bluuebunny/crossref_metadata_2025 huggingface dataset:
Engineered multicomponent electrospun nanocomposite scaffolds comprising polyurethane loaded with ghee and propolis for bone tissue repair
Authors: Mani Mohan Prasath , Jaganathan Saravana Kumar
Published: February 2020

In Ayurveda, pure ghee is used as one of the components for the treatment of pain caused by the bone fracture. In this study, novel nanocomposites based on polyurethane (PU), ghee and propolis were developed using the electrospinning technique. Morphology analysis revealed that the novel developed PU/ghee (817 ± 138.39 nm) and PU/ghee/propolis (576 ± 144.96 nm) nanocomposites possessed smaller fiber diameter than the pure PU membrane (890 ± 116.911 nm). The presence of ghee and propolis in PU was confirmed by hydrogen bond formation as revealed in Fourier infrared analysis. The contact angle was found to be increased in PU/ghee (122° ± 1°) indicating the hydrophobic nature while the angle was decreased in PU/ghee/propolis (55° ± 1°) suggesting the hydrophilic nature. The surface roughness of electrospun nanocomposites was found to decrease while thermal stability was observed to be enhanced for the nanocomposite as indicated in atomic force microscopy and thermogravimetric analysis. Further, the blood compatibility assessments revealed the delayed activation of blood clots in the electrospun scaffolds suggesting better blood compatibility. Moreover, the hemolytic assay suggested the developed nanocomposites (PU/ghee – 1.61% and PU/ghee/propolis – 1.52%) as non-hemolytic material and also enhanced safety to RBCs. The cytocompatibility studied revealed the better proliferation rates of human fibroblast cells in the developed nanocomposites (PU/ghee – 148.3% ± 6.028% and PU/ghee/propolis – 156.7% ± 5.686%) indicating its non-toxicity. So, the newly developed PU/ghee and PU/ghee/propolis nanocomposites were found to possess desirable characteristics such as better physicochemical, improved blood compatibility and non-toxic behavior which might be utilized as an appropriate candidate for bone tissue engineering.
Diagnostic Value of Combination of MicroRNA-192 in Urinary Sediment and B-Ultrasound for Bladder Cancer
Authors: Jiang Fuquan , Li Changfeng , Han Jiansong , Wang Linlin
Published: February 2020

Objective:

We aimed to explore the diagnostic value of microRNA-192 expression in urinary sediment combined with B-ultrasound in the diagnosis of bladder cancer.

Methods:

A total of 118 patients with bladder cancer and 120 patients with benign urinary system diseases were selected for collection of urinary sediment. Real-time quantitative polymerase chain reaction was applied to detect the microRNA-192 expression (normalized to U6 level) in urinary sediment. Besides, the relationship between microRNA-192 expression and clinicopathological characteristics was analyzed. Furthermore, receiver operating characteristic curve was performed to analyze clinical value of microRNA-192 expression alone and microRNA-192 expression in urinary sediment combined with B-ultrasound in the diagnosis of bladder cancer.

Results:

MicroRNA-192 expression was significantly downregulated in urinary sediment of patients with bladder cancer, which was related to tumor stage and tumor size ( P < .05). The results of receiver operating characteristic curve analysis showed that the best critical value of microRNA-192 expression in urinary sediment for the diagnosis of bladder cancer was 0.785 with the sensitivity and specificity of 76.7% and 78.0%, respectively. The sensitivity and specificity of microRNA-192 expression in urinary sediment combined with B-ultrasound in the diagnosis of bladder cancer were 93.2% and 76.7%, respectively. The sensitivity of combined diagnosis (93.2%) was not significantly different from that of cystoscopy (93.2%; P > 0.05). There were significant differences between the expression of microRNA-192 in urinary sediment and the sensitivity of B-ultrasound examination alone with cystoscopy ( P < .05).

Conclusion:

The downregulation of microRNA-192 expression in urinary sediment of patients with bladder cancer may be related to tumor progression. The microRNA-192 expression in urinary sediment is valuable in the diagnosis of bladder cancer, which shows high sensitivity in diagnosis of bladder cancer when combined with B-ultrasound.
Taste coding strategies in insular cortex
Authors: Staszko Stephanie M , Boughter John D , Fletcher Max L
Published: February 2020

While the cortical representation of sensory stimuli is well described for some sensory systems, a clear understanding of the cortical representation of taste stimuli remains elusive. Recent investigations have focused on both spatial and temporal organization of taste responses in the putative taste region of insular cortex. This review highlights recent literature focused on spatiotemporal coding strategies in insular cortex. These studies are examined in the context of the organization and function of the entire insular cortex, rather than a specific gustatory region of insular cortex. In regard to a taste quality-specific map, imaging studies have reported conflicting results, whereas electrophysiology studies have described a broad distribution of taste-responsive neurons found throughout insular cortex with no spatial organization. The current collection of evidence suggests that insular cortex may be organized into a hedonic or “viscerotopic” map, rather than one ordered according to taste quality. Further, it has been proposed that cortical taste responses can be separated into temporal “epochs” representing stimulus identity and palatability. This coding strategy presents a potential framework, whereby the coordinated activity of a population of neurons allows for the same neurons to respond to multiple taste stimuli or even other sensory modalities, a well-documented phenomenon in insular cortex neurons. However, these representations may not be static, as several studies have demonstrated that both spatial representation and temporal dynamics of taste coding change with experience. Collectively, these studies suggest that cortical taste representation is not organized in a spatially discrete map, but rather is plastic and spatially dispersed, using temporal information to encode multiple types of information about ingested stimuli.

