bluuebunny/crossref_metadata_2025 huggingface dataset:
Bone mineral density reference values in Singaporean adults and comparison for osteoporosis establishment – The Yishun Study
Authors: Chen Kexun , Wee Shiou-Liang , Pang Benedict Wei Jun , Lau Lay Khoon , Jabbar Khalid Abdul , Seah Wei Ting , Sriniva Sivasubramanian , Mallya Jagadish Ullal , Ng Tze Pin
Published: September 2020

Background

While there have been studies in Singapore on the prevalence and economic burden of osteoporotic hip fracture, there is a severe lack of reference data on bone mineral density and prevalence of osteoporosis. The purpose of this study is to establish the reference values for BMD and compare prevalence of osteoporotic conditions using other available reference values so as to better understand the status of bone health in Singaporean adults.

Methods

We carried out a population-based cross-sectional study using dual-energy x-ray absorptiometry (Hologic Discovery Wi) to measure the bone mineral density of Singaporean adults aged ≥ 21 years. A total of 542 participants were recruited from the large north-eastern residential town of Yishun. ﻿We computed T- scores (denoted by TSG) for each individual in the study. Similar diagnoses were also done based on T-scores provided by the densitometer (TDXA), NHANES database (TNHANES), and China (TCHN), and the differences in prevalence compared. We then compared the concordance between TSG and TDXA in the classification of osteoporosis. Osteoporosis was defined according to criteria by the World Health Organization (WHO).

Results

Peak lumbar spine BMD was 1.093±0.168g/cm2 in women, and 1.041±0.098g/cm2 for men. Peak whole-body BMD was 1.193±0.93g/cm2 in women at, and 1.224±0.112g/cm2 for men. Prevalence of osteoporosis based on lumbar spine was 9.3% in postmenopausal women, and 0.7% in men after 50 years of age. The percentage difference in prevalence range from 60.5 - 163.6%, when using reference values from TDXA, TNHANES, and TCHN. Comparing diagnosis using TDXA and TSG cut-off values, 28 versus 15 women were diagnosed as osteoporotic respectively. ﻿ The kappa statistics was 0.81 for women and 0.85 for men.

Conclusion

Our study shows that T-scores provided by DXA manufacturer over-diagnosed osteoporosis in Singaporeans, and the prevalence of osteoporotic conditions is not accurately represented. This over-diagnosis may result in unnecessary treatment in some individuals.
Investigating the frequency of Free-living amoeba in water resources with emphasis on Acanthamoeba in Bandar Abbas city, Hormozgan province, Iran in 2019-2020
Authors: Attariani Homa , Turki Habibollah , Shoja Saeed , Salahi-Moghaddam Abdoreza , Ghanbarnejad Amin , Shamseddin Jebreil
Published: September 2020

Objective: These amoebas can cause dangerous illnesses when they accidentally enter the human body, so it is necessary to determine various forms of organisms in water resources to prevent the danger they can cause and risks to human health. Currently, in Bandar Abbas, there is no sufficient information about the distribution of Acanthamoeba, and we intended to study its frequency and determine the related genotypes. Results: Out of 83 water samples collected from different resources in the city, 31 plates (37.3%) were found to be positive for free-living amoebae. Of these, five were identified as Acanthamoeba (6%) by culture method and 8 (9.6%) by molecular method. Positive sample sequence analysis enabled us to distinguish two genotypes of T4 (7 cases) and T15 (1 case) in this study.
Demographic and clinical characteristics of foreign residents who visited hospitals for mental health problems in Japan: A multicenter study in a metropolitan area
Authors: Takubo Youji , Nemoto Takahiro , Iwai Momoko , Kashima Minako , Yamaguchi Eriko , Maruyama Akiko , Miura Sachio , Saito Hisaaki , Tsujino Naohisa , Mizuno Masafumi
Published: September 2020

Background: International immigration to Japan, where homogeneous ethnicity is a population characteristic, has been growing. Although immigration is recognized as a risk factor for multiple mental-health related issues, there are few regional reports on foreign residents who visit a hospital for mental health problems in Japan. We aimed to examine such patients’ characteristics.Methods: A multicenter retrospective study using medical records was conducted. The subjects were foreign patients who presented at the psychiatry departments in three core regional hospitals in the Keihin region, which faces Tokyo Bay and is well known to include the largest traditional industrial zone in Japan, over a period of three years. We investigated the patients’ demographic and clinical information including country/region of origin, spoken language, use of a medical interpreter, pathway to hospitals, and outcome.Results: The percentage of foreign individuals among all patients was 1.4% (205/14511). The mean age of the foreign patients was 45.8 years, and the sex ratio was 1:1.9 (men: women). Regarding the country/region of origin, China (35.1%) was the most common country, followed by the Philippines (18.5%), Korea (16.1%), and Brazil (4.9%). Several subjects (22.9%) could not speak Japanese; therefore, interpretation was required by family members/friends (17.1%) or a professional interpreter (5.4%). Neurotic disorder (ICD-10 code: F4) was the most common diagnosis (24.4%).Conclusions: The percentage of foreign patients seeking psychiatric treatment (1.4%) was relatively low, compared with the percentage of foreign residents living in the Keihin region (4.4%). The age distribution of foreign residents who visited psychiatric department was dissociated from the age distribution of foreign residents in Japan. This suggests that young foreign residents with a relatively high risk for mental illness are not accessing appropriate services. The development of a community-based integrated care system accessible to foreign residents seems to be indispensable.
Factors associated with conducting planning for secondary oral health care services in Brazil
Authors: de Lucena Edson Hilan Gomes , Silva Rênnis Oliveira da , de Lucena Carolina Dantas Rocha Xavier , Mepatia Amalia Issufo , Cavalcanti Yuri Wanderley , de Goes Paulo Savio Angeiras , de Sousa Maria Fátima
Published: September 2020

