression analyses were employed to assess the associations between ADHD medication, and OAT opioid use, and dispensations of other potentially addictive drugs and DAAs against hepatitis C infection.

Results
A total of 9,235 OAT patients were included. The proportion of patients who were dispensed ADHD medication increased from 3.5% to 4.6% throughout the study period. The three most dispensed CAS were short- and intermediate-acting methylphenidate (55%), lisdexamphetamine (24%), and dexamphetamine (17%) in 2017. Buprenorphine, rather than methadone, as OAT opioid (adjusted odds ratio: 1.6, CI: 1.2-2.1) was associated with being dispensed ADHD medication. Among patients who received CAS and OAT opioids each calendar year, the dispensed doses of methylphenidate increased from 63 mg/day in 2015 to 76 mg/day in 2017 (p = 0.01). Eighty-five of 142 patients receiving ADHD medications were also dispensed other addictive drugs concomitantly in 2017. Similar results were found in 2015 and 2016.

Conclusion
Co-prescription of ADHD medications was low among patients on OAT in Norway, considering a high prevalence of ADHD in this patient group. On the other hand, concurrent dispensations of multiple addictive drugs were common in this population. Understanding the underlying reasons for such prescribing is essential, and research on how to optimize ADHD medication of patients with ADHD receiving OAT is needed.
Risk factor analysis for predicting kyphosis reoccurrence of thoracolumbar burst fracture patients treated with posterior short-segment fixation
Authors: Sun Xiangyao , Chen Zhaoxiong , Sun Siyuan , Zhang Tongtong , Zhang Xinuo , Hai Yong , Lu Shibao
Published: March 2020

Background: The thresholds of risk factors of kyphosis recurrence in thoracolumbar burst fracture patients were still controversial. The aim of this multi-center study was to identify these thresholds. Methods: 169 patients were included in this study. Upper intervertebral angle (UIVA), lower intervertebral angle (LIVA), Cobb angle (CA), anterior vertebral height ratio (AVH%), regional angle (RA), posterior vertebral height ratio (PVH%), vertebral wedge angle (VWA), anteroposterior ratio (A/P%), Clinical assessment included Load Sharing Classification (LSC) score, Thoracolumbar Injury Classification and Severity (TLICS) score, Visual Analogue Scale (VAS), and Body mass index (BMI) were perioperatively evaluated. Patients were divided into KR group and none KR (NKR) group according to whether the loss of CA correction was less than 5˚ or not. The risk factors of KR before or after implant removal were analyzed, respectively. Results: There were significant improvements in postoperative parameters compared with preoperative parameters, such as AVH%, A/P%, VAS, CA, VWA, PVH% ( P < 0.001, respectively), and UIVA ( P = 0.02). Age (AUC = 0.828) and BMI (AUC = 0.846) were good predictors of KR before implant removal. BMI (AUC = 0.871) was a good predictor of KR after implant removal. Conclusions: There were significant differences in risk factors of KR at different postoperative follow-up stages: age > 49 years, BMI > 24 were risk factors of KR before implant removal; BMI > 25.17 was a risk factor of KR after implant removal.
Comparison of simultaneous bilateral versus unilateral total knee replacement on pain levels and functional recovery
Authors: Alghadir Ahmad H , Iqbal Zaheen A , Anwer Shahnawaz , Anwar Dilshad
Published: March 2020

Background

Total knee replacement is a common operative procedure to improve pain, function, and quality of life in patients with end stage knee osteoarthritis. The current study aimed to compare simultaneous bilateral versus unilateral total knee replacement on pain intensity and recovery of function.

Methods

A total of 80 patients (bilateral 50, unilateral 30) aged 63.28 (9.4) years undergone total knee replacement participated in the current study. The participants were admitted for 5-7 days in the hospital. Participants in both the group received similar inpatient and outpatient physiotherapy sessions. Pain intensity and function capacity were assessed at baseline, day 7, and day 30 post-operatively using visual analogue scale and lower extremity functional scale, respectively. Repeated measures analysis of variance was used to analyze the data.

Results

Both groups showed a significant reduction of pain intensity (Day 0, mean 8.9, SD 1.0; Day 30, mean 2.2, SD 1.3 in bilateral total knee replacement; Day 0, mean 8.8, SD 1.1; Day 30, mean 2.0, SD 1.5 in unilateral total knee replacement; p<0.001) and improvement in the functional capacity (Day 0, mean 16.2, SD 10.1; Day 30, mean 55.6, SD 14.6 in bilateral total knee replacement; Day 0, mean 19.1, SD 9.1; Day 30, mean 56.7, SD 15.8 in unilateral total knee replacement; p<0.001) following total knee replacement at 30 days post-operatively. However, there was a non-significant difference noted between bilateral versus unilateral total knee replacement on the reduction of pain intensity (mean changes, 6.9 versus 6.8) and improvement in the functional capacity (mean changes, 39.4 versus 37.6) at 30 days post-operatively (p>0.05).

