bluuebunny/crossref_metadata_2025 huggingface dataset:
Practice, Perceived Barriers and Motivating factors to medical-incident reporting: A cross-section survey of health care providers at Mbarara Regional Referral Hospital, Southwestern Uganda.
Authors: Turyahabwe Naome , Mwesigwa James , Atuhairwe Christine , Taremwa Ivan Mugisha
Published: January 2020

Background: Medical-incident reporting (MIR) ensures patient safety and delivery of quality of care by minimizing unintentional harm among health care providers. We explored medical-incident reporting practices, perceived barriers and motivating factors among health care providers at Mbarara Regional Referral Hospital (MRRH).Methods: We conducted a cross-sectional descriptive study on 158 health provider at Mbarara Regional Referral Hospital (MRRH), Western Uganda. Data was gathered using a structured questionnaire and analyzed with SPSS. The chi-square was used to determine factors associated with MIR at MRRH.Results: The results showed that there was no formal incident reporting structure. However the medical-incidences identified were: medication errors (89.9%), diagnostic errors (71.5%), surgical errors (52.5%) and preventive error (47.7%). The motivating factors of MIR were: establishment of a good communication system, instituting corrective action on the reported incidents and reinforcing health workers knowledge on MIR (p-value 0.004); presence of effective organizational systems like: written guidelines, practices of open door policy, no blame approach, and team work were significantly associated with MIR (p-value 0.000). On the other hand, perceived barriers to MIR were: lack of knowledge on incidents and their reporting, non-existence of an incident reporting team and fear of being punished (p value 0.669).Conclusion: Medical Incident Reporting at MRRH was sub-optimal. Therefore setting up an incident management team and conducting routine training MIR among health care workers will increase patient safety.
An artificially simulated outbreak of a respiratory infectious disease
Authors: Guo Zuiyuan , Xu Shuang , Tong Libo , Dai Botao , Liu Yuandong , Dan Xiao
Published: January 2020

Background Outbreaks of respiratory infectious diseases often occur in crowded places. To understand the pattern of spread of an outbreak of a respiratory infectious disease and provide a theoretical basis for targeted implementation of scientific prevention and control, we attempted to establish a stochastic model to simulate an outbreak of a respiratory infectious disease at a military camp. This model fits the general pattern of disease transmission and further enriches theories on the transmission dynamics of infectious diseases.
Methods We established an enclosed system of 500 people exposed to adenovirus type 7 (ADV 7) in a military camp. During the infection period, the patients transmitted the virus randomly to susceptible people. The spread of the epidemic under militarized management mode was simulated using a computer model named “the random collision model”, and the effects of factors such as the basic reproductive number ( R 0 ), time of isolation of the patients (TOI), interval between onset and isolation (IOI), and immunization rates (IR) on the developmental trend of the epidemic were quantitatively analysed.
Results Once the R 0 exceeded 1.5, the median attack rate increased sharply; when R 0 =3, with a delay in the TOI, the attack rate increased gradually and eventually remained stable. When the IOI exceeded 2.3 days, the median attack rate also increased dramatically. When the IR exceeded 0.5, the median attack rate approached zero. The median generation time was 8.26 days, (95% confidence interval [CI]: 7.84-8.69 days). The partial rank correlation coefficients between the attack rate of the epidemic and R 0 , TOI, IOI, and IR were 0.61, 0.17, 0.45, and -0.27, respectively.
Conclusions The random collision model not only simulates how an epidemic spreads with superior precision but also allows greater flexibility in setting the activities of the exposure population and different types of infectious diseases, which is conducive to furthering exploration of the epidemiological characteristics of epidemic outbreaks.
Reverse Wedge Effect Following Intramedullary Nailing of a Basicervical Trochanteric Fracture Variant Combined with a Mechanically Compromised Greater Trochanter
Authors: Zhang Yu , Hu Jun , Qin Xiaodong , Li Xiang , Hong Guqi
Published: January 2020

Background: To introduce an unreported intraoperative complication in intramedullary nailing (IN) of an anatomically reduced trochanteric fracture variant characterized by a basicervical fracture line and coronally disrupted greater trochanter (GT). Materials and Methods: A total of 414 trochanteric fractures (TF) treated with intramedullary nails from 2013 to 2017 were included in this study. After analysis of intraoperative fluoroscopy data, 33 cases, including 21 females and 12 males, with a mean age of 72.5 years (33 to 96 years) were identified for internal rotation of the cephalocervical fragment and inferior opening at the basicervical fracture line caused by nailing a satisfactorily reduced TF. The morphological features of this group of patients were analyzed on computed tomography (CT) scan. On radiograph, the magnitude of the displacement and final femoral neck-shaft angle (NSA) were measured.Results: CT analysis demonstrated that the basicervical fracture line and the posterolateral fragment (PLF) detached from the GT were the two dominant features of this cohort. They were classified according to the number of main fragments: a 3-fragmentary subgroup containing three consistent fragments (cephalocervical fragment, PLF and distal femoral shaft) and a 4-fragmentary subgroup embracing one additional fragment (lesser trochanter). The four subtypes were as follows: the 3-fragmentary S indicating a small PLF (6 cases), the 3-fragmentary M presenting a moderate PLF (3 cases), the 3-fragmentary L standing for the PLF involving whole lesser trochanter (LT) (4 cases) and the 4-fragmentary GL incorporating separated PLF and LT fragments (20 cases). Geological analysis demonstrated that the majority of the basicervical fracture lines (81.8%) just crossed the center of the piriformis fossa, while the others marginally involved the medial wall of the GT. Postoperatively, the mean width of the inferior opening at the basicervical region was 9.2±4.6 mm. The mean NSA was 135.2±7.8 degrees. The comparison between the 3- and 4-fragmentary subgroups revealed no significant differences in magnitude of displacement and NSA.Conclusion: This unreported intraoperative complication predominantly occurred in the intramedullary nailed basicervical trochanteric fracture variant combined with a PLF from the GT. The magnitude of the secondary displacement was substantial and resulted in a relative valgus reduction. This secondary displacement was caused by an impingement of the reamer with the superolateral cortex of the cephalocervical fragment and should be addressed during the operation. Level of Evidence: Therapy IV
First-trimester maternal serum alpha-fetoprotein is not a good predictor for adverse pregnancy outcomes: a retrospective study of 3325 cases
Authors: Hu Jilin , Zhang Jinman , He Guilin , Zhu Shu , Tang Xinhua , Su Jie , Li Qian , Kong Yamin , Zhu Baosheng
Published: January 2020

