bluuebunny/crossref_metadata_2025 huggingface dataset:
A Randomized, Placebo-Controlled Study of Romosozumab for the Treatment of Hip Fractures
Authors: Schemitsch Emil H. , Miclau Theodore , Karachalios Theofilos , Nowak Lauren L. , Sancheti Parag , Poolman Rudolf W. , Caminis John , Daizadeh Nadia , Dent-Acosta Ricardo E. , Egbuna Ogo , Chines Arkadi , Maddox Judy , Grauer Andreas , Bhandari Mohit
Published: January 2020

Background:

Romosozumab is a bone-forming antibody that increases bone formation and decreases bone resorption. We conducted a double-blinded, randomized, phase-2, dose-finding trial to evaluate the effect of romosozumab on the clinical outcomes of open reduction and internal fixation of intertrochanteric or femoral neck hip fractures.

Methods:

Patients (55 to 94 years old) were randomized 2:3:3:3 to receive 3 subcutaneous injections of romosozumab (70, 140, or 210 mg) or a placebo postoperatively on day 1 and weeks 2, 6, and 12. The primary end point was the difference in the mean timed “Up & Go” (TUG) score over weeks 6 to 20 for romosozumab versus placebo. Additional end points included the time to radiographic evidence of healing and the score on the Radiographic Union Scale for Hip (RUSH).

Results:

A total of 332 patients were randomized: 243 to receive romosozumab (70 mg, n = 60; 140 mg, n = 93; and 210 mg, n = 90) and 89 to receive a placebo. Although TUG scores improved during the study, they did not differ significantly between the romosozumab and placebo groups over weeks 6 to 20 (p = 0.198). The median time to radiographic evidence of healing was 16.4 to 16.9 weeks across treatment groups. The RUSH scores improved over time across treatment groups but did not differ significantly between the romosozumab and placebo groups. The overall safety and tolerability profile of romosozumab was comparable with that of the placebo.

Conclusions:

Romosozumab did not improve the fracture-healing-related clinical and radiographic outcomes in the study population.

Level of Evidence:

Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
Chronic Posterior Sternoclavicular Dislocation in a Contact Athlete
Authors: Albors Laura Mena , Lee R. Jay
Published: January 2020

Case:

Traumatic posterior sternoclavicular dislocation (PSCD) is an uncommon injury that often presents in a delayed fashion and can be difficult to diagnose. Standard treatments include reduction of acute injuries and possible reconstruction for chronic injuries. We describe a 16-year-old male football player with a traumatic PSCD and initial dyspnea and dysphagia. He returned to playing contact sports without undergoing reduction.

Conclusions:

Contrary to the literature that suggests reduction as a primary treatment of PSCD, this case shows that a contact-sport athlete may be able to return to competitive sports with a chronic PSCD.
Treatment of Meniscal Deficiency with Meniscal Allograft Transplantation and Femoral Osteotomy in a Patient with History of Lateral Discoid Meniscus
Authors: Zaffagnini Stefano , Espinosa Maximiliano , Neri Maria Pia , Marcacci Maurilio , Grassi Alberto
Published: January 2020

Case:

A 15-year-old woman with multiple arthroscopic procedures for left lateral discoid meniscus since the age of 9 presented with pain, swelling, and mechanical symptoms. A meniscal allograft transplantation (MAT) and lateral opening-wedge femoral osteotomy was performed. At the 6-year follow-up, the patient presented a visual analog scale (VAS) score of 0, subjective International Knee Documentation Committee (IKDC) of 88, and Lysholm of 95. At 15-year follow-up, the VAS score was 0, subjective IKDC 85.1, and Lysholm 86.

Conclusions:

MAT associated with femoral osteotomy was an effective procedure in this patient with pain and functional limitation after total meniscectomy in the setting of discoid meniscus and valgus malalignment. Good clinical and magnetic resonance imaging-related outcomes were achieved at the intermediate and long-term follow-up.
Implementasi Pengendalian Pemanfaatan Ruang dan Sanksi Administratif Dalam Rencana Tata Ruang Wilayah Kabupaten Sidoarjo
Authors: Sugiarto Agus
Published: January 2020

This research aimed to organize spatial arrangement in accordance with the provisions of the legislation and creating spatial order, there should be efforts to increase supervision and control of spatial utilization of space. There are some instruments that must be observed in control of spatial planning in Sidoarjo. The purpose of this study is to describe and analyzed the implementation of controls spatial use Sidoarjo. Date analysis technique used is descriptive qualitative models. The results showed that of the four (4) instrument control utilization of existing space, only 2 (two) instrument that is implemented by the Government of Sidoarjo regency namely instrument permitting and sanctioning. Implementation of administrative sanctions for violations of the space utilization is merely a written warning, followed by sealing. There are no penalties up to the demolition level of development.
Implementasi Undang-Undang Nomor 20 Tahun 2011 Tentang Rumah Susun (Studi Pada Rumah Susun Sederhana Sewa Di Kecamatan Sidoarjo Kabupaten Sidoarjo)
Authors: Subaktiawan Eko , Fauziah Luluk
Published: January 2020

