bluuebunny/crossref_metadata_2025 huggingface dataset:
Neuroprotective effect of astrocyte-derived IL-33 in neonatal hypoxic-ischemic brain injury
Authors: Jiao Mengya , Li Xiangyong , Chen Liying , Wang Xiaodi , Yuan Baohong , Liu Tao , Dong Qun , Mei Hanfang , Yin Hui
Published: March 2020

Background: Interleukin-33 (IL-33) is a well-recognized pleiotropic cytokine which plays crucial roles in immune regulation and inflammatory responses. Recent studies suggest that IL-33 and its receptor ST2 are involved in the pathogenesis of neurological diseases. Here, we explore the effect of IL-33/ST2 signaling in neonatal hypoxic-ischemic (HI) brain injury and elucidate the underlying mechanisms of action.Methods: The brain HI model was established in neonatal C57BL/6 mice by left common carotid artery occlusion with 90 min hypoxia, and treated with IL-33 at a dose of 0.2 μg/day i.p. for three days. TTC staining and neurobehavioral observation were used to evaluate the HI brain injury. Immunofluorescence and flow cytometry were applied to determine the expression of IL-33 and its receptor ST2 on brain CNS cells, cell proliferation and apoptosis. OGD experiment was used to assay the viability of astrocytes and neurons. RT-qPCR was used to measure the expression of neurotrophic factor-associated genes.Results: The expression level of IL-33 was markedly enhanced in astrocytes 24 h after cerebral HI in neonatal mice. Exogenous delivery of IL-33 significantly alleviated brain injury 7 d after HI, whereas ST2 deficiency exacerbated brain infarction and neurological deficits post HI. Flow cytometry analyses demonstrated high levels of ST2 expression on astrocytes, and the expression of ST2 was further elevated after HI. Intriguingly, IL-33 treatment apparently improved astrocyte response and attenuated HI-induced astrocyte apoptosis through ST2 signaling pathways. Further in vitro studies revealed that IL-33-activated astrocytes released a series of neurotrophic factors, which are critical for raising neuronal survival against oxygen glucose deprivation. Conclusions: The activation of IL-33/ST2 signaling in the ischemic brain improves astrocyte response, which in turn affords protection to ischemic neurons in a glial-derived neurotrophic factor-dependent manner.
Dissection of the mutation accumulation process during bacterial range expansions
Authors: Bosshard Lars , Peischl Stephan , Ackermann Martin , Excoffier Laurent
Published: March 2020

Background

Recent experimental work has shown that the evolutionary dynamics of bacteria expanding across space can differ dramatically from what we expect under well-mixed conditions. During spatial expansion, deleterious mutations can accumulate due to inefficient selection on the expansion front, potentially interfering with and modifying adaptive evolutionary processes.

Results

We used whole genome sequencing to follow the genomic evolution of 10 mutator Escherichia coli lines during 39 days (∼1650 generations) of a spatial expansion, which allowed us to gain a temporal perspective on the interaction of adaptive and non-adaptive evolutionary processes during range expansions. We used elastic net regression to infer the positive or negative effects of mutations on colony growth. The colony size, measured after three day of growth, decreased at the end of the experiment in all 10 lines, and mutations accumulated at a nearly constant rate over the whole experiment. We find evidence that beneficial mutations accumulate primarily at an early stage of the experiment, leading to a non-linear change of colony size over time. Indeed, the rate of colony size expansion remains almost constant at the beginning of the experiment and then decreases after ∼12 days of evolution. We also find that beneficial mutations are enriched in genes encoding transport proteins, and genes coding for the membrane structure, whereas deleterious mutations show no enrichment for any biological process.

Conclusions

Our experiment shows that beneficial mutations target specific biological functions mostly involved in inter or extra membrane processes, whereas deleterious mutations are randomly distributed over the whole genome. It thus appears that the interaction between genetic drift and the availability or depletion of beneficial mutations determines the change in fitness of bacterial populations during range expansion.
Contralateral C7 Transfer to Axillary and Median Nerves in Rats with Total Brachial Plexus Avulsion
Authors: Liu Yuzhou , Xiao Feng , Zhuang Yongqing , lao jie
Published: March 2020

Background: Contralateral cervical 7 nerve (cC7) was used to repair two recipient nerves simultaneously for patients with total brachial plexus avulsion (TBPA). Objective: To evaluate the effect of cC7 transfer to axillary and median nerves in rats with TBPA. Methods: Eighty S-D rats were divided into 4 groups randomly on average. Group A: cC7 － median nerve, Group B: cC7 － axillary nerve, Group C: cC7 － median and axillary nerves, Group D: TBPA without repair. The evaluation tools included behavioral tests, electromyogram (EMG), measurement of cross-sectional area of muscle fiber, nerve fiber count and gene expression assay. Results: The effective rates of EMG were 90% and 70% in Flexor Carpi Radialis (FCR) in Group A and C, while 70% and 60% in deltoid (DEL) in Group B and C, respectively. In behavioral test, the differences of effective rates between groups were not significant. The mean cross-sectional area of FCR in Group A or C was significantly larger than that in Group D. Either the number of median or axillary nerve fibers in Group A, B or C was statistically more than that in Group D. No matter for FCR or DEL, there were no significant differences in the ratios of relative expression of Muscle Atrophy F-box （ MAFBOX ） and Muscle RING Finger 1 （ MURF1 ） among these groups. Conclusion: Compared with cC7 transfer to median nerve, cC7 transfer to both median and axillary nerves did not affect median nerve recovery. The deltoid muscle also could be restored. The recovery proportion of axillary nerve was less than that of median nerve.
Preoperative SCC-Ag as a predictive marker for the use of adjuvant chemotherapy in cervical squamous cell carcinoma with intermediate-risk factors
Authors: Guo Hong-tao , Bi Xue-han , Lei Ting , Lv Xiao , Yao Guang , Chen Yao , Liu Chang
Published: March 2020

