bluuebunny/crossref_metadata_2025 huggingface dataset:
Shared Decision-making between health care providers and patients at a Tertiary Hospital Diabetic Clinic in Tanzania
Authors: Vedasto Osward , Morris Baraka , Furia Francis Fredrick
Published: August 2020

Background Patients’ participation in decision making regarding their treatment is defined in ethical, legal and human rights standards in the provision of care that concerns health providers and the entire community. This study was conducted to document experiences of patients and health care providers on shared decision making. Methods:This study employed a phenomenological study design using in-depth interview technique. Study participants were diabetic patients visiting the clinic and healthcare providers working at Muhimbili National Hospital. Data was collected using the semi-structured interview guide with open-ended questions using an audio digital recorder. Content analysis method was used during analysis whereby categories were reached through the process of coding assisted by Nvivo 12 software. Results Participants in this study expressed the role of shared decision-making in the care of patients with diabetes, with report of engagement of patients by health care providers in making treatment decisions. Participants reported no use of decision-making aids; however, health education tools were reported by participants to be used for educating patients. Limited time, patient beliefs and literacy were documented as barriers of effective engagement of patients in decision making by their healthcare providers. Conclusion Engagement of patients in decision-making was noted in this study as experienced by participants of this study. Time, patient beliefs and patient literacy were documented as barriers for patients engagement, therefore diabetic clinic at Muhimbili National Hospital need to devise mechanisms for ensuring patients involvement in treatment decisions.
Metabolomic profiling on plasma reveals potential biomarkers for screening and early diagnosis of intestinal-type gastric cancer and precancerous stages
Authors: Du Lijing , Li Shasha , Xiao Xue , Li Jin , Jin Huizi , Hua Zhaolai , Ma Juming , Wang Xi , Yan Shikai
Published: August 2020

Background: Gastric cancer (GC) with majority of intestinal-type adenocaricinoma remains one of the most common cancers all over the world. GC faces a great challenge in the clinical diagnosis, that it often can be detected at advanced stages, and leads to the loss of optimum time for treatment and poor prognosis. Thus, there is a critical need to develop effective and noninvasive strategies for early diagnosis of the disease process. Methods: Totally, 82 participants were enrolled in the study, including 50 chronic superficial gastritis (CSG) patients, 7 intestinal-type early gastric cancer (EGC) and 25 intestinal-type advanced gastric cancer (AGC) ones. Metabolites profiling on patient plasma was performed using ultra-high performance liquid chromatography coupled with quadrupole-time-of-flight mass spectrometry (UPLC-Q-TOF/MS). Principal components analysis, orthogonal partial least squares-discriminant analysis as well as Random forest were utilized to evaluate the variation on endogenous metabolites for intestinal-type GC patients and to screen potential biomarkers. Furthermore, the proposed biomarkers were used to create logistic regression models, which discrimination efficiency and accuracy was ascertained by receiver operating characteristic curve (ROC) analysis. Metabolic pathway analysis were carried out on MetaboAnalyst.Results: Totally 50 metabolites were detected with differentially expression among CSG, intestinal-type EGC and AGC patients. L-carnitine, L-proline, pyruvaldehyde, phosphatidylcholines (PC) (14:0/18:0), lysophosphatidylcholine (14:0) (LysoPC 14:0), lysinoalanine were defined as the potential biomarker panel for the diagnosis among CSG and EGC patients. Compared with EGC patients, 6 significantly changed metabolites, PC(O-18:0/0:0) and LysoPC(20:4(5Z,8Z,11Z,14Z)) were found to be up-regulated in AGC patients, whereas L-proline, L-valine, adrenic acid and pyruvaldehyde down-regulated. ROC analysis demonstrated a high diagnostic performance for metabolite panels with area under the curve (AUC) of 0.931 to 1. Moreover, the metabolomic pathway analysis revealed several metabolism pathway disorder, including amino acid and lipid metabolisms, in intestinal-type GC patients.Conclusions: In this study, a total of six metabolites were identified to contribute significantly to the diagnosis of intestinal-type GC and precancerous stages, respectively, and over 93.1% AUC value was achieved in AUC test on biomarker panels, It indicated that the biomarker panels are· sensitive to the early diagnosis of intestinal-type GC disease, which is expected to be developed as a promising diagnostic and prognostic tool for disease stratification studies.
Prescription of antibiotics to children with acute otitis media in Danish general practice
Authors: Olsen Jonas , Lykkegaard Jesper , Hansen Malene Plejdrup , Waldorff Frans B , Lous Jørgen , Andersen Merethe K
Published: August 2020