Purpose: To investigate the predictive values of first-trimester maternal serum alpha-fetoprotein (MS-AFP) to preterm birth, stillbirth, preeclampsia and small for gestational age (SGA). Methods: We retrospectively reviewed the data on the first-trimester MS-AFP levels and pregnancy outcomes of 3325 singleton pregnant women. The cutoff value of 2.5 multiple of the median (MoM) was used to evaluate the risks of adverse pregnancy outcomes (APOs) regarding MS-AFP. The receiver operating characteristic (ROC) curves were used to evaluate the predictive efficiencies of MS-AFP to these disorders. Results: A total of 181 pregnancies resulted in preterm birth, 32 in stillbirth, 81 in preeclampsia, and 362 in SGA. Compared to women with MS-AFP < 2.5MoM, those with MS-AFP ≥ 2.5MoM had increased risks (odds ratio, 95% confidence interval) of preterm birth (2.53, 1.65~3.88), preeclampsia (3.05, 1.71~5.43) and SGA (1.90, 1.34~2.69), and had an earlier distribution of gestational weeks at delivery (P = 0.004) and a lower distribution of neonatal birth weights (P = 0.000), but the actual between-group differences were minuscule. The areas under ROC curves were 0.572 (P = 0.001), 0.579 (P = 0.015) and 0.565 (P = 0.000) for preterm birth, preeclampsia and SGA, respectively. Subdivisions for the disorders did not obviously improve the performances of MS-AFP. Conclusion: Elevated first-trimester MS-AFP is associated with increased risk of preterm birth, preeclampsia and SGA. However, the predictive efficiencies were low and it is not a good predictor for these APOs.
Predicting patient outcomes in psychiatric hospitals with routine data: a machine learning approach
Authors: Wolff Jan , Gary Alexander , Jung Daniela , Normann Claus , Kaier Klaus , Binder Harald , Domschke Katharina , Klimke Ansgar , Franz Michael
Published: January 2020

Background: A common problem in machine learning applications is availability of data at the point of decision making. The aim of the present study was to use routine data readily available at admission to predict aspects relevant to the organization of psychiatric hospital care. A further aim was to compare the results of a machine learning approach with those obtained through a traditional method and those obtained through a naive baseline classifier.Methods: The study included consecutively discharged patients between 1st of January 2017 and 31st of December 2018 from nine psychiatric hospitals in Hesse, Germany. We compared the predictive performance achieved by stochastic gradient boosting (GBM) with multiple logistic regression and a naive baseline classifier. We tested the performance of our final models on unseen patients from another calendar year and from different hospitals. Results: The study included 45,388 inpatient episodes. The models’ performance, as measured by the area under the Receiver Operating Characteristic curve, varied strongly between the predicted outcomes, with relatively high performance in the prediction of coercive treatment (area under the curve: 0.83) and 1:1 observations (0.80) and relatively poor performance in the prediction of short length of stay (0.69) and non-response to treatment (0.65). The GBM performed slightly better than logistic regression. Both approaches were substantially better than a naive prediction based solely on basic diagnostic grouping. Conclusion: The present study has shown that administrative routine data can be used to predict aspects relevant to the organisation of psychiatric hospital care. Future research should investigate the predictive performance that is necessary to provide effective assistance in clinical practice for the benefit of both staff and patients.
Novel heavy metal resistance gene clusters are present in the genome of Cupriavidus neocaledonicus STM 6070, a new species of Mimosa pudica microsymbiont isolated from heavy-metal-rich mining site soil
Authors: Klonowska Agnieszka , Moulin Lionel , Ardley Julie , Braun Florence , Gollagher Margaret , Zandberg Jaco Daniel , Marinova Dora , Huntemann Marcel , Reddy T.B.K. , Varghese Neha , Woyke Tanja , Ivanova Natalia , Seshadri Rekha , Kyrpides Nikos , Reeve Wayne
Published: January 2020