Purpose: For cervical cancer patients whose tumors display a combination of intermediate risk factors, postoperative radiation with or without adjuvant chemotherapy is suggested for them. However, who should be administered with adjuvant chemotherapy is unknown. The current study was designed to explore the clinical value of squamous cell carcinoma antigen (SCC-Ag) in guiding the use of adjuvant chemotherapy in cervical cancer patients. Materials and Methods: A retrospective study of 301 cervical cancer patients treated by surgery and adjuvant treatment from March 2006 to March 2016 was performed. All patients were divided into two groups according to receiving adjuvant chemotherapy or not. Overall survival (OS), disease-free survival (DFS) were compare between patients who did and did not receive adjuvant radiotherapy. Multivariate analysis was employed to detect clinical factors associated with disease-free survival, local recurrence-free survival and distant metastasis-free survival. Results: For patients with high pre-treatment SCC-Ag level, DFS and OS in adjuvant chemo-radiotherapy group were higher than that in adjuvant radiotherapy group. Besides, the rates of distant metastasis were found lower in patients who did receive adjuvant chemotherapy than those who did not. For patients with low pre-treatment SCC-Ag level, the 5-year OS and DFS were similar between groups of adjuvant chemo-radiotherapy and adjuvant radiotherapy. Multivariable analysis indicated adjuvant chemotherapy was independent predictors of DFS and distant metastasis-free survival (DMFS) in patients with high SCC-Ag level. Conclusion: SCC-Ag can serve as an indication for the administration of adjuvant chemotherapy in cervical cancer patients.
Therapeutic effects of different treatment periods against ischemic stroke and toxicology study of Angong Niuhuang Pill in rats
Authors: Chen Jianzhao , Chai Yushuang , He Yuanfeng , Huang Jisheng , Wan Ting , Lu Yuan , Peng Zilun , Li Wenjuan , Ning Na , Guo Qiuping
Published: March 2020

Background : Angong Niuhuang Pill (ANP) is one of the most famous drugs to treat stroke in China, but there is no definite treatment period in drug instruction. In this study, we used middle cerebral artery occlusion (MCAO) model to evaluate its therapeutic effects of different treatment periods and studied its toxic effect in rats. Methods : Protective effect of ANP was observed in the cerebral ischemia-reperfusion model in rats; ANP (270 mg/kg) three different treatment period included 1 day, 4 days and 7 days. The observation period was 30 days. Therapeutic effect was evaluated by detecting neurological function, cerebral infraction volume, brain histology and cytokines. Three dose including 550, 1640, 4910 mg/kg were studied in toxicology study. The administration period was 30 days. Toxic effect was evaluated by detecting appearance, behavior, excrement character, food-intake, body weight, hematological parameters and biomarkers such as TBA, GSTα, Cystatin C, clusterin, GSH, S-100B and MBP. Results : Seven days treatment period of ANP had better effect than 1 day and 4 days treatment periods in rat MCAO model from neurological function scores, the volume of cerebral infarction, brain histology and the serum content of IL-1β, TNF-α and NO; the brain content of IL-1β and NO. The results of 30 days multiple dose toxicology study showed no animal death in all groups; in ANP 4910 mg/kg group, the kidney and liver coefficient increased about 10%, the body weight grew more slowly, the TBA increased slightly. There was no abnormal change in histology. These all recovered after drug withdraw for 8 weeks. Conclusion: Seven days treatment period of ANP had more protective effect than 1 day and 4 days treatment periods in ischemic stroke rat. No observed adverse effect level (NOAEL) of ANP was 1640 mg/kg; the safety margin of ANP was 270-1640 mg/kg. These data provided reference to modify drug instruction.
Hepatocellular carcinoma with right atrial tumor thrombus: a systematic review
Authors: Yuan Shi-Min , Guo Yi-Xian
Published: March 2020

Background: Hepatocellular carcinoma with right atrial tumor thrombus is uncommon but with a dismal prognosis.
Methods: By comprehensive retrieval of literature published between 2000 and 2019, 53 reports were obtained with 187 patients recruited into this study. The extracted data included patient characteristics, tumor characteristics, treatment, follow-up and outcomes. Statistical analyses applied were student t , Fisher exact and I 2 tests. Patients were devided into 6 groups according to treatment of choices: transarterial chemoembolization (TACE), surgery, radiotherapy, chemotherapy, interventional treatment and supportive care.
Results: The overall survival rate of this cohort was 40.8%. The survival rate of patients receiving TACE was 33.3% and that of surgical patients was 41.9%. The survival time of patients with TACE was longer than surgical patients, but lack of a statistical significance. Patients had a follow-up of 15.7±16.6 (median 10) months. The patients receiving radiotherapy had the longest follow-up among all groups. Intra- and/or extrahepatic recurrence of hepatocellular carcinoma was the major mobidity. The mortality rates in a decremental sequence for patients receiving different treatments were supportive care >radiotherapy >surgery >TACE >interventional treatment. No difference was found in mortality between patients reported from case reports and those from non-case reports.
Conclusions: Even though advanced hepatocellular carcinoma with right atrial thrombus is an aggressive malignancy, the the present study showed that patients’ prognosis was improved and survival time elongated with active treatments such as TACE and surgery. The present systematic review reveals improved outcomes with active treatments against conservative treatments.
Wrist deformity, bother and function following wrist fracture in the elderly
Authors: Lawson Andrew , Santhakumar Partiban , Naylor Justine M , Churches Tim , Frost Steve , Harris Ian A
Published: March 2020