Background: Planning in health services specifically aims to improve the health status of a given population, guaranteeing access with equity and justice, as well as streamlining the response of the health system to the needs perceived by the community. This research aims to identify the factors associated with planning Specialized Dental Clinics (SDCs).Methods: Secondary data were used from the external evaluation of the database of the first National Program for Access and Quality Improvement of SDCs (NPAQI–SDCs) and the informed Outpatient Information System of the Unified Health System (OIS/UHS), which contains data on the specialized dental procedures performed at SDCs. It consisted of a quantitative study in which Pearson chi-square statistical tests (p ˂ 0.05) and a multivariate logistic regression were applied with odds ratio (OR) estimate. Results: The results indicated that the realization of planning in SDCs was associated with lower coverage of the Oral Health Team of the Familiy Health Strategy in a municipality (OR = 1.4; 95% CI: 1.0-1.9, p = 0.049), additional training for managers (p = 0.038), the practice of self-assessment (OR = 8.2; 95% CI: 5.8-11.6; p = 0.000) and meeting service production targets (OR = 1.9; 95% CI: 1.2-3.2; p = 0.011). Conclusion: The results indicate that the work processes of the SDCs, especially with regard to service management, are essential to the proper functioning of the service and the practice of planning is linked to the technical capacity and commitment of service managers.
Impact of racism and discrimination on the physical and mental health among Aboriginal and Torres Strait Islander peoples living in Australia: a protocol for a scoping review
Authors: Kairuz Camila A , Casanelia Lisa M , Bennett-Brook Keziah , Coombes Julieann , Yadav Uday Narayan
Published: September 2020

Background Racism is increasingly recognised internationally as a key factor contributing to health disparities. A comprehensive body of strong research from international authors has reported negative associations between racism and health outcomes. In Australia, although the literature is more limited, available findings follow global trends. Australia has an identified health gap between Aboriginal and Torres Strait Islander peoples and non-Indigenous Australians, and despite efforts to bridge this gap, health inequities continue to exist. This scoping review aims to assess, analyse and synthesise the relationship between racism and discrimination on the physical and mental health of Aboriginal and Torres Strait Islander peoples living in Australia.Method This is the study protocol for a scoping review. A systematic search will be conducted using five electronic databases: PubMed, CINAHL, Embase, Web of Science and the Australia’s National Institute for Aboriginal and Torres Strait Islander Health Research. The database search will include studies published between 2000 and 2020. Reference lists of the included articles will be searched. Outcome measures will include physical and mental health components including chronic conditions, depression and anxiety, psychological distress, social and emotional difficulties, suicide and health-related outcomes such as wellbeing and life satisfaction. Duplications will be removed, and titles and abstracts will be reviewed to select studies. Full-text screening of preselected studies will be performed by four reviewers independently, to select studies according to inclusion criteria. Included studies will be appraised for quality using appropriate tools tailored for each study design. Data will be extracted, and study findings and characteristics synthesised in a narrative summary. Discussion Our scoping review will synthesise the evidence on the impacts of racism and discrimination in relation to the physical and mental health of Aboriginal and Torres Strait Islander peoples living in Australia. These findings could guide future health interventions by addressing the exposure of racism and racial discrimination in order to reduce health disparity. It is anticipated the findings to be of interest to policymakers, researchers, Aboriginal and Torres Strait Islander communities and community health organisations and other stakeholders interested in optimising public health interventions for and in partnership with Aboriginal and Strait Torres Islander communities of Australia. Scoping review registration The protocol for this review has been registered on the International prospective register of systematic reviews (PROSPERO). The registration ID is CRD42020186193.
Evaluation of the District Health Information System 2 supported malaria reporting system in Solomon Islands
Authors: Wangdi Kinley , Sarma Haribondu , Leaburi John , McBryde Emma , Clements Archie CA
Published: September 2020

