bluuebunny/crossref_metadata_2025 huggingface dataset:
Assessment of malaria as a public health problem in and around Arjo Didhessa Sugar Cane Plantation area, Western Ethiopia
Authors: Dufera Mebrate , Debsu Regea , Tiruneh Gemechu
Published: January 2020

Background: Although much progress has been made in reducing malaria morbidity and mortality worldwide in the last decade, malaria still remains the third leading cause of death and still considered as major public health problem. Objectives : The main objective of this study was to assess malaria as a public health problem in and around sugar cane plantation area of Arjo Didhessa sugar factory, Western Ethiopia. Methods: A community based cross sectional study supplemented with clinical retrospective data, which included 452 study subjects was employed and the study period extended from May 2016 up to November of 2017. A standardized questionnaire was used to assess malaria risk factors and blood samples were received from all study participants and further subjected to Giemsa staining for determination of malaria prevalence. Data was analyzed by SPSS version 20.Malaria risk factors were identified by multivariate logistic regression at significance level of P < 0.05 . Results: The overall malaria prevalence was 3.1%; Plasmodium vivax being the main type of malaria parasite. Overnight outdoor sleeping and improper utilization of mosquito bed nets were found to be statistically significant as malaria risk factors in the community. In the retrospective studies of five years, the peak malaria cases (13.84%) were reported in 2013 and less cases (1.24%) in 2017. Conclusion: The prevalence of malaria observed in the area is still higher as compared to national prevalence of malaria. Therefore; we recommend further strengthening of malaria prevention and control strategies. Additionally, educative training opportunities must be provided for workers in the plantation area on malaria prevention and control.
Outcomes of Patients with Initially Locally Advanced Pancreatic Adenocarcinoma who did not Benefit from Resection: A Prospective Cohort Study
Authors: Garnier Jonathan , Ewald Jacques , Marchese Ugo , Gilabert Marine , Launay Simon , Moureau-Zabotto Laurence , Poizat Flora , Giovannini Marc , Delpero Jean-Robert , Turrini Olivier
Published: January 2020

Background: The current study aimed to evaluate the outcomes of patients with unresectable non-metastatic locally advanced pancreatic adenocarcinoma (LAPA) who did not benefit from resection considering the treatment strategy in the clinical settings. Methods: Between 2010 and 2017, a total of 234 patients underwent induction chemotherapy for LAPA that could not be treated with surgery. After oncologic restaging, continuous chemotherapy or chemoradiation (CRT) was decided for patients without metastatic disease. The Kaplan–Meier method was used to determine overall survival (OS), and the Wilcoxon test to compare survival curves. Multivariate analysis was performed using the stepwise logistic regression method. Results: FOLFIRINOX was the most common induction regimen (168 patients, 72%), with a median of 6 chemotherapy cycles and resulted in higher OS, compared to gemcitabine (19 vs. 16 months, hazard ratio (HR)=1.2, 95% confidence interval: 0.86–1.6, P =.03). However, no difference was observed after adjusting for age (≤75 years) and performance status score (0–1). At restaging, 187 patients (80%) had non-metastatic disease: CRT was administered to 126 patients (67%) while chemotherapy was continued in 61 (33%). Patients who received CRT had characteristics comparable to those who continued with chemotherapy, with similar OS. They also had longer progression-free survival (median 13.3 vs. 9.6 months, HR=1.38, 95% confidence interval: 1–1.9, P <.01) and limited short-term treatment-related toxicity. Conclusions: The median survival of patients who could not undergo surgery was 19 months. Hence, CRT should not be eliminated as a treatment option and may be useful as a part of optimised sequential chemotherapy for both local and metastatic disease.
Comprehensive analysis on phenotype and genetic basis of Chinese Fanconi anemia patients: dismal outcomes call for nationwide studies
Authors: Nie Daijing , Zhang Jing , Wang Fang , Zhang Wei , Liu Lili , Chen Xue , Zhang Yang , Cao Panxiang , Xiong Min , Wang Tong , Wu Ping , Ma Xiaoli , Tian Wenjun , Wang Mangju , Chen Kylan N. , Liu Hongxing
Published: January 2020

Background: Fanconi anemia (FA) is the most common inherited bone marrow failure (BMF) syndrome with 22 related genes identified. The ALDH2 rs671variant has been proved related to accelerate the progression of BMF in FA patients. The phenotype and genetic basis of Chinese FA patients have not been investigated yet.Methods: We analyzed the 22 FA-related genes of 63 BMF patients suspected to be FA. Clinical manifestations, morphological and cytogenetic feathers, ALDH2 genotypes, treatment, and outcomes of the definite cases were retrospectively studied.Results: A total of 24 patients were confirmed the diagnosis of FA with the median age of BMF onset was 4.5-year-old. The number of patients manifested as congenital malformations and growth retardation were 21/24 and 14/24, respectively. BM dysplasia and cytogenetic abnormalities were found in 15/23 and 10/22 patients. All the patients with abnormal karyotypes also manifested as BM dysplasia or had evident blasts. Thirty-nine different mutations were identified involving seven genes and including twenty-one novel mutations. FANCA mutations contributed to 58.33% of cases. Ten patients harboring ALDH2-G/A genotype have a significantly younger age of BMF onset (p=0.024). Within the 22 patients adhering to continuous follow-up, 18 patients underwent hematopoietic stem cell transplantations (HSCTs). During the 33.5 months of follow-up, 8/22 patients died, seven of which were HSCT-related, and one patient who did not receive HSCT died from severe infection.Conclusion: The phenotypic and genetic spectrum of Chinese FA patients is broad. Bone marrow dysplasia and cytogenetic abnormalities are prevalent and highly consistent. The overall outcome of HSCTs is disappointing. Nationwide multicenter studies are needed for the rarity and adverse outcome of this disease.
Cumulative Incidence of Hepatocellular Carcinoma and Hepatitis B Surface Antigen Seroclearance after Nucleos(t)ide analogue-induced Hepatitis B e Antigen Seroclearance
Authors: Lee Hyun Woong , Lee Jung Il , Kim Saein , Kim Sora , Chang Hye Young , Lee Kwan Sik
Published: January 2020