This research aims to describe the implementation, the role of actor, and the proponent factors and resistor factors of Law Policy 2011 No. 20 about Flat in Rental Simple Flat of Sidoarjo Subdistrict and Sidoarjo Regency. This research uses qualitative descriptive method. Data accumulation technique is made by abservation, interview and documentation. While the analysing technique started from data accumulation, data reduction, data presentation, and getting the conclusion. The result shows that the implementation of flat development policy hasn’t been running well, socialiszation to the society hasn’t been overall, and the resources to manage flat haven’t been quite enough, but the employees are discipline enough and responsible to do their duties, the bureaucracy structure has been good, the authority distribution has been fair and definite. The actor who has a role is the government as a main implementator, private party as a construction service provider and society as the user. The proponent factors are discipline employees on doing disposition and bureaucracy structure is affirming the duties distribution. While, the resistor factors are the less socialiszation to the society and the minimizing of flat operational resources.
Perubahan Sosial Ekonomi Petani Agroforestri Berbasis Kopi di Kabupaten Jember Jawa Timur
Authors: Zahro Munailatis , Subekti Sri , Widjayanthi Lenny
Published: January 2020

This study aimed to explain the changing both in social and economic aspects of farmers as a result of forest conversion process to agroforestry system in Harjomulyo Village, Jember Regency. This study used qualitative research. The information gained from informans who were selected purposively through snowball sampling. Observation, interview and documentational study were methods which were used to collect information. Triangulation technique also used in this study to check the validity of information. This study used interactive model of Miles & Huberman which consists of data reduction to conlusion. The result of this study showed that socio change occured  farmer coorperation with Perhutani. While in economic change showed that economic condition increase, saving insurance credit, and availability tuition fees for children.
The Opportunities and Limitations of Livelihood Capitals of an Urban Agricultural Households
Authors: Narongchai Wanichcha , Chmnanmak Rukchanok
Published: January 2020

This study aims at investigating the opportunities and limitations of livelihood capitals of an urban agricultural. With the Participatory Action Research method (PAR) via qualitative approach, 14 agricultural households residing and working in Kra-nuan Municipal District in KhonKaen Province were interviewed in-depth and brainstormed. The data was collected from December 2017 to March 2018 and analyzed using Content Analysis approach. The result showed that urban agricultural households lived in a village located in flourish economic municipal district where accessible facilities and services were available, but they still mainly carried on a traditional agricultural occupation. Due to the expansion of the city and rising cost of living, it was necessary for them to improve their production process. They brainstormed to analyze their resources and realized that they had rich natural, physical, and financial capitals of which they could utilize and make their living out. However, human and social capitals were found to obstruct the development of their occupation. In this situation, they teamed up and changed the production process from relying on long-term corps to implementing the integrated farming in which some land was also allocated for short-term corps for additional income. This was regarded as a livelihood strategy with limited chances and capitals.
Happiness Elements of Elders in Rural Northeast, Thailand: Dynamic of Social Change in Globalization Era
Authors: Chumnanmak Rukchanok , Ayuwat Dusadee , Narongchai Wanichcha
Published: January 2020

This study aims to study elements for the elder's happiness in rural area of the north- eastern region, under the dynamic of social changes in the globalization. The study is a qualitative research having the unit of analysis both of individual and community lev- els. Data is collected from the in-depth interview with 18 elders, covering all age ranges, living in rural areas. The studiedarea is named O-lo village in PhuKiew district, Chaiya- phum province where contains high rates of the elders in the northeast. The data was collected during June to October 2017 using interview guide as a tool, and is analyzed with content analysis. The result reveals that the elders in O-lo community are happy with their family conditions. Their happiness consists of 4 elements as the followings. The first element is family meaning there are families or relatives to take care of. The elder always ask in order to follow up for their offspring's well-being and give moral support to them. The second element is regarding their health. The elders are in good health and able to take care of themselves. They can also help out their families with housework. This is also the result of their convenient accessibility to medical treatment. The third element is economic aspect. The elders have their occupations and incomes from various sources including their work, money given from their children, and the welfare elder allowances. The last element is social aspect. They feel safety in their lifes and properties. Moreover, they join social activities organized by the community in order to relieve themselves from stress, make merit in temples, and participate in any activities enhancing value of the elders.
Skipped-Generation Families: Economic Happiness in Rural North-Eastern Thailand
Authors: Kwalamthan Wattanachai , Ayuwat Dusadee , Narongchai Wanichcha
Published: January 2020

This paper investigates economic happiness of skipped-generation families in rural north-eastern Thailand. The qualitative methodological approach was implemented in the study. Data collection was conducted in April - May 2018 and in-depth interview was used as a research instrument to collect data from two groups of key informants, including 1) community leaders, community seniors, and community commitees, In total eight persons, and 2) skipped-generation families living in a rural north-eastern region of Thailand, in total twenty families. Data analysis was done by the content analysis method. The study indicated that skipped-generation families are the familes with grandparents and grandchildren living together. Most families have an agricultural occupation, because they have a lot of land by inheritance and divided into two parts: housing and farming. Mostly agricultural income by sugar canes and farming can earn 2,400 USD per year. Moreover, remittances from international migrant only 450 USD per month is spent on family expenses and education of grandchildren. Some families do not have enoughmoney to invest in farming in the next year, and they have a lot more debt than 3,000 USD from a migrant who goes to work abroad. However, skipped-generation families have a perception of economic happiness "An empty hand is no lure for a hawk, no man is happy who does not think himself so" So, skipped-generation families must take this view to manage the economic situation of the family, even though the incomes are insuf-ficient to cover their living and lack of labor due to migrant workers going to work abroad. This affects the economic happiness of skipped-generation families to sustain their living in a rural society.SKIPPED-GENERATION FAMILIES:Economic Happiness in Rural North-Eastern Thailand
Implementasi Kebijakan Parkir Berlangganan di Kabupaten Sidoarjo (Studi Di Dinas Perhubungan Kabupaten Sidoarjo)
Authors: Fatimah Siti , Rodiyah Isnaini
Published: January 2020

