bluuebunny/crossref_metadata_2025 huggingface dataset:
Periconceptional stressors and social support and risk for adverse birth outcomes
Authors: Weber Kari A. , Carmichael Suzan L. , Yang Wei , Tinker Sarah C. , Shaw Gary M. ,   National Birth Defects Prevention Study
Published: August 2020

Background

The prevalence of preterm birth and low birth weight has been increasing slightly in recent years. A few studies have suggested that psychosocial stress during pregnancy may increase risk for these adverse birth outcomes. To extend those observations, we analyzed various major life event stressors separately and cumulatively as potential risk factors for preterm birth and low birth weight using granular categories of each outcome in a large, population-based study. Additionally, we assessed if greater social support buffered any effects.

Methods

Data were from a nested prevalence study of 4395 women in the National Birth Defects Prevention Study who delivered live-born non-malformed infants (controls) between 2006 and 2011. Participants completed a standardized, computer-assisted interview between 6 weeks and 24 months after delivery that included questions on stress and social support from 3 months before pregnancy to the 3rd month of pregnancy. Cumulative stress and support indices were also calculated. Preterm birth was divided into “early preterm” (< 32 weeks), “late preterm” (32–36 weeks) and “term.” Low birthweight was divided into “very low birth weight” (< 1500 g), “low birth weight” (1500–2499 g) and “normal birth weight” (≥2500 g). Relative risks and 95% confidence intervals (95% CI) were calculated using Poisson regression.

Results

For women reporting relationship difficulties, there was a suggestive risk of early preterm birth (RR: 1.9, 95%CI: 0.9–3.9) and very low birthweight (RR: 2.0, 95%CI: 0.9–4.4). For women reporting that they or someone close to them were victims of abuse, violence, or crime, there was an increased risk of low birthweight (RR: 1.8, 95%CI: 1.1–2.7) and late preterm birth (RR: 1.5, 95%CI: 1.0–2.2). There were no strong associations observed between social support questions and the various outcomes.

Conclusions

Our results add some support to prior evidence that certain stressors may be associated with increase selected adverse birth outcomes risk. We did not find strong evidence that social support buffered the observed risks in our study.
Effectiveness of the AJCC 8th edition staging system for selecting patients with T1–2N1 breast cancer for post-mastectomy radiotherapy: a joint analysis of 1986 patients from two institutions
Authors: Wang Shulian , Wen Ge , Tang Yu , Yang Yong , Jing Hao , Wang Jianyang , Zhang Jianghu , Zhao Xuran , Sun Guangyi , Jin Jing , Song Yongwen , Liu Yueping , Fang Hui , Zhang Yujing , Li Yexiong
Published: August 2020

Background

The role of post-mastectomy radiotherapy (PMRT) in the treatment of patients with T1–2N1 breast cancer is controversial. This study’s purpose was to evaluate the risk of recurrence of T1–2N1 breast cancer and the efficacy of PMRT in low-, medium- and high-risk groups of patients.

Methods

Post-mastectomy patients with T1–2N1 breast cancer were restaged according to the American Joint Committee on Cancer Staging Manual, 8th edition (AJCC 8th ed.) staging system. Recurrence scores were generated using prognostic factors identified for loco-regional recurrence and distant metastasis in patients without PMRT, and three risk groups were identified. Rates of loco-regional recurrence and distant metastasis were calculated with a competing risk model and compared using Gray’s test. Disease-free survival and overall survival were calculated using the Kaplan-Meier method and compared using the log-rank test. The Cox proportional hazards regression model was used for the multivariate analysis.

Results

Data from 1986 patients (1521without PMRT; 465 with PMRT) were analyzed. Patients without PMRT were stratified into low-, intermediate- and high-risk groups by age, tumor location, AJCC 8th ed. stage, number of positive nodes and lympho-vascular invasion. The 5-year loco-regional recurrence rate and distant metastasis rates for the three risk groups were significant at 2.5, 5.4 and 16.2% (p <  0.001) respectively, and 4.9, 8.4 and 18.6% (p <  0.001) respectively. In the high-risk group, loco-regional recurrence (p <  0.001), and distant metastasis (p = 0.044) were significantly reduced, and disease free survival (p = 0.004), and overall survival (p = 0.029) were significantly improved after PMRT. In the low- and intermediate-risk groups, PMRT had no significant effect on loco-regional recurrence (p = 0.268), distant metastasis (p = 0.252), disease free survival (p = 0.608) or overall survival (p = 0.986).

Conclusion

Our results showed no benefits of PMRT in the low-risk group, and thus, omitting PMRT radiotherapy in this population could be considered.
Monitoring and evaluation of breast cancer screening programmes: selecting candidate performance indicators
Authors: Muratov Sergei , Canelo-Aybar Carlos , Tarride Jean-Eric , Alonso-Coello Pablo , Dimitrova Nadya , Borisch Bettina , Castells Xavier , Duffy Stephen W. , Fitzpatrick Patricia , Follmann Markus , Giordano Livia , Hofvind Solveig , Lebeau Annette , Quinn Cecily , Torresin Alberto , Vialli Claudia , Siesling Sabine , Ponti Antonio , Giorgi Rossi Paolo , Schünemann Holger , Nyström Lennarth , Broeders Mireille ,   On behalf of the ECIBC contributor group, Autelitano Mariangela , Colzani Edoardo , Daneš Jan , Gräwingholt Axel , Ioannidou-Mouzaka Lydia , Knox Susan , Langendam Miranda , McGarrigle Helen , Pérez Gómez Elsa , van Engen Ruben , Warman Sue , Young Kenneth , van Landsveld-Verhoeven Cary , Lerda Donata , Saz-Parkinson Zuleika , Parmelli Elena , Janusch-Roi Annett
Published: August 2020

Background

In the scope of the European Commission Initiative on Breast Cancer (ECIBC) the Monitoring and Evaluation (M&E) subgroup was tasked to identify breast cancer screening programme (BCSP) performance indicators, including their acceptable and desirable levels, which are associated with breast cancer (BC) mortality. This paper documents the methodology used for the indicator selection.

