bluuebunny/crossref_metadata_2025 huggingface dataset:
Health and Adverse Childhood Experiences Among Homeless Youth
Authors: Barnes Andrew J. , Gower Amy L. , Sajady Mollika , Lingras Katherine A.
Published: February 2020

Background and Objectives Homelessness is associated with health problems and with adverse childhood experiences (ACEs). The risk of chronic health conditions for homeless compared to housed youth, and how this risk interacts with ACEs remains unclear. This study investigated the relationship between ACEs, housing, and child health, and whether: 1) ACEs and health vary by housing context; 2) ACEs and homelessness confer independent health risks; and 3) ACEs interact with housing with regard to adolescent health. Methods Using data from 119,254 8th-11th graders, we tested independent and joint effects of ACEs and past-year housing status (housed, family homelessness, unaccompanied homelessness) on overall health and chronic health conditions, controlling for sociodemographic covariates. Results The prevalence of ACEs varied by housing status, with 34.1% of housed youth experiencing ≥1 ACE vs. 56.3% of family-homeless and 85.5% of unaccompanied-homeless youth. Health status varied similarly. Homelessness and ACEs were independently associated with low overall health and chronic health conditions, after adjusting for covariates. Compared to housed youth, both family-homeless youth and unaccompanied-homeless youth had increased odds of low overall health and chronic physical and/or mental health conditions. All ACE x housing-status interactions were significant (all p<0.001), such that ACE-related health risks were moderated by housing status. Conclusions ACEs and housing status independently predict health status during adolescence beyond other sociodemographic risks. Being homeless unaccompanied is also riskier than being homeless with family, and every additional ACE increases this risk. Clinicians and health systems should advocate for policies that include stable housing as a protective factor.
Experimental infection with the hookworm, Necator americanus, promotes gut microbial diversity in human volunteers with relapsing multiple sclerosis
Authors: Jenkins Timothy , Pritchard David , Tanasescu Radu , Telford Gary , Paraiakovou Marina , Constantinescu Cris , Cantacessi Cinzia
Published: February 2020

Background Helminth-associated changes in gut microbiota composition have been hypothesised to contribute to the immune-suppressive properties of parasitic worms. Multiple sclerosis is an immune-mediated autoimmune disease of the central nervous system whose pathophysiology has been recently linked to alterations of gut microbial communities. Results In the present study we investigated, for the first time, qualitative and quantitative changes in gut microbial composition of human volunteers with remitting multiple sclerosis (RMS) prior to and following experimental infection with the human hookworm, Necator americanus ( N+ ), and following anthelmintic treatment, and compared the findings with data obtained from a cohort of RMS patients subjected to placebo treatment ( PBO ). Bacterial 16S rRNA high-throughput sequencing data revealed significantly decreased microbial alpha diversity in the gut microbiota of PBO compared to N+ subjects over the course of the trial; additionally, we observed significant differences in the abundances of several bacterial taxa with putative immune-modulatory functions between study cohorts. Parabacteroides were significantly expanded in the gut microbiota of N + individuals for which no relapses were recorded at the end of the trial. Conclusions Overall, these data lend support to the hypothesis of a contributory role of parasite-associated alterations in gut microbial composition to the immunomodulatory properties of hookworm parasites.
Shifts in microbial diversity, composition and functionality in the gut and genital microbiome during a natural SIV infection in vervet monkeys
Authors: Jasinska Anna J , Dong Tien S , Lagishetty Venu , Katzka William , Jacobs Jonathan P , Schmitt Christopher , Cramer Jennifer Danzy , Ma Dongzhu , Coetzer Willem G , Grobler J. Paul , Turner Trudy R , Freimer Nelson , Pandrea Ivona , Apetrei Cristian
Published: February 2020

Background: The microbiota plays an important role in HIV pathogenesis in humans. Microbiota can impact health through several pathways such as increasing inflammation in the gut, metabolites of bacterial origin, and microbial translocation from the gut to the periphery which contributes to systemic chronic inflammation, immune activation, and the development of AIDS. Unlike HIV-infected humans, SIV-infected vervet monkeys do not experience gut dysfunction, microbial translocation and chronic immune activation and do not progress to immunodeficiency. Here, we provide the first reported characterization of the microbial ecosystems of the gut and genital tract in a natural nonprogressing host of SIV, wild vervet monkeys from South Africa. Results: We characterized fecal, rectal, vaginal, and penile microbiomes in vervets from populations heavily infected with SIV from diverse locations across South Africa. Geographic site, age, and sex affected the vervet microbiome across different body sites. Fecal and vaginal microbiome showed marked stratification with three enterotypes in fecal samples and two vagitypes, which were predicted functionally distinct within each body site. Bioclimatic factors, biome type, and environmental temperature, influenced microbiomes locally associated with vaginal and rectal mucosa. Several fecal microbial taxa were linked to plasma levels of immune molecules, for example, MIG was positively correlated with Lactobacillus and Escherichia/Shigella and Helicobacter , and IL-10 was negatively associated with Erysipelotrichaceae , Anaerostipes , Prevotella and Anaerovibrio , and positively correlated with Bacteroidetes , and Succinivibrio . During the chronic phase of SIV infection, we observed a significant increase in gut microbial diversity, alterations in community composition (including a decrease in Proteobacteria/ Succinivibrio in the gut) and functionality (including a decrease in genes involved in bacterial invasion of epithelial cells in the gut), and partial reversibility of acute infection-related shifts in microbial abundance. As part of our study, we also developed an accurate predictor of SIV infection using fecal samples. Conclusions: The vervets infected with SIV and humans infected with HIV differ in microbial responses to infection. These responses to SIV infection may aid in preventing microbial translocation and subsequent disease progression in vervets, and may represent host microbiome adaptations to the virus.
Eosinophilic Gastroenteritis as a Cause of Non-Helicobacter pylori, Non-gastrotoxic Drug Ulcers in Children
Authors: Joo Jung Yeon , Cho Jin Min , Yoo In Hyuk , Yang Hye Ran
Published: February 2020