BackgroundDistrict Health Information Systems 2 (DHIS2) is used for supporting health information management in 67 countries, including Solomon Islands. However, there have been few published evaluations of the performance of DHIS2-enhanced disease reporting systems, in particular for monitoring infectious diseases such as malaria. The aim of this study was to evaluate DHIS2 supported malaria reporting in Solomon Islands and to develop recommendations for improving the system.MethodsThe evaluation was conducted in three administrative areas of Solomon Islands: Honoria City Council, and Malaita and Guadalcanal Provinces. Records of nine malaria indicators from 1st January to 31st December 2016 were extracted from the DHIS2 database. The indicators permitted assessment in four core areas: availability, completeness, timeliness and reliability. To obtain more detailed information on the performance of the malaria case reporting system, focus group discussions were conducted with health centre nurses, whilst in-depth interviews were conducted with stakeholder representatives from government (province and national) staff and WHO officials who were users of DHIS2. ResultsData were extracted from nine health centres in Honoria City Council and 64 health centres in Malaita Province. The completeness and timeliness from the two provinces of all nine indicators were 28.2% and 5.1% respectively. The most reliable indicator in DHIS2 was ‘clinical malaria’ (i.e. numbers of clinically diagnosed malaria cases) with 62.4% reliability. Challenges to completeness were a lack of supervision, limited feedback, high workload, and a lack of training and refresher courses. Health centres located in geographically remote areas, a lack of regular transport, high workload and too many variables in the reporting forms led to delays in timely reporting. Reliability of reports was impacted by a lack of technical professionals such as statisticians and unavailability of tally sheets and reporting forms. ConclusionThe availability, completeness, timeliness and reliability of nine malaria indicators collected in DHIS2 were variable within the study area, but generally low. Continued onsite support, supervision, feedback and additional enhancements such as electronic reporting will be required to further improve the malaria reporting system.
Systemic elucidate the potential bioactive compounds and hypoglycemic mechanism of Polygonum multiflorum based on network pharmacology
Authors: Song Yunfei , Yang Jianbo , Jing Wenguang , Wang Qi , Liu Yue , Cheng Xianlong , Wei Feng , Ma Shuangcheng
Published: September 2020

Background: Diabetes is a complex metabolic disease characterized by hyperglycemia, plaguing the whole world. However, the action mode of multi-component and multi-target for traditional Chinese medicine (TCM) could be a promising treatment of diabetes mellitus. According to the previous research, the TCM of polygonum multiflorum (PM) showed noteworthy hypoglycemic effect. Up to now, its hypoglycemic active ingredients and mechanism of action are not yet clear. In this study, network pharmacology was employed to elucidate the potential bioactive compounds and hypoglycemic mechanism of Polygonum multiflorum (PM).Methods: First, the compounds with good pharmacokinetic properties were screened from the self-established library of PM, and the targets of these compounds were predicted and collected through database. Relevant targets of diabetes were summarized by searching database. The intersection targets of compound-targets and disease-targets were obtained soon. Secondly, the interaction net between the compounds and the filtered targets was established. These key targets were enriched and analyzed by PPI analysis, molecular docking verification. Finally, the key genes were used to find the biologic pathway and explain the therapeutic mechanism by GO and KEGG analysis. Results: In this study, 29 hypoglycemic components and 63 hypoglycemic targets of PM were filtrated based on online network database. Then the component-target interaction network was constructed and five key components resveratrol, apigenin, kaempferol, quercetin and luteolin were further obtained. Sequential studies turned out, AKT1, EGFR, ESR1, PTGS2, MMP9, MAPK14, and KDR were the common key targets. Docking studies indicated that the bioactive compounds could stably bind the pockets of target proteins. There were 38 metabolic pathways, including regulation of lipolysis in adipocytes, prolactin signaling pathway, TNF signaling pathway, VEGF signaling pathway, FoxO signaling pathway, estrogen signaling pathway, linoleic acid metabolism, Rap1 signaling pathway, arachidonic acid metabolism, and osteoclast differentiation closely connected with the hypoglycemic mechanism of PM.Conclusion: In summary, the study used systems pharmacology to elucidate the main hypoglycemic components and mechanism of PM. The work provided a scientific basis for the further hypoglycemic effect research of PM and its monomer components, but also provided a reference for the secondary development of PM.
NFAT2 overexpression suppresses the malignancy of hepatocellular carcinoma through inducing Egr2 expression
Authors: Wang Jian , Zhang Yamin , Liu Lei , Cui Zilin , Shi Rui , Hou Jianchun , Liu Zirong , Yang Long , Wang Lianjiang , Li Yang
Published: September 2020

BACKGROUND: Nuclear factor of activated T cells 2 (NFAT2) has been reported to regulate the development and malignancy of few tumors. In this study, we aimed to explore the effect of NFAT2 expression on cell fate of HepG2 cell and its potential mechanisms. METHODS: Firstly, the pcDNA3.1-NFAT2 plasmid was transfected into HepG2 cells to construct NFAT2 overexpressed HepG2 cells. Then, the chemical count kit-8 cell viability assay, Annexin V-FITC apoptosis detection, EdU labeling proliferation detection, transwell and wound healing experiments were performed. The expression of Egr2 and FasL, and the phosphorylation of AKT and ERK, after ionomycin and PMA co-stimulation, was detected, while the Ca2+ mobilization stimulated by K+ solution was determined. At last, the mRNA and protein expression of NFAT2, Egr2, FasL, COX-2 and c-myc in carcinoma and adjacent tissues was investigated. RESULTS: The NFAT2 overexpression suppressed the cell viability, invasion and migration capabilities, and promoted apoptosis of HepG2 cells. NFAT2 overexpression induced the expression of Egr2 and FasL and suppressed the phosphorylation of AKT and ERK. The sensitivity and Ca2+ mobilization of HepG2 cells was also inhibited by NFAT2 overexpression. Compared with adjacent tissues, the carcinoma tissues expressed less NFAT2, Egr2, FasL and more COX-2 and c-myc. CONCLUSION: The current study firstly suggested that NFAT2 suppressed the aggression and malignancy of HepG2 cells through inducing the expression of Egr2. The absence of NFAT2 and Egr2 in carcinoma tissues reminded us that NFAT2 may be a promising therapeutic target for hepatocellular carcinoma treatment.
Differentially expressed genes in cotyledon of ewes fed mycotoxins
Authors: Britt Jessica L , Noorai Rooksana , Duckett Susan
Published: September 2020

