bluuebunny/crossref_metadata_2025 huggingface dataset:
Improving management of comorbidity in patients with colorectal cancer using comprehensive medical assessment: A pilot study
Authors: Signal Virginia , Jackson Christopher , Signal Louise , Hardie Claire , Holst Kirsten , McLaughlin Marie , Steele Courtney , Sarfati Diana
Published: November 2019

Background: Screening for and active management of comorbidity soon after cancer diagnosis shows promise in altering cancer treatment and outcomes for comorbid patients. Prior to a large multi-centre study, piloting of the intervention (comprehensive medical assessment) was undertaken to investigate the feasibility of the comorbidity screening tools and proposed outcome measures, and the feasibility, acceptability and potential effect of the intervention. Methods: In this pilot intervention study, 72 patients of all ages (36 observation/36 intervention) with newly diagnosed or recently relapsed colorectal adenocarcinoma were enrolled and underwent comorbidity screening and risk stratification. Intervention patients meeting pre-specified comorbidity criteria were referred for intervention, a comprehensive medical assessment carried out by geriatricians. Each intervention was individually tailored but included assessment and management of comorbidity, polypharmacy, mental health particularly depression, functional status and psychosocial issues. Recruitment and referral to intervention were tracked, verbal and written feedback were gathered from staff, and semi-structured telephone interviews were conducted with 13 patients to assess screening tool and intervention feasibility and acceptability. Interviews were transcribed and analysed thematically. Patients were followed for 6 - 12 months after recruitment to assess feasibility of proposed outcome measures (chemotherapy uptake and completion rates, grade 3 - 5 treatment toxicity, attendance at hospital emergency clinic, and unplanned hospitalisations) and descriptive data on outcomes collated. Results: Of the 29 intervention patients eligible for the intervention, 21 received it with feedback indicating that the intervention was acceptable. Those in the intervention group were less likely to be on 3+ medications, to have been admitted to hospital in previous 12 months, or to have limitations in daily activities. Collection of data to measure proposed outcomes was feasible with 55% (6/11) of intervention patients completing chemotherapy as planned compared to none (of 14) of the control group. No differences were seen in other outcome measures. Overall the study was feasible with modification, but the intervention was difficult to integrate into clinical pathways. Conclusions: This study generated valuable results that will be used to guide modification of the study and its approaches prior to progressing to a larger-scale study. Trial registration: Retrospective, 26 August 2019, ACTRN12619001192178.
How to collect non-medical data in a pediatric trial: diaries and interviews
Authors: JEANNIC Anaïs LE , Maoulida Hassani , Guilmin-Crépon Sophie , Alberti Corinne , Tubiana-Rufi Nadia , Durand-Zaleski Isabelle
Published: November 2019

Background: Non-medical data such as patients’ and caregivers’ time can be relevant to assess therapeutic strategies. For chronic pediatric conditions, patients’ and caregivers’ time spent in seeking and providing care (i.e. indirect cost in an economic evaluation) can be significantly different depending on the treatment arm. In order to explore methods to collect information on care burden for caregivers and patients, we investigated whether or not a patient diary provided additional information compared to retrospective investigator-led interviews and whether a diary filled intermittently produced more or less information than a continuous diary. The main objective of this study was to identify which type of data collection was most effective to measure caregivers’ time and estimate indirect treatment costs over a 9-month period.
Methods: Start-In! is a randomized controlled trial comparing the efficacy of three strategies of real-time continuous glucose monitoring (CGM) for 12 months in children and adolescents with type 1 diabetes. We designed an ancillary study to assess methods of patients’ and caregivers’ time (indirect costs): data entered was retrospectively in the case report form by investigators during quarterly follow-up visits, with the help of diaries filled prospectively by children or caregivers either continuously or intermittently. Data about absence from school and work as well as caregivers’ time for diabetes care were collected and comparisons carried out between the three collection methods.
Results: At the end of the 9-month study, 42% of study participants failed to return their diary. For the diaries that were received, less than 10 were contributive on top of the information entered on 82 patients directly by investigators .Based upon this information, we calculated that over 9 months, caregivers lost on average 3.9 days of working time, (€786), and 4 days of personal time, i.e. the equivalent of €526, as well as around 15 minutes of care per day, i.e. the equivalent of €1,700.
Conclusions: Data collection by investigators during quarterly visits cannot be replaced by a diary. The completion of diaries appeared to represent an important additional burden to children and their caregivers and provided limited additional information compared to investigators ‘entries in the CRF.
Trial registration: Start-In! trial registry name: Study of Insulin Therapy Augmented by Real Time Sensor IN Type 1 Children and Adolescents (START-IN!). ClinicalTrials.gov Identifier: NCT00949221. Registered on July 30, 2009.
The Prevalence, Awareness, Management and Control of Hypertension in Men and Women in Benin, West Africa: the TAHES study.
Authors: DESORMAIS ILEANA , Amidou Salimanou Ariyoh , Houehanou Yessito Corine , Houinato Stephan Dismand , Gbagouidi Gwladys Nadia , Preux Pierre Marie , Aboyans Victor , Lacroix Philippe
Published: November 2019

