bluuebunny/crossref_metadata_2025 huggingface dataset:
KAJIAN PSIKOLOGI SASTRA NOVEL BIDADARI BERMATA BENING KARYA HABIBURRAHMAN EL SHIRAZY DAN NILAI PENDIDIKAN KARAKTER TOKOH DALAM PERSPEKTIF PEMBELAJARAN BAHASA INDONESIA
Authors: Bastian Novia Rahmah , Suyitno Suyitno , Ulya Chafit
Published: December 2019

The purpose of this research is to describe and explain: (1) intrinsic element of novel Bidadari Bermata Bening; (2) psychological burden of the main character; (3) character education values; (4) the position of novel Bidadari Eye Bening by Habiburrahman El-Shirazy in Indonesian Language Learning perspective. This research was conducted by qualitative descriptive method and using psychology approach of literature. The results of this study indicate that: (1) each element of the novel has relevance with other elements so as to make the story coherent. (2) psychological analysis for the psychological burden of the main character using Sigmund Freud's theory of analysis which includes the three elements of personality namely id, ego, and superego. (3) the values of character education contained in the novel include religious, honest, tolerance, discipline, hard work, creative, independent, curiosity, respectful achievement, friendly / communicative, peace loving, social caring, and responsibility. (4) novel Bidadari Bermata Bening by Habiburrahman El Shirazy can be used as Learning material of Bahasa Indonesia.
PENINGKATAN KOMPETENSI MENEMUKAN INFORMASI PADA BUKU TELEPON MELALUI MODEL PEMBELAJARAN KOOPERATIF TEAMS GAMES TOURNAMENT PADA SISWA KELAS VIII PUSAT KEGIATAN BELAJAR MASYARAKAT SAHABAT KARANGANYAR
Authors: Mukhlisin Muhammad Abid , Setiawan Budhi , Hastuti Sri
Published: December 2019

The research was aimed to know whether cooperative learning model with teams games tournament type could improve both process and the scanning reading competention on finding  information from phone book. This research subjects was the eighth grade students of PKBM Sahabat Karanganyar in academic year of 2016/2017. Data were collected by document analysis, observation, and interview. The data validity was tested by data triangulation technique. Data was analyzed by comparative descriptive technique. This research procedure consists of: (1) the planning; (2) the act of learning; (3) observation; and (4) analysis and reflection. The result showed that there were improvement of process and scanning reading competention on finding information from phone book through cooperative learning model with teams games tournament type in the eighth grade students of PKBM Sahabat Karanganyar in academic year of 2016/2017.
KAJIAN PSIKOLOGI SASTRA DAN NILAI PENDIDIKAN KARAKTER NOVEL RANTAU 1 MUARA KARYA AHMAD FUADI SERTA RELEVANSINYA SEBAGAI MATERI AJAR APRESIASI SASTRA DI SMA
Authors: Azizah Nisa’ A’fifatul , Waluyo Herman J , Ulya Chafit
Published: December 2019

This study aims to describe and explain (1) the intrinsic element of novel Rantau 1 Muara by Ahmad Fuadi, (2) the emotional condition of the character depicted in the novel Rantau 1 Muara by Ahmad Fuadi according to Sigmund Freud’s theory, (3) the values of character education contained in the novel Rantau 1 Muara by Ahmad Fuadi, (4) the relevancy of novel Rantau 1 Muara by Ahmad Fuadi as a teaching material for literary appreciation class in Senior High School level. This study used a descriptive qualitative method with literary psychology approach. Data collection was carried out with document analysis techniques and indept interviews. The validity data test has been done using triangulation theory technique and data triangulation. The analysis of data was conducted using flow analysis i.e, the data reduction, data presentation, and conclutions determination. The results of the study are (1) the intrinsic elements that build the novel Rantau 1 Muara are theme, characterizations, plot, settings, and author’s point of view; (2) the emotional  conditions experienced by characters in the novel Rantau 1 Muara are influenced by three elements i.e, id, ego, and superego; (3) the value of character education that contained in the novel Rantau 1 Muara there are 13 values including religious, honest, tolerance, discipline, hardwork, independent, curiosity, spirit of nationality, love the country, friendly/ communicate, like reading, concern to social issue, and responsibly; (4) novel Rantau 1 Muara can be used as an alternative teaching material of literary appreciation class in Senior High School level.
Lunate Excision with Partial Bicolumnar Wrist Fusion: A New Alternative for Isolated Radiolunate Arthritis?
Authors: El Abiad Rami , Rizkallah Maroun , Issa El Khoury Fouad , El Rayes Johnny , Maalouf Peter
Published: December 2019

Case:

We report the case of 2 patients presenting with advanced isolated radiolunate arthritis with limited wrist strength and range of motion (ROM). After failure of conservative therapy, both patients underwent lunate excision and scaphocapitate and triquetrohamate joints fusion using compression headless screws. Improved functional outcomes are reported at 4 years of follow-up with painless wrists and increased grip strength and ROM.

Conclusions:

Lunate excision and partial bicolumnar wrist fusion lead to increased grip strength and wrist ROM. This is a unique alternative for people suffering isolated radiolunate osteoarthritis, for which no standard surgical care exists.
Complete Avulsion of Quadriceps Tendon in a Child with Juvenile Idiopathic Arthritis
Authors: Yousef Mohamed A. , Rosenfeld Scott
Published: December 2019

Case:

We report a rare case of complete avulsion of the quadriceps tendon in an 8-year-old child with juvenile idiopathic arthritis (JIA). Our patient presented with acute onset of pain and effusion with a history of feeling a “pop” in the knee after a fall while playing kickball. Although knee radiographs showed a cortical irregularity involving the superior patellar pole, it was assumed that the symptoms were a result of a JIA flare rather than an acute injury. Complete quadriceps disruption was later diagnosed by magnetic resonance imaging, and surgical repair was performed.