Impact statement

The organization of taste coding in insular cortex is widely debated. While early work has focused on whether taste quality is encoded via labeled line or ensemble mechanisms, recent work has attempted to delineate the spatial organization and temporal components of taste processing in insular cortex. Recent imaging and electrophysiology studies have reported conflicting results in regard to the spatial organization of cortical taste responses, and many studies ignore potentially important temporal dynamics when investigating taste processing. This review highlights the latest research in these areas and examines them in the context of the anatomy and physiology of the insular cortex in general to provide a more comprehensive description of taste coding in insular cortex.
Advanced Data Analytics for Clinical Research Part II: Application to Cardiothoracic Surgery
Authors: Zhou Nicolas , Corsini Erin M. , Jin Shida , Barbosa Gregory R. , Kell Trey , Antonoff Michael H. , Antonoff Mara B.
Published: February 2020

In the first part of this series, we introduced the tools of Big Data, including Not Only Standard Query Language data warehouse, natural language processing (NLP), optical character recognition (OCR), and Internet of Things (IoT). There are nuances to the utilization of these analytics tools, which must be well understood by clinicians seeking to take advantage of these innovative research strategies. One must recognize technical challenges to NLP, such as unintended search outcomes and variability in the expression of human written texts. Other caveats include dealing written texts in image formats, which may ultimately be handled with transformation to text format by OCR, though this technology is still under development. IoT is beginning to be used in cardiac monitoring, medication adherence alerts, lifestyle monitoring, and saving traditional labs from equipment failure catastrophes. These technologies will become more prevalent in the future research landscape, and cardiothoracic surgeons should understand the advantages of these technologies to propel our research to the next level. Experience and understanding of technology are needed in building a robust NLP search result, and effective communication with the data management team is a crucial step in successful utilization of these technologies. In this second installment of the series, we provide examples of published investigations utilizing the advanced analytic tools introduced in Part I. We will explain our processes in developing the research question, barriers to achieving the research goals using traditional research methods, tools used to overcome the barriers, and the research findings.
Comparison of clinical outcomes of three-corner arthrodesis and bicolumnar arthrodesis for advanced wrist osteoarthritis
Authors: Gauci Marc Olivier , Waitzenegger Thomas , Chammas Pierre-Emmanuel , Coulet Bertrand , Lazerges Cyril , Chammas Michel
Published: February 2020

We retrospectively compared results of 27 wrists with bicolumnar arthrodesis with mean follow-up of 67 months to 28 wrists with three-corner arthrodesis adding triquetral excision with mean follow-up of 74 months in 54 patients (55 wrists). Minimal follow-up was 2 years for all patients. Capitolunate nonunion occurred in three wrists with bicolumnar arthrodesis and six wrists with three-corner arthrodesis, and radiolunate arthritis developed in four wrists with three-corner arthrodesis. Among patients with bicolumnar arthrodesis, hamatolunate arthritis occurred in seven wrists, all with a Viegas type II lunate; and pisotriquetral arthritis occurred in three wrists. At mean 5 years after surgery, 45 wrists had not needed revision surgery, and both groups had similar revision rates. The wrists with three-corner arthrodesis and bicolumnar arthrodesis had similar functional outcomes, and range of wrist motion was not significantly different between the two groups. We concluded that bicolumnar arthrodesis results in greater longevity than three-corner arthrodesis for a type I lunate. We do not recommend bicolumnar arthrodesis for type II lunate. We also concluded that three-corner arthrodesis has a greater incidence of radiolunate arthritis and capitolunate nonunion.

Level of evidence: III
Partial trapeziectomy and pyrocarbon interpositional arthroplasty for trapeziometacarpal osteoarthritis: minimum 8-year follow-up
Authors: Smeraglia Francesco , Barrera-Ochoa Sergi , Mendez-Sanchez Gerardo , Basso Morena A. , Balato Giovanni , Mir-Bullo Xavier
Published: February 2020

We undertook a retrospective study to evaluate minimal 8-year outcomes of 46 trapeziometacarpal joints (46 patients) treated with pyrocarbon implant arthroplasty after partial trapeziectomy for trapeziometacarpal joint osteoarthritis in two different hand surgery units. The mean follow-up interval was 9.5 years (average 113 months with a range 97–144 months). The study showed that pyrocarbon interpositional arthroplasty provided pain relief and high patient satisfaction. All patients experienced a reduction in the DASH score, with an average change of 30 points. The visual analogue scale score, the Kapandji score, and key pinch also showed remarkable improvement. The PyroDisk implant exhibited good longevity, with good implant survival. A review of the literature revealed that the functional outcomes after implant surgery are not superior to more common techniques, such as trapeziectomy with or without ligamentoplasty. Therefore, this is a reliable surgery but may not have added benefits over simpler surgical treatments. This implant could have a role, perhaps in a select group of young patients, as a time-procuring procedure.