Objective Wrist deformity in older people is common following treatment for a wrist fracture, particularly after non-surgical treatment. A cohort of older wrist fracture patients were surveyed by telephone regarding perceived deformity, bother with deformity and patient-reported wrist function. The objectives were to: 1. determine whether older patients with wrist fractures perceived a deformity of their wrist and if they were bothered by it; 2. test if there were associations between deformity and treatment-type and between deformity and function; 3. test for associations between bother and treatment-type and between bother and function; 4. measure the test-retest reliability of the ‘bother’ question. Results Of 98 eligible patients who were invited to participate, 41 responded. Out of 41, 14 (34%) believed they had a deformity and 4 (10%) reported that they were bothered by the appearance of their wrist. Deformity was associated with non-surgical treatment (RR=3.85, p=0.006) but was not significantly associated with functional outcomes (p=0.15). All those who were bothered belonged to the non-surgical treatment group. Bother was significantly associated with poorer functional outcomes (p=0.006) and this association was clinically significant (MD=35 points). The deformity and bother questions were found to have excellent test-retest reliability; ᴋ=1.00 and ᴋ=0.92, respectively.
Structured reporting has the potential to reduce reporting times of dual-energy x-ray absorptiometry exams
Authors: Kim Su Hwan , Sobez Lara M. , Spiro Judith E. , Curta Adrian , Ceelen Felix , Kampmann Eric , Goepfert Martin , Bodensohn Raphael , Meinel Felix G. , Sommer Wieland H. , Sommer Nora N. , Galiè Franziska
Published: March 2020

Background
In recent years, structured reporting has been shown to be beneficial with regard to report completeness and clinical decision-making as compared to free-text reports (FTR). However, the impact of structured reporting on reporting efficiency has not been thoroughly evaluted yet. The aim of this study was to compare reporting times and report quality of structured reports (SR) to conventional free-text reports of dual-energy x-ray absorptiometry exams (DXA).

Methods
FTRs and SRs of DXA were retrospectively generated by 2 radiology residents and 2 final-year medical students. Time was measured from the first view of the exam until the report was saved. A random sample of DXA reports was selected and sent to 2 referring physicians for further evaluation of report quality.

Results
A total of 104 DXA reports (both FTRs and SRs) were generated and 48 randomly selected reports were evaluated by referring physicians. Reporting times were shorter for SRs in both radiology residents and medical students with median reporting times of 2.7 min (residents: 2.7, medical students: 2.7) for SRs and 6.1 min (residents: 5.0, medical students: 7.5) for FTRs. Information extraction was perceived to be significantly easier from SRs vs FTRs (P<0.001). SRs were rated to answer the clinical question significantly better than FTRs (P<0.007). Overall report quality was rated significantly higher for SRs compared to FTRs (P<0.001) with 96% of SRs vs 79% of FTRs receiving high or very high-quality ratings. All readers except for one resident preferred structured reporting over free-text reporting and both referring clinicians preferred SRs over FTRs for DXA.

Conclusions
Template-based structured reporting of DXA might lead to shorter reporting times and increased report quality.
A model for evaluation of the electric activity and oxygenation in the erector spinae muscle during isometric loading adapted for spine patients
Authors: Ekström Lars , Zhang Qiuxia , Abrahamson Josefin , Beck Joel , Johansson Christer , Westin Olof , Todd Carl , Baranto Adad
Published: March 2020

Background:
Simultaneous measurement of electromyography (EMG) and local muscle oxygenation is proposed in an isometric loading model adjusted for patients that have undergone spinal surgery.
Methods:

Twelve patients with degenerative lumbar spinal stenosis (DLSS) were included. They were subjected to a test protocol before and after surgery. The protocol consisted of two parts, a dynamic and an isometric Ito loading with a time frame of 60 seconds and accompanying rest of 120 seconds. The Ito test was repeated three times. EMG was measured bilaterally at the L4 level and L2 and was recorded using surface electrodes and collected (Biopac Systems Inc). EMG signal was expressed as RMS and median frequency (MF). Muscle tissue oxygen saturation (MrSO 2 ) was monitored using a Near-infrared spectroscopy (NIRS) device ( INVOS ® 5100C Oxymeter). Two NIRS sensors were positioned bilaterally at the L4 level.

The intensity of the leg and back pain and perceived exertion before, during and after the test was evaluated with a Visual Analogue Scale (VAS) and Borg RPE-scale, respectively.
Results:

All patients were able to perform and complete the test protocol pre- and postoperatively. A consistency of lower median and range values was noted in the sensors of EMG1 (15.3 µV, range 4.5-30.7 µV) and EMG2 (13.6 µV, range 4.0 -46.5 µV) that were positioned lateral to NIRS sensors at L4 compared with EMG3 (18.9 µV, range 6.5 -50.0 µV) and EMG4 (20.4 µV, range 7.5 -49.0 µV) at L2. Right and left side of the erector spinae exhibited a similar electrical activity behaviour over time during Ito test (60s). Regional MrSO 2 decreased over time during loading and returned to the baseline level during recovery on both left and right side. Both low back and leg pain was significantly reduced postoperatively.
Conclusion:

Simultaneous measurement of surface EMG and NIRS seems to be a promising tool for objective assessment of paraspinal muscle function in terms of muscular activity and local muscle oxygenation changes in response to isometric trunk extension in patients that have undergone laminectomy for spinal stenosis.

