bluuebunny/crossref_metadata_2025 huggingface dataset:
Introduction of multi-dose PCV 13 vaccine in Benin: from the decision to vaccinators experience
Authors: Abdoulaye Alfa Daleb , Houngnihin Roch A. , Ilboudo G. Patrick , Dick Naomi , Kaucley Landry , Essoh Téné-Alima
Published: August 2020

Background

In 2011, Benin introduced the 13-valent pneumococcal conjugated vaccine (PCV13), in a single-dose vial, into its Expanded Programme for Immunisation (EPI) with support from Gavi. In April 2018, with the support of the Agence de Médecine Préventive Afrique (AMP) and other technical and financial partners, the single-dose vial was transitioned to a four-dose vial. Here we describe the decision-making process and the experience of the vaccinators during the change.

Methods

We carried out semi-structured, individual interviews with 61 participants individuals involved in the EPI: 7 from central level, 5 from regional level, 7 from township level and 42 from district level. The interviews were recorded and transcribed, and the information categorised, using Nvivo software, and then analysed.

Results

The Inter-agency Coordination Committee (ICC), the Benin National Advisory Committee for Vaccines and Vaccination, (BNACVV) and the World Health Organisation (WHO) (i.e., the traditional governance structures involved in vaccination decisions) were not involved in the decision to change to the four-dose vial for PCV13. The decision was taken by the EPI, supported by Gavi.

The vaccination errors observed in the first months following the change in presentation were due to the absence of guidelines for changes in vaccine presentation and the central-level actors’ perception that it was ‘only a change in the vial’, and therefore that the communication and training for a new vaccine were not required since the vaccine itself and its administration mode were unchanged.

Conclusions

It is important that the other countries eligible for Gavi support that are about to change to the multi-dose vial PCV13 presentation learn from Benin’s experience. The main lessons learned are that changes in the presentation of an established vaccine should follow the same process as the introduction of a new vaccine, and that all stakeholders involved in vaccines and vaccination should participate in the decision-making process and implementation.
SNHG14 induces osteogenic differentiation of human stromal (mesenchymal) stem cells in vitro by downregulating miR-2861
Authors: Du Mingchang , Wu Bo , Fan Shiwen , Liu Ye , Ma Xu , Fu Xun
Published: August 2020

Background

The differentiation of human stromal (mesenchymal) stem cells (hMSCs) is a critical procedure for the development of osteoblast. SNHG14 is a newly discovered lncRNA that has been barely studied. Our preliminary experiments showed that SNHG14 may be dysregulated in the differentiation of hMSCs. In this study, we focused on elucidating the relationships among SNGH14, miR-2861, and osteoblastic differentiation of hMSCs.

Method

To investigate the roles of SNHG14 and miR2861 in hMSCs differentiation, qRT-PCR, luciferase activity, cell transfections, the detections of ALP activity, and Alizarin Red staining were performed.

Result

We found that the expression of SNHG14 was enhanced, while the expression of miR-2861 was suppressed in serum and hMSCs from patients with osteoporosis. SNHG14 could target miR-2861, and shSNHG14 suppressed osteoblast differentiation of hMSC. MiR-2861 suppressed osteoblast differentiation of hMSC. In addition, the effects of SNHG14 on osteoblast differentiation of hMSC were attenuated by miR-2861.

Conclusion

In conclusion, our experimental data showed that the induction effects of SNHG14 on osteoblast differentiation of hMSC were attenuated by miR-2861. SNHG14 could induce osteogenic differentiation of hMSC in vitro by targeting miR-2861.
BAck iN the Game (BANG) – a smartphone application to help athletes return to sport following anterior cruciate ligament reconstruction: protocol for a multi-centre, randomised controlled trial
Authors: Ardern Clare L. , Kvist Joanna ,   on behalf of the BANG Trial Group, Ardern Clare , Kvist Joanna , Fältström Anne , Stålman Anders , O’Halloran Paul , Webster Kate , Taylor Nicholas
Published: August 2020

Background

Sustaining injury is a common consequence of playing sport. At least one in every three recreational athletes with anterior cruciate ligament (ACL) reconstruction do not return to their preinjury sport following treatment. Psychological factors including confidence and fear of new injury exert large effects on returning to sport. The primary aim of this trial is to test whether a custom smartphone application delivering cognitive-behavioural therapy is effective for improving the number of people who return to their preinjury sport and level following ACL reconstruction.

Methods

Participants scheduled for primary ACL reconstruction are recruited prior to surgery from one of six trial sites in Sweden. We aim to recruit 222 participants (111 in each group) for the BANG trial. Participants are randomly allocated to receive either usual rehabilitation care alone or usual rehabilitation care plus the Back in the Game smartphone application intervention. Back in the Game is a 24-week Internet-delivered programme, based on cognitive-behavioural therapy. The primary outcome is return to the preinjury sport and level at 12 months follow-up. The secondary outcomes assess physical activity participation, new knee injuries, psychological factors, quality of life and physical function. Physical activity participation and new injuries are self-reported every two weeks for 12 months, then every 4 weeks to 24 months follow-up. Psychological readiness to return to sport, knee self-efficacy, motivation to participate in leisure time physical activity, knee-related quality of life, and self-reported knee function are also assessed at 3, 6, 9, 12 and 24 months after surgery. A clinical assessment of strength, knee range of motion, effusion and hopping performance is completed by a blinded assessor at 12 months to assess physical function.