Background: Hepatitis B e antigen (HBeAg) seroclearance has been considered as the treatment endpoint in HBeAg-positive patients with chronic hepatitis B (CHB). Although HBeAg seroclearance has been accomplished, some aspects are yet unclear. We investigated the cumulative incidence of hepatocellular carcinoma (HCC) and evaluated hepatitis B surface antigen (HBsAg) seroclearance in patients undergoing nucleos(t)ide analogue (NA)-induced HBeAg seroclearance. Methods: In this retrospective cohort study, 203 patients with CHB were HBsAg and HBeAg seropositive before NA (entecavir or tenofovir) treatment. All patient who experienced NA -induced HBeAg seroclearance were recruited. Patients with documented HBeAg seroclearance were followed-up every 6 months. Baseline characteristics and laboratory results were recorded. Results: The mean age at HBeAg seroclearance was 40 years (range, 20-84), and the mean follow-up duration was 5 years (range, 2-11). The cumulative incidence of HCC was 1.5% to 11.5% at 1 to 8 years after HBeAg seroclearance. Cirrhosis was the only significant factor for HCC development (hazard ratio [HR], 24.651; confidence interval [CI], 3.018 to 201.365; P = 0.003). The cumulative incidence of HBsAg seroclearance was 3.5% to 18.7% after 1 to 8 years from HBeAg seroclearance. Conclusions: A significant proportion of patients developed HCC after NA-induced HBeAg seroclearance. The presence of liver cirrhosis at the time of HBeAg seroclearance serves as an independent factor for HCC development. Some patients with NA-induced HBeAg seroclearance achieved HBsAg seroclearance.
Sex-specific patterns of senescence in artificial insect populations varying in sex-ratio to manipulate reproductive effort
Authors: Jehan Charly , Chogne Manon , Rigaud Thierry , Moret Yannick
Published: January 2020

Background: The disposable soma theory of ageing assumes that organisms optimally trade-off limited resources between reproduction and longevity to maximize fitness. Early reproduction should especially trade-off against late reproduction and longevity because of reduced investment into somatic protection, including immunity. Moreover, as optimal reproductive strategies of males and females differ, sexually dimorphic patterns of senescence may evolve. In particular, as males gain fitness through mating success, sexual competition should be a major factor accelerating male senescence. In a single experiment, we examined these possibilities by establishing artificial populations of the mealworm beetle, Tenebrio molitor, in which we manipulated the sex-ratio to generate variable levels of investment into reproductive effort and sexual competition in males and females. Results: As predicted, variation in sex-ratio affected male and female reproductive efforts, with contrasted sex-specific trade-offs between lifetime reproduction, survival and immunity. High effort of reproduction accelerated mortality in females, without affecting immunity, but high early reproductive success was observed only in balanced sex-ratio condition. Male reproduction was costly on longevity and immunity, mainly because of their investment into copulations rather than in sexual competition. Conclusions: Our results suggest that T. molitor males, like females, maximize fitness through enhanced longevity, partly explaining their comparable longevity.
Up-regulating autophagy by targeting the mTOR-4EBP1 pathway: a possible mechanism for improving cardiac function in mice with experimental dilated cardiomyopathy
Authors: Jin Bo , Shi Haiming , Jun Zhu , Wu Bangwei , Geshang Quzhen
Published: January 2020

Background: Autophagy plays a crucial role in the pathological process of cardiovascular diseases. However, little is known about the pathological mechanism underlying autophagy regulation in dilated cardiomyopathy (DCM). Methods: We explored whether up-regulating autophagy could improve cardiac function in mice with experimental DCM through the mTOR-4EBP1 pathway. Animal model of DCM was established in BALB/c mice by immunization with porcine cardiac myosin. Both up- or down-regulation of autophagy were studied by administration of rapamycin or 3-MA in parallel. Morphology, Western blotting, and echocardiography were applied to confirm the pathological mechanisms. Results: Autophagy was activated and autophagosomes were significantly increased in the rapamycin group. The collagen volume fraction (CVF) was decreased in the rapamycin group compared with the DCM group (9.21 ± 0.82 % vs 14.38 ± 1.24 %, P<0.01). The expression of p-mTOR and p-4EBP1 were significantly decreased in rapamycin-induced autophagy activation, while the levels were increased by down-regulating autophagy with 3-MA. In the rapamycin group, the LVEF and FS were significantly increased compared with the DCM group (54.12 ± 6.48 % vs 45.29 ± 6.68 %, P <0.01; 26.89 ± 4.04 % vs 22.17 ± 2.82 %, P <0.05). As the inhibitor of autophagy, 3-MA aggravated the progress of maladaptive cardiac remodeling and declined cardiac function in DCM mice. Conclusions: The study indicated a possible mechanism for improving cardiac function in mice with experimental DCM by up-regulating autophagy via the mTOR-4EBP1 pathway, which could be a promising therapeutic strategy for DCM.
Suicide among people treated for drug use disorders: a Danish national record-linkage study
Authors: Hesse Morten , Thylstrup Birgitte , Seid Abdu Kedir , Skogen Jens Christoffer
Published: January 2020