Background Sub-Saharan Africa is facing a growing burden of non-communicable diseases, including cardiovascular diseases (CVDs), due to epidemiological transitions. Among their risk factors, hypertension is a major determinant of CVDs, but the prevalence and level of awareness and management of this condition are poorly studied in African populations. The aim of this study was to determine the prevalence of hypertension and identify its associated risk factors as well as the awareness and management of this condition in a community-dwelling cohort in Benin. Methods A cross-sectional door-to-door study was conducted in the population over the age of 25 years in Tanve, a rural setting in Benin. The questionnaire and anthropometric measurements of the World Health Organization STEPWISE survey were used. Blood pressure was measured using standard procedures. Results The sample included 1777 subjects (60.9% females, mean age was 42.5±16.5 years). The prevalence of hypertension was 32.9%, similar in men (32.8%) and women (33.0%, p=0.9342). Age and obesity were significantly associated with hypertension. Less than half (42%) of hypertensive people were aware about their condition and only 46.3% of them were treated. Awareness ratios differed between men and women (respectively 32.9% vs. 47.5%; p= 0.0039) and was not influenced by age, education, occupation, marital status or income. Female sex was the only factor associated with better controlled HTN, independent of socio-economic parameters. Conclusion This large population-based study confirms the high prevalence, low awareness, and low control of hypertension in men and women in sub-Saharan Africa. Only half of the populations with hypertension are aware of their hypertension, indicating a high burden of undiagnosed and un-controlled high blood pressure in these populations.
Trauma induced tissue survival in vitro with a muscle-biomaterial based osteogenic organoid system: a proof of concept study
Authors: He Tao , Hausdorf Jörg , Chevalier Yan , Klar Roland Manfred
Published: November 2019

Background The translation from animal research into the clinical environment remains problematic, as animal systems do not adequately replicate the human in vivo environment. Bioreactors have emerged as a good alternative that can reproduce part of the human in vivo processes at an in vitro level. However, in vitro bone formation platforms primarily utilizes stem cells only, with tissue based in vitro systems remaining poorly investigated. As such, the present pilot study explored the tissue behavior and cell survival capability within a new in vitro skeletal muscle tissue-based biomaterial organoid bioreactor system to maximize future bone tissue engineering prospects. Results Three dimensional printed β-tricalcium phosphate/hydroxyapatite devices were either wrapped in a sheet of rat muscle tissue or first implanted in a heterotopic muscle pouch that was then excised and cultured in vitro for up to 30 days. Devices wrapped in muscle tissue showed cell death by day 15. Contrarily, devices in muscle pouches showed angiogenic and limited osteogenic gene expression tendencies with consistent TGF-ß 1 , COL4A1 , VEGF-A , RUNX-2 , and BMP-2 upregulation, respectively. Histologically, muscle tissue degradation and fibrin release was seen being absorbed by devices acting possibly as a support for new tissue formation in the bioceramic scaffold that supports progenitor stem cell osteogenic differentiation.Conclusions These results therefore demonstrate that the skeletal muscle pouch-based biomaterial culturing system can support tissue survival over a prolonged culture period and represents a novel organoid tissue model that with further adjustments could generate bone tissue for direct clinical transplantations.
Government Spending, Recession, and Suicide: Evidence from Japan
Authors: Matsubayashi Tetsuya , Sekijima Kozue , Ueda Michiko
Published: November 2019

Backgrounds: Austerity has been shown to have an adverse influence on people’s mental health and suicide rates. Most existing studies have focused on the governments’ reactions to a single event, for example, the Great Recession of 2008. Methods: This study focused on significant changes in fiscal policy between 2001 and 2014 in Japan. The size of expenditures by national and local governments decreased dramatically between 2001 and 2006 under the neoliberal reform and then increased after the global economic crisis and the Great East Japan Earthquake. Using the data from 47 prefectures between 2001 and 2014, we tested whether more spending by the local governments was associated with a lower suicide rate in their jurisdiction. We also investigated whether this relationship was particularly salient during a more severe recession. Results: Our analysis revealed that an increase of 1% in the per capita local government expenditures was associated with a decrease of 0.2% in the suicide rates among males and females aged between 40 and 64 and that this correlation was strengthened as the unemployment rate increased, particularly among males. Conclusions: Government’s reaction to economic crises can either exacerbate or mitigate the negative impact of the economic recession on people’s mental health and suicide rates.
Fatty acid biosynthesis and transcriptional regulation of Stearoyl-CoA Desaturase 1 (SCD1) in Buffalo milk
Authors: Li Zhipeng , Lu Suyu , Cui Kuiqing , Shafique Laiba , Rehman Saif ur , Luo Chan , Wang Zhiqiang , Liu Qingyou
Published: November 2019

Background: Nutritionally, buffalo milk is of immense importance due to high contents of fatty acid (FA), highly energetic and nutritive value. The composition of FA has been regarded as functional food component, which facilitate to manufacture a variety of processed milk products. Moreover, Buffalo milk contains more unsaturated FAs (UFA) such as oleic and linolenic acids, which have been shown to exert a number of physiological effects. However, inadequate information reported about the chemical composition and mechanism of FA synthesis in buffalo milk. Our conducted research hypothesize that, the expression of SCD1 gene could alter the biosynthesis of fatty acid (FA) in epithelial cells of mammary gland and subsequently affect the FA contents in buffalo milk. Present study investigated transcriptional and biological role of Stearoyl-CoA Desaturase 1 (SCD1) in the buffalo mammary epithelial cells (BMECs) during FA and triacylglycerol (TAG) synthesis. Results: Results showed that unsaturated fatty acid contents are much higher in concentration in buffalo milk as compared to Holstein cow. Significantly, higher expression level of FAS, ACACA, SREBP1, PPARG, GPAT and AGPAT genes were also been observed with the expression of the SCD1 in buffalo milk. Moreover, studies showed that, SCD1 gene alteration in BMECs also causes the change in the expression of FA synthesis related genes mentioned above and subsequently affect the FA composition in the cells. Overexpression of SCD1 significantly increased the expression of genes associated with FA and TAG synthesis and also improved the FA and unsaturated FA contents in BMECs, while down-regulation of SCD1 appear opposite consequences. Conclusion: Thus, present study clearly demonstrated that, alteration in the expression of SCD1 plays an important role in FA and TAG synthesis and can directly or indirectly affect biosynthesis and metabolic pathways in BMECs and may be used as a symbol for important mechanism that contributes the characterization of buffalo milk.
Roles and strategies of international humanitarian organisations in handling the Liberia Ebola outbreak
Authors: Kangbai Jia Bainga , Alameldeen Ahmed
Published: November 2019