Discussion

This protocol outlines how we plan to assess the efficacy of a custom smartphone application, delivering cognitive-behavioural therapy to address fear, confidence and recovery expectations, for improving return to sport following serious sports-related musculoskeletal injury. The BANG trial employs a pragmatic design to best reflect the reality of, and inform, clinical practice.

Trial registration

ClinicalTrials.gov,NCT03959215. Registered 22 May 2019.
Novel transplant of combined platelet-rich fibrin Releasate and bone marrow stem cells prevent bone loss in Ovariectomized osteoporotic mice
Authors: Wong Chin-Chean , Liao Jeng-Hao , Sheu Shi-Yuan , Lin Po-Yu , Chen Chih-Hwa , Kuo Tzong-Fu
Published: August 2020

Background

Osteoporosis is a metabolic bone disorder characterized by deterioration in the quantity and quality of bone tissue, with a consequent increase susceptibility to fracture.

Methods

In this study, we sought to determine the efficacy of platelet-rich fibrin releasates (PRFr) in augmenting the therapeutic effects of stem cell-based therapy in treating osteoporotic bone disorder. An osteoporosis mouse model was established through bilateral ovariectomy on 12-week-old female ICR (Institute of Cancer Research) mice. Eight weeks postoperatively, the ovariectomized (OVX) mice were left untreated (control) or injected with PRFr, bone marrow stem cells (BMSCs), or the combination of BMSCs and PRFr. Two different injection (single versus quadruple) dosages were tested to investigate the accumulative effects of BMSCS and PRFr on bone quality.

Eight weeks after injection, the changes in tibial microstructural profiles included the percentage of bone volume versus total tissue volume (BV/TV, %), bone mineral density (BMD, g/cm3), trabecular number (Tb.N, number/mm), and trabecular separation (Tb.Sp, mm) and bony histology were analyzed.

Results

Postmenopausal osteoporosis model was successfully established in OVX mice, evidenced by reduced BMD, decreased BV/TV, lower Tb.N but increased Tb.Sp. Eight weeks after injection, there was no significant change to BMD and bone trabeculae could be detected in mice that received single-injection regimen. In contrast, in mice which received 4 doses of combined PRFr and BMSCs, the BMD, BV/TV, and TB.N increased, and the TB.Sp decreased significantly compared to untreated OVX mice. Moreover, the histological analysis showed the trabecular spacing become narrower in OVX-mice treated with quadruple injection of BMSCs and combined PRFr and BMSCs than untreated control.

Conclusion

The systemic administration of combined BMSCs and PRFr protected against OVX-induced bone mass loss in mice. Moreover, the improvement of bony profile scores in quadruple-injection group is better than the single-injection group, probably through the increase in effect size of cells and growth factors. Our data also revealed the combination therapy of BMSCs and PRFr has better effect in enhancing osteogenesis, which may provide insight for the development of a novel therapeutic strategy in osteoporosis treatment.
Clinical efficacy of transverse preputial island flap urethroplasty for single-stage correction of proximal hypospadias: a single-centre experience in Chinese patients
Authors: Cui Xu , He Yuanbin , Huang Wenhua , Chen Liu , Wang Yunjin , Zhou Chaoming
Published: August 2020

Background

This study was designed to summarize the clinical outcomes of transverse preputial island flap urethroplasty for single-stage correction of proximal hypospadias in our hospital.

Method

This study retrospectively analysed the clinical data, including the preoperative general information, intraoperative and postoperative data, and follow-up data, of 155 children with proximal hypospadias who were admitted to our hospital from January 2009 to January 2019.

Results

During follow-up, a total of 92 postoperative complications occurred, and 41 patients underwent reoperation. There were 49 patients with urinary fistula, 26 patients with urethral stricture, 9 patients with urethral diverticulum and 8 patients with urinary tract infection. Regarding the family members’ satisfaction with the cosmetic appearance of the penis, the satisfaction rate with the urinary meatus was 85.2%, the satisfaction rate with the glans appearance was 87.7%, the satisfaction rate with the the appearance of the foreskin of the penis was 92.3%, and the satisfaction rate with the overall penis shape was 89.0%.

Conclusion

Proximal hypospadias is a serious condition that is often combined with severe chordee, and transverse preputial island flap urethroplasty for single-stage correction is an effective surgical procedure for treating this condition.
Prevalence of microhematuria in renal colic and urolithiasis: a systematic review and meta-analysis
Authors: Minotti Bruno , Treglia Giorgio , Pascale Mariarosa , Ceruti Samuele , Cantini Laura , Anselmi Luciano , Saporito Andrea
Published: August 2020

Background

This systematic review and meta-analysis aims to investigate the prevalence of microhematuria in patients presenting with suspected acute renal colic and/or confirmed urolithiasis at the emergency department.

Methods

A comprehensive literature search was conducted to find relevant data on prevalence of microhematuria in patients with suspected acute renal colic and/or confirmed urolithiasis. Data from each study regarding study design, patient characteristics and prevalence of microhematuria were retrieved. A random effect-model was used for the pooled analyses.