Methods

The indicators were identified through a multi-stage process. First, a scoping review was conducted to identify existing performance indicators. Second, building on existing frameworks for making well-informed health care choices, a specific conceptual framework was developed to guide the indicator selection. Third, two group exercises including a rating and ranking survey were conducted for indicator selection using pre-determined criteria, such as: relevance, measurability, accurateness, ethics and understandability. The selected indicators were mapped onto a BC screening pathway developed by the M&E subgroup to illustrate the steps of BC screening common to all EU countries.

Results

A total of 96 indicators were identified from an initial list of 1325 indicators. After removing redundant and irrelevant indicators and adding those missing, 39 candidate indicators underwent the rating and ranking exercise. Based on the results, the M&E subgroup selected 13 indicators: screening coverage, participation rate, recall rate, breast cancer detection rate, invasive breast cancer detection rate, cancers > 20 mm, cancers ≤10 mm, lymph node status, interval cancer rate, episode sensitivity, time interval between screening and first treatment, benign open surgical biopsy rate, and mastectomy rate.

Conclusion

This systematic approach led to the identification of 13 BCSP candidate performance indicators to be further evaluated for their association with BC mortality.
Differentiating the lung lesions using Intravoxel incoherent motion diffusion-weighted imaging: a meta-analysis
Authors: Liang Jianye , Li Jing , Li Zhipeng , Meng Tiebao , Chen Jieting , Ma Weimei , Chen Shen , Li Xie , Wu Yaopan , He Ni
Published: August 2020

Background and objectives

The diagnostic performance of intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) in the differential diagnosis of pulmonary tumors remained debatable among published studies. This study aimed to pool and summary the relevant results to provide more robust evidence in this issue using a meta-analysis method.

Materials and methods

The researches regarding the differential diagnosis of lung lesions using IVIM-DWI were systemically searched in Pubmed, Embase, Web of science and Wangfang database without time limitation. Review Manager 5.3 was used to calculate the standardized mean difference (SMD) and 95% confidence intervals of apparent diffusion coefficient (ADC), tissue diffusivity (D), pseudo-diffusivity (D*), and perfusion fraction (f). Stata 12.0 was used to pool the sensitivity, specificity, and area under the curve (AUC), as well as publication bias and heterogeneity. Fagan’s nomogram was used to predict the post-test probabilities.

Results

Eleven studies with 481 malignant and 258 benign lung lesions were included. Most include studies showed a low to unclear risk of bias and low concerns regarding applicability. Lung cancer demonstrated a significant lower ADC (SMD = -1.17, P < 0.001), D (SMD = -1.02, P < 0.001) and f values (SMD = -0.43, P = 0.005) than benign lesions, except D* value (SMD = 0.01, P = 0.96). D value demonstrated the best diagnostic performance (sensitivity = 89%, specificity = 71%, AUC = 0.90) and highest post-test probability (57, 57, 43 and 43% for D, ADC, f and D* values) in the differential diagnosis of lung tumors, followed by ADC (sensitivity = 85%, specificity = 72%, AUC = 0.86), f (sensitivity = 71%, specificity = 61%, AUC = 0.71) and D* values (sensitivity = 70%, specificity = 60%, AUC = 0.66).

Conclusion

IVIM-DWI parameters show potentially strong diagnostic capabilities in the differential diagnosis of lung tumors based on the tumor cellularity and perfusion characteristics, and D value demonstrated better diagnostic performance compared to mono-exponential ADC.
Plasma fibroblast skin tightening treatment resulting in bilateral chemical eye injury secondary to EMLA cream: a case report
Authors: Patel Sirjhun , Shamdas Mohith , Cobb Caroline
Published: August 2020

Background

Plasma fibroblast skin tightening treatment is a relatively novel and growing minimally invasive aesthetic skin procedure. The treatment claims to rejuvenate skin by improving facial lines, wrinkles and skin pigmentation associated with photo-ageing. The skin is often anaesthetised prior to the procedure with topical creams such as EMLA (Eutectic mixture of local anaesthetics). We present the first case of bilateral chemical eye injury following plasma fibroblast skin tightening treatment secondary to EMLA cream. EMLA cream was inadvertently administered to both eyes in preparation for the treatment.

Case presentation

A patient was referred from the emergency department to a tertiary ophthalmology centre with bilateral exquisite eye pain, inability to open the eyes, photosensitivity and reduced vision. She underwent cosmetic plasma fibroblast skin tightening treatment at her local salon four hours earlier. She was found to have bilateral alkali chemical eye injuries with significant diffuse corneal epithelial loss. The injury was thought to be caused by inadvertent ocular exposure to EMLA cream, which was used in preparation for the plasma fibroblast skin tightening treatment. She was treated with topical antibiotics and achieved satisfactory recovery.

