bluuebunny/crossref_metadata_2025 huggingface dataset:
Postoperative diastolic perfusion pressure is associated with the development of acute kidney injury in patients after cardiac surgery: A retrospective analysis
Authors: Jin Jifu , Yu Jiawei , Chang Su Chi , Xu Jiarui , Xu Sujuan , Jiang Wuhua , Shen Bo , Zhuang Yamin , Wang Chunsheng , Ding Xiaoqiang , Teng Jie
Published: November 2019

Background: We aimed to investigate the relationship between the perioperative hemodynamic parameters and the occurrence of cardiac surgery-associated acute kidney injury.
Methods: A retrospective study was performed in patients who underwent cardiac surgery at a tertiary referral teaching hospital. Acute kidney injury was determined according to the KDIGO criteria. We investigated the association between the perioperative hemodynamic parameters and cardiac surgery-associated acute kidney injuryto identify the independent hemodynamic predictors for acute kidney injury.Subgroup analysis was further performed in patients with chronic hypertension.
Results: Among 300 patients, 29.3% developed acute kidney injury during postoperative intensive care unit period. Multivariate logistic analysis showed the postoperative nadir diastolic perfusion pressure, but not mean arterial pressure, central venous pressure and mean perfusion pressure, was independently linked to the development of acute kidney injury after cardiac surgery (odds ratio 0.945, P = 0.045). Subgroup analyses in hypertensive subjects ( n = 91)showed the postoperative nadir diastolic perfusion pressure and peak central venous pressure were both independently related to the development of acute kidney injury (nadir diastolic perfusion pressure, odds ratio 0.886, P = 0.033; peak central venous pressure, odds ratio 1.328, P = 0.010, respectively).
Conclusions: Postoperative nadir diastolic perfusion pressure was independently associated with the development of cardiac surgery-associated acute kidney injury. Furthermore, central venous pressure should be considered as a potential hemodynamic target for hypertensive patients undergoing cardiac surgery.
Knowledge and practices regarding tuberculosis infection control among nurses in Ibadan, South-West Nigeria: a cross-sectional study
Authors: Akande Patrick Aboh
Published: November 2019

Background: Nurses are particularly vulnerable to nosocomial tuberculosis (TB) infection because, being in the frontline of patient care, they are frequently exposed to patients with infectious TB disease. Although cost-effective measures are available for TB infection control (TBIC), they are often poorly implemented. Knowledge of TBIC is known to positively influence the practice of the measures. There is however limited data on the knowledge and practice of TBIC among nurses in Nigeria. This study was aimed at determining the levels of TBIC-related knowledge and practices of nurses in Ibadan, and associated socio-demographic factors. Methods: This cross-sectional study utilized a self-administered questionnaire to collect data from 200 nurses in two secondary health facilities, in May 2014. STATA version 13 was used to analyze data: mean knowledge and practice scores of the nurses and logistic regression to explore their association with socio-demographic factors. Results: The respondents had mean knowledge and practice scores of 68.2% and 79.9% respectively. Using cut-off points of 80% and 100% for good knowledge and practice scores respectively, small proportions of the nurses had good scores- knowledge (10.5%) and practice (6%). Knowledge was found not to be significantly associated with the socio-demographic factors. Work experience was the only factor that was significantly associated with practice, with the more experienced nurses (>18 years of experience) having lesser odds of obtaining good practice scores (OR 0.25, 95%CI 0.06-0.94). Also, there was no significant association between knowledge and practice scores. No structured TBIC training had been conducted at this time. Conclusions: The study revealed that small proportions of the nurses had good knowledge and practice scores. The findings from this study will be useful for the planning of interventions to improve TBIC among nurses and other healthcare workers, and to benchmark monitoring and evaluation of the interventions. It is recommended that the nurses should be trained on TBIC to equip them with necessary knowledge and skills. This, together with appropriate TBIC policy directives, availability of TBIC equipment/supplies and facility architectural remodeling will contribute to optimal implementation of TB preventive measures.
Individual and healthcare system factors influencing antenatal care attendance in Saudi Arabia
Authors: Alanazy Wdad , Brown Amy
Published: November 2019

Background The World Health Organisation recommends women have at least 4 antenatal care visits (ANC) during a low risk pregnancy. However, in Saudi Arabia, many mothers miss these appointments placing their health and that of their baby at risk. Limited research exploring why this is happening usually focuses on low maternal education or personal barriers such as lack of transport. The aim of the current research was therefore to understand what factors at the individual and healthcare systems level were associated with missing antenatal care in Saudi Arabia.Methods Two hundred and forty two pregnant women in their third trimester completed a questionnaire examining their care attendance alongside barriers to attending care. These included maternal demographic background, health literacy, personal barriers, health care system factors and staff communication).Results Over half of women had missed at least one appointment and a third had delayed their care. Mothers who had missed appointments blamed health care system factors such as poor clinic facilities and waiting times. Attending care was not associated with maternal education or literacy. However perceptions of staff communication, consistency and care were lower amongst those who had missed at least one appointment.Conclusions Although in previous research health professionals believe it is maternal education that leads to poor attendance, in our sample at least, it is in fact perceptions of staff communication that affect attendance. Making changes at the health care level e.g. through adapting clinic times and investing in staff training may increase antenatal care attendance in Saudi Arabia.
Diagnostic capability of a linear discriminant function applied to a novel Spectralis OCT glaucoma-detection protocol
Authors: Bambo Maria Pilar , Fuentemilla Enrique , Cameo Beatriz , Fuertes Isabel , Ferrandez Blanca , Güerri Noemi , Polo Vicente , Larrosa Jose M. , Pablo Luis E. , Garcia-Martin Elena
Published: November 2019