Conclusions:

Complete rupture of the quadriceps tendon is an unusual, disabling injury in children that necessitates prompt diagnosis and early surgical repair. High index of suspicion and thorough physical evaluation are essential for the diagnosis of such injuries, especially in children with complex medical conditions.
Ultrasound-Guided Suction Technique for Trauma-Related Large Consolidated Buttock Hematoma
Authors: Kim Chul-Ho , Kim Yoonseok , Kim Jaeyoung
Published: December 2019

Case:

Occasionally, a large, deep, consolidated hematoma is hard to evacuate without an incision, yet there are concerns about possible complications of surgical removal. We present a case of a 21-year-old military recruit with a large submuscular buttock hematoma that was successfully treated with an ultrasound-guided suction technique under local anesthesia using only a stab incision.

Conclusions:

The ultrasound-guided suction technique for a large hematoma was safe and effective in this patient.
Acetabular Fracture Around a Birmingham Hip Resurfacing Prosthesis
Authors: Joseph Noah M. , Benedick Alexander , Ochenjele George
Published: December 2019

Case:

A traumatic displaced transverse periprosthetic acetabular fracture around a well-functioning Birmingham hip resurfacing prosthesis was treated with open reduction and internal fixation. The acetabular component was found to be well-fixed intraoperatively and did not require revision. The patient recovered with excellent clinical and radiographic results at the 1-year follow-up with a Harris Hip Score of 94.

Conclusions:

Internal fixation, rather than revision arthroplasty, offers acceptable outcomes in patients with periprosthetic acetabular fractures about well-fixed hip resurfacing prostheses. Radiographic and intraoperative assessment of stability is critical in guiding treatment.
Influence of the Maryland All-Payer Model on Primary Total Knee Arthroplasties
Authors: Delanois Ronald E. , Etcheson Jennifer I. , Dávila Castrodad Iciar M. , Mohamed Nequesha S. , Pollak Andrew N. , Mont Michael A.
Published: December 2019

Update

This article was updated on September 10, 2020 because of previous errors. In Tables I and II, on pages 2 and 3, data observations with a count of £10 were reported in individual table cells, which is against a provision of the State Data Use Agreement put forth by the Agency for Healthcare Research and Quality. Thus, all values of £10 have been replaced by a symbol pointing to the footnote: “Censored in accordance with the Agency for Healthcare Research and Quality Data Use Agreement to maintain patient confidentiality.”

An erratum has been published: JBJS Open Access. 2020;5(3):e19.00041ER.

Background:

In 2014, Maryland received a waiver for the Global Budget Revenue (GBR) program. We evaluated GBR’s impact on patient and hospital trends for total knee arthroplasty (TKA) in Maryland compared with the U.S. Specifically, we examined (1) patient characteristics, (2) inpatient course, and (3) costs and charges associated with TKAs from 2014 through 2016.

Methods:

A comparative analysis of TKA-treated patients in the Maryland State Inpatient Database (n = 36,985) versus those in the National Inpatient Sample (n = 2,117,191) was performed. Patient characteristics included race, Charlson Comorbidity Index (CCI), morbid obesity, patient income status, and primary payer. Inpatient course included length of hospital stay (LOS), discharge disposition, and complications.

Results:

In the Maryland TKA cohort, the proportion of minorities increased from 2014 to 2016 while the proportion of whites decreased (p = 0.001). The proportion of patients with a CCI of ≥3 decreased (p = 0.014), that of low-income patients increased (p < 0.001), and that of patients covered by Medicare or Medicaid increased (p < 0.001). In the U.S. TKA cohort, the proportion of blacks increased (p < 0.001), that of patients with a CCI score of ≥3 decreased (p < 0.001), and the proportions of low-income patients (p < 0.001) and those covered by Medicare or Medicaid increased (p < 0.001). In both Maryland and the U.S., the LOS (p < 0.001) and complication rate (p < 0.001) decreased while home-routine discharges increased (p < 0.001). Costs and charges decreased in Maryland (p < 0.001 for both) whereas charges in the U.S. increased (p < 0.001) and costs decreased (p < 0.001).

Conclusions:

While the U.S. health reform and GBR achieved similar patient and hospital-specific outcomes and broader inclusion of minority patients, Maryland experienced decreased hospital charges while hospital charges increased in the U.S.