Background

Ergot alkaloids (E+) are mycotoxins produced by the endophytic fungus, Epichloë coenophiala, in tall fescue that are associated with ergotism in animals. Exposure to ergot alkaloids during gestation reduces fetal weight and placental mass in sheep. These reductions are related to vasoconstrictive effects of ergot alkaloids and potential alterations in nutrient transport to the fetus. Cotyledon samples were obtained from eight ewes that were fed E+ (n = 4; E+/E+) or E- (endophyte-free without ergot alkaloids; n = 4; E-/E-) seed during both mid (d 35 to 85) and late (d 85-133) gestation to assess differentially expressed genes associated with ergot alkaloid induced reductions in placental mass and fetal weight, and discover potential adaptive mechanisms to alter nutrient supply to fetus.

Results

Ewes fed E+/E+ fescue seed during both mid and late gestation had 20% reduction in fetal body weight and 33% reduction in cotyledon mass compared to controls (E-/E-). Over 13,000 genes were identified with 110 upregulated and 33 downregulated. Four genes had a |log2FC|>5 for ewes consuming E+/E+ treatment compared to controls: LECT2, SLC22A9, APOC3, and MBL2. REViGO revealed clusters of upregulated genes associated glucose, carbohydrates, lipid, protein, macromolecular and cellular metabolism, regulation of wound healing and response to starvation. For downregulated genes, no clusters were present, but all enriched GO terms were associated with anion and monocarboxylic acid transport. The complement and coagulation cascade and the peroxisome proliferator-activated receptor signaling pathway were found to be enriched for ewes consuming E+/E+ treatment.

Conclusions

Consumption of ergot alkaloids during gestation altered the cotyledonary transcriptome specifically related to macronutrient metabolism, wound healing and starvation. These results show that ergot alkaloid exposure upregulates genes involved in nutrient metabolism to supply the fetus with additional substrates in attempts to rescue fetal growth.
Professional development arising from multiple-site workplace learning: boundary crossing between the education and clinical contexts.
Authors: Barry Margot , Kuijer-Siebelink Wietske , Niewenhuis Loek A.F.M. , Scherpbier Nynke
Published: September 2020

Background: This research explores the value of an inter-organisational jurisdiction, on the professional development of faculty members in their roles of researcher and educator. Faculty members from a Dutch university of applied sciences, who work in both the education and clinical practice contexts, participated in this research.Methods: Individual semi-structured interview were conducted with nine faculty members, from various academic health professions, on their experiences of professional development arising from working in both the clinical and education contexts. In this exploratory, post-positive interview study, interview transcripts were analysed thematically.Results: Participants reported that working in two organisational contexts, whilst performing two faculty roles that span both contexts, enhances their ability to broker connections between research, teaching and practice. The boundary crossing activities which participants performed, contributed to professional development in all faculty roles. The broker role was not seen as being a unique role which is distinct from research and practice roles. Broker activities were seen as generic and supportive of the roles that bestow academic status and expertise.Conclusions: To the participants in this research, the relevance of the broker role in professional development is not as evident as the relevance of roles that enhance specialisation and subject specific expertise. They consider broker activities as supportive to the roles of researcher and teacher. The broker role is time consuming, but not yet visible as a distinct professionalisable work-package in its own right. It is also not well defined in literature.. A better understanding of the broker role could lead to its development in order to harness its professional development potential tenably across academic roles.
“It’s really no more difficult than putting on fluoride varnish”: A qualitative exploration of dental professionals’ views of silver diamine fluoride for the management of carious lesions in children
Authors: Seifo Nassar , Cassie Heather , Radford John , Innes Nicola
Published: September 2020

