bluuebunny/crossref_metadata_2025 huggingface dataset:
Magnetic resonance enterography, colonoscopy, and fecal calprotectin correlate in colonic Crohn’s disease
Authors: Somwaru Alexander S. , Khanijow Vikesh , Katabathina Venkat S.
Published: December 2019

Background

Fecal calprotectin (FCP), magnetic resonance enterography (MRE), and colonoscopy are complementary biometric tests that are used to assess patients with Crohn’s Disease (CD). While prior studies have evaluated the association between combinations of these tests, no study has established a correlation between all three: FCP, MRE, and colonoscopy. We prospectively investigated if there is correlation between these three tests, which may result in improved clinical outcomes that can then be used to streamline patient monitoring and treatment modification.

Methods

One hundred fifty-six patients with colonic CD were prospectively examined between March 2017 and December 2018. FCP levels, MRE, and colonoscopy were assessed in parallel on all 156 patients. Clinical CD activity was measured with the Crohn’s Disease Activity Index (CDAI). CD activity with FCP was measured with a quantitative immunoassay. CD activity on MRE was measured with the Magnetic Resonance Index of Activity (MaRIA). CD activity on colonoscopy was measured with the Crohn’s Disease Endoscopic Index of Severity (CDEIS).

Results

One hundred twelve patients (72%) had active disease (Crohn’s Disease Activity Index > 150) and 44 patients (28%) were in clinical remission disease (Crohn’s Disease Activity Index < 150). FCP levels, MaRIA, and CDEIS are highly correlated with positive and significant Pearson and Spearman coefficients, respectively (P < 0.0001), in univariate analyses. Regression analysis (multivariate analyses) demonstrates significant, positive correlation between FCP and MaRIA (r = 1.07, P < 0.0001) and between FCP and CDEIS (r = 0.71, P = 0.03), and between.

MaRIA and CDEIS (r = 0.63, P = 0.01).

Conclusions

FCP levels significantly correlate with the degree of active inflammation in patients with colonic Crohn’s Disease. Improved clinical results may be achieved by using a biometric strategy that incorporates FCP, colonoscopy, and MRE together. This strategy may in-turn be used in the future to streamline monitoring disease activity and adjustment of therapy to improve long term patient outcomes.
Flexitrate regional citrate anticoagulation in continuous venovenous hemodiafiltration: a retrospective analysis
Authors: Lenga Ilan , Hopman Wilma M. , O’Connell Adam J. , Hume Francesca , Wei Charles C. Y.
Published: December 2019

Background

Flexitrate, an innovative regional citrate anticoagulation (RCA) protocol, was compared to traditional RCA (tRCA) and Heparin anticoagulation protocols in intensive care patients treated with continuous renal replacement therapy (CRRT).

Methods

A single-center, retrospective, cohort study, was done in a 26-bed intensive care unit in a large community hospital. Eighty dialysis sessions (Flexitrate = 2852 h, tRCA = 3580 h and Heparin = 2026 h), performed in 53 patients, were evaluated for filter life, RCA control, and metabolic control.

Results

In the Flexitrate cohort, 3.8% of filters clotted, compared to 16.9% with tRCA and 28.3% with Heparin (p < 0.001 for Flexitrate compared to either tRCA or Heparin). Filter survival was significantly improved with Flexitrate compared to tRCA (HR 0.24, p = 0.018) or Heparin (HR 0.14, p = 0.004).

Anticoagulation control was superior with Flexitrate with Patient Ionized Calcium out of target a median of 16% of the time, compared to 27% for tRCA (p < 0.001). Filter Ionized Calcium was out of target a median of 6.8% of the time, compared to 23% for tRCA (p = 0.03).

Flexitrate produced significantly less alkalosis, hypernatremia, and hypocalcemia than tRCA, and overall metabolic control was comparable to Heparin anticoagulation. The only adverse metabolic outcome with Flexitrate was increased hypomagnesemia.

Conclusions

The Flexitrate protocol extended filter life, delivered more consistent anticoagulation, and provided superior metabolic control compared to a tRCA protocol. Filter life was superior to Heparin anticoagulation, with similar metabolic control. A randomized control trial comparing these protocols is recommended.
Oral health and Candida carriage in socioeconomically disadvantaged US pregnant women
Authors: Xiao Jin , Fogarty Colleen , Wu Tong Tong , Alkhers Naemah , Zeng Yan , Thomas Marie , Youssef Moustafa , Wang Lin , Cowen Lauren , Abdelsalam Hossam , Nikitkova Anna
Published: December 2019

Background

Despite the well-documented associations between poor maternal oral health and increased risk for adverse birth outcomes and dental caries in children after birth, prenatal oral health care is under-utilized, especially among the underserved population. In addition, oralCandidahas recently been suggested as a potential culprit for children’s dental caries, with evident maternal contributions. Therefore, this study aimed to obtain epidemiological data on the oral health and oralCandidacarriage in a cohort of underserved US pregnant women, and reveal factors associated with their oralCandidacarriage.

Methods

Demographic-medical-oral hygiene practice data were collected. Comprehensive oral examination was conducted. Caries status and plaque index were recorded. Oral samples (saliva, plaque and swab) were processed to identifyCandidaspecies andStreptococcus mutansby culturing-dependent and -independent methods. Multiple logistic regression analyses were used to identify factors associated with oralCandidacarriage and caries severity.