Background: Substance use disorders are a major risk factor for suicide. However, less is known about specific risk factors for suicide in people with substance use disorders. Methods: This population cohort study assessed suicide among people treated for drug use disorders in Denmark 2000-2010, and described risk factors for completed suicide. Data from 27,942 individuals enrolled in treatment were linked to national registers and matched with controls without drug use disorder and with (n=138,136) or without psychiatric history (n=1,574). Competing risk regression was used to identify risk factors of completed suicide. Results: There were 163 suicides among patients with a history of drug treatment (0.6% of patients). Increased risk was associated with younger age at enrolment (hazard ratio [HR] = 0.97, 95% confidence interval (CI): 0.95, 0.98), history of psychiatric care (HR=1.96, CI 95%: 1.39, 2.77), opioid use (HR=1.81, 95% CI: 1.23, 2.68), and alcohol use (HR=1.56, 95% CI: 1.09, 2.23). Lower risk was associated with cannabis use (HR=0.69, 95% CI: 0.50, 0.96). Compared with age- and gender-matched controls without a history of treatment for substance use disorders or recent psychiatric care, the standardized mortality ratio due to suicide was 7.13 for people with drug use disorder without a history of psychiatric care (95% CI: 5.81, 8.44), 13.48 for people with drug use disorder and psychiatric history (95% CI: 9.75, 17.22), and 13.61 for people with psychiatric history only (95% CI: 6.72, 20.50). Conclusions: Risk of suicide is increased among people with drug use disorders. Access to treatment for co-morbid mental health problems for people with drug use disorders could potentially reduce risk of suicide.
The extended recovery ring-stage survival assay provides a superior association with patient clearance half-life and increases throughput
Authors: Davis Sage Z. , Singh Puspendra P. , Vendrely Katelyn M. , Shoue Douglas A. , Checkley Lisa A. , McDew-White Marina , Button-Simons Katrina A. , Cassady Zione , Sievert Mackenzie A.C. , Foster Gabriel J. , Nosten François H. , Anderson Timothy J.C. , Ferdig Michael T.
Published: January 2020

Background Tracking and understanding artemisinin resistance is key for preventing global setbacks in malaria eradication efforts. The ring-stage survival assay (RSA) is the current gold standard for in vitro artemisinin resistance phenotyping. However, the RSA has several drawbacks: it is relatively low throughput, has high variance due to microscopy readout, and correlates poorly with the current benchmark for in vivo resistance, patient clearance half-life post-artemisinin treatment. Here a modified RSA is presented, the extended Recovery Ring-stage Survival Assay (eRRSA), using 15 cloned patient isolates from Southeast Asia with a range of patient clearance half-lives, including parasite isolates with and without kelch13 mutations. Methods P. falciparum cultures were synchronized with single layer Percoll during the schizont stage of the erythrocytic cycle. Cultures were left to reinvade to early ring-stage and parasitemia was quantified using flow cytometry. Cultures were diluted to 2% hematocrit and 0.5% parasitemia in a 96-well plate to start the assay, allowing for increased throughput and decreased variability between biological replicates. Parasites were treated with 700nM of dihydroartemisinin or an equivalent amount of dimethyl sulfoxide (DMSO) for 6 h, washed three times in drug-free media, and incubated for 66 or 114 h, when samples were collected and frozen for PCR amplification. A SYBR Green-based quantitative PCR method was used to quantify the fold-change between treated and untreated samples. Results 15 cloned patient isolates from Southeast Asia with a range of patient clearance half-lives were assayed using the eRRSA. Due to the large number of pyknotic and dying parasites at 66 h post-exposure (72 h sample), parasites were grown for an additional cell cycle (114 h post-exposure, 120 h sample), which drastically improved correlation with patient clearance half-life compared to the 66 h post-exposure sample. A Spearman correlation of 0.8393 between fold change and patient clearance half-life was identified in these 15 isolates from Southeast Asia, which is the strongest correlation reported to date. Conclusions eRRSA drastically increases the efficiency and accuracy of in vitro artemisinin resistance phenotyping compared to the traditional RSA, which paves the way for extensive in vitro phenotyping of hundreds of artemisinin resistant parasites.
Personal and social patterns predict influenza vaccination decision
Authors: Shaham Adir , Chodick Gabriel , Shalev Varda , Yamin Dan
Published: January 2020

Background: Seasonal influenza vaccination coverage remains suboptimal in most developed countries, despite longstanding recommendations of public health organizations. The individual’s decision regarding vaccination is located at the core of non-adherence. We analyzed large-scale data to identify personal and social behavioral patterns for influenza vaccination uptake, and develop a model to predict vaccination decision of individuals in an upcoming influenza season. Methods: We analyzed primary data from the electronic medical records of a retrospective cohort of 250,000 individuals between the years 2007 and 2017, collected from 137 clinics. Individuals were randomly sampled from the database of Maccabi Healthcare Services. Maccabi’s clients are representative of the Israeli population, reflect all demographic, ethnic, and socioeconomic groups and levels. We used several machine-learning models to predict whether a patient would get vaccinated in the future. Models’ performance was evaluated based on the area under the ROC curve. Results: The vaccination decision of an individual can be explained in two dimensions, Personal and social. The personal dimension is strongly shaped by a “default” behavior, such as vaccination timing in previous seasons and general health consumption, but can also be affected by temporal factors such as respiratory illness in the prior year. In the social dimension, a patient is more likely to become vaccinated in a given season if at least one member of his family also became vaccinated in the same season. Vaccination uptake was highly assertive with age, socioeconomic score, and geographic location. An XGBoost-based predictive model achieved an ROC-AUC score of 0.91 with accuracy and recall rates of 90% on the test set. Prediction relied mainly on the patient’s individual and household vaccination status in the past, age, number of encounters with the healthcare system, number of prescribed medications, and indicators of chronic illnesses. Conclusions: Our ability to make an excellent prediction of the patient’s decision sets a major step toward personalized influenza vaccination campaigns, and will help shape the next generation of targeted vaccination efforts.
Acceptability of screening for pregnancy intention in general practice: a population survey of people of reproductive age
Authors: Hammarberg Karin , Hassard Julie , de Silva Renee , Johnson Louise
Published: January 2020