This study aims to analyze and describe the implementation of a subscription parking policy in Sidoarjo Regency as well as supporting and inhibiting the implementation of a subscription parking policy in Sidoarjo Regency. The type of this research is descrip- tive research with qualitative approach. Data collection is done by observation, interviews, and documentation with informants. Data analysis technique uses Miles & Huber- man theory, namely data collection, data reduction, data presentation, and conclusion. The results showed that the implementation of a subscription parking policy in Sidoarjo Regency had not run effectively because the standard operating procedures had not been implemented optimally by the supervisors and carved out a subscription; facilities and infrastructure are inadequate; as well as the salary of supervisors and parking atten- dants subscribers are minimal. The conclusion of this study is that the implementation of a subscription parking policy in Sidoarjo Regency has not run effectively related to stan- dard operating procedures, facilities and infrastructure, and the level of compliance of the parking attendants subscription.
Título del envío: Gli interventi di restauro e di abbellimento della chiesa di Santa Maria dei Greci dal periodo Normanno al Borbonico
Authors: Magrì Rosanna
Published: January 2020

La storia dei restauri e delle opere di “abbellimento” eseguiti nella chiesa di Santa Maria dei Greci in Agrigento attraversa un intervallo temporale che va dal periodo normanno ai nostri giorni, in un continuo lavoro di ricerca voluto da studiosi, che hanno creduto fortemente nella valorizzazione del monumento. La chiesa – sorta sui resti del tempio dorico risalente alla seconda metà del V secolo a. C.– è edificata con molta probabilità durante il periodo bizantino tra il 395 - Editto di Teodosio - e il 596, quindi prima della conquista musulmana. La struttura architettonica bizantina della chiesa ha subito, nel corso dei secoli, importanti trasformazioni che hanno determinato quella che oggi è la sua conformazione attuale. L’esame del periodo, che abbraccia quasi sette secoli – dal 1100 al 1750 - durante il quale sono state apportate all’edificio importanti trasformazioni architettoniche e completamenti stilistici, costituisce l’oggetto della presente argomentazione.
Formulation of Boundary Conditions at the Surface of a Porous Medium
Authors: Neale Graham , Nader Walter
Published: January 2020

In petroleum engineering practice it is sometimes necessary to predict fluid flow occurring within adjacent regions of porous medium and open space (for example, fractured porous media, 1–3 vuggy media, 4 porous granules5). In such situations the governing flow equations are well known: Darcy's law and the Navier-Stokes equation. However, the set of boundary conditions at the permeable interfaces is seldom obvious. The usual conditions assumed are that the mass flux normal to the surface IS continuous, that the pressure is continuous across the surface, and that the tangential velocity in the free fluid tends to zero at the surface. The first two conditions are completely satisfactory; however, the third is clearly only an approximation. 6
Prevalence and risk factors of chronic kidney disease and diabetic kidney disease in a central Chinese urban population: a cross-sectional survey
Authors: Author) Jiayu Duan(Former Corresponding , Duan Guang-Cai , Wang Chong-Jian , Liu Dong-Wei , Qiao Ying-Jin , Pan Shao-Kang , Jiang Deng-Ke , Liu Yong , Zhao Zi-Hao , Liang Lu-Lu , Tian Fei , Author) Zhang-Suo Liu(New Corresponding
Published: January 2020