Background In Early August 2014, the World Health Organisation declared an Ebola Virus Disease (EVD) outbreak in the region of West Africa. The West African EVD outbreak was the largest, most severe, and complex in the nearly four-decade history of this disease. The management of EVD cases in Liberia was similar to the other affected West African countries. Methods We reviewed the method and strategies used by some of the international humanitarian organisations in handling the 2013-2016 Ebola outbreak in Liberia. This report is a collection of personal field experiences in Liberia as well as personal interviews of healthcare personnel working for some of these international organisations working on the Ebola emergency in Liberia. Findings Medecins Sans Frontieres (MSF) was the first humanitarian NGO to deploy medical staff to the field in Liberia during the 2013-2016 EVD outbreak. MSF staffs were already operating in Liberia even before the declaration of the outbreak in August 2014.Conclusions The slow response by the international humanitarian organisations to lend their support in bringing the EVD outbreak to and exhibited the fear the international community have for deadly infectious diseases more than armed conflicts.Recommendations We recommend regularly training in public health emergency preparedness for third world countries that are highly susceptible to health emergencies such as Ebola outbreak to help prepared them ahead of such outbreak.
Whole Genome Sequencing of Nontuberculous Mycobacterium (NTM) Isolates from Sputum and Environmental Specimens in Co-Habiting Patients with NTM Pulmonary Disease
Authors: Yoon Jung-Ki , Kim Taek Soo , Kim Jong-Il , Yim Jae-Joon
Published: November 2019

Background : Nontuberculous mycobacterium (NTM) species are ubiquitous microorganisms. NTM pulmonary disease (NTM-PD) is caused not by human-to-human transmission but by independent environmental acquisition. However, recent studies using next-generation sequencing (NGS) have reported trans-continental spread of Mycobacterium abscessus among patients with cystic fibrosis. Results : We investigated NTM genomes through NGS to examine transmission patterns in three pairs of co-habiting NTM-PD patients who were suspected of patient-to-patient transmission. Three pairs of patients with NTM-PD co-habiting for at least 15 years were enrolled: a mother and a daughter with M. avium PD, a couple with M. intracellulare PD, and a second couple, one of whom was infected with M. intracellulare PD and the other of whom was infected with M. abscessus subsp. massiliense PD. Whole genome sequencing was performed using NTM colonies isolated from patients and environmental specimens. Genetic distances were estimated based on single nucleotide polymorphisms (SNPs) in the NTM genomes. Comparing SNPs in the consensus regions, the minimum pairwise SNP distances of NTM isolates derived from the two pairs of patients infected with the same NTM species were over 10,000. In phylogenetic analysis, the NTM isolates from patients with M. avium PD clustered with isolates from different environmental sources. Conclusions : In conclusion, considering the genetic distances between NTM strains, the likelihood of patient-to-patient transmission in pairs of co-habiting NTM-PD patients without overt immune deficiency is minimal.
Efficacy and experience of arthroscopic lateral patella retinaculum releasing through/outside synovial membrane for the treatment of lateral patellar compression syndrome
Authors: Chen Ji-Bin , Chen Dong , Xiao Ya-Ping , Chang Jian-Zhong , Li Te
Published: November 2019

Objective: To investigate the method and effect of arthroscopic lateral patella retinaculum releasing (LPRR) through/outside synovial membrane for the treatment of lateral patellar compression syndrome (LPCS). Methods: From September 2014 to December 2017, 125 patients with LPCS underwent arthroscopic LPRR through/outside synovial membrane combined with joint debridement. In the outside synovial membrane (OSM) group, the joint was cleaned first. The surface of lateral patella retinaculum (LPR) was created the chamber for arthroscopic operation. The LPR was released under the arthroscopy, and the synovial membrane was retained. In the through synovial membrane (TSM) group, the joint was cleaned first, and the synovial membrane, joint capsule and LPR, and superficial fascia were gradually incised from the joint cavity to the subcutaneous tissue. The synovial membrane was cut open. Active rehabilitation training was conducted after surgery. Before and after surgery, Lysholm score, patella medial shift, Kujala score, VAS score and surgical complications were evaluated and compared. Results: All patients in this study were followed up for 1.5-5 years. All patients had significant reduction in knee pain and improved function after 1 month and 1 year. The final follow-up of the Lysholm score, the distance of patella medial shift, the Kujala score, and the VAS score in the OSM group and the TSM group were significantly improved compared with those before surgery (P<0.001), but these observed targets at the last follow-up and before surgery between the two groups were compared with no statistical differences. In the TSM group, 5 patients had hemarthrosis and 3 cases joint adhesion. There were no postoperative complications in the OSM group. Conclusion: Arthroscopic closing LPRR for the treatment of LPCS can effectively improve the function and symptoms of the patellofemoral joint. It has the advantages of small trauma, good effect and rapid recovery. Among them, the hemarthrosis and joint adhesion in the TSM group were significantly higher than those in the OSM group, and arthroscopic closing LPRR outside synovial membrane was more advantageous.
The incidence of stroke among patients undergoing elective posterior lumbar fusion: a retrospective cohort study
Authors: Arena Patrick , Mo Jingping , Sabharwal Charu , Begier Elizabeth , Zhou Xiaofeng , Gurtman Alejandra , Liu Qing , Shen Rongjun , Wentworth Charles , Huang Kui
Published: November 2019