Background: Optimal parental preconception health benefits reproductive outcomes . However, preconception health promotion is not routinely offered in primary health care settings to people of reproductive age. The aim was to gauge the planned preconception health behaviours and attitudes towards being asked about pregnancy intention by a general practitioner (GP) among people of reproductive age in Australia. Method: The research was conducted on a single wave of Australia’s first and only probability-based online panel, Life in Australia™. Members of the Life in Australia™ panel are Australian residents aged 18 years or over. All active members between the ages of 18 and 45 years were eligible to participate. Eligible panel members were invited to complete a survey about fertility and childbearing. Data were collected from 18 February to 4 March 2019. Results: In all 965 female and male members of Life in Australia™ aged between 18 and 45 years were invited to complete the survey. Of these, 716 (74.2%) agreed. Most respondents indicated that if they were planning to have a child they would try to optimise their preconception health by adopting a healthier diet (80%), seeing a GP for a health check-up (78%), reducing alcohol consumption (78% of those consuming alcohol), getting fitter (73%), and stopping smoking (70% of smokers). Three in four (74%) stated that they would not mind if their GP asked them about their pregnancy intentions. Conclusion: Findings suggests that routinely asking people of reproductive age about their pregnancy intentions and advising those who are planning pregnancy about what they can do to ensure optimal preconception health would be acceptable to most people and may improve reproductive outcomes.
Effects of Low Versus Standard Pressure Pneumoperitoneum on Renal Syndecan-1 Shedding and VEGF Receptor-2 Expression in Living-donor Nephrectomy: A Randomized Controlled Study
Authors: Aditianingsih Dita , Mochtar Chaidir Arif , Lydia Aida , Siregar Nuryati Chairani , Margyaningsih Nur Ita , Madjid Amir Sjarifuddin , Suwarto Suhendro
Published: January 2020

Background
Laparoscopic nephrectomy is a preferred technique for living kidney donation. However, positive-pressure pneumoperitoneum may have an unfavorable effect on the remaining kidney and other distant organs due to inflamed vascular endothelium and renal tubular cell injury in response to increased systemic inflammation. Early detection of vascular endothelial and renal tubular response is needed to prevent further kidney injury due to increased intraabdominal pressure induced by pneumoperitoneum. Transperitoneal laparoscopic living donor nephrectomy represented a human model of mild increasing intraabdominal pressure. This study aimed to assess the effect of increased intraabdominal pressure on vascular endothelium and renal tubular cells by comparing the effects of low and standard pressure pneumoperitoneum on vascular endothelial growth factor receptor-2 (VEGFR-2) expression and the shedding of syndecan-1 as the early markers to a systemic inflammation.
Methods
We conducted a prospective randomized study on 44 patients undergoing laparoscopic donor nephrectomy. Subjects were assigned to standard (12 mmHg) or low pressure (8 mmHg) groups. Baseline, intraoperative, and postoperative plasma interleukin-6, syndecan-1, and sVEGFR-2 were quantified by ELISA. Syndecan-1 and VEGFR-2 expression were assessed immunohistochemically in renal cortex tissue. Renal tubule and peritubular capillary ultrastructures were examined using electron microscopy. Perioperative hemodynamic changes, end-tidal CO2, serum creatinine, blood urea nitrogen, and urinary KIM-1 were recorded.
Results
The low pressure group showed lower intra- and postoperative heart rate, intraoperative plasma IL-6, sVEGFR-2 levels and plasma syndecan-1 than standard pressure group. Proximal tubule syndecan-1 expression was higher in the low pressure group. Proximal-distal tubules and peritubular capillary endothelium VEGFR-2 expression were lower in low pressure group. The low pressure group showed renal tubule and peritubular capillary ultrastructure with intact cell membranes, clear cell boundaries, and intact brush borders, while standard pressure group showed swollen nuclei, tenuous cell membrane, distant boundaries, vacuolizations, and detached brush borders.
Conclusion
The low pressure pneumoperitoneum attenuated the inflammatory response and resulted in reduction of syndecan-1 shedding and VEGFR-2 expression as the renal tubular and vascular endothelial proinflammatory markers to injury due to a systemic inflammation in laparoscopic nephrectomy.
Trial registration
ClinicalTrial.gov NCT:03219398, July 17th 2017.
Keywords: pneumoperitoneum, renal resistive index, interleukin-6, syndecan-1, sVEGFR-2, laparoscopic nephrectomy
The effects of combined magnesium and zinc supplementation on metabolic status in patients with type 2 diabetes mellitus and coronary heart disease
Authors: Hamedifard Zahra , Farrokhian Alireza , Reiner Željko , Bahmani Fereshteh , Taghizadeh Mohsen , Ghotbi Maryam , Asemi Zatollah
Published: January 2020