Results

Eighty-two socioeconomically disadvantaged women (48 pregnant and 34 non-pregnant) were enrolled. More pregnant women (79.1%) had > = 1 untreated decayed tooth when compared to their non-pregnant counterparts (47.1%) (p = 0.01). The average number of decayed teeth in pregnant and non-pregnant women was 3.9 and 3.1 (p > 0.05). Caries severity was positively associated with race (African American vs. white), plaque index and salivaryCandida albicanslevel.C. albicanswas the most predominant/abundantCandidastrain, with cheek and tonsil as the most common colonized sites. The detection ofC. albicanswas 56%/56% in saliva and 40%/47% in plaque of the pregnant and non-pregnant groups, respectively. Study women’s oralCandidacarriage is positively associated with hypertension [p = 0.03, odds ratio = 14.47(1.28, 163.51)], decayed teeth number [p = 0.04, odds ratio = 1.31 (1.01,1.69)] and salivaryS. mutanslevel [p = 0.03, odds ratio = 4.80 (1.18–19.43)].

Conclusions

Socioeconomically disadvantaged US women are in need of improved prenatal oral health, a large proportion of them have untreated decayed teeth and high carriage of oralCandida. Due to the observed significant association between the decayed teeth number and oralCandidacarriage, providing oral health care during pregnancy (including limiting decayed teeth) will not only improve women’s oral health, but also present as a promising approach to reduce oralCandidacarriage in women.
Treatment of consistent BRAF/HRAS gene mutation and MYC amplification radiation-induced abdominal wall angiosarcoma with low-dose apatinib: a case report
Authors: Guan Jieshan , Luo Zhijie , Xiao Zhiwei , Xie Yubin , Lin Lizhu
Published: December 2019

Background

An extremely rare condition, radiation-induced angiosarcoma is characterized by a poor prognosis, high recurrence rate and lack of effective treatment. Herein, we present a case report of a 48-year-old female patient with radiation-induced abdominal wall angiosarcoma who showed a dramatic response to low-dose apatinib.

Case presentation

The patient, who was diagnosed with cervical squamous cell carcinoma 20 years ago, had received radiotherapy and chemotherapy after operation. Angiosarcomas of the abdominal wall appeared 9 years later. After repeated surgical operations and intravenous chemotherapy for the angiosarcomas, the patient developed tumor recurrence and pulmonary metastasis. The abdominal wall tumors showed repeated rupture and bleeding, with poor wound healing. On evaluation, laboratory findings detected the negative serum tumor markers CEA, CA 125, CA 15–3 and CA 19–9. Imaging showed multiple subcutaneous nodules and masses in the abdominal wall, accompanied by suspected small subpleural nodule at the lower lobe of the right lung. Immunohistochemistry of previous surgical pathology indicated that CD31, ERG and Vim were positive. The result of whole exome sequencing suggested the mutations of BRAF and HRAS, and the amplification of MYC. Based on the above results, the patient was clinically diagnosed with radiation-induced angiosarcoma of the abdominal wall with pulmonary metastasis. The patient was treated with low-dose apatinib and rejected reoperation or chemotherapy.

Results

At the 6-month follow-up visit, the abdominal wall lesions that had previously ruptured stopped bleeding and showed significant shrinkage. Imaging showed that most of the abdominal wall lesions had partially regressed, and some of the lesions on the abdominal wall and the suspected lesion of subpleural nodule at the lower lobe of the right lung had disappeared.

Conclusions

We described this case and reviewed the literature on radiation-related angiosarcoma. Importantly, this case suggests that apatinib may be an effective and sensitive treatment for radiation-induced angiosarcoma even at the lowest dosage, without aggravating the bleeding of lesions.
Fatal myositis and spontaneous haematoma induced by combined immune checkpoint inhibitor treatment in a patient with pancreatic adenocarcinoma
Authors: Liu Yuan , Liu Zhi , Zeng Xuejun , Bai Chunmei , Chen Lin , Lin Songbai , Tian Xinlun
Published: December 2019

Background

Immune checkpoint inhibitors (ICIs) have achieved unprecedented success in cancer treatment over the past decade. The application of ICIs hasled to the discovery of various types of immune-related adverse events (irAEs). Here, we report a case of fatal myositis and spontaneous haematoma following concurrent treatment of nivolumab and ipilimumab for pancreatic adenocarcinoma.

Case presentation

A 71-year-old gentleman with pancreatic adenocarcinoma underwent the Whipple procedure in September 2014. The patient received 8 cycles of adjuvant chemotherapy with gemcitabineand achieved a complete responsein April 2015. Treatment with the PD-1 inhibitor nivolumab was started due to suspected tumour recurrence in November 2015. In August 2016, the CTLA-4 inhibitor ipilimumab was added to nivolumab for 2 cycles. Eight weeks after the last dose, the patient developed severe myositis complicated with spontaneous haematomain skeletalmuscle. Pathology of the skeletal muscle autopsy revealed lymphocytic infiltration. Intense immunosuppressive therapy, including high-dose corticosteroids and methotrexate, resulted in clinical success in the treatment of myositis. However, the patient died of cancer recurrence.