Level of evidence: IV
How and when to refer patients for oncogenetic counseling in the era of PARP inhibitors
Authors: Neviere Zoé , De La Motte Rouge Thibault , Floquet Anne , Johnson Alison , Berthet Pascaline , Joly Florence
Published: February 2020

Poly(ADP-ribose)polymerase (PARP) inhibitors are targeted therapy for cancers with homologous repair deficiency (HRD). They were first approved for ovarian cancer and have changed current treatment strategies. They have also demonstrated efficacy in HER2-negative metastatic breast cancer and advanced prostate cancer with BRCA1/2 or ATM mutations. Patients with somatic and/or germline BRCA1/2 mutations benefit more from these treatments than other patients. Nowadays, the diagnosis of HRD is largely based on germline genetic testing, which is performed after an in-person genetic counseling session, even for patients without any family history of cancer. However, with the increasing number of PARP inhibitor indications across different tumor types, rapid access to oncogenetic consultations will become a challenge. To meet this demand, tumor genomic testing could be offered at initial diagnosis. Telephone counseling and other referral systems could replace in-person consultations for certain subgroups of patients deemed to have a low risk of harboring a germline mutation. This article reviews international guidelines for genetic counseling testing. We herein propose new care pathways for breast, prostate and ovarian cancers, including tumor genomic testing at initial diagnosis in order to help triage genetic counseling referrals.
Examining Identification Practices and Services for Young Advanced and Gifted Learners in Selected North Carolina School Districts
Authors: Matthews Michael S. , Rhodes Heather A.
Published: February 2020

Because schools often do not begin formal processes to identify students with gifts and talents until the third grade, many kindergarten through second-grade teachers face challenges in identifying and meeting the needs of these learners. We examined gifted education plans from a sample of seven districts in and around the Charlotte, North Carolina, region to learn how these districts address gifted or advanced learners in kindergarten, first, and second grades in their policies. We summarize the content and range of these policies, and recommend that effective approaches should include universal screening, early identification (i.e., in kindergarten), and the use of additional pathways to identification and differentiated educational services to meet the needs of young advanced learners. We conclude with recommendations for future study in this underinvestigated area.
Bibenzyl Derivatives From Leaves of Dendrobium officinale
Authors: Ren Gang , Deng Wen-Zan , Xie Yan-Fei , Wu Chun-Hua , Li Wen-Yan , Xiao Chuan-Yun , Chen Yun-Long
Published: February 2020

Nine compounds were isolated from leaves of Dendrobium officinale, including 1 new bibenzyl derivative, denofficin (1), and 8 known structurally related compounds, dendrocandin B (2), dendrocandin U (3), 3,4-dihydroxy-5,4′-dimethoxy bibenzyl (4), moscatilin (5), 4,4′-dihydroxy-3,5-dimethoxy bibenzyl (6), ( S)-3,4,α-trihydroxy-5,4′-dimethoxy bibenzyl (7), gigantol (8), densiflorol A (9). The structures of these compounds were identified by spectroscopic methods. All isolated compounds were screened for their cytotoxicity against human cervical cancer cell line HeLa cells. Of them, compounds 1-3, 5, 6, and 8 were found to have the capabilities of proliferation inhibition against HeLa cells with half-maximal inhibitory concentration values ranging from 8.0 to 92.4 μM.
The Viability and Anti-Inflammatory Effects of Hyaluronic Acid-Chitlac-Tracimolone Acetonide- β-Cyclodextrin Complex on Human Chondrocytes
Authors: Tarricone Elena , Elia Rossella , Mattiuzzo Elena , Faggian Alessia , Pozzuoli Assunta , Ruggieri Pietro , Brun Paola
Published: February 2020

Objective

To compare the effects of the complex triamcinolone acetonide-hydroxypropyl-β-cyclodextrin (TA-CD) on in vitro inflamed primary human articular chondrocytes in the presence or absence of the mixture hyaluronic acid-Chitlac, a lactose-modified chitosan (HA-CTL).

Design

Changes in cell viability and pro-inflammatory cytokines gene expression were analyzed in human chondrocytes using an in vitro model of macrophage-mediated inflammation. Human monocytes U937 were differentiated to macrophages by phorbol 12-myristate 13-acetate (PMA) and lipopolysaccharides (LPS). The anti-inflammatory effects of the complex TA-CD and HA-CTL mixture were assessed on chondrocytes exposed for 24 hours to U937 conditioned medium (CM), by quantitative polymerase chain reaction analysis.

Results

The TA-CD viability was enhanced by the presence of the HA-CTL mixture in chondrocyte cultures. The exposure of cells to CM significantly increased interleukin-1β and interleukin-6 gene expression, and when the complex TA-CD was added to the inflamed cells, gene transcription of cytokines was restored to near baseline values, both in the presence or in the absence of HA-CTL mixture.