Background: The present research aimed to analyze the impacts of magnesium and zinc supplement on the metabolic level in the patients suffering from CHD (coronary heart disease) and T2DM (type 2 diabetes mellitus). Methods: According to the research design, a randomized, double-blind, placebo-controlled trial has been implemented on 55 women suffering from CHD and T2DM. Therefore, the participants have been randomly divided into 2 groups for taking placebo (n = 28) or 250 mg magnesium oxide plus 220 mg zinc sulfate (n =27) or for 12 weeks. Results: Magnesium and zinc considerably declined the levels of fasting plasma glucose (FPG) (β -9.44 mg/dL, 95% CI, -18.30, -0.57; P = 0.03) and levels of insulin (β -1.37 µIU/mL, 95% CI, -2.57, -0.18; P = 0.02). Moreover, levels of HDL-cholesterol have been remarkably enhanced (β 2.09 mg/dL, 95% CI, 0.05, 4.13; P = 0.04) in comparison to the placebo. There have been an association between magnesium and zinc intake and a considerable decrease of C-reactive protein (CRP) (β -0.85 mg/L, 95% CI, -1.26, -0.45; P < 0.001), a considerable enhancement in the total nitrite (β 5.13 µmol/L, 95% CI, 1.85, 8.41; P = 0.003), and total anti-oxidant capacities (TAC) (β 43.44 mmol/L, 95% CI, 3.39, 83.50; P=0.03) in comparison to the placebo. Furthermore, magnesium and zinc remarkably reduced the Beck Depression Inventory index (BDI) (β -1.66; 95% CI, -3.32, -0.009; P = 0.04) and Beck Anxiety Inventory (BAI) (β -1.30; 95% CI, -2.43, -0.16; P=0.02) in comparison to the placebo. Conclusions: In patients with T2DM and CVD the 12-week intake of magnesium and zinc affected FPG, HDL-cholesterol, CRP, insulin, NO, TAC levels, and BDI and BAI score usefully. Trial registration: Current Controlled Trials http://www.irct.ir: IRCT20130211012438N31 at 11 May 2019 of registration. This study retrospectively registered.
Evaluation of the national implementation of the VA Diffusion of Excellence Initiative on Advance Care Planning via Group Visits: Protocol for a quality improvement evaluation
Authors: Matthieu Monica M. , Ounpraseuth Songthip T. , Painter Jacob , Waliski Angie , Williams James “Silas” , Hu Bo , Smith Robin , Garner Kimberly K.
Published: January 2020

Background Traditionally system leaders, service line managers, researchers, and program evaluators, hire specifically dedicated implementation staff to ensure that a healthcare quality improvement effort can “go to scale”. However, little is known about the impact of hiring dedicated staff and whether funded positions, amid a host of other delivered implementation strategies, is the main difference among sites with and without funding used to execute the program, on implementation effectiveness and cost outcomes. Methods/Design In this mixed methods program evaluation, we will determine the impact of funding staff positions to implement, sustain, and spread a program, Advance Care Planning (ACP) via Group Visits (ACP-GV), nationally across the entire United States Department of Veterans Affairs (VA) healthcare system. In ACP-GV, Veterans, their families, and trained clinical staff with expertise in ACP meet in a group setting to engage in discussions about ACP and the benefits to Veterans and their trusted others of having an Advance Directive (AD) in place. To determine the impact of the ACP-GV National Program, we will use a propensity score matched control design to compare ACP-GV and non-ACP-GV sites on the proportion of ACP discussions in VHA facilities. To account for variation in funding status, we will document and compare funded and unfunded sites on the effectiveness of implementation strategies (individual and combinations) used by sites in the National Program on ACP discussion and AD completion rates across the VHA. In order to determine the fiscal impact of the National Program and to help inform future dissemination across VHA, we will use a budget impact analysis. Finally, we will purposively select, recruit, and interview key stakeholders, who are clinicians and clinical managers in the VHA who offer ACP discussions to Veterans, to identify the characteristics of high-performing (e.g., high rates or sustainers) and innovative sites (e.g., unique local program design or implementation of ACP) to inform sustainability and further spread. Discussion As an observational evaluation, this protocol will contribute to our understanding of implementation science and practice by examining the natural variation in implementation and spread of ACP-GV with or without funded staff positions.
Taxonomic scheme of the order Chaetophorales (Chlorophyceae, Chlorophyta) based on Chloroplast genomes
Authors: Liu Benwen , Hu Yu Xin , Hu Zheng Yu , Liu Guo Xiang , Zhu Huan
Published: January 2020