BackgroundDespite evidence that Silver Diamine Fluoride (SDF) can be effective in managing carious lesions in primary teeth, the use of SDF in the UK remains limited. This study explored dental professionals’ views and experiences of using SDF for managing carious lesions in children. In addition, it explored what they perceived to be the advantages, disadvantages, barriers and enablers to the use of SDF in practice.MethodsFifteen semi-structured face-to-face or over-the-phone interviews were conducted with 14 dental professionals from NHS Tayside and NHS Grampian in Scotland. Interviews were transcribed verbatim, coded and analysed using a thematic approach.ResultsThirteen of 14 dental professionals interviewed were familiar with, or had some existing knowledge of, SDF. Four had used it to treat patients. The majority of participants thought that the main advantage of SDF was that it required minimal patient cooperation. SDF was also perceived as a simple, pain-free and non-invasive treatment approach that could help acclimatise children to the dental environment. However, SDF-induced black staining of arrested carious lesions was most commonly reported as the main disadvantage and greatest barrier to using it in practice. Participants believed that this discolouration would concern some parents who may fear that the black appearance may instigate bullying at school and that others may judge parents as neglecting their child’s oral health. Participants thought that education of clinicians about SDF use and information sheets for parents would enhance the uptake of SDF in dental practice. Participants believed that younger children might not be as bothered by the discolouration as older ones and they anticipated greater acceptance of SDF for posterior primary teeth by both parents and children.ConclusionDental professionals were aware that SDF can be used for arresting carious lesions. They pointed out that the staining effect of carious lesions is a major disadvantage that could be a barrier for many parents. Participants considered the application process to be simple and non-invasive and requires a minimum level of child cooperation. Participants appreciated the potential of SDF in paediatric dentistry and suggested actions that could help overcome the barriers they highlighted.
Infection deteriorating hepatitis B virus related acute-on-chronic liver failure: a retrospective cohort study
Authors: Zhai Xing-Ran , Tong Jing-Jing , Wang Hong-Min , Xu Xiang , Mu Xiu-Ying , Chen Jing , Liu Zi-Feng , Wang Yu , Su Hai-Bin , Hu Jin-Hua
Published: September 2020

Background: Infection is common in acute-on-chronic liver failure (ACLF), which may worsen the clinical condition and prognosis. However, the characteristics of infection and its influence on prognosis in hepatitis B virus related ACLF (HBV-ACLF) as defined by the European Association for the Study of the Liver (EASL) have not been clarified. We aimed to investigate the characteristics of infection and its influence on mortality in patients with HBV-ACLF defined by EASL in China.Methods: We performed a retrospective cohort study in patients with HBV-ACLF defined by EASL in a single center from January 2015 to December 2017. These patients were divided into two groups with and without infection. The incidence, sites of infection, isolated strains, and risk factors associated with mortality were evaluated. Results: A total of 289 patients were included, among them 185 (64.0%) were diagnosed with an infection. The most common type of infection was pneumonia (55.7%), followed by spontaneous bacterial peritonitis (47.6%) and others. The gram-negative bacteria were the most frequent (58.3%). Patients with one, two, and three or more infection sites had a gradually increasing incidence of sepsis (P<0.01), septic shock (P<0.001), and ACLF-3 (P<0.05). Also, patients with infection isolated one, two, and three or more strains showed a growing incidence of sepsis (P<0.01) and septic shock (P<0.001). Patients with infection showed a significantly higher 28-day mortality than those without (P<0.01), especially in patients with ACLF-3. Infection was identified as an independent risk factor for 28-day mortality in all HBV-ACLF patients. Pneumonia and sepsis were identified as independent predictors of 28-day mortality for patients with infection.Conclusions: Infection is associated with severe clinical course and high mortality in HBV-ACLF defined by EASL. The increased number of infection sites or isolated strains was associated with the occurrence of sepsis and septic shock. Pneumonia and sepsis were independent predictors for mortality in HBV-ACLF patients with infection.
Appropriate insertion point for percutaneous pedicle screw placement in the lumbar spine using c-arm fluoroscopy: a cadaveric study
Authors: Xu Wei-Xing , Ding wei-guo , Xu Bin , Hu Tian-Hong , Sheng Hong-Feng , Zhu Jia-Fu , Zhu Xiao-Long
Published: September 2020

Background: We studied the characteristics and regularity of appropriate insertion points for percutaneous pedicle screw placement in the lumbar spine using C-arm X-ray fluoroscopy. The purpose of this study was to improve the accuracy of percutaneous pedicle screw placement and reduce the incidence of superior-level facet joint violation. Methods: Six normal spinal specimens were included. Three different methods for placing percutaneous pedicle screws in the lumbar spine were applied, including the Roy-Camille method, Magerl method and Weinstein method. The relationships among the insertion point, pedicle projection and proximal facet joint on C-arm X-ray films were studied. The projection morphology of the vertebral pedicle in different segments of the lumbar spine was observed. The relationship between the outer edge of the pedicle projection and the outer edge of the cranial articular process was also studied. The distance between the insertion point and the facet joint (M1), the distance between the insertion point and outer edge of the cranial articular process (M2), and the distance between the insertion point and the projection center of the pedicle (M) were measured. Results: In this study, we found that the projection shape of the vertebral pedicle differed across segments of the lumbar spine: the shape for L1-L3 was oval, and that for L4-L5 was round. The radiographic study showed that the outer edge of the cranial articular process was located on the lateral side of the outer edge of the pedicle projection and did not overlap with the pedicle projection. M for the Weinstein group was larger than that for the Roy-Camille group (P < 0.05). M1 for the Weinstein group was larger than that for the Roy-Camille and Magerl groups (P < 0.05). M2 for the Roy-Camille group was negative, M2 for the Magerl group was 0, and M2 for the Weinstein group was positive. Conclusion: Under C-arm X-ray fluoroscopy, we were able to accurately identify the characteristics and regularity of the appropriate insertion point for percutaneous pedicle screw placement in the lumbar spine, which was important for improving the accuracy of percutaneous pedicle screw placement and reducing the incidence of superior-level facet joint violation.
Characterization of the Serum Levels of Meteorin-like in Patients with Inflammatory Bowel Disease and its Association with Inflammatory Cytokines
Authors: Gholamrezayi Afsane , Mohamadinarab Maryam , Rahbarinejad Pegah , Fallah Soudabeh , Barez Shekufe Rezghi , Setayesh Leila , Moradi Nariman , Fadaei Reza , Chamani Elham , Tavakoli Tahmine
Published: September 2020

