bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of the Short-Segment Internal Fixation with Intermediate Inclined-Angle polyaxial Screw at the Fractured Vertebra on the Treatment of Denis type B Thoracolumbar Fracture
Authors: xiong chengjie , Huang Biwang , Wei Tanjun , Kang Hui , Xu Feng
Published: April 2020

Background: Short-segment internal fixation with intermediate straight-forward monoaxial screws (SSIF-SFM) and long-segment internal fixation (LSIF) are the tow major surgical options for thoracolumbar (TL) fracture. However, SS IF-SFM might not provide adequate support to the spine and LSIF is un necessarily extensive. SSIF with intermediate inclined-angle polyxial screw (SSIF-IAP) might offer an alternative solution for the treatment of TL fracture.
Methods: A retrospective study was conducted. 69 patients (47 males and 22 females; average 34.5 years) with Denis type B TL fracture who met the criteria for inclusion were enrolled. Sagittal Cobb’s angle (SCA), anterior vertebral body height (AVBH), vertebral body index (VBI) and spinal canal encroachment (SCE) were measured and assessed. Visual analogue scale (VAS) and oswestry disability index (ODI) were also evaluated.
Results: The average value of incision length, blood loss, duration of operation and hospital stay in the SSIF–IAP group and SSIF-SFM group were significantly decreased compared with those in the LSIF group. The AVBH and VBI in the SSIF-IAP group and LSIF group were significantly improved than those in the SSIF–SFM group at 6-month and the latest follow-ups (p < 0.05). The correction losses of AVBH and VBI (calculated by the reduction of AVBH and VBI) in the SSIF-IAP group and LSIF group were also significantly decreased compared with those in the SSIF–SFM group at 6-month and the latest follow-ups (P < 0.05). There was no significant difference of SCE among the three groups postoperatively. The VAS and ODI in the SSIF-IAP group and SSIF-SFM group were significantly decreased compared with those in the LSIF group at 6-month and the latest follow-ups (P < 0.05).
Conclusion: Both SSIF- IAP and LSIF can improve the biomechanical stability as compared with SSIF -SFM . Moreover, SSIF-IAP was an effective and reliable operative technique for patients with Denis type B TL fracture.
Effect of Bone Morphogenetic Protein-2/Hydroxyapatite on Ankle Fusion with Bone Defect in a Rabbit Model
Authors: Dang Le Hoang Nam , Lee Kwang-Bok
Published: April 2020

Background

Revision ankle-fusion surgery after a failure of total ankle arthroplasty has a problem with bone-defect management by implant removal. For the reconstruction of bone defects, autogenous bone often causes minor and major complications. Recombinant human-bone morphogenetic protein-2 (rhBMP-2) plays essential roles in bone regeneration strategies and Hydroxyapatite (HA) is beneficial as the rhBMP-2 carrier. In this study, we evaluate whether rhBMP-2/HA can replace autogenous bone in a rabbit ankle-fusion model with distal tibia bone defect.

Methods

The bone defect was created in the distal tibia. The ankle fusion was performed by a cannulated screw from lateral malleolus and various treatments on bone defect. Thirty male white New Zealand rabbits were divided into three groups of 10 animals on each group dependent on treatment methods as control group (no treatment into defect), auto-bone group (autogenous bone treatment), and rhBMP-2/HA group (40 μL of 1 μg/mL rhBMP-2/ 100 μL HA). Bone formation on defect and the union of the ankle joint were evaluated by X-ray, micro-CT and histological analysis at 8 weeks and 12 weeks, postoperatively.

Results

Radiographic assessment found the control and auto-bone groups still had the bone defect present, but rhBMP-2/HA group showed complete replacement of the defect with newly formed bone at 12 weeks. Micro-CT showed significantly higher new bone formation within the defect in the rhBMP-2/HA group than in the auto-bone and control groups at 8 weeks ( p > 0.05 and p < 0.01, respectively) and 12 weeks ( p < 0.05, p < 0.001, respectively). Fusion rate (%) analysis of micro-CT showed a higher percentage of union in the rhBMP-2/HA group than in the auto-bone and control groups at 8 weeks ( p > 0.05, p < 0.001, respectively) and 12 weeks ( p < 0.001 and p < 0.001, respectively). The histological showed the highest osteointegration between distal tibia and talus in the rhBMP-2/HA group at 12 weeks.

Conclusions

This study indicated that rhBMP-2/ HA showed much better bone fusion than did the autogenous bone graft and was effective in promoting fusion rate and improving the quality of the ankle joint fusion.
Distinctive nursing practices in working with mothers to care for hospitalised children at a district hospital in KwaZulu-Natal, South Africa: a descriptive observational study
Authors: North Natasha , Leonard Angela , Bonaconsa Candice , Duma Thobeka , Coetzee Minette
Published: April 2020