Results

Forty-nine articles including 15′860 patients were selected through the literature search. The pooled microhematuria prevalence was 77% (95%CI: 73–80%) and 84% (95%CI: 80–87%) for suspected acute renal colic and confirmed urolithiasis, respectively. This proportion was much higher when the dipstick was used as diagnostic test (80 and 90% for acute renal colic and urolithiasis, respectively) compared to the microscopic urinalysis (74 and 78% for acute renal colic and urolithiasis, respectively).

Conclusions

This meta-analysis revealed a high prevalence of microhematuria in patients with acute renal colic (77%), including those with confirmed urolithiasis (84%). Intending this prevalence as sensitivity, we reached moderate values, which make microhematuria alone a poor diagnostic test for acute renal colic or urolithiasis. Microhematuria could possibly still important to assess the risk in patients with renal colic.
Vitamin D receptor gene polymorphisms and the risk of the type 1 diabetes: a meta-regression and updated meta-analysis
Authors: Zhai Na , Bidares Ramtin , Makoui Masoud Hassanzadeh , Aslani Saeed , Mohammadi Payam , Razi Bahman , Imani Danyal , Yazdchi Mohammad , Mikaeili Haleh
Published: August 2020

Background

The association between the polymorphisms in the vitamin D receptor (VDR) gene and the risk of type 1 diabetes mellitus (T1DM) has been evaluated in several studies. However, the findings were inconclusive. Thus, we conducted a meta-analysis to comprehensively evaluate the effect ofVDRgene polymorphisms on the risk of T1DM.

Methods

All relevant studies reporting the association betweenVDRgene polymorphisms and susceptibility to T1DM published up to May 2020 were identified by comprehensive systematic database search in ISI Web of Science, Scopus, and PubMed/MEDLINE. Strength of association were assessed by calculating of pooled odds ratios (ORs) and 95% confidence intervals (CIs). The methodological quality of each study was assessed according to the Newcastle–Ottawa Scale. To find the potential sources of heterogeneity, meta-regression and subgroup analysis were also performed.

Results

A total of 39 case–control studies were included in this meta-analysis. The results of overall population rejected any significant association betweenVDRgene polymorphisms and T1DM risk. However, the pooled results of subgroup analysis revealed significant negative and positive associations betweenFokIandBsmIpolymorphisms and T1DM in Africans and Americans, respectively.

Conclusions

This meta-analysis suggested a significant association betweenVDRgene polymorphism and T1DM susceptibility in ethnic-specific analysis.
Effects of remaining dentin thickness on the bond strength of bleached dentin
Authors: Jiang Lei , Lin Xiu-jiao , Chen Ying-hui , Yu Hao
Published: August 2020

Background

The bond strength of resin composites to dentin was reported to be related to either the remaining dentin thickness (RDT) or bleaching treatment. However, information is limited regarding the effects of RDT on the bond strength of bleached dentin. The present study aimed to investigate the effects of RDT on the microshear bond strength (μSBS) of resin cement to bleached dentin.

Methods

A total of 120 dentin specimens were prepared and randomly divided into 2 groups: a bleaching group (group B) and a control group (group C). Hydrogen peroxide with a concentration of 35% (Ultradent, USA) was applied on the dentin surface for 2 × 1 d for group B, while no bleaching treatment was performed for group C. After the treatment, the specimens were finished and polished to obtain different RDTs (2, 1, and 0.5 mm) and divided into 3 groups of 20 specimens each. The bonding procedure was performed using Panavia V5 (Kuraray, Japan) with a bonding area of 0.785 mm2. For each group, half of the specimens were subjected to 5000 thermal cycles (subgroup T), while the other half did not receive thermocycling (subgroup N) (n = 10). The specimens were then subjected to the μSBS test using a universal testing machine. Data were analyzed by a three-way analysis of variance (α = 0.05). The fracture modes of the specimens were confirmed with a measuring microscope. Representative specimens with different fracture modes were observed with scanning electron microscopy (SEM).

Results

The μSBS values were significantly affected by bleaching treatment (p < 0.001), whereas no significant effect was observed for thermocycling (p = 0.293). In terms of RDT, a significantly different μSBS value was found among the subgroups with different RDTs in group C (p = 0.003). However, the RDT did not significantly affect the μSBS values of bleached dentin in group B (p = 0.779). The μSBS values were significantly lower in group B than in group C (p < 0.001). A higher percentage of adhesive failure was observed in group B than in group C.

Conclusion

Based on the present findings, it can be concluded that the RDT did not affect the bond strength of resin cement to bleached dentin.

Clinical significance

Since RDT did not affect the bond strength of resin cement to bleached dentin, bonding procedures should not be performed immediately after intracoronal bleaching, even if the dentin is planned to be removed due to a tooth preparation process.
Comparison between bidirectional Stratafix® barbed suture and conventional suture in laparoscopic myomectomy: a retrospective study
Authors: Nakayama Kentaro , Razia Sultana , Ishikawa Masako , Yamashita Hitomi , Ishibashi Tomoka , Sasamori Hiroki , Sawada Kiyoka , Kurose Sonomi , Sato Seiya , Kyo Satoru
Published: August 2020

Background

Laparoscopic myomectomy (LM) is one of the techniques feasible for the treatment of intramural myoma. This technique is reported to be difficult when large fibroids are involved because of excessive blood loss during surgery. Skillful and fast suturing appears to be associated with reduced blood loss during LM. In this study we compared the surgical outcomes of using bidirectional Stratafix® barbed suture versus conventional suture during LM.