Background: Acute otitis media (AOM) is a common and most often self-limiting infection in childhood, usually managed in general practice. Even though antibiotics are only recommended when certain diagnostic and clinical criteria are met a high antibiotic prescription rate is observed. The study’s objective was to analyse associations between patient- and general practitioner (GP) characteristics and antibiotic prescribing for children with AOM in an effort to explain the high antibiotic prescribing rates.Methods: All general practices in the Northern, Southern and Central regions of Denmark were invited to record symptoms, examinations, findings and antibiotic treatment for all children ≤ 7 years of age diagnosed with AOM during a four-week winter period in 2017/2018. Associations were analysed by means of multivariate logistic regressions. The study design was cross-sectional. Results: GPs from 60 general practices diagnosed 278 children with AOM of whom 207 (74%) were prescribed antibiotics, most often penicillin V (60%). About half of the children had tympanometry performed. Antibiotic prescribing rates varied considerably between practices (0-100%). Antibiotic prescribing was associated with fever (odds ratio (OR) 3.69 95% confidence interval (CI) 1.93-7.05), purulent ear secretion (OR 2.35 95% CI 1.01-5.50) and poor general condition (OR 3.12 95% CI 1.31-7.46), and the practice’s antibiotic prescribing rate to other patients with symptoms of an acute respiratory tract infection (OR 2.85 CI 95% 1.07-7.60) and specifically to other children with AOM (OR 4.15 CI 95% 1.82-9.47).Conclusion: GPs’ antibiotic prescribing rates for children with AOM vary considerably even considering the of signs, symptoms, request for antibiotics, and use of tympanometry. Interventions to reduce overprescribing should be targeted high-prescribing practices.
Cost-effectiveness of different surgical treatment approaches for early breast cancer: a retrospective matched cohort study from China
Authors: Yang Qing , Zhong Xiaorong , Zhang Wei , Luo Ting , He Ping , Zheng Hong
Published: August 2020

Background: Both breast-conserving surgery and breast reconstruction surgery are less popular in China, although they can improve patients' quality of life. The main reason comes from the economy. There is currently no economic evaluation of different surgical treatment options for early breast cancer. Our study aims to assess the economic impact and long-term cost-effectiveness of different surgical treatments for early breast cancer. The surgical approaches are including mastectomy (MAST), breast-conserving therapy (BCT), and mastectomy with reconstruction (MAST+RECON).Methods: We applied the propensity score matching method to perform a 1: 1 match on patients undergoing these three types of surgery in a tertiary academic medical center from 2011 to 2017 to obtain a balanced sample of covariates between groups. A Markov model was established. Clinical data and cost data were obtained from the medical records. Health utility values were derived from clinical investigations. Strategies were compared using an incremental cost-effectiveness ratio (ICER).Results: The total cost of MAST, MAST+RECON and BCT was $35,282.24, $69,428.82 and $73,661.08, respectively. The quality-adjusted life year (QALYs) were 17.94, 18.71 and 20.49, respectively. Compared with MAST, MAST+RECON and BCT have an ICER of $106708.06/QALY and $15050.53/QALY, respectively. The ICER of BCT vs. MAST was less than the threshold of $27,931.04. The reliability and stability of the results were confirmed by Monte Carlo simulation and sensitivity analysis.Conclusions: We believe that in the context of the limited resources in China, after comparing the three surgical approaches, BCT is the more cost-effective and preferred solution.
Safety of bronchoscopy in patients with malignant hematologic disorders
Authors: Uruga Hironori , Sato Toshitaka , Nishida Aya , Uchida Naoyuki , Tsuji Masanori , Moriguchi Shuhei , Takahashi Yui , Ogawa Kazumasa , Murase Kyoko , Hanada Shigeo , Takaya Hisashi , Miyamoto Atsushi , Morokawa Nasa , Kimura Muneyoshi , Araoka Hideki , Tsuchihashi Rumiko , Asano-Mori Yuki , Wake Atsushi , Taniguchi Shuichi , Kishi Kazuma
Published: August 2020

Background: To evaluate the safety of bronchoscopy and describe factors affecting its complication rate in patients with malignant hematologic disorders. Methods: Between January 2009 and December 2018, 316 bronchoscopies in 282 patients with malignant hematologic disorders and pulmonary infiltrates were performed at our institution. The bronchoscopic procedure used and its complications were evaluated. Results: The most common underlying disease was acute myeloid leukemia (134/282 patients, 47.5%). Platelet transfusion was performed the day before or the day of bronchoscopy in 42.4%, supplemental oxygen was administered before the procedure in 23.1%, and midazolam was used in 74.4%. Thirty-five bronchoscopies (11.1%) were complicated by hemoptysis and 7 patients developed pneumothorax, 4 of whom required thoracic drainage. Two patients (0.6%) were intubated within 48 hours of the procedure and prolonged oxygen desaturation (>48 hours) occurred in 3.8%. Multivariate analysis showed that only use of midazolam significantly reduced the risk of prolonged oxygen desaturation (hazard ratio 0.28, 95% confidence interval 0.09–0.85, p = 0.03). Transbronchial lung biopsy significantly increased the risk of hemoptysis (hazard ratio 10.40, 95% confidence interval 4.18–25.90, p = 0.00), while use of midazolam significantly reduced the risk (hazard ratio 0.31, 95% confidence interval 0.14–0.73, p = 0.01). Conclusions: Bronchoscopy is relatively safe in patients with malignant hematologic disorders. Sedation with midazolam may reduce the risk of prolonged oxygen desaturation and hemoptysis, though transbronchial lung biopsy may increase the risk for hemoptysis. ​
The Analysis of Risk Factors to Hypotension Occurring after Caesarean Spinal Anesthesia for Parturients with Scarred Uterus
Authors: Chen Wei , Cao Ya , Chen Quan Yong , Lu Yan , Wang Bing , Wang Hai , Ding Fang , Guo Ling
Published: August 2020