Level of Evidence:

Economic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Effect of water flow on growth of Catla catla (Hamilton, 1822) reared in recirculatory aquaculture system
Authors: Nagar Pankaj , Mishra Ashutosh , Kumar Prem , Tewari Hema , Ram R.N.
Published: December 2019

Production performance of the Indian major carp, catla Catla catla (Hamilton, 1822) was examined at different water flow rates in recirculatory aquaculture system (RAS), in Tarai region of Uttarakhand. The experiment was conducted in 12 FRP tanks of RAS with sand filter and UV filters, with four treatments and three replicates for each treatment viz., control, T0 (83 l h-1 or one time in two days); T1 (667 l h-1 or 4 times in a day); T2 (333 l h-1 or 2 times in a day) and T3 (167 l h-1 one time in a day) from November 2015 to April 2016. The fingerlings of catla having uniform body weight (10.00±0.6 g) were stocked randomly in all treatment groups at the rate of 25 no.m-3. Physical properties of water such as water temperature, electrical conductivity and total dissolved solids were analysed weekly throughout the experimental period and ranged from 15.8 to 27.8°C, 271 to 384.3 µS cm-1 and 216.3 to 274 mg l-l, respectively. Water parameters such as pH, dissolve oxygen, free carbon dioxide, alkalinity, hardness, ammonia, nitrate and phosphate were also analysed which varied from 7.2 to 8.4, 5.4 to 7.9 mg l-l, 1.8 to 3 mg l-l, 118 to 167.3 mg l-l, 133.3 to 241.6 mg l-l, 0.02 to 0.08 mg l-l, 0.11 to 0.42 mg l-l and 0.02 to 0.08 mg l-l respectively. The best food conversion ratio (FCR) was recorded in T0 (1.61) followed by T3 (1.65), T1 (1.70) and T2 (1.81). Highest specific growth rate (SGR) was recorded in T2 (0.88%), followed by T1 (0.86%), T3 (0.85%) and T0 (0.84%). The best protein efficiency ratio (PER) was recorded in T2 (2.31) followed by T3 (2.54), T1 (2.56) and T0 (2.62). Among different treatment groups, the survival rate of catla varied from 78 in T0 to 83% in T1.. Significantly higher (p<0.05) growth performance of catla was recorded in T2 as compared to other tanks.
Biometric studies of Ailia coila (Hamilton, 1822) from river Brahmaputra, Assam, India
Authors: Sogoi Pranab , Chakraborty S.K. , Bhattacharjya B.K. , Sharma S.K. , Ramteke M.
Published: December 2019

For the study of length-weight relationship, morphometric and meristic characters, a total of 711 specimens (196 male and 515 female) of the Gangetic ailia, Ailia coila (Hamilton, 1822) were collected from Uzanbazar and Dhubri landing centres of river Brahmaputra, Assam during September 2013 to April 2014. The length and weight of males ranged from 66 to 154 mm and 1.218 to 20.5309 grespectively and that of females ranged from 66 to 161 mm and 1.4344 to18.2907 g respectively. The length-weight relationship was established as W = 0.002773 L 3.189306 and W = 0.005794 2.86234 for male and female, respectively. The analysis of covariance showed significant difference in ‘b’ values between sexes and student ‘t’ test indicated positive allometric growth for male and isometric growth for female. The morphometric characters were compared; showed maximum co-efficient of correlation (r) in standard and pre-dorsal length (0.98) while lowest was observed in mandibular barbel length (0.69) against the total length. Based on the study of meristic traits, the fin formula can be written as B6, P12-15, V5-6, C14-18, A61-75, GR17-24. The minor variations in meristic and morphometric characters could be attributed to genetic components and difference in geographical and environmental parameters like temperature and food availability. The study will helpful in identification of stock and stock-specific management strategies of this species in river Brahmaputra, Assam.
Feeding diets with graded levels of fermented soybean meal to Pacific whiteleg shrimp Penaeus vannamei (Boone, 1931): Effect on digestive enzymes, immune responses and carcass composition
Authors: Jannathulla SR. , Imran Khan H. , Thulasi D. , Kathyayani S. , Ambasankar K. , Panigrahi A. , Muralidhar M. , Syama Dayal J.
Published: December 2019

A 45-days indoor trial was performed to assess the effect of fermented soybean meal (FSBM) on digestive enzyme activity, immune responses and carcass composition of amino acids, fatty acids, and minerals in Penaeus vannamei (Boone, 1931). Five iso-nitrogenous diets were formulated by replacing fishmeal (w/w) with FSBM (200, 250, 300. 350 and 400 g kg-1). A total of 300 juveniles (3.08±0.07 g) were randomly distributed to the experimental tanks at the rate of twenty shrimp per tank with three replications for each treatment. Protease activity (p<0.05) decreased with increase in the inclusion level of fermented ingredients. Shrimp fed with FSBM300 diet had a significantly (p<0.05) higher amylase activity than others. Whereas, the lipase activity was not affected significantly due to the dietary change. Total haemocyte count varied from 11.24 to18.54x106 cells ml-1 in FSBM diet fed shrimps. Control group showed highest activity of phenoloxidase (2.85 dopochrome ml-1) but it did not significantly differ from other treatments. Shrimp fed fermented ingredients had no significant difference in carcass amino acids. Eicosapentaenoic (C20:5) and docosahexaenoic acids (C22:6) were significantly (p<0.05) affected in shrimp reared with FSBM350 and FSBM400 diets. Calcium had a significant difference between the treatments, while other elements were not influenced. The results concluded that fishmeal could be partially substituted with fermented ingredients in the diet of P. vannamei without having any negative effect on immune responses and carcass micro-nutrients.
Liver transplantation in Jehovah’s witnesses: 13 consecutive cases at a single Institution
Authors: Costanzo Diego , Bindi Maria , Ghinolfi Davide , Esposito Massimo , Corradi Francesco , Forfori Francesco , De Simone Paolo , De Gasperi Andrea , Biancofiore Gianni
Published: December 2019