Background: Bruch membrane opening–minimum rim width (BMO–MRW) assessment offers a new diagnostic use in glaucoma patients of the Glaucoma Module Premium Edition (GMPE) available for the Spectralis optical coherence tomography (OCT) system. The objective of our research was to evaluate the diagnostic benefits of examining BMO–MRW and peripapillary retinal nerve fibre layer (pRNFL) readings acquired with Spectralis OCT to distinguish between healthy and mild glaucoma patients, comparing those readings with the standard pRNFL application. Moreover, we investigated whether using a particular combination of BMO–MRW and pRNFL parameters with a linear discriminant function (LDF) could further enhance glaucoma diagnosis.
Methods: 136 eyes from 136 individuals were incorporated into this observational, prospective cross-sectional study: 68 mild primary open-angle glaucoma (POAG) patients according to the Hodapp-Parrish-Anderson criteria (mean deviation between 0 and -6 dB) and 68 healthy control subjects selected by Propensity Score Matching. MRW and pRNFL thickness around the disc (diameters: 3.5 mm, 4.1 mm, and 4.7 mm) were obtained using the BMO–MRW protocol, and pRNFL thickness at 3.5 mm was obtained with the standard glaucoma application. The group data were contrasted. One sample was chosen at random to develop the LDF (teaching set: 34 healthy subjects and 34 POAG patients) using a combination of MRW and pRNFL parameters (acquired with the BMO–MRW protocol); the other sample provided a test of how the LDF performed on an independent group (validating set: 34 healthy subjects and 34 POAG patients). The receiver operating curves (ROCs) were plotted for every measurement and contrasted with the proposed LDF. The OCT parameters with the best area under the receiver operating characteristic curve (AUC) were determined.
Results: Global MRW and pRNFL thicknesses were significantly thinner in the POAG group (p < 0.001). The BMO–MRW parameters showed good diagnostic accuracy; the largest AUCs reached 0.875 for the LDF and 0.879 for global RNFL thickness using the standard glaucoma application. There were no statistical differences between the AUCs calculated.
Conclusions: BMO–MRW parameters show a strong capability to differentiate between mild glaucoma and control eyes. Our LDF based on the new BMO–MRW OCT protocol did not perform better than isolated parameters.
Whole grain food diet slightly reduces cardiovascular risks in obese/overweight adults: a systematic review and meta-analysis
Authors: Wang Weihao , Li Jianan , Chen Xiaoxi , Yu Miao , Pan Qi , Guo Lixin
Published: November 2019

Background: The effects of whole grain diet on cardiovascular risks in obese and overweight adults is not well established. Our goal was to conduct a systematic review and meta-analysis on the effect of whole grain diet on cardiovascular risks in obese/overweight adults. Methods: PubMed, Embase and Cochrane were systematically scanned for randomized controlled trials (RCTs), and studies were selected based on certain inclusion and exclusion criteria. The primary outcome was the effectiveness of whole grain food consumption in reducing body weight. The secondary outcomes were the effect of whole grain food consumption on cardiovascular disease (CVD) risk factors including plasma low-density lipoprotein cholesterol (LDL-C), insulin resistance index, blood pressure, body mass index (BMI), C-reactive protein (CRP), and waist circumference in obese/overweight adults. Results: Our results showed that whole grain consumption was associated with lower body weight (mean difference (MD) =-0.5, 95% confidence intervals (CI) [-0.74, 0.25], I2 = 35%, P < 0.0001), lower LDL-C (MD =-0.08, 95% CI [-0.16, 0.00], I2 = 27%, P = 0.05), and lower CRP (MD =-0.36, 95% CI [-0.54, -0.18], I2=69%, P<0.0001), compared with the control group. However, there were no significant differences in waist circumference (MD=-0.12, 95% CI [-0.92, 0.68], I2=44%, P=0.76), systolic blood pressure (MD=-0.11, 95% CI [-1.55, 1.33], I2=3%, P=0.88), diastolic blood pressure (MD=-0.44, 95% CI [-1.44, 0.57], I2=15%, P=0.39), and fasting glucose (MD=-0.05, 95% CI [-0.12, 0.01], I2=31%, P=0.11) between the two groups. Conclusion: This study suggests that whole grain food consumption can slightly reduce body weight, LDL-C and CRP in obese/overweight population.
Thyroid dysfunction and risk factors in patients with newly diagnosed type 2 diabetes: A cross-sectional study
Authors: Li Yanli , Yi Min , Deng Xiaoyi , Mosha Singla Sethiel , Li Wangen , Zhang Xiaodan
Published: November 2019