Background: The presence of family members and their active involvement in caring for hospitalised children is an established practice in many African paediatric settings, with family members often regarded as a resource. This aspect of African paediatric nursing practice lacks formal expression or a clear conceptual basis, and difficulties arise when applying concepts of family involvement originating from the culturally distinct practice environments of higher resourced settings including Europe and America. The aim of this study was to articulate a nurse-led practice innovation intended to facilitate family involvement in the care of hospitalised children, observed in a paediatric inpatient ward in a district hospital in rural KwaZulu-Natal, South Africa.
Methods: A qualitative case study design was used. Data collection included visual research methods (graphic facilitation, sociograms and photo-elicitation) as well as a focus group, interviews and practice observation. Activities associated with 20 nurses and 22 mother-child dyads were observed. Data were subjected to content analysis, with Standards for Reporting Qualitative Research (SRQR) applied.
Results: Findings relate to six aspects of practice, categorised thematically as: preserving the mother-child pair; enabling continuous presence; psychological support and empathy; sharing knowledge; mothers as a resource; and belief and trust.
Conclusion: The nursing practices and organisational policies observed in this setting relating to the facilitation of continuous maternal presence represent a distinctive nursing practice innovation. This deliberate practice contrasts with models of care provision which originate in higher resourced settings including Europe and America, such as Family Centred Care, and contrasts with informal practices in local African settings which tolerate the presence of mothers in other settings, as well as local institutional policies which limit mothers’ presence to varying extents.
Single-nucleotide polymorphism rs17548629 in RIPK1 gene may be associated with lung cancer in a young and middle-aged Han Chinese population
Authors: Yang Shimin , Yu Fanglin , Lin Mingyan , Sun Linyi , Wei Junjie , Lai Cheng , Cai Lin , Hu Zhijian , He Fei
Published: April 2020

Background Genetic biomarkers of lung cancer (LC) susceptibility may provide a basis for treatment and prevention. This study analyzed an association between SNPs (single nucleotide polymorphisms) in the complementary region of the 3′-UTR (3' untranslated region) of microRNAs of the gene RIPK1 (receptor-interacting serine/threonine-protein kinase 1) and LC among an adult Han Chinese population aged younger than 60 years. Also explored the effect of regulation of the RIPK1 gene via rs17548629 and microRNA-1197 on the occurrence of LC. Methods RIPK1 variants (rs17548629, rs77736895) were determined in a population of 571 adults (younger than 60 years) with LC, and 609 gender- and age-matched healthy individuals. Bioinformatics methods predicted the microRNAs bound to rs17548629. Dual luciferase reporter assay was performed to confirm the presence of both rs17548629 and the predicted microRNA. Results A mutation (T) of rs17548629 was associated with an increased risk for LC in this population under the codominant and recessive genetic models. The risk of lung adenocarcinoma in rs17548629 mutant carriers was 1.769-fold higher than that of the wildtype. In vitro , the luciferase activity of co-transfected mutant psiCHECK2- RIPK1 and microRNA-1197 mimics was less than that of the group transfected with microRNA-1197 mimics only. Factorial analysis indicated interactions between microRNA-1197 mimics and genotypes of rs17548629. Conclusion A mutation (T) of rs17548629 may increase the risk of LC/lung adenocarcinomain adult Han populations younger than 60 years. When carrying the T allele, rs17548629 may be the target of hsa-miR-1197. This mutation may affect transcriptional level of the RIPK1, thereby promoting the occurrence of LC.
Influx of diverse, drug resistant and transmissible Plasmodium falciparum into a malaria-free setting in Gulf Cooperation (GCC) countries.
Authors: Al-Rumhi Abir , Al-Hashami Zainab , Al-Hamidhi Salama , Gadalla Amal , Naeem Raeece , Ranford-Cartwright Lisa C. , Pain Arnab , Sultan Ali A. , Babiker Hamza
Published: April 2020

Background Successful malaria control programs have interrupted local malaria transmission in almost all the Gulf Cooperation Council (GCC) countries. However, a massive influx of imported malaria via migrant workers from endemic areas sustains a threat for the re-introduction of local transmission. Here we examined the origin of imported malaria into one of the GCC countries (Qatar) and assessed the extent of genetic diversity, and carriage of drug resistance genes of imported Plasmodium falciparum and it’s potential to re-introduce the disease. Methods We examined imported malaria reported in Qatar, between 2013 and 2016. We focused on P. falciparum infections and estimated total parasite and gametocyte density using qPCR and qRT-PCR, respectively. In addition, we examined ten neutral microsatellites and four drug resistance genes, Pfmrp1, Pfcrt, Pfmdr1 and Pfkelch13 , to assess the extent of diversity of imported P. falciparum and its potential carriage of drug resistance genotypes respectively. Results The majority of imported malaria comprised P. vivax , while P. falciparum and mixed species infections ( P. falciparum /P. vivax ) were less frequent. The main origin of P. vivax was the Indian subcontinent, while P. falciparum was most apparent among expatriates from Africa. Imported P. falciparum was highly diverse carrying multiple genotypes as well as early and late gametocytes. We observed a high prevalence of SNPs implicated in drug resistance among imported P. falciparum , with some novel SNPs in Pfkelch13 . Conclusions The high influx of genetically diverse P. falciparum, with multiple drug resistance marker gene mutations and high capacity of producing gametocytes, sustains threat for re-introduction of drug resistant malaria into GCC countries. This scenario highlights the impact of current globalisation of movement of humans in reintroducing malaria infections to areas targeted for elimination.
Cavernous malformation hemorrhage due to trans-mural pressure alterations after cerebrospinal fluid diversion: a case report
Authors: Hartley Benjamin , Birnbaum Corinne , Hoffman Caitlin E
Published: April 2020