Background: Although stroke is an uncommon but life-threatening complication among spinal surgery patients, the recognition of this adverse event is critical given the aging population undergoing surgical procedures. The objective of this study was to estimate the incidence of stroke among adults undergoing elective posterior lumbar fusion (PLF) during post-operative risk windows and among different subgroups. Methods: A retrospective cohort study using a longitudinal electronic healthcare record (EHR) database was conducted from January 1, 2007 to June 30, 2018. Elective PLF, stroke, and select clinical characteristics were defined based on International Classification of Disease codes. Patients aged 18 to 85 years with ≥ 183 days of enrollment in the database prior to undergoing elective PLF were followed from the index date until the occurrence of stroke, death, loss to follow-up, or end of study period, whichever occurred first. Incidence proportions (IPs) and rates (IRs) of stroke were estimated in the following risk windows: index hospitalization, ≤ 30 days, ≤ 90 days, ≤ 180 days, and ≤ 365 days post-operation Results: A total of 43,063 patients were eligible for the study. The IP of stroke following elective PLF ranged from 0.29% (95% confidence interval [CI]: 0.25%, 0.35%) during index hospitalization to 1.12% (95% CI: 1.03%, 1.23%) ≤ 365 days post-operation; the IR of stroke following elective PLF per 1000 person-years decreased consistently from 229.08 (95% CI: 192.38, 272.78) during index hospitalization to 13.68 (95% CI: 12.51, 14.96) ≤ 365 days post-operation. Stratified analyses revealed that older patients had a higher incidence of stroke. Additionally, black patients had higher stroke incidences than white, Asian, or other patients. Furthermore, the incidence of post-operative stroke was higher among patients with a history of type 2 diabetes than among patients without such history. Conclusions: The incidence of stroke following elective PLF found here using an EHR database is slightly higher than that reported in the literature; however, the discrepancy is due to differences in the variable definitions, study populations, follow-up periods, and data sources between our study and those in the literature.
Usefulness of a radial applanation tonometry device in blood pressure related clinical decision making by anesthesiologists
Authors: Chen Guo , Zhou Xiaoshuang , Liu Bin , Lan Haidan , Liu Jin , Li Xiao
Published: November 2019

Purpose: Radial artery tonometry (AT) can continuously measure arterial blood pressure (ABP) noninvasively. This study aimed to evaluate AT for continuous ABP monitoring during anesthesia and compared AT to invasive (IBP) and non-invasive (NIBP) ABP measurements at clinical decision-making moments. Methods: 243 patients undergoing elective surgery were prospectively included in the study and AT was applied on the right or left arm while IBP and NIBP were recorded simultaneously. At moments when the IBP signal required a clinical decision by the anesthesiologist for situations of hyper- or hypotension, comparison was made whether AT and NIPB signals would require a clinical decision as well. Agreement/discrepancy of clinical decision-making was analyzed, additionally bias, precision, and percentage error of AT was compared to IBP at these moments. Results: 513 clinical decision moments were recorded. Decision moments based on AT signal did not differ significantly from decision moments based on IBP (1 vs. 1; IQR, 1 – 2 vs. 0 – 3, P = 0.06), while NIBP based decision moments showed significant differences (0 vs. 1; IQR, 0 – 2 vs. 0 – 3, P＜0.001). Subgroup analysis of patients divided by age, BMI and surgery time also showed no significant differences between IBP and AT. Conclusions: ABP measurement using AT is feasible and safe. AT provides relevant and efficient information to anesthesiologists; at moments when IBP called for action, AT called for action as well, but not NIBP. AT also showed clinically satisfactory agreement with IBP at moments of hypo- and hypertension.
Use of peripheral vascular access in the prehospital setting: is there room for improvement?
Authors: Gonvers Erin , Spichiger Thierry , Albrecht Eric , Dami Fabrice
Published: November 2019