Background : Diabetes mellitus (DM) and thyroid dysfunction (TD) are two closely associated disorders. The coexistence of TD could adversely influence metabolic control and even increase the long-term mortality in patients with DM. The objective of the present study was to investigate the prevalence and risk factors of TD in patients with type 2 DM (T2DM).
Methods : This is an observational cross-sectional study. A total of 340 patients with newly diagnosed T2DM who were admitted to ward of endocrinology department were included for analysis. Thyroid function was examined and its relationship with demographic, metabolic and diabetes-related parameters were evaluated
Results : The prevalence of TD was 21.2% in the total population. The low T3 syndrome was the most frequent TD, in 14.7% of patients. Low FT3 level was associated with diabetic complications including presence of diabetic ketosis (DK) or diabetic ketoacidosis (DKA) (r = -0.388, P ≤ 0.001) and microalbuminuria (r = -0.302, P ≤ 0.001). Metabolic and demographic factors, including age, glycemic control and insulin resistance also correlated with levels of thyroid hormones. DK or DKA (OR = 6.161, P ≤ 0.001) and microalbuminuria (OR = 3.950, P = 0.002) were risk factors of low T3 syndrome.
Conclusion : TD is not rarely seen in patients with newly diagnosed T2DM. Diabetic complications and diabetes-related metabolic and demographic factors are related to the presence of TD.
Astrocyte-derived exosomes enriched with miR-873a-5p inhibit neuroinflammation via microglia phenotype modulation after traumatic brain injury
Authors: long xiaobing , Yao Xiaolong , Jiang Qian , Yang Yiping , He Xuejun , Tian Weidong , zhao kai , Zhang Huaqiu
Published: November 2019

Background: The interaction between astrocytes and microglia plays a vital role in the damage and repair of brain lesions due to traumatic brain injury (TBI). Recent studies have shown that exosomes act as potent mediators involved in intercellular communication. Methods: In the current study, the expression of inflammatory factors and miR-873a-5p in the lesion area and edema area was evaluated in 15 patients with traumatic brain injury. Exosomes secreted by astrocytes were detected by immunofluorescence, Western blot, and electron microscopy. A mouse model of TBI and an in vitro model of lps-induced primary microglia were established to study the protective mechanism of exosomes from miR-873a-5p-overexpressing in TBI-induced nerve injury. Results: We discovered that exosomes derived from activated astrocytes promote microglial M2 phenotype transformation following TBI. More than 100 miRNAs were detected in these astrocyte-derived exosomes. miR-873a-5p is a major component that was highly expressed in human traumatic brain tissue. Moreover, miR-873a-5p significantly inhibited LPS-induced microglial M1 phenotype transformation and the subsequent inflammation through decreased phosphorylation of ERK and NF-κB p65. This effect also greatly improved the mNSS score and attenuated brain injury in a strictly controlled cortical impact mouse model. Conclusions: Taken together, our research indicates that miRNAs in the exosomes derived from activated astrocytes play a key role in the astrocyte-microglia interaction. miR-873a-5p, as one of the main components of these astrocyte-derived exosomes, attenuated microglia-mediated neuroinflammation and improved neurological deficits following TBI by inhibiting the NF-kB signalling pathway. These findings suggest a potential role for miR-873a-5p in treating traumatic brain injury.
Molecular delimitation of European leafy liverworts of the genus Calypogeia based on plastid super-barcodes
Authors: Ślipiko Monika , Myszczyński Kamil , Buczkowska Katarzyna , Bączkiewicz Alina , Szczecińska Monika , Sawicki Jakub
Published: November 2019

Background Molecular research revealed that some of the European Calypogeia species described on the basis of morphological criteria are genetically heterogeneous and, in fact, are species complexes. DNA barcoding is already commonly used for correct identification of difficult to determine species, to disclose cryptic species, or detecting new taxa. Among liverworts, some DNA fragments, recommend as universal plant DNA barcodes, cause problems in amplification. Super-barcoding based on genomic data, makes new opportunities in a species identification. Results On the basis of 22 individuals, representing 10 Calypogeia species, plastid genome was tested as a super-barcode. It is not effective in 100%, nonetheless its success of species discrimination (95.45%) is still conspicuous. It is not excluded that the above outcome may have been upset by cryptic speciation in C. suecica, as our results indicate. Having the sequences of entire plastomes of European Calypogeia species, we also discovered that the ndhB and ndhH genes and the trnT-trnL spacer identify species in 100%. Conclusions This study shows that even if a super-barcoding is not effective in 100%, this method does not close the door to a traditional single- or multi-locus barcoding. Moreover, it avoids many complication resulting from the need to amplify selected DNA fragments. It seems that a good solution for species discrimination is a development of so-called “specific barcodes” for a given taxonomic group, based on plastome data.
Overexpression of GmNFYA5 confers drought tolerance to transgenic Arabidopsis and soybean plants
Authors: Ma Xiao-Jun , Yu Tai-Fei , Li Xiao-Hui , Cao Xin-You , Ma Jian , Chen Jun , Zhou Yong-Bin , Chen Ming , Ma You-Zhi , Zhang Jun-Hua , Xu Zhao-Shi
Published: November 2019