Keywords:
Spinal stenosis, EMG, NIRS, paraspinal muscle, muscle oxygenation, muscle activity, laminectomy.
Personalising screening of sight-threatening diabetic retinopathy - qualitative evidence to inform effective implementation
Authors: Byrne Paula , Thetford Clare , Gabbay Mark , Clarke Pam , Doncaster Emily , Harding Simon
Published: March 2020

Background

Internationally, systematic screening for sight-threatening diabetic retinopathy (STDR) usually includes annual recall. Researchers and policy-makers support extending screening intervals, citing evidence from observational studies with low incidence rates. However, there is little research around the acceptability to people with diabetes (PWD) and health care professionals (HCP) about changing eye screening intervals.

Methods

We conducted a qualitative study to explore issues surrounding acceptability and the barriers and enablers for changing from annual screening, using in-depth, semi-structured interviews analysed using the constant comparative method. PWD were recruited from general practices and HCPs from eye screening networks and related specialties in North West England using purposive sampling. Interviews were conducted prior to the commencement of and during a randomised controlled trial (RCT) comparing fixed annual with variable (6, 12 or 24 month) interval risk-based screening.

Results

Thirty PWD and 21 HCP participants were interviewed prior to and 30 PWD during the parallel RCT. The data suggests that a move to variable screening intervals was generally acceptable in principle, though highlighted significant concerns and challenges to successful implementation. The current annual interval was recognised as unsustainable against a backdrop of increasing diabetes prevalence. There were important caveats attached to acceptability and a need for clear safeguards around: the safety and reliability of calculating screening intervals, capturing all PWDs, referral into screening of PWDs with diabetic changes regardless of planned interval. For PWDs the 6-month interval was perceived positively as medical reassurance, and the 12-month seen as usual treatment. Concerns were expressed by many HCPs and PWDs that a 2-year interval was too lengthy and was risky for detecting STDR. There were also concerns about a negative effect upon PWD care and increasing non-attendance rates. Amongst PWDs, there was considerable conflation and misunderstanding about different eye-related appointments within the health care system.

Conclusions

Implementing variable-interval screening into clinical practice is generally acceptable to PWD and HCP with important caveats, and misconceptions must be addressed. Clear safeguards against increasing non-attendance, loss of diabetes control and alternative referral pathways are required. For risk calculation systems to be safe, reliable monitoring and clear communication is required.
Pioglitazone for primary stroke prevention in Asian patients with type 2 diabetes and cardiovascular risk factors: A retrospective study
Authors: Hung Yi-Chih , Chiu Lu-Ting , Huang Hung-Yu , Bau Da-Tian
Published: March 2020

Background: To date, studies assessing the efficacy of pioglitazone solely for primary stroke prevention in Asian patients with type 2 diabetes mellitus (DM) and present multiple cardiovascular (CV) risk factors are rare. Thus, we aimed to assess the effect of pioglitazone on primary stroke prevention in Asian type 2 DM patients without established CV diseases but with risk factors for CV diseases. Methods: Between 2000 and 2012, we enrolled patients aged ≥18 years who were newly diagnosed with type 2 diabetes and had at least one of the following CV risk factors: hypertension, hyperlipidemia, proteinuria, and obesity. Patients with a history of stroke and those using insulin or glucagon-like peptide-1 agonist for more than 3 months were excluded. Patients were divided into the pioglitazone user group and non-pioglitazone user group based on their receipt of pioglitazone during the follow-up period. Propensity-score matching (1:1) was used to balance the distribution of the baseline characteristics and medications. Follow-up was terminated upon ischemic stroke development, withdrawal from the insurance system, or on December 31, 2013, whichever occurred first. The overall incidence of new-onset ischemic stroke in the two groups was subsequently compared. Subgroup analyses of ischemic stroke were conducted using different baseline features. Additionally, the effect of the pioglitazone exposure dose on the occurrence of ischemic stroke was evaluated. The chi-square test, Student’s t-test, Kaplan–Meier method, and log-rank test were some of the statistical tests conducted herein.Results: A total of 6,637 patients were included in the pioglitazone and non-pioglitazone group. Compared to patients who did not receive pioglitazone, those administered pioglitazone had a lower risk of developing ischemic stroke (adjusted hazard ratio: 0.72; 95% confidence interval: 0.57–0.9). Subgroup analyses defined by different baseline features did not reveal significant alterations to the observed effect of pioglitazone. Moreover, a significant trend regarding the decrease in ischemic stroke risk and the increase in pioglitazone dose (p-value for trend=0.03) was observed.Conclusion: Pioglitazone use decreased the risk of new-onset ischemic stroke in Asian patients with type 2 DM and CV risk factors.
Thermal effect of holmium laser during ureteroscopic lithotripsy
Authors: Liang Hui , Liang Lijian , Yu Yin , Huang Bin , Chen Jia’nan , Wang Chaoguo , Zhu Zhangguo , Liang Xiaozhong
Published: March 2020