Background: While Helicobacter pylori (H. pylori) ulcers has declined recently, H. pylori-negative and/or gastrotoxic drug-negative peptic ulcers (HNGN-PU) has increased. This study aimed to analyze the etiology of peptic ulcers in children and the differences in clinical, laboratory, endoscopic, and histopathologic findings of peptic ulcers according to etiology, including eosinophilic gastroenteritis (EoGE). Methods: In total, 255 children (157 boys and 98 girls) with peptic ulcers were recruited. The subjects were categorized into 5 groups according to the etiology of the ulcer: 1) H. pylori infection (n = 51); 2) gastrotoxic drugs (n = 18); 3) idiopathic (n = 144); 4) systemic disease (n = 23); 5) EoGE (n = 19). Clinical data were reviewed and analyzed retrospectively. Results: Age at diagnosis, ulcer recurrence, atopic dermatitis history, white blood cell count, blood eosinophil count, platelet count, serum albumin level, iron level, erythrocyte sedimentation rate, and C-reactive protein level differed significantly among the 5 groups (all p < 0.05). Regarding endoscopic findings, multiple ulcers and gastric mucosal nodularity differed among the 5 groups (all p < 0.05). When comparing the EoGE ulcer group with the others, EoGE group revealed older ages (p = 0.022), higher rates of ulcer recurrence (p = 0.018), atopic dermatitis history (p = 0.001), and both blood and tissue eosinophilia (both p = 0.001). Conclusions: EoGE ulcers constituted 10.2% of HNGN-PU in pediatric patients. In children with HNGN-PU, peripheral eosinophilia, ulcer recurrence, and atopic dermatitis history might imply EoGE, necessitating thorough investigation of tissue eosinophils during endoscopic biopsy. Trial registration: 255 children retrospectively registered between between July 2003 and April 2017.
The Developed Patient Healthy Questionnaire-8 with a Greater Impact on Quality of Life Compared with the Somatic Symptom Scale-8 in Functional Dyspepsia
Authors: Yuan Chaoqun , Yong Guizhen , Wang Xi , Xie Ting , Wang Chunyan , Yuan Yuan , He Guobin
Published: February 2020

Background: To adapt insufficiencies of the Somatic Symptom Scale-8 (SSS-8) measuring somatization in functional dyspepsia (FD) to develop PHQ-8, of which reliability, validity and the effects of somatization evaluated by the developed PHQ-8 on quality of life (QoL) were further assessed.Methods: 612 FD patients completed a 25 items questionnaire. 8 items were selected from 25 items to constitute the PHQ-8 by discrete degree, correlation coefficient, factor analysis and Cronbach coefficient four methods. Reliability and validity for the PHQ-8 and the SSS-8 were compared by principal component and confirmatory factor analysis. The effects of somatization, depression and anxiety on the Nepean Dyspepsia Index (NDI) for QoL were explored by Pearson correlation coefficient and linear regression analysis.Results: Cronbach’s α coefficients for the PHQ-8 and the SSS-8 were 0.601, 0.553, and cumulative contribution rates of three extracted factors were 55.103%, 51.666%, respectively. Somatization evaluated by the PHQ-8(r=0.309, P<0.001) and the SSS-8 (r=0.281, P<0.001) were related to the NDI. The model for the PHQ-8 showed χ2=31.247, RMR=0.01, RMSEA=0.042, GFI=0.984. Linear regression analysis showed that somatization measured by the PHQ-8 (β=0.270, P<0.001), anxiety (β=0.163, P<0.001) and depression (β=0.136, P=0.003) were determinants of the NDI; somatization measured by the SSS-8 (β=0.250, P<0.001), anxiety (β=0.156, P<0.001) and depression (β=0.155, P =0.001) were determinants of the NDI.Conclusions: The developed PHQ-8 had a better reliability and validity, which assessing somatization appeared to have a greater impact on QoL than that of the SSS-8. These results suggested that the developed PHQ-8 might improve to study the effects of somatization on QoL instead of the SSS-8 in specific FD patients.
Exome sequencing for diagnosis of congenital hemolytic anemia
Authors: Mansour-Hendili Lamisse , Aissat Abdelrazak , Badaoui Bouchra , Sakka Mehdi , Gameiro Christine , Ortonne Valérie , Wagner-Ballon Orianne , Pissard Serge , Picard Véronique , Ghazal Khaldoun , Bahuau Michel , Guitton Corinne , Mansour Ziad , Duplan Mylène , Petit Arnaud , Chalumeau Nathalie Costedoat , Michel Marc , Bartolucci Pablo , Moutereau Stéphane , Funalot Benoît , Galactéros Frédéric
Published: February 2020