Background : This study was conducted to evaluate and update the current prevalence of and risk factors for chronic kidney disease (CKD) and diabetic kidney disease (DKD) in China. Methods : From December 2017 to June 2018, a total of 5231 subjects were randomly recruited from 3 communities in 3 districts of Zhengzhou. CKD was defined as estimated glomerular filtration rate (eGFR) < 60 mL/min.1.73m 2 or urinary albumin to creatinine ratio ≥ 30 mg/g (albuminuria). Diabetic subjects with systolic blood blood pressure > 140 mmHg, albuminuria or an eGFR less than 60 mL/min/1.73 m 2 were classified as having DKD. Participants completed a questionnaire assessing lifestyle and relevant medical history, and blood and urine specimens were taken. Serum creatinine, uric acid, total cholesterol, triglycerides, low-density lipoprotein, high-density lipoprotein and urinary albumin were assessed. The age- and sex-adjusted prevalences of CKD and DKD were calculated, and risk factors associated with the presence of reduced eGFR, albuminuria, DKD, severity of albuminuria and progression of reduced renal function were analyzed by binary and ordinal logistic regression. Results : The overall adjusted prevalence of CKD was 16.8% (15.8 – 17.8%) and that of DKD was 3.5% (3.0 – 4.0%). Decreased renal function was detected in 132 participants (2.9%, 95% confidence interval [CI]: 2.5 – 3.2%), whereas albuminuria was found in 858 participants (14.9%, 95% CI: 13.9 – 15.9%). In all participants with diabetes, the prevalence of reduced eGFR was 6.3% (95% CI = 3.9 – 8.6%) and that of albuminuria was 45.3% (95% CI = 40.4 – 50.1%). The overall prevalence of CKD in participants with diabetes was 48.0% (95% CI = 43.1 – 52.9%). The results of the binary and ordinal logistic regression indicated that the factors independently associated with a higher risk of reduced eGFR and albuminuria were older age, sex, smoking, alcohol consumption, overweight, obesity, diabetes, hypertension, dyslipidemia and hyperuricemia. Conclusions : Our study shows the current prevalence of CKD and DKD in residents of Central China. The high prevalence suggests an urgent need to implement interventions to relieve the high burden of CKD and DKD in China.
Psychosocial Syndemic of Suicidal Ideation: A Cross-sectional Study Among Sexually Transmitted Infection Patients in Shanghai, China
Authors: Wang Suping , Ni Yang , Gong Ruijie , Shi Yuan , Cai Yong , Ma Jin
Published: January 2020

Background: We sought to verify whether psychosocial health problems among patients with sexually transmitted infections (STIs) were associated with these patients’ suicidal ideation, and to examine the syndemic effect of multiple psychosocial problems on suicidal ideation. Methods: This was a cross-sectional study of 519 STI patients at the Shanghai Skin Disease Hospital. Demographic, psychosocial, and suicidal ideation information of the participants was collected by questionnaire. Logistic regressions were performed to detect the association between demographic variables and suicidal ideation, as well as each individual psychosocial variable and suicidal ideation, and to verify the syndemic effect of psychosocial factors. Results: Of the participants, 25.0% (130/519) reported having suicidal ideation. In univriable analysis, low self-esteem, loneliness, depression, entrapment, defeat, and unsatisfied interpersonal needs were associated with suicidal ideation. Multivariable analysis found depression (odds ratio [OR] 4.1; 95% confidence interval [CI]: 2.3–7.2) and entrapment (OR: 2.1; 95%CI: 1.1–4.1) each had a more significant relation with suicidal ideation than the other psychosocial problems examined. STI patients who experienced two or more psychosocial health problems had approximately fourfold odds of suicide ideation (adjusted OR [AOR]: 4.2; 95%CI: 2.6–6.8) compared with those in the non-syndemic group, especially in the high-level (five or more psychosocial problems) group (AOR: 7.0; 95%CI: 3.9–12.5). Conclusions: The study found the participants had a high rate of suicidal ideation and suffered from severe psychosocial problems. These results show a syndemic effect of psychosocial problems on increasing the odds of suicidal ideation. This suggests an urgent need for efforts to prevent suicidal ideation among STI patients to improve the social and health conditions of this population.
Comparison of refractive outcomes after photorefractive keratectomy with different optical zones using Mel 90 excimer laser
Authors: Shin Dae Hwan , Lee Yong Woo , Song Ji Eun , Choi Chul Young
Published: January 2020

Background: To compare the changes in clinical outcomes and the degree of regression between a 6.0 mm optical zone (6.0 OZ) and 6.5 mm optical zone (6.5 OZ) following photorefractive keratectomy (PRK).Methods: The records of 95 eyes that had undergone PRK with a 6.0 OZ (n = 40) and a 6.5 OZ (n = 55) were retrospectively reviewed. We compared data including the spherical equivalent of manifest refraction (SE of MR), simulated K (Sim K), thinnest corneal thickness, change in thinnest corneal thickness (the initial value divided by corrected diopter [ΔTCT/CD]), Q value, corneal higher order aberrations (HOAs) and spherical aberration (SA) pre-operation, at 3 and 6 months postoperative and at the last follow-up visit (Mean; 20.71 ± 10.52, 17.47 ± 6.57 months in the 6.0 and 6.5 OZ group, respectively).Results: There were no significant differences in the SE of MR, Sim K and UDVA between the 6.0 OZ group and the 6.5 OZ group over 1 year of follow-up after PRK, and the 6.0 OZ group required less ΔTCT/CD than the 6.5 OZ group. The 6.5 OZ group showed better results in terms of post-operative HOAs of RMS, SA and Q value. When comparing that pattern of change in Sim K, there was no significant difference between the 6.0 OZ group and the 6.5 OZ group.Conclusions: The clinical refractive outcomes and regression after PRK using Mel 90 excimer laser with a 6.0 OZ were comparable to those with a 6.5 OZ.
Tele-transitions of Care (TTOC). A 12-month, Randomized Controlled Trial evaluating the use of Telehealth to achieve Triple Aim Objectives
Authors: Noel Kimberly , Messina Catherine , Hou Wei , Schoenfeld Elinor , Kelly Gerald
Published: January 2020