Background Cupriavidus strain STM 6070 was isolated from nickel-rich soil collected near Koniambo massif, New Caledonia, using the invasive legume trap host Mimosa pudica. STM 6070 is a heavy metal-tolerant strain that is highly effective at fixing nitrogen with M. pudica. Here we have provided an updated taxonomy for STM 6070 and described salient features of the annotated genome, focusing on heavy metal resistance (HMR) loci and heavy metal efflux (HME) systems.Results The 6,771,773 bp high-quality-draft genome consists of 107 scaffolds containing 6,118 protein-coding genes. ANI values show that STM 6070 is a new species of Cupriavidus. The STM 6070 symbiotic region was syntenic with that of the M. pudica-nodulating Cupriavidus taiwanensis LMG 19424T. In contrast to the nickel and zinc sensitivity of C. taiwanensis strains, STM 6070 grew at high Ni2+ and Zn2+ concentrations. The STM 6070 genome contains 55 genes, located in 12 clusters, that encode HMR structural proteins belonging to the RND, MFS, CHR, ARC3, CDF and P-ATPase protein superfamilies. These HMR molecular determinants are putatively involved in arsenic (ars), chromium (chr), cobalt-zinc-cadmium (czc), copper (cop, cup), nickel (nie and nre), and silver and/or copper (sil) resistance. Seven of these HMR clusters were common to symbiotic and non-symbiotic Cupriavidus species, while four clusters were specific to STM 6070, with three of these being associated with insertion sequences. Within the specific STM 6070 HMR clusters, three novel HME-RND systems (nieIC cep nieBA, czcC2B2A2, and hmxB zneAC zneR hmxS) were identified, which constitute new candidate genes for nickel and zinc resistance.Conclusions STM 6070 belongs to a new Cupriavidus species, for which we have proposed the name Cupriavidus neocaledonicus sp. nov.. STM6070 harbours a pSym with a high degree of gene conservation to the pSyms of M. pudica-nodulating C. taiwanensis strains, probably as a result of recent horizontal transfer. The presence of specific HMR clusters, associated with transposase genes, suggests that the selection pressure of the New Caledonian ultramafic soils has driven the specific adaptation of STM 6070 to heavy-metal-rich soils via horizontal gene transfer.
Effects of synbiotic supplementation on energy and macronutrients homeostasis and muscle wasting of critical care patients: study protocol and a review of previous studies
Authors: Seifi Najmeh , Safarian Mohammad , Nematy Mohsen , Rezvani Reza , Khadem-Rezaian Majid , Sedaghat Alireza
Published: January 2020

Background: Among critically ill patients, regardless of the heterogeneity of disease state, an extreme and persistent dysbiosis occurs. Dysbiosis in critically ill patients may make them prone to hospital-acquired infections, sepsis, multi-organ failure (MOF), energy homeostasis disturbance, muscle wasting, and cachexia. Modulation of gut microbiota through synbiotics can be considered as a potential treatment for muscle wasting and macronutrients homeostasis disturbances. Methods: This is a prospective, single center, double-blind; a parallel randomized controlled trial that aimed to evaluate the effects of synbiotic supplementation on energy and macronutrient ‎homeostasis and muscle wasting in critical care patients.‎ A total of 40 hemodynamically- stable adult critically ill patients who receive enteral nutrition via nasogasteric tube (NGT) in the 24-48h after admission will be included in this study. Eligible patients will be randomly assigned to receive Lactocare (ZistTakhmir) capsules 500 mg every 12h or a placebo capsule which contains only the sterile maize starch and is similar to synbiotic capsules for 14 days. The synbiotic and placebo capsules will be given through nasogastric tube, separately from gavage, after feeding. Discussion: Gut microbiota modulation through synbiotics is proposed to improve clinical prognosis and reduce infectious complications, ventilator dependency and ICU stay by improving energy and macronutrient homeostasis and reducing muscle protein catabolism.
Urinary continence outcomes of four years of follow-up and predictors of early and late urinary continence in patients undergoing robot-assisted radical prostatectomy
Authors: Li Xing , Zhang Huan , Jia Zhuo , Wang Yunpeng , Song Yong , Liao Limin , Zhang Xu
Published: January 2020

Background: The robot-assisted radical prostatectomy (RARP) has been widely applied in recent years; however, only a few studies are reported about long urinary continence after surgery. The present study aimed to examine the outcomes of continence rates (CRs) and determine the risk and protective factors of urinary continence in patients with prostate cancer (PCa) undergoing RARP. Methods: This retrospective study included 650 patients treated with RARP with perioperative data and at least one year of follow-up from January 2009 to November 2017. Also, the preoperative, intraoperative, and postoperative parameters of the patients were analyzed. Continence was defined as no pad use. Early and late continence was defined as the return of urinary continence within 3 months and beyond 12 months post-surgery, respectively. CRs were examined from 1–48 months postoperatively. Logistic regression analysis evaluated the association between the predictive factors and urinary continence in the early and late stages. Results: No significant difference was detected in the CR from 12–48 months postoperatively (P=0.766). Logistic regression analysis proved that pelvic lymph node dissection (PLND) was a significant risk factor of urinary continence at 1 month. Nerve-sparing (NS) was a significant protective factor of urinary continence at 1, 3, and 6 months. Advanced age was an independent risk factor of urinary continence at 6, 12, and 24 months. Other variables were not statistically significant predictors of urinary continence. Conclusions: The current results demonstrated that CR gradually improved with time within 1 year and stabilized 1 year after the surgery. PLND, NS, and age were significant determinants of continence in the early and late stages, respectively. These parameters could be used for preoperative identification of patients at high risk and counseling about postoperative expectations for urinary continence.
Efficacy and Safety of Capecitabine Metronomic Chemotherapy versus Conventional Chemotherapy as Maintenance Strategy in Responders After Induction Therapy in Metastatic Colorectal Cancer
Authors: Shi Min , Ma Tao , Xi Wenqi , Jiang Jingling , Wu Junwei , Zhou Chenfei , Yang Chen , Zhu Zhenggang , Zhang Jun
Published: January 2020