Background: Congenital hemolytic anemia constitutes a heterogeneous group of rare genetic disorders of red blood cells. Diagnosis is based on clinical data, family history and phenotypic testing, genetic analyses being usually performed as a late step. In this study, we explored 40 patients with congenital hemolytic anemia by whole exome sequencing: 20 patients with hereditary spherocytosis and 20 patients with unexplained hemolysis.Results: A probable genetic cause of disease was identified in 82.5% of the patients (33/40): 100% of those with suspected hereditary spherocytosis (20/20) and 65% of those with unexplained hemolysis (13/20). We found that several patients carried genetic variations in more than one gene (3/20 in the hereditary spherocytosis group, 6/13 fully elucidated patients in the unexplained hemolysis group), giving a more accurate picture of the genetic complexity of congenital hemolytic anemia. In addition, whole exome sequencing allowed us to identify genetic variants in non-congenital hemolytic anemia genes that explained part of the phenotype in 3 patients.Conclusion: The rapid development of next generation sequencing has rendered the genetic study of these diseases much easier and cheaper. Whole exome sequencing use for congenital hemolytic anemia could provide a more precise and quicker diagnosis, improve patients’ healthcare and probably has to be democratized notably for complex cases.
Resistin Induces Chemokine and Matrix Metalloproteinase Production via CAP1 Receptor and Activation of P38-MAPK and NF-κB Signalling Pathways in Human Chondrocytes
Authors: Zhao Cheng-Wu , Song Wen-Xia , Liu Bo , Gao Yu-Hang , Ding Lu , Huang Yi-Fan , Qi Xin
Published: February 2020

BackgroundResistin is an adipokine also detected higher expression in serum and synovial fluid of patients with knee osteoarthritis (KOA). Resistin is known to be related closely to insulin resistance and inflammation. However, the pathogenic role of resistin in KOA remain unclear. Purpose of the study is to investigate whether resistin induces KOA by binding to functional receptor adenylyl cyclase-associated protein 1 (CAP1) and activating the p38 mitogen-activated protein kinase (p38-MAPK) and nuclear factor-κB (NF-κB) signalling pathways in human chondrocytes. MethodsWe enrolled 103 patients with radiographic KOA and 86 healthy participants as controls. The levels of resistin in serum and synovial fluid (SF) were determined via enzyme-linked immunosorbent assay (ELISA). CAP1 expression in cartilage tissues (21 samples of KOA cartilage and 10 samples of healthy hip cartilage) was measured using immunohistochemistry (IHC), quantitative real-time polymerase chain reaction ( qRT-PCR ), and western blotting assays. Effects of resistin on chondrocytes and CAP1 were evaluated via qRT-PCR and co-immunoprecipitation . The roles of CAP1, p38-MAPK, and NF-κB signalling pathways in the development of KOA were evaluated via adenovirus-mediated CAP1 short hairpin RNA, qRT-PCR, western blotting, and ELISA. Results﻿Expression of resistin in serum and SF was elevated in severe radiographic KOA. CAP1 levels were higher in KOA cartilage and were positively correlated with resistin expression. Resistin promoted increased expression of CCL3, CCL4, MMP13, and ADAMTS-4 through CAP1 receptor. Resistin also directly bound to CAP1 as confirmed by co-immunoprecipitation. CAP1 knockdown in chondrocytes attenuated resistin-induced expression of CCL3, CCL4, MMP13, and ADAMTS-4 and activation of the p38-MAPK and NF-κB signalling pathways . ConclusionsOur study shows that resistin bound to CAP1 and upregulated the expression of proinflammatory cytokines and matrix-degrading enzymes via p38-MAPK and NF-κB signalling pathways in human chondrocytes.
Clinical manifestations including the EULAR Sjögren's Syndrome Disease Activity Index in anti-Ro52/SS-A antibody-seropositive patients with Sjögren's syndrome
Authors: Nakamura Hideki , Morimoto Shimpei , Shimizu Toshimasa , Takatani Ayuko , Nishihata Shin-ya , Kawakami Atsushi
Published: February 2020

Background: Relationship between anti-Ro52/SS-A antibody (anti-Ro52) and clinical manifestation of Sjögren's syndrome (SS) was sporadically described regarding involvement of internal organs.Objectives: To determine the clinical factors relevant to anti-Ro52 with SS.Methods: We conducted a retrospective study of subjects with suspected SS (n=149), patients with rheumatoid arthritis (RA) (n=62), and healthy subjects (n=50). We analyzed components of the American-European Consensus Group (AECG) criteria, Raynaud's phenomenon (RP), anti-centromere antibody (ACA), serum IgG, rheumatoid factor, and the EULAR Sjögren's Syndrome Disease Activity Index (ESSDAI).Results: Among the 149 suspected SS subjects, 115 subjects were classified as having SS. Anti-Ro52 was observed in 70 SS patients (60.9%), of whom 31 patients had markedly elevated anti-Ro52 (>500 U/ml). In the SS group, three patients with anti-Ro60−/anti-Ro52+ and 17 patients without anti-Ro were observed. Compared to ACA, the relevance of positive anti-Ro52 toward positive anti-Ro60 was significantly higher (p<0.05). We observed relevance between the anti-Ro52 concentration and anti-Ro60 that was significantly affected by xerophthalmia, xerostomia, ACA seropositivity, RP, serum IgG level, and RF. The anti-Ro52 concentration well discriminated six clinical factors (ROC AUC >0.75) for ACA seropositivity, ESSDAI score ≥1, and RF or moderately high serum IgG, focus score ≥1, and anti-La/SS-B antibody seropositivity (ROC AUC >0.7). A linear relationship between the ESSDAI score and anti-Ro52 was observed.Conclusion: Significant relevance between anti-Ro52 and anti-Ro60 as well as significant items including the ESSDAI regarding the anti-Ro52 concentration was revealed. Regarding relevance toward anti-Ro60, anti-Ro52 had a higher association than ACA.(246/250 words)
Drug Safety of Benzodiazepines in Patients with Chronic Obstructive Pulmonary Disease
Authors: Liao Yi-Hsiang , Chen Liang-Yu , Liao Kuang-Ming , Chen Chung-Yu
Published: February 2020