Background : Poor transitions of care leads to increased health costs, over-utilization of emergency room departments, increased re-hospitalizations and causes poor patient experiences and outcomes. This study evaluated Telehealth feasibility in improving transitions of care. Methods : This is a 12-month randomized controlled trial, evaluating the use of telehealth (remote patient monitoring and video visits) versus standard transitions of care with the primary outcomes of hospital readmission and emergency department utilization and secondary outcomes of access to care, medication management and adherence and patient engagement. Electronic Medical Record data, Health Information Exchange data and phone survey data was collected. Multi-variable logistic regression models were created to evaluate the effect of Telehealth on hospital readmission, emergency department utilization, medication adherence. Chi-square tests or Fisher’s exact tests were used to compare the percentages of categorical variables between the Telehealth and control groups. T tests or Wilcoxon rank sum tests were used to compared means and medians between the two randomized groups. Results : The study conducted between June 2017 and 2018, included 102 patients. Compared with the standard of care, Telehealth patients were more likely to have medicine reconciliation (p = 0.013) and were 7 times more likely to adhere to medication than the control group (p = 0.03). Telehealth patients exhibited enthusiasm (p = 0.0001), and confidence that Telehealth could improve their healthcare (p= 0.0001). Telehealth showed no statistical significance on emergency department utilization (p = 0.691) nor for readmissions (p = 0.31). 100% of Telehealth patients found the intervention to be valuable, 98% if given the opportunity, reported they would continue using telehealth to manage their healthcare needs, and 94% reported that the remote patient monitoring technology was useful. Conclusions: Telehealth can improve transitions of care after hospital discharge improving patient engagement and adherence to medications. Although this study was unable to show the effect of Telehealth on reduced healthcare utilization, more research needs to be done in order to understand the true impact of Telehealth on preventing avoidable hospital readmission and emergency department visits.
In depth analysis of the association of FTO SNP (rs9939609) with expression of the classical phenotype of PCOS: a Sri Lankan study
Authors: Branavan Umayal , Wijesundera Sulochana , Chandrasekharan Vishvanath , Arambepola Carukshi , Wijeyaratne Chandrika
Published: January 2020

Background: PCOS is a common disorder of women due to genetic, endocrine and environmental effects that manifests from puberty. The rs9939609 variant of fat mass and obesity associated (FTO) gene is linked to metabolic derangement in PCOS. We previously identified FTO (rs9939609) as a susceptibility locus for PCOS among Sri Lankan women and also explored the role of kisspeptin. Associated factors of the FTO candidate gene among South Asians with PCOS are unknown. Methods: This study aimed to determine the association between FTO (rs9939609) polymorphism with clinical (BMI, acanthosis nigricans, hirsutism) and biochemical (serum kisspeptin and testosterone levels) characteristics of PCOS in a cohort of Sri Lankan women. Genetic and clinical data including serum kisspeptin and testosterone concentrations of our previously reported cases (n=55) and controls (n=110) were re-analyzed, specifically for an association with rs9939609 variant of FTO gene. Results: Logistic regression analysis (AA – OR=5.7, 95% CI=2.41-13.63, p<0.05) and genetic inheritance analysis (AA – OR=5.49, 95%CI=2.34-12.88, p<0.05) showed that FTO (rs9939609) polymorphism is significantly associated with PCOS and its metabolic manifestations. Serum testosterone was significantly higher in affected women with mutant genotypes (AA+AT) than the normal allele (TT) (p<0.05). Although serum kisspeptin was higher in subjects with PCOS and mutant alleles than controls, this difference was not significant (p>0.05). Conclusion: FTO gene variant rs9939609 is associated with hyperandrogenemia and metabolic manifestations of PCOS among women of Sri Lankan descent with the well-characterized phenotype. Serum kisspeptin and the FTO genotypes lack a significant association when adjusted for confounders.
The burden of unrecognised chronic kidney disease in patients with type 2 diabetes at a county hospital clinic in Kenya: implications to care and need for screening.
Authors: Otieno Frederick C. F. , Ogola Elijah N , Kimando Mercy W , Mutai Ken K
Published: January 2020

Background: Chronic Kidney Disease (CKD) in patients with type 2 diabetes enhances the cardiovascular risk profiles and disease, and is a strong predictor of progression to end-stage kidney disease. Early diagnosis is encouraged for referral to specialist kidney care to initiate active management that would optimize outcomes including forestalling progression to end-stage kidney disease.
This study was conducted in a regional referral public health facility in Central Kenya with a high prevalence of type 2 diabetes. It was aimed at finding out the burden of undiagnosed chronic kidney disease in their clinic of ambulatory patients with type 2 diabetes who dwell mainly in the rural area.
Methods: A cross-sectional study was conducted at the out-patient of Nyeri County hospital. A total of 385 patients were enrolled over five months. Informed consent was obtained and clinical evaluation was done, a spot sample of urine obtained for albuminuria and venous blood drawn for HbA1c, Lipids and serum creatinine. Estimated GFR (eGFR) was calculated using the Cockroft-Gault equation. Chronic kidney disease (CKD) was classified on KDIGO scale. Albuminuria was reported as either positive or negative. Descriptive statistics for data summary and regression analysis were employed on SPSS v23.
Results: A total of 385 participants were included in the study, 252 (65.5%) were females. There were 39.0 % (95%CI 34.3-44.2) patients in CKD/KDIGO stages 3, 4 and 5 and 32.7% (95%CI, 27.8-37.4) had Albuminuria. The risk factors that were significantly associated with chronic kidney disease/KDIGO stages 3, 4 and 5 were: age >50years, long duration with diabetes >5years and hypertension. Employment and paradoxically, obesity reduced the odds of having CKD, probably as markers of better socio-economic status.
Conclusion: Unrecognized CKD of KDIGO stages 3,4 and 5 occurred in over thirty percent of the study patients. The risk factors of hypertension, age above 50, long duration of diabetes should help identify those at high risk of developing CKD, for screening and linkage to care. They are at high risk of progression to end-stage kidney disease and cardiovascular events. The imperative of screening for chronic kidney disease is availing care in publicly-funded hospitals.
Voluntary Medical Male Circumcision and Sexual Practices among Sexually Active Circumcised Men in Mzuzu, Malawi: A Cross-Sectional Study
Authors: Chatsika Zimveka Jones , Kumitawa Andrew , Samuel Vincent , Azizi Steven Chifundo , Jumbe Vincent C
Published: January 2020