Conclusion

This case report highlights a possible complication following plasma fibroblast skin tightening treatment. We lay emphasis on the importance identifying chemical injury and recommend that medication attention should be sought if there is any concern.
Careful conversations: an educational video to support parents in communicating about weight with their children
Authors: Klupt Kody A. , Oreskovich Stephan M. , Bernard-Genest Julie , Patel Barkha P. , Chu Lisa , Dettmer Elizabeth , Walsh Catharine M. , Strom Michele , McPherson Amy C. , Strub Jonah , Steinberg Alissa , Steinegger Cathleen , Hamilton Jill K.
Published: August 2020

Background

Parents may struggle to initiate healthy weight-related conversations with their children. Educational videos may be an effective tool for improving parents’ knowledge and self-efficacy on this topic. The aim of this pilot study was to develop an educational video to assist parents in weight-related conversations with their child, and to assess changes in parents’ self-efficacy on this topic.

Methods

Video development was based on a scoping review and semi-structured interviews with parents. Respondent demographics and user satisfaction were assessed at pre- and post- video, and 4–6 months later. Self-efficacy scores were compared between parent groups based on weight concerns over time.

Results

Fifty-seven parents participated in the video questionnaires, and 40 repeated measures 4–6 months later. Significant improvements in self-efficacy in “raising the issue of weight” and “answering questions or concerns” were found after watching the video (p ≤ 0.002) compared to baseline, and scores 4–6 months post baseline remained slightly elevated, but non-significant. Parents with concerns about their child being overweight had significantly lower perceived self-efficacy scores compared to parents with no concerns about their child’s weight (p = 0.031). The video was found to be positively received and of relevance to parents across a number of different domains.

Conclusion(s)

Preliminary findings suggest an educational video about initiating weight-related conversations may be an effective tool for increasing parents’ perceived self-efficacy in the short term. Further work is needed to validate findings in a randomized controlled trial, and with diverse parent populations.

Trial registration

ClinicalTrials.govIdentifier:NCT03664492. Registered 10 September 2018 – Retrospectively registered
Community-based cluster randomized controlled trial: empowering households to identify and provide appropriate care for low-birthweight newborns in Nepal
Authors: Hodgins Stephen , Rajbhandari Binamra , Joshi Deepak , Ban Bharat , Khatry Subarna , Mullany Luke C.
Published: August 2020

Background

Most newborn deaths occur among those of low birthweight (LBWt), due to prematurity &/or impaired fetal growth. Simple practices can substantially mitigate this risk. In low-income country settings where many births occur at home, strategies are needed that empower mothers to determine if their babies are at higher risk and, if so, to take measures to reduce risk. Earlier studies suggest that foot-length may be a good proxy for birthweight. An earlier Nepal study found a 6.9 cm cut-off performed relatively well, differentiating normal from low birthweight.

Methods

Community-based, cluster-randomized controlled trial. Objective: to determine whether family-administered screening, associated with targeted messages improves care practices known to mitigate LBWt-associated risks. Participants: women participating in a parent trial in rural Nepal, recruited late in pregnancy. Women were given a 6.9 cm card to assess whether the baby’s foot is small; if so, to call a number on the card for advice. Follow-up visits were made over the 2 weeks following the birth, assessing for 2 behavioral outcomes: reported skin-to-skin thermal care, and care-seeking outside the home; assessed restricting to low birthweight (using 2 cutoffs: 2500 g and 2000 g). Randomization: 17 clusters intervention, 17 control.

The study also documented performance along the presumed causal chain from intervention through behavioral impact.

Results

2022 intervention, 2432 control. Intervention arm: 519 had birthweight < 2500 g (vs. 663 among controls), of which 503 were available for analysis (vs. 649 among controls). No significant difference found on care-seeking; for those < 2500 g RR 1.13 (95%CI: 0.97–1.131). A higher proportion of those in the intervention arm reported skin-to-skin thermal care than among controls; for those < 2500 g RR 2.50 (95%CI: 2.01–3.1). However, process measures suggest this apparent effect cannot be attributed to the intervention; the card performed poorly as a proxy for LBWt, misclassifying 84.5% of those < 2000 as normal weight.

Conclusions

Although the trial found an apparent effect on one of the behavioral outcomes, this cannot be attributed to the intervention; most likely it was a result of pure chance. Other approaches are needed for identifying small, at-risk babies in such settings, and targeting them for appropriate care messaging.

Trial registration

ClinicalTrials.gov NCT02802332, registered 6/16/2016.
Bacteria drug resistance profile affects knee and hip periprosthetic joint infection outcome with debridement, antibiotics and implant retention
Authors: Rudelli Bruno Alves , Giglio Pedro Nogueira , de Carvalho Vladimir Cordeiro , Pécora José Ricardo , Gurgel Henrique Melo Campos , Gobbi Ricardo Gomes , Vicente José Riccardo Negreiros , Lima Ana Lucia Lei Munhoz , Helito Camilo Partezani
Published: August 2020

Background

Evaluate the effect of bacteria drug resistance profile on the success rates of debridement, antibiotics and implant retention.