Conclusion

Simultaneous bilateral total knee replacement was associated with a similar reduction of pain intensity and recovery of function compared to unilateral total knee replacement, suggesting the use of simultaneous bilateral total knee replacement in patients with bilateral knee osteoarthritis since its costs and rehabilitation process could be reduced compared to staged bilateral total knee replacement.
Ubiquitin-specific protease-44 inhibits the proliferation and migration of cells via inhibition of JNK pathway in clear cell renal cell carcinoma
Authors: Zhou Jiangqiao , Wang Tianyu , Qiu Tao , Chen Zhongbao , Ma Xiaoxiong , Zhang Long , Zou Jilin
Published: March 2020

Background: Clear cell renal cell carcinoma (ccRCC) is the most common form of adult kidney cancer. Ubiquitin-specific protease (USP)44 has been reported to be involved in various cancers. We investigated the function, role and molecular mechanism of USP44 in ccRCC. Methods: Data obtained from the Cancer Genome Atlas Data Portal and Gene Expression Omnibus database were analyzed to uncover the clinical relevance of USP44 expression and tumor development. USP44 function in the proliferation and migration of tumor cells was assessed by cellular and molecular analyses using ccRCC lines (786-O cells and Caki-1 cells).Results: USP44 showed low expression in ccRCC cancer tissues compared with that in normal tissue. USP44 expression was negatively correlated with tumor stage, tumor grade, and patient survival . USP44 overexpression inhibited the proliferation and migration of 786-O cells and Caki-1 cells significantly. USP44 overexpression also prohibited cell proliferation by upregulating expression of P21, downregulating cyclin-D1 expression, and inhibiting cell migration by upregulating expression of matrix metalloproteinase (MMP)2 and MMP9. USP44 knockdown enhanced the proliferation and migration of 786-O cells and Caki-1 cells. USP44 function in inhibiting the proliferation and migration of 786-O cells and Caki-1 cells was associated with phosphorylation of Jun N-terminal kinase (JNK). Conclusion: USP44 may be a marker in predicting ccRCC progression. Inhibition by USP44 of the proliferation and migration of 786-O cells and Caki-1 cells is dependent upon the JNK pathway.
Height predict incident non-alcoholic fatty liver disease among general adult population in Tianjin, China, independent of body mass index, waist circumference, waist-to-height ratio, and metabolic syndrome
Authors: Kumari Shubham , Wang Xuena , Liu Yunyun , Gu Yeqing , Huang Yuhan , Zhang Qing , Liu Li , Meng Ge , Wu Hongmei , Sun Shaomei , Wang Xing , Zhou Ming , Jia Qiyu , Wang Guolin , Song Kun , Niu Kaijun
Published: March 2020

Background : Early-life hormonal and nutritional factors can greatly influence the risk of non-alcoholic fatty liver disease (NAFLD). Adult height is a simple marker for these factors. This study aimed to investigate the association between adult height and NAFLD.
Methods : We performed a prospective cohort study of 35,994 participants aged 25 years or over with measured height at baseline. NAFLD was diagnosed by abdominal ultrasound and self-reported history of alcohol intake. Multivariable Cox proportional hazards regression models were conducted to assess the gender-specific association between height and the risk of NAFLD.
Results: During a follow-up period of 5.5 years, 6 ,245 of 35,994 subjects developed NAFLD. The adjusted hazard ratios (95% confidence interval) of NAFLD for increasing quintiles of height were 1.00 (reference), 0.82 (0.73, 0.92), 0.84 (0.73, 0.97), 0.72 (0.61, 0.85) and 0.63 (0.50, 0.79) ( P for trend < 0.0001) in males, and 1.00 (reference), 1.00 (reference), 0.80 (0.69, 0.91), 0.72 (0.61, 0.85), 0.60 (0.49, 0.74) and 0.45 (0.35, 0.59) ( P for trend <0.0001) in females, respectively.
Conclusions: A higher adult height was associated with lower risk of NAFLD among males and females in Tianjin, China.
Meta-analytic evaluation of the correlation between event-free survival and overall survival in randomized controlled trials of newly diagnosed Ewing sarcoma.
Authors: Tanaka Kazuhiro , Kawano Masanori , Iwasaki Tatsuya , Itonaga Ichiro , Tsumura Hiroshi
Published: March 2020

Background

In randomized controlled trials (RCTs) of adjuvant treatment for malignant tumors, event-free survival (EFS) is considered the most acceptable surrogate for overall survival (OS). However, even though EFS has repeatedly been selected as a primary endpoint in RCTs of Ewing sarcoma (ES), the surrogacy of EFS for OS has not been investigated. This study aimed to evaluate the surrogacy of EFS for OS in RCTs of chemotherapy for newly diagnosed ES using a meta-analytic approach.