Background: Voluntary Medical Male Circumcision (VMMC) is one of the strategies being promoted to prevent sexual heterosexual transmission of HIV. It has been adopted by 14 countries with high HIV prevalence and low circumcision rates. The 60% protective efficacy of VMMC has come with misconceptions in some societies in Malawi, hence VMMC clients may opt for risky sexual practices owing to its perceived protective effect. The study estimated proportion of circumcised men engaging in risky sexual behaviors post-VMMC, assessed knowledge on VMMC protective effect and identified socio-demographic factors associated with risky sexual practices. Method: A cross sectional study was conducted at two sites of Mzuzu city. Systematic random sampling was used to select 322 participants aged 18-49 who had undergone VMMC. The independent variables included age, location, occupation, religion, marital status and education. Outcome variables were non condom use, having multiple sexual partners and engaging in transactional sex. Data from questionnaires was analyzed using Pearson’s chi square test and logistic regression. Results: Out of 322 respondents, 84.8% (273) understood the partial protection offered by VMMC in HIV prevention. Ninety-six percent of the participants self-reported continued use of condoms post VMMC. Overall 23.7% - 38.3% participants self-reported engaging in risky sexual practices post VMMC, 23.7% (76) had more than one sexual partner; 29.2% (94) paid for sex while 39.9% (n=187) did not use a condom. Residing in high density areas was associated with non-condom use, (p = 0.043). Being single (p <0.001), and residing in low density areas (p = 0.004) was associated with engaging in transactional sex. Conclusion: Risky sexual practices are evident among participants that have undergone VMMC. Messages on safer sexual practices and limitations of VMMC need to be emphasized to clients, especially unmarried or single and those residing in low density areas.
Efficacy of acupuncture in improving the symptoms and the quality of life of patients with moderate or severe acne vulgaris: a protocol for a randomized controlled trial
Authors: Jiao Ruimin , Huang Man , Zhang Weina , Liu Zhishun
Published: January 2020

Background : Acne vulgaris (AV) is a common chronic dermatologic disease that tends to impair the appearance and the quality of life (QoL) of patients. Although several trials have indicated the effectiveness of acupuncture for treatment of patients with AV, the results of these trials have been contested owing to potential bias in their design. Thus, there is a lack of robust data to evaluate the efficacy of acupuncture in patients with AV. In addition, none of the previous clinical trials of acupuncture therapy for AV used QoL as a primary outcome or employed a sham acupuncture control arm. The aim of the study is to evaluate the effect of acupuncture on the symptoms and the QoL of patients with moderate or severe AV. Methods/design: One hundred eligible participants with AV will be randomly assigned to acupuncture or sham acupuncture groups (1:1 allocation). All participants will receive 4-week treatment comprising of a total of 12 sessions (3 sessions per week). The primary outcome will be change from baseline in the Skindex-16 scale total score at treatment completion. The secondary outcomes will be: Skindex-16 subscale score; the Dermatology Life Quality Index scale total score; the total lesion count and inflammatory lesion count; visual analogue scale scores for assessment of itch and pain; patient expectations of acupuncture; and the blinding of the effect of sham acupuncture. Follow-up evaluation will be performed at weeks 16 and 28. All outcome analyses will be performed in the intention-to-treat population. Discussion: We expect to evaluate the effectiveness of acupuncture in ameliorating the symptoms and improving the QoL of patients with moderate or severe AV compared with sham acupuncture with more robust evidence. The limitations of the trial design are its single center scope, relatively small sample size, and lack of blinding of the acupuncturists. Trial Registration: Chinese Clinical Trial Registry, ChiCTR-1900023649 (Date of registration: Jan 2, 2019). Keywords: acupuncture, acne vulgaris, quality of life, randomized-controlled trial, protocol.
How does the WHO Surgical Safety Checklist fit with existing perioperative risk management strategies? An ethnographic study across surgical specialties in Norway
Authors: Wæhle Hilde Valen , Haugen Arvid Steinar , Wiig Siri , Søfteland Eirik , Sevdalis Nick , Harthug Stig
Published: January 2020