Conclusion

The addition of HA-CTL mixture significantly attenuated cytotoxicity induced by TA and preserved the anti-inflammatory effects, thus confirming the chondroprotective role of the HA-CTL mixture.
The medicalisation of disabled children and young people in child sexual abuse: Impacts on prevention, identification, response and recovery in the United Kingdom
Authors: Franklin Anita , Brady Geraldine , Bradley Louise
Published: February 2020

Understandings of disability are situated within social, political and economic circumstances. Internationally, medical conceptualisations of disability prevail, influencing policy and practice, creating a discourse which encourages categorisation, diagnosis and prescribed ways of understanding behaviour. This body of knowledge has a profound influence, providing powerful explanatory models of disability. Such discourse excludes other ways of knowing, with little attention paid to competences and the construction of worlds especially from the perspectives of disabled children themselves. This article draws upon a small number of UK qualitative studies which have examined disabled child abuse and included the experiences of disabled children. These studies have highlighted how medicalised notions of disability have led to both medicalised and psychiatrised responses to abuse, which have ill-served disabled children. It could be argued that medicalisation has led to disabled children being labelled as either ‘too disabled’ to be abused or ‘not disabled enough’ to receive an appropriate response which meets their needs; they are also sometimes regarded as showing signs of mental ill health when such signs are more likely to be an understandable manifestation of the trauma of abuse. Evidence collected indicate that much can be learnt from understanding the construction of disabled childhoods and how our current limited exploration of this affects how society prevents, identifies and responds to disabled child abuse and associated trauma. Drawing upon disabled children’s recommendations to ‘see me, hear me and understand me’, this article will argue that in order to protect disabled children and support them to recover from abuse, we need to move away from a tick-box culture of medicalising, categorising, psychiatrising and ‘othering’ to a greater understanding of disabled children’s worlds, and to a rights-based model of disabled child protection whereby we challenge the increased barriers to support faced by disabled children who have experienced abuse.
Getting data analytics on board at The Cage
Authors: Perdana Arif , Gaffoor Junaitha , Lee Hwee Hoon
Published: February 2020

This case illustrates the challenges in implementing data analytics in a small and medium enterprise. A small and medium enterprise in Singapore, The Cage, runs a sports facilities rental business that has adopted basic data analytics and enjoyed the benefits data analytics offers. Since implementing enterprise resource planning in 2016 for their business processes, it now has readily available financial and customer data. Using available data from its enterprise resource planning system, The Cage now wants to incorporate more advanced data analytics into its decision-making process. While The Cage acknowledges the impact of data analytics on its business, it encounters practical challenges in the data lifecycle, namely, data discovery, data collection, analysis and modelling building, and data governance.
Challenges associated with physical assessments for people living with dementia: Modifying standard assessment protocols
Authors: Parfitt Gaynor , Post Dannielle , Penington Alison , Davison Kade , Corlis Megan
Published: February 2020

Objectives:

Regular physical activity for older adults as they age is important for maintaining not only physical function but also independence and self-worth. To be able to monitor changes in physical function, appropriate validated measures are required. Reliability of measures such as the timed-up-and-go, five-repetition sit-to-stand, handgrip strength, two-minute walk, 30-second sit-to-stand, and four-metre walk has been demonstrated; however, the appropriateness of such measures in a population of adults living with dementia, who may be unable to follow instructions or have diminished physical capacity, is not as well quantified. This study sought to test modified standard protocols for these measures.

Methods:

Modification to the standard protocols of the timed-up-and-go, five-repetition sit-to-stand, handgrip strength, two-minute walk, 30-second sit-to-stand, and four-metre walk was trialled. This occurred through modification of procedural components of the assessment, such as encouraging participants to use their hands to raise themselves from a seated position, or the incorporation of staged verbal cueing, demonstration, or physical guidance where required. The test–retest reliability of the modified protocols was assessed using Pearson’s correlation, and performance variances were assessed using the %coefficient of variation. Intraclass correlations were included for comparisons to previous research and to examine measurement consistency within three trials.

Results:

At least 64% of the population were able to complete all measures. Good test–retest reliability was indicated for the modified measures (timed-up-and-go = 0.87; five-repetition sit-to-stand = 0.75; handgrip strength = 0.94; two-minute walk = 0.87; the 30-second sit-to-stand = 0.93; and the four-metre walk = 0.83), and the %coefficient of variation (7.2%–14.8%) and intraclass correlation (0.77–0.98) were acceptable to good.

Conclusion:

This article describes the methodology of the modified assessments, presents the test–retest statistics, and reports how modification of the current protocols for common measures of physical function enabled more older adults living with dementia in a residential aged care facility to participate in assessments, with high reliability demonstrated for the measures.
Individualised management of obliterative urethral stricture in female patients – four patients and four management strategies
Authors: Nayyar Rishi , Bansal Devanshu , Singh Prabhjot , Jain Siddharth , Seth Amlesh
Published: February 2020

Level of evidence: 4
Biological resurfacing of grade IV articular cartilage ulcers in knee joint with Hyalofast
Authors: Tan Shijie Ian , Tho Samuel Jun Wei , Tho Kam San
Published: February 2020

Introduction:

Hyalofast grafting with microfracture is a new minimally invasive treatment method being proposed for joint cartilage defects. This study was done to measure the clinical efficacy of Hyalofast grafting after microfractures.