Background : Meteorin-like (Metrnl) is a newly discovered adipokine with insulin sensitizing and anti-inflammatory properties. The relation among Metrnl, Inflammatory Bowel Disease (IBD), and obesity still remained unexplored. Methods : The present study was conducted on 54 healthy control, 42 Ulcerative Colitis (UC), and 43 Crohn's disease (CD) patients who were diagnosed by pathological examination. In all participants, serum levels of adiponectin, Metrnl, interleukin (IL)-6, and Tumor necrosis factor (TNF-α) were measured using ELISA kits.Results: Metrnl concentration was considerably decreased in both UC (85.25±36.55 pg/mL) and CD (76.93±27.92 pg/mL) patients in comparison to control group (107.52±35.33 pg/mL). In addition, the level of adiponectin decreased in these two patient groups compared to the controls. However, IL-6 and TNF-α significantly elevated in the patient groups. Moreover, Metrnl showed an inverse correlation with body mass index (BMI) in the controls and the patients. In addition, there was an inverse correlation among Metrnl, IL-6, and TNF-α in both of the patient groups. Conclusions : The current study is the first one reporting the decreased serum levels of Metrnl in patients with IBD, which is inversely related with BMI, TNF-α, and IL-6. These results suggested a possible relation of Metrnl with the pathogenesis of IBD, particularly through inflammatory process that need further study to dissect the possible mechanism. Keywords : Meteorin-like, Inflammatory Bowel Disease, Ulcerative Colitis, Crohn's disease, Interleukin, Tumor necrosis factor, Adiponectin
“If you are on duty, you may be afraid to come out to attend to a person”: Fear of crime and security challenges in maternal acute care in Nigeria from a realist perspective.
Authors: Etiaba Enyi , Manzano Ana , Agbawodikeizu Uju , Ogu Udochukwu , Ebenso Bassey , Uzochukwu Benjamin , Onwujekwe Obinna , Ezumah Nkoli , Mirzoev Tolib
Published: September 2020

Background Maternal and Child Health is a global priority. Access and utilization of facility-based health services remain a challenge in low and middle-income countries. Evidence on barriers to providing and accessing services omits information on the role of security within facilities. This paper explores the role of security in the provision and use of maternal health services in primary healthcare facilities in Nigeria. Methods Study was carried out in Anambra state, Nigeria. Qualitative data were initially collected from 35 in-depth interviews and 24 focus groups with purposively identified key informants. Information gathered was used to build a programme theory that was tested with another round of interviews (17) and focus group (4) discussions. Data analysis and reporting were based on the Context-Mechanism-Outcome heuristic of Realist Evaluation methodology. Results The presence of a male security guard in the facility was the most important security factor that facilitated provision and uptake of services. Others include perimeter fencing, lighting and staff accommodation. Lack of these components constrained provision and use of services, by impacting on behaviour of staff and patients. Security concerns of facility staff who did not feel safe to let in people into unguarded facilities, mirrored those of pregnant women who did not utilize health facilities because of fear of not being let in and attended to by facility staff. Conclusion Health facility security should be key consideration in programme planning, to avert staff and women’s fear of crime which currently constrains provision and use of maternal healthcare at health facilities.
Nomogram for Prediction of fatal outcome in Patients with Severe COVID-19: A Multicenter Study
Authors: Yang Yun , Zhu Xiaofei , Huang Jian , Chen Cui , Zheng Yang , He Wei , Zhao Linghao , Gao Qian , Huang Xuanxuan , Fu Lijuan , Zhang Yu , Chang Yanqin , Zhang Huojun , Lu Zhijie
Published: September 2020