Background：This study examined the risk factors for hypotension after caesarean spinal anesthesia with low dose of bupivacaine and sulfentanyl in parturients with scarred uterus. Methods：A total of 322 singleton-pregnancy parturients with scarred uterus who had been scheduled for caesarean spinal anesthesia were randomly sampled. The data on the basic information of the parturients, the gestation, the fetus and the anesthesia were recorded and filed according to the clinical questionnaires on hypotension in caesarean section. The parturients whose systolic blood pressure dropped below 90 mmHg or decreased by 20% during the time from the completion of anesthesia until the delivery of infant were classified as Group hypotension (Group H) and the rest were in Group non-hypotension (Group N). This study analyzed the correlation of 39 factors to the occurrence of hypotension, and further analyzed the statistically significant factors through binary classification logistic regression.Results：Of the 322 sampled parturients, 148 parturients suffered hypotension. The incidence of hypotension in this study was 45.96%. The result of univariate analysis showed statistically significant differences in the factors including height (p=0.005), post-pregnancy Body Mass Index (BMI) (p=0.00), fasting time (p=0.031),weight gain in gestation (p=0.000), fundal height (p=0.047), exercise history in gestation (p=0.006) and dermatomal level of analgesia (p=0.000) between the two groups. The variables with statistical significance were analyzed by multivariate logistic regression model. The result showed that BMI in gestation (OR=1.146, 95% CI 1.041-1.262, p <0.05), weight gain in gestation (OR = 1.126, 95% CI 1.060-1.198, p <0.001), exercise history in gestation (OR = 0.399, 95% CI 0.205-0.778, p = 0.007), and dermatomal level of analgesia (OR = 2.248, 95% CI 1.645-3.074, p <0.001) were risk factors for hypotension after caesarean spinal anesthesia in parturients with scarred uterus. Conclusion：The incidence of hypotension after caesarean spinal anesthesia in parturients with scarred uterus was relatively high. The post-pregnancy BMI, weight gain in gestation, exercise history in gestation and dermatomal level of analgesia after anesthesia were risk factors for hypotension after caesarean spinal anesthesia in parturients with scarred uterus. These findings play an important role in predicting the occurrence of hypotension after caesarean spinal anesthesia in parturients with scarred uterus. Trial registration：Chinese Clinical Trial Registry (chiCTR-ROC-17011251)
A one-year cohort study of complications, continuation, and failure rates of postpartum TCu380A in Tanzania
Authors: Rwegoshora France John , Muganyizi Projestine Selestine , Kimario Grasiana Festus , Paul Ponsian Patrick , Makins Anita
Published: August 2020

Background: Less than 1% of married women in Tanzania use an Intrauterine Contraceptive Device (IUD) for contraception. An initiative by the International Federation of Gynecology and Obstetrics (FIGO) has been in progress since 2015 resulting in escalated method uptake in implementing hospitals. This study investigates failure rate, complications, and risk factors for one-year continuation of TCu380A IUD when used for immediate postpartum contraception under the initiative in Tanzania Methodology: A prospective cohort study of women who had TCu380A insertion within 48 hours of delivery in 6 hospitals in Tanzania between 1st December 2017 and 18th April 2018 was conducted. Face to face post insertion interviews were made with 1114 clients before discharge and later through phone calls up to the beginning of 13th month postpartum. Postpartum Intrauterine Device (PPIUD) continuation status, complications, duration of time they stayed with the IUD and the currently used method if PPIUD was discontinued were enquired. The outcome variable was PPIUD continuation at one year of IUD insertion. Data were analyzed using Statistical Product and Service Solutions software (SPSS) for Windows version 20 (IBM SPSS Statistics, Chicago, IL, USA). Results: In total 511(45.8%)clients had consented and availed to complete the one-year follow-up. Out of these, 440 still had IUD, giving a one-year continuation rate of 86.1%. Most (63%) IUD discontinuations occurred in the period between 7th week and 6 months of insertion. One-year method expulsion rate was 2.1%. There was one reported pregnancy that gives a method failure rate of about 2 per 1000. The independent risk factors in favor of method continuation at one year were absence of medical or social problem, being a youth (16-24 years), and delivery by Cesarean section. Conclusions: The continuation rate when CuT380A is used for immediate postpartum contraception is high, with low complication and failure rates. Some medical and social factors are important for method continuation, hence the need to consider in training, counselling and advocacy.
Long non-coding RNA MIR4300HG polymorphisms are associated with postoperative nausea and vomiting: a genome-wide association study
Authors: Sugino Shigekazu , Konno Daisuke , Kawai Yosuke , Nagasaki Masao , Endo Yasuhiro , Hayase Tomo , Yamazaki-Higuchi Misako , Kumeta Yukihiro , Tachibana Shunsuke , Saito Katsuhiko , Suzuki Jun , Kido Kanta , Kurosawa Nahoko , Namiki Akiyoshi , Yamauchi Masanori
Published: August 2020

Background: Genetic factors such as single nucleotide polymorphisms (SNPs) play a key role in the development of postoperative nausea and vomiting (PONV). However, previous findings are not widely applicable to different populations because of population-specific genetic variation. We developed a Japanese-specific DNA microarray for high-throughput genotyping. The aim of the current study was to identify SNPs associated with PONV on a genome-wide scale using this microarray in a sample of Japanese surgical patients. Methods: Associations between 659,636 SNPs and the incidence of PONV 24 h after surgery in a limited sample of 24 female patients were assessed using the microarray. After imputation of genotypes at 24,330,529 SNPs, 78 SNPs were found to be associated with the incidence of PONV. We chose 4 of the 78 SNPs to focus on by in silico functional annotation. Finally, we genotyped these 4 candidate SNPs in 255 patients using real-time PCR to verify association with the incidence of PONV. Results: The T > C variant of rs11232965 in the long non-coding RNA MIR4300HG was significantly associated with reduced incidence of PONV among genotypes and between alleles (p = 0.01 and 0.007). Conclusions: We identified a novel SNP (rs11232965) in the long non-coding RNA MIR4300HG that is associated with PONV. The rs11232965-SNP variant (T > C) is protective against the incidence of PONV. Trial registration: This study was registered at the UMIN Clinical Trials Registry (Identifier: UMIN000022903, date of registration: June 27th, 2016, retrospectively registered, https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000026392).
Social Determinants of Mental Health Care Systems: Intensive Community Based Care in The Veterans Health Administration
Authors: Bhalla Ish P , Stefanovics Elina A , Rosenheck Robert A
Published: August 2020