Methods:

Forty-six patients were assessed for knee function using knee injury and osteoarthritis outcome score (KOOS) after undergoing microfracture and Hyalofast grafting surgery. We further divided the 46 patients into a group of 10 patients who had no associated procedures done with the microfracture and Hyalofast grafting surgery. All patients had magnetic resonance imaging (MRI) of the affected knee pre-surgery and two patients had MRI done post-surgery. Due to another unrelated injury, we were also able to obtain further arthroscopic findings of another patient’s knee 18 months after microfracture and Hyalofast grafting.

Results:

There was a statistically significant improvement in all categories of the KOOS (symptoms, pain, daily living, sports and quality of life) compared between years 1, 2 and 3 against pre-surgery. For the subgroup of Hyalofast only, there was a statistically significant improvement in symptoms, pain and daily living categories of the KOOS compared between years 1, 2 and 3 against pre-surgery.

Conclusions:

Our study shows that Hyalofast grafting after microfracture is a viable alternative to treatment for patients with grade 4 cartilage ulcers.
‘The chemists’ war’ in Sydney’s seas: Water, time, and everyday militarisms
Authors: Neimanis Astrida
Published: February 2020

Approximately 28 kilometres off the coast of Sydney in Australia, at a depth of 275 metres, some 5000 tons of unused chemical weapons were dumped in the sea. These dumps join similar sea burial grounds all around Australia’s coasts and are part of the hundreds of thousands of tons of chemical ordnance dumped in the planet’s oceans after the Second World War. While this may seem like spectacular assault of old militarisms on fragile ocean ecologies, scientific research suggests that these dumps probably pose a negligible environmental risk. What then are we to make of these souvenirs of the First World War, also known as ‘the chemists’ war’, in Sydney’s seas? In this paper, I consider how sea dumped chemical weapons should concern us, but in ways that complicate the seemingly spectacular story they tell. Specifically, I extend Rob Nixon’s ( 2011 ) important theoretical contribution on slow and spectacular violence as a means for understanding the environmental afterlives of war. Sydney’s chemical weapons dumps underscore that Nixon’s framework cannot be interpreted dualistically; rather these undersea chemical dumps help us fathom how the slow and the spectacular are always queerly tangled, and how any unidirectionality of damage is more uncertain that a seemingly straight temporality of slowness would suggest. By productively leveraging the spectacular, I argue that Nixon’s concept helps us explore the more entangled, complex, and even contradictory ways in which militarisms pervade and shape everyday life. In tracing the queer temporal lineaments that suture the slow to the spectacular in tentacular ways, the everyday persistence of chemical militarisms, hidden in plain view, and the ways that they come to matter, are offered up for closer scrutiny.
Decision-making Processes in Indian Joint Families and Their Implications for HR Professionals
Authors: Ramachandran Kavil , Antony Sanjay Paul
Published: February 2020

Family businesses constitute a large portion of successful enterprises in India, as it does in different parts of the world. In its journey from a founder-driven small entity to a professionally run organisation, one key transformation it has to go through is the process of ‘institutionalisation’. The human resource (HR) leader plays a key role in this process. An exploration of the role the HR function has to play during the various phases of this transformation journey could serve as a guide to HR professionals building their careers with family businesses. Our effort has been to develop a model which could work along with validated tools which measure the influence a family could have on a business. We hope that such knowledge would prepare the HR leader to be better prepared to play the role of a partner during the evolution of the organisation into a professionally run entity.
What is new in the landscape of insulin-sensitizing agents for polycystic ovary syndrome treatment
Authors: Romualdi Daniela , Versace Valeria , Lanzone Antonio
Published: February 2020

Polycystic ovary syndrome, the most common gynecological endocrinopathy, is burdened with a state of hyperinsulinemia and insulin resistance in 50–80% of affected women. Wherever the origin of these metabolic abnormalities lies, their pathogenetic role in determining, perpetuating, and worsening the clinical traits of the syndrome is ascertained. Many studies have already highlighted possible mechanisms: hyperinsulinemia and insulin resistance may contribute to hyperandrogenemia, chronic anovulation, and other comorbidities of the syndrome by differentially affecting the endocrine glands (ovaries, adrenals, and pituitary) and peripheral tissues (fat mass and skeletal muscle). Based on these evidences, in the past years, thorough research has been focused on the possible role of insulin-sensitizing agents in the treatment of polycystic ovary syndrome. Many compounds were tested to verify their efficacy against polycystic ovary syndrome–related metabolic dysfunction, both relying on previous acquired experiences in the field of diabetes mellitus and experimenting new agents, in particular, those belonging to the class of nutraceuticals. We sought to summarize the most relevant aspects of insulin-sensitizing treatments in polycystic ovary syndrome, by reporting the relevant literature on this topic and by keeping an attentive eye on the newly published international guidelines on polycystic ovary syndrome 2018. This overview encompasses metformin, thiazolidinediones, inositols, alpha-lipoic acid, and GLP1-R analogues. Starting from the analysis of the mechanisms of action, we anchored to the state of the art of the use of these drugs in polycystic ovary syndrome, to the most recent evidences for clinical practice and to the remaining open questions around indications, dose, treatment schedules, and side effects.
The mismatch repair system (mutS and mutL) in Acinetobacter baylyi ADP1
Authors: Zhou Hua , Zhang Linyue , Xu Qingye , Zhang Linghong , Yu Yunsong , Hua Xiaoting
Published: February 2020

Background

Acinetobacter baylyi ADP1 is an ideal bacterial strain for high-throughput genetic analysis as the bacterium is naturally transformable. Thus, ADP1 can be used to investigate DNA mismatch repair, a mechanism for repairing mismatched bases. We used the mutS deletion mutant (XH439) and mutL deletion mutant (XH440), and constructed a mutS mutL double deletion mutant (XH441) to investigate the role of the mismatch repair system in A. baylyi.