Background The World Health Organization (WHO) Surgical Safety Checklist (SSC) has demonstrated beneficial impacts on a range of patient- and team outcomes, though variation in SSC implementation and staffʼs perception of it remain challenging. Precisely how frontline personnel integrate the SSC with pre-existing perioperative clinical risk management remains underexplored – yet likely an impactful factor on how SSC is being used and its potential to improve clinical safety. This study aimed to explore how members of the multidisiplinary perioperative team integrate the SSC within their risk management strategies. Methods An ethnographic case study including observations (40h) in operating theatres and in-depth interviews of 17 perioperative team members was carried out at two hospitals in 2016. Data were analysed using content analysis. Results We identified three themes reflecting the integration of the SSC in daily surgical practice: 1) Perceived usefullness; implying an intuitive advantage assessment of the SSCʼs practical utility in relation to relevant work; 2) Modification of implementation; reflecting performance variability of SSC on confirmation of items due to precence of team members; barriers of performance; and definition of SSC as performance indicator, and 3) Communication outside of the checklist; including formal- and informal micro-team formations where detailed, specific risk communication unfolded. Conclusion When the SSC is not integrated within existing risk management strategies, but perceived as an “add on”, its fidelity is compromised, hence limiting its potential clinical effectiveness. Implementation strategies for the SSC should thus integrate it as a risk-management tool and include it as part of risk-management education and training. This can improve team learning around risk comunication, foster mutual understanding of safety perspectives and enhance SSC implementation.
Posterior only instrumented fusion provides incomplete curve control for early-onset scoliosis in type 1 neurofibromatosis
Authors: Cai Siyi , Li zhenyao , Qiu Guixing , shen Jianxiong , Zhao Hong , Zhao Yu , Wang Yipeng , Zhang Jianguo
Published: January 2020

Background: The mid-long term outcomes of posterior spinal fusion in pediatric neurofibromatosis type 1 (NF-1) patients are rarely reported, so does the effectiveness of itsorthopeidc maintenance function. This study aims to evaluate the mid-long term surgical outcomes of posterior only instrumented spinal fusion for early-onset scoliosis (EOS) in NF-1 patients. Methods: A retrospective review was performed on a cohort of 10 NF-1 patients having EOS from 2008 to 2014 in our hospital, including four male and six female patients with an age averaged at 7.8 years old when they underwent posterior only instrumented spinal fusion for their EOS. Both general clinical data and surgical specific data of the patients were collected and reviewed, and the dystrophic progression of EOS was evaluated during the follow-up. Results: The average duration of follow-up was 54 months (24 to 88 months). All patients underwent posterior only instrumented spinal fusion at 1 stage. The primary curves of EOS were thoracic in 9 cases and 1 patient had lumbar scoliosis. Preoperative major curve was significantly corrected (from 66.1 to 31.1 degrees). However, the major curve deteriorated significantly to 40.1 degrees on average at the end of the follow-up. The T1-S1 distance increased 2.8 cm on average and kept increasing at a rate of 0.6cm/year during the follow-up. Conclusions: Posterior only fusion surgery was not a good option to treat the EOS in NF-1 patients despite the relatively short segments involvement in the disease. The maintenance of orthopedic effect after treatment was not satisfactory.
Barriers for teaching communication skills in Spanish Medical Schools: a qualitative study with academic leaders
Authors: Ruiz-Moral Roger , de Leonardo Cristina García , Pérez Alvaro Cerro , Martínez Fernando Caballero , Martín Diana Monge
Published: January 2020

Background: In recent years, Spanish medical schools (MSs) have incorporated training in communication skills (CS), but how this training is being carried out has not yet been evaluated.
Objective: To identify the barriers to the introduction and development of CS teaching in Spanish MSs.
Methods: In a previous study, 34 MSs (83% of all MSs in Spain) were invited to participate in a study that explored the factual aspects of teaching CS in these schools. The person responsible for teaching CS at each school was contacted again for this study and asked to respond to a single open-ended question. Two researchers independently conducted a thematic analysis of the responses.
Results: We received responses from 30 MSs (85.7% of those contacted and 73% of all MSs in Spain). Five main thematic areas were identified, each with different sub-areas: negative attitudes of teachers and academic leaders; organisation, structure and presence of CS training in the curriculum; negative attitudes of students; a lack of trained teachers; and problems linked to teaching methods and necessary educational logistics.
Conclusions: The identified barriers and problems indicate that there are areas for improvement in teaching CS in most Spanish MSs. There seems to be a vicious circle based on the dynamic relationship and interdependence of all these problems that should be faced with different strategies and that requires a significant cultural shift as well as decisive institutional support at the local and national levels. The incorporation of CS training into MS curricula represents a major challenge that must be addressed for students to learn CS more effectively and avoid negative attitudes towards learning CS
Impact of preoperative fecal short chain fatty acids on postoperative infectious complications in esophageal cancer patients
Authors: Motoori Masaaki , Tanaka Koji , Sugimura Keijiro , Miyata Hiroshi , Saito Takuro , Miyazaki Yasuhiro , Fujitani Kazumasa , Kado Yukiko , Asahara Takashi , Yano Masahiko
Published: January 2020