Methods

This retrospective study included all patients who underwent LM for the treatment of intramural myoma in our institution between 2015 and 2020. The patients were divided into 2 groups according to the technique of suturing during LM: Group 1 comprised patients in whom Stratafix® barbed suture was used (n = 29), and group 2 comprised those in whom conventional suture was used (n = 15). Data of patient age, myoma size, the number of myoma nodes, hemoglobin levels, total operation time, total suturing time, and blood loss during surgery were compared between the 2 groups.

Results

No significant differences in age (p = 0.463) or myoma size (P = 0.373) were observed between the 2 groups. Operation time (P = 0.0104), suturing time (P = 0.007), and blood loss (P = 0.0375) during surgery were significantly less with Stratafix® barbed suture than with conventional suture. No patient required intraoperative transfusion or conversion to laparotomy.

Conclusion

The use of bidirectional barbed suture reduces operation time, suturing time, and blood loss. As these new sutures have barbs, no knot-tying is required; thus, continuous suturing becomes very simple and maintaining hemostasis is easy. Unskilled gynecological surgeons who apply this suture technique can also perform LM easily. As the bidirectional barbed suture has multiple points of fixation, this suture technique can reapproximate tissue securely, which reduces the chances of reoperation because of proper suture knotting. Therefore, bidirectional Stratafix® barbed sutures could be an optimal and efficient alternative to conventional sutures for use by gynecological surgeons in Japan.
A survey on the attitudes of Chinese medical students towards current pathology education
Authors: Xu Chun , Li Yiping , Chen Pingsheng , Pan Min , Bu Xiaodong
Published: August 2020

Background

Pathology education provides information on pathology and guides students to become pathologists. Recently, the Ministry of Education of the People’s Republic of China required the establishment of the system of ‘High-quality Online and Offline Courses’, which indicates that online courses will play an important role in higher education. Furthermore, the number of pathologists currently cannot satisfy clinical needs. To solve this health issue and implement the policy from the Ministry of Education, it is necessary to improve the current state of pathology education. First, we need to know students’ opinions of the current courses and their professional choices.

Methods

Online questionnaires covering the quality of traditional courses, attitudes towards online courses, and suggestions for optimizing courses were designed and applied. Whether students want to become pathologists and the underlying reasons for this interest are also included in this survey. Participants are medical students from certain colleges in Nanjing. The collected data were assessed by statistical analyses, and p-values less than 0.05 were considered significant.

Results

Of the 342 valid responses, 60.94% of undergraduate students showed their interest in pathology courses, and among them, 48.72% expressed that they may become pathologists. However, the corresponding percentage is only 29.59% in the group without interest. To optimize curricula, the top two suggestions are introducing more clinical cases (undergraduate students, 64.45%; graduate students, 79.09%) and making the classes lively and interesting (undergraduate students, 59.77%; graduate students, 62.79%). Approximately 80.00% of students consider online courses to be good supplementary materials to traditional courses, and approximately half prefer an online-offline mixed learning model. Salary, interest, and employment status are the main factors influencing students’ professional choices.

Conclusions

Students are generally satisfied with traditional pathology courses, and online courses are good supplementary materials in their opinions. It has been suggested that clinical cases be introduced in classes. It is more likely that students who have an interest in pathology will become pathologists. The data from this survey also show that the main causes of the shortage of pathologists are a lack of engaging work and an unsatisfactory salary.
Surgical referrals in Northern Tanzania: a prospective assessment of rates, preventability, reasons and patterns
Authors: Jumbam Desmond T. , Menon Gopal , Lama Tenzing N. , Lodge II William , Maongezi Sarah , Kapologwe Ntuli A. , Citron Isabelle , Barash David , Varallo John , Barringer Erin , Cainer Monica , Ulisubisya Mpoki , Alidina Shehnaz , Nguhuni Boniface
Published: August 2020

Background

An effective referral system is essential for a high-quality health system that provides safe surgical care while optimizing patient outcomes and ensuring efficiency. The role of referral systems in countries with under-resourced health systems is poorly understood. The aim of this study was to examine the rates, preventability, reasons and patterns of outward referrals of surgical patients across three levels of the healthcare system in Northern Tanzania.

Methods

Referrals from surgical and obstetric wards were assessed at 20 health facilities in five rural regions prospectively over 3 months. Trained physician data collectors used data collection forms to capture referral details daily from hospital referral letters and through discussions with clinicians and nurses. Referrals were deemed preventable if the presenting condition was one that should be managed at the referring facility level per the national surgical, obstetric and anaesthesia plan but was referred.