Background: Holmium laser lithotripsy is the most common technique for the management of ureteral stone. Studies founded that holmium laser firing can produce lethal heating which will cause thermal injury towards ureter. The aim of our current study is to explore factors affecting thermal effect of holmium laser during ureteroscopic lithotripsy.Materials and Methods: An in vitro experimental model is design to simulate the ureteroscopic lithotripsy procedure. Different laser power settings (10w (0.5JX20Hz, 1.0JX10Hz), 20w (1.0JX20Hz, 2.0JX10Hz), 30w (1.5JX20Hz, 3.0JX10Hz)) with various firing time (3s, 5s, 10s) and irrigation flow rates（10ml/min, 15ml/min, 20ml/min and 30ml/min）were employed in the experiment. The temperature around the laser tip was recorded by thermometer.Results: The temperature in the “ureter” rises significantly with the increasing laser power, prolonging firing time and reducing irrigation flow. The highest regional temperature is 78.0℃ at the experimental set-up, and the lowest temperature is 23.5℃. Higher frequency setting produces more heat at the same power. Laser power<=10w, irrigation flow>=30ml/ml and “high-energy with low-frequency” can permit a safe working temperature.Conclusion: We clarify that the thermal effect of holmium laser is related with both laser working parameters and irrigation flow. The proper setting is the key factor to ensure the safety during ureteroscopic holmium laser lithotripsy.
Biofilm formation on three different endotracheal tubes: A prospective clinical trial
Authors: Thorarinsdottir Hulda Rosa , Kander Thomas , Holmberg Anna , Petronis Sarunas , Klarin Bengt
Published: March 2020

Background: Biofilm formation on endotracheal tubes (ETTs) is an early and frequent event in mechanically ventilated patients. The biofilm is anticipated to act as a reservoir for infecting microorganisms, contributing to the development and relapses of ventilator-associated pneumonia (VAP). Once a biofilm has formed on an ETT surface it is difficult to eradicate. The aims of this clinical study were to compare biofilm formation on three widely used ETT´s with different surface properties and to explore possible predictive factors of biofilm formation.
Methods: The grade of biofilm formation on endotracheal tubes of polyvinyl chloride (PVC), silicone-coated PVC, and PVC coated by noble metals were compared after mechanical ventilation for > 24 hours in critically ill patients. The comparison was based on scanning electron microscopy (SEM) observations of ETT surfaces and biofilm grading, surveillance and biofilm cultures, and the occurrence of VAP.
Results: A high-grade (score ≥ 7) biofilm formation on the ETTs was associated with the development of VAP (OR, 4.17; 95% CI 1.14 to 15.3; p = 0.031). Silicone-coated ETTs and PVC tubes coated with noble metals were independently associated with reduced high-grade biofilm formation compared to non-coated PVC ETTs (OR, 0.18; 95% CI 0.06 to 0.59; p = 0.005 and OR, 0.34; 95% CI 0.13 to 0.93; p = 0.036, respectively). No significant difference was detected between silicon-coated ETTs and noble metal-coated ETTs (OR, 0.54; 95% CI 0.17 to 1.65; p = 0.278). The microbes found in the ETT biofilm were frequently found in surveillance cultures at intubation and often remained in the biofilm after appropriate antibiotic therapy. Colonization with common VAP pathogens in surveillance cultures or duration of invasive ventilation did not predict higher biofilm formation on ETTs.
Conclusion: Biofilm formation on ETTs were an early and frequent event in critically ill patients. High-grade biofilm formation on ETTs was associated with the development of VAP. Silicone-coated ETTs and PVC tubes coated with noble metals were independently associated with reduced high-grade biofilm formation in comparison to non-coated PVC ETTs. Clinicians may consider changing the ETT after an episode of VAP to avoid microbial persistence and possibly VAP relapse.
Risk assessment for foot ulcers among Tunisian subjects with diabetes: a cross sectional outpatient study
Authors: Zantour Baha , Bouchareb Soumaya , Ati Zohra El , Boubaker Fadia , Alaya Wafa , Kossomtini Wassiaa , Sfar Mmohamed Habib
Published: March 2020

BackgroundDiabetic foot is an underestimated and redoubtable diabetes complication. The aims of our study were to assess diabetic foot ulcer risk factors according to International Working Group on the Diabetic Foot (IWGDF) classification, stratify patients into risk categories and identify factors associated with higher-risk gradeMethodsCross-sectional setting over a period of 07 months, patients were randomly selected from the diabetic outpatients attending our unit of diabetology. Questionnaire and clinical examination were made by the same physician. Patients free of active foot ulcer were included. ResultsAmong 230 patients evaluated, 10 had an active foot ulcer and were excluded. Five patients (2.27%) had a history of foot ulcer and 3(1.36%) had a lower-limb amputation. Sensory neuropathy, as measured by the 5.07(10g) Semmes-Weinstein monofilament testing, was present in 23.63% of patients, whereas 36.82% had a peripheral arterial disease based on clinical findings, and 43.63% had foot deformities. According to the IWGDF classification, Group 0: 72.72%, Group 1: 5.9%, Group 2: 17.73% and Group 3: 3.63%. After univariate analysis, patients in higher–risk groups were significantly more often female, had higher age and BMI, longer diabetes duration, elevated waist circumference, low school level, retinopathy and hyperkeratosis. Multivariate logistic regression analysis identified 3 significant independent factors associated with high-risk groups: retinopathy (OR=2.529, CI95 [1.131-5.655], p=0.024), hyperkeratosis (OR=2.658, CI95 [1.222-5.783], p=0.014) and school level (OR=0.489, CI95 [0.253-9.44], p=0.033)Conclusions Risk factors for foot ulceration were rather common in diabetic outpatients. The screening of diabetic patients at risk for foot ulceration should start early, integrated with sustainable patient education
Frequency of kdr mutations in the voltage-sensitive sodium channel (VSSC) gene in Aedes aegypti from Yogyakarta and implications for Wolbachia-infected mosquito trials
Authors: Wuliandari Juli R. , Hoffmann Ary A. , Tantowijoyo Warsito , Endersby-Harshman Nancy M.
Published: March 2020