Background: The aim of this study is to demonstrate that capecitabine metronomic chemotherapy is non-inferior to capecitabine conventional chemotherapy as maintenance treatment, who have responded to 16-18 weeks first-line chemotherapy in metastatic colorectal cancer (mCRC). Methods: The study design is a prospective, randomized, open label, phase II clinical trial. Those mCRC patients who respond well after 16-18 weeks of standard doublet chemotherapy as induction may enrolled into this study, randomly divided into capecitabine metronomic group or standard dosage group. The duration of disease control after randomization and progression free survival from enrollment are primary endpoints. Meanwhile, the overall survival, safety and quality of life are secondary endpoints. The sample size required to achieve the research objectives of this project is 79 cases in each group. The study recently started on 29-01-2018, and will last for 36 months. Discussion: This project intends to study the efficacy and safety of capecitabine metronomic chemotherapy in the maintenance treatment of advanced colorectal cancer, and to explore the strategy of "low toxicity, high efficiency, economy and individualization" which is suitable for China's national conditions and pharmacoeconomics. It has great clinical application prospects and clear socio-economic value.
Vaccination accelerates hepatic erythroblastosis induced by blood-stage malaria
Authors: Delic Denis , Wunderlich Frank , Al-Quraishy Saleh , Abdel-Baki Abdel-Azeem S. , Dkhil Mohamed A. , Araúzo-Bravo Marcos J.
Published: January 2020

Background: Vaccination induces survival of otherwise lethal blood-stage infections of the experimental malaria Plasmodium chabaudi. Blood-stage malaria induces extramedullary erythropoiesis in the liver. This study investigates how vaccination affects the course of malaria-induced expression of erythrocytic genes in the liver. Methods: Female Balb/c mice were vaccinated at week 3 and week 1 before challenging with 106 P. chabaudi-parasitized erythrocytes. The non-infectious vaccine consisted of erythrocyte ghosts isolated from P. chabaudi-infected erythrocytes. Gene expression microarrays and quantitative real-time PCR were used to compare mRNA expression of different erythrocytic genes in the liver of vaccination-protected and non-protected mice during infections on days 0, 1, 4, 8, and 11 p.i. Results: Global transcriptomics analyses reveal vaccination-induced modifications of malaria-induced increases in hepatic gene expression on days 4 and 11 p.i. On these days, vaccination also alters hepatic expression of the erythropoiesis-involved genes Ermap, Kel, Rhd, Rhag, Slc4a1, Gypa, Add2, Ank1, Epb4.1, Epb4.2, Epb4.9, Spta1, Sptb, Tmod1, Ahsp, Acyp1, Gata1, Gfi1b, Tal1, Klf1, Epor, and Cldn13. In vaccination-protected mice, expression of these genes, except Epb4.1, is significantly higher on day 4 p.i. than in un-protected non-vaccinated mice, reaches maximal expression at peak parasitaemia on day 8 p.i., and is slowed down or even decreased towards the end of crisis phase on day 11 p.i.. After day 1 p.i., Epor expression takes about the same course as that of the other erythroid genes. Hepatic expression of Epo, however, is delayed in both vaccinated and non-vaccinated mice for the first 4 days p.i. and is maximal at significantly higher levels in vaccinated mice on day 8 p.i., before declining towards the end of crisis phase on day 11 p.i. Conclusion: The present data indicate that vaccination accelerates malaria-induced erythroblastosis in the liver for 1-2 days. This may contribute to earlier replenishment of peripheral red blood cells by liver-derived reticulocytes, which may favour final survival of otherwise lethal blood-stage malaria, since reticulocytes are not preferred as host cells by P. chabaudi.
Levels of sex steroid hormones and their receptors in women with preeclampsia
Authors: Author) Kuo-Chung Lan(Former Corresponding , Lai Yun-Ju , Cheng Hsin-Hsin , Tsai Ni-Chin , Su Yu-Ting , Tsai Ching-Chang , Author) Te-Yao Hsu(New Corresponding
Published: January 2020

Background: Pregnant women have high serum concentrations of sex steroid hormones, which are major regulators of paracrine and autocrine responses for many maternal and placental functions. The main purpose of this study was to compare patients with preeclampsia and patients with uncomplicated pregnancies in terms of serum steroid hormones (estradiol [E2], progesterone [P4], dehydroepiandrosterone sulfate [DHEAS], and testosterone [T]) throughout pregnancy and the levels of cord blood and placental steroid receptors during the third trimester. Methods: Quantitative real-time reverse transcription PCR, western blotting, and immunohistochemistry were used to determine the levels of steroid hormones in the serum and cord blood and the placental levels of estrogen receptor-α (ERα), ERβ, androgen receptor (AR), and progesterone receptor (PR). Results: There were 45 women in the uncomplicated pregnancy group and 30 women in the preeclampsia group. Serum levels of T were greater and serum levels of E2 were reduced in the preeclampsia group, but the two groups had similar levels of P4 and DHEAS during the third trimester. Cord blood had a decreased level of DHEAS in the preeclampsia group, but the two groups had similar levels of P4, E2, and T. The two groups had similar placental mRNA levels of ERα, ERβ, AR, and PR, but the preeclampsia group had a higher level of ERβ protein and a lower level of ERα protein. Immunohistochemistry indicated that the preeclampsia group had a greater level of ERβ in the nucleus and cytoplasm of syncytiotrophoblasts and stromal cells. Conclusions: Women with preeclampsia had lower levels of steroid hormones, estrogen, and ERα but higher levels of T and ERβ. These molecules may have roles in the pathogenesis of preeclampsia.
Efficient biotransformation of (S)-1-phenyl-1, 2-ethanediol using xylan as co-substrate by a coupled multi-enzyme Escherichia coli system
Authors: Rao Junchao , Zhang Rongzhen , Xu Guanyu , Li Lihong , Xu Yan
Published: January 2020