Many comorbidities, including depression, anxiety, dyspnea, and insomnia, occur in patients with chronic obstructive pulmonary disease (COPD). These patients may be prescribed benzodiazepines (BZDs). However, there are some concerns that benzodiazepines increase the risk of drug overdose, hypercapnic respiratory failure, acute exacerbation and increased mortality. The aim of our study was to evaluate the drug safety of BZDs in patients with COPD. We used the National Health Insurance Research Database (NHIRD) in Taiwan from 2002 to 2016 to perform a retrospective cohort study. We enrolled patients who were exposed to the first prescription of BZDs, non-BZDs or a combination (mix user) after COPD diagnosis. We performed 1:1:1:1 propensity score matching in three groups. The outcomes were COPD with acute exacerbation and all-cause mortality. Poisson regression analysis was performed to evaluate the incidence rate ratios (IRRs) for the outcomes in the groups. After propensity score matching, there were 2856 patients in each group. After adjusting for confounding factors, we found that compared to BZD users, non-BZD and mix users had nonsignificant differences in outpatient management of acute exacerbations, hospitalization management of acute exacerbations, emergency department management of acute exacerbations and all-cause mortality. Using BZDs or non-BZDs is safe in terms of COPD exacerbation. However, BZD, non-BZD, and mix users showed increased COPD-related respiratory events compared to nonusers.
Preoperative adjuvant therapy for locally advanced and recurrent/metastatic gastrointestinal stromal tumors: a retrospective study
Authors: Qi Jing , Liu He-li , Ren Feng , Liu Sheng , Shi Wei , Liu Wei-Hang , Cai Gao-Qiang , Liao Guo-Qing
Published: February 2020

Background Preoperative imatinib mesylate therapy for gastrointestinal stromal tumors (GISTs) is controversial. This study aimed to explore the clinical efficacy and optimal duration of preoperative imatinib mesylate (IM) therapy in patients with locally advanced and recurrent/metastatic GISTs. Methods We retrospectively examined patients who received preoperative imatinib mesylate therapy from January 2013 to December 2018 at Xiangya Hospital, Central South University and the Second Xiangya Hospital of Central South University, China. Clinical data, including the results of tests for mutations in KIT and PDGFR, findings from regularly conducted re-examinations, abdominal enhanced computed tomography/magnetic resonance imaging data, responses to imatinib, progression-free survival and overall cancer-specific survival, were recorded. Results A total of 25 patients were enrolled in our study, including 18 with a locally advanced GIST and 7 with recurrent or metastatic GISTs. Their ages ranged from 22 to 70 years (M:F = 1.6:0.9), with a mean age of 50.48±12.51 years. The tumor locations included the stomach (56.0%), rectum (16.0%), enterocoelic/retroperitoneal sites (12.0%) and the small intestine (12.0%). Based on testing for mutations in KIT and PDGFR, 22 patients received 400 mg/d KIT, and 3 patients received 600 mg/d PDGFR. The median duration of preoperative IM therapy was 8.96±4.81 months, ranging from 3 to 26 months. According to the Choi criteria, 24 patients achieved a partial response (PR), and 1 patient had stable disease (SD). All patients underwent surgery after preoperative IM therapy, and no postoperative complications appeared. The 2-year PFS and 5-year PFS were 92% and 60%, respectively, and the total 5-year cancer-specific survival (CSS) was 92%. Conclusion Preoperative imatinib therapy is feasible for locally advanced and recurrent/metastatic GISTs and can effectively shrink the tumor size, allow organ sparing and avoid extensive organ resection. Moreover, the optimal duration of preoperative IM therapy in patients with locally advanced and recurrent/metastatic GISTs was 8.96±4.81 months, ranging from 3 to 26 months, and gastric GISTs had a better response to preoperative IM therapy than did non-gastric GISTs.
Origin of a novel CYP20A1 transcript isoform through multiple Alu exaptations creates a potential miRNA sponge
Authors: Bhattacharya Aniket , Jha Vineet , Singhal Khushboo , Fatima Mahar , Singh Dayanidhi , Chaturvedi Gaura , Dholakia Dhwani , Kutum Rintu , Pandey Rajesh , Bakken Trygve E. , Seth Pankaj , Pillai Beena , Mukerji Mitali
Published: February 2020