Background: In the inner city of Yogyakarta, Indonesia, insecticide resistance is expected in the main dengue vector, Aedes aegypti, because of the intensive local application of pyrethroid insecticides. However, detailed information about the nature of resistance in this species is required to assist the release of Wolbachia mosquitoes in a dengue control program so that we can ensure that insecticide resistance in the strain of Ae. aegypti being released matches that of the background population.Methods: High-resolution melt genotyping was used to screen for kdr mutations associated with pyrethroid resistance in the voltage-sensitive sodium channel (VSSC) gene in Ae. aegypti of some areas in the inner city of Yogyakarta.Results: The results show that the V1016G mutation predominated, with individuals homozygous for the 1016G allele at a frequency of 82.1% and the mutant allele G at a frequency of 92%. Two patterns of co-occurrence of mutations were detected in this study, homozygous individuals V1016G/S989P; and heterozygous individuals V1016G/F1534C/S989P. We found the simultaneous occurrence of kdr mutations V1016G and F1534C at all collection sites, but not within individual mosquitoes. Homozygous mutants at locus 1016 were homozygous wildtype at locus 1534 and vice versa, and heterozygous V1016G were also heterozygous for F1534C. The most common tri-locus genotype co-occurrences were homozygous mutant 1016GG and homozygous wild-type FF1534, combined with homozygous mutant 989PP (GG/FF/PP) at a frequency of 38.28%.Conclusions: Given the relatively small differences in frequency of resistance alleles across the city area, locality variations in resistance should have minor implications for the success of Wolbachia mosquito trials being undertaken in the Yogyakarta area.
Characteristics of a single- versus multiple-injection axillary brachial plexus block: a single-blinded randomised, clinical trial
Authors: Grape Sina , Kirkham Kyle , Bloc Sébastien , Albrecht Eric
Published: March 2020

Background. An ultrasound-guided axillary brachial plexus block is usually performed with a multiple-injection technique. However, when the arm is abducted at 160°, the musculocutaneous nerve lies close to the axillary artery, and all four nerves can be blocked with a single-injection. This randomised controlled single-blinded trial tested the hypothesis that a single-injection technique has a reduced procedure time and is as effective as a multiple-injection technique.Methods. Fifty ASA I-III patients were randomised to receive an ultrasound-guided multiple- or single-injection axillary brachial plexus block with 32ml 1:1 mixture of mepivacaine 1% and ropivacaine 0.5%. In the single injection group, the needle was positioned below the axillary artery, without repositioning, while in the multiple injection group, each nerve was blocked separately. The primary outcome was the procedure time. Secondary outcomes included onset time of action, block success rate 30 minutes after injection, and rest, dynamic pain score (numeric rating scale, 0-10) at 24 postoperative hours.Results. The procedure time was significantly reduced in the single-injection group with a mean (95%CI) of 6min (5-6), versus 4min (4-4) in the multiple-injection group (p<0.001). Success rates were 96% [95%CI:80%-100%] and 88% [95%CI:69%-97%] in the single- and multiple-injection groups, respectively (p=0.30). Other secondary outcomes were similar between groups, except onset time that was prolonged in the single-injection group with a mean time (95%CI) of 23min (19-27) versus 17min (15-19), p=0.01.Conclusions. An axillary brachial plexus block performed with a single-injection technique is associated with a reduced procedure time, an increased onset time and an equivalent success rate.
A Comparison of nivolumab and pembrolizumab for advanced NSCLC in the second-line treatment: A Systematic Review and Network Meta-analysis
Authors: zhang jie , zhou rui , zhu jing
Published: March 2020

Objectives : As reported, nivolumab and pembrolizumab have shown to be superior to docetaxel in advanced NSCLC. Therefore, we performed a systematic review and network meta-analysis to compare the efficacy and safety of nivolumab and pembrolizumab. Materials and Methods : Randomized controlled trials (RCTs) assessing the effect and safety of nivolumab or pembrolizumab versus docetaxel for patients with advanced NSCLC in the second-line treatment were included. Two investigators independently searched articles, extracted data, and assessed the quality of included studies. After that, we performed pairwise direct meta-analyses (nivolumab vs. docetaxel and pembrolizumab vs. docetaxel) and indirect comparison (nivolumab vs. pembrolizumab) using network meta-analyses methods. Results : Four RCTs involving 2391 patients were included in the meta-analysis. In analyses of overall survival (OS), progression-free survival (PFS) and overall response rate (ORR) in the direct meta-analysis, nivolumab and pembrolizumab both showed survival benefits when compared with docetaxel. For the indirect comparison, nivolumab show no signifcant difference in OS, PFS and ORR when compared with pembrolizumab (OS: HR 1.03; 95% CI 0.84–1.26; PFS: HR 0.95; 95% CI 0.80–1.14; ORR: HR 1.08; 95% CI 0.67–1.73). For the safety analysis, nivolumab and pembrolizumab both have less toxicity than docetaxel. In indirect comparison, nivolumab showed less all-grade toxicity (OR 0.71; 95% CI 0.49–1.04) and grade 3–5 toxicity (OR 0.32; 95% CI 0.21–0.49) when compared with pembrolizumab.Conclusion : Our meta-analysis suggests that nivolumab and pembrolizumab demonstrated similar clinical benefit for patients with advanced NSCLC in the second-line treatment. It seems that nivolumab has less toxicity when compared with pembrolizumab.
Estimating of the required midwife in maternity ward in hospital using Workload Indicator of Staffing Need Method
Authors: Tabatabaee Seyed Saeed , Daghighbin Elahe
Published: March 2020