Conclusion

Myositis due to immunotherapy can be a fatal adverse event of ICIs, which requires close monitoring and cautious management.
Clinical significance of neutrophil-to-lymphocyte ratio as a predictor of lymph node metastasis in gastric cancer
Authors: Kosuga Toshiyuki , Konishi Tomoki , Kubota Takeshi , Shoda Katsutoshi , Konishi Hirotaka , Shiozaki Atsushi , Okamoto Kazuma , Fujiwara Hitoshi , Kudou Michihiro , Arita Tomohiro , Morimura Ryo , Murayama Yasutoshi , Kuriu Yoshiaki , Ikoma Hisashi , Nakanishi Masayoshi , Otsuji Eigo
Published: December 2019

Background

Precise staging is indispensable to select the appropriate treatment strategy for gastric cancer (GC); however, the diagnostic accuracy of conventional modalities needs to be improved. This study investigated the clinical significance of the preoperative neutrophil-to-lymphocyte ratio (NLR) for the prediction of pathological lymph node metastasis (pN+) in GC.

Methods

This was a retrospective study of 429 patients with GC who underwent curative gastrectomy. The predictive ability of NLR for pN+ was examined in comparison with that of computed tomography.

Results

The preoperative NLR ranged from 0.6 to 10.8 (median, 2.0), and the optimal cut-off value for predicting pN+ was 1.6 according to the receiver operating characteristic curve with the maximal Youden index. Multivariate analysis identified a NLR ≥ 1.6 (odds ratio (OR) 3.171; 95% confidence interval (CI) 1.448–7.235, p = 0.004) and cN+ (OR 2.426; 95% CI 1.221–4.958, p = 0.011) to be independent factors associated with pN+ in advanced GC (cT2-T4). On the other hand, a NLR ≥ 1.6 was not useful for predicting pN+ in early GC (cT1). In advanced GC, a NLR ≥ 1.6 detected pN+ with a higher sensitivity (84.9%) and negative predictive value (NPV) (63.9%) than conventional modalities (50.0 and 51.7%, respectively). When the subjects were limited to those with advanced GC with cN0, the sensitivity and NPV of a NLR ≥ 1.6 for pN+ increased further (90.7 and 81.0%, respectively).

Conclusion

The preoperative NLR may be a useful complementary diagnostic tool for predicting pN+ in advanced GC because of its higher sensitivity and NPV than conventional modalities.
Internet addiction test: Croatian preliminary study
Authors: Černja Iva , Vejmelka Lucija , Rajter Miroslav
Published: December 2019

Background

Everyday internet usage is particularly significant in the population of adolescents and young people. Besides numerous benefits, internet usage brings certain risks of addictive behavior. Internet Addiction Test (IAT) is the most spread scale for measuring internet addiction. The aim of this study was to investigate internet addiction on a sample of Croatian adolescents.

Methods

Overall, 352 students aged between 15 and 20 from randomly selected high schools participated in the study. We have collected the data on the Internet Addiction Test along with basic demographic information. The main analyses included the factorization of IAT test and the measurement of prevalence of internet addiction with the analysis of the gender differences.

Results

The results showed that 3.4% of high school students reported high levels of internet addiction, while 35.4% of respondents reported some signs of addiction. Three-factor structure of IAT was obtained with dimensions: Emotional and cognitive internet preoccupation, then Neglecting work and lack of self-control and the last one is Social problems. Although the first factor has the most significant role in internet addiction risk, gender differences were found only in the last two factors, where boys have higher scores on Social Problems, while girls have higher scores on Neglecting work and lack of self-control.

Conclusions

Based on our results, the prevention activities should be focused on the area of ​​emotional and social competence and the responsible use of internet. Since the result show that a third of the sample show moderate signs of addiction, programs of both indicated and selective prevention should be systematically planned for the general population of adolescents as well as for the groups in risk. The obtained gender differences indicate that the preventive and treatment programs should take into account gender specifics.
Sociodemographic characteristics associated with adolescent depression in urban and rural areas of Hubei province: a cross-sectional analysis
Authors: Li Guo , Mei Junhua , You Jing , Miao Jinfeng , Song Xiaoyan , Sun Wenzhe , Lan Yan , Qiu Xiuli , Zhu Zhou
Published: December 2019

Background

China has experienced rapid socioeconomic, and health transitions over the last four decades, and urban–rural disparities are becoming increasingly apparent. Research on depression among rural and urban students can provide evidence on the relationship between sociodemographic characteristics and adolescent depression.

Methods

We examined the association between sociodemographic characteristics and adolescent depression among 3605 students from Wuhan city and Jianli county that was recruited from the local junior middle school via a cross-sectional study. Univariate and multivariate logistic regression models were used to explore the sociodemographic characteristics of adolescent depression in urban and rural areas, respectively. Nomograms were constructed to calculate individual depression risk of junior middle school students.

Results

32.47% of rural students and 35.11% of urban students display depressive symptoms. The protective factors of depression in urban students are exercise habit, younger, key class, better academic achievement and males, while Left-behind children (LBC), poor academic achievement and females had higher depression risk in rural area. Two nomograms were constructed to screen the adolescent depression in urban and rural junior middle school students, respectively. The clinical tools were well calibrated.