Results

Seven hundred forty-three total outward referrals were recorded during the study period. The referral rate was highest at regional hospitals (2.9%), followed by district hospitals (1.9%) and health centers (1.5%). About 35% of all referrals were preventable, with the highest rate from regional hospitals (70%). The most common reasons for referrals were staff-related (76%), followed by equipment (55%) and drugs or supplies (21%). Patient preference accounted for 1% of referrals. Three quarters of referrals (77%) were to the zonal hospital, followed by the regional hospitals (17%) and district hospitals (12%). The most common reason for referral to zonal (84%) and regional level (66%) hospitals was need for specialist care while the most common reason for referral to district level hospitals was non-functional imaging diagnostic equipment (28%).

Conclusions

Improving the referral system in Tanzania, in order to improve quality and efficiency of patient care, will require significant investments in human resources and equipment to meet the recommended standards at each level of care. Specifically, improving access to specialists at regional referral and district hospitals is likely to reduce the number of preventable referrals to higher level hospitals, thereby reducing overcrowding at higher-level hospitals and improving the efficiency of the health system.
Segmentation of health-care consumers: psychological determinants of subjective health and other person-related variables
Authors: Bloem Sjaak , Stalpers Joost , Groenland Edward A. G. , van Montfort Kees , van Raaij W. Fred , de Rooij Karla
Published: August 2020

Background

There is an observable, growing trend toward tailoring support programs – in addition to medical treatment – more closely to individuals to help improve patients’ health status. The segmentation model developed by Bloem & Stalpers [Nyenrode Research Papers Series 12:1–22, 2012] may serve as a solid basis for such an approach. The model is focused on individuals’ ‘health experience’ and is therefore a ‘cross-disease’ model. The model is based on the main psychological determinants of subjective health: acceptance and perceived control. The model identifies four segments of health-care consumers, based on high or low values on these determinants. The goal of the present study is twofold: the identification of criteria for differentiating between segments, and profiling of the segments in terms of socio-demographic and socio-economic variables.

Methods

The data (acceptance, perceived control, socio-economic, and socio-demographic variables) for this study were obtained by using an online survey (a questionnaire design), that was given (random sample N = 2500) to a large panel of Dutch citizens. The final sample consisted of 2465 participants – age distribution and education level distribution in the sample were similar to those in the Dutch population; there was an overrepresentation of females. To analyze the data factor analyses, reliability tests, descriptive statistics and t-tests were used.

Results

Cut-off scores, criteria to differentiate between the segments, were defined as the medians of the distributions of control and acceptance. Based on the outcomes, unique profiles have been formed for the four segments: 1. ‘Importance of self-management’ – relatively young, high social class, support programs: high-quality information. 2. ‘Importance of personal control’ – relatively old, living in rural areas, high in homeownership; supportive programs: developing personal control skills. 3. ‘Importance of acceptance’ – relatively young male; supportive programs: help by physicians and nurses. 4. ‘Importance of perspective and direction’ – female, low social class, receiving informal care; support programs: counseling and personal care.

Conclusions

The profiles describe four segments of individuals/patients that are clearly distinct from each other, each with its own description. The enriched descriptions provide a better basis for the allocation and developing of supportive programs and interventions across individuals.
Certification as support for resilience? Behind the curtains of a certification body — a qualitative study
Authors: Johannesen Dag Tomas Sagen , Lindøe Preben Hempel , Wiig Siri
Published: August 2020

Background

Certification in healthcare often involves independent private sector bodies performing legally required or voluntary external assurance activities. These certification practices are embedded in international standards founded in traditional beliefs about rational and predictable processes for quality and safety improvement. Certification can affect organizational and cultural changes, support collaboration and encourage improvement that may be conducive to resilient performance. This study explores whether ISO 9001 quality management system certification can support resilience in healthcare, by looking at characteristics in the objectives, methods, and practice of certification from a certification body’s perspective.

Methods

One of Norway’s four certification bodies in healthcare was studied, using an explorative embedded single-case design. The study relies on document analysis of the international standards and associated guidances for the performance of certification bodies and thematic analyses of data from 60 h of observations of auditors in three certification processes and nine qualitative interviews with managers and personnel from the certification body. Results from the analyses were compared to identify discrepancies between the written and perceived certification approach and practice.

Results

Standards and guidances for certification embed an elasticity between formal and consistent assessments of nonconformities in organizations and emphasize holistic approaches that brings added value. Auditors were then left with the latitude to navigate their auditing strategy during interaction with the auditees. Members of the certification body perceived and practiced a holistic and flexible auditing approach using opportunities to share knowledge, empower and make guidance for improvement.

Conclusions

ISO certification expects structures and systems to ensure consistent and objective certification processes. At the same time, it embodies a latitude to adopt flexible and context-specific certification approaches, as demonstrated by a certification body in this study, to give added value to the certified organizations. Such an ISO 9001 certification approach may support resilient performance in healthcare by nurturing the potential to respond and learn. These results are important for further development of methods that certification bodies use in the auditing encounter.
A comparison of four different models of acute respiratory distress syndrome in sheep
Authors: Engel Monique , Nowacki Relana M. E. , Jonker Elly M. , Ophelders Daan , Nikiforou Maria , Kloosterboer Nico , Zimmermann Luc J. I. , van Waardenburg Dick A. , Kramer Boris W.
Published: August 2020

Background

Acute respiratory distress syndrome (ARDS) can have various causes. The study objective was to investigate whether different pathophysiologic models of ARDS would show different respiratory, cardiovascular and inflammatory outcomes.