Background: ( S )-1-phenyl-1,2-ethanediol is an important chiral intermediate in the synthesis of liquid crystals and chiral biphosphines. ( S )-carbonyl reductase II from Candida parapsilosis catalyzes the conversion of 2-hydroxyacetophenone to ( S )-1-phenyl-1,2-ethanediol with NADPH as a cofactor. Glucose dehydrogenase with a Ala258Phe mutation is able to catalyze the oxidation of xylose with concomitant reduction of NADP + to NADPH, while endo-β-1,4-xylanase 2 catalyzes the conversion of xylan to xylose. In the present work, the Ala258Phe glucose dehydrogenase mutant and endo-β-1,4-xylanase 2 were introduced into the ( S )-carbonyl reductase II-mediated chiral pathway to strengthen cofactor regeneration by using xylan as a naturally abundant co-substrate. Results: We constructed several coupled multi-enzyme systems by introducing ( S )-carbonyl reductase II, the A258F glucose dehydrogenase mutant and endo-β-1,4-xylanase 2 into Escherichia coli . Different strains were produced by altering the location of the encoding genes on the plasmid. Only recombinant E. coli /pET-G-S-2 expressed all three enzymes, and this strain produced ( S )-1-phenyl-1,2-ethanediol from 2-hydroxyacetophenone as a substrate and xylan as a co-substrate. The optical purity was 100% and the yield was 98.3% under optimal conditions of 35°C, pH 6.5 and a 2:1 substrate-co-substrate ratio. The introduction of A258F glucose dehydrogenase and endo-β-1,4-xylanase 2 into the ( S )-carbonyl reductase II-mediated chiral pathway caused a 54.6% increase in yield, and simultaneously reduced the reaction time from 48 h to 28 h. Conclusions: This study demonstrates efficient chiral synthesis using a pentose as a co-substrate to enhance cofactor regeneration. This provides a new approach for enantiomeric catalysis through the inclusion of naturally abundant materials.
Indoor air pollution exposures and cardiometabolic health across four diverse settings in Peru: a cross-sectional study
Authors: Kephart Josiah L , Fandiño-Del-Rio Magdalena , Koehler Kirsten , Bernabe-Ortiz Antonio , Miranda J Jaime , Gilman Robert H , Checkley William
Published: January 2020

Background Indoor air pollution is an important risk factor for health in low- and middle-income countries. Methods We measured indoor fine particulate matter (PM 2.5 ) and carbon monoxide (CO) concentrations in 617 houses across four settings with varying urbanisation, altitude, and biomass cookstove use in Peru, between 2010 and 2016. We assessed the associations between indoor pollutant concentrations and blood pressure (BP), exhaled carbon monoxide (eCO), C-reactive protein (CRP), and haemoglobin A1c (HbA1c) using multivariable linear regression. Results We found high concentrations of indoor PM 2.5 across all four settings (geometric mean ± geometric standard deviation of PM 2.5 daily average in µg/m 3 ): Lima 41.1 ± 1.3, Tumbes 35.8 ± 1.4, urban Puno 14.1 ± 1.7, and rural Puno 58.8 ± 3.1. High indoor CO concentrations were common in rural households (geometric mean ± geometric standard deviation of CO daily average in ppm): rural Puno 4.9 ± 4.3. Higher indoor PM 2.5 was associated with having a higher systolic BP (1.51 mmHg per interquartile range (IQR) increase, 95% CI 0.16 to 2.86), a higher diastolic BP (1.39 mmHg higher DBP per IQR increase, 95% CI 0.52 to 2.25), and a higher eCO (2.05 ppm higher per IQR increase, 95% CI 0.52 to 3.57). There was no evidence of associations between indoor air exposures and CRP or HbA1c outcomes. Conclusions Excessive indoor concentrations of PM 2.5 are widespread across varying levels of urbanisation, altitude, and biomass cookstove use in Peru and are associated with worse BP and higher eCO.
A convenient clinical nomogram for predicting the cancer-specific survival of individual patients with small-intestine adenocarcinoma
Authors: Wang Na , Yang Jin , Lyu Jun , Liu Qingqing , He Hairong , Liu Jie , Li Li , Ren Xuequn , li zhendong
Published: January 2020