Background: Cavernous malformations are rare cerebral pseudo-vascular lesions with annualized bleeding rates of 0.5 – 3% in most studies. Of the various explored risk factors for bleeding to date, only prior hemorrhage has shown significant correlation. Case Presentation: In this case, we describe a 65-year old man with a peri-ventricular atrial cavernous malformation that hemorrhaged after CSF diversion via ventriculoperitoneal shunting. Serial imaging showed that bleeding continued until the shunt was revised with a programmable valve set at maximum resistance with the addition of a gravitational unit, thereby lowering the trans-mural pressure differential across the cavernous malformation. Conclusions: Given that other vascular lesions are subject to hemorrhage from alterations in trans-mural pressure dynamics, we hypothesize that cavernous malformations are similarly affected by trans-mural pressure gradients as they are composed of primitive vascular elements. This hypothesis is corroborated by the temporal correlation of interventions, imaging, and exam findings in the present case, and suggests a potentially important risk factor for hemorrhage in CM patients that affects prognostication and management.
Stepwise in vitro induction of human somitic mesoderm and its derivatives
Authors: Yamanaka Yoshihiro , Uemura Maya , Alev Cantas
Published: April 2020

Our understanding of human somitogenesis is limited and largely based on insights gained from model organisms. Pluripotent stem cell-based in vitro approaches aiming to recapitulate distinct aspects of this core developmental process have recently been reported, including our recent paper on the in vitro recapitulation of the human segmentation clock1. Here we describe in detail our stepwise induction protocol of presomitic mesoderm (PSM), somitic mesoderm (SM), and its two major derivatives, sclerotome (SCL) and dermomyotome (DM) from human induced pluripotent stem cells (iPSCs). We further briefly address the subsequent molecular and functional analysis of these in vitro induced human mesodermal lineages and cell-types.
A quick and improvement effect of leucine enriched dietary supplement on malnutrition in acute stroke patients receiving enteral tube feeding
Authors: Mori Takahisa , Yoshioka Kazuhiro
Published: April 2020

Background:Malnutrition often occurs in acute stroke patients receiving enteral tube feeding (ETF). Unless malnutrition is improved, their clinical outcome is poor. However, strategies to improve malnutrition in these patients have not been established. Branched-chain amino acids (BCAA) may enhance protein synthesis and attenuate inflammation. Our study aimed to investigate whether a leucine enriched BCAA dietary supplement (LEBDs) could quickly improve a patient's nutritional status during the early stage of malnutrition. Methods:We retrospectively analyzed acute stroke patients who 1) were admitted between December 2016 and July 2017; 2) underwent ETF for seven days or longer after admission; 3) who underwent blood examination on admission, the 5th day, and seventh day; 4) in whom transthyretin (TTR) was less than 15 mg/dl on the 5th day, and 5) received LEBDs containing 1.44 g leucine per 200 kcal twice a day on the 5th day. We evaluated patients' features, serum albumin (Alb) (g/dl), transthyretin (TTR) (mg/dl), and high sensitive C-reactive protein (CRP) (mg/dl) on admission, the fifth day, and the seventh day. Results:Fifteen patients met our inclusion criteria. Their median age, body mass index (BMI), body weight (BW), serum blood glucose (BG), Alb, TTR, and CRP were 82 years, 21.8 kg/m2, 50 kg, 150 mg/dl, 3.5 g/dl, 12.7 mg/dl, and 1.02 mg/dl, respectively. Their median calorie intake was 1,200 kcal/day. On the 5th day, their median Alb and TTR decreased to 2.6 g/dl (p<0.0001) and 11.8 mg/dl (p<0.01), respectively, and their median CRP increased to 5.24 mg/dl (p<0.01). On the 7th day, TTR increased to 15.7 mg/dl (p<0.001), and CRP decreased to 4.77 mg/dl (p<0.05), whereas their median Alb was 2.6 g/dl (ns) and did not significantly change. ConclusionThe leucine enriched BCAA dietary supplement had a quick and improvement effect on the transthyretin and CRP level.
Peri-acetabular bone remodelling after uncemented total hip arthroplasty with monoblock press-fit cups: an observational study
Authors: Anderl Conrad , New Georg Mattiassich , New Reinhold Ortmaier , New Martin Steinmair , New Josef Hochreiter
Published: April 2020

Background: Bone stock preservation in total hip replacement is essential to allow for later revisions in an increasingly younger and fitter index patient population. While contemporary modular press-fit acetabular cups lead to rigid fixation with equatorial stress and central osteolysis, more elastic fixation may cause different peri-acetabular bone remodelling. The purpose of this study was to investigate changes in peri-acetabular bone mineral density (BMD) in uncemented elastic fixation with monoblock press-fit cups.Methods: This prospective observational study included 45 patients with monoblock cups. We evaluated peri-acetabular BMD using dual-energy X-ray absorptiometry and reported functional outcomes and complications.Results: At a mean follow-up of 24.2 ± 2.2 months, we found that BMD stabilised in DeLee and Charnley zones I and III and recovered to baseline value in zone II. The mean Harris Hip Scores improved significantly from 56.9 ± 20.0 to 97.2 ± 4.0 (p < 0001). Other than one peri-operative dislocation, we saw no post-operative complications.Conclusions: We confirmed favourable adaptive bone changes with BMD stabilisation in the equatorial zones and recovery to pre-operative values in the central zone. Additionally, excellent clinical outcomes and few prosthesis-related complications confirmed the favourable results of monoblock acetabular cups.
Age and pain score before gastrointestinal endoscopies in children are predictors for post procedure pain.
Authors: Galai Tut , Yerushalmy-Feler Anat , Heller Nathan P. , Ben-Tov Amir , Weintraub Yael , Amir Achiya , Moran-Lev Hadar , Zac Lilach , Cohen Shlomi
Published: April 2020