Methods

All early acute periprosthetic infections in hip and knee arthroplasties treated with DAIR at our institution over the period from 2011 to 2015 were retrospectively analyzed. The success rate was evaluated according to the type of organism identified in culture: multidrug-sensitive (MSB), methicillin-resistant Staphylococcus aureus (MRSA), multidrug-resistant Gram-negative bacteria (MRB) and according to other risk factors for treatment failure. The data were analyzed using univariate and multivariate statistics.

Results

Fifty-seven patients were analyzed; there were 37 in the multidrug-sensitive bacteria (MSB) group, 11 in the methicillin-resistant Staphylococcus aureus (MRSA) group and 9 in the other multidrug-resistant Gram-negative bacteria (MRB) group. There was a statistically significant difference (p < 0.05) in the treatment failure rate among the three groups: 8.3% for the MSB group, 18.2% for the MRSA group and 55.6% for the MRB group (p = 0.005). Among the other risk factors for treatment failure, the presence of inflammatory arthritis presented a failure rate of 45.1 (p < 0.05).

Conclusion

DAIR showed a good success rate in cases of early acute infection by multidrug-sensitive bacteria. In the presence of infection by multidrug-resistant bacteria or association with rheumatic diseases the treatment failure rate was higher and other surgical options should be considered in this specific population. The MRSA group showed intermediate results between MSB and MRB and should be carefully evaluated.
Cherubism as a systemic skeletal disease: evidence from an aggressive case
Authors: Morice Anne , Joly Aline , Ricquebourg Manon , Maruani Gérard , Durand Emmanuel , Galmiche Louise , Amiel Jeanne , Vial Yoann , Cavé Hélène , Belhous Kahina , Piketty Marie , Cohen-Solal Martine , Berdal Ariane , Collet Corinne , Picard Arnaud , Coudert Amelie E. , Kadlub Natacha
Published: August 2020

Background

Cherubism is a rare autosomal dominant genetic condition caused by mutations in theSH3BP2gene. This disease is characterized by osteolysis of the jaws, with the bone replaced by soft tissue rich in fibroblasts and multinuclear giant cells. SH3BP2 is a ubiquitous adaptor protein yet the consequences of SH3BP2 mutation have so far been described as impacting only face. Cherubism mouse models have been generated and unlike human patients, the knock-in mice exhibit systemic bone loss together with a systemic inflammation.

Case presentation

In light of these observations, we decided to search for a systemic cherubism phenotype in a 6-year-old girl with an aggressive cherubism. We report here the first case of cherubism with systemic manifestations. Bone densitometry showed low overall bone density (total body Z-score = − 4.6 SD). Several markers of bone remodelling (CTx, BALP, P1NP) as well as inflammation (TNFα and IL-1) were elevated. A causative second-site mutation in other genes known to influence bone density was ruled out by sequencing a panel of such genes.

Conclusions

If this systemic skeletal cherubism phenotype should be confirmed, it would simplify the treatment of severe cherubism patients and allay reservations about applying a systemic treatment such as those recently published (tacrolimus or imatinib) to a disease heretofore believed to be localised to the jaws.
Examination and diagnosis of electronic patient records and their associated ethics: a scoping literature review
Authors: Jacquemard Tim , Doherty Colin P. , Fitzsimons Mary B.
Published: August 2020

Background

Electronic patient record (EPR) technology is a key enabler for improvements to healthcare service and management. To ensure these improvements and the means to achieve them are socially and ethically desirable, careful consideration of the ethical implications of EPRs is indicated. The purpose of this scoping review was to map the literature related to the ethics of EPR technology. The literature review was conducted to catalogue the prevalent ethical terms, to describe the associated ethical challenges and opportunities, and to identify the actors involved. By doing so, it aimed to support the future development of ethics guidance in the EPR domain.

Methods

To identify journal articles debating the ethics of EPRs, Scopus, Web of Science, and PubMed academic databases were queried and yielded 123 eligible articles. The following inclusion criteria were applied: articles need to be in the English language; present normative arguments and not solely empirical research; include an abstract for software analysis; and discuss EPR technology.

Results

The medical specialty, type of information captured and stored in EPRs, their use and functionality varied widely across the included articles. Ethical terms extracted were categorised into clusters ‘privacy’, ‘autonomy’, ‘risk/benefit’, ‘human relationships’, and ‘responsibility’. The literature shows that EPR-related ethical concerns can have both positive and negative implications, and that a wide variety of actors with rights and/or responsibilities regarding the safe and ethical adoption of the technology are involved.

Conclusions

While there is considerable consensus in the literature regarding EPR-related ethical principles, some of the associated challenges and opportunities remain underdiscussed. For example, much of the debate is presented in a manner more in keeping with a traditional model of healthcare and fails to take account of the multidimensional ensemble of factors at play in the EPR era and the consequent need to redefine/modify ethical norms to align with a digitally-enabled health service. Similarly, the academic discussion focuses predominantly on bioethical values. However, approaches from digital ethics may also be helpful to identify and deliberate about current and emerging EPR-related ethical concerns.
Identification of risk factors for patients with diabetes: diabetic polyneuropathy case study
Authors: Metsker Oleg , Magoev Kirill , Yakovlev Alexey , Yanishevskiy Stanislav , Kopanitsa Georgy , Kovalchuk Sergey , Krzhizhanovskaya Valeria V.
Published: August 2020

Background

Methods of data mining and analytics can be efficiently applied in medicine to develop models that use patient-specific data to predict the development of diabetic polyneuropathy. However, there is room for improvement in the accuracy of predictive models. Existing studies of diabetes polyneuropathy considered a limited number of predictors in one study to enable a comparison of efficiency of different machine learning methods with different predictors to find the most efficient one. The purpose of this study is the implementation of machine learning methods for identifying the risk of diabetes polyneuropathy based on structured electronic medical records collected in databases of medical information systems.