Methods

We performed a prospective, randomized study in 27 ventilated ewes inducing ARDS using three different techniques to mimic the pulmonary causes of ARDS (ARDSp): warm saline lavage (n = 6), intratracheal hydrochloric acid (HCl; n = 6), intratracheal albumin (n = 10), and one technique to mimic an extrapulmonary cause of ARDS (ARDSexp): intravenous lipopolysaccharide (LPS iv;n = 5). ARDS was defined when PaO2was < 15 kPa (112 mmHg) when ventilated with PEEP 10 cm H2O and FiO2 = 1.0. The effects on gas exchange were investigated by calculating the oxygenation index (OI) and the ventilation efficacy index (VEI) every 30 min for a period of 4 h. Post mortem lung lavage was performed to obtain broncho-alveolar lavage fluid (BALF) to assess lung injury and inflammation. Lung injury and inflammation were assessed by measuring the total number and differentiation of leukocytes, the concentration of protein and disaturated phospholipids, and interleukine-6 and -8 in the BALF. Histology of the lung was evaluated by measuring the mean alveolar size, alveolar wall thickness and the lung injury score system by Matute-Bello et al., as markers of lung injury. The concentration of interleukin-6 was determined in plasma, as a marker of systematic inflammation.

Results

The OI and VEI were most affected in the LPS iv group and thereafter the HCl group, after meeting the ARDS criteria. Diastolic blood pressure was lowest in the LPS iv group. There were no significant differences found in the total number and differentiation of leukocytes, the concentration of protein and disaturated phospholipids, or interleukin-8 in the BALF, histology of the lung and the lung injury score. IL-6 in BALF and plasma was highest in the LPS iv group, but no significant differences were found between the other groups. It took a significantly longer period of time to meet the ARDS criteria in the LPS iv group.

Conclusions

The LPS model caused the most severe pulmonary and cardiovascular insufficiency. Surprisingly, there were limited significant differences in lung injury and inflammatory markers, despite the different pathophysiological models, when the clinical definition of ARDS was applied.
Significance of tumor mutation burden combined with immune infiltrates in the progression and prognosis of ovarian cancer
Authors: Bi Fangfang , Chen Ying , Yang Qing
Published: August 2020

Background

Ovarian cancer (OC) is the most malignant tumor in the female reproductive system. About 75% of OC in complete remission of clinical symptoms still develop a recurrence. Therefore, searching for new treatment methods plays an important role in improving the prognosis of OC.

Methods

We downloaded the MAF files, RNA-seq data and clinical information from the TCGA database. The “maftools” package in R software was used to visualize the OC mutation data. We calculated the tumor mutation burden (TMB) of OC and analyzed its correlation with clinicopathological parameters and prognostic value. Tumor mutation burden related signature model was constructed to predict the overall survival (OS) of OC.

Results

The results revealed that there was a statistical correlation between TMB and FIGO stage, grade and tumor residual size of ovarian cancer patients. The Kaplan–Meier curve indicated that a high TMB is associated with better clinical outcomes of OC. The difference analysis indicated 24 upregulated genes and 619 downregulated genes in the high-TMB group compared with the low-TMB group. Besides, the TMBRS model based on five hub genes (RBMS3, PLA2G5, CDH2, AMHR2 and ADAMTS8) was constructed to predict the OS of OC. The ROC curve and validation data sets all revealed that the TMBRS model was reliable in predicting recurrence risk. Immune microenvironment analysis indicated the correlations between TMB and infiltrating immune cells.

Conclusions

Our results suggest that TMB plays an important role in the prognosis and guiding immunotherapy of OC. By detecting the TMB of OC, clinicians can more accurately treat patients with immunotherapy, thereby improving their survival rate.
Association between triglyceride glucose index and obstructive sleep apnea risk in Korean adults: a cross-sectional cohort study
Authors: Kang Hyeon Hui , Kim Sei Won , Lee Sang Haak
Published: August 2020

Background

Triglyceride glucose (TyG) index is a reliable marker of insulin resistance, which is linked to obstructive sleep apnea (OSA). However, the relationship between TyG index and OSA has not been adequately assessed. This study aimed to evaluate the association between TyG index and OSA.

Methods

TyG index was assessed in 180 (mean age: 48.6 ± 13.8 years; 73.9% male) consecutive Korean adults with suspected OSA admitted to the sleep clinic at St. Paul’s Hospital between 2010 and 2012. The occurrence of more than 5 apnea-hypopnea index (AHI) events/h was used to define OSA. TyG index was calculated using the following equation: In [fasting triglycerides (mg/dL) × fasting glucose (mg/dL)/2]. All participants were grouped according to TyG index tertiles. Multivariate logistic regression analysis was used to determine factors associated with increased OSA risk.