Background Order Chaetophorales currently includes six families, namely Schizomeridaceae, Aphanochaetaceae, Barrancaceae, Uronemataceae, Fritschiellaceae, and Chaetophoraceae. Most studies have primarily focused on intergeneric phylogenetic relationships within this order and the phylogenetic relationships with four other Chlorophycean orders (Chaetophorales, Chaetopeltidales and Oedogoniales, and Volvocales). This study aimed to phylogenetically reconstruct order Chaetophorales and determine the taxonomic scheme and to further the current understanding of the evolution of order Chaetophorales. The taxonomic scheme of Chaetophorales has been inferred primarily through phylogenetic analysis based on rDNA sequences and phylogenetic relationships among families in order Chaetophorales remain unclear. Results In present study, seven complete and five fragmentary chloroplast genomes were harvested. Phylogenomic and comparative genomic analysis were performed to determine the taxonomic scheme within Chaetophorales. Consequently, Oedogoniales was found to be a sister to a clade linking Chaetophorales and Chaetopeltidales, Schizomeriaceae, and Aphanochaetaceae clustered into a well-resolved basal clade in Chaetophorales, inconsistent with the results of phylogenetic analysis based on rDNA sequences. Comparative genomic analyses revealed that the chloroplast genomes of Schizomeriaceae and Aphanochaetaceae were highly conserved and homologous, highlighting the closest relationship in this order. Germination types of zoospores precisely correlated with the phylogenetic relationships. Conclusions In conclusion, chloroplast genome structure analyses, synteny analyses, and zoospore germination analyses were concurrent with phylogenetic analyses based on the chloroplast genome, and all of them robustly determined the unique taxonomic scheme of Chaetophorales and the relationships of Oedogoniales, Chaetophorales, and Chaetopeltidales.
Management of complex renal cysts in Canada: Results of a survey study
Authors: Couture Félix , Finelli Antonio , Tétu Amélie , Bhindi Bimal , Breault Rodney H. , Kapoor Anil , Kassouf Wassim , Lavallée Luke , Tanguay Simon , Violette Philippe D. , Richard Patrick O.
Published: January 2020

Background Bosniak III and IV cysts have a high risk of malignancy and have traditionally been managed surgically. However, growing evidence suggests that many can be managed by active surveillance. The main objective of this study was to characterize the use of surveillance in the management of complex renal cysts. Methods A web-based survey was sent to all registered, active members of the Canadian Urological Association (N=583) in October 2018. Results The survey response rate was 24.7%. Management of Bosniak III cysts varied considerably. A large proportion of respondents (33.1%) offered active surveillance in >50% of cases. Only 13.7% of respondents reported never or rarely (<5% of cases) offering surveillance. In contrast, for Bosniak IV cysts, 60.1% of urologists never or rarely offered surveillance, while only 10.1% offer it in >50% of cases. A significantly greater proportion of academic urologists, compared to non-academic urologists, viewed surveillance as a management option for patients with a Bosniak III or IV cyst. The most commonly reported barriers to a greater adoption of surveillance were concerns regarding its oncologic safety, the lack of data to support surveillance in this population, and the lack of triggers for discontinuation of active surveillance and intervention. Conclusions Despite active surveillance being included as a management option in guidelines, many Canadian urologists are reluctant to offer surveillance to patients with Bosniak III or IV cysts. Practice patterns are heterogeneous among those offering surveillance. High-quality studies are required to better define the benefits and risks of cystic renal mass surveillance.
Long term outcomes of Burch colposuspension and transobturator tape and single incision needleless (DynaMesh®- SIS minor) for the surgical treatment of female stress urinary incontinence patients who underwent combined pelvic reconstructive surgery or hysterectomy
Authors: Akdemir Yesim , Dincer Fadime , Buyukuysal Cagatay , Ozmen Ulku , Harma Muge , Harma Mehmet Ibrahim
Published: January 2020

Background Women with SUI often require combined pelvic reconstructive surgery because of sharing risk factors of pelvic relaxation. The aim of this study was to evaluate the efficacy of Burch colposuspension, the transobturator tape (TOT), and single incision needleless (DynaMesh®- SIS minor) procedures in patients with SUI who also underwent combined pelvic reconstructive surgery or hysterectomy. Methods We carried out a prospective cohort study that included 142 patients who underwent Burch colposuspension (n:43), TOT(n:40), or SIS(n:39) procedures combined pelvic reconstructive surgery or hysterectomy between January 2010 and July 2018. During clinical follow-up, objective cure, subjective cure, failure and surgical success rates were analyzed. Quality of life and symptom severity were assessed by IIQ-7, UDI-6, OAB-V8, SSI, SSQ-8 and PGI-I. Primary outcome was surgical success which was defined when any of the objective cure, subjective cure or improvement has achieved and secondary outcomes were; intraoperative bladder injury, sling extrusion, de novo urgency, voiding dysfunction, length of hospital stay, and outcomes of patient reported quality of life questionnaires. Results Surgical success rate were higher in Burch group than SIS group and also higher in TOT group than SIS group (88,4% vs 61,5% and 87,5% vs 61,5% respectively, p=0,003) Urinary incontinence complaints were higher and quality of life were lower in in SIS group when compared with Burch group. No difference was seen in between Burch and TOT groups, and TOT and SIS groups in terms of IIQ-7, UDI-6, OAB-V8, SSI, and SSQ-8 scores. Conclusions Both Burch and TOT were safe and effective procedures in patients with SUI who required additional pelvic surgeries. Although surgical outcome of SIS procedure in SUI patients that had concomitant pelvic surgeries in our study was not promising, the data are not clear and further randomized studies are needed to clarify these observations.
The Expression of Ptch1 and Ptch2 in the Stenotic Tissue of Congenital Ureteropelvic Junction Obstruction in Children
Authors: Yang Yanfang , han wenwen , Zhang Weiping , Sun Ning
Published: January 2020