Background: Since deinstitutionalization in the 1950s-1970s, public mental health care has changed its focus from asylums to general hospitals, outpatient clinics and specialized community-based programs addressing both clinical and social determinants of mental health. Analysis of the place of community-based programs within a comprehensive health system such as the Veterans Health Administration (VHA) may illuminate the role of social forces in shaping contemporary public mental health systems. Methods: National VHA administrative data were used to compare veterans who exclusively received outpatient clinic care to those receiving four types of specialized community-based services, addressing: 1) functional disabilities from severe mental illness (SMI), 2) justice system involvement, 3) homelessness, and 4) vocational rehabilitation. Bivariate comparisons and multinomial logistic regression analyses compared groups on demographics, diagnoses, service use, and psychiatric prescription fills. Results: An hierarchical classification of 1,386,487 Veterans who received specialty mental health services from VHA in Fiscal Year 2012, showed 1,134,977 (81.8%) were seen exclusively in outpatient clinics; 27,931 (2.0 %) received intensive SMI-related services; 42,985 (3.1%) criminal justice services; 160,273 (11.6%) specialized homelessness services; and 20,921 (1.5%) vocational services. Compared to those seen only in clinics, veterans in the four community treatment groups were more likely to be black, diagnosed with HIV and hepatitis, had more numerous substance use diagnoses and made far more extensive use of mental health outpatient and inpatient care. Conclusions: Almost one-fifth of VHA mental health patients receive community-based services prominently addressing major social determinants of health and multimorbid substance use disorders.
Pilot trial on the efficacy and safety of pantethine in children with pantothenate kinase-associated neurodegeneration: A single-arm, open-label study.
Authors: Chang Xuting , Zhang Jie , Jiang Yuwu , Yao Bufan , Wang Jingmin , Wu Ye
Published: August 2020

Objective This study aimed to explore the efficacy and safety of pantethine in children with pantothenate kinase-associated neurodegeneration (PKAN).Methods A single-arm, open-label study was conducted. All subjects received pantethine during the 24-week period of treatment. The primary endpoints were change of the Unified Parkinson’s Disease Rating Scale (UPDRS) I–III and Fahn–Marsden (FM) score from baseline to week 24 after treatment.Results Fifteen children with PKAN were enrolled, and all patients completed the study. After 24 weeks of treatment with pantethine at 60mg/kg per day, there was no difference in either UPDRS I–III (t=0.516, P=0.614) or FM score (t=0.353, P=0.729) between the baseline and W24. Whereas the rates of increase in UPDRS I-III (Z=2.614, p=0.009) and FM scores (Z=2.643, p=0.008) were slowed. Four patients (26.7%) were evaluated as “slightly improved” by doctors through blinded video assessment. Patients with lower baseline UPDRS I–III or FM scores were more likely to be improved. The quality of life of family members improved after pantethine treatment, evaluated by PedsQL TM 2.0 FIM scores, whereas the quality of life of the patients was unchanged at W24, evaluated by PedsQL TM 4.0 and PedsQL TM 3.0 NMM. Serum level of CoA was comparable between baseline and W24. There was no drug related adverse event during the study.Conclusions Pantethine could not significantly improve motor function in children with PKAN after 24 weeks treatment, but it may delay the progression of motor dysfunction in our study. Pantethine was well-tolerated at 60mg/kg per day.Trial registration:Clinical trial registration number at www.chictr.org.cn：ChiCTR1900021076，Registered 27 January2019，the first participant was enrolled 30 September 2018，and other 14 participants were enrolled after the trial was registered.
Characteristics of acute ischemic stroke in hospitalized patients in Tibet: A retrospective comparative study
Authors: Lu Yuxuan , Zhuoga Cidan , Jin Haiqiang , Zhu Feiqi , Zhao Yuhua , Ding Zhijie , He Shihua , Du Ailian , Xu Jun , Luo Jingjing , Sun Yongan
Published: August 2020