Results

We determined the survival rates after UV irradiation and measured the mutation frequencies, rates and spectra of wild-type ADP1 and mutSL mutant via rifampin resistance assay (RifR assay) and experimental evolution. In addition, transformation efficiencies of genomic DNA in ADP1 and its three mutants were determined. Lastly, the relative growth rates of the wild type strain, three constructed deletion mutants, as well as the rifampin resistant mutants obtained from RifR assays, were measured. All three mutants had higher survival rates after UV irradiation than wild type, especially the double deletion mutant. Three mutants showed higher mutation frequencies than ADP1 and favored transition mutations in RifR assay. All three mutants showed increased mutation rates in the experimental evolution. However, only XH439 and XH441 had higher mutation rates than the wild type strain in RifR assay. XH441 showed higher transformation efficiency than XH438 when donor DNA harbored transition mutations. All three mutants showed higher growth rates than wild-type, and these four strains displayed higher growth rates than almost all their rpoB mutants. The growth rate results showed different amino acid mutations in rpoB resulted in different extents of reduction in the fitness of rifampin resistant mutants. However, the fitness cost brought by the same mutation did not vary with strain background.

Conclusions

We demonstrated that inactivation of both mutS and mutL increased the mutation rates and frequencies in A. baylyi, which would contribute to the evolution and acquirement of rifampicin resistance. The mutS deletion is also implicated in increased mutation rates and frequencies, suggesting that MutL may be activated even in the absence of mutS. The correlation between fitness cost and rifampin resistance mutations in A. baylyi is firstly established.
Comparison of exclusion, imputation and modelling of missing binary outcome data in frequentist network meta-analysis
Authors: Spineli Loukia M. , Kalyvas Chrysostomos
Published: February 2020

Background

Missing participant outcome data (MOD) are ubiquitous in systematic reviews with network meta-analysis (NMA) as they invade from the inclusion of clinical trials with reported participant losses. There are available strategies to address aggregate MOD, and in particular binary MOD, while considering the missing at random (MAR) assumption as a starting point. Little is known about their performance though regarding the meta-analytic parameters of a random-effects model for aggregate binary outcome data as obtained from trial-reports (i.e. the number of events and number of MOD out of the total randomised per arm).

Methods

We used four strategies to handle binary MOD under MAR and we classified these strategies to those modelling versus excluding/imputing MOD and to those accounting for versus ignoring uncertainty about MAR. We investigated the performance of these strategies in terms of core NMA estimates by performing both an empirical and simulation study using random-effects NMA based on electrical network theory. We used Bland-Altman plots to illustrate the agreement between the compared strategies, and we considered the mean bias, coverage probability and width of the confidence interval to be the frequentist measures of performance.

Results

Modelling MOD under MAR agreed with exclusion and imputation under MAR in terms of estimated log odds ratios and inconsistency factor, whereas accountability or not of the uncertainty regarding MOD affected intervention hierarchy and precision around the NMA estimates: strategies that ignore uncertainty about MOD led to more precise NMA estimates, and increased between-trial variance. All strategies showed good performance for low MOD (<5%), consistent evidence and low between-trial variance, whereas performance was compromised for large informative MOD (> 20%), inconsistent evidence and substantial between-trial variance, especially for strategies that ignore uncertainty due to MOD.

Conclusions

The analysts should avoid applying strategies that manipulate MOD before analysis (i.e. exclusion and imputation) as they implicate the inferences negatively. Modelling MOD, on the other hand, via a pattern-mixture model to propagate the uncertainty about MAR assumption constitutes both conceptually and statistically proper strategy to address MOD in a systematic review.
Psychometric properties of instrumented postural sway measures recorded in community settings in independent living older adults
Authors: Alqahtani Bader A. , Sparto Patrick J. , Whitney Susan L. , Greenspan Susan L. , Perera Subashan , Brach Jennifer S.
Published: February 2020

Background

In the last few decades, research related to balance in older adults has been conducted in lab-based settings. The lack of portability and high cost that is associated with the current gold standard methods to quantify body balance limits their application to community settings such as independent living facilities. The purpose of the study was to examine the relative and absolute reliability and the convergent validity of static standing balance performance using an accelerometer device.