Conclusion

The field-based research examined sociodemographic characteristics potentially associated with adolescent depression and offered an effective and convenient tool of individualized depression risk evaluation for junior middle school students. Future longitudinal epidemiologic research on adolescent depression may help to further validate the discovery of present study, which will support developing policies and practices to minimize the factors of adolescent depression.
Psychological changes and associated factors among patients with tuberculosis who received directly observed treatment short-course in metropolitan areas of Japan: quantitative and qualitative perspectives
Authors: Shiratani Kae Nagahiro
Published: December 2019

Background

The directly observed treatment short-course (DOTS) is one of the most effective tuberculosis (TB) control measures worldwide. However, despite its aim of providing comprehensive and humanistic care, few studies have examined its psychological effects from the patient’s perspective. Thus, this study aimed to evaluate the psychological changes and identify associated factors among patients with TB undergoing the DOTS program in Japan.

Methods

This cross-sectional study recruited patients with TB receiving the DOTS program via 32 public health centers in four metropolitan cities in Japan. Surveys were administered to the patients and their attending public health or clinical nurses, who were responsible for their care and the DOTS program. Data were collected regarding the patients’ demographic and clinical characteristics, post-traumatic growth (using the Post-Traumatic Growth Inventory-Short Form [PTGI-SF]), and medication adherence, alongside open-ended questions, from 2014 to 2015. Additionally, the patients’ appraisal of the DOTS program’s efficacy and nurses’ assessment of the program’s practices were measured using two original questionnaires. Factors associated with post-traumatic growth were analyzed using variable estimation, correlation analysis, and logistic regression. Thematic analysis was conducted on the open-ended responses.

Results

Questionnaires were returned by 127 patients (125 valid answers); 98 (78.4%) of the respondents were men. Their mean age was 63.3 (standard deviation: 15.8) years. The mean PTGI-SF score was 21.7 (standard deviation: 11.1). The logistic regression analysis found that post-traumatic growth was significantly associated with the patients’ appraisal of the program’s efficacy (odds ratio [OR] = 1.157, 95% confidence interval [CI] = 1.026–1.304) and nurses’ assessment of the practices (OR = 1.307, 95% CI = 1.065–1.603). In the qualitative analysis, “Non-acceptance,” “Frustration,” and “Anxiety” were extracted as barriers to treatment; “Fear,” “Acquiring a partner,” “Relief,” and “Belief” were extracted as treatment drivers; and “Life changes” and “Rebuilding oneself” were extracted as treatment outcomes.

Conclusions

The DOTS program in Japan improves patients’ treatment adherence and leads to recovery and psychological growth. Even in other regions, it may be effective to incorporate this program’s practices that place importance on partnerships with patients. It is also necessary to continue refined quantitative and qualitative evaluations.
No straight lines – young women’s perceptions of their mental health and wellbeing during and after pregnancy: a systematic review and meta-ethnography
Authors: Lucas Grace , Olander Ellinor K. , Ayers Susan , Salmon Debra
Published: December 2019

Background

Young mothers face mental health challenges during and after pregnancy including increased rates of depression compared to older mothers. While the prevention of teenage pregnancy in countries such as the United States and the United Kingdom has been a focus for policy and research in recent decades, the need to understand young women’s own experiences has been highlighted. The aim of this meta-ethnography was to examine young women’s perceptions of their mental health and wellbeing during and after pregnancy to provide new understandings of those experiences.

Methods

A systematic review and meta-ethnographic synthesis of qualitative research was conducted. Seven databases were systematically searched and forward and backward searching conducted. Papers were included if they were from Organisation for Economic Co-operation and Development countries and explored mental health and wellbeing experiences of young mothers (age under 20 in pregnancy; under 25 at time of research) as a primary research question – or where evidence about mental health and wellbeing from participants was foregrounded. Nineteen papers were identified and the Critical Appraisal Skills Programme checklist for qualitative research used to appraise the evidence. Following the seven-step process of meta-ethnography, key constructs were examined within each study and then translated into one another.

Results

Seven translated themes were identified forming a new line of argument wherein mental health and wellbeing was analysed as relating to individual bodily experiences; tied into past and present relationships; underpinned by economic insecurity and entangled with feelings of societal surveillance. There were ‘no straight lines’ in young women’s experiences, which were more complex than dominant narratives around overcoming adversity suggest.

Conclusions

The synthesis concludes that health and social care professionals need to reflect on the operation of power and stigma in young women’s lives and its impact on wellbeing. It adds to understanding of young women’s mental health and wellbeing during and after pregnancy as located in physical and structural factors rather than individual capacities alone.
Anti-HIV-1 protease activity of the crude extracts and isolated compounds from Auricularia polytricha
Authors: Sillapachaiyaporn Chanin , Nilkhet Sunita , Ung Alison T. , Chuchawankul Siriporn
Published: December 2019

Background

Acquired immunodeficiency syndrome (AIDS) is caused by the Human immunodeficiency virus type-1 (HIV-1). HIV-1 protease (HIV-1 PR) is an essential enzyme for the HIV replication, and therefore, it is an important target for antiretroviral drugs development, particularly from natural products. Auricularia polytricha (AP) is an edible mushroom with several important therapeutic properties. These properties will be investigated as HIV-1 PR inhibitors.