Background: Numerous studies of acute ischemic stroke (AIS) have been conducted at low altitude regions, and the related findings were used to instruct clinic management while corresponding studies at high altitude are few. This study aimed to analyse AIS clinic characteristics at high altitude regions by conducting a hospital-based comparative study between Tibet and Beijing. Methods: This study included the diagnoses of AIS patients from People’s Hospital of Tibet Autonomous Region (PHOTAR) and Peking University First Hospital (PUFH) between 1st January 2014, and 31st December 2017, where data including patient demographics, treatment time, onset season, risk factors, infarction location, laboratory data, image examination results, treatments, and AIS subtype were collected and compared. Continuous and categorical variables were analysed with a two-sample t-test or Wilcoxon rank sum test and chi-square test, respectively. Significant risk factors were examined with binary logistic regression analysis.Results: In total, 236 and 1021 inpatients from PHOTAR and PUFH were included, respectively. The PHOTAR patients were younger than the PUFH patients (P<0.001). Young adult stroke, erythrocytosis, and hyperhomocysteinemia were more frequent in PHOTAR patients (all P<0.001). Other vascular risk factors, including hypertension, diabetes mellitus, hyperlipidaemia, and smoking and alcohol consumption history, were less prevalent in PHOTAR patients than in PUFH patients. The rate of intravenous thrombolysis and the rate of within intravenous thrombolysis window time were also lower in PHOTAR patients (both P<0.001). PHOTAR groups also tended to have anterior circulation infarction. Erythrocytosis and hyperhomocysteinemia were independent risk factors in PHOTAR, and here young adults accounted for a larger proportion of stroke cases. Conclusion:﻿ In Tibet, the average age of AIS patients were less, and anterior circulation infarctions were also more common. Erythrocytosis and hyperhomocysteinemia may contribute to these differences. Here young adult stroke also accounted for a higher proportion, and this may be associated with erythrocytosis. Our findings present the first hospital-based comparative study in Tibet and may contribute to policies for stroke prevention in this region.
“One-stop shop”: Safety and efficacy of combining atrial septal defect occlusion and left atrial appendage closure for patients with atrial septal defect and atrial fibrillation.
Authors: zhihui zhang , qing yao , haiyun Huang , ping zhu , xiang xu , zhiyuan Song , huakang Li
Published: August 2020

Background: One-stop occlusion, which is defined as the combination of atrial septal defect [ASD] or patent foramen ovale [PFO] occlusion and left atrial appendage [LAA] closure, in patients with ASD/PFO and atrial fibrillation (AF) has not yet been investigated systematically. This study aimed to evaluate the safety and efficacy of one-stop occlusion in the treatment of adult patients with ASD/PFO and AF.Methods: Inpatients with AF and ASD/PFO were recruited between August 2014 and April 2019. Preoperatively, transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) were conducted to identify the ASD/PFO size and margin, presence of thrombus in the LAA, and LAA orifice width and depth at 0°, 45°, 90°, and 135°. After confirmation of the indications of LAA closure (LAAC) and ASD/PFO occlusion, the procedures were performed simultaneously under general anesthesia. Oral anticoagulants were administered for 45-60 days, followed with regular evaluation of TTE and TEE.Results: Forty-nine patients (age, 65.6±9.6 years) were recruited in this study, including 24 patients with ASD and 25 patients with PFO. They were treated with LAAC and ASD/PFO occlusion successfully. The mean ASD size and mean diameter of the ASD occluders were 14.2±7.7 and 25.4±8.5 mm, respectively. The mean PFO size was 3.5±0.4 mm. The mean maximal LAA orifice width and depth were 20.5±3.4 and 28.3±3.6 mm, respectively. All patients were implanted with a Watchman device (diameter, 27.1±2.9 mm). Postoperatively, all patients took anticoagulants orally for 45-60 days, and their mean postoperative follow-up duration was 29.0±12.1 months. Postoperative TEE showed that all had normal positioning of the LAA and ASD/PFO occluders. At 45-60 days after operation, TEE showed that the LAA and ASD/PFO occluder were in the normal position; however, two patients who took warfarin and novel oral anticoagulants, respectively, have developed occluder thrombosis. After adjusted anticoagulant therapy, TEE showed that the thrombus disappeared at 6 months after operation.Conclusion: One-stop occlusion is safe and effective for the treatment of adult patients with ASD/PFO and AF. It is also feasible to administer warfarin or novel oral anticoagulants after operation.
Preoperative identification of clinicopathological prognostic factors for relapse-free survival in clinical N1 non-small cell lung cancer: A retrospective single center-based study
Authors: Aragaki Masato , Kato Tatsuya , Fujiwara-Kuroda Aki , Hida Yasuhiro , Kaga Kichizo , Wakasa Satoru
Published: August 2020

Background: Given the difficulty in preoperatively diagnosing lymph node metastasis, patients with Stage I–III non-small cell lung cancer (NSCLC) are likely to be included in the clinical N1 (cN1) group. However, better treatment options might be selected through further stratification. This study aimed to identify preoperative clinicopathological prognostic and stratification factors for patients with cN1 NSCLC. Methods: This retrospective study evaluated 60 patients who were diagnosed with NSCLC during 2004–2014. Clinical nodal status had been evaluated using routine chest computed tomography (CT) and/or positron emission tomography (PET). To avoid biasing the fluorodeoxyglucose uptake values based on inter-institution or inter-model differences, we used only two PET systems (one PET system and one PET/CT system). Relapse-free survival (RFS) and overall survival (OS) were the primary study outcomes. The maximum standardized uptake value (SUVmax) was calculated for each tumor and categorized as low or high based on the median value. Patient sex, age, histology, tumor size, and tumor markers were also assessed. Results: Poor OS was associated with older age (P = 0.0159) and high SUVmax values (P = 0.0142). Poor RFS was associated with positive carcinoembryonic antigen (CEA) expression (P = 0.0035) and high SUVmax values (P = 0.015). Multivariate analyses confirmed that poor OS was independently predicted by older age (hazard ratio [HR] = 2.751, confidence interval [CI]: 1.300–5.822; P = 0.0081) and high SUVmax values (HR = 5.121, 95% CI: 1.759–14.910; P = 0.0027). Furthermore, poor RFS was independently predicted by positive CEA expression (HR = 2.376, 95% CI: 1.056–5.348; P = 0.0366) and high SUVmax values (HR = 2.789, 95% CI: 1.042–7.458; P = 0.0410). The primary tumor’s SUVmax value was also an independent prognostic factor for both OS and RFS. Conclusions: For patients with cN1 NSCLC, preoperative prognosis and stratification might be performed based on CEA expression, age, and the primary tumor’s SUVmax value. To enhance the prognostic value of the primary tumor’s SUVmax value, minimizing bias between facilities and models could lead to a more accurate prognostication.
Relationship of T1 Slope with sagittal alignment parameters of the upper and subaxial cervical spine in patients with cervical lordotic and kyphotic curvature
Authors: Sun Dong , Liu Peng , Wang Zhaolin , Cheng Jie , Mou Jianhui , Wang Yipeng , Tian Fenghua , Liu Shuang , Bao Hongmei , Sun Na
Published: August 2020