Background: Primate-specific Alus contribute to transcriptional novelties in conserved gene regulatory networks. Alu RNAs are present at elevated levels in stress conditions and consequently leads to transcript isoform specific functional role modulating the physiological outcome. One of the possible mechanisms could be Alu nucleated mRNA-miRNA interplay. Result: Using combination of bioinformatics and experiments, we report a transcript isoform of an orphan gene, CYP20A1 ( CYP20A1_Alu-LT ) through exaptation of 23 Alus in its 9kb 3’UTR. CYP20A1_Alu-LT , confirmed by 3’RACE, is an outlier in length and expressed in multiple cell lines. We demonstrate its presence in single nucleus RNA-seq of ~16000 human cortical neurons (including rosehip neurons). Its expression is restricted to the higher primates. Most strikingly, miRanda predicts ~4700 miRNA recognition elements (MREs; with threshold< -25kcal/mol) for ~1000 miRNAs, which have majorly originated within the 3’UTR-Alus post exaptation. We hypothesized that differential expression of this transcript could modulate mRNA-miRNA networks and tested it in primary human neurons where CYP20A1_Alu-LT is downregulated during heat shock response and upregulated upon HIV1-Tat treatment. CYP20A1_Alu-LT could possibly function as a miRNA sponge as it exhibits features of a sponge RNA such as cytosolic localization and ≥10 MREs for 140 miRNAs. Small RNA-seq revealed expression of nine miRNAs that can potentially be sponged by CYP20A1_Alu-LT in neurons. Additionally, CYP20A1_Alu-LT expression was positively correlated (low in heat shock and high in Tat) with 380 differentially expressed genes that contain cognate MREs for these nine miRNAs. This set is enriched in genes involved in neuronal development and hemostasis pathways. Conclusion: We demonstrate a potential role for CYP20A1_Alu-LT as miRNA sponge through preferential presence of MREs within Alus in a transcript isoform specific manner. This highlights a novel component of Alu-miRNA mediated transcriptional modulation leading to physiological homeostasis.
How practice in plant collection influences interactions with illustrations and written texts on local plants? Case study from Daghestan, North Caucasus
Authors: Kołodziejska Iwa Urszula , Kaliszewska Iwona Julia
Published: February 2020

Background It is only recently that written sources of local knowledge on plants are not being ignored by scholars as not belonging to “traditional” knowledge. However, usually ethnobotanical texts, if they at all focus on knowledge from written sources, they do not pay attention to the actual processes of interaction with written texts and illustrations. During our research we examined people’s interactions with texts, illustrations and herbarium specimens of plants they collect or are familiar with. We focused on a small community of Shiri people in the mountainous village and in the lowland settlements in the Republic of Daghestan, Russia. In the paper we address the following questions: how do Shiri people interact with illustrations, written text and herbaria specimens? How amount of practice in plant collection influences reading of the texts about plants and looking at illustrations? What are the methodological implications of the ways people interact with illustrations, texts and herbaria specimens? Methods Our research was based on long term ethnographic fieldwork: co-designing of a booklet showing edible plants people collect in Shiri, semi-structured interviews and video-recording and observing interactions between people and text/illustrations/voucher specimens. Results We identified three kinds of interactions between individuals and text/illustrations: “text-wayfaring” – predominantly a bodily interaction between individual and illustrations and text; “fact/spelling checking” – predominantly discursive and information focused; “between wayfaring and fact checking” – the mix of the two above. Using the idea of textual poaching as well as knowledge making approach we show that the way of interacting influences what is acquired from the text/illustrations and how. This process influences reader’s LEK. The mere presence of the information in the text available to people does not imply that they will acquire it, make use of it and change their LEK. Photographs and pressed specimens of locally known plants are often not (or only partly) recognized. Video-recording is essential for analysing the above interactions. Conclusions In ethnobotanical research it is important to pay more attention to people’s interaction with their sources of knowledge, including text and illustrations. Discursive part of LEK is more easily influenced by written sources. Practice of plant collection is not as easily influenced.
Successful treatment with belimumab in a patient with refractory systemic lupus erythematosus after initiation of hemodialysis: Considering the synergistic effect of belimumab and immunological burn-out phenomenon in end stage renal disease patients on hemodialysis
Authors: Ogura Shota , Karasawa Kazunori , Ono Wataru , Ito Ayaki , Seki Momoko , Yamaguchi Yoshiko , Kamizawa Miwa , Tosaka Mai , Ushio Yusuke , Sugiura Naoko , Takabe Tomo , Miyabe Yoei , Iwabuchi Yuko , Akiyama Kenichi , Sato Masayo , Moriyama Takahito , Uchida Keiko , Nitta Kosaku
Published: February 2020

Background: In patients with systemic lupus erythematosus (SLE), disease activity can persist even after initiating dialysis. However, guidelines for the treatment of patients with SLE after dialysis is initiated have not yet been established. Case presentation: We describe the case of a 62-year-old Japanese woman who was diagnosed with SLE at age 12, progressed to end-stage renal disease (ESRD), and initiated hemodialysis for lupus nephritis. However, SLE activity persisted after hemodialysis. Cyclophosphamide and mycophenolate mofetil were administered in addition to prednisolone and immunoadsorption, but this treatment strategy was limited by side effects. The patient was subsequently treated with belimumab, and the activity of SLE decreased rapidly. Conclusions: ESRD patients with SLE show no significant decrease in transitional B cells, and have elevated levels of B-cell activating factor (BAFF). Both transitional B cells and BAFF are important therapeutic targets for belimumab, indicating that patients with ESRD may benefit from belimumab therapy. However, the effects of belimumab may be potentiated in patients with uremia, who may be more susceptible to adverse events such as infections. Patients with SLE who receive belimumab after initiation of hemodialysis therefore require careful follow-up. Here we report the first case of belimumab administration in a patient with SLE after initiation of hemodialysis.
What is the level of uptake of Partner Notification Services in HIV testing in Selected Health Facilities in Muranga County – Kenya; a retrospective Study
Authors: Kariuki Rewel , Rithaa Gilbert Koome , Elvis Oyugi , Gachathi Daniel
Published: February 2020