Background & Aims: To develop an effective model of predicting fatalOutcome in the severe coronavirus disease 2019 (COVID-19) patients.Methods: Between February 20, 2020 and April 4, 2020, consecutive COVID-19 patients from three designated hospitals were enrolled in this study. Independent high- risk factors associated with death were analyzed using Cox proportional hazard model. A prognostic nomogram was constructed to predict the survival of severe COVID-19 patients.Results: There were 124 severe patients in the training cohort, and there were 71 and 76 severe patients in the two independent validation cohorts, respectively. Multivariate Cox analysis indicated that age ≥ 70 years (HR 1.184, 95% CI 1.061-1.321), Panting(breathing rate ≥ 30/min) (HR 3.300, 95% CI 2.509-6.286), lymphocyte count < 1.0 × 109/L (HR 2.283, 95% CI 1.779-3.267), and IL-6 >10pg/mL (HR 3.029, 95% CI 1.567-7.116) were independent high-risk factors associated with fatal outcome. We developed the nomogram for identifying survival of severe COVID-19 patients in the training cohort (AUC 0.900, [95% CI 0.841-0.960], sensitivity 95.5%, specificity 77.5%); in validation cohort 1 (AUC 0.811, [95% CI 0.698-0.924], sensitivity 77.3%, specificity 73.5); in validation cohort 2 (AUC 0.862, [95% CI 0.763-0.961], sensitivity 92.9%, specificity 64.5%). The calibration curve for probability of death indicated a good consistence between prediction by the nomogram and the actual observation. The prognosis of severe COVID-19 patients with high levels of interleukin-6 (IL-6) receiving tocilizumab was better than that of those patients without tocilizumab both in the training and validation cohorts, but without difference (p = 0.105 for training cohort, p = 0.133 for validation cohort 1, and p = 0.210 for validation cohort 2).Conclusions: This nomogram could help clinicians to identify severe patients who have high risk of death, and to develop more appropriate treatment strategies to reduce the mortality of severe patients. Tocilizumab may improve the prognosis of severe COVID-19 patients with high levels of IL-6.
Conceptualizations of Clinical Decision-Making: A scoping review in geriatric emergency medicine
Authors: Gamborg Maria Louise , Mehlsen Mimi , Paltved Charlotte , Tramm Gitte , Musaeus Peter
Published: September 2020

Background Clinical decision-making (CDM) is an important competency for young doctors especially under complex and uncertain conditions in geriatric emergency medicine (GEM). However, research in this field is characterized by a vague conceptualization of CDM. To evolve and evaluate evidence-based knowledge of CDM, it is important to identify different definitions and their operationalisations in studies on GEM. Objective A scoping review of empirical articles was conducted to provide an overview of the documented evidence of findings and conceptualizations of CDM in GEM. Methods A detailed search for empirical studies focusing on CDM in a GEM setting was conducted in PubMed, ProQuest, Scopus, EMBASE and Web of Science. In total, 52 publications were included in the analysis, utilizing a data extraction sheet, following the PRISMA guidelines. Reported outcomes were summarized. Results Four themes of operationalization of CDM emerged: CDM as dispositional decisions, CDM as cognition, CDM as a model, and CDM as clinical judgement. Study results and conclusions naturally differed according to how CDM was conceptualized. Thus, frailty-heuristics lead to biases in treatment of geriatric patients and the complexity of this patient group was seen as a challenge for young physicians engaging in CDM. Conclusions This scoping review summarizes how different studies in GEM use the term CDM. It provides an analysis of findings in GEM and call for more stringent definitions of CDM in future research, so that it might lead to better clinical practice.
Infertility policy analysis: a comparative study of selected lower middle- middle- and high-income countries
Authors: Morshed-Behbahani Bahar , Lamyian Minoor , Joulaei Hassan , Rashidi Batool Hossein , Montazeri Ali
Published: September 2020

BackgroundInfertility has recently become a salient but neglected global issue. Policies to address the sexual and reproductive health and rights (SRHR) are vital, especially in lower middle and middle-income countries (LMICs). Hence, the aim of this study was to compare the national infertility policies in the selected countries (LMICs comparing with high-income) to determine gaps or to confirm desirable policies in the given health systems.MethodsThis study has executed a comparative policy analysis of infertility services using the universal health coverage framework (financial protection, population coverage, and service features) in three scopes (prevention, treatment, and supportive care). Seven countries that had infertility programs in their health sectors were selected.ResultsThe results showed that financial protection was good in high and middle-income countries, but in a lower middle income, and in one high-income country was poor. The findings also showed that health systems in the same countries had no infertility services for men. Preventive and supportive care services were neglected in LMICs by governments.ConclusionThe findings indicate that income is not the only factor that fulfills universal health coverage for infertility care services. Perhaps to achieve equity in infertility care services, it should be seen as a universal human right to accomplish the right to have a child and to have a life with physical and mental health for all men and women.
Differential gene expression in skin RNA of horses affected with degenerative suspensory ligament desmitis
Authors: Haythorn Abigail , Young Madeline , Stanton James , Zhang Jian , Mueller P.O.E. , Halper Jaroslava
Published: September 2020

Background

Equine Degenerative Suspensory Desmitis (DSLD) is a systemic connective tissue disorder first identified in Peruvian Paso horses, but afflicting other horse breeds as well. Inappropriate accumulation of proteoglycans in connective tissues, most prominently in tendons and ligaments leads to progressive and debilitating lameness and pain. It is largely unknown what drives the overproduction of proteoglycans, but our previous studies suggest involvement of bone morphogenetic protein 2 (BMP2), a member of the transforming growth factor β (TGFβ) family, impacting synthesis of proteoglycans. To identify potential players in pathogenesis of DSLD a new approach utilizing next generation sequencing was undertaken.

Methods

Next generation sequencing was performed using RNA extracted from skin biopsies of six control Peruvian Pasos and six horses with DSLD (4 Peruvian Pasos and 2 Warmbloods). The CuffDiff result sets were validated with algorithms used to run them. This was based on the determined False Discovery Rates derived from the P-values adjusted for multiple testing for any given result.