Background: The objective of this study was to develop a practical nomogram for predicting the cancer-specific survival (CSS) of patients with small-intestine adenocarcinoma. Methods: Patients diagnosed with small-intestine adenocarcinoma. between 2010 and 2015 were selected for inclusion in this study from the Surveillance, Epidemiology, and End Results (SEER) database. The selected patients were randomly divided intothe training and validation cohorts at a ratio of 7:3.The predictors of CSS were identified by applying both forward and backward stepwise selection methods in a Cox regression model. The performance of the nomogram was measured by the concordance index (C-index), the area under receiver operating characteristic curve (AUC), calibration plots, the net reclassification improvement (NRI), the integrated discrimination improvement (IDI), and decision-curve analysis (DCA). Results: Multivariate Cox regression indicated that factors including age at diagnosis, sex, marital status, insurance status, histology grade, SEER stage, surgery status, T stage, and N stage were independent covariates associated with CSS. These factors were used to construct a predictive model, which was built and virtualized by a nomogram. The C-index of the constructed nomogram was 0.858. The AUC values indicated that the established nomogram displayed better discrimination performance than did the seventh edition of the American Joint Committee on Cancer TNM staging system in predicting CSS. The IDI and NRI also showed that the nomogram exhibited superior performance in both the training and validation cohorts. Furthermore, the calibrated nomogram predicted survival rates that closely corresponded to actual survival rates, while the DCA demonstrated the considerable clinical usefulness of the nomogram. Conclusion: We have constructed a nomogram for predicting the CSS of small-intestine adenocarcinoma patients. This prognostic model may improve the ability of clinicians to predict survival in individual patients and provide them with treatment recommendations.
Tranexamic Acid is Associated with Reduced Mortality, Hemorrhagic Expansion, and Vascular Occlusive Events in Traumatic Brain Injury – Meta-analysis of Randomized Controlled Trials
Authors: July Julius , Pranata Raymond
Published: January 2020

Introduction This systematic review and meta-analysis aimed to synthesize the latest evidence on the efficacy and safety of tranexamic acid (TXA) on traumatic brain injury (TBI). Methods We performed a systematic literature search on topics that compared intravenous TXA to placebo in patients with TBI up until January 2019 from several electronic databases. Results There were 30.522‬ patients from 7 studies. Meta-analysis showed that TXA was associated with reduced mortality (RR 0.92 [0.88, 0.97], p=0.002; I 2 : 0%) and hemorrhagic expansion (RR 0.79 [0.64, 0.97], p=0.03; I 2 : 0%). Both TXA and control group has a similar need for neurosurgical intervention (p=0.87) and unfavourable Glasgow Outcome Scale (GOS) (p=0.59). The rate for vascular occlusive events (p=0.09), and its deep vein thrombosis subgroup (p=0.23), pulmonary embolism subgroup (p=1), stroke subgroup (p=0.38), and myocardial infarction subgroup (p=0.15) were similar in both groups. Subgroup analysis on RCTs with low risk of bias showed that TXA was associated with reduced mortality and hemorrhagic expansion. TXA was associated with reduced vascular occlusive events (RR 0.85 [0.73, 0.99], p=0.04; I 2 : 4%). GRADE was performed for the RCT with low risk of bias subgroup, it showed a high certainty of evidence for lower mortality, less hemorrhage expansion, and similar need for neurosurgical intervention in TXA group compared to placebo group. Conclusion TXA was associated with reduced mortality and hemorrhagic expansion but similar need for neurosurgical intervention and unfavorable GOS. Vascular occlusive events were slightly lower in TXA group on subgroup analysis of RCTs with low risk of bias.
Development and Validation of Dust Exposure Prevention Questionnaire for Heart Patients Based on the Health Belief Model
Authors: Noroozi Farzaneh , Eisapareh Kumars , Bahadori Alireza , Bagherzadeh Razieh , Ghahremani Leila , mokarami hamidreza
Published: January 2020

Background: Many heart patients suffer from respiratory failures. It is necessary to prevent exposure to dust by taking educational steps to change the behaviors of heart patients.The present study aimed at developing and validating a dust prevention questionnaire based on the health belief model . Methods: A mixture of qualitative and quantitative methods was used to design and develop the desired tool in 2018. The qualitative section of the research was performed to identify the preventive behaviors needed by cardiovascular patients when exposed to dust using the expert panel’s opinions and literature review. The quantitative section of the research was performed to evaluate the psychometric properties of the research tool. The research population included 417 people with heart diseases referred to a heart hospital in Bushehr, Iran. Results: The designed questionnaire included a total of 27 items divided into six domains, namely perceived susceptibility, perceived barriers, perceived severity, perceived benefits, guidance of action, and self-efficacy. The means of Content Validity Ratio (CVR) and Content Validity Index (CVI) were 0.93 and 0.9, respectively. In addition, all designed items had good correlations with the total scores of their related domains. However, the model fit indices were not suitable. Hence, to fully fit the model to the data, it was tried to improve the model by releasing some parameters based on the modification indices suggested by AMOS software. The modified model had an acceptable fit . The results of Cronbach’s alpha coefficient also showed the appropriate reliability of all six domains. Conclusions: The designed questionnaire had desirable psychometric properties and appropriate validity to determine the factors involved in preventing dust complications in heart patients. Designing this questionnaire could also be considered as an effective step to evaluate the effective factors in preventing dust complications in patients with heart diseases .
Subclinical Cardiovascular Risk Signs in Adults with Juvenile Idiopathic Arthritis in Sustained Remission
Authors: Aranda-Valera Inmaculada Concepcion , Rosa Iván Arias de la , Roldan-Molina Rosa , Abalos-Aguilera Maria del Carmen , Torres-Granados Carmen , Patiño-Trives Alejandra , Luque-Tevar Maria , Ibañez-Costa Alejandro , Guzman-Ruiz Rocio , Malagón Maria del Mar , Escudero-Contreras Alejandro , Lopez-Pedrera Chary , Collantes-Estevez Eduardo , Barbarroja Nuria
Published: January 2020