Results

The overall prevalence of OSA in study participants was determined to be 83.9%. The prevalence of OSA increased (I [lowest]: 71.6%; II: 88.7%; III [highest]: 91.4%), and lowest peripheral oxygen saturation (SpO2) levels decreased (I: 83.3 ± 8.5%; II: 79.9 ± 8.7%; III: 79.0 ± 8.3%), as TyG index tertile increased (P < 0.05). TyG index was correlated with AHI (r = 0.179) and lowest SpO2(r = − 0.188) (P < 0.05, respectively). Univariate linear regression analysis revealed an association between TyG and AHI (β = 10.084;P = 0.016). Multivariate logistic regression analysis showed that TyG index (odds ratio [OR]: 3.348; 95% confidence interval [CI]: 1.081–10.372), age ≥ 55 years (OR: 5.426; 95% CI: 1.642–17.935), and obesity (OR: 3.801; 95% CI: 1.468–9.842) were associated with increased OSA risk (allP < 0.05). The optimal TyG index cut-off value for predicting OSA was 8.83 (sensitivity: 61.6%; specificity: 69.0%; area under the curve: 0.688;P = 0.001). The predictive value of the OSA cut-off value improved when age ≥ 55 years and obesity were considered.

Conclusion

Increased TyG index was independently associated with increased OSA risk.
The adaptation of sport assessment-patella questionnaire into simplified Chinese version: cross-cultural adaptation, reliability and validity
Authors: Weng Weizong , Zhi Xin , Jia Zhenyu , Liu Shanshan , Huang Jianming , Wan Fang , He Jia , Chen Shiyi , Cui Jin
Published: August 2020

Background

The original version of Victorian Institute of Sport Assessment-Patella Questionnaire (VISA-P) is developed in English, and aimed to assess the severity of patellar tendinopathy symptoms. Before used in China, it should be translated to Chinese version.

Objectives

Our aim is to make a translation/cross-culturally adaption for the VISA-P into simplified Chinese version (VISA-PC). And primarily validate the VISA-PC in Chinese speaking population.

Methods

The translation process of VISA-P questionnaire into simplified Chinese version (VISP-PC) followed the International recognized guideline. Cross-cultural adaptation was carried out with a clinical measurement study. A total of 128 projects which consisted 33 healthy students, 39 patients with patellar tendinopathy and 56 military students (receive military training as at-risk population) were included into this study. Internal consistency was evaluated with Cronbach’s alpha, and test-retest reliability was assessed with intraclass correlation coefficients (ICCs). Construct validity and floor and ceiling effects were also tested.

Results

The scores were 95.84 ± 5.97 of healthy group, 91.87 ± 9.03 of at-risk group, 62.49 ± 11.39 of pathological group. There is no ceiling and floor effect of VISA-PC. The Cronbach’s alpha (0.895) and ICC (0.986) values showed good internal consistency and reliability. There were high correlations between VISA-PC and Kujala patellofemoral score (r = 0.721). VISA-PC score also had good correlation with the relevant SF-36 items.

Conclusion

The VISA-PC was well translated into simplified Chinese version (VISA-PC), which is reliable and valid for Chinese-speaking patients with patellar tendinopathy.

Level of evidence

II.
Erythropoietin prevents necrotizing enterocolitis in very preterm infants: a randomized controlled trial
Authors: Wang Yong , Song Juan , Sun Huiqing , Xu Falin , Li Kenan , Nie Chunxia , Zhang Xiaoli , Peng Xirui , Xia Lei , Shen Ziyun , Yuan Xiao , Zhang Shan , Ding Xue , Zhang Yaodong , Kang Wenqing , Qian Liling , Zhou Wenhao , Wang Xiaoyang , Cheng Xiuyong , Zhu Changlian
Published: August 2020

Background

Necrotizing enterocolitis (NEC) is one of the most severe complications in very preterm infants, but there are currently no accepted methods to prevent NEC. Studies have shown that erythropoietin (EPO) has the potential to prevent NEC or improve outcomes of preterm NEC. This study aimed to determine whether recombinant human EPO (rhEPO) could protect against NEC in very preterm infants.

Methods

The study was a prospective randomized clinical trial performed among four NICU centers. A total of 1327 preterm infants with gestational age ≤ 32 weeks were admitted to the centers, and 42 infants were excluded leaving 1285 eligible infants to be randomized to the rhEPO or control group. Infants in the rhEPO group were given 500 IU/kg rhEPO intravenously every other day for 2 weeks, while the control group was given the same volume of saline. The primary outcome was the incidence of NEC in very preterm infants at 36 weeks of corrected gestational age.

Results

A total of 1285 infants were analyzed at 36 weeks of corrected age for the incidence of NEC. rhEPO treatment significantly decreased the incidence of NEC (stage I, II and III) (12.0% vs. 17.1%,p = 0.010), especially confirmed NEC (stage II and III) (3.0% vs. 5.4%,p = 0.027). Meanwhile, rhEPO treatment significantly reduced the number of red blood cells transfusion in the confirmed NEC cases (1.2 ± 0.4 vs. 2.7 ± 1.0,p = 0.004). Subgroup analyses showed that rhEPO treatment significantly decreased the incidence of confirmed NEC at gestational age < 28 weeks (p = 0.019), and the incidence of all stages NEC in preterm infants with hemoglobin < 90 g/l (p = 0.000) and 5 min Apgar score > 5 (p = 0.028).