Background: Previous studies have shown that prehospital-insertion of peripheral vascular access is highly variable. The aim of this study is to establish the rate of peripheral vascular access placement and its use with regard to both the severity of cases and the main problem suspected by the paramedics involved. Over-triage was considered to have taken place where peripheral vascular access was placed but unused and these cases were specifically analysed in order to evaluate the possibility of improving current practice. Methods: This is a one-year retrospective study conducted throughout one state of Switzerland. Data were extracted from the state’s public health service database, collected electronically by paramedics on RescueNet® from Siemens. The following data were collected and analyzed: sex, age, main diagnosis suspected by paramedics and the National Advisory Committee for Aeronautics score (NACA) to classify the severity of cases. Results: A total of 33 055 missions were included, 29 307 (88.7%) with a low severity. A peripheral vascular access was placed in 8 603 (26.0%) cases, of which 5 678 (66.0%) were in patients with low severity. In 3 948 (45.9%) cases peripheral vascular access was set but unused with 2 626 (66.5%) of these cases being patients with low severity. Opiates represent 48.3% of all medications given. The most frequent diagnosis among unused peripheral vascular access were: respiratory distress (12.7%), neurological deficit without coma or trauma (9.6%), cardiac condition with thoracic pain and without trauma or loss of consciousness (9.6%) and decreased general condition of the patient (8.5%). Conclusions: Peripheral vascular access was set in 26% of patients, nearly half of which were unused. To reduce over-triage, special attention should be dedicated to cases defined by EMS on site as low severity, as they do not require placement of a peripheral vascular access as a precautionary measure. Alternative routes, such as the intra-nasal route, should be promoted, particularly for analgesia, whose efficiency is well documented. Emergency medical services medical directors may also consider modifying protocols of acute clinical situations when data show that mandatory peripheral vascular access, in stroke cases for example, is almost never used.
Identifying predictive patients’ characteristics in case of High Flow Nasal Cannula failure when used for post-extubation failure
Authors: Terstappen Afra L.E. , Haas Lenneke E.M. , Seumeren Esther S.E. van , Balzereit Anja , Endeman Henrik
Published: November 2019

Background: High Flow Nasal Cannula (HFNC) is a relatively new but broadly used type of oxygen therapy. Hence, not much is known about HFNC in the setting of post-extubation failure. Aim of this study is to identify patients’ characteristics that predict failure of HFNC when used for post-extubation failure. Methods: This retrospective, observational study was conducted in a Dutch ICU. Between 2008 and 2014 all subjects aged 18 and older who started with HFNC due to respiratory failure within 2 to 72 hours after extubation were included. Primary outcome was patient characteristics predicting failure of HFNC. Failure was defined as reintubation or death following HFNC. Success was defined as the opportunity to stop HFNC after a non-specified time. Secondary outcome was the difference in length of stay (LOS) and mortality between the success and failure group. Results: A total of 246 subjects were included; in 135 (55%) cases HFNC failed. The success and failure group were comparable in terms of age, primary diagnosis and duration of mechanical ventilation prior to extubation. HFNC was started 19 ± 15 hours (mean ± SD) after extubation. Significant differences were found for breathing frequency (success: 22 ± 7/min vs. failure: 24 ± 7/min, p=0.009) and the presence of acute kidney injury (51% vs. 79%, p=0.003). There was a non-significant difference in pH (7.43 ± 0.07 vs. 7.40 ± 0.08, p=0.08). After logistic breathing frequency (p=0.02) and pH (p=0.01) remained independent predictors of HFNC failure. LOS at the ICU after starting HFNC differed (success: 181 ± 177 hours vs. failure: 405 ± 519 hours, p<0.001). ICU and hospital mortality were not significantly different between groups. Conclusion: In more than half of the patients HFNC failed when used for post-extubation failure. Breathing frequency and pH were predictors of HFNC failure.
Postoperative Pulmonary Complications in Complex Paediatric and Adult Spine Deformity: A Retrospective Review of Consecutive Patients Treated at SRS GOP Site in Ghana
Authors: Wulff Irene , Duah Henry Ofori , Tutu Henry Osei , Ofori-Amankwah Gerhard , Yankey Kwadwo Poku , Owiredu Mabel Adobea , Yahaya Halima Bidemi , Akoto Harry , Oteng-Yeboah Audrey , Group FOCOS Spine Research , Boachie-Adjei Oheneba
Published: November 2019

Background Pulmonary complications are important cause of morbidity and mortality in patients following spinal surgeries. There is paucity of literature on pulmonary complications following complex spine deformity surgery in underserved regions. This study sought to assess the incidence and risk factors of pulmonary complication following complex spine deformity surgery Methods Data of 276 complex spine deformity patients aged 3-25yrs who were consecutively treated at a single site were retrospectively reviewed. Data was analyzed using Stata 14 software. Patients were labelled into two groups: Grp 1: patients with pulmonary complications(N=17) vs Grp 2: patients with no pulmonary complications (N=259). Comparative analysis for risk factors included independent t-test and chi square test for independence. Multivariate logistic regression analysis was also performed. Results The incidence proportion of pulmonary complication was 17/276 (6.1%) (Grp 1) whiles 259 pts had no pulmonary events (Grp 2). There were 8M/9F for Grp 1 vs 100M/159F Grp 2, p=0.48. BMI was similar in both groups (17.2 vs 18.4km -2 , p=0.15). Average pre-op sagittal cobb (90.6 vs 88.7deg, p=0.87.), coronal cobb (95 vs 88.5deg, p=0.43), Pre-Op FVC (45.3 vs 62.0%, p=0.02), Pre-Op FEV1 (41.9% vs 63.1, p<0.001), Grp 1 vs Grp 2, respectively. EBL, OR time and Surgery Levels were similar in both Grps. Thoracoplasty was performed in 41.18% vs 21.57%, p=0.06, SPO 47.06% vs 42.31%, p=0.04 and VCR 5.88% vs 20.31%, p=0.145, Grp 1 vs Grp 2, respectively. Multivariate logistic regression showed that every unit increase in pre-Op FVC (%) decreases the odds of pulmonary complication by 5% (OR=0.95, 95% CI 0.90 to 0.99, p=0.045). Conclusion The observed 6.1% incidence of pulmonary complications is comparable to reported series. Only pre-Op FVC was an independent predictor of pulmonary complications. The observed case fatality rate (17%) following pulmonary complications highlights the need for thorough preoperative evaluation to identify high risk patients. Key words: Complex spine deformity; Pulmonary complications; late presentation; Forced Vital Capacity; Halo Gravity Traction; FVC; pediatric deformity; scoliosis; Pulmonary function tests; PFT; complications; Preoperative management.
Misdiagnosis rate of the prolonged disorders of consciousness on a clinical consensus compared with a repeated Coma-Recovery Scale-Revised assessment
Authors: Wang Jing , Hu Xiaohua , Hu Zhouyao , Sun Ziwei , Laureys Steven , Di Haibo
Published: November 2019