Methods

The sequential hexane (APH), ethanol (APE) and water (APW) extracts from AP were screened for inhibitory activity against HIV-1 PR. The extract that consistently showed the strong HIV-1 PR inhibition was further investigated for its phytochemical constituents. The compounds were purified by column chromatography. The isolated compounds were structurally elucidated using 1D and 2D NMR, HRMS, FTIR, and GC/MS techniques. Each compound was screened against HIV-1 PR to determine its inhibitory activity and to provide an explanation for the activity found in the extract.

Results

Hexane crude extract of AP (APH) exhibited significant inhibition on HIV-1 PR activity. Four major compounds isolated from APH fraction were identified to be two triacylglycerols, linoleic acid and ergosterol. Moreover, all four compounds showed significant inhibition of HIV-1 PR activity.

Conclusion

The findings from this study suggest that AP is a good source of fatty esters, fatty acids and ergosterol. These natural products exhibit anti-HIV-1 properties by blocking HIV-1 PR. These important biological results warrant further development of AP as an alternative antiretroviral drug.
TestIME: an application for evaluating the efficiency of Chinese input method engines in electronic medical record entry task
Authors: Yang Feihong , Guo Haihong , Li Jiao
Published: December 2019

Background

With the wide application of Electronic Medical Record (EMR) systems, it has become a daily work for doctors using keyboards to input clinical information into the EMR system. Chinese Input Method Engine (IME) is essential for doctors to convert pinyin to Chinese characters, and an efficient IME would improve doctors’ healthcare work. We developed a tool (called TestIME) to evaluating the efficiency of the current IMEs used in doctors’ working scenario.

The proposed TestIME consists of four major function modules: 1) Test tasks assignment, to ensure that participants using different IMEs to complete the same test task in a random order; 2) IME automatic switching, to automatically switch the input method engines without changing the experimental settings; 3) participants’ behavior monitoring, to record the participants’ keystrokes and timestamp during the typing process; 4) questionnaire, to collect the participants’ subjective data. In addition, we designed a preliminary experiment to demonstrate the usability of TestIME. We selected three sentences from EMR corpus and news corpus as test texts respectively, and recruited four participants in a medical school to complete text entry tasks using the TestIME.

Results

Our TestIME was able to generate 72 files that record the detailed participants’ keyboard behavior while transcribing test texts, and 4 questionnaires that reflect participants’ psychological states. These profiles can be downloaded in a structured format (CSV) from the TestIME for further analysis.

Conclusions

We developed a tool (TestIME) to evaluate Chinese input methods in the EMR entry tasks. In the given text input scenario in healthcare, the TestIME is capable to record doctors’ keyboard behavior, frequently used Chinese terms, IME usability feedback etc. These user profiles are important to improve current IME tools for doctors and further improve healthcare service.
Health system readiness for innovation scale-up: the experience of community-based distribution of injectable contraceptives in Nigeria
Authors: Akinyemi Oluwaseun , Harris Bronwyn , Kawonga Mary
Published: December 2019

Background

Following the successful pilot of the community-based distribution of injectable contraceptives (CBDIC) by community health extension workers (CHEWs) in Gombe, northern Nigeria in 2010, there was a policy decision to scale-up the innovation to other parts of the country. However, there is limited understanding of health system factors that may facilitate or impede the successful scale-up of this innovation beyond the pilot site. Thus, this study assessed the health system readiness to deliver CBDIC in Nigeria and how this may influence the scale-up process.

Methods

This study was conducted in two Local Government Areas in Gombe State in September 2016. Seven key informant interviews were held with purposively sampled senior officials of the ministries of health at the federal and state levels as well as NGO program managers. Also, 10 in-depth interviews were carried out with health workers. All transcripts were analyzed using the thematic framework analysis approach.

Result

The availability of a policy framework that supports task-shifting and task-sharing, as well as application of evidence from the pilot programme and capacity building programmes for health workers provided a favourable environment for scale-up. Health system challenges for the scale-up process included insufficient community health workers, resistance to the task-shifting policy from professional health groups (who should support the CHEWs), limited funding and poor logistics management which affected commodity distribution and availability. However, there were also a number of health worker innovations which kept the scale-up going. Health workers sometimes used personal resources to make up for logistics failures and poor funding. They often modify the process in order to adapt to the realities on the ground.

Conclusion

This study shows health system weaknesses that may undermine scale-up of CBDIC. The study also highlights what happens when scale-up is narrowly focused on the intervention without considering system context, capacity and readiness. However, agency and discretionary decision-making among frontline health workers facilitated the process of scaling up, although the sustainability of this is questionable. Benefits observed during the pilot may not be realised on a larger scale if health system challenges are not addressed.
The role of real-world data in the development of treatment guidelines: a case study on guideline developers’ opinions about using observational data on antibiotic prescribing in primary care
Authors: Steels Stephanie , van Staa Tjeerd Pieter
Published: December 2019

Background

Antimicrobial resistance (AMR) is a prominent threat to public health. Although many guidelines have been developed over the years to tackle this issue, their impact on health care practice varies. Guidelines are often based on evidence from clinical trials, but these have limitations, particularly in the breadth and generalisability of the evidence and evaluation of the guidelines’ uptake. The aim of this study was to investigate how national and local guidelines for managing common infections are developed and explore guideline committee members’ opinions about using real-world observational evidence in the guideline development process.