Background: To identify the relationship between T1 slope and the sagittal alignment parameters of the upper and subaxial cervical spine in patients with cervical lordosis and kyphosis.Methods: Relevant sagittal radiographic parameters pertaining to patients with non-specific neck pain but with no associated neurogenic symptoms were retrospectively analyzed. Patients were categorized into lordotic alignment and kyphotic alignment groups based on the C2-C7 Cobb. Correlation among radiographic variables was assessed with the Pearson correlation coefficient and linear regression analysis. Between-group differences with respect to cervical alignment parameters were assessed with One-way Analysis of Variance.Results: Intra-observer and inter-observer agreement (two independent observers) was rated as excellent (kappa: 0.91 - 0.93). Inter-observer agreement for the two independent observers was rated as and substantial (kappa: 0.79 - 0.80), respectively. Significant between-group differences were observed with respect to C0-C1 angle, C1-C2 angle, C0-C2 angle, C2-C7 SVA (sagittal vertical axis) and TS-CL (T1 slope minus cervical lordosis) (P<0.01 for all), but not with respect to T1S (T1 slope) (P=0.367). In both groups, C2-C7 SVA showed a significant linear correlation with T1S (r2=0.712 vs. r2=0.467) and TS-CL (r2=0.810 vs. r2=0.248).Conclusion: This study showed that the two cervical alignment types (lordosis and kyphosis) have different angular variation in upper and subaxial cervical spine. With the increase in T1 slope, the upper cervical C0-C2 Cobb angle and the C2-7 SVA in the lordotic group were significantly higher than that of the kyphotic group. TS-CL mismatch may significantly impact lordotic cervical alignment in patients with lordosis.
A Web Based Dynamic MANA Nomogram for Predicting the Malignant Cerebral Edema in patients with large hemispheric infarction
Authors: Sun Wenzhe , Li Guo , Song Yang , Zhu Zhou , Yang Zhaoxia , Chen Yuxi , Miao Jinfeng , Song Xiaoyan , Lan Yan , Qiu Xiuli , Zhu suiqiang , Fan Yebin
Published: August 2020

Background: For large hemispheric infarction (LHI), malignant cerebral edema (MCE) is a life-threatening complication with a mortality rate approaching 80%. Establishing a convenient prediction model of MCE after LHI is vital for the rapid identification of high-risk patients as well as for a better understanding of the potential mechanism underlying MCE.Methods: 142 consecutive patients with LHI within 24h of onset from January 1, 2016 to August 31, 2019 were retrospectively collected. MCE was defined as patient death or received decompressive hemicraniectomy (DHC) with obvious mass effect (≥ 5mm midline shift or Basal cistern effacement). Binary logistic regression was performed to identify independent predictors of MCE. Independent prognostic factors were incorporated to build a dynamic nomogram for MCE prediction. Results: After adjustment for confounders, four independent factors were identified, including previously known atrial fibrillation (KAF), midline shift (MLS), National Institutes of Health Stroke Scale (NIHSS) and anterior cerebral artery (ACA) territory involvement. To facilitate the use of nomogram for clinicians, we use “Dynnom” package to build dynamic MANA (acronym for MLS, ACA territory involvement, NIHSS and KAF) nomogram on web page (http://www.MANA-nom.com) to calculate the exact probability of developing MCE. The c-statistic of MANA nomogram was up to 0.887 ± 0.041 and AUC-ROC value in this cohort was 0.887 (95%CI, 0.828~0.934).Conclusions: Independent predictors of MCE included KAF, MLS, NIHSS, and ACA territory involvement. The dynamic MANA nomogram is a convenient, practical and effective clinical decision-making tool for predicting MCE after LHI in Chinese patients.
A Novel Method of Constrained Feature Selection by the Measurement of Pairwise Constraints Uncertainty
Authors: Berahmand Kamal , Rostami Mehrdad , Forouzandeh Saman
Published: August 2020

In the past decades, the rapid growth of computer and database technologies has led to the rapid growth of large-scale datasets. On the other hand, data mining applications with high dimensional datasets that require high speed and accuracy are rapidly increasing. Semi-supervised learning is a class of machine learning in which unlabeled data and labeled data are used simultaneously to improve feature selection. The goal of feature selection over partially labeled data (semi-supervised feature selection) is to choose a subset of available features with the lowest redundancy with each other and the highest relevancy to the target class, which is the same objective as the feature selection over entirely labeled data. This method actually used the classification to reduce ambiguity in the range of values. First, the similarity values of each pair are collected, and then these values are divided into intervals, and the average of each interval is determined. In the next step, for each interval, the number of pairs in this range is counted. Finally, by using the strength and similarity matrices, a new constraint feature selection ranking is proposed. The performance of the presented method was compared to the performance of the state-of-the-art, and well-known semi-supervised feature selection approaches on eight datasets. The results indicate that the proposed approach improves previous related approaches with respect to the accuracy of the constrained score. In particular, the numerical results showed that the presented approach improved the classification accuracy by about 3% and reduced the number of selected features by 1%. Consequently, it can be said that the proposed method has reduced the computational complexity of the machine learning algorithm despite increasing the classification accuracy.
UBA2 Activates Wnt/ β-catenin Signaling Pathway during Protection of R28 Retinal Precursor Cells from Hypoxia by Extracellular Vesicles derived from Placental Mesenchymal Stem Cells
Authors: Koh Kyungmin , Park Mira , Bae Eun Soo , Duong Van-An , Park Jong-Moon , Lee Hookeun , Lew Helen
Published: August 2020