Methods

For the purposes of our study, we developed a structured procedure for predictive modelling, which includes data extraction and preprocessing, model adjustment and performance assessment, selection of the best models and interpretation of results. The dataset contained a total number of 238,590 laboratory records. Each record 27 laboratory tests, age, gender and presence of retinopathy or nephropathy). The records included information about 5846 patients with diabetes. Diagnosis served as a source of information about the target class values for classification.

Results

It was discovered that inclusion of two expressions, namely “nephropathy” and “retinopathy” allows to increase the performance, achieving up to 79.82% precision, 81.52% recall, 80.64% F1 score, 82.61% accuracy, and 89.88% AUC using the neural network classifier. Additionally, different models showed different results in terms of interpretation significance: random forest confirmed that the most important risk factor for polyneuropathy is the increased neutrophil level, meaning the presence of inflammation in the body. Linear models showed linear dependencies of the presence of polyneuropathy on blood glucose levels, which is confirmed by the clinical interpretation of the importance of blood glucose control.

Conclusion

Depending on whether one needs to identify pathophysiological mechanisms for one’s prospective study or identify early or late predictors, the choice of model will vary. In comparison with the previous studies, our research makes a comprehensive comparison of different decisions using a large and well-structured dataset applied to different decision support tasks.
The experiences of individuals with cervical spinal cord injury and their family during post-injury care in non-specialised and specialised units in UK
Authors: McRae Jackie , Smith Christina , Emmanuel Anton , Beeke Suzanne
Published: August 2020

Background

Individuals with acute cervical spinal cord injury require specialised interventions to ensure optimal clinical outcomes especially for respiratory, swallowing and communication impairments. This study explores the experiences of post-injury care for individuals with cervical spinal cord injury and their family members during admissions in specialised and non-specialised units in the United Kingdom.

Methods

Semi-structured interviews were undertaken with individuals with a cervical spinal cord injury and their family member, focussing on the experience of care across units. Eight people with spinal cord injury levels from C2 to C6, were interviewed in their current care settings. Six participants had family members present to support them. Interviews were audio-recorded and transcribed with data inputted into NVivo for thematic analysis.

Results

The study identified six themes from the participant interviews that highlighted different experiences of care in non-specialised and specialised settings. A number of these were related to challenges with the system, whilst others were about the personal journey of recovery. The themes were titled as: adjustment, transitions, “the golden opportunity”, “when you can’t eat”, communication, and “in the hands of the nurses and doctors”.

Conclusions

Whilst participants reported being well cared for in non-specialised units, they felt that they did not receive specialist care and this delayed their rehabilitation. Participants were dependent on healthcare professionals for information and care and at times lost hope for recovery. Staff in non-specialised units require training and guidance to help provide support for those with dysphagia and communication difficulties, as well as reassurance to patients and families whilst they wait for transfer to specialised units.
Occurrence of extended-spectrum beta-lactamase-producing Enterobacteriaceae, microbial loads, and endotoxin levels in dust from laying hen houses in Egypt
Authors: Ahmed Marwa F. E. , Ramadan Hazem , Seinige Diana , Kehrenberg Corinna , Abd El-Wahab Amr , Volkmann Nina , Kemper Nicole , Schulz Jochen
Published: August 2020

Background

Poultry houses are often highly contaminated with dust, which might contain considerable amounts of microorganisms and endotoxins. The concentrations of microorganisms and endotoxins in dust from laying hen houses in Egypt are unknown. However, to estimate the risks for birds, the environment, and people working in laying hen houses, it is important to gather information about the composition of these dusts. Here we report the microbial loads, the occurrence of antimicrobial-resistant bacteria, and endotoxin concentrations in dust samples from 28 laying hen farms in Dakahliya Governorate, Egypt, and discuss the results relevant to the literature.

Results

Pooled settled dust samples (n = 28) were analyzed for total viable counts of bacteria and fungi (CFU/g), the occurrence of extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae, Salmonella spp., and methicillin-resistant Staphylococcus aureus (MRSA), and endotoxin concentrations (ng/g). The means and standard deviations of total viable counts were 7.10 × 108 ± 2.55 × 109 CFU/g for bacteria and 5.37 × 106 ± 7.26 × 106 CFU/g for fungi. Endotoxin levels varied from 2.9 × 104 to 6.27 × 105 ng/g. None of the tested samples contained Salmonella spp. or MRSA. In contrast, by direct plating, Enterobacteriaceae were found frequently (57%; n = 16), and suspected ESBL-producing Enterobacteriaceae occurred in 21% (n = 6) of the sampled barns. Using an enrichment method, the detection of Enterobacteriaceae and suspected ESBL-producing Enterobacteriaceae increased to 20 and 16 positive barns, respectively. Taking results from both methods into account, Enterobacteriaceae and suspected ESBL-producing Enterobacteriaceae were detected in 23 barns Overall, 100 ESBL suspected isolates (Escherichia coli, n = 64; Enterobacter cloacae, n = 20; and Klebsiella pneumoniae n = 16) were identified to species level by MALDI-TOF MS. Isolates from 20 barns (71% positive barns) were confirmed as ESBL producing Enterobacteriaceae by the broth microdilution test.