Methods

A total of 131 participants (85% female, mean age 80 ± 8 years) were included for the validity aim, and a subsample of 38 participants were enrolled in the reliability testing (89% female, mean age 76 ± 7 years). The root-mean-square (RMS) and normalized path length (NPL) for sway in antero-posterior (AP) and medio-lateral (ML) directions were calculated for different standing balance conditions. Test-retest reliability was assessed over two testing visits occurring 1 week apart using the intraclass correlation coefficient (ICC) for relative reliability, and the minimal detectable change (MDC) was calculated for the absolute reliability. Spearman’s rank correlation coefficient was used to test convergent validity at baseline between balance measurements and related mobility measures.

Results

Reliability of balance performance using accelerometers was good to excellent with ICC values ranging from 0.41 to 0.83 for RMS sway and from 0.49 to 0.82 for NPL sway. However, the ICC during semi-tandem stance in A-P direction was 0.35, indicating poor reliability. The MDC of the sway measurements ranged from 2.4 to 9.4 for the RMS and 5.2 to 13.8 for the NPL. Balance measurements were correlated with mobility measurements.

Conclusions

Using a portable accelerometer to quantify static standing postural control provides reliable measurements in community settings.
Challenges in the provision of kidney care at the largest public nephrology center in Guatemala: a qualitative study with health professionals
Authors: Flood David , Wilcox Katharine , Ferro Andrea Aguilar , Mendoza Montano Carlos , Barnoya Joaquin , Garcia Pablo , Lou-Meda Randall , Rohloff Peter , Chary Anita
Published: February 2020

Background

Chronic kidney disease (CKD) is increasing worldwide, and the majority of the CKD burden is in low- and middle-income countries (LMICs). However, there is wide variability in global access to kidney care therapies such as dialysis and kidney transplantation. The challenges health professionals experience while providing kidney care in LMICs have not been well described. The goal of this study is to elicit health professionals’ perceptions of providing kidney care in a resource-constrained environment, strategies for dealing with resource limitations, and suggestions for improving kidney care in Guatemala.

Methods

Semi-structured interviews were performed with 21 health professionals recruited through convenience sampling at the largest public nephrology center in Guatemala. Health professionals included administrators, physicians, nurses, technicians, nutritionists, psychologists, laboratory personnel, and social workers. Interviews were recorded and transcribed in Spanish. Qualitative data from interviews were analyzed in NVivo using an inductive approach, allowing dominant themes to emerge from interview transcriptions.

Results

Health professionals most frequently described challenges in providing high-quality care due to resource limitations. Reducing the frequency of hemodialysis, encouraging patients to opt for peritoneal dialysis rather than hemodialysis, and allocating resources based on clinical acuity were common strategies for reconciling high demand and limited resources. Providers experienced significant emotional challenges related to high patient volume and difficult decisions on resource allocation, leading to burnout and moral distress. To improve care, respondents suggested increased budgets for equipment and personnel, investments in preventative services, and decentralization of services.

Conclusions

Health professionals at the largest public nephrology center in Guatemala described multiple strategies to meet the rising demand for renal replacement therapy. Due to systems-level limitations, health professionals faced difficult choices on the stewardship of resources that are linked to sentiments of burnout and moral distress. This study offers important lessons in Guatemala and other countries seeking to build capacity to scale-up kidney care.
Factors related to the burden of family caregivers of elderly patients with spinal Tumours in Northwest China
Authors: Luo Jing , Zhou Yongchun , Liu Haiping , Hu Jing
Published: February 2020

Background

Family caregivers of elderly patients with spinal tumours experience considerable pain and burden during the care process. This study aims to investigate the factors associated with caregiver burden in family caregivers of elderly patients with spinal tumours.

Methods

A total of 220 elderly patients with spinal tumours (age ≥ 65 years) hospitalized at the spine centre of our hospital from January 2015 to December 2017 and their family caregivers were recruited for this cross-sectional study. All participants completed a sociodemographic questionnaire. Caregiver burden, social support and self-efficacy were assessed by the Chinese version of the Zarit Burden Interview (ZBI), the Social Support Rating Scale (SSRS) and the General Self-Efficacy Scale (GSE), respectively. The factors related to caregiver burden were analysed by multivariate analysis.P < 0.05 was considered statistically significant.

Results

The 216 elderly patients with spinal tumours were 71.59 ± 8.49 years old, and their caregivers were 70.46 ± 9.13 years old. A total of 170 patients were cared for by their spouses, who accounted for 78.7% of all caregivers. The ZBI score for the family caregivers was 35.5 ± 7.5, and most caregivers (84.5%) reported a moderate or heavy burden. The factors related to caregiver burden included patient paralysis, the primary cancer site, chemotherapy and/or radiation, cognitive dysfunction, functional status, monthly income, pain score, caregivers’ SSRS score, and GSE score.

Conclusions

Most family caregivers of elderly patients with spinal tumours have a considerable caregiver burden. Interventions based on social support and self-efficacy can help reduce caregiver burden.
Factors associated with macrosomia, hypoglycaemia and low Apgar score among Fijian women with gestational diabetes mellitus
Authors: Fuka Falahola , Osuagwu Uchechukwu L. , Agho Kingsley , Gyaneshwar Rajat , Naidu Swaran , Fong James , Simmons David
Published: February 2020

Background

Gestational diabetes mellitus (GDM) in Fiji is a serious public health issue. However, there are no recent studies on GDM among pregnant women in Fiji. The aim of this study was to examine prevalence of, and sociodemographic factors associated with adverse neonatal outcomes among Fijian women with GDM.