Background. Jehovah's Witnesses represent a tremendous clinical challenge when indicated to liver transplantation because they refuse blood transfusion on religious grounds and the procedure is historically associated with potential massive peri-operative blood loss. We herein describe a peri-operative management pathway with strategies toward a transfusion-free environment with the aim not only of offering liver transplant to selected Jehovah's Witnesses patients but also, ultimately, of translating this practice to all general surgical procedures.Methods. This is a retrospective review of prospective medical records of JW patients who underwent LT at our Institution. The peri-operative multimodal strategy to liver transplantation in Jehovah's Witnesses includes a pre-operative red cell mass optimization package and the intra-operative use of normovolemic haemodilution, veno-venous bypass and low central venous pressure. Results In a 9-year period, 13 Jehovah’s Witness patients received liver transplantation at our centre representing the largest liver transplant program from deceased donors in Jehovah's Witnesses patients reported so far. No patient received blood bank products but 3 had fibrinogen concentrate and one tranexamic acid to correct ongoing hyper-fibrinolysis. There were 4 cases of acute kidney injury (one required extracorporeal renal replacement treatment) and one patient needed vasoactive medications to support blood pressure for the first 2 postoperative days. Two patients underwent re-laparotomy. Finally, of the 13 recipients, 12 were alive at the 1 year follow-up interview and 1 died due to septic complications. Conclusions. Our experience confirms that liver transplantation in selected Jehovah's Witnesses patients can be feasible and safe provided that it is carried out at a very experienced centre and according to a multidisciplinary approach
Prepared for PrEP: Preferences for HIV pre-exposure prophylaxis among Chinese men who have sex with men in an online national survey
Authors: Huang Wenting , Wu Dan , Ong Jason O. , Smith M. Kumi , Yang Fan , Fu Hongyun , Tang Weiming , Tucker Joseph D.
Published: December 2019

Background: Pre-exposure prophylaxis (PrEP) is not widely available in China. Previous studies reported low awareness and inconclusive findings on the acceptability of PrEP among Chinese men who have sex with men (MSM). Methods: We conducted a secondary analysis of an online national survey comparing preferences for oral and long-acting injectable PrEP among MSM and identifying correlates of preferences. The study did not collect detailed information about partner types that may influence negotiated safety and PrEP uptake. Results: Nine-hundred and seventy-nine men from the larger sample of 1045 men responded to the PrEP survey questions. Most men (81.9%) had never heard of PrEP, but reported interest in using PrEP. More participants chose injectable PrEP (36.3%) as their preferred formulation than oral PrEP (24.6%). Men who had at least two HIV tests (adjusted OR = 1.36, 95%CI 1.04, 1.78) more commonly preferred injectable PrEP. Conclusion: Our findings may help inform PrEP messaging in areas where PrEP has yet to be scaled up.
Acceptability and Appropriateness of a Perinatal Depression Preventive Group Intervention: A Qualitative Analysis
Authors: Diebold Alicia , Segovia Melissa , Johnson Jessica K. , Degillio Aria , Zakieh Dana , Park Hee Jin , Lim Kenneth , Tandon S. Darius
Published: December 2019

Background Perinatal depression is a prevalent public health concern. Although preventive interventions exist, there is limited literature on the acceptability and appropriateness of these interventions, especially those delivered by paraprofessionals. The Mothers and Babies Program (MB) is a group-based perinatal depression preventive intervention delivered prenatally. A current cluster-randomized controlled trial is examining the acceptability, appropriateness, and effectiveness of MB delivered by mental health professionals compared to paraprofessional staff from home visiting programs. Methods The full study enrolled 874 pregnant women. Fifty-three facilitators were trained and delivered the MB intervention to women in one of seven states in the United States. Semi-structured interviews were attempted with a randomly-selected subset of the full sample of pregnant women who received the MB intervention and with all facilitators. Specifically, interviews were conducted with 88 women who received the MB group intervention (45 in the paraprofessional-led arm and 43 in the mental health professional-led arm) and 46 women who facilitated the groups (27 home visiting staff and 19 mental health professionals). Interviews were conducted over the phone in English or Spanish and audio recorded. The recordings were translated into English, as needed, and transcribed. Thematic analysis was conducted using NVIVO to identify key themes related to intervention acceptability and appropriateness. Similarities and differences between study arms were explored. Results Clients and facilitators found the MB content and group format acceptable. Challenges included maintaining group attendance, transportation issues, and managing group discussion. Overall, facilitators found the intervention appropriate for pregnant clients with some challenges presented for clients in crisis situations, experiencing housing instability, and with literacy and learning challenges. Participants provided suggestions for improvement, both for the course content and implementation. There were no significant differences found between study arms. Conclusions Overall, clients and facilitators enjoyed MB irrespective of study arm, and facilitators found the intervention appropriate for the population. These findings add to the qualitative literature on perinatal depression preventive interventions, specifically those delivered by paraprofessionals.
Forced Treadmill Running Reduces Systemic Inflammation Yet Worsens Upper Limb Discomfort in a rat model of Work-Related Musculoskeletal Disorders
Authors: Smith Tianqi Tenchi Gao , Barr-Gillespie Ann E , Klyne David M , Harris Michelle Y , Amin Mamta , Paul Ryan W , Cruz Geneva E , Gallagher Sean , Zhao Huaqing , Barbe Mary Frances
Published: December 2019