Background:Juvenile Idiopathic Arthritis (JIA) is one of the most common chronic diseases of childhood that often persists into adulthood and can result in significant long-term morbidity. As a long lasting chronic inflammatory disease, concern has been raised regarding the risk of premature development of cardiovascular disease (CVD) in JIA. This study aims to determine whether adults with JIA in clinical remission and medium-long duration of the disease display subclinical signs of CVD risk. Methods: This is a cross-sectional study including 25 patients diagnosed with JIA according to the International League of Associations for Rheumatology criteria (ILAR 2001) and 25 age- and sex-matched controls. Remission was determined by JADAS10<1 and according to Wallace criteria. The presence of traditional CVD risk factors was analyzed. An extensive clinical analysis including body mass index (BMI), lipid profile, homeostatic model assessment – insulin resistance (HOMA-IR) and arterial blood pressure was performed. Intima media thickness of the common carotid artery (cIMT) was measured as a marker of subclinical atherosclerosis. Several proinflammatory cytokines, molecules involved in the endothelial dysfunction and adipokines were quantified on serum by ELISA. In vitro studies were carried out in healthy peripheral mononuclear cells (PBMCs), adipocytes and endothelial cells which were treated with serum from JIA patients under sustained remission. The expression of inflammatory molecules, oxidative stress and endothelial activation markers and adipokines was analyzed. Results : Mean duration of the disease was 13.47 ± 5.47 years. Mean age was 25.11 ± 7.21. Time in remission was 3.52 ± 3.33 years. CVD risk factors were similar in JIA patients and controls. However, cholesterol levels were significantly elevated in JIA patients. Serum levels of adipocytokines, oxidative stress and endothelial activation markers were elevated in serum and PBMCs from JIA patients. Serum of those JIA patients induced the activation of adipocytes, endothelial cells and healthy PBMCs. Conclusions: Long-term JIA adult patients in remission might have subclinical signs of inflammation and CVD risk, showed by an increase in the levels of inflammatory cytokines, endothelial activation and oxidative stress markers and adipokines, molecules closely involved in the alteration of the vascular system. Thus, CVD risk assessment might be considered as part of routine clinical care in those patients.
Quantitative ethnopharmacological documentation and molecular confirmation of medicinal plants used by the Manobo tribe of Agusan del Sur, Philippines
Authors: Dapar Mark Lloyd Granaderos , Alejandro Grecebio Jonathan Duran , Meve Ulrich , Liede-Schumann Sigrid
Published: January 2020

Background Philippines is renowned as one of the species-rich countries and culturally megadiverse in ethnicity worldwide. Ethnomedicinal knowledge of Indigenous Cultural Communities/Indigenous Peoples (ICCs/IPs) is vital for biodiversity conservation and healthcare improvement. This study aims to document the traditional practices, medicinal plant use, and knowledge; to determine the relative importance, consensus, and the extent of all medicinal plants used; and to integrate molecular confirmation to some medicinal plants used by the Agusan Manobo. Methods Quantitative ethnopharmacological data were obtained using semi-structured interviews, group discussions, field observations, and guided field walks with a total of 335 key informants comprising of tribal chieftains, traditional healers, community elders and residents of the community with their traditional medical knowledge. The use categories (UC), use report (UR), fidelity level (FL), and informant consensus factors (ICF) were quantified. The informants' medicinal plant use knowledge and practices were statistically analyzed using the descriptive and inferential statistics Mann-Whitney U and Kruskal-Wallis tests. Results A total of 122 medicinal plant species belonging to 108 genera and 51 families, used in 16 use categories, were collected and identified. Integrative molecular approach confirmed 24 species with uncertain identity using multiple universal markers. The highest ICF (0.96) was cited for the category of abnormal signs and symptoms (ASS). The maximum FL values of 100% were found for Carica papaya L., Premna odorata Blanco, Cinnamomum mercadoi S.Vidal, Tinospora crispa (L.) Hook.f. & Thomson, and Ficus concinna (Miq.) Miq. used for the treatment of dengue fever, cough with phlegm, stomach trouble, joint pain, and fracture and dislocation, respectively. The highest UR (1134) and UC (12) was reported for Anodendron borneense (King & Gamble) D.J.Middleton. Statistically, the medicinal plant knowledge among respondents was significantly different ( p <0.001) when grouped according to education, gender, position, occupation, civil status, and age but not significantly different ( p =0.379) when grouped according to location. Conclusion Documenting such traditional knowledge of medicinal plants and practices is highly important for future management and conservation strategies of these plant genetic resources. This quantitative ethnopharmacological study will serve as a future reference not only for more ethnopharmacological documentation but also for further pharmacological studies and public healthcare improvement.
Oncolytic Newcastle disease virus delivered by Mesenchymal stem cells-engineered system enhances the therapeutic effects altering tumor microenvironment in a murine papillomavirus tumor model
Authors: Keshavarz mohsen , Ebrahimzadeh Mir Saeed , Miri Seyed Mohammad , Dianat-Moghadam Hassan , Ghorbanhosseini Seyedeh Sara , Mohebbi Seyed Reza , Keyvani Hossein , Ghaemi Amir
Published: January 2020