Background: Crop productivity is challenged by abiotic stresses, among which drought stress is the most common. NF-Y genes, especially NF-YA genes, regulate tolerance to abiotic stress. Results: Soybean NF-Y gene GmNFYA5 was identified to have the highest transcript level among all 21 NF-YA genes in soybean ( Glycine max L.) under drought stress. Drought-induced transcript of GmNFYA5 was suppressed by the ABA synthesis inhibitor naproxen (NAP). GmNFYA5 transcript was detected in various tissues at vegetative and reproductive growth stages with higher levels in roots and leaves than in other tissues, which was consist with the GmNFYA5 promoter:GUS fusion assay. Overexpression of GmNFYA5 in transgenic Arabidopsis plants caused enhanced drought tolerance in seedlings by decreasing stomatal aperture and water loss from leaves. Overexpression and suppression of GmNFYA5 in soybean resulted in increased and decreased drought tolerance, respectively, relative to plants with an empty vector (EV). Transcript levels of ABA-dependent genes ( ABI2 , ABI3 , NCED3 , LEA3 , RD29A , P5CS1 , GmWRKY46 , GmNCED2 and GmbZIP1 ) and ABA-independent genes ( DREB1A , DREB2A , DREB2B , GmDREB1 , GmDREB2 and GmDREB3 ) in transgenic plants overexpressing GmNFYA5 were higher than those of wild-type plants under drought stress; suppression of GmNFYA5 transcript produced opposite results. GmNFYA5 probably regulated the transcript abundance of GmDREB2 and GmbZIP1 by binding to the promoters in vivo. Conclusions: Our results suggested that overexpression of GmNFYA5 improved drought tolerance in soybean via both ABA-dependent and ABA-independent pathways.
covRNA - Discovering covariate associations in large-scale gene expression data
Authors: Urban Lara H , Remmele Christian W , Dittrich Marcus , Schwarz Roland F , Müller Tobias
Published: November 2019

Objective The biological interpretation of gene expression measurements is a challenging task. While ordination methods are routinely used to identify clusters of samples or co-expressed genes, these methods do not take sample or gene annotations into account. We aim to provide a tool that allows users of all backgrounds to assess and visualize the intrinsic correlation structure of complex annotated gene expression data and discover the covariates that jointly affect expression patterns. Results The Bioconductor package covRNA provides a convenient and fast interface for testing and visualizing complex relationships between sample and gene covariates mediated by gene expression data in an entirely unsupervised setting. The relationships between sample and gene covariates are tested by statistical permutation tests and visualized by ordination. The methods are inspired by the fourthcorner and RLQ analyses used in ecological research for the analysis of species abundance data, that we modified to make them suitable for the distributional characteristics of both, RNA-Seq read counts and microarray intensities, and to provide a high-performance parallelized implementation for the analysis of large-scale gene expression data on multi-core computational systems. CovRNA provides additional modules for unsupervised gene filtering and plotting functions to ensure a smooth and coherent analysis workflow.
Long term comparison between flipped classroom and team-based learning on a prosthodontic class
Authors: Hayama Rika , Okura Kazuo , Oshima Masamitsu , Hosoki Maki , Suzuki Yoshitaka , Miyagi Mayu , Inoue Miho , Rodis Omar Marianito Maningo , Matsuka Yoshizo
Published: November 2019

Background Active learning is a concept that allows students to study and learn actively by themselves to get knowledge. There are several methods of active learning, including flipped classroom (FC) and team-based learning (TBL). In FC, students are required to study before classes. In TBL, students also study before class. The students take individual readiness assurance test (IRAT) and group readiness assurance test (GRAT), then discuss group assignment projects (GAPs) during class. The purpose of this study was to compare the effectiveness between FC and TBL using longitudinal term-end examination data.Methods FC and TBL effectiveness was assessed from the results of the term-end examinations from 2014 to 2017. The students were asked to answer questions on the favorable and unfavorable responses of FC and TBL. To check the difficulty of the term-end examinations, control dentists took the same examinations.Results Multi-way ANOVA showed that the correct answer rate in term-end examinations was significantly different in comparison with the time of the trial, and for the participants (students and dentists). The term-end examination score of FC and TBL did not show a statistical difference. According to the students, the favorable responses of FC and TBL were on the study habit and the video contents, while the unfavorable responses were mainly on the study materials.Conclusions There is no statistical difference between FC and TBL on term-end examination scores. There were no interactions between the test period and the participants (students or dentists), and the test period and class format.
Ethnic and Gender Biases in Clinical Performance Assessment (CPA) in Healthcare Education: A Systematic Review
Authors: Chao Iris C.I. , Violato Efrem , Concannon Brendan , McCartan Charlotte , Nicpon Katarzyna , King Sharla , Roberts Mary Roduta
Published: November 2019

Background: Several forms of bias, including ethnic and gender bias, are thought to impact evaluations on Clinical Performance Assessments (CPAs). Unfairness may influence student learning attitudes if a loss of trust causes a lack of engagement in learning. Understanding the biases occurring in CPAs can lead to well-designed examiner training to ensure equality and fairness. The purpose of this systematic review is to determine the current evidence in the literature for ethnic and/or gender bias by examiners evaluating pre-licensure healthcare students in CPAs using standardized patients (SPs). Methods: Literature was systematically searched in CINAHL, PubMed and Medline from inception to February 2019, and no date range was set. Studies related to the investigation of ethnic and/or gender biases occurring in CPAs using SPs for examining health professions students were selected. A systematic review was conducted to assess the methodological quality and strength of evidence of relevant research and to identify if any potential ethnic and/or gender bias occurred in CPAs. The Guidelines for Critical Review were used to appraise the selected studies. Results: Nine studies published from 2003 to 2017 were retrieved for review. Three studies met all the Guidelines for Critical Review quality criteria, indicating stronger evidence of their outcomes, two of the studies reported ethnic and/or gender bias existing in the CPAs. Overall, four studies found ethnic and/or gender bias in CPAs, but all study results had small effect sizes. Conclusions: No systematic and consistent bias was found across the studies; nonetheless, the possibility of ethnic or gender bias by some examiners cannot be ignored. To minimize potential examiner bias, the investigation of Frame of Reference training, multiple examiners per station, and combination assessments in CPAs is recommended.
The behavioural and neuropathologic sexual dimorphism and absence of MIP-3α in tau P301S mouse model of Alzheimer’s disease
Authors: Sun Yao , Guo Yongqing , Feng Xuejian , Jia Meng , Ai Ning , Dong Yue , Zheng Yayuan , Fu Lu , Yu Bin , Zhang Haihong , Wu Jiaxin , Yu Xianghui , Wu Hui , Kong Wei
Published: November 2019