Methods

Six semi-structured interviews were completed with participants who had contributed to the development or adjustment of national or local guidelines on antimicrobial prescribing over the past 5 years (from the English National Institute for Health and Care Excellence (NICE)). Interviews were audio recorded and transcribed verbatim. Data was analysed thematically. This also included review of policy documents including guidelines, reports and minutes of guideline development group meetings that were available to the public.

Results

Three key themes emerged through our analysis: perception versus actual guideline development process, using other types of evidence in the guideline development process, and guidelines are not enough to change antibiotic prescribing behaviour. In addition, our study was able to provide some insight between the documented and actual guideline development process within NICE, as well as how local guidelines are developed, including differences in types of evidence used.

Conclusions

This case study indicates that there is the potential for a wider range of evidence to be included as part of the guideline development process at both the national and local levels. There was a general agreement that the inclusion of observational data would be appropriate in enhancing the guideline development process, as well providing a potential solution for monitoring guideline use in clinical practice, and improving the implementation of treatment guidelines in primary care.
Case-control study on factors associated with a decreased milk yield and a depressed health status of dairy herds in northern Germany
Authors: Jensen Katharina Charlotte , Frömke Cornelia , Schneider Bettina , Do Duc Phuong , Gundling Frieder , Birnstiel Katrin , Schönherr Franziska , Scheu Theresa , Kaiser-Wichern Anika , Woudstra Svenja , Seyboldt Christian , Hoedemaker Martina , Campe Amely
Published: December 2019

Background

In the past years, it became apparent that health status and performance differ considerably within dairy farms in Northern Germany. In order to obtain clues with respect to possible causes of these differences, a case-control study was performed. Case farms, which showed signs of health and performance problems, and control farms, which had none of these signs, were compared. Risk factors from different areas such as health management, housing, hygiene and nutrition were investigated as these are known to be highly influential. The aim of this study was to identify major factors within these areas that have the strongest association with health and performance problems of dairy herds in Northern Germany.

Results

In the final model, a lower energy density in the roughage fraction of the diet, more pens with dirty lying areas and a low ratio of cows per watering spaces were associated with a higher risk for herd health problems. Moreover, case farms were affected by infections with intestinal parasites, lungworms, liver flukes and Johne’s Disease numerically more often than control farms. Case farms more often had pens with raised cubicles compared to the deep bedded stalls or straw yards found in control farms. In general, the hygiene of the floors and beddings was worse in case farms. Concerning nutrition, the microbiological and sensory quality of the provided silages was often insufficient, even in control farms. Less roughage was provided to early lactating cows and the feed was pushed to the feeding fence less frequently in case farms than in control farms.

Conclusions

The results show that milk yield and health status were associated with various factors from different areas stressing the importance of all aspects of management for good animal health and performance. Moreover, this study confirmed well-known risk factors for health problems and performance losses. These should better be taken heed of in herd health management.
Changes in specific serum biomarkers during the induction of prostatic hyperplasia in dogs
Authors: Golchin-Rad Kamran , Mogheiseh Asghar , Nazifi Saeed , Ahrari Khafi Mohammad Saeed , Derakhshandeh Nooshin , Abbaszadeh-Hasiri Mohammad
Published: December 2019

Background

Prostatic hyperplasia (PH) is one of the most important disorders in intact dogs. In this study, we aimed to induce PH experimentally using the combination of testosterone and estrogen and evaluate important factors associated with this disease.

Results

The results showed that in the induction group, prostate volume and prostate specific antigen (PSA) concentration increased significantly on day 21 onwards compared to those of the control group. Canine prostatic specific esterase (CPSE) and dihydrotestosterone (DHT) concentrations increased significantly on day 42 onwards while the testosterone levels increased on day 63. In addition, prostatic acid phosphatase (PAP) concentration did not change significantly in the control and induction groups. Biochemistry profiles and hematologic factors were measured for monitoring the function of liver and kidney, and there were no adverse effects following the induction of PH.

Conclusions

It seems that testosterone and estrogen administration led to prostatic hyperplasia during 2 months. Investigating the size of the prostate, accompanied by prostate markers including CPSE, PSA, DHT, and testosterone, is helpful for the PH diagnosis. However, further studies should be carried out on PAP.
High levels of unreported intraspecific diversity among RNA viruses in faeces of neonatal piglets with diarrhoea
Authors: Cortey Martí , Díaz Ivan , Vidal Anna , Martín-Valls Gerard , Franzo Giovanni , Gómez de Nova Pedro José , Darwich Laila , Puente Héctor , Carvajal Ana , Martín Marga , Mateu Enric
Published: December 2019

Background

Diarrhoea is a major cause of death in neonate pigs and most of the viruses that cause it are RNA viruses. Next Generation Sequencing (NGS) deeply characterize the genetic diversity among rapidly mutating virus populations at the interspecific as well as the intraspecific level. The diversity of RNA viruses present in faeces of neonatal piglets suffering from diarrhoea in 47 farms, plus 4 samples from non-diarrhoeic piglets has been evaluated by NGS. Samples were selected among the cases submitted to the Veterinary Diagnostic Laboratories of Infectious Diseases of the Universitat Autònoma de Barcelona (Barcelona, Spain) and Universidad de León (León, Spain).