Conclusions

Dust in Egyptian laying hen houses contains high concentrations of microorganisms and endotoxins, which might impair the health of birds and farmers when inhaled. Furthermore, laying hens in Egypt seem to be a reservoir for ESBL-producing Enterobacteriaceae. Thus, farmers are at risk of exposure to ESBL-producing bacteria, and colonized hens might transmit these bacteria into the food chain.
Antioxidant capacity of lipid- and water-soluble antioxidants in dogs with subclinical myxomatous mitral valve degeneration anaesthetised with propofol or sevoflurane
Authors: Tomsič Katerina , Nemec Svete Alenka , Nemec Ana , Domanjko Petrič Aleksandra , Pirman Tatjana , Rezar Vida , Vovk Tomaž , Seliškar Alenka
Published: August 2020

Background

Antioxidants located in both the hydrophilic and lipophilic compartments of plasma act as a defence system against reactive oxygen species (ROS). Excessive production of ROS during anaesthesia affects the antioxidant capacity of plasma and may result in oxidative stress. The aim of this study was to evaluate the antioxidant capacity of lipid- (ACL) and water-soluble (ACW) antioxidants in client-owned dogs diagnosed with periodontal disease and early-stage myxomatous mitral valve degeneration (MMVD) and anaesthetised for a dental procedure with propofol and sevoflurane or with propofol only.

Results

Dogs with MMVD were anaesthetised with propofol and sevoflurane (MMVD/PS, n = 8) or with propofol only (MMVD/P, n = 10). Dogs with no evidence of MMVD (PS, n = 12) were anaesthetised with propofol and sevoflurane. Blood samples for determination of ACL and ACW were collected before and 5 min, 60 min and 6 h after induction to anaesthesia. In MMVD/PS dogs, ACL was significantly higher at all sampling times when compared to PS dogs. Compared to basal values, only anaesthesia maintained with propofol significantly increased ACL at 60 min in dogs with MMVD. In MMVD/P dogs, ACW increased after induction to anaesthesia and remained elevated up to 6 h after anaesthesia. Compared to basal values, anaesthesia maintained with sevoflurane significantly increased ACW only at 60 min in both dogs with and without MMVD. The only difference between propofol and propofol/sevoflurane anaesthesia in dogs with MMVD was significantly higher ACW at 60 min after induction to anaesthesia in the propofol group.

Conclusions

Regarding antioxidant capacity, propofol could be a better choice than sevoflurane for anaesthesia of dogs with early-stage MMVD, although further studies are necessary to clarify the advantage of this antioxidant capacity.
Constructing conjugate vaccine against Salmonella Typhimurium using lipid-A free lipopolysaccharide
Authors: Chiu Tzu-Wei , Peng Chi-Jiun , Chen Ming-Cheng , Hsu Mei-Hua , Liang Yi-Hua , Chiu Cheng-Hsun , Fang Jim-Min , Lee Yuan Chuan
Published: August 2020

Background

Salmonella enterica serotype Typhimurium is a nontyphoidal and common foodborne pathogen that causes serious threat to humans. There is no licensed vaccine to prevent the nontyphoid bacterial infection caused by S. Typhimurium.

Methods

To develop conjugate vaccines, the bacterial lipid-A free lipopolysaccharide (LFPS) is prepared as the immunogen and used to synthesize the LFPS–linker–protein conjugates 6a–9b. The designed bifunctional linkers 1–5 comprising either an o-phenylenediamine or amine moiety are specifically attached to the exposed 3-deoxy-D-manno-octulosonic acid (Kdo), an α-ketoacid saccharide of LFPS, via condensation reaction or decarboxylative amidation. In addition to bovine serum albumin and ovalbumin, the S. Typhimurium flagellin (FliC) is also used as a self-adjuvanting protein carrier.

Results

The synthesized conjugate vaccines are characterized by sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE) and fast performance liquid chromatography (FPLC), and their contents of polysaccharides and protein are determined by phenol–sulfuric acid assay and bicinchoninic acid assay, respectively. Enzyme-linked immunosorbent assay (ELISA) shows that immunization of mouse with the LFPS–linker–protein vaccines at a dosage of 2.5 μg is sufficient to elicit serum immunoglobulin G (IgG) specific to S. Typhimurium lipopolysaccharide (LPS). The straight-chain amide linkers in conjugates 7a–9b do not interfere with the desired immune response. Vaccines 7a and 7b derived from either unfractionated LFPS or the high-mass portion show equal efficacy in induction of IgG antibodies. The challenge experiments are performed by oral gavage of S. Typhimurium pathogen, and vaccine 7c having FliC as the self-adjuvanting protein carrier exhibits a high vaccine efficacy of 74% with 80% mice survival rate at day 28 post the pathogen challenge.