Background: Musculoskeletal disorders can result from prolonged repetitive and/or forceful movements. Performance of an upper extremity high repetition high force task increases serum pro-inflammatory cytokines and upper extremity sensorimotor declines in a rat model of work-related musculoskeletal disorders. Since one of the most efficacious treatments for musculoskeletal pain is exercise, this study investigated the effectiveness of treadmill running in preventing these responses. Methods: Twenty-nine young adult female Sprague-Dawley rats were used. Nineteen were trained for 5 weeks to pull a lever bar at high force (15 min/day). Thirteen went on to perform a high repetition high force reaching and lever-pulling task for 10 weeks (10-wk HRHF; 2 hrs/day, 3 days/wk). From this group, five were randomly selected to undergo forced treadmill running exercise (TM) during the last 6 weeks of task performance (10-wk HRHF+TM, 1 hr/day, 5 days/wk). Results were compared to 10 control rats and 6 rats that underwent 6 weeks of treadmill running following training only (TR-then-TM). Voluntary task and reflexive sensorimotor behavioral outcomes were assessed. Serum was assayed for inflammatory cytokines and corticosterone, reach limb median nerves for CD68+ macrophages and extraneural thickening, and reach limb flexor digitorum muscles and tendons for pathological changes. Results: 10-wk HRHF rats had higher serum levels of IL-1α, IL-1β and TNFα, than control rats. In the 10-wk HRHF+TM group, IL-1β and TNFα were lower, whereas IL-10 and corticosterone were higher, compared to 10-wk HRHF only rats. Unexpectedly, several voluntary task performance outcomes (grasp force, reach success, and participation) worsened in rats that underwent treadmill running, compared to untreated 10-wk HRHF rats. Examination of forelimb tissues revealed lower cellularity within the flexor digitorum epitendon but higher numbers of CD68+ macrophages within and extraneural fibrosis around median nerves in 10-wk HRHF+TM than 10-wk HRHF rats. Conclusions: Treadmill running was associated with lower systemic inflammation and moderate tendinosis, yet higher median nerve inflammation/fibrosis and worse task performance and sensorimotor behaviors. Continued loading of the injured tissues in addition to stress-related factors associated with forced running/exercise likely contributed to our findings.
Doctors experiences on the quality of care for pesticide poisoning patients in hospitals in Kampala, Uganda: a qualitative exploration using donabedian’s model
Authors: Ssemugabo Charles , MPH Sarah Nalinya , Halage Abdullah Ali , Neebye Ruth Mubeezi , Musoke David , Jørs Erik
Published: December 2019

Background: Pesticides are responsible for a significant percentage of deaths globally with majority occurring in sub-Saharan Africa. Deaths due to pesticide poisoning can be reduced if poisoning cases are managed optimally. However, the quality of care given to pesticide poisoning patients is still insufficient especially in sub-Saharan Africa. This study was aimed at exploring doctors’ experiences on quality of care for pesticide poisoning cases in hospitals in Kampala, Uganda.
Methods: Fifteen (15) in-depth interviews were conducted with doctors who were directly involved in management of pesticide poisoning patients in the accident and emergency, Medicine, Pediatrics and Intensive Care Unit wards in 5 hospitals in Kampala, Uganda. All interviews were transcribed and subjected to directed content analysis with the guidance of the Donabedian model of quality of care which emphasizes structure, process and outcome measures as pertinent ensuring quality care.
Results: Doctors reported structural, process and outcome facets that support diagnosis and treatment of pesticide poisoning cases improved the quality of care provided by doctors. Among the structures includes hospital units such as Intensive Care Unit (ICU), pediatrics and internal medicine; equipment and clinical guidelines such as airway, breathing and consciousness (ABC) protocol; and doctors’ knowledge and experiences. Doctors relied on history, and signs and symptoms to establish the cause and severity of pesticide poisoning. However, some patients and caretakers provided inaccurate pesticide poisoning history. Due to its availability in hospitals, doctors largely relied on atropine to manage pesticide poisoning cases whether or not relevant to treat the actual pesticide poisoning. Although majority of the cases treated recovered, those due to suicide were further referred to the hospital psychiatrist. Sharing experiences of managing pesticide poisoning patients among health workers and engaging in sensitization outreaches against pesticide poisoning were reported as potential activities to improve quality of care for pesticide poisoning patients.
Conclusion: Doctors reflected on the structure, process and outcome measures of quality of care given to pesticide poisoning patients. The implications of hospital structures and clinical process to the quality of the outcomes of care demonstrates their importance to improve management of pesticide poisoning cases in hospitals in Kampala, Uganda.
Microscopic features of small bowel mucosa of patients with Crohn’s disease
Authors: Cui Yun , Lu Shi-yuan , Xu Jie , Peng Yan-shen , Miao Qi , Wang Xiao-Qing , Chen Xiao-yu , Ran Zhi-hua
Published: December 2019