Background: Previous studies have shown that a single Coma-Recovery Scale-Revision (CRS-R) assessment can identify high misdiagnosis rate for a clinical consensus. The aim of this study was to investigate the misdiagnosis rate of clinical consensus compared to repeated behavior scale assessments in patients with prolonged disorders of consciousness (DOC).
Methods: Patients with prolonged DOC during hospitalization were screened by clinicians, and the clinicians formed a clinical consensus diagnosis. Trained professionals also used the CRS-R to evaluate the consciousness levels of the enrolled patients for repeated times (≥5 times) within a week. After the repeated evaluation results, the enrolled patients with prolonged DOC were divided into unresponsive wakefulness syndrome (UWS), minimally conscious state (MCS), and emergence from MCS (EMCS). Furthermore, the relationship between the results of the CRS-R and the clinical consensus were analyzed.
Results: In this study, 137 patients with a clinical consensus of prolonged DOC were enrolled. After the single CRS-R behavior evaluation, it was found that the misdiagnosis rate of clinical MCS was 24.7%, while the repeated CRS-R evaluation results showed that the misdiagnosis rate of clinical MCS was 38.2%. A total of 16.7% of EMCS cases were misdiagnosed as MCS, and 1.1% of EMCS cases were misdiagnosed as UWS.
Conclusions: The current clinical consensus of the misdiagnosis rate is still relatively high. Therefore, clinicians should be aware of the importance of the bedside CRS-R behavior assessment and should apply the CRS-R tool to daily procedures.
Documentation of vaccine wastage in two different geographic contexts under the universal immunization program in India
Authors: Das Manoja Kumar , Sood Mangla , Tambe Muralidhar , Sharma Thakur Dutt , Parande M A , Surwade Jitendra B , Salunke N M , Patil S S , Pawar Bhagwan , Guleri Rajesh , Kaushal Chitra , Sindhu Monica
Published: November 2019

Background Government of India is introducing new and relatively costly vaccines under immunization program. Monitoring of vaccine wastage is needed to guide the program implementation and forecasting. Under pilot introduction of rotavirus vaccine in two districts both 5- and 10-doses vials were used, which was considered as an opportunity for documenting the wastage.Methods A survey conducted in two districts (Kangra, Himachal Pradesh and Pune, Maharashtra) covered 49 vaccine stores, 34 sub-centres and 34 outreach sessions collected vaccine receipt, distribution and usage data for two complete years 2016 and 2017.Results The overall wastage rates for almost all vaccines were higher in Kangra district (BCG 37.1%, DPT 32.1%, Measles 32.2%, OPV 50.8%, TT 34.1% and pentavalent 18.4%) than Pune district (BCG 35.1%, DPT 25.4%, Measles 21.7%, OPV 14.3%, TT 23.1% and pentavalent 13.2%). Wastage for pneumococcal conjugate and measles-rubella vaccines were 27% and 40.5%, respectively. With transition from 5- to 10-doses vials for rotavirus vaccine, wastage at stores levels increased in both Kangra (29% to 33.2%) and Pune (17.8% to 25.7%) districts. With transition from intramuscular to intradermal fractional inactivated polio vaccine, the wastage increased from 36.1% to 54.8% in Kangra and 18.4% to 26.9% in Pune district.Conclusions The observed vaccine wastage rates were relatively higher than program assumption for forecasting. The observed variations in the vaccine wastage indicates need for state or region based documentation and monitoring in India for appropriate programmatic action.
Monetary value of disability-adjusted-life-years lost from all causes in Mauritius
Authors: MUSANGO Laurent , Nundoochan Ajoy , Wilder Philippe Van , Kirigia Joses Muthuri
Published: November 2019