Conclusions

This study demonstrates that lipid-A free lipopolysaccharide prepared from Gram-negative bacteria is an appropriate immunogen, in which the exposed Kdo is connected to bifunctional linkers to form conjugate vaccines. The decarboxylative amidation of Kdo is a novel and useful method to construct a relatively robust and low immunogenic straight-chain amide linkage. The vaccine efficacy is enhanced by using bacterial flagellin as the self-adjuvanting carrier protein.

Graphical abstract
Short-course Benznidazole treatment to reduce Trypanosoma cruzi parasitic load in women of reproductive age (BETTY): a non-inferiority randomized controlled trial study protocol
Authors: Cafferata María L. , Toscani María A. , Althabe Fernando , Belizán Jose M. , Bergel Eduardo , Berrueta Mabel , Capparelli Edmund V. , Ciganda Álvaro , Danesi Emmaria , Dumonteil Eric , Gibbons Luz , Gulayin Pablo E. , Herrera Claudia , Momper Jeremiah D. , Rossi Steven , Shaffer Jeffrey G. , Schijman Alejandro G. , Sosa-Estani Sergio , Stella Candela B. , Klein Karen , Buekens Pierre
Published: August 2020

Background

Retrospective observational studies suggest that transmission of Trypanosoma cruzi does not occur in treated women when pregnant later in life. The level of parasitemia is a known risk factor for congenital transmission. Benznidazole (BZN) is the drug of choice for preconceptional treatment to reduce parasitic load.

The fear of treatment-related side effects limits the implementation of the Argentine guideline recommending BZN 60d/300 mg (or equivalent) treatment of T. cruzi seropositive women during the postpartum period to prevent transmission in a future pregnancy. A short and low dose BZN treatment might reduce major side effects and increase compliance, but its efficacy to reduce T. cruzi parasitic load compared to the standard 60d/300 mg course is not yet established. Clinical trials testing alternative BZN courses among women of reproductive age are urgently needed.

Methods and design

We are proposing to perform a double-blinded, non-inferiority randomized controlled trial comparing a short low dose 30-day treatment with BZN 150 mg/day (30d/150 mg) vs. BZN 60d/300 mg. We will recruit not previously treated T. cruzi seropositive women with a live birth during the postpartum period in Argentina, randomize them at 6 months postpartum, and follow them up with the following specific aims:

Specific aim 1: to measure the effect of BZN 30d/150 mg compared to 60d/300 mg preconceptional treatment on parasitic load measured by the frequency of positive Polymerase Chain Reaction (PCR) (primary outcome) and by real-time quantitative PCR (qPCR), immediately and 10 months after treatment.

Specific aim 2: to measure the frequency of serious adverse events and/or any adverse event leading to treatment interruption.

Trial registration

ClinicalTrials.gov. Identifier: NCT03672487. Registered 14 September 2018
Lay knowledge of cervical cancer in Manhiça district, Mozambique: a qualitative study
Authors: Menendez Yara Alonso , Cambaco Olga , Mindú Carolina , Nhantumbo Hoticha , Uamusse Titos , Matsinhe Graça , Matsinhe Benigna , Manjate Rosa Marlene , Bardají Azucena , Menendez Clara , Sevene Esperança , Munguambe Khátia
Published: August 2020

Background

Mozambique has one of the highest cervical cancer incidence rates in the world. Health interventions are still being conceived solely from a non-communicable disease standpoint despite that it is also a sexual and reproductive health problem. The objective of this study was to assess the extent to which lay perceptions of cervical cancer align with biomedical knowledge from the standpoint of sexual and reproductive health.

Methods

10 focus group discussions were carried out with 10 target groups in Manhiça. The target groups were diverse in terms of age, sex, educational level and occupation. There were a total of 116 participants. The focus groups discussions were applied to obtain verbal information and trigger debates around beliefs and attitudes about cervical cancer as well as to explore notions of transmission and aetiology of the disease. The discussions were recorded for later transcription and analysis, following a combination of content and thematic analysis.

Results

Participants were familiar with the biomedical term ‘cervical cancer’ but knowledge of its aetiology and transmission was limited. Cervical cancer was readily associated to sexual transmission and sexually transmitted infections, and conceived as a ‘wound that does not heal’. The term ‘cancer’ caused confusion, as it was perceived to happen only in limbs, understood as hereditary, not transmissible and as an illness of the West.

Conclusions

Lay perceptions of cervical cancer do, to a large extent, align with biomedical ones, thus, there is common ground to frame future health interventions from a sexual and reproductive health standpoint. Some misperceptions were identified which could be reduced through social behaviour change communication initiatives.
Reliability and application of the new morphological classification system for chronic symptomatic osteoporotic thoracolumbar fracture
Authors: Hao Ding-Jun , Yang Jun-Song , Tuo Yuan , Ge Chao-Yuan , He Bao-Rong , Liu Tuan-Jiang , Huang Da-Geng , Jia Shuai-jun , Liu Peng , Zhang Jia-Nan , Du Jin-Peng
Published: August 2020

Background

We propose a new classification system for chronic symptomatic osteoporotic thoracolumbar fracture (CSOTF) based on fracture morphology. Research on CSOTF has increased in recent years; however, the lack of a standard classification system has resulted in inconvenient communication, research, and treatment. Previous CSOTF classification studies exhibit different symptoms, with none being widely accepted.