Methods

We identified seven RCTs of newly diagnosed ES through a systematic review, and a meta-analysis was performed to evaluate the efficacy and adverse events associated with chemotherapy for previously untreated ES. The correlation between EFS and OS was investigated using weighted linear regression analysis and Spearman rank correlation coefficients (ρ). The strength of the correlation was evaluated using the coefficient of determination (R2).

Results

A total of 3,612 patients were randomly assigned to 17 treatment arms in the eligible RCTs. The meta-analysis revealed that the hazard ratios for OS and EFS showed significantly better results in the experimental treatment groups with increasing toxicities. The correlation between the hazard ratios for EFS and OS was good (R2 = 0.747, ρ = 0.683), and the correlation tended to be more favorable in cases of localized ES (R2 = 0.818, ρ = 0.929).

Conclusions

Overall, the trial-level correlation between EFS and OS was good for newly diagnosed ES and was very good in cases of localized disease. EFS may be useful as a surrogate endpoint in RCTs of ES, and the surrogacy of EFS is worth verifying using individual data.
Long Term Outcomes of Cataract Surgery in Severe and End Stage Glaucoma with Controlled IOP:A Retrospective Study
Authors: Fu Lin , Chan Yau Kei , Li Junhua , Nie Li , Li Na , Pan Weihua
Published: March 2020

Background: To investigate the long term surgical outcomes of cataract surgery in severe and end stage glaucoma patients with preoperative intraocular pressure less than 21mmHg, and to detect the associated factors.Methods: A retrospective study of primary angle closure glaucoma patients was conducted on who underwent cataract surgery or combined with goniosynechialysis from March 2015 to April 2018. Main outcome measures were visual acuity, intraocular pressure, number of glaucoma medications and complications. Results: Sixteen patients (19 eyes) were included. The mean age was 64.89 ± 11.68 years and the mean followed up duration was 21.89 ± 7.85 months. The final visual acuity was significantly improved from 0.69 ± 0.55 to 0.46 ± 0.52 logMAR , within 12 (63.2%) eyes improved, 4 (21.1%) eyes kept unchanged, and 3 (15.8%) eyes reduced. Linear regression analysis indicated that higher mean deviation, higher visual field index and lower glaucoma stage associated with better final visual acuity (r = -0.511, r = -0.493, r = 0.537 respectively). Moreover, the final number of medications were reduced from 1.26 ± 0.99 to 0.26 ± 0.56 (p < 0.01). The mean intraocular pressure was not significantly reduced with the final IOP of 14.48 ± 3.74 mmHg (p = 0.97). While the eyes with intraocular pressure above 15 mmHg was decreased to 6 (31.6%) eyes compared to 10 (52.6%) eyes at baseline. Moreover, the number of eyes free of medications was increased from 4 (21.1%) preoperatively to 15 (78.9%) eyes postoperatively.Conclusions: Final visual acuity was significantly improved in the severe and end stage primary angle closure glaucoma patients and the number of eyes came off medications increased by 57.8% after cataract surgery. Preoperatively, the glaucoma stage, mean deviation and visual field index are important parameters to predict the final visual acuity after cataract surgery.
Knowledge, attitudes and practices towards viral haemorrhagic fevers amongst healthcare workers in urban and rural public healthcare facilities in the N’zérékoré prefecture, Guinea: a cross-sectional study
Authors: Raab Manuel , Pfadenhauer Lisa M. , Millimouno Tamba Jacques , Hoelscher Michael , Froeschl Guenter
Published: March 2020

Introduction: The 2013-2016 Ebola epidemic in West Africa began in Guinea’s Forest region, a region now considered to be at high risk for future epidemics of viral haemorrhagic fevers (VHF). Good knowledge, attitudes and practices towards VHF amongst healthcare workers in such regions are a central pillar of infection prevention and control (IPC). To inform future training in IPC, this study assesses the knowledge, attitudes and practices (KAP) towards VHF amongst healthcare workers in public healthcare facilities in the most populated prefecture in Forest Guinea, and compares results from urban and rural areas.
Methods: In June and July 2019, we interviewed 102 healthcare workers in the main urban and rural public healthcare facilities in the N’zérékoré prefecture in Forest Guinea. We used an interviewer-administered questionnaire adapted from validated KAP surveys.
Results: The great majority of respondents demonstrated good knowledge and favourable attitudes towards VHF. However, respondents reported some gaps in preventive practices such as VHF suspect case detection. They also reported a shortage of protective medical equipment used in everyday clinical work in both urban and rural healthcare facilities and a lack of training in IPC, especially in rural healthcare facilities. However, whether or not healthcare workers had been trained in IPC did not seem to influence their level of KAP towards VHF.
Conclusions: Three years after the end of the Ebola epidemic, our findings suggest that public healthcare facilities in the N’zérékoré prefecture in Forest Guinea still lack essential protective equipment and some practical training in VHF suspect case detection. To minimize the risk of future VHF epidemics and improve management of outbreaks of infectious diseases in the region, current efforts to strengthen the public healthcare system in Guinea should encompass questions of supply and IPC training.