Background Double-balloon enteroscopy enables performing numerous small bowel biopsies for pathologic analysis. However, most histopathological characteristics of Crohn’s disease are non-specific characteristics. We aimed to explore the small bowel mucosal histopathologic characters of Crohn’s disease and identify some disease-specific changes.Methods We included 253 patients without tumors and grouped them into Crohn’s disease, suspected Crohn’s disease, and non-Crohn’s disease groups. These patients underwent double-balloon endoscopy examination and small bowel biopsy at Renji Hospital, Shanghai. All histopathological sections were reviewed, and >20 histopathological parameters were assessed. Immunohistochemistry was conducted when necessary.Results There were different forms of granulomatous lymphangitis on the small bowel mucosa in Crohn’s disease. They showed as various macrophages or epithelioid cells in the lumina of lymphatics or in the center of the villi with or without evident obstruction. These features were only observed in Crohn’s disease patients. Furthermore, they were correlated with granuloma and lymphangiectasia. Additionally, 15 other features showed significant differences among the three groups, and Crohn’s disease patients showed an average of almost seven histopathological characteristics.Conclusions We described the detailed morphologies of granulomatous lymphangitis on the small bowel mucosa and recommend it as a useful histopathological feature for the diagnosis of Crohn’s disease. In terms of specificity and sensitivity, it was superior to non-caseating epithelioid granuloma.
Increased songbird nest depredation due to Aleppo pine (Pinus halepensis) encroachment in Mediterranean shrubland
Authors: Ben-David Asaf , Shamon Hila , Izhaki Ido , Efronny Roni , Maor Roi , Dayan Tamar
Published: December 2019

Background In recent decades, a decrease of passerine densities was documented in Mediterranean shrublands. At the same time, a widespread encroachment of Aleppo pines ( Pinus halepensis ) to Mediterranean shrubland occurred. Such changes in vegetation structure may affect passerine predator assemblage and densities, and in turn impact passerine densities. Depredation during the nesting season is an important factor to influence passerine population size. Understanding the effects of changes in vegetation structure (pine encroachment) on passerine nesting success is the main objective of this study. We do so by assessing the effects of Aleppo pine encroachment on Sardinian warbler ( Sylvia melanocephala ) nest depredation in Mediterranean shrublands. We examined direct and indirect predation pressures through a gradients of pine density, using four methods: (1) placing dummy nests; (2) acoustic monitoring of mobbing events; (3) direct observations on nest predation using cameras; and (4) observation of Eurasian jay ( Garrulus glandarius ) behaviour as indirect evidence of predation risk.
Results We found that Aleppo pine encroachment to Mediterranean shrublands increased nest predation by Eurasian jays. Nest predation was highest in mixed shrubland and pines. These areas are suitable for warblers but had high occurrence rate of Eurasian jays.
Conclusions Encroaching pines directly increase activity of Eurasian jays in shrubland habitats, which reduced the nesting success of Sardinian warblers. These findings are supported by multiple methodologies, illustrating different predation pressures along a gradient of pine densities in natural shrublands. Management of Aleppo pine seedlings and removal of unwanted trees in natural shrubland might mitigate arrival and expansion of predators and decrease the predation pressure on passerine nests.
Measurement of cerebrovascular reserve by multimodal imaging for cerebral arterial occlusion or stenosis patients: protocol of a prospective, randomized, controlled clinical trial
Authors: zhipeng xiao , ke ji , yong lin , jieqing wan , yaohua pan , yichao jin , xiaohua zhang
Published: December 2019

Background Cerebrovascular reactivity (CVR), index of cerebral hemodynamics, might guide the treatment of ischemic stroke. However, the previous studies that the therapeutic strategy of stroke mainly depends on the degree of vascular stenosis with steady-state vascular parameters, such as cerebral blood flow, and CVR factors are not under consideration. Measurement of CVR by multimodal image might improve the prognosis for ischemic stroke. Methods/design The study is a prospective, randomized, paralleled controlled clinical trial to examine the multimodal image evaluation for CVR. A total of 66 eligible patients will be recruited from Renji hospital, Shanghai Jiaotong University School of Medicine. The patients will be categorized based on CVR into two subgroups as follows: CVR>10% group and CVR<10% group. And the patients will be randomly assigned to medical management, percutaneous transluminal angioplasty and stenting, and intracranial and extra-cranial bypass groups in a 1:1:1 ratio. The primary end point is all adverse events and ipsilateral stroke recurrence at 6, 12, 24 months after the management. The secondary outcomes include the CVR, the National Institute of Health stroke scale and the Modified Rankin Scale at 6, 12, 24 months. Discussion Measurement of cerebrovascular reserve by multimodal image is recommended by most recent studies to guide the treatment of ischemic stroke, and thus its efficacy and evaluation accuracy need to be established in randomized controlled settings. This prospective, randomized, paralleled controlled registry study, together with other ongoing studies, will present more evidence for optimal individualized accurate treatment of ischemic stroke.
TOPK Promotes Metastasis of Esophageal Squamous Cell Carcinoma by Activating the Src/GSK3β/STAT3 Signaling Pathway via γ-Catenin
Authors: Jiang Yanan , Zhang Jing , Zhao Jimin , Li Zhenzhen , Chen Hanyong , Qiao Yan , Chen Xinhuan , Liu Kangdong , Dong Ziming
Published: December 2019