Background Gastrointestinal endoscopy may be associated with pain and anxiety. Predictors for high pain scores after endoscopies in children are not known. The aim of our study was to identify risk factors for prolonged recovery and higher pain scores after gastrointestinal endoscopy in children. Methods All the children that were electively admitted for gastrointestinal endoscopies were included. We retrospectively collected demographic, clinical and endoscopic data as well as information on the recovery process. A numerical rating scale and the Faces, Legs, Activity, Cry, and Consolability Scale were used for pain scoring. Results During the study period (01/2016-10/2016), 284 children (median age 10.7 years, interquartile range 6.7-14.8) were recruited. In a univariate analysis, older age, higher pre-procedure pain scores, longer procedure durations, higher number of biopsies and longer recovery duration were associated with higher post-procedure pain scores. In a multivariate analysis higher pain scores before the procedure (OR 12.42, 95% CI 3.67-42, P < 0.001) and older age (OR 1.016, 95% CI 1.007-1.025, P < 0.001) were associated with higher pain scores after the procedure. Children with a higher pain score before the procedure also had a longer recovery period (OR 5.28, 95% CI (1.93‐14.49), P = 0.001). Conclusion Older age and higher pain score before the procedure were identified as predictors for higher pain score after pediatric gastrointestinal endoscopies. Children with these risk factors should be identified before the procedure in order to personalize their post-procedure management. Retrospectively registered TLV-0144-17
Biomechanical Control of Paretic Lower Limb During Imposed Weight Transfer in Individuals Post-Stroke
Authors: Hsiao Hao-Yuan , Gray Vicki , Borrelli James , Rogers Mark W
Published: April 2020

Background: stroke is a leading cause of disability with associated hemiparesis resulting in difficulty bearing and transferring weight on to the paretic limb. Difficulties in weight bearing and weight transfer may result in impaired mobility and balance, increased fall risk, and decreased community engagement. Despite considerable efforts aimed at improving weight transfer after stroke, impairments in its neuromotor and biomechanical control remain poorly understood. In the present study, a novel experimental paradigm was used to characterize differences in weight transfer biomechanics in individuals with chronic stroke versus able-bodied controls. Methods: fifteen participants with stroke and fifteen age-matched able-bodied controls participated in the study. Participants stood with one foot on each of two custom built platforms. One of the platforms dropped 4.3 cm vertically to induce lateral weight transfer and weight bearing. Sagittal plane kinematics, vertical ground reaction forces, and center of pressure velocity were measured. All participants completed the clinical Step Test and Four-Square Step Test. Results: reduced ankle and knee joint angular displacement and velocity, delayed inter-joint timing, and altered center of pressure control (COP) were exhibited in the stroke group compared to the control group. In addition, increased COP velocity stabilization time in the medial-lateral direction during induced weight transfer predicted Step Test scores in individuals post-stroke. Conclusions: the induced weight transfer paradigm characterized the stroke-related abnormalities in the control of weight transfer compared to controls. Decreased joint flexion of the ankle and knee, altered inter-joint timing, and altered COP control appear to be related to limitations during gait. Future work will investigate the potential of improving functional weight transfer through induced weight transfer training exercise.
Poly(I:C) preconditioning ameliorates cognitive dysfunction after cerebral I/R injury by inhibiting TRAF6 signaling
Authors: Wang Peng-Fei , Zhong Wei-Bin , Ju Xiao-Hua , LI Zhen-Guang , Wang Fa-Xiang
Published: April 2020

Objective: Toll-like receptor (TLR) activation plays an important role in cerebral ischemia-reperfusion injury. In addition, increasing evidence suggests that TLRs may affect cognitive behavior through TLR-mediated signaling. Here, we explored the protective effects of TLR3 on cognitive dysfunction after ischemia in the context of poly(I:C) preconditioning.Materials and Methods : Mice (n=84) were randomly divided into the sham group, AAV (vector) group, middle cerebral artery occlusion (MCAO) model group, poly(I:C) (pre) + MCAO model group, and AAV (TRAF6) + poly(I:C) (pre) + MCAO model group. The mice were injected i.p. with poly(I:C) (1.25 mg/g) 24 h prior to cerebral ischemia. Then, neurological scores were assessed, and the infarct volume was measured after cerebral ischemia-reperfusion. We evaluated the poly(I:C) preconditioning-induced attenuation of neuronal damage using Nissl and TUNEL staining. We assessed the poly(I:C) preconditioning-mediated inhibition of I/R-induced glial activation, inflammatory factor levels and TRAF6 expression. We also assessed whether TRAF6 affects poly(I:C) preconditioning to improve cognitive dysfunction and neuroprotection.Results: The results showed that compared with those of the sham group and AAV (vector) group, the functional neurological scores and focal infarct volume of the MCAO group and poly(I:C) preconditioning group were significantly increased. The results also showed that compared with those of the MCAO group, the functional neurological scores and focal infarct volume of the poly(I:C) preconditioning group were significantly reduced. Our results indicated that poly(I:C) preconditioning significantly attenuated neuronal apoptosis and cell loss. Poly(I:C) preconditioning also inhibited I/R-induced glial cell activation and reduced NF-κB, TNF-α and IL-β levels. Our findings showed that poly(I:C) preconditioning affected cognitive dysfunction following cerebral I/R. Here, we observed that poly(I:C) preconditioning affected the expression and distribution of TRAF6 following cerebral I/R. TRAF6 overexpression abolished poly(I:C)-induced neuroprotection and worsened cognitive dysfunction in cerebral I/R injury.Significance: Our findings suggested that poly(I:C) preconditioning ameliorates cognitive dysfunction after cerebral I/R injury by inhibiting TRAF6 signaling, which is a potential therapeutic target for the treatment of cognitive dysfunction after stroke.
The Effect of Workplace Violence on Depression among Medical Staffs in China: The Mediating Role of Interpersonal Trust
Authors: Wang Haipeng , Zhang Yuxia , Sun Long
Published: April 2020