Methods

Imaging data of 368 patients with CSOTF treated at our hospital from January 2010 to June 2017 were systematically analyzed to develop a classification system. Imaging examinations included dynamic radiography, computed tomography scans, and magnetic resonance imaging. Ten investigators methodically studied the classification system grading in 40 cases on two occasions, examined 1 month apart. Kappa coefficients (κ) were calculated to determine intraobserver and interobserver reliability. Based on the radiographic characteristics, the patients were divided into 5 types, and different treatments were suggested for each type. Clinical outcome evaluation included using the visual analog score (VAS), the Oswestry disability index (ODI), and the American Spinal Injury Association (ASIA) impairment scale.

Results

The new classification system for CSOTF was divided into types I–V according to whether the CSOTF exhibited dynamic instability, spinal stenosis or kyphosis deformity. Intra- and interobserver reliability were excellent for all types (κ = 0.83 and 0.85, respectively). The VAS score and ODI of each type were significantly improved at the final follow-up compared with those before surgery. In all patients with neurological impairment, the ASIA grading after surgery was significantly improved compared with that before surgery (P < 0.001).

Conclusions

The new classification system for CSOTF demonstrated excellent reliability in this initial assessment. The treatment algorithm based on the classification can result in satisfactory improvement of clinical efficacy for the patients of CSOFT.
Incidence and risks for surgical site infection after closed tibial plateau fractures in adults treated by open reduction and internal fixation: a prospective study
Authors: Li Junyong , Zhu Yanbin , Zhao Kuo , Zhang Junzhe , Meng Hongyu , Jin Zhucheng , Ma Jiangtao , Zhang Yingze
Published: August 2020

Background

Surgical site infection (SSI) was the most common complication of tibial plateau fracture after open reduction and internal fixation (ORIF). Severe infections even required repeat surgeries, which would cause serious psychological harm to patients and increased the economic burden of treatment. In order to identify the characteristics of the SSI and to avoid the occurrence of SSI, we conducted a prospective study to investigate the incidence and independent risk factors of SSI after ORIF for closed tibial plateau fractures in adults.

Methods

This study was performed at a first-level trauma center. From October 2014 to December 2018, the study subjects were adult patients with closed fractures of the tibial plateau, all of whom underwent open reduction and internal fixation (ORIF) treatment. Finally, a total of 1108 patients were followed up. We collected patient demographics information, surgery-related variables, and indexes from preoperative laboratory examinations. Univariate and multivariate logistic analysis models were used to investigate the potential risk factors.

Results

Twenty-five patients (2.3%, 25/1108) developed SSI. A total of 15 of 25 infections (60.0%) were due to Staphylococcus aureus and 3 (12.0%) were due to MRSA. Independent risk factors of SSI identified by multivariate logistic analysis model were bone grafting: autograft (OR 6.38; 95% CI 2.155–18.886; p = 0.001) and allograft (OR 3.215; 95% CI 1.009–10.247; p = 0.048), fracture type (Schartzker V–VI) (OR 8.129; 95% CI 2.961–22.319; p < 0.001), aspartate aminotransferase (>40 U/L) (OR 5.500; 95% CI 2.191–13.807; p < 0.001), white blood cell (>10*109/L) (OR 2.498; 95% CI 1.025–6.092; p = 0.044), and anion gap (>16 mmol/L) (OR 8.194; 95% CI 1.101–60.980).

Conclusions

We should pay enough attention to patients who carried one or more of these factors at admission and adopt more reasonable treatment strategies to reduce or avoid the occurrence of SSI.
Deep learning-based ovarian cancer subtypes identification using multi-omics data
Authors: Guo Long-Yi , Wu Ai-Hua , Wang Yong-xia , Zhang Li-ping , Chai Hua , Liang Xue-Fang
Published: August 2020

Background

Identifying molecular subtypes of ovarian cancer is important. Compared to identify subtypes using single omics data, the multi-omics data analysis can utilize more information. Autoencoder has been widely used to construct lower dimensional representation for multi-omics feature integration. However, learning in the deep architectures in Autoencoder is difficult for achieving satisfied generalization performance. To solve this problem, we proposed a novel deep learning-based framework to robustly identify ovarian cancer subtypes by using denoising Autoencoder.

Results

In proposed method, the composite features of multi-omics data in the Cancer Genome Atlas were produced by denoising Autoencoder, and then the generated low-dimensional features were input into k-means for clustering. At last based on the clustering results, we built the light-weighted classification model with L1-penalized logistic regression method. Furthermore, we applied the differential expression analysis and WGCNA analysis to select target genes related to molecular subtypes. We identified 34 biomarkers and 19 KEGG pathways associated with ovarian cancer.

Conclusions

The independent test results in three GEO datasets proved the robustness of our model. The literature reviewing show 19 (56%) biomarkers and 8(42.1%) KEGG pathways identified based on the classification subtypes have been proved to be associated with ovarian cancer. The outcomes indicate that our proposed method is feasible and can provide reliable results.
Correction to: Musashi2 promotes EGF-induced EMT in pancreatic cancer via ZEB1-ERK/MAPK signaling
Authors: Sheng Weiwei , Shi Xiaoyang , Lin Yiheng , Tang Jingtong , Jia Chao , Cao Rongxian , Sun Jian , Wang Guosen , Zhou Lei , Dong Ming
Published: August 2020

An amendment to this paper has been published and can be accessed via the original article.