Background
Esophageal squamous cell carcinoma (ESCC) is a fatal disease with poor prognosis. The predominant reason for ESCC-related death is distal metastasis. A comprehensive understanding of the molecular mechanism underlying metastasis is needed for improving patient prognosis. T-LAK cell-originated protein kinase (TOPK) is a MAPKK-like kinase, which plays a vital role in various physiological and pathophysiological processes. However, the role of TOPK in ESCC metastasis is unclear.
Methods
Tissue array was used to evaluate the correlation between TOPK expression and ESCC lymph node metastasis. Wound healing assay, transwell assay, and lung metastasis mice model were used to examine the role of TOPK in the migration of ESCC cells in vitro and in vivo. Protein kinase array, mass spectrometry (MS), and molecular modeling were used to examine the pathways and direct target proteins of TOPK that are involved in ESCC metastasis. Additionally, immunofluorescence and western blotting analyses were performed to verify these findings.
Results
The enhanced expression of TOPK was correlated with lymph node metastasis in the ESCC tissues. TOPK knockdown or treatment with the TOPK inhibitor (HI-TOPK-032) decreased the invasion and migration of ESCC cells in vitro. HI-TOPK-032 also inhibited the lung metastasis in ESCC cell xenograft in vivo model. Moreover, TOPK promoted the invasion of ESCC cells by activating the Src/GSK3β/STAT3 and ERK signaling pathways via γ-catenin.
Conclusion
The findings of this study reveal that TOPK is involved in ESCC metastasis and promoted the ESCC cell mobility by activating the Src/GSK3β/STAT3 and ERK signaling pathways. This indicated that TOPK may be a potential molecular therapeutic target for ESCC metastasis.
Efficacy and safety of Guhong injection for treating the Coronary microvascular disease:study protocol for a randomized controlled trial
Authors: Zhuang Jieqin , Liu Shuling , Cai Hairong , Dai Xingzhen , Chen Yanhong , Jin Zilin , Chen Bojun
Published: December 2019

Background: Coronary microvascular disease (CMVD) refers to cardiovascular diseases with normal coronary angiography but evidence of myocardial ischemia or microcirculation lesions, often presenting as angina pectoris attack. Coronary artery of microtubules dysfunction is one of the pathogenesis of coronary heart disease,but the occurrence and development and the current of CMVD intervention therapy remains to be further researched.Chinese traditional medicine (TCM)has advantages in the treatment of cardiovascular diseases, therefore, this article describes an ongoing randomized controlled clinical trial, based on the theory of TCM, for the purpose of evaluating the efficacy and safety of Guhong injection ,a Chinese patent medicine,compared with placebo in patients suffering from CMVD.
Methods/design: This is a multicenter, randomized, parallel arm, open-label, double-blind, placebo-controlled clinical trial. A total of 260 eligible patients will be allocated and randomly assigned, in a ratio of 1:1, to either the experimental group or the control group. The treatment course is 10 consecutive days, with a 8-week follow-up. The primary outcome is the frequency of angina attacks, Secondary outcomes include myocardial metabolites, ecg changes, quantitative score of TCM syndromes, inflammatory response and endothelial function indicators.
Discussion: This trial is strictly designed in accordance with principles and regulations issued by the China Food and Drug Administration (CFDA). The results will provide high quality evidence on the efficacy and safety of Guhong injection in the treatment of CMVD.
Trial registration: Chinese Clinical Trials Registry, ChiCTR1900022902. Registered on 27 April 2019.
Keywords: Guhong injection, Coronary microvascular disease, randomized controlled trial, inflammatory response,endothelial function
A Retrospective Analysis on Metastatic Rate of the Internal Mammary Lymph Node and Its Clinical Significance in Adjuvant Radiotherapy of Breast Cancer Patients
Authors: Li Li , Zhang Hongyan , Wang Linwei , xie Conghua , Zhou Yunfeng , Zhong Yahua
Published: December 2019

Background: There is a discrepancy about the metastatic rate of internal mammary lymph nodes (IMNs) between clinical and pathologic findings. We aimed to investigate the metastatic rate of IMNs and to provide recommendations on target volume delineation of IMNs for adjuvant radiotherapy in breast cancer patients. Methods: We retrospectively analyzed data from 114 breast cancer patients treated with surgery without adjuvant radiotherapy who developed local and/or regional lymph node recurrence/metastasis at our institute from January 2015 to January 2019. Patients with widely lung or pleural metastases were excluded. We first analyzed the recurrence rate with the chest wall, the metastatic rate of internal mammary/anterior mediastinal, ipsilateral axillary and supraclavicular lymph nodes, and then investigated the distribution of the IMNs. Results: Among the 114 included patients, the recurrence rate with the chest wall, metastatic rate of IMNs, IMNs/anterior mediastinal lymph nodes, ipsilateral axillary lymph nodes, and the ipsilateral supraclavicular lymph nodes was 43%, 37.7%, 59.6%, 12.3%, and 22.8%, respectively. The metastatic IMNs were mainly located from the first to the second intercostal space. However, metastatic lymph nodes could also be observed above the upper edge of the first rib. Conclusions: The metastatic rate is high in the IMNs and irradiation of the internal mammary lymphatic chain is required. It is suggested that the upper bound of the internal mammary lymphatic chain should be up to the subclavian vein with a 5-mm margin, thus connecting to the caudal border of supraclavicular clinical target volume in breast cancer patients at high risk of recurrence.
Performance of ultrasonography screening for breast cancer: a systematic review and meta-analysis
Authors: Yang Lei , Wang Shengfeng , Zhang Liwen , Sheng Chao , Song Fengju , Huang Yubei
Published: December 2019