Objective Ptch1 and Ptch2 are expressed in tubular epithelium and stromal cells adjacent to the UPJ. They mediated inhibition of smoothened, a transmembrane protein expressed on the cell surface. If the pathway was disturbed, UPJO might be onset. The aim of this study was to determine the expression of Ptch1 (P1) and Ptch2 (P2) in stenotic segments in children with congenital ureteropelvic junction obstruction (UPJO) versus in normal control subjects. Materials and methods Stenotic segments of ureter tissues were obtained from 20 UPJO patients. Extrinsic stenosis, such as vessel and ureteral polyp, were excluded. The control ureter specimens were obtained from 10 patients with Wilm’s tumor, and the tissues were confirmed histologically to be unaffected. Immunofluorescence, Western blot and real-time PCR were used to investigate the expression of P1 and P2. Statistical methods were used to find the differences between the two groups Results P1 and P2 were identified that located in the cytoplasm of smooth muscle in two groups through Immunohistochemistry. However, there were no statistical differences between the two groups in P1 and P2 with immunohistochemistry (P=0.31 and P=0.3, respectively). Meanwhile there were no statistical differences with Western blot (P=0.75 and P=0.9, respectively) and real-time PCR (P=0.52 and P=0.45, respectively). But we found that in the immunofluorescence P1 were diffused in controls and mainly surrounding the nucleuses of smooth muscle cells in UPJO. Conclusions The expression of P1 and P2 between the two group had no statistically significant. P1 mainly surrounding the nucleuses of smooth muscle cells in UPJO. The P1 pathway might be disturbed by the abnormal distribution of P1 rather than the quantity.
Incidence and Epidemiology of Acute Kidney Injury in a Pediatric Malawian Trauma Cohort: a Prospective Observational Study
Authors: Bjornstad Erica C. , Muronya William , Smith Zachary H. , Gibson Keisha , Mottl Amy K , Charles Anthony , Marshall Stephen W. , Golightly Yvonne M. , Munthali Charles K. , Gower Emily W.
Published: January 2020

Introduction: Acute kidney injury (AKI) is highly associated with mortality risk in children worldwide. Trauma can lead to AKI and is a leading cause of pediatric death in Africa. However, there is no information regarding the epidemiology of pediatric, trauma-associated AKI in Africa.Methods: Prospective cohort study of pediatric trauma patients admitted to a tertiary referral hospital in Malawi. Participants enrolled at admission were followed prospectively throughout their hospitalization. AKI was defined by sequential serum creatinine measurements and Kidney Disease Improving Global Outcomes criteria. We calculated descriptive statistics and univariate relative risks (RR) for hypothesis-generation of potential risk factors associated with AKI.Results: We analyzed data from 114 participants. Depending on baseline creatinine definition, AKI incidence ranged from 4-10%. The new Schwartz equation estimated baseline creatinine values best and yielded an AKI incidence of 9.7%. Almost one in ten children died during hospitalization, but those with AKI (n=4) were at significantly higher risk of death compared to those without AKI (40.0% vs 6.2%; RR 6.5, 95% CI 2.2-19.1). Burn injuries were most commonly associated with AKI (63.6%). Other potential AKI risk factors included multiple injuries, trunk or facial injuries, and recent consumption of herbal remedies.Conclusions: AKI occurs in 10% of admitted pediatric trauma patients in Malawi and increases the risk of death 7-fold compared to those without AKI. This large unrecognized burden in trauma requires further investment by researchers, clinicians and policymakers to develop evidenced-based triage, recognition, and management approaches to prevent the associated sequelae and potential mortality from AKI.
Human adipose tissue-derived mesenchymal stem cells in Parkinson's disease：Inhibit T helper 17 cell differentiation and regulate immune balance towards a regulatory T cell phenotype
Authors: Bi Yong , Liang Huazheng , Lin Xiaobin , Yang Dehao , Zhang Xiaowei , Ke Jianming , Xiao Jingjing , Chen Zhilin , Chen Weian , Zhang Xu , Wang Shaoshi , Liu Chun-Feng
Published: January 2020

Parkinson's disease (PD), known as a neurodegenerative disorder, shows typical pathology of neuroinflammation, which might be the result of the imbalance between regulatory T cells (Treg) and T helper 17 (Th17) cells. The present study aimed to investigate the modulating effect of Ad-MSCs on peripheral blood mononuclear cells (PBMCs) derived from PD patients. CD4 + peripheral blood T cells were isolated and co-cultured with Ad-MSCs at a ratio of 4:1 under Th17 or Treg polarizing conditions, respectively, for 4 days. Our results showed that Ad-MSCs specifically inhibited the differentiation of IL-17-producing CD4 + T cells collected from PBMCs of PD patients evidenced by the decreased expression of RORγt- the key transcription factor for Th17 cells, IL-6R, and IL-23R. In the meantime, Ad-MSCs and induced a functional CD4 + CD25 + Foxp3 + T regulatory cell phenotype evidenced by the secretion of IL-10. Furthermore, levels of LIF protein and its receptor mRNA were significantly increased under both polarizing conditions. These findings suggest that the regulation of the Th17/Treg balance by Ad-MSCs was correlated with the increase in LIF secretion. Therefore, Ad-MSCs are an important player in ­modulating inflammatory responses and a potential therapeutics for PD patients.
Prevalence and molecular characterization of methicillin-resistant Staphylococcus aureus with mupirocin, fusidic acid and/or retapamulin resistance
Authors: Chen Wenjing , He Chunyan , Yang Han , Shu Wen , Cui Zelin , Tang Rong , Zhang Chuanling , Liu Qingzhong
Published: January 2020