Background: Identification of people living with HIV is key in HIV prevention and control. Partner Notification service is a World Health Organization backed strategy of reaching out to sexual partners of people diagnosed with HIV for HIV testing. However, its adoption and success rate in Kenya remains unknown. Methods: A cross sectional facility based study was undertaken in five purposively selected health facilities in Muranga County, Kenya. A retrospective review of patient medical records data for HIV positive index clients and their Sexual Partners conducted. Census approach applied to extract data for study subjects from Partner Notification Service registers for the period covering January 2017 to August 2018. Epi Info software was used for data analysis. Results: A total of 183 index clients offered Partner notification services. The mean age of the indexed clients studied was 39(SD ±13.1). Females comprised 64 % of clients studied. Of the 183 indexed clients, 89% accepted the services and elicited 216 sexual partners for tracing. The ratio of elicited sexual partners to index client was 1.3:1. Out of the 216 sexual partners, 77% were reached and tested. A total of 46 [32%] of the sexual partners elicited and traced, tested HIV positive. The most preferred approaches were provider referral (51%) and contract referral (45%). Dual referral (4%) was the least preferred approach. Conclusions: Partner notification services is acceptable and an effective strategy of increasing HIV case identification and raising awareness to exposed sexual partners in low resource countries.
HIV Risk in Female Sex Workers in the Chinese Border Region
Authors: Wang Yuan Yuan , Wilson Amanda , Chen Rusen , Cen Ping , Wang Yuehui , Yao Xing , Wang Tang , Li Shiyue , Yan Hong
Published: February 2020

Background: Female sex workers (FSWs) in Yunnan are a highly vulnerable population to HIV virus. The HIV positive FSWs can then pass onward the HIV transmission via commercial sex. Yunnan is located near the “Golden Triangle” border region, which has the highest HIV/AIDS prevalence rates in China. Method: In order to understanding of the HIV burden and risk in FSWs in the border region of China, semi-structured interviews were conducted between May 2018 and June 2018 with 20 FSWs recruited in Hekou County, Yunnan province, China. Results: Thematic analysis was applied for the data analysis. There were four themes that were actively interpreted from the data, including: Desire for Condom Use, Poor Gynaecological Service Access, Low HIV/AIDS Literacy, and Working Without the Influence. Conclusion: There is an urgent demand for HIV prevention among FSWs and their clients in the Chinese border regions. It is essential for governmental infrastructures to implement practical strategies in terms of HIV prevention for FSWs in China. Keywords human immunodeficiency virus (HIV), female sex workers (FSWs), “Golden Triangle”, China A Brief Summary of Findings Female sex workers (FSWs) in Yunnan are a highly vulnerable population to HIV virus. There is an urgent demand for HIV prevention among FSWs in the Chinese border regions.
Users' perspectives on non-clinical quality of care in public and private primary healthcare in Albania
Authors: Gabrani Jonila , Schindler Christian , Wyss Kaspar
Published: February 2020

Background: Aiming to tackle the rise of non-communicable diseases and an ageing population, Albania is engaged in boosting primary healthcare services and quality of care. The patients’ perspectives on their experience with public and private providers are, however, missing, although their viewpoints are critical while shaping the developing services. Consequently, we analyse perceptions of users of PHC services as it relates to non-clinical quality of care and the association to sociodemographic characteristics of patients and the type of provider. Methods: A facility-based survey was conducted in 2018 using the World Health Organization responsiveness questionnaire which is based on a 4-point scale along eight non-clinical domains of quality of care. The data of 954 patients were analysed through descriptive statistics and linear mixed regression models. Results: Similar mean values were reported on total scale of the quality of care for private and public providers, also after sociodemographic adjustments. The highest mean scores was reported for the domain ‘communication’ (3.75) followed by ‘dignity’ (3.65), while the lowest mean scores were given for ‘choice’ (2.89) and ‘prompt attention’ (3.00). Urban governmental PHC services were rated significantly better than private outpatient clinics in ‘coordination of care’ (2.90 vs 2.12, p < 0.001). In contrast, private outpatient clinics were rated significantly higher than urban PHC clinics in ‘confidentiality’ (3.77 vs 3.38, p = 0.04) and ‘quality of basic amenities’ (3.70 vs 3.02, p < 0.001). For the other domains, no statistically significant differences were observed. ‘Autonomy’ was reported as least important attribute of quality. Enrolment in health insurance was a predictor of higher quality ratings (coefficient = 0.06, p = 0.02). Conclusion: While the perception of non-clinical care quality was found to be high and similar for public and private providers, promptness and coordination of care require attention to meet patient’s expectations on good quality of care. There is a need to shift from a ‘paternalistic’ model to a ‘co-managing the illness’, raising awareness on autonomy.
Outcomes of a 12-month patient-centred medical home model on patient activation and self-management behaviours among primary care patients presenting with chronic diseases in Sydney, Australia.
Authors: John James , Tannous Kathy , Jones Amanda
Published: February 2020