Background To investigate the performance of primary ultrasound (US) screening for breast cancer, and that of supplemental US screening for breast cancer after negative mammography (MAM).Methods Electronic databases (PubMed, Scopus, Wed of Science, and Embase) were systematically searched to identify relevant studies published between January 2003 and May 2018. Only high-quality or fair-quality studies reporting any of the following performance values for supplemental or primary US screening were included: sensitivity, specificity, cancer detected rate (CDR), recall rate (RR), biopsy rate (BR), and proportions of invasive cancers (ProIC) or node-positive cancers (ProNPC) among screening-detected cancers.Results Twenty-three studies were included, including 12 studies in which supplemental US screening was used after negative MAM and 11 joint screening studies in which both MAM and US were used as primary screening methods. Meta-analyses revealed that supplemental US screening could detect 96% [95% confidential intervals (CIs): 82% to 99%] of occult breast cancers missed by MAM and identify 94% (95% CIs: 88% to 97%) of healthy women, with a CDR of 2.9/1000 (95%CIs: 1.8/1000 to 3.9/1000), RR of 8.6% (95%CIs: 4.8% to 13.5%), BR of 3.9% (95%CIs: 2.5% to 5.5%), ProICof 73.9% (95%CIs: 49.0% to 93.7%), and ProNPC of 72.6% (95%CIs: 51.9% to 90.0%). Compared with primary MAM screening, primary US screening led to the recall of significantly more women with positive screening results [1.2% (95%CIs:0.4% to 1.9%), P =0.004] and detected significantly more invasive cancers [20.2% (95%CIs: 7.2% to 33.1%), P = 0.002]. However, there were no significant differences for other performance measures between the two screening methods, including sensitivity, specificity, CDR, BR, and ProNPC.Conclusions Supplemental US screening could detect occult breast cancers missed by MAM, while primary US screening would be considered as comparable to primary MAM screening in certain subgroup of women, but with a higher recall rate and a higher detection rate for invasive cancers.
Clinical and histologic tissue responses of skin incisions closed with glycomer 631 and lactomer 9-1 using subcuticular technique in pigs
Authors: Plavec Tanja , Švara Tanja , Zdovc Irena , Gombač Mitja , Damjanovska Marija , Pintarič Tatjana Stopar , Cvetko Erika , Seliškar Alenka
Published: December 2019

Background: Glycomer 631 and lactomer 9-1 are absorbable suture materials indicated for soft tissue approximation in non-infected wounds. Pigs are often used as surgical models in translational research, however, the reports of tissue reactions to both suture materials in pigs are limited. The aim of this study was to assess clinical and histologic responses of skin incisions closed with subcuticular technique using glycomer 631 and lactomer 9-1 in pigs.
Results: Skin incisions of 17 pigs were closed with glycomer 631 and lactomer 9-1 and clinical reactive score (CRS) including erythema, swelling, discharge, and dehiscence was calculated on postoperative days 7 and 14. Subcuticular tissue reaction was assessed histologically on postoperative day 14 (the presence of extravascular neutrophils, macrophages, multinucleated giant cells, lymphocytes, fibroblasts, bacterial colonies, overall severity of inflammatory response to suture material), and the cumulative score of variables calculated as aggregate tissue irritation score (ATIS). Tissue samples were examined for suture extrusion and evaluated microbiologically. Clinical reactive score did not differ between the suture materials. Only one variable of ATIS, overall severity of inflammatory response, was lower (p = 0.029) when glycomer 631 was used. Suture extrusion was found in 10/17 of incisions closed by glycomer 631 and in 7/13 of incisions closed by lactomer 9-1. Trueperella pyogenes was isolated from the skin and from the area of tissue reaction in six pigs.
Conclusions: No difference in CRS between the suture materials was observed. Glycomer 631 induced less tissue reaction only in terms of overall severity of inflammatory response. Suture extrusion was observed in more than 50% of incisions regardless of the suture material. Trueperella pyogenes was the only pathogen isolated from the tissue surrounding the suture material. Thinner suture material with less knots should be used for subcuticular closure in pigs.
WITHDRAWN: Integration of practice nurse competencies in general practices in Belgium: a qualitative evaluation study of a postgraduate program.
Authors: Matthys Evi , Bogaert Peter Van , Remmen Roy
Published: December 2019

Background Recently, first steps were taken to educate primary care nurses in Belgium and consequently specifically trained practice nurses have only just been introduced in Belgian general practices. Therefore, it is unclear what the experiences of general practitioners (GPs) and trained practice nurses (PNs) are concerning these new multidisciplinary collaborations. With this qualitative study we would like to report new insights in the visions and experiences of GPs and PNs concerning the new postgraduate education for PNs, the current and future roles and responsibilities taken on by trained PNs, and the experienced collaboration between GPs and trained PNs. Methods A qualitative research methodology was chosen, based on the principles of a descriptive qualitative research design. This study was conducted in primary healthcare in Belgium. Four focus group interviews were conducted. A total of twenty PNs and ten GPs participated. The PNs had followed or were currently following the postgraduate program for PNs, all the GPs were experienced in collaborating with a trained PN. Results Four major themes could be derived from the data: practice nurses’ roles and responsibilities, importance of protocol care, consequences of the collaboration, and future opportunities and perspectives. GPs expressed the importance of education for PNs, in order for them to take on more responsibilities in the practices. Trained PNs showed a lot of initiative towards taking on a broader range of tasks. They both expressed the importance of care protocols in support of a good multidisciplinary collaboration. The impact on the daily practice was experienced as far-reaching by GPs. While collaborating with trained PNs, GPs experienced the ability to provide a higher quality of care . Conclusion Both GPs and trained PNs have positive experiences about providing shared care in general practices. GPs were surprised by the initiative, shown by PNs, and by the broad range of tasks nurses took on. The impact of this collaboration on both the daily practice and the quality of patient care, is unanimously experienced as positive, even though it entails a higher workload. GPs have specific future expectations about the PN education and roles.