Methods

We used cross-sectional data of 255 pregnant women with GDM who gave birth to singleton infants at Colonial War Memorial Hospital (CWMH) in Suva city. Women underwent testing for GDM during antenatal clinic visits and were diagnosed using modified International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria. Multivariable logistic regression analysis was used to investigate factors associated with neonatal outcomes.

Results

Women with a previous baby weighing > 4 kg were 6.08 times more likely to experience neonatal macrosomia (Adjusted odds ratio (AOR) = 6.08; 95%CI: 2.46, 15.01). Compared to unmarried women, the odds of macrosomia among married women reduced by 71% (AOR = 0.29; 95%CI: 0.11, 0.77). Compared with delivery before 38 weeks of gestation, the infants of women who delivered between 38 and 41 weeks of gestation were 62 and 86% less likely to experience neonatal hypoglycaemia and Apgar score < 7 at 5 mins, respectively. The offspring of women who were overweight and obese had higher odds of neonatal hypoglycaemia. Late booking in gestation (≥28 weeks) was significantly associated with Apgar score < 7 at 5 min (AOR = 7.87; 95%CI: 1.11, 55.75). Maternal pre-eclampsia/pregnancy induced hypertension was another factor associated with low Apgar score in infants.

Conclusions

The study found high rates of adverse neonatal outcomes among off springs of Fijian women with GDM and showed that interventions targeting pregnant women who are overweight, had a previous baby weighing > 4 kg, had pre-eclampsia, delivered before 38 weeks of gestation, and those who booked later than 13 weeks in gestation, are needed to improve pregnancy outcomes.
Correction to: Low-cost HPV testing and the prevalence of cervical infection in asymptomatic populations in Guatemala
Authors: Lou Hong , Gharzouzi Eduardo , Guerra Sarita Polo , Fokom Domgue Joël , Sawitzke Julie , Villagran Guillermo , Garland Lisa , Boland Joseph F. , Wagner Sarah , Rosas Héctor , Troxler Jami , McMillen Heidi , Kessing Bailey , Alvirez Enrique , Castillo Miriam , Morales Hesler , Argueta Victor , Rosingh Andert , van Aerde-van Nunen Femke J. H. B. , Lopez Griselda , Pinedo Herbert M. , Schiffman Mark , Dean Michael , Orozco Roberto
Published: February 2020

Following publication of the original article [1], an error was reported in the tagging of Joël Fokom Domgue in the author group. The tagging in this correction article has been fixed.
Multicenter investigation of pediatric gastrointestinal tract magnets ingestion in China
Authors: Wang Kai , Zhang Dan , Li Xianling , Wang Zengmeng , Hou Guangjun , Jia Xinjian , Niu Huizhong , Qi Shiqin , Deng Qingqiang , Jiang Bin , Bian Hongqiang , Yang Heying , Chen Yajun
Published: February 2020

Purpose

To describe the incidence and management of gastrointestinal tract Buckyball magnets ingestions in a multicenter Chinese pediatric patient population, and discuss the preventive measures.

Methods

Medical records of 74 pediatric patients from 9 large Chinese hospitals during the past 10 years, who were diagnosed as buckyball magnets ingestion and got invasive treatment, were retrospectively studied. The follow-up was through telephone and outpatient service to estimate the post-surgery condition. Information collection was through online questionnaire.

Results

Among the 74 cases, there were 50 boys (68%) and 24 girls (32%). The median age was 36 (interquartile range (IQR) 22–77) months, with a range of 7 months to 11 years, and it showed two peaks, the first between 1 and 3 years, and the second between 6 to 11 years. The annual case number showed a sharp increase over time, and the total case number in the last 2 years (2017 and 2018) showed a greater than 9-fold increase when compared with the first 2 years (2013 and 2014). The majority of ingestions were unintentional, with only 3 patients deliberately swallowing the Buckyball magnets. The median time of ingestion until the onset of emergent symptoms was 2 (IQR 1–5) days, and ranged from 4 h to 40 days. Twenty-one patients had no symptoms, and the remaining cases presented with abdominal pain, vomiting, fever, abdominal distension, excessive crying, melena, and the ceasing of flatus and defecation. Gastroscopy, colonoscopy, laparoscopic surgery and laparotomy surgery were performed in accordance with the algorithm from the North American Society of Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN). Procedural and operative findings included gastrointestinal mucosa erosion, ischemia and necrosis, perforation, and abdominal abscess, fistula and intestinal obstruction. The median number of Buckyball magnets ingested was 4 (IQR 2–8), with a range from 1 to 39. During the median follow-up period of 6 (IQR 1–15) months, 3 patients had intestinal obstruction, and one underwent a second operation. The remaining 71 patients courses were uneventful during the follow-up period. None of the 74 patients reported a second swallowing of foreign bodies.

Conclusions

The incidence of pediatric gastrointestinal tract magnets ingestion in China is increasing. Management of such patients should follow the NASPGHAN algorithm. Preventive measures to limit children’s access to Buckyball magnets should be taken from three levels, namely the national administration, producer, and consumer.