Background The Republic of Mauritius lost a total of 402,565 disability-adjusted-life-years (DALY) from all causes in 2017. The objectives of this study were (a) to estimate the monetary value of DALY lost in 2017, and projected to be lost from all causes in Mauritius in 2030; and (b) to estimate the monetary value of DALY savings in year 2030, if the country would attain the United Nations Sustainable Development Goal 3 (SDG3) targets 3.1, 3.2, 3.3, 3.4 and 3.6.Methods Human capital approach is used to monetarily value DALY lost from 293 causes in 2017. The monetary value of DALY lost in 2017 from each cause is equal to the Mauritius net gross domestic product (GDP) per capita multiplied by the number of DALY lost from a specific cause. The percentage reductions implied in the five SDG3 targets were used in the projections of the monetary values of DALY expected in 2030. The potential savings equals monetary value of DALY lost in 2017 minus monetary value of DALY expected in 2030. The DALY data was obtained from the Institute of Health Metrics and Evaluation Global Burden of Disease Study 2017 database; the current health expenditure per capita data was from the WHO Global Health Expenditure Database; and the per capita GDP data was obtained from the IMF outlook database.Results The DALY lost in 2017 had a total monetary value of Int$9,564,741,771. Of which, 82.9% resulted from non-communicable diseases; 10.2% from communicable, maternal, neonatal and nutritional diseases; and 6.9% from injuries. Full attainment of the five SDG 3 targets would avert DALY losses with a value of Int$2,986,241,156.Conclusions Diseases and injuries causes a significant DALY lost per year with a substantive monetary value. Full achievement of the SDG3 targets 3.1, 3.2, 3.3, 3.4 and 3.6 might potentially save the country about 9.351% of the total GDP of Mauritius in 2019. In order to achieve such savings, the country require to further strengthen the national health system, the other systems that tackle social determinants of health, and the national health research system.
The prevalence and correlates of burnout among Chinese preschool teachers
Authors: Li Shen , Li Yibo , Lv Hao , Jiang Rui , Zhao Peng , Zheng Xin , Wang Lili , Li Jie , Mao Fuqiang
Published: November 2019

Background: A series of studies have suggested that teachers are likely to experience professional burnout in various regions around the world. To date, no known research has been conducted to investigate the prevalence and correlates of burnout among preschool teachers in China. Objective: This study examined the level of self-reported burnout and correlates of burnout among Chinese preschool teachers. Methods: A cross-sectional study was conducted among1795 preschool teachers in Tianjin, China, during August 2018- October 2018. The validated Chinese version of the 15-item Maslach Burnout Inventory was used to assess burnout. A self-administered questionnaire collected the sociodemographic factors. The psychological factors were collected by the Chinese version of the 20-item Center for Epidemiologic Studies Depression Scale (CES-D) and the Perceived Stress Scale-14. Results: The prevalence of burnout in Chinese preschool teachers was 53.2% ( 95% CI：51%─56%). Burnout rate was significantly decreased in overweight (P=0.001, OR=0.58, 95% CI: 0.42-0.79) and obesity (P=0.048, OR=0.75, 95% CI: 0.56-1.00) teachers compared with teachers with normal weight. The type of school (P=0.007, OR=1.45, 95% CI: 1.11-1.91), income satisfaction (P=0.001, OR=0.67, 95% CI: 0.53-0.86), depression (P<0.001, OR=3.08, 95% CI: 2.34-4.05) and perceived stress (P<0.001, OR=1.15, 95%CI: 1.13-1.18) were significantly associated with burnout. Conclusions: The prevalence of burnout among preschool teachers in Tianjin, China, is high. Burnout was significantly associated with BMI, the type of school, income satisfaction, depression and perceived stress among Chinese preschool teachers. Keywords: Burnout, Stress, Preschool teachers, Depression
An Infodemiology Approach to Assess the Impact of the Great Recession on Anxiety and Depression in France.
Authors: Ramos-Gomez Ariadna , Perez-Escatel Aldo , Villaseñor-Garcia Elio Atenogenes , Ramos-Remus Cesar
Published: November 2019

Background: The global financial crisis of 2008 and subsequent sovereign debt crisis in Europe had a profound multidimensional impact on developed economies, including on the construct of health. Mental health is a key factor for productivity and an indicator of the general well-being of the population. France poses mental health and public policies characteristics that differentiated it from other countries of the European Union. This study aimed to assess whether depression and anxiety increased throughout the course of the 2008 debt crisis in France.
Methods: This is an ecological study using an infodemiology approach. The search terms for depression and anxiety were extended with related words according to culture to form a distress index. Google Trends was used to mine the distress index search terms in a period before the debt crisis (2004) until 2018, using open source libraries, and pandas to merge information. Diverse economic- and employment-related datasets for France were used as covariates in multiple linear regression analyses, and the expected seasonal variability as a dummy variable.
Results: The results showed that for each additional demand for unemployment benefits, search traffic for the distress index was expected to increase by 0.09% (p< 0.001, r2 0.89), even after controlling for the expected seasonal variations in the distress index. However, there was no significant association with unemployment rate.
Conclusions: Contrary to reports from other countries, the mild effect of demand for unemployment benefits on the distress index may be explained by aspects of social protection policies in France.
PNO1 promotes cell proliferation in prostate cancer
Authors: Hu Jianpeng , Cui Feilun , Xv Zhipeng , Tan Jian , Wang Zhengyu
Published: November 2019

Background Prostate cancer (PCa) is one of the most commonly diagnosed cancers. The functions of PNO1 in yeasts were involved in regulating ribosome and proteasome biogenesis. However, its roles in PCa remained largely unclear. Methods The present study evaluated the expression levels of PNO1 in PCa by using GSE45016, GSE55945 and GSE17951 datasets. Then, in vivo and in vitro assays were conducted to detect the biological functions of PNO1 in PCa. BALB/c mice were used for in vivo assay in this study. Microarray and bioinformatic analysis were carried out to detect the downstream targets and pathways regulated by PNO1. Results The present study for the first time demonstrated PNO1 was up-regulated in PCa samples compared to normal tissues. ShRNA mediated knockdown of PNO1 significantly suppressed PCa proliferation and clone formation, however, induced PCa apoptosis. Microarray analysis and bioinformatics analysis revealed PNO1 was involved in regulating multiple cancer related biological processes, such as regulation of DNA repair, single organismal cell-cell adhesion, translational initiation, RNA splicing, transcription, and positive regulation of mRNA catabolic process. OF note, in vivo results showed PNO1 knockdown remarkably reduced the PCa growth rate. Conclusions Despite more in-depth research is still required, this study showed PNO1 could serve as a potential biomarker for PCa.
Endoscopic dacryocystorhinostomy to treat congenital nasolacrimal canal dysplasia: A retrospective analysis in 40 children
Authors: Cui Yan-Hui , Zhang Cheng-Yue , Liu Wen , Wu Qian , Yu Gang , Li Li , Wei Wen-Bin
Published: November 2019