Background: Cervical cancer is the most common human papillomavirus (HPV)-related cancer caused by persistent genital high-risk HPV infection. Cancer immunotherapy has represented great potential as a new promising cancer therapeutic approach. Here, we report Mesenchymal stem cells (MSCs) as a carrier for the delivery of oncolytic Newcastle disease virus (NDV) for the treatment of HPV-associated tumor.Methods: For this purpose, MSCs obtained from the bone marrow of C57BL mice, then cultured and characterized subsequently by the flow cytometry analysis for the presence of cell surface markers. In this study, we sought out to determine the impacts of MSCs loaded with oncolytic NDV on splenic T cell and cytokine immune responses, caspase-3 and -9 expression, and myeloid and myeloid-derived suppressor cells (MDSCs) by histological and immunohistochemical studies in the tumor microenvironment (TME).Results: our findings proved that MSCs possess both migratory capacity and tumor tropism toward transplanted tumor tissue after peritumoral administration. Tumor therapy experiments indicated that oncolytic NDV delivered by MSCs-engineered system significantly reduces tumor growth, which is associated with the enhancement of E7-specific lymphocyte proliferation, CD8+ T cell cytolysis responses, and splenic IFN-γ, IL-4 and IL-12 responses compared with control groups. Moreover, the treatment upregulated the concentration of apoptotic proteins (caspase 3 and 9) and increased infiltration of tumor microenvironment with CD11b+myeloid and Gr1+MDSCs cells.Conclusions: Our data suggest MSCs carrying oncolytic NDV as a potentially effective strategy for cancer immunotherapy through inducing splenic Th1 immune responses and MDSCs expansion in the tumor microenvironment.
Design, rationale, and analysis plan for the Stand Up for Health trial in contact centres: a stepped wedge feasibility study
Authors: Parker Richard A. , Manner Jillian , Sivaramakrishnan Divya , Baker Graham , Stoddart Andrew , Lloyd Scott , Jepson Ruth
Published: January 2020

Background: Contact centres are one of the most sedentary workplaces, with employees spending a very high proportion of their working day sitting down. About a quarter of contact centre staff regularly experience musculoskeletal health problems due to high levels of sedentary behaviour, including lower back pain. There have been no previous randomised studies specifically aiming to reduce sedentary behaviour in contact centre staff. To address this gap, the Stand Up for Health (SUH) study aims to test the feasibility and acceptability of a complex theory-based intervention to reduce sedentary behaviour in contact centres. Methods: The Stand Up for Health study has a stepped wedge cluster randomised trial design, which is a pragmatic design whereby clusters (contact centres) are randomised to time points at which they will begin to receive the intervention. All contact centre staff have the opportunity to experience the intervention. To minimise the resource burden in this feasibility study, data collection is not continuous, but undertaken on a selective number of occasions, so the stepped wedge design is “incomplete”. Eleven contact centres in England and Scotland have been recruited, and the sample size is approximately 27 per centre (270 in total. The statistical analysis will predominantly focus on assessing feasibility, including the calculation of recruitment rates and rates of attrition. Exploratory analysis will be performed to compare objectively measured sedentary time in the workplace (measured using an activPAL™ device) between intervention and control conditions using a linear mixed effects regression model. Discussion: This is the first stepped wedge feasibility study seeking to reduce sedentary behaviour in call centres. We employ an incomplete stepped wedge design to restrict data collection to certain time points to make data collection feasible. This trial will potentially inform the design of a future large multi-centre stepped wedge trial.
Improved survival rate and functional recovery of TKA in cementless fixation compared with cemented component: a systematic review and meta-analysis
Authors: Liu Yuan , Zeng Yi , Wu Yuangang , Li Mingyang , Xie Huiqi , Shen Bin
Published: January 2020

Background: Whether the cement could be given up in total knee arthroplasty (TKA) was still in controversy. We perform this meta-analysis to compare the rate of revision and functional recovery between two kinds of fixation in TKA. Methods: Randomized controlled trials (RCTs), prospective/retrospective observational studies from PubMed (on 2019 Sep), EMBASE (on 2019 Sep), and the Cochrane Central Register of Controlled Trials (CENTRAL) and Web of Science (on 2019 Sep) were searched. Continuous outcomes were presented as mean difference or standard mean difference with 95% CI and discontinuous outcomes were reported as relative risk (RR) with 95% CI. Random-effects or fixed-effects model was conducted to analyze the extracted data. The PRISMA guidelines and Cochrane Handbook were adopted to assess the quality of the results reported in included studies to ensure that the results of our meta-analysis were reliable and veritable. The continuous and dichotomous outcome were collected in a standard form, and the data were analysed by using Review Manager 5.3 software. Finally, the results were presented in the Forest plots. The rate of revision and reasons caused revision was the primary outcome of our study.Results: Twenty-six studies involving 2369 patients in cementless TKA and 2654 patients in cemented TKA were finally included in our meta-analysis. 26 studies were divided into three subgroups according to the length of follow-up. The studies in the first subgroup followed less than 5.5 years, the second followed less than 10.5 years, and the third followed more than 10.5 years. Cementless fixation significantly decreased the rate of aseptic loosing (p=0.0002) and revision (p=0.0002) in the first subgroup. Other reasons such as periprosthetic joint infection (PJI), instability and polyethylene wear were not significantly different between two groups. Significantly better functional recovery was got in cementless TKA in terms of Knee Society Score (p=0.004) and Oxford Knee Score (p=0.007). Significantly less patients in cementless group require manipulation under anesthesia (p=0.007). However, there was no significant difference regarding the rate of complication between two kinds of fixation in TKA.Conclusion: Not only the rate of aseptic loosing was decreased, rate of revision was also significantly decreased in cementless TKA within 5.5 years. In addition, the cementless TKA performed better in postoperative functional recovery according to Knee Society Function Score and Oxford Knee Score. However, the rate of complication was not significantly different in two kinds of fixation in TKA.