Background: Tau hyper-phosphorylation has been considered a major contributor to neurodegeneration in Alzheimer’s disease (AD) and related tauopathies, and has gained prominence in therapeutic development for AD. To elucidate the pathogenic mechanisms underlying AD and evaluate therapeutic approaches targeting tau, numerous transgenic mouse models that recapitulate critical AD-like pathology have been developed. Tau P301S transgenic mice is one of the most widely used mouse models in AD research. Extensive studies have demonstrated that sex significantly influences AD pathology, behavioral status and therapeutic outcomes, suggesting that studies using mouse models of AD must consider sex- and age-related differences in neuropathology, behavior, and plasma content. Method: We systematically investigated differences in tau P301S transgenic mice (PS19 line) and wildtype littermates of different sex behavioral performance, tau neuropathology and biomarkers in plasma and brain. Results: Male P301S transgenic mice exhibited significant changes in weight loss, survival rate, clasping, kyphosis, composite phenotype assessment, nest building performance, tau phosphorylation at Ser202/Thr205 and astrocyte activation compared to that of wild type littermates. In contrast, female P301S transgenic mice were only sensitive in the Morris Water Maze and open field test. In addition, we characterized the absence of macrophage-inflammatory protein (MIP-3α) and the upregulation of interferon (IFN)-γ, interleukin (IL)-5, and IL-6 and. Male P301S transgenic mice expressed more plasma biomarkers than those of female P301S mice. Conclusion: Our findings highlight sexual dimorphism in the behavior, neuropathology, and biomarkers in tau P301S transgenic AD mice, indicating that the use of male P301S transgenic mice may be more suitable for assessing anti-phosphorylated tau therapeutic strategies for AD and related tauopathies, and the MIP-3α may be a new potential plasma biomarker.
The efficacy of Narrative Exposure Therapy for Children (KIDNET) as a Treatment for Traumatized Young Refugees versus Treatment as Usual: Study Protocol for a Multi-Center Randomized Controlled Trial (YOURTREAT)
Authors: Wilker Sarah , Catani Claudia , Wittmann Jasmin , Preusse Melissa , Schmidt Telja , May Theodor , Ertl Verena , Doering Bettina , Rosner Rita , Zindler Areej , Neuner Frank
Published: November 2019

Background: Germany hosts a large number of refugees from war-affected countries. The integration of refugees, in particular young refugees from the Middle East, is one of the major current social challenges in Germany. Mental disorders, first of all post-traumatic stress disorder (PTSD) that results from war experiences, are common among young refugees and interfere with quality of life as well as functional integration. Evidence regarding effective treatment options for this population is scarce. In this trial, we aim to evaluate the pragmatic, short-term psychotherapy Narrative Exposure Therapy for Children (KIDNET) for the treatment of young refugees in Germany. Methods: In a rater-blinded multi-center randomized-controlled trial, KIDNET is compared to treatment as usual (TAU) within the general health care system. A total number of 80 young refugees who fulfill the diagnostic criteria of PTSD will be randomized to either KIDNET or TAU. Diagnostic interviews will take place at baseline before treatment as well as six and 12 months thereafter. They will assess exposure to traumatic events, PTSD and comorbid symptoms, as well as parameters of integration. Discussion: The results of this study will provide evidence regarding effective treatment options for young refugees in Germany, a population that has been understudied and received only limited access to mental health care so far. Next to the effects of treatment on mental health outcomes, integration parameters will be investigated. Therefore, this study will provide broad insights into treatment options for young refugees and their potential implications on successful integration. Trial registration: German Clinical Trials Register (Deutsches Register Klinischer Studien; DRKS), registered on May 15 th , 2019. The trial registration number is DRKS00017222 (www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00017222)
Combined extracorporeal shock wave lithotripsy and endoscopic treatment for pain in chronic pancreatitis (SCHOKE Trial): study protocol for a randomized sham-controlled trial
Authors: Olesen Søren Schou , Drewes Asbjørn M. , Maragoni Rajesh Goud , Tandan Manu , Lakhtakia Sundeep , Ramchandani Mohan , Rao G V , Reddy D Nageshwar , Talukdar Rupjyoti
Published: November 2019