Conclusion

Repeated low-dose rhEPO treatment is beneficial against NEC in very preterm infants.

Trial registrationThe protocol was registered retrospectively at ClinicalTrials.gov (NCT03919500) on April 18, 2019.https://clinicaltrials.gov/ct2/show/NCT03919500
Maize tassels detection: a benchmark of the state of the art
Authors: Zou Hongwei , Lu Hao , Li Yanan , Liu Liang , Cao Zhiguo
Published: August 2020

Background

The population of plants is a crucial indicator in plant phenotyping and agricultural production, such as growth status monitoring, yield estimation, and grain depot management. To enhance the production efficiency and liberate labor force, many automated counting methods have been proposed, in which computer vision-based approaches show great potentials due to the feasibility of high-throughput processing and low cost. In particular, with the success of deep learning, more and more deeper learning-based approaches are introduced to deal with agriculture automation. Since different detection- and regression-based counting models have distinct characteristics, how to choose an appropriate model given the target task at hand remains unexplored and is important for practitioners.

Results

Targeting in-field maize tassels as a representative case study, the goal of this work is to present a comprehensive benchmark of state-of-the-art object detection and object counting methods, including Faster R-CNN, YOLOv3, FaceBoxes, RetinaNet, and the leading counting model of maize tassels—TasselNet. We create a Maize Tassel Detection Counting (MTDC) dataset by supplementing bounding box annotations to the Maize Tassels Counting (MTC) dataset to allow the training of detection models. We investigate key factors effecting the practical applications of the models, such as convergence behavior, scale robustness, speed-accuracy trade-off, as well as parameter sensitivity. Based on our benchmark, we summarise the advantages and limitations of each method and suggest several possible directions to improve current detection- and regression-based counting approaches to benefit next-generation intelligent agriculture.

Conclusions

Current state-of-the-art detection- and regression-based counting approaches can all achieve a relatively high degree of accuracy when dealing with in-field maize tassels, with at least 0.85 $$R^2$$

R
2

values and 28.2% rRMSE error. While detection-based methods are more robust than regression-based methods in scale variations and can infer extra information (e.g., object positions and sizes), the latter ones have significantly faster convergence behaviors and inference speed. To choose an appropriate in-filed plant counting method, accuracy, robustness, speed and some other algorithm-specific factors should be taken into account with the same priority. This work sheds light on different aspects of existing detection and counting approaches and provides guidance on how to tackle in-field plant counting. The MTDC dataset is made available at https://git.io/MTDC
Design and study protocol for a cluster randomized trial of a multi-faceted implementation strategy to increase the uptake of the USPSTF hypertension screening recommendations: the EMBRACE study
Authors: Moise Nathalie , Phillips Erica , Carter Eileen , Alcantara Carmela , Julian Jacob , Thanataveerat Anusorn , Schwartz Joseph E. , Ye Siqin , Duran Andrea , Shimbo Daichi , Kronish Ian M.
Published: August 2020

Background

The US Preventive Services Task Force (USPSTF) recommends out-of-office blood pressure (BP) testing to exclude white coat hypertension prior to hypertension diagnosis. Despite improved availability and coverage of home and 24-h ambulatory BP monitoring (HBPM, ABPM), both are infrequently used to confirm diagnoses. We used the Behavior Change Wheel (BCW) framework, a multi-step process for mapping barriers to theory-informed behavior change techniques, to develop a multi-component implementation strategy for increasing out-of-office BP testing for hypertension diagnosis. Informed by geographically diverse provider focus groups (n = 63) exploring barriers to out-of-office testing and key informant interviews (n = 12), a multi-disciplinary team (medicine, psychology, nursing) used rigorous mixed methods to develop, refine, locally adapt, and finalize intervention components.

The purpose of this report is to describe the protocol of the Effects of a Multi-faceted intervention on Blood pRessure Actions in the primary Care Environment (EMBRACE) trial, a cluster randomized control trial evaluating whether a theory-informed multi-component strategy increased out-of-office testing for hypertension diagnosis.

Methods/design

The EMBRACE Trial patient sample will include all adults ≥ 18 years of age with a newly elevated office BP (≥ 140/90 mmHg) at a scheduled visit with a primary care provider from a study clinic. All providers with scheduled visits with adult primary care patients at enrolled ACN primary care clinics were included. We determined that the most feasible, effective implementation strategy would include delivering education about out-of-office testing, demonstration/instruction on how to perform out-of-office HBPM and ABPM testing, feedback on completion rates of out-of-office testing, environmental prompts/cues via computerized clinical decision support (CDS) tool, and a culturally tailored, locally accessible ABPM testing service. We are currently comparing the effect of this locally adapted multi-component strategy with usual care on the change in the proportion of eligible patients who complete out-of-office BP testing in a 1:1 cluster randomized trial across 8 socioeconomically diverse clinics.

Conclusions

The EMBRACE trial is the first trial to test an implementation strategy for improving out-of-office testing for hypertension diagnosis. It will elucidate the degree to which targeting provider behavior via education, reminders, and decision support in addition to providing an ABPM testing service will improve referral to and completion of ABPM and HBPMs.

Trial registration

Clinicaltrials.gov, NCT03480217, Registered on 29 March 2018