Results

The analyses identified the presence of 12 virus species corresponding to 8 genera of RNA viruses. Most samples were co-infected by several viruses. Kobuvirus and Rotavirus were more commonly reported, with Sapovirus, Astrovirus 3, 4 and 5, Enterovirus G, Porcine epidemic diarrhoea virus, Pasivirus and Posavirus being less frequently detected. Most sequences showed a low identity with the sequences deposited in GenBank, allowing us to propose several new VP4 and VP7 genotypes for Rotavirus B and Rotavirus C.

Conclusions

Among the cases analysed, Rotaviruses were the main aetiological agents of diarrhoea in neonate pigs. Besides, in a small number of cases Kobuvirus and Sapovirus may also have an aetiological role. Even most animals were co-infected in early life, the association with enteric disease among the other examined viruses was unclear. The NGS method applied successfully characterized the RNA virome present in faeces and detected a high level of unreported intraspecific diversity.
A female patient with retinoblastoma and severe intellectual disability carrying an X;13 balanced translocation without rearrangement in the RB1 gene: a case report
Authors: Tsutsumi Makiko , Hattori Hiroyoshi , Akita Nobuhiro , Maeda Naoko , Kubota Toshinobu , Horibe Keizo , Fujita Naoko , Kawai Miki , Shinkai Yasuko , Kato Maki , Kato Takema , Kawamura Rie , Suzuki Fumihiko , Kurahashi Hiroki
Published: December 2019

Background

Female carriers of a balanced X; autosome translocation generally undergo selective inactivation of the normal X chromosome. This is because inactivation of critical genes within the autosomal region of the derivative translocation chromosome would compromise cellular function. We here report a female patient with bilateral retinoblastoma and a severe intellectual disability who carries a reciprocal X-autosomal translocation.

Case presentation

Cytogenetic and molecular analyses, a HUMARA (Human androgen receptor) assay, and methylation specific PCR (MSP) and bisulfite sequencing were performed using peripheral blood samples from the patient. The patient’s karyotype was 46,X,t(X;13)(q28;q14.1) by G-banding analysis. Further cytogenetic analysis located the entireRB1gene and its regulatory region on der(X) with no translocation disruption. The X-inactivation pattern in the peripheral blood was highly skewed but not completely selected. MSP and deep sequencing of bisulfite-treated DNA revealed that an extensive 13q region, including theRB1promoter, was unusually methylated in a subset of cells.

Conclusions

The der(X) region harboring theRB1gene was inactivated in a subset of somatic cells, including the retinal cells, in the patient subject which acted as the first hit in the development of her retinoblastoma. In addition, the patient’s intellectual disability may be attributable to the inactivation of the der(X), leading to a 13q deletion syndrome-like phenotype, or to an active X-linked gene on der (13) leading to Xq28 functional disomy.
Smoking heroin with cannabis versus injecting heroin: unexpected impact on treatment outcomes
Authors: Morgan Nirvana , Daniels William , Subramaney Ugasvaree
Published: December 2019

Background

In several countries, especially in Africa, the dominant method of heroin intake is smoking a joint of cannabis laced with heroin. There is no data exploring the impact of smoking heroin with cannabis on treatment outcomes.

Aim

To compare treatment outcomes between people who inject heroin and people who smoke heroin with cannabis.

Methodology

Three hundred heroin users were assessed on admission to inpatient rehabilitation and after treatment. We compared drug use, psychopathology, criminality, social functioning and general health between heroin injectors and heroin-cannabis smokers at treatment entry, and at 3 and 9 months after rehabilitation.

Results

The sample comprised 211 (70.3%) heroin-cannabis smokers and 89 (29.7%) heroin injectors. Eighty-four percent were followed up at 3 months and 75% at 9 months. At 9 months, heroin-cannabis smokers had a higher proportion of those who relapsed to heroin use compared with intravenous (IV) users (p = 0.036). The median number of heroin use episodes per day was lower for IV users than heroin-cannabis smokers at both follow-up points (p = 0.013 and 0.0019). A higher proportion of IV users was HIV positive (p = 0.002). There were no significant differences in psychopathology, general health, criminality and social functioning between IV users and heroin-cannabis smokers at all three time points.

Conclusions

Heroin users who do not inject drugs but use other routes of administration may have increased risk for relapse to heroin use after inpatient rehabilitation and should therefore have equal access to harm reduction treatment services. Advocating a transition from injecting to smoking heroin in an African context may pose unique challenges.
Family composition and age at menarche: Findings from the international Health Behaviour in School-aged Children study
Authors: Steppan Martin , Whitehead Ross , McEachran Juliet , Currie Candace
Published: December 2019

Background

Early menarche has been associated with father absence, stepfather presence and adverse health consequences in later life. This article assesses the association of different family compositions with the age at menarche. Pathways are explored which may explain any association between family characteristics and pubertal timing.