Background: Pain is the primary symptom of chronic pancreatitis (CP) and remains a considerable therapeutic challenge. In patients with obstruction of the pancreatic duct, including stones and strictures, endoscopic treatment with or without preceding extracorporeal shock wave lithotripsy (ESWL) have been used for pancreatic duct decompression. The rationale for these procedures is based on the assumption that obstruction of the pancreatic duct leads to ductal hypertension and pain. However, clinical pain symptoms correlate poorly with pancreatic duct morphology and the evidence for pancreatic duct decompression as an effective treatment for pain is based on case-series and comparison between different procedures, while no randomised prospective sham-controlled trials are currently available. The SCHOKE trial is a randomized sham-controlled trial designed to determine if pancreatic duct decompression is an effective treatment for pain in patients with CP. Methods: The SCHOKE trial is a randomized, single-blinded, parallel-group, sham-controlled trial designed to evaluate the effect of combined ESWL and endoscopic treatment for pain in patients with CP. In total, 106 adult patients with painful CP and pancreatic duct obstruction will be randomized to combined ESWL and subsequent endoscopic treatment or corresponding sham procedures. The primary outcome is pain relief during the 3 months post-randomization period as documented in a pain diary. Secondary outcomes include quality of life and functional scores, patient’s global impression of change, change in use of analgesics, frequency of hospitalization and complications. Standard follow-up is at 3 and 6 months after randomization. In an experimental sub-study, quantitative sensory testing obtained before and after intervention will be used to obtain information on central pain processing and to develop models for prediction of treatment outcome.Discussion: The SCHOKE trial investigates if pancreatic duct decompression, obtained by combined ESWL and endoscopic treatment, is effective for pain treatment in patients with CP.Trial registration: ClinicalTrials.gov, NCT03966781. Registered on 25th May 2019.
The effect of tumor necrosis on postoperative survival of patients with solitary small hepatocellular carcinoma
Authors: Ling Yi-hong , Chen Jie-wei , Wen Shi-hong , Huang Chao-yun , Li Peng , Lu Liang-he , Mei Jie , Li Shao-hua , Wei Wei , Cai Muyan , Guo Rong-ping
Published: November 2019

Background: Small hepatocellular carcinoma (sHCC) is a special subtype of HCC with the maximum tumor diameter ≤ 3 cm and favorable long-term outcomes. Surgical resection or radiofrequency ablation offer the greatest chance for cure; however, many patients still undergo tumor recurrence after primary treatment. So far, there is no clinical applicable method to assess biological aggressiveness in solitary sHCC.Methods: In the present study, we retrospectively evaluated tumor necrosis of 335 patients with solitary sHCC treated with hepatectomy between December 1998 and 2010 from Sun Yat-sen University Cancer Center.Results: In the current study, the presence of tumor necrosis was observed in 157 of 335 (46.9%). Further correlation analysis showed that the presence of tumor necrosis in sHCC was significantly correlated with tumor size and vascular invasion (P = 0.026, 0.003, respectively). The presence of tumor necrosis was associated closely with poorer cancer-specific overall survival (OS) and recurrence-free survival (RFS) as evidenced by univariate (P < 0.001; hazard ratio, 2.821; 95% CI, 1.643-4.842) and multivariate analysis (P = 0.005; hazard ratio, 2.208; 95% CI, 1.272-3.833). More importantly, the combined model by tumor necrosis, vascular invasion and tumor size can significantly stratify the risk for RFS and OS and improve the ability to discriminate sHCC patients’ outcomes (P < 0.0001 for both).Conclusions: Our findings provide evidence that tumor necrosis has the potential to be a parameter for cancer aggressiveness in solitary sHCC. The combined prognostic model may be a useful tool for identifying solitary sHCC patients with worse outcomes.
First-year drug therapy of new-onset rheumatoid and undifferentiated arthritis: A nationwide register-based study.
Authors: Muilu Paula , Rantalaiho Vappu , Kautiainen Hannu , Virta Lauri , Eriksson Johan , Puolakka Kari
Published: November 2019

Backgroud: In this retrospective cohort study, we wanted to evaluate the drug therapies used for early rheumatoid (RA) and undifferentiated (UA) arthritis patients. Methods: From a nationwide register maintained by the Social Insurance Institution, information on sex, date of birth, and date of special medicine reimbursement decision for all new Finnish RA and UA patients between 2011-14 were collected, and their DMARD purchases during the first year after the diagnosis were analyzed. Results: A total of 7338 patients with early RA (67.3% female, 68.1% seropositive) and 2433 with early UA (67.8% female) were identified. DMARDs were initiated during the first month after the diagnosis to 92.0 % of the patients with seropositive RA, 90.3% with seronegative RA and to 87.7% with UA (p<0.001). Respectively, 72.1%, 63.4%, and 42.9% of the patients (p<0.001) used methotrexate; 49.8%, 35.9%, and 16.0% (p<0.001) as part of a DMARD combination during the first month. By the end of the first year after the diagnosis, self-injected biologics were initiated to 2.6%, 5.3% and 3.1% (p<0.001) of them. Only 1.4%, 2.6% and 3.0% (p<0.001) of the patients were not receiving any DMARDs. During the first year, 83.4% of the seropositive RA patients had purchased methotrexate, 50.4% sulfasalazine, 72.1% hydroxychloroquine, and 72.6% prednisolone. Conclusions: Currently, combination therapy including methotrexate is a common treatment strategy for early seropositive RA in Finland. Despite an easy access to biologics, these drugs are seldom needed during the first year after diagnosis.
The incidence of depression and anxiety in patients with ankylosing spondylitis: A systematic review and meta-analysis
Authors: Park Jamie YE , Howren Alyssa M , Zusman Enav Z , Esdaile John M , De Vera Mary A
Published: November 2019