Background: Workplace violence has been recognized globally as a serious occupational hazard in health services occupations, and existing studies have identified that workplace violence can significantly lead to depression. Interpersonal trust, an important topic, also has been proved associated with workplace violence and depression. However, the moderating effect of interpersonal trust has not been tested before, which can help us to further understand the effect mechanism of workplace violence on depression. Method: In the current study, we collected 3,426 valid questionnaires based on a cross-sectional design among medical staff in Chinese hospitals. Depression, workplace violence, interpersonal trust, social support, physical diseases, and some other social-demographic variables were evaluated. Results: The data analyzed in the current study supported that there were 52.2% of medical staff experienced workplace violence before. Experiencing verbal violence (b=2.99, p<0.001), experiencing physical violence (b=3.70, p<0.01), experiencing both kinds of the violence (b=4.84, p<0.001), high level of interpersonal trust (b=0.22, p<0.001), nursing (b=1.10, p<0.05), manager (b=-1.72, p<0.001), suffering physical disease (b=3.35, p<0.001), social support (b=-0.23, p<0.001) were significantly associated with depression. Interpersonal trust had a partial mediating effect on the relationship between workplace violence and depression. Conclusion: Interpersonal trust can be a mediator between workplace violence and depression. Some potential strategies would be beneficial to promoting the mental health status among medical staff.
Parenteral supplementation of omega-3 fatty acid on the prognosis of sepsis: a retrospective study
Authors: Chen Youlian , Chen HuaiSheng , Liu XunFa , Jiang YiChun , Ma YongHui , Liu XueYan , Tang XueMing , Wang Wei
Published: April 2020

Objectives The role of omega-3 fatty acids in the treatment of sepsis is always on paradox. we tried to retrieve and download the patients’ data in a certain period through the hospital information system, used data sorting so as to screen out the patients with sepsis so as to find out the role of omega-3 fatty acids in sepsis. Methods Through the hospital information system, retrieve and include the patients who were admitted to the Department of critical medicine of Shenzhen People's Hospital from December 2016 to June 2019, screen out patients diagnosed with sepsis according to a certain criterion. The patients were grouped by whether they were applicated with omega-3 fatty acid or not. Results A total of 1733 cases included into analysis, among of whom 303 cases were applicated with omega-3 fatty acid. The amounts and baseline conditions between both groups were imbalance. Severity of omega-3 fatty acid group was higher than that of control group. Chi-square test found that the mortality rate of omega-3 fatty acid was higher than that of control group (p < 0.0001). But age, gender, whether there is abdominal infection, whether there is septicemia, shock, the need for mechanical ventilation, and the need for renal replacement therapy may all affect the prognosis of the patients. If these factors were used as covariates, multiple logistic regression analysis showed that there was no significant difference in mortality rate between the treatment group and the control group (P = 0.574). Survival analysis showed that the survival rate of treatment group was higher than that of the control group when at the end of total treatment duration (P = 0.035). Conclusion For patients with more severe sepsis, doctors are more likely to use omega-3 fatty acids in the early stage. Omega-3 fatty acids may improve the long-term prognosis of sepsis, but the conclusion still needs to be accepted carefully.
The changes of thyroid hormone in euthyroid patients with diabetes
Authors: Qin Ken , Zhang Fan , Wu Qinqin , Liu Zhenrong , Huang Yan , Tan Jing , Zhou Yiling , An Zhenmei , Li Shuangqing , Li Sheyu
Published: April 2020

Background Thyroid dysfunction is suggested to be associated with diabetes, but it is not clear if the thyroid hormone levels are associated with diabetes in euthyroid adults. Objective To investigate the association between thyroid hormone levels and diabetes in euthyroid adults. Methods Among the euthyroid adults who underwent health examination in West China Hospital, Sichuan University in 2016, patients with diabetes were identified according to the medical history, fasting blood glucose and HbA1c. Age and sex matched controls were identified from the population. The patients with diabetes group was further divided into two subgroups: patients with newly diagnosed diabetes (NDD) and with previously diagnosed diabetes (PDD). Independent t-test and multivariate logistic regression models were used to investigate the difference on the levels of thyroid stimulating hormone (TSH), free thyroxine (FT4), free triiodothyronine (FT3) and the ratio of FT4/FT3 between groups. Results We included 32,557 participants, 2,271 with diabetes and 1,187 NDD. Compared to the patients without diabetes, the odds ratios (ORs) per one unit of TSH, FT4, FT4/FT3 ratio and FT3 in patients with diabetes were 0.88 [95% confidence interval (CI): 0.82-0.95], 1.11 (95% CI: 1.08-1.14), 2.05 (95%CI: 1.81-2.32) and 0.85 (95%CI: 0.78-0.93), respectively. Compared to NDD group, the ORs per one unit of TSH, FT4, FT4/FT3 ratio and FT3 of the PDD group were 0.81 (95%CI: 0.71-0.92), 1.08 (95%CI: 1.04-1.12), 1.76 (95%CI: 1.49-2.08) and 1.01 (95%CI: 0.92-1.12), respectively. Conclusion In euthyroid adults, diabetes and its duration were significantly associated with thyroid hormone turnover. Patients with a previously diagnosed diabetes may be more likely to present elevated FT4/FT3 ratio, indicating an adaptive change of thyroid gland.
Integrating the prevention of mother-to-child transmission of HIV after AIDS denialism in South Africa: Perspectives of experts and health care workers - A qualitative study
Authors: MUTABAZI Jean Claude , Gray Corie , Muhwava Lorrein , Trottier Helen , Ware Lisa Jayne , Norris Shane , Murphy Katherine , Levitt Naomi , Zarowsky Christina
Published: April 2020