Background: Stem cell transplantation has been proposed as an alternative treatment for intractable optic nerve disorders characterized by irrecoverable loss of cells. Mesenchymal stem cells, with varying tissue regeneration and recovery capabilities, are being considered for potential cell therapies. To overcome the limitations of cell therapy, we isolated exosomes from human placenta–derived mesenchymal stem cells (hPMSCs), and investigated their therapeutic effects in R28 cells (retinal precursor cells) exposed to CoCl2. Method: After nine hours of exposure to CoCl2, the hypoxic damaged R28 cells were divided into non treatment group (CoCl2+R28 cells) and treatment group (CoCl2+R28 cells treated with exosome). Immunoblot analysis was performed for Pcna, Hif-1α, Vegf, Vimentin, Thy-1, Gap43, Ermn, Neuroflament, Wnt3a, β-catenin, phospo-GSK3β, Lef-1, UBA2, Skp1, βTrcp, and ubiquitin. The proteomes of each group were analyzed by liquid chromatography/tandem mass (LC-MS/MS) spectrometry. Differentially expressed proteins (DEPs) were detected by label-free quantification and the interactions of the proteins were examined through signal transduction pathway and gene ontology analysis. Result: We observed that Exosome could significantly recover proliferation damaged by CoCl2 treatment. In addition, treatment group presented the decreased expression of Hif-1α protein (P < 0.05) and increased expression of proliferation marker, Pcna, and nerve regeneration–related factors such as Vimentin, Thy-1 and Neuroflament (P < 0.05) compared with non-treatment group. In total, 200 DEPs were identified in non-treatment group and treatment group (fold change ≥ 2, p < 0.05). Catenin and ubiquitin systems (UBA2, UBE2E3, UBE2I) were found in both the DEP lists of downregulated proteins from non-treatment group and upregulated proteins from treatment group. The mRNA expressions of ubiquitin systems were significantly decreased under hypoxic condition. Moreover, UBA2 and Wnt/β-catenin protein were associated with rescue of the hypoxic damaged R28 cells. Using a siRNA system, we could find it out that hPMSC exosoms could not repair altered expressions of target proteins by CoCl2 in lacking UBA2 R28 cells. Conclusion: This study reported that hypoxic damaged expression of regeneration markers in R28 cells were significantly recovered by hPMSC exosomes. We could also demonstrate that UBA2 played a key role in activating the Wnt/β-catenin signaling pathway during protection of hypoxic damaged R28 cells, induced by hPMSC exosomes.
In vitro propagation of three mosaic disease resistant cassava cultivars
Authors: SESSOU Amitchihoué Franck , Kahia Jane W. , Houngue Jerome Anani , Ateka Elijah Miinda , Dadjo Colombe , Ahanhanzo Corneille
Published: August 2020

Background Cassava is a staple food for over 800 million people globally providing a cheap source of carbohydrate. However, the cultivation of cassava in the country is facing to viral diseases, particularly cassava mosaic disease (CMD) which can cause up to 95% yield losses. With aim to supply farmers demand for clean planting materials, there is need to accelerate the production of the elite cultivars by use of tissue culture in order to cope with the demand.Methods Nodal explants harvested from the greenhouse grown plants were sterilised using different concentrations of a commercial bleach JIK (3.85% NaOCl) and varying time intervals. Microshoots induction was evaluated using thidiazuron (TDZ), benzyl amino purine (BAP), and kinetin. Rooting was evaluated using different auxins (Naphthalene acetic acid NAA and Indole-3-butyricacid IBA). PCR-based SSR and SCAR markers were used to verify the presence of CMD2 gene in the regenerated plantlets.Results The highest level of sterility in explants (90%) was obtained when 20% Jik was used for 15 minutes. The best cytokinin for microshoots regeneration was found to be kinetin with optimum concentrations of 5, 10 and 20 µM for Agric-rouge, Atinwewe, and Agblehoundo respectively. Medium without growth regulators was the best for rooting the three cultivars. A survival rate of 100%, 98%, and 98% was recorded in the greenhouse for Agric-rouge, Atinwewe, and Agblehoundo respectively and the plantlets appeared to be morphologically normal. The SSR and SCAR analysis of micropropagated plants showed a profile similar to that of the mother plants indicating that the regenerated plantlets retained the CMD2 gene after passing through in vitro culture, as expected with micropropagation.Conclusion The nodal explants was established to be 20% of Jik (3.85% NaOCl) with an exposure time of 15 minutes. Kinetin was proved to be the best cytokinins for microshoot formation with the optimum concentration of 5, 10 and 20µM for Agric-rouge, Atinwewe, and Agblehoundo respectively. The protocol developed during this study will be useful for mass propagation of the elite cassava cultivars.
Low Resolution Face Recognition Using Generative Adversarial Network (Gan)
Authors: Martin Howard , - Suharjito
Published: August 2020