Background: As awareness for the importance of mental health continues to expand in rheumatology, it is important to understand the epidemiology of psychiatric complications in ankylosing spondylitis (AS) with the ultimate goal of future prevention and improved quality of care. This study aims to review evidence on the incidence and determinants of depression and/or anxiety among patients with AS. Methods: We searched Medline, Embase, Cochrane Database of Systematic Reviews, CINAHL Complete, and PsycINFO for full-length observational studies that involved a sample or population of patients with AS and assessed depression and/or anxiety. Primary outcomes extracted were: 1) risk estimates for depression and/or anxiety (e.g., relative risk [RR]); and 2) determinants or factors identified as independent predictors of depression and/or anxiety using multivariable regression approaches and corresponding estimates (e.g., odds ratios [OR]). Where relevant, we pooled estimates using random effects models. Results: Out of 783 titles from our search strategy, we reviewed 39 manuscripts. Four studies assessed the incidence of depression and meta-analyzing reported estimates from three of these studies yielded a pooled RR of 1.51 (95% CI 1.28 to 1.79). Differences in risk of depression among men and women with AS were inconclusive, suggesting need for further study. The incidence of anxiety was comparatively less studied with only one included study reporting a hazard ratio of 1.85 (95% CI 1.37 to 2.49). Education level was a key determinant, with lower levels associated with higher odds of depression (OR 6.65; 9% CI 1.36 to 32.51) and anxiety (OR 9.31; 9% CI 1.39 to 62.19) among AS patients. Conclusions: Our systematic review and meta-analysis shows an increased risk of depression and anxiety among patients with AS. These findings suggest the importance of monitoring and care for psychiatric conditions in AS.
Stigma and discrimination: A barrier to the utilisation of a nutritional program in HIV care services in Ethiopia
Authors: Tesfay Fisaha , Javanparast Sara , Mwanri Lillian , Ziersch Anna
Published: November 2019

Background In Ethiopia, stigmatizing attitudes towards people living with HIV have reduced over time. This is mainly due to improved HIV knowledge and the expansion of access to HIV care and support services. However, HIV stigma and discrimination remain a key challenge, and have negative impacts on access to and utilisation of HIV services including nutritional programs. A small number of studies have examined the experience of stigma related to nutritional programs provided to people living with HIV, but this is limited. This study explored HIV status disclosure and experience of stigma among people living with HIV enrolled in a nutritional program in HIV care setting in Ethiopia and impacts on program utilisation.Methods and participants As part of a larger study, qualitative in-depth interviews were conducted with 20 adults living with HIV, 15 caregivers of children living with HIV and 13 program staff in the nutritional program in three hospitals in the Tigray region of Northern Ethiopia. Framework analysis was employed to analyse the data and NVivo 11 was used to assist data analysis.Results The study found varying levels of positive HIV status disclosure, depending on who the target of disclosure was. Disclosing to family members was reported to be less problematic by most participants. Despite reported benefits of the nutritional in terms of improving their weight and overall health status, adults and caregivers of children living with HIV revealed experience of stigma and discrimination and fear of discovery of positive HIV status due to: a) nutritional support (Plumpynut/sup) to HIV by the community; b) increased frequency of visits to HIV services.Conclusion There is evidence that enrolment in the nutritional program is associated with increased concern about stigma and discrimination, which in turn negatively affected the utilisation of the nutritional program and HIV service more broadly. Nutritional programs in HIV care should include strategies which take these concerns into account by mainstreaming stigma prevention and mitigation activities. Further research should be done to identify innovative ways of social inclusion to mitigate stigma and improve utilisation.
Time Dependent Hazard Ratio Estimation Using Instrumental Variables Without Conditioning on an Omitted Covariate
Authors: MacKenzie Todd , Martinez-Camblor Pablo , O'Malley James
Published: November 2019

Estimation that employs instrumental variables (IV) can reduce or eliminate bias due to confounding. In observational studies instruments result from natural experiments such as the effect of clinician preference or geographic distance on treatment selection. In randomized studies the randomization indicator is an instrument, especially if the study is blinded, e.g. no placebo effect. Estimation via instruments is a highly developed field for linear models but the use of instruments in time-to-event analysis is far from established. Various IV-based estimators of the hazard ratio (HR) from Cox's regression models have been proposed. We extend IV based estimation of Cox's models beyond proportionality of hazards, and address estimation of a log-linear time dependent hazard ratio and a piecewise constant HR. We estimate the marginal time-dependent hazard ratio unlike other approaches that estimate the hazard ratio conditional on the omitted covariates. Due to the non-collapsibility of the Cox's models these two estimands are not identical. We report the results of simulations that includes the use of copulas to generate potential times-to-event that have a given marginal structural time dependent hazard ratio but are dependent on omitted covariates. We demonstrate the method to estimate the time dependent hazard ratio for two vascular interventions.
Prevalence and causes of visual impairment and blindness in three ecological regions of Nepal
Authors: Shrestha Mohan Krishna , Sun Sunjuri Zhi Yu , Limbu Ben , Poudel Manish , Khanal Shankar Prasad , Pradhan Bandana , Shrestha Mangala
Published: November 2019