Background Integrating vertical programmes into routine health services under complex socio-political and health system conditions is a priority and a challenge. The successful rollout of Prevention of Mother-to-Child Transmission programmes (PMTCT) in sub-Saharan Africa has decreased Human Immunodeficiency Virus (HIV), reduced child mortality and improved maternal health. In South Africa, PMTCT is now integrated into existing health services and this experience could serve as a relevant example for integrating other programmes into comprehensive primary care. We explored the perspectives of both experts and frontline health workers (FHCWs) in South Africa on PMTCT integration into primary health care (PHC) in the context of post-AIDS denialism using a Complex Adaptive Systems framework. Methods We conducted a total of 20 in-depth semi-structured interviews; 10 with experts (PMTCT and health system experts, policymakers, researchers and activists) and 10 with FHCWs including clinic managers, nurses and midwives. All interviews were conducted in person, audio-recorded and transcribed. Three investigators collaborated in coding transcripts and used an iterative approach for thematic analysis. Results Experts and FHCWs agreed on the importance of integrated PMTCT services. Experts reported a slow and partial integration of PMTCT programs into PHC following its initial rollout as a stand-alone program in the aftermath of the AIDS denialism period. Experts and FHCWs diverged on the challenges associated with integration of PMTCT. Experts highlighted bureaucracy, HIV stigma and discrimination and a shortage of training for staff as major barriers to PMTCT integration. In comparison, FHCWs emphasized high workloads, staff turnover and infrastructure issues (such as lack of rooms, small spaces, etc.) as their main challenges to integration. Both experts and FHCWs suggested that working with community health workers, particularly in the post-partum period, helped to address cases of loss to follow-up of women and their babies and to improve linkages to protein-chain reaction (PCR) testing and immunisation. Conclusions Despite organised efforts in South Africa, experts and FHCWs reported multiple barriers for the full integration of PMTCT programmes in PHC, especially postpartum. Our results suggest opportunities to address operational challenges towards more integrated PMTCT and other health services in order to improve maternal and child health.
A comparative evaluation of different NeuroMyelitis Optica Spectrum Disorder sets criteria
Authors: Papeix Caroline , Beigneux Ysoline , Maillart Elisabeth , de Seze Jérôme , Lubetzki Catherine , Vukusic Sandra , Collongues Nicolas , Marignier Romain
Published: April 2020

Background

Three different sets of criteria have been proposed for the diagnosis of neuromyelitis optica spectrum disorders (NMOSD).

OBJECTIVE

To compare the specificity, sensitivity and diagnostic accuracy of the three different sets of NMOSD criteria, in patients presenting with inflammatory disorders of the central nervous system suggestive of NMOSD.

Methods

From 236 suspected NMOSD referred for serum AQP4-IgG testing between 2012 and 2014, the three sets of NMOSD criteria (1999, 2006 NMO criteria and 2015 International Panel for NMO Diagnosis criteria) were applied and compared to the final diagnosis.

Results

Seventy-six patients fulfilled at least one set of criteria and 28 patients fulfilled all NMOSD set of criteria. The final diagnosis was NMOSD in 66 cases, MS according to the MacDonald 2010 in 85 cases and another diagnosis in 85 cases. 2006 NMO criteria has the highest specificity (99%) and 2015 IPND NMOSD criteria, the highest sensitivity (97%). For the 1999, 2006 and 2015 IPND NMOSD criteria, the accuracy was respectively 82%, 87% and 97%.

Conclusions

Our study highlights the limitations of the first set of criteria, that include optico-spinal form of MS. The accuracy of NMO/SD diagnostic criteria improved from 1999 to 2015. It confirms the increased performance of the last set of criteria which covers a larger spectrum of clinical presentation. This study raises some the concern to classify patients with seronegative transverse myelitis or optic neuritis, and MOG-antibody associated disease.
Dynamic curve analysis of indicators related to lumbar cistern drainage for postoperative meningitis
Authors: Ma Weining , Li Chun , Cong Lin
Published: April 2020

Background

Lumbar cisterna drainage (LCD) is widely used in neurosurgery as an effective treatment for postoperative meningitis, vasospasm of subarachnoid hemorrhage and ventricular system hemorrhage, and for reducing intracranial pressure in patients with severe craniocerebral trauma. The purpose of this work was two-fold: to analyze the dynamic curve of cerebrospinal fluid (CSF) related indices in cases of postoperative meningitis after selective craniotomy and to provide reference data for the clinical treatment with LCD.

Methods

We conducted a retrospective study of LCD placement in patients who underwent either supratentorial craniotomy (n=23) or subtentorial craniotomy (m=28). Primary outcomes measured included pre-intervention and post-intervention dynamic changes of body temperature, and CSF biochemical parameters (white blood cell (WBC) count, polykaryocyte percentage, protein, glucose and chloride) over the course of 13 days of catheter placement. We also assessed the bivariate correlation between WBC count changes, polykaryocyte percentage, body temperature and daily CSF drainage volume. Finally, we analyzed the effect of average daily drainage volume, antibiotic choice, and surgical site on the WBC count change curves.