Although face recognition system has achieved a very good performance in the past years, but Low Resolution Face Recognition (LRFR) is still challenging because low resolution image would decrease the accuracy. This research aimed to solved and get the best SR method to solved LRFR problem. YTF dataset used for fine tuning SR methods. While LFW dataset used for fine tuning and evaluating FaceNet model. The images would be increased using Res-Net GAN and RRDB GAN. Then the images would be recognized using FaceNet. The images that had been increased by RRDB GAN reached the highest accuracy 98.96 %.
Self-Reported Morbidities, Nutritional Characteristics, and Associated Factors in Institutionalized and Non-Institutionalized Elderly
Authors: ABDELHAFID BENKSIM , Rachid Ait Addi , elhassania khalloufi , Aziz Habibi , Mohammed Cherkaoui
Published: August 2020

Background: Older people make up a large part of the world's population and their numbers are expected to increase significantly by 2030. The objective of this study is to determine socio-economic, health and nutritional characteristics of institutionalized and non-institutionalized elders in the province of Marrakech.Methods: This cross-sectional study was conducted among 368 participants in Marrakech province between March 2017 and June 2019 through a face-to-face interview. Of all participants, 180 elders are residing in public institutions and 188 at home. Face-to-face interviews provided information on socioeconomic and health characteristics. Results: Institutionalized elders were illiterate (80.0%), had low incomes (95.5%), and unmarried (73.3%).They reported less children (1.52±2.35) and no health insurance (98.9%). Institutional residents suffered from malnutrition (22.2%), hearing impairments (35.6%) and severe edentulism (43.3%). There was no significant difference between both groups on daily activities and depression. A multivariate analysis identified a model with three significant variables associated with non-institutionalized elders: health insurance (P=0.001; OR=107.49), number of children (P=0.001; OR=1.74) and nutritional status (p=0.001; OR=3853). The data were analyzed by using SPSS version 16.0. Statistical significance was set at p<0.05.Conclusions: This study shows that the institutionalization of the elderly is considerably induced by various factors such as nutritional problems, lack of health insurance and family structure. To mitigate the effects of this phenomenon, home care strategies and preventive actions should be carried out to delay the referral of the elderly to institutions and to keep them socially active
Metabolomic analysis of serum and placenta in preeclampsia
Authors: Dong Ying , Liu Xiaowei , Zhao Shenglong , Zheng Yuanyuan , Li Chunbo , Si Dandan , Chen Jinmei , Wang Jing , Chen Lu , Hu Siqi , Liu Jingrui , Tang Guodong , Lu Yifan , Yue Xiaofei , Zhao Zhen , Zhai Yanhong , Cao Zheng
Published: August 2020

Background: Preeclampsia (PE) is one of the main causes of maternal and fetal morbidity and mortality worldwide. This study was aimed to explore the potential metabolic alterations in women diagnosed with PE and reveal the underlying pathogenesis of disease.Methods: Healthy pregnant women and patients diagnosed with PE were recruited from August 2017 to February 2018. The metabolomic analysis of serum (n=90) and placenta (n=9) samples collected from the two groups were performed with the high performance liquid chromatography coupled with quadrupole-time-of light mass spectrometry (HPLC-QTOF-MS).Results: In serum, 16 metabolites that were present in different concentrations between the two groups were identified, of which pyroglutamic acid (pGlu), methionine, glutamine and taurocholic acid may be used as potential PE diagnosis biomarkers with the area under ROC curve of 0.901, 0.909, 0.892 and 0.873 respectively. Furthermore, the metabolic pathways analysis with differential metabolites in serum and placenta samples showed that linoleic acid and alpha- linolenic acid metabolism, phenylalanine, tyrosine and tryptophan biosynthesis, D-glutamine/D-glutamate metabolism, phenylalanine metabolism, glutathione (GSH) metabolism and tryptophan metabolism were significantly altered and might be involved in PE pathogenesis.Conclusions: These results showed the altered metabolic pathways could contribute to the pathophysiologic mechanisms of PE.
Alterations in MicroRNA Gene Expression Profile in Liver Transplant Patients with Hepatocellular Carcinoma
Authors: Afshari Afsoon , Yaghobi Ramin , Karimi Mohammad hossin , Mowla Jvad
Published: August 2020

Background: HCC can lead to liver failure, rendering liver transplant. Since miRNAs can receive early evaluation before clinical symptoms are manifested, they might be detected as biomarkers of several disorders. Therefore, in the present study, alterations in miRNAs as biomarkers were detected in LT patients with HCC. Methods: Fourteen tissue samples composed of 5 rejected and 9 non-rejected ones were used for studying the microRNAs expression pattern by LNA-array probe. The result was evaluated by qRT-PCR on 30 other tissue samples composed of 10 rejected and 20 non-rejected ones for the selected miRNAs. All samples were collected from liver transplanted patients with HCC.Results: The study results revealed that in rejected patients compared to non-rejected ones, hsa-miR-3158-5p, -4449, -4511, and -4633-5p were up-regulated and hsa-miR-122-3p, -194-5p, 548as-3p, and -4284 were down-regulated.Conclusion: It was concluded that the tissue levels of specific miRNAs (especially hsa-miR-3158-5p, -4449, -194-5p and 548as-3p) correlated well with the development of HCC, which could be further studied as biomarkers.