Background: Patient activation is an important precursor not only for effective self-management of chronic comorbidity but also to empower patients in actively making decisions concerning their health. Studies report that increased activation in terms of high patient activation measure (PAM) scores are associated with increased patient engagement with the health care system, better compliance to treatment protocols, and improved health outcomes. This study aims to evaluate outcomes of Patient-Centred Medical Home model called ‘WellNet’ on activation levels of patients with multimorbidity in general practices across Sydney, Australia. Methods: A total of 636 patients consented to participate in the WellNet program delivered across six general practices in Northern Sydney, Australia. The WellNet treatment comprised of a team-based care with General Physicians collaborating with trained Chronic Disease Management care coordinators. After a comprehensive assessment, the care team designed patient-tailored care plan with self-management support and care navigation according to the level of risk and health care needs. Level of patient activation was measured using the validated PAM 13-item scale at baseline and follow-up. A case-series design was employed to determine significant differences between baseline and 12-months using General Linear Models. Multiple imputation was used to compute missing follow-up scores using Markov Chain Monte Carlo (MCMC) algorithm known as fully conditional specification (FCS). Multivariate regression models were employed to identify significant predictors of activation at follow-up. Results: Of the 626 patients, 420 reported their PAM levels at follow-up. The adjusted model showed significant mean difference in PAM scores of 6.5 (95%CI 5.0-8.1; p-value<0.001) after controlling for baseline covariates. Multivariate regression models determined that older age (OR = -0.14; 95% CI -0.28, -0.01), baseline activation score (OR = 0.48; 95% CI 0.37, 0.59), and private insurance (uninsured patients) (OR = -3.41; 95% CI -6.50, -0.32) were significant predictors of patient activation at follow-up. Conclusion: The WellNet study is the first of its kind in Australia to report on changes in the activation and self-management among patients with multimorbidity. PCMH has the potential to improve patient activation and engagement which can lead to long-term health benefits and sustained self-management behaviours.
Differences in patient population and service provision between nurse practitioner and general practitioner consultations in Swiss primary care: a case study
Authors: Gysin Stefan , Meier Rahel , Vught Anneke van , Merlo Christoph , Gemperli Armin , Essig Stefan
Published: February 2020

Background Primary care systems around the world have implemented nurse practitioners (NPs) to ensure access to high quality care in times of general practitioner (GP) shortages and changing health care needs of a multimorbid, ageing population. In Switzerland, NPs are currently being introduced, and their exact role is yet to be determined. The aim of this study was to get insight into patient characteristics and services provided in NP consultations compared to GP consultations in order to appraise whether the NP role meets the political and demographic demands in Swiss primary care.Methods This case study used retrospective observational data from electronic medical records of a family practice with one NP and two GPs. Data on patient-provider encounters were collected between August 2017 and December 2018. We used logistic regression to assess associations between the assignment of the patients to the NP or GP and patient characteristics and delivered services respectively. Results Data from 5,210 patients participating in 27,811 consultations were analyzed. The average patient age was 44.3 years (SD 22.6), 47.1% of the patients were female and 19.4% multimorbid. 1,613 (5.8%) consultations were with the NP, and 26,198 (94.2%) with the two GPs. Patients in NP consultations were more often aged 85+ (OR 3.43; 95%-CI 2.70-4.36), multimorbid (OR 1.37; 95%-CI 1.24-1.51; p <0.001) and polypharmaceutical (OR 1.28; 95%-CI 1.15-1.42; p <0.001) in comparison to GP consultations. In NP consultations, vital signs (OR 3.05; 95%-CI 2.72-3.42; p <0.001) and anthropometric data (OR 1.33; 95%-CI 1.09-1.63; p 0.005) were measured more frequently, and lab tests (OR 1.16; 95%-CI 1.04-1.30; p 0.008) were ordered more often compared to GP consultations, independent of patient characteristics. By contrast, medications (OR 0.35; 95%-CI 0.30-0.41; p <0.001) were prescribed or changed less frequently in NP consultations. Conclusions NPs could offer care to the growing number of multimorbid, polypharmaceutical elderly, and might relieve work pressure from the GPs. Hence, the NP role has the potential to meet the current political and demographic demands in Swiss primary care. An extended scope of practice, especially prescription rights, could foster further professional practice and role implementation.
Modeling the indoor tracking method based on particle water wave optimization
Authors: Guo Yangyong
Published: February 2020

A new tracking algorithm is proposed based on particle filter and water wave optimization for the problem that indoor tracking accuracy is not high enough. In this algorithm, the observation equation of the node location is first given using the least squares estimation algorithm based on the node signal intensity. Meanwhile, the algorithm steps of indoor tracking are designed using the water wave optimization, and the particle filter is introduced to accelerate the convergence. Finally, the performance of the algorithm is simulated through simulation experiments. The results show that the algorithm can adapt well to indoor environment.
MiR-133a-3p transferred by circulating microvesicles derived from myocardial ischemic preconditioning protects cardiomyocytes against hypoxia/reoxygenation injury
Authors: Zhao Junyu , Zhu Qian , Shang Man , Liu Miao , Wang Yilu , Li Yeyi , Wu Yanna , Liu Yanxia , Song Junqiu
Published: February 2020