Results

Bioinformatics analysis of transcriptomes revealed differential expression of over 1500 genes, including increased expression of genes for several growth factors (most prominently BMP2, FGF5, CTGF, members of the EGF family), of mediators of signaling (Fos, Myc, MAPK system), and keratins. Two genes encoding for enzymes involved in synthesis of hyaluronan were also overexpressed. Gene expression was decreased for protein cores of many proteoglycans, several growth factors, most collagens and many peptides with immune function.

Conclusions

The overexpression of BMP2 correlates well with our previous data. However, the decrease in expression of numerous proteoglycans was unexpected. A mutation in a gene of a less characterized proteoglycan and/or glycosyltransferase with subsequent increased production of hyaluronan and/or a proteoglycan(s) undetected in our study could account for the systemic proteoglycan deposition. Decreased collagen gene expression indicates abnormal connective tissue metabolism. The increased expression of keratin genes and FGF5 supports reports of skin abnormalities in DSLD. Underexpression of immune function genes corresponds with lack of inflammation in DSLD tissues. Finally, though the proteoglycan and/or glycosaminoglycan abundant in DSLD has not been identified, we validated our previous data, including overexpression of BMP2 , and systemic nature of DSLD due to disturbed metabolism of the extracellular matrix.
Vitamin D status in adults and children in Transcarpathia, Ukrainein 2019
Authors: Shchubelka Khrystyna
Published: September 2020

Background: Vitamin D deficiency is a global health problem, it is assessed by measuring serum 25-hydroxivitamin D (25(OH) D), nevertheless epidemiological data for many countries remains underreported.Objectives:To study the prevalence of vitamin D deficiency throughout the calendar year in a large cohort recruited ina multiethnic Transcarpathian region of Ukraine.Methods: In this retrospective study 25(OH)D serum concentration was measured during all 12 months of the year 2019 by electrochemoluminescent assay on the automatic analyzer Cobas e411 in 1,823 subjects, including both children and adults (1551 females (85.03%) and 273 males (14.97%)). ResultsThe mean 25(OH) D concentration in adults demonstrates significantly lower levels compared to children (22.67±8.63 ng/ml vs. 26.00±10.72 ng/ml respectively, p<0.001). Adult women expressed significantly lower mean annual serum 25 (OH) D concentrations in comparison to men (22.29±8.46 ng/ml vs. 25.75±9.38 ng/ml respectively, p< 0.001). In contrast, children did not show a significant difference between sexes (girls 24.98±10.38 ng/ml vs. boys 27.01±11.01 ng/ml, p=0.2003). In the winter months, 25(OH)D levels fell below 20 ng/ml in 51,74 % of adult population of Thranscarpathia, and in 12.91%, - below 12 ng/ml.ConclusionsThe results of this study contradict the previously reported evaluations of the vitamin D levels in Ukraine which were assessed by measuring serum 25(OH) D. Specifically, only approximately half of the studied population is vitamin D deficient during winter season. This study features the most representative sample size in Ukraine to date.
Systematic review and bibliometric analysis of African anesthesia and critical care medicine research Part I: Hierarchy of evidence and scholarly productivity
Authors: Kanmounye Ulrick Sidney , Tochie Joel Noutakdie , Mbonda Aimé Noula , Wafo Cynthia Solam , Daya Leonid , Atem Thompson Hope , Nyalundja Arsène Daniel , Eyaman Daniel Cheryl
Published: September 2020

Background: Research is an essential component of Anesthesia, and the contributions of researchers and institutions can be appreciated from the analysis of scholarly outputs. Such analyses help identify major contributors and trends in publication. Little is known about the state of Anesthesia and Critical Care Medicine (A.C.C.M.) research in Africa. We aimed to describe African A.C.C.M. research's current landscape by determining its productivity per country and point towards possible ideas for improvement. Methods: The authors searched PubMed, Embase, Web of Science, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) from inception to May 4, 2020, for articles on or about A.C.C.M. in Africa. Studies were selected based on their titles and abstracts. Rayyan software was later on used for data management in the review selection process. Then, the full-text of eligible articles were screened. Data were extracted, and the number of articles per physician anesthesia providers and provider density were calculated. Kruskal Wallis test and Spearman's correlation were used, and a P-value <0.05 was considered statistically significant.Results: Of the 4690 articles, only 886 (18.9%) were included in the analysis. The articles were published between 1946 and 2020 in 278 target journals. 55 (6.2%) articles were published in the South African Journal of Surgery, 51 (5.8%) in Anesthesia and Analgesia, and 46 (5.2%) in Anaesthesia. 291 (32.8%) studies were cross-sectional. 195 (22.0%) first authors were from Nigeria, 118 (13.3%) from South Africa, and 88 (9.9%) from the U.S.A. Malawi (1.67), Togo (1.06), and Sierra Leone (1.00) had the highest number of articles per provider. Whereas Ethiopia (580.00), Nigeria (336.21), and Malawi (333.33) had the highest number of articles per provider density. Conclusion: We identified the most and least productive African countries in A.C.C.M. research and a low-quality hierarchy of evidence in these publications. Hence, the study's findings may aid in driving the A.C.C.M. research agenda and capacity building in Africa.