Background: To investigate the therapeutic effectiveness and safety of endoscopic dacryocystorhinostomy (EN-DCR) to treat congenital nasolacrimal canal dysplasia (CNCD). Methods: Forty children (50 eyes) with congenital nasolacrimal duct obstruction (CNLDO) and lacrimal bony dysplasia, including 8 children with bony atresia (10 eyes) and 32 with bony stenosis (40 eyes), were recruited in this retrospective study. Standardized EN-DCR was performed in all cases. The postoperative observations included relief of symptoms, fluorescein dye disappearance test (FDDT), syringing of lacrimal passages and anastomotic patency under nasal endoscopy. Patients were followed up for 8-18 months. Results: Standardized EN-DCR surgery had a success (cure and improvement) rate of 100%, including a cure rate of 82% and an improvement rate of 18%. The cure rate among 40 cases of bony nasolacrimal duct stenosis was 82.5%, while that of 10 cases of bony nasolacrimal duct atresia was 80%. Statistical analysis showed that nether the receipt of other treatments before surgery nor the type of bony nasolacrimal duct dysplasia affected the cure rate. No significant complications were observed during postoperative follow-up except for four cases (4 eyes) that suffered middle turbinate and nasal mucosal adhesion and two cases with sinusitis. Conclusions: CNCD is a type of CNLDO that does not respond to conservative and conventional treatment. EN-DCR represents a safe and effective treatment for children with CNCD. In addition, the combination of EN-DCR with lacrimal CT scanning provides advantages over traditional lacrimal surgery in that it has a high success rate with a low incidence of complications. Key words: nasal endoscopy; endoscopic dacryocystorhinostomy (EN-DCR); children; congenital nasolacrimal duct obstruction (CNLDO); nasolacrimal canal dysplasia
SURFACE ROUGHNESS OF PARTS MADE TITANIUM ALLOYS MACHINED WITH FACE MILL OF ORIGINAL CONSTRUCTION
Authors: Hlembotska Larysa , Melnyk Oleksandr
Published: November 2019

Importance of the use of titanic alloys is shown in many industries of engineer. Problems which arise at their processing are described that negatively affect process productivity and indicators of surface quality and etc. This is especially important when machining plane surfaces of parts by face milling. The surface roughness depends first of all on geometrical parameters and the shape of the cutting edge of the tool insert that contacts the processed surface. Therefore it was developed an original design of face mill with a stepped insert arrangement with a cylindrical front surface, and at the same time process productivity was improved. Expediency of use of the proposed design of a face mill it is proved by comparative experimental studies of influence of a form of a front surface of round inserts on roughness of the machined surface of parts from titanium alloy VT1-0. The comparison was made between the machining of the face mill with a cylindrical front insert surface and a standard face mill with round inserts (ISO 6462:2011). A non-composite second-order plan was received results of the study were obtained for the conditions of machining titanium alloy. The profile of the machined surface was investigated to evaluate the roughness Ra and it was determined that, with the maximum cutting modes, the face mill of the original design provided a lower roughness of the machined surface than a standard mill. The optimum cutting modes are determined by the criterion of the roughness of the machined surface of parts made of titanium alloy VT1-0 and the process productivity of face milling. The proposed face mill provides a 1.26 time increase in productivity compared to machining a standard face mill while obtaining minimal roughness.
RESEARCH OF INFORMATION PROTECTION METHODS IN COMPUTER SYSTEMS FOR MONITORING AND DIAGNOSTICS OF ELECTRIC SUPPLY OF RAILWAYS
Authors: Holub Halyna , Soloviova Olena
Published: November 2019

In modern conditions of growth of informatization, to ensure the reliability of the functioning of distributed computer information-diagnostic and control systems, which are mandatory for consideration, there are problems of assessing security and implementing protection of operational information. The state of information protection and the reliability of computer systems for corporate monitoring and diagnosis of the railway power supply system are analyzed. The main tasks in the intellectualization of component systems are defined, namely traction electric network. The principles of information protection are proposed, which include: active protection of information; convincing protection of information, consisting in the justification of the design and measures to protect the conditions and circumstances. Such a principle as the continuity of the information protection process provides for the organization of the protection of objects at all stages of the development and operation life cycle. A variety of information protection tools provides for the exclusion of patterns at the stage of selecting cover objects and various ways to implement protection, not excluding the use of standard solutions. The combination of the above principles in the work is called an integrated approach to information security, which is the basis for the creation of computer information protection systems. According to the sphere of information security, this approach complies with international ISO standards, and for the technical protection of information and state standards it complies with the requirements of existing national legislative and regulatory documents. To ensure the security of information stored and processed in computer systems, the coordinated application of various security measures is necessary.