Data on the prevalence of resistance to mupirocin (MUP), fusidic acid (FA) and retapamulin (RET) in methicillin-resistant Staphylococcus aureus (MRSA) from China are still limited. In this study we examined these three antibiotics resistance pheno and geno-typically in 1206 MRSA clinical isolates. Phenotypic MUP, FA and RET resistance was determined by MICs, and genotypically by PCR and DNA sequencing examining genes mupA / B , fusB - D , cfr and vgaA / Av , and mutations in ileS , fusA / E , rplC , and 23S RNA V domain. The genetic characteristics of resistance isolates were conducted by PFGE and MLST. Overall MRSA MUP, FA and RET resistance was low (5.1%, 1.0% and 0.3%, respectively). The mupA was the mechanism of high-level MUP resistance. All low-level MUP resistance isolates possessed an equivocal mutation N213D in IleS, and 2 of them additionally had the reported V588F mutation impacting the Rossman fold. FusA mutations, such as L461K, H457Q, H457Y and V90I, were the primary FA resistance mechanisms among high-level resistance isolates, most of which contained fusC ; however, all low-level resistance strains carried fusB . No resistance mechanisms detected were found among RET resistance isolates. Genetic analysis demonstrated clone spread for MUP resistance isolates. In conclusion, MUP, FA and RET exhibited highly activity against MRSA isolates. Acquired genes and chromosome-borne genes mutations were responsible for MUP and FA resistance, and further investigation is needed to uncover the RET resistance mechanisms. Moreover, the surveillance to MUP in MRSA should be strengthened to prevent resistance increase due to the expansion of clones.
Characterization of chemotaxis and motility response towards fructose in Escherichia coli
Authors: Liu Fanghai , Wang Fangbin , Liu Jian
Published: January 2020

BackgroundPeritrichously flagellated bacteria such as Escherichia coli perform chemotaxis by a biased random walk toward various chemicals, which was driven by the bacterial flagellar motor. The chemotaxis system is a perfect robust system which can adapt to its pre-stimulus level after the stimulus. Fructose, a typical monosaccharide that can attract Escherichia coli. Previous studies have shown Escherichia coli to be chemotactic to both amino acids and simple sugars. However, little is known about the chemotaxis and motility response of Escherichia coli towards fructose.ResultsIn this study, we characterized the chemotaxis behavior of Escherichia coli to different concentrations of fructose from 0mM to 50mM by using microfluidics and bead assay. We observed the wild-type cells responded to the stimulus of fructose, which suggested fructose is an attractant to Escherichia coli, while the cells defective in chemotaxis could not sense the stimulus of fructose. Fructose affects the motor behavior of wild-type cells and reduces the CCW motor speeds significantly compared to CW motor speeds, contrast to that fructose cannot affect the motor speeds of cells defective in chemotaxis. The CW biases of wild-type cells increased with the addition of fructose. And the fructose promotes bacterial aggregation on surface by lowering the bacteria motor speed.ConclusionsWe found that fructose is an attractant to Escherichia coli, with the wild-type cells showed stronger response to higher concentration of fructose, while cells lacking chemoreceptors and CheY cannot sense or respond to fructose. The motility of wild-type cells was reduced in various concentrations of fructose, which helped the aggregation of cells near the surface, in contrast with the result that the fructose showed no effect on the motility of the cells defective in chemotaxis. Similar phenomena are expected to be found in the effect of other monosaccharides to Escherichia coli.
Heterologous prime-boost: an important candidate immunization strategy against tembusu virus
Authors: Pan Yuting , Jia Renyong , Li Juping , Wang Mingshu , Chen Shun , Liu Mafeng , Zhu Dekang , Zhao Xinxin , Wu Ying , Yang Qiao , Yin Zhongqiong , Jing Bo , Huang Juan , Zhang Shaqiu , Zhang Lin , Liu Yunya , Yu Yanlin , Tian Bin , Pan Leichang , Rehman Mujeeb Ur , Cheng Anchun
Published: January 2020

Background Tembusu virus (TMUV), a newly emerging pathogenic flavivirus, is acute and spreads rapidly which causes massive economic losses in the Chinese duck industry. Vaccination is the most effective method to prevent TMUV. So, it’s urgent to look for an effective vaccine strategy against TMUV. Heterologous prime-boost regimen priming with DNA vaccine and boosting with recombinant adenovirus vaccine have been proven to be the successful strategy in protecting against virus in experimental animal models. Methods In this study, heterologous and homologous prime-boost strategies using DNA vaccine and recombinant adenovirus vaccine expressing prM-E or E protein of TMUV were evaluated to protect ducks against the infection of TMUV for the first time, including priming and boosting with DNA vaccine, priming and boosting with recombinant adenovirus vaccine, and priming with DNA vaccine and boosting with recombinant adenovirus vaccine. Humoral and cellular immune responses were detected and evaluated. We then challenged the ducks with TMUV at 12 days after boosting to assay for the clinical symptoms, mortality, viral loads and histopathological lesions of these different strategies. Results Comparing with homologous prime-boost strategies, higher levels of specific antibodies against E protein and the neutralizing antibodies against TMUV were detected in heterologous prime-boost regimen. And also, it could induce higher levels of IFN-γ than homologous prime-boost strategies in the later stage. Interestingly, heterologous prime-boost strategy induced higher level of IL-4 in the early stage, but gradually decreased and was even lower than homologous prime-boost strategy in the later stage. Moreover, the heterologous prime-boost strategy could efficiently protect ducks with low viral tiers, no clinical symptoms and histopathological lesions in this experiment after challenging with TMUV while slight clinical symptoms and histopathological lesions were observed in homologous prime-boost strategies. Conclusions Our results indicated that the heterologous prime-boost strategy induced higher levels of humoral and cellular immune responses and better protection against the TMUV infection in ducks than the homologous prime-boost strategies, suggesting that heterologous prime-boost strategy is an important candidate for the design of a novel vaccine strategy against TMUV.