Background: Human resources are considered as a major component of the health sector. The aim of this study was to estimate the number of midwives required in maternity wards in hospitals by using WISN method. Methods and Materials: This cross-sectional descriptive study was conducted in three hospitals affiliated to Mashhad University of Medical Sciences in Iran in 2019. The workload and the standard working time were determined through holding expert meetings; available working time was determined through holding meetings with personnel affairs experts and the actual workload was determined based on information management system and information registries. Microsoft Excel and stata were used to analyze data. Results: 10 factors related to midwives’ available working time were identified. Annual available working time for midwives in the studied hospitals was 1378 hours per year. In this study, labor, delivery, recovery and postpartum, recovery after cesarean care and new born cardiopulmonary resuscitation (CPR) were identified as the main activities of midwives. The results have shown that the Centre hospital and the educational hospital faced with 2 and 13 midwives shortage, respectively, while the non-educational hospital had 2 surplus midwives. Conclusion: workforce recruitment has a significant role in the hospitals Keywords: Workload Indicator of Staffing Need, Midwife, Hospital, Workforce
Comparing effects of continuous glucose monitoring systems (CGMs) and self monitoring of blood glucose (SMBG) among adults with type 2 diabetes mellitus: A systematic review protocol
Authors: Zheng Mingyue , Luo Yunting , Lin Wei , Khoja Adeel , He Qian , Yang Shenqiao , Zhao Xuan , Hu Peng
Published: March 2020

Background: Continuous glucose monitors (CGMs) have been used to manage diabetes with reasonable glucose control among patients with type 2 diabetes (T2D) in recent decades. CGM systems measure interstitial fluid glucose levels to provide information about glucose levels, which identifies fluctuation that would not have been identified with conventional self-monitoring. Self-monitoring of blood glucose (SMBG) is a classical tool to achieve glycaemic control. However, the effectiveness of glucose control, costs, and quality of life are needed to evaluate and compare CGM and SMBG among adults with T2D.Methods: The review will compare the various forms of CGM systems (i.e flash-CGM, real-time-CGM, retrospective-CGM) versus SMBG/usual intervention regarding diabetes management among adults with T2D. The following databases will be searched: Cochrane Library, Science Direct, PubMed, EMBASE, CINAHL, PsycINFO, Scopus and grey literature for the identification of studies. The studies involving adults (aged ≥ 18 years old) will be included. We will include and summararize randomised clinical trials (RCTs) with respect to authors, publication type, year, status, and type of devices. Studies published in English between February 2010 and March 2020 will be included as the field of CGMs among T2D patients has emerged over the last decade. Primary outcomes that will be measured will be; HbA1c, body weight, time spent with hypoglycaemia or hyperglycaemia, blood pressure, quality of life. Secondary outcome measured will be morbidity, all-cause mortality, user satisfaction, and barriers. Study selection, data extraction, and risk of bias assessment will be conducted independently by at least two authors. A third author will determine and resolve discrepancies. Moreover, the quality of the evidence of the review will be assessed according to the Grading of Recommendations Assessment, Development and Evaluation Tool (GRADE).Discussion: The systematic review will synthesise evidence on the comparison between using CGMs and SMBG. The results will support researchers and health care professionals to determine the most effective methods/technologies in the overall diabetes management. Moreover, this review will provide more detailed information about the barriers of using CGMs to improve implementation.Systematic review registration: PROSPERO CRD42020149212
Educational Initiatives and Implementation of Electroencephalography into the Acute Care Environment: a protocol of a Systematic Review
Authors: Taran Shaurya , Ahmed Wael , Bui Esther , Prisco Lara , Hahn Cecil , McCredie Victoria A.
Published: March 2020