Results

After LCD, a trend of increased WBC count was observed on the first day of drainage, followed by an overall decrease in WBC count. There was a statistically significant ( P<0.05 ) difference between the WBC count before drainage and the WBC count on the fourth day of drainage. Polykaryocyte percentage decreased initially and then increased progressively each day after drainage. There was a negative correlation between the change curve of the WBC count and the curve of daily drainage volume (r = -0.56). When the daily drainage volume was 250-300 ml/d, the change curve pattern of the WBC count was consistent with the overall trend of the WBC count, and there was no significant difference in the curve of the WBC count between different surgical sites ( P > 0.05 ).

Conclusions

LCD is an effective method for the treatment of postoperative meningitis. The WBC count can decrease significantly by the fourth day after drainage, and placement of the LCD for six to seven days is ideal. An average drainage volume of 250-300 ml/d is safe and effective.
Intervening the up-regulated SLC7A5 could mitigate the inflammatory mediator by mTOR-P70S6K signal in rheumatoid arthritis synoviocytes.
Authors: Xu Jing , Jiang Congshan , Cai Yongsong , Guo Yuanxu , Wang Xipeng , Zhang Jiaxiang , Xu Jiawen , Xu Ke , Zhu Wenhua , Wang Si , Zhang Fujun , Geng Manman , Han Yan , Ning Qilan , Xu Peng , Meng Liesu , Lu Shemin
Published: April 2020

Objective The increased bioenergetic and biosynthetic demands of sustained inflammation and changes to nutrient and oxygen availability are found in rheumatoid arthritis (RA). This study aimed to observe the effects of SLC7A5 (amino acid transporter) on synoviocytes of RA patients and pinpoint the underlying molecular mechanisms. Methods Synovial tissues were collected from OA and RA patients. Fibroblast-like synoviocytes (FLS) were isolated from synovial tissues from RA patients. SLC7A5 expression was evaluated by using RT-qPCR, immunofluorescence and Western blotting. Matrix metalloproteinases (MMPs) expression was evaluated by using RT-qPCR and Western blotting. RNAi and antibody blocking treatments were used to knockdown the expression of SLC7A5 or block its transporting function. Results The SLC7A5 expression was significantly upregulated in the FLS from RA patients compared with that in FLS from OA patients. Cytokine IL-1β played a crucial role in up-regulating SLC7A5 expression via NF-κB pathway in FLS. Intervening SLC7A5 expression with RNAi or blocking SLC7A5 function by monoclonal antibody could ameliorate the MMP3 and MMP13 protein expression. Furthermore, up regulation of SLC7A5 enhanced mTOR-P70SK6 signaling activation which could promote the protein translation of MMP3 and MMP13 in RA FLS. Conclusion SLC7A5 up-regulation could be induced by activated NF-κB pathway, further resulted in an enhanced mTOR-P70S6K activity and the protein expression of MMP3 and MMP13 in FLS from RA patients.
Twelve-month complications, continuation and failure rate of CuT380A when used for immediate postpartum contraception in Tanzania: A cohort study
Authors: Rwegoshora France John , Muganyizi Projestine Selestine , Kimario Grasiana Festus , Paul Ponsian Patrick , Makins Anita
Published: April 2020

Background

Less than 1% of married women in Tanzania use an Intrauterine Contraceptive Device (IUD) for the purpose of contraception. An initiative by the International Federation of Gynecology and Obstetrics (FIGO) has been on 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 1 st December 2017 and 18 th April 2018 was conducted. Immediate, face to face post insertion interviews were made with 1114 clients and later at the beginning of 13 th month through phone calls. 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 by end of 12 months, giving a one-year continuation rate of 86.1%. Most (63%) IUD discontinuations occurred in the period between 7 th 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, adolescence (16-24 years), and delivery by Cesarean section.

Conclusions

The continuation rate when CuT380A is used for immediate postpartum contraception is high and with low failure rate. Some medical and social factors are important for method continuation, hence the need to consider in training, counselling and advocacy.
Using routine programmatic data to measure HIV incidence among pregnant women in Botswana
Authors: Ortblad Katrina Frances , Mawandia Sheshth , Bakae Odirile , Tau Lenna , Grande Matias , Mogomotsi Goabaone Pankie , Mmatli Esther , Ngombo Modise , Seckel Laura , Heffron Renee , Pintye Jillian , Ledikwe Jenny
Published: April 2020

Introduction: Pregnant women in sub-Saharan Africa have high risk of HIV acquisition, yet approaches for measuring maternal HIV incidence using routine surveillance systems are undefined. We used programmatic data from routine antenatal care (ANC) HIV testing in Botswana to measure real-world HIV incidence during pregnancy. Methods: From January 2018 to September 2019, the Botswana Ministry of Health and Wellness implemented an HIV testing program at 139 ANC clinics. The program captured information on testers’ age, testing date and result, and antiretroviral treatment (ART) initiation. In our analysis, we excluded individuals who previously tested HIV-positive prior to their first ANC visit. We defined incident HIV infection as testing HIV-positive at an ANC visit after a prior HIV-negative result within ANC. Results: Overall, 29,570 pregnant women (median age 26 years, IQR 22-31) tested for HIV at ANC clinics: 3% (836) tested HIV-positive at their first recorded ANC visit and 97% tested HIV-negative (28,734). Of those who tested HIV-negative, 28% (7,940/28,734) had a repeat HIV test recorded at ANC. The median time to HIV re-testing was 92 days (IQR 70-112). In total, 17 previously undiagnosed HIV infections were detected (HIV incidence 8 per 1,000 person-years, 95% CI 0.5-1.3). ART initiation among women newly diagnosed with HIV at ANC (853) was 88% (671/762). Conclusions: In Botswana, real-world HIV incidence among pregnant women at ANC remains above levels of HIV epidemic control (≤1 per 1,000 person-years). This study shows how HIV programmatic data can answer timely population-level epidemiological questions and inform ongoing implementation of HIV prevention and treatment programs.
FSTL1 aggravates OVA-induced allergic airway inflammation by activating NLRP3 inflammasome
Authors: Wang Yan , Liu Tian , Wang Jun-fei , Liu Bao-yi , Wu Jin-xiang , Zhao Ji-ping , Li Shuo , Xu Jia-wei , Cao Li-li , Zhang Jin-tao , Dong Liang
Published: April 2020