Methods

Cross-sectional, international data on the age at menarche, family structure and covariates (age, psychosomatic complaints, media consumption, physical activity) were collected from the 2009–2010 Health Behaviour in School-aged Children (HBSC) survey. The sample focuses on 15-year old girls comprising 36,175 individuals across 40 countries in Europe and North America (N = 21,075 for age at menarche). The study examined the association of different family characteristics with age at menarche. Regression and path analyses were applied incorporating multilevel techniques to adjust for the nested nature of data within countries.

Results

Living with mother (Cohen’s d = .12), father (d = .08), brothers (d = .04) and sisters (d = .06) are independently associated with later age at menarche. Living in a foster home (d = −.16), with ‘someone else’ (d = −.11), stepmother (d = −.10) or stepfather (d = −.06) was associated with earlier menarche. Path models show that up to 89% of these effects can be explained through lifestyle and psychological variables.

Conclusions

Earlier menarche is reported amongst those with living conditions other than a family consisting of two biological parents. This can partly be explained by girls’ higher Body Mass Index in these families which is a biological determinant of early menarche. Lower physical activity and elevated psychosomatic complaints were also more often found in girls in these family environments.
The tyrosine 73 and serine 83 dephosphorylation of H1N1 swine influenza virus NS1 protein attenuates virus replication and induces high levels of beta interferon
Authors: Cheng Jinghua , Tao Jie , Li Benqiang , Shi Ying , Liu Huili
Published: December 2019

Background

Nonstructural protein 1 (NS1) is a virulence factor encoded by influenza A virus (IAV) that is expressed in the nucleus and cytoplasm of host cells during the earliest stages of infection. NS1 is a multifunctional protein that plays an important role in virus replication, virulence and inhibition of the host antiviral immune response. However, to date, the phosphorylation sites of NS1 have not been identified, and the relationship between phosphorylation and protein function has not been thoroughly elucidated.

Method

In this study, potential phosphorylation sites in the swine influenza virus (SIV) NS1 protein were bioinformatically predicted and determined by Phos-tag SDS-PAGE analysis. To study the role of NS1 phosphorylation sites, we rescued NS1 mutants (Y73F and S83A) of A/swine/Shanghai/3/2014(H1N1) strain and compared their replication ability, cytokine production as well as the intracellular localization in cultured cells. Additionally, we used small interfering RNA (siRNA) assay to explore whether changes in the type I IFN response with dephosphorylation at positions 73 and 83 were mediated by the RIG-I pathway.

Results

We checked 18 predicted sites in 30 SIV NS1 genes to exclude strain-specific sites, covering H1N1, H1N2 and H3N2 subtypes and identified two phosphorylation sites Y73 and S83 in the H1N1 SIV protein by Phos-tag SDS-PAGE analysis. We found that dephosphorylation at positions 73 and 83 of the NS1 protein attenuated virus replication and reduced the ability of NS1 to antagonize IFN-β expression but had no effect on nuclear localization. Knockdown of RIG-I dramatically impaired the induction of IFN-β and ISG56 in NS1 Y73F or S83A mutant-infected cells, indicating that RIG-I plays a role in the IFN-β response upon rSIV NS1 Y73F and rSIV NS1 S83A infection.

Conclusion

We first identified two functional phosphorylation sites in the H1N1 SIV protein: Y73 and S83. We found that dephosphorylation at positions 73 and 83 of the NS1 protein affected the antiviral state in the host cells, partly through the RIG-I pathway.
PCR-based reverse genetics strategy for bluetongue virus recovery
Authors: Xu Qingyuan , Ge Jinying , Li Maolin , Sun Encheng , Zhou Yawei , Guo Yunze , Wu Donglai , Bu Zhigao
Published: December 2019

Background

Bluetongue virus (BTV), an emerging insect vector mediated pathogen affecting both wild ruminants and livestock, has a genome consisting of 10 linear double-stranded RNA genome segments. BTV has a severe economic impact on agriculture in many parts of the world. Current reverse genetics (RG) strategy to rescue BTV mainly rely on in vitro synthesis of RNA transcripts from cloned complimentary DNA (cDNA) corresponding to viral genome segments with the aid of helper plasmids. RNA synthesis is a laborious job which is further complicated with a need for expensive reagents and a meticulous operational procedure. Additionally, the target genes must be cloned into a specific vector to prepare templates for RNA transcription.

Result

In this study, we have developed a PCR based BTV RG system with easy two-step transfection. Viable viruses were recovered following a first transfection with the seven helper plasmids and a second transfection with the 10 PCR products on the BSR cells. Further, recovered viruses were characterized with indirect immunofluorescence assays (IFA) and gene sequencing. And the proliferation properties of these viruses were also compared with wild type BTV. Interestingly, we have identified that viruses containing the segment 2 of the genome from reassortant BTV, grew slightly slower than the others.

Conclusion

In this study, a convenient PCR based RG platform for BTV is established, and this strategy could be an effective alternative to the original available BTV rescue methods. Furthermore, this RG strategy is likely applicable for other Orbiviruses.