Background: Visual impairment and blindness are significant public health issues worldwide. This study aimed to estimate the prevalence and causes of moderate to severe visual impairment (MSVI) and blindness in people aged 15 years and above across three ecological regions of Nepal.
Methods: A comparative cross-sectional study was conducted in one district in each of the three ecological regions of Nepal. Intensive training was provided to health workers on how to conduct door-to-door enumeration, visual acuity testing and referral when indicated for comprehensive ocular examination by technicians and ophthalmologists to diagnose and treat ocular morbidities. Collected data were analyzed using Statistical Package for Social Science (SPSS) v19.0 and Stata v10.0 software.
Results: Altogether 5234 participants were enrolled in the study (participation rate 96.4%). The overall prevalence of MSVI was 9.5% (95% CI = 8.7 - 10.3) which was 4.7% in the Mountain district, 11.2% in the Hill district and 21.2% in the Tarai district. In those aged 15-49 years MSVI prevalence was 1.5% and in those aged ≥50 it was 25.1%. The overall prevalence of blindness was 0.9% (95% CI=0.6-1.2), and the prevalence of blindness in the 15-49 and ≥50 age groups was 0.2% and 2.3% respectively. Most cases of visual impairment and blindness (95.5%) were due to cataract and uncorrected refractive error. Overall, cataract was the leading cause of visual impairment and blindness (53.5%), followed by uncorrected refractive error (39.5%).
Conclusion: The prevalence of visual impairment and blindness varied significantly with age, ethnicity and locality. The correction of refractive error and cataract surgery would reduce nine in ten cases of moderate to severe visual impairment and blindness.

Key words: Epidemiology, Public health, visual, Optic and refraction
Short‐Term Effects of Cover Crops on Soil Microbial Characteristics and Biogeochemical Processes across Actively Managed Farms
Authors: Strickland Michael S. , Thomason Wade E. , Avera Bethany , Franklin Josh , Minick Kevan , Yamada Steffany , Badgley Brian D.
Published: November 2019

Core Ideas

The effect of cover crops on soil microbes and biogeochemistry was examined.

Cover crops increase microbial biomass and bioavailable soil carbon.

Increasing cover crop biomass amplifies belowground effects.

Agricultural soils are largely degraded or under threat of degradation. Given a growing human population and the subsequent need to feed this population, agricultural practices must maintain productivity and soil quality. Cover cropping regimes are a management approach that aims to address these dual goals. Although the use of cover crops has been linked to many positive effects on soil quality and crop yields, few studies have examined their effects on soil microbial community structure and function under active farm management. We assessed soil characteristics and microbial community structure and function between agricultural field plots with and without cover crops. We expected microbes would respond in the short‐term to increasing cover crop biomass, with increases in microbial activity and a shift in C acquisition toward substrates indicative of root exudation. In the presence of cover crops, we found active microbial biomass and bioavailable‐C increased by 64 and 37%, respectively, indicating the potential for increased C sequestration. Soil NH4+ increased by 64%, whereas soil NO3‐ decreased by 30%, indicating a shift toward less mobile N forms and the potential of greater nutrient retention under cover cropping regimes. Additionally, increasing cover crop biomass was related to lower microbial biomass C/N ratios and to decreased utilization of recalcitrant C substrates. These results potentially suggest a shift toward greater microbial utilization of root‐derived compounds with increasing cover crop biomass. Together, these results indicate that, in the short‐term, the presence of cover crops may improve soil quality, as measured by indices of microbial activity, and soil C and nutrients.
Current Insights into Nonuniform Flow across Scales, Processes, and Applications
Authors: Abou Najm Majdi , Lassabatere Laurent , Stewart Ryan D.
Published: November 2019

Core Ideas

Nonuniform flow has proven to be the rule rather than the exception in nearly all soils.

Computational and technological advancements are promising for nonuniform flow.

They allow improved visualization and characterization of structures across scales.

We need to translate apparent complexity of geosystems into reproducible outcomes.

Those outcomes must be of generalizable applicability in flow and transport research.
Isolation and identification of Acanthamoeba genotypes and Naegleria spp. from the water samples of public swimming pools in Qazvin, Iran
Authors: Paknejad Nastaran , Hajialilo Elham , Saraei Mehrzad , Javadi Amir
Published: November 2019

Free-living amoeba (FLA), including Acanthamoeba and Naegleria are facultative parasites in humans. The amoeba have widespread distribution in various water sources. The aim of this study was isolation and molecular identification of Acanthamoeba and Naegleria isolated from swimming pools and also hot and cold tub waters in Qazvin province. The samples (166 water samples) were cultured to isolate and identify positive specimens. PCR (polymerase chain reaction) amplification, sequencing and phylogenetic analysis were conducted to confirm the isolated species and genotypes of amoeba. According to morphological characterizations, 18.6% of specimens were identified as FLA, which in 71% were Acanthamoeba by PCR method. Molecular analysis revealed that 36.3%, 18.1% and 4.5% of Acanthamoeba specimens were identified as T3, T4 and T11 Acanthamoeba genotypes, respectively. Protacanthamoeba bohemica (27.2%) and Acanthamoeba sp. (4.5%) were found among the specimens. The results of osmo-tolerance and thermo-tolerance assays demonstrated that 50% of T3 and 25% of T4 genotypes of Acanthamoeba were highly pathogenic parasites. The molecular approach showed the presence of Naegleria lovaniensis (9%) in hot tub water of swimming pools. This study demonstrated that the swimming pools and hot tub water in Qazvin province were contaminated with Acanthamoeba and Naegleria species.