Background: Use of electroencephalography (EEG) is currently recommended by the American Clinical Neurophysiology Society for a wide range of indications, including diagnosis of nonconvulsive status epilepticus and evaluation of unexplained disorders of consciousness. Data interpretation usually occurs by expert personnel (e.g. epileptologists, neurophysiologists), with information relayed to the primary care team. However, data cannot always be read in time-sensitive fashion, leading to potential delays in EEG interpretation and patient management. Multiple training programs have recently been described to enable non-experts to rapidly interpret EEG at the bedside. A comprehensive review of these training programs, including the tools used, outcomes obtained, and potential pitfalls, is currently lacking. Therefore, the optimum training program and implementation strategy remain unknown.Methods: We will conduct a systematic review of descriptive studies, case series, cohort studies and randomized controlled trials assessing training programs for EEG interpretation by non-experts. Our primary objective is to comprehensively review educational programs in this domain and report their structure, patterns of implementation, limitations, and trainee feedback. Our secondary objective will be to compare the performance of non-experts for EEG interpretation with a gold standard (e.g. interpretation by a certified electroencephalographers). Studies will be limited to those performed in acute care settings in both adult and paediatric populations (intensive care unit, emergency department, or post-anesthesia care units). Comprehensive search strategies will be developed for MEDLINE, EMBASE, WoS, CINAHL, and CENTRAL to identify studies for review. The gray literature will be scanned for further eligible studies. Two reviewers will independently screen the search results to identify studies for inclusion. A standardized data extraction form will be used to collect important data from each study. If possible, we will attempt to meta-analyse the quantitative data. If heterogeneity between studies is too high, we will present meaningful quantitative comparisons of secondary outcomes as per the synthesis without meta-analysis (SWiM) reporting guidelines.Discussion: We will aim to summarize the current literature in this domain to understand the structure, patterns, and pitfalls of EEG training programs for non-experts. This review is undertaken with a view to inform future education designs, potentially enabling rapid detection of EEG abnormalities and timely intervention by the treating physician.PROSPERO registration: Submitted and undergoing review (URL currently unavailable).
A Study on Generating Stained Glass Animation from Video Clip
Authors: Kang Dongwann , Lee Taemin , Shin Yong-Hyeon , Seo Sanghyun
Published: March 2020

This paper presents a way to generate a stained glass animation from a given video input. We first obtain low-frequency components from input video frames to get rid of textures which cause over-segmentation in image segmentation. Then we segment input video volume by employing mean-shift video segmentation. The segmented regions are too large to be architecturally stable, subdivision is required. To sub-divide regions temporally coherent, we obtain the panoramic image from the segmented regions, and sub-divide them by using weighted Voronoi diagram. To render these sub-divided regions as stained glass pieces, we find the best match glass piece in the real stained glass piece image database and transfer its color to that region. Finally, we generate lead came at the boundary of regions, which results in a temporally coherent stained glass animation.
Helminthic therapy of experimental autoimmune encephalomyelitis by Dicrocoelium ova
Authors: Navi Zahra , Rad Mozhdeh Jafari , Fata Abdolmajid , Moghaddas Elham , Mahmoudi Mahmoud , Rastin Maryam , Bazaz Mojtaba Mousavi , Arab Fahimeh Lavi , Negah Sajad Sahab , Heidari Amir Reza , Azghadi Naser Morgan
Published: March 2020

Background Experimental Autoimmune Encephalomyelitis (EAE) is an animal model of Multiple Sclerosis (MS). This study was conducted to evaluate the efficacy of Dicrocoelium ova on Experimental Autoimmune Encephalomyelitis (EAE) treatment in C57BL6 mice.Methods Twenty-eight C57BL/6 mice were assigned in four groups as control(C), prophylaxis (P), treatment1 (T1), and treatment2 (T2). Prior to induction of EAE in prophylaxis group and on days 7 and 18 in T1 and T2 groups, respectively, Dicrocoelium eggs were injected to each mouse. Clinical score, weight changes, and incidence time of EAE were recorded. IFN- γ and IL-4 assay and histopathological study by (H&E) and Toluidine-Blue (TB), and Luxol Fast Blue (LFB) were done. Data were analyzed using SPSS software version 21.Results The disease score was significantly lower in P and T1 groups than the control group (p=0.01). IFN- γ was lower in P and T1 groups than the control group. The highest level of IL-4 was observed in the T1 group. The total number of Neuroglia cells of corpus callosum was similar in all groups, but density increased in T1 group compared to the control group (P = 0.03).Conclusions : The results of the study showed that, Dicrocoelium eggs have the great potential efficacy to stimulate immunomodulation toward treatment of EAE during the initial phase.
Antimicrobial resistance profile among bacteria isolated from patients presenting with wounds at Kabale Regional Referral Hospital, South western Uganda
Authors: Baguma Andrew , Musinguzi Benson , Kagirita Atek Atwiine , Bazira Joel
Published: March 2020

Background Bacterial Wound infection and antimicrobial resistance remains a public health challenge. The challenge remains worse due to nosocomial bacterial infection often characterized by multidrug resistance. Infected wounds are often associated with delayed epidermal maturation resulting into prolonged hospitalization. Data on profile of clinical significant bacteria and their respective antibiotic drug resistance in Uganda is still limited. In this study we emphasized on phenotypic characterization of bacteria that cause wound infections at Kabale Regional Hospital (KRRH) and determining the respective antimicrobial susceptibility profiles.Methods Between June 2016 – to June 2017 a total of 276 Pus specimens were collected from patients at KRRH and analyzed for bacterial infection by standard bacterial cultures techniques. Pus specimens were all from wounds (surgical and non-surgical). Antibiotic susceptibility testing was performed and reported based on CLSI guidelines.Results One-hundred and ninety-five specimens were positive following bacterial culture (70.7%). Staphylococcus aureus and Escherichia coli were the most frequently isolated bacteria. Antibiotic drug resistance testing revealed that 68% of S. aureus isolates were Methicillin resistant. For Escherichia coli isolates, 73% were ciprofloxacin and levofloxacin resistant while resistance to Imipenem was common among Klebsiella sp.Conclusions Wound infection is mainly caused by gram negative bacteria particularly, Escherichia coli , Klebsiella spp., Proteus spp., and Pseudomonas spp. G positive cocci particularly S. aureus is also an important pathogen among other implicated gram positive cocci. There are high levels of multi - antimicrobial resistance among both Gram negative and Gram positive bacteria.