Background Microvesicles (MVs) are submicron membrane vesicles as mediators of intercellular communication. The aim of our study was to investigate protective mechanism of circulating MVs derived from ischemic preconditioning (IPC-MVs) on myocardial I/R injury. Results Administration of IPC-MVs reduced infarct size and activity of lactate dehydrogenase (LDH) in myocardial I/R injury in vivo. Meanwhile, IPC-MVs could increase cell viability and reduce LDH activity in hypoxia/reoxygenation (H/R) injured H9c2 cells in vitro. Microarray analysis demonstrated that miR-133a-3p expression in IPC-MVs increased apparently compared with Sham-MVs. We found that miR-133a-3p increased cell viability, decreased LDH activity and apoptosis , as well as suppressed H/R-induced endoplasmic reticulum stress (ERS). MVs induced by hypoxic preconditioning enriched with FAM-miR-133a-3p allowed the transfer of miR-133a-3p to target cells. In addition, miR-133a-3p was significantly increased in H/R injured H9c2 cells by treatment with IPC-MVs. Epidermal growth factor receptor (EGFR) is a target gene of miR-133a-3p. AG1478 (EGFR inhibitor) significantly increased cell viability, decreased LDH activity and ERS-induced apoptosis in H9c2 cells under H/R injury. Conclusions The findings of this study showed that IPC-MVs exerted cardioprotective effects by transferring miR-133a-3p into H/R injured cardiomyocytes targeting EGFR, thus attenuating ERS-induced apoptosis. MiR-133a-3p transferred by IPC-MVs may provide a novel therapy for myocardial I/R injury.
Fire needle plus cupping for acute herpes zoster: Study protocol for a randomised controlled trial
Authors: Zhang Ying , Liang Zuohui , Li Shihua , Yang Ling , Guo Taipin , Yan Xu , Yang Juanjuan , Xu Qiannan , Zhang Qing , Zhao Jian , Li Cailian , Liu Xiuhong
Published: February 2020

Background Herpes zoster (HZ) is a common skin disease caused by invasion of the varicella-zoster virus into the ganglia and skin. Severe pain caused by HZ seriously affects the normal life of patients; thus, pain often becomes the patient’s first complaint. Fire needle plus cupping may be effective for acute herpes zoster (AHZ), but the evidence is insufficient. Methods This is a three-arm randomized controlled trial with an observation time of 1 week. A total of 96 patients with AHZ pain are divided into three groups by stratified randomization, with 32 in each group: (a) fire needle + cupping (FC); (b) famciclovir + gabapentin (FG), famciclovir hydrochloride, 3 × 0.25 g/d orally (p.o.), with an individualized dose of gabapentin 900-3600 mg/d p.o.; and (c) fire needle + cupping + famciclovir (FCF). The above intervention lasts for 1 week, and all patients receive analgesia (nonopioid analgesics [analgin or paracetamol] and opioid analgesics [tramadol or morphine]). Groups a and c undergo 1 to 7 sessions of fire needles and cupping treatments per patient, with gabapentin and analgesic medication administered depending on the patient’s needs. The primary outcome measure is the assessment of changes in pain intensity before and after treatment (visual analogue scale ranging from 0-100 mm). Secondary outcome measures are changes in substance P and beta-endorphin concentrations in peripheral plasma before and after treatment. Quantitative scoring methods are used to evaluate the symptoms and physical signs before and after treatment, including pain classification, local itching, burning sensation, fever, local lymphadenopathy, skin lesion area, blisters, herpes clusters, vesicular traits, ulcers, and pimples. In addition, analgesic needs and side effects are evaluated. Discussion: The results of this study will be obtained by randomised controlled trial(RCT), and the outcomes will be analyzed and evaluated to prove FC may be effective for AHZ. Trial registration :The registration number is ChiCTR1800015372. Registered on 28 March 2018.
The Impact of Fasting in Ramadan on Metabolic and Anthropometric Indices in Trained Type ΙΙ Diabetic Patients: A Prospective Observational Study
Authors: Yazdanyar Tayebe , Sohrab Mehrnoush , Ramezani Atena , Kashi Zahra , Abadi Parastoo Karimi Ali , Bahar Adele , Shirzad Mahboobeh , Abdolmaleki Elham Yousefi , Aarabi Mohsen
Published: February 2020

Background: Fasting has certain effects on metabolic and anthropometric parameters in diabetic patients. It is, therefore, necessary for patients to receive proper education related to their physical activities, eating habits, blood glucose monitoring, and medications. The aim of this study was to investigate the effects of Ramadan fasting on metabolic and anthropometric indices in type ΙΙ diabetic patients.Methods: This prospective observational study was performed during Ramadan 2018. The study population consisted of diabetic patients who desired to fast and received information on physical activity, eating habits, blood glucose monitoring, and taking their medications before Ramadan. Fasting blood sugar (FBS), blood sugar 2-hour postprandial (BS2hpp), glycosylated hemoglobin (HbA1C), and the lipids profile were assessed before and after Ramadan month. FBS and BS2hpp were also evaluated on the fifteenth day of Ramadan. The significance level for data analysis was considered p<0.05.Results: Out of 40 diabetic cases who completed the study, 6 (15%) were male and 34 (75%) were female. The mean age of participants was 55.2 ± 9.3 years. The anthropometric variables, including weight, BMI, waist, and blood pressure, decreased significantly after Ramadan fasting (p<0.05). FBS decreased significantly (125.1 ± 27.4 vs 105.2 ± 21.4, p<0.0001) and serum triglyceride increased significantly (127.5 ± 45.5 vs 166.5±53.5 mg/dl, p<0.001) after fasting compared to pre-Ramadan measurement. Other variables remained unchanged.Conclusion: The results of this study indicate that type II diabetic patients who have controlled blood sugar and received information based on clinical guidelines about their lifestyle and medications can fast safely during the holy month of Ramadan.