Background

Asthma is a common respiratory disease characterized by chronic airway inflammation. As a novel inflammatory mediator, follistatin-like protein 1 (FSTL1) can activate immune reaction, suggesting that it may contribute to inflammatory disorders such as asthma. Besides, there are growing evidences that nucleotide-binding domain and leucine-rich repeat protein 3 (NLRP3) / Interleukin (IL)-1β axis participates in asthma. In this study, we investigated the role of FSTL1 in allergic airway inflammation and its underlying mechanism of activating NLRP3 inflammasome.

Methods

Circulating FSTL1 and IL-1β levels were quantified in serum of asthmatic patients and controls. Whole-body ablation Fstl1 heterozygous mice (Fstl1 +/- ) and control group were assessed after the experimental treatment. The effects of FSTL1 on NLRP3 inflammasome were also tested in primary macrophages of mice in vitro.

Results

The concentration of FSTL1 and IL-1β in serum of asthmatic patients were elevated compared with controls and were positively correlated. FSTL1 deficiency ameliorated infiltration of inflammatory cells,corresponding pathological changes,cytokine responses (IL-1β, IL-5,IL-13), mucous hypersecretion and hyper-responsiveness of airway after Ovalbumin (OVA) exposure in the mouse model. Additionally, inhibition of NLRP3 with MCC950 attenuated FSTL1-induced activation of NLRP3 inflammasome and airway inflammation in vivo and vitro.

Conclusions

Our data showed that FSTL1 played an important role in allergic airway inflammation by activating NLRP3 inflammasome, providing the possibility that FSTL1 could be applied as a therapeutic strategy on asthma.
Machine Learning for Predicting Pathological Complete Response in Patients with Locally Advanced Rectal Cancer after Neoadjuvant Chemoradiotherapy
Authors: Huang Chun-Ming , Huang Ming-Yii , Huang Ching-Wen , Tsai Hsiang-Lin , Su Wei-Chih , Chang Wei-Chiao , Wang Jaw-Yuan , Shi Hon-Yi
Published: April 2020

BACKGROUND For patients with locally advanced rectal cancer (LARC), achieving pathological complete response (pCR) after neoadjuvant chemoradiotherapy (CRT) results in best prognosis. So far, no reliable prediction model has been available. We aim to evaluate the performance of an artificial neural network (ANN) model in the prediction of pCR in patients with LARC. METHODS Predictive accuracy was compared between the ANN, k-earest neighbor (KNN), support vector machines (SVM), naïve Bayes classifier (NBC), and multiple logistic regression (MLR) models. RESULTS A total of 236 patients with LARC were used to compare the forecasting models. We trained the model with an estimation data set, and evaluated model performance with a validation data set. The ANN model significantly outperformed the KNN, SVM, NBC, and MLR models in predicting pCR. Our results revealed that post-CRT carcinoembryonic antigen was the most influential predictor of pCR, followed by intervals between CRT and surgery, chemotherapy regimens, clinical nodal stage, and clinical tumor stage. CONCLUSIONS Compared with conventional prediction models, the ANN model was more accurate in the prediction of pCR. The predictors of pCR can be used to identify which patients with LARC can benefit from watch-and-wait approaches.
Eating disorders among borderline patients: understanding the prevalence and psychopathology
Authors: Khosravi Mohsen
Published: April 2020

Background: Common comorbidity and the shared psychopathology in borderline personality disorder (BPD) and feeding and eating disorder (FED) resulted in conceptualization of the relationship theory between disordered eating behaviors (DEB), alexithymia, depression, and anxiety. Therefore, the present study aims at investigating the FED prevalence in patients with BPD and evaluating the relationship between DEB, alexithymia, anxiety, and depression.Methods: This cross-sectional study was performed from August 2018 to November 2019; 110 patients with BPD and 110 healthy people were studied in this research. The participants were selected by systematic random sampling out of the patients referring to Baharan psychiatric hospital in Zahedan, Iran, with the sampling interval of 3. The subjects were evaluated by demographic data form, the 26-item eating attitudes test (EAT-26), 20-item Toronto alexithymia scale (TAS-20), Beck anxiety disorder (BAI), and Beck depression inventory-II (BDI-II).Results: The results show a 65.4% (n = 72) prevalence of FED in borderline patients; the highest and lowest prevalence rates are reported for avoidant/restrictive food intake disorder (ARFID) and bulimia nervosa, respectively. The highest mean score of TAS-20 is reported in anorexia nervosa. The regression analysis results show that anxiety and depression play a mediating role in the relationship between alexithymia and DEB.Conclusions: The results suggest that alexithymia should be paid clinical attention as a trait and distress-independent construct in the BPD and FED comorbidity.