Background: The intestinal epithelial barrier allows absorption of dietary nutrients and prevents passage of pathogens and toxins into the body. Severe insults have a negative impact on the intestinal environment, which may decrease intestinal barrier function and cause bacterial translocation. Bacterial translocation, which can cause infectious complications, is defined as the passage of microbes from the gastrointestinal tract across the mucosal barrier to extraintestinal sites. The aim of this study was to investigate the correlation between concentrations of preoperative fecal organic acids and the occurrence of postoperative infectious complications in patients with esophageal cancer. Methods: Fifty-five patients with esophageal cancer who underwent esophagectomy were enrolled in this study. Perioperative synbiotics were administered to all patients. Perioperative clinical characteristics and concentrations of preoperative fecal organic acids were compared between patients with and without postoperative infectious complications. Results: Postoperative infectious complications occurred in 10 patients. In patients with complications, the concentrations of acetic acid and propionic acid were significantly lower than in patients without complications (p=0.044 and 0.032, respectively). The concentration of butyric acid was nonsignificantly lower in patients with complications, while the concentration of lactic acid was nonsignificantly higher. The calculated gap between the concentrations of fecal acetic acid plus propionic acid plus butyric acid minus lactic acid was significantly lower in patients with complications. Multivariate analysis revealed that a low gap between acetic acid plus propionic acid plus butyric acid minus lactic acid was an independent risk factor for postoperative infectious complications (p=0.027). Conclusions : Preoperative fecal concentrations of organic acids had a clinically important impact on the occurrence of postoperative infectious complications in patients with esophageal cancer. To reduce postoperative infectious complications, it may be useful to modulate the intestinal environment and maintain concentrations of fecal organic acids before surgery.
Glycogen synthase kinase 3 (GSK-3) controls T-cell motility andinteractions with antigen presenting cells
Authors: Taylor Alison , Rudd Christopher E.
Published: January 2020

Objective:The threonine/serine kinase glycogen synthase kinase 3 (GSK-3) targets multiple substrates in T-cells and regulates the expression of Tbet and PD-1. However, it has been unclear whether GSK-3 has any effect on T-cell motility or their interactions with antigen presenting cells.
Results: Here, we show that GSK-3 controls T-cell motilityand interactions with other cells. Inhibition of GSK-3, using structurally distinct inhibitors, reduced T-cell motility in terms of speed and distance travelled. Furthermore, SB415286 reduced the number of cell to cell contacts, however the duration of these established contacts with other cells did not differ in the presence of SB415286. This inhibition of motility did not affect the ability of GSK-3 inhibitors to enhance cytolytic T-cell (CTL) function in killing tumor targets. These data show that the inhibition of GSK-3 has differential effects on T-cell motility and CTL function where the negative effects on cell-cell interactions is overridden by the increased cytolytic potential of CTLs.
Outcomes of children with hepatoblastoma who underwent liver resection at a tertiary hospital in China: A retrospective analysis
Authors: Li Jiahao , Li Huixian , Wu Huiying , Niu Huilin , Li Haibo , Pan Jing , Yang Jiliang , Tan Tianbao , Hu Chao , Xu Tao , Zhang Xiaohong , Zheng Manna , Li Kuanrong , Zou Yan , Yang Tianyou
Published: January 2020

Objective: To report the outcomes of hepatoblastoma resected in our institution.
Methods: We diagnosed 135 children with hepatoblastoma at our institution between January 2010 and December 2017. Patients who underwent liver resection were included for analysis. However, patients who abandoned treatment after diagnosis were excluded from analysis, but their clinical characteristics were provided in the supplementary material.
Results: Forty-two patients abandoned treatment, whereas 93 patients underwent liver resection and were included for statistical analysis. Thirty-six, 23, 3, and 31 patients had PRETEXT stages II, III, IV, and unspecified tumours, respectively. Seven patients had ruptured tumour; 9 had lung metastasis (one patient had portal vein thrombosis concurrently). Sixteen patients underwent primary liver resection; 22, 25, and 30 patients received cisplatin-based neoadjuvant chemotherapy and delayed surgery, preoperative transarterial chemoembolization (TACE) and delayed surgery, and a combination of cisplatin-based neoadjuvant chemotherapy, TACE, and delayed surgery, respectively. Forty patients had both PRETEXT and POST-TEXT information available for analysis. Twelve patients were down-staged after preoperative treatment, including 2, 8, and 2 patients from stages IV to III, III to II, and II to I, respectively. Ten patients with unspecified PRETEXT stage were confirmed to have POST-TEXT stages II (n=8) and I (n=2) tumours. Seven tumours were associated with positive surgical margins, and 12 patients had microvascular involvement. During a median follow-up period of 30.5 months, 84 patients survived without relapse, 9 experienced tumour recurrence, and 4 died. The 2-year event-free survival (EFS) and overall survival (OS) rates were 89.4±3.4%, and 95.2±2.4%, respectively; they were significantly better among patients without metastasis (no metastasis vs metastasis: EFS, 93.5±3.7% vs 46.7±19.0%, adjusted p =0.004. OS, 97.6±2.4% vs 61.0±18.1%, adjusted p =0.003), and similar among patients treated with different preoperative strategies (chemotherapy only vs TACE only vs Both: EFS, 94.7±5.1% vs 91.7±5.6% vs 85.6±6.7%, p =0.542. OS, 94.1±5.7% vs 95.7±4.3% vs 96.7±3.3%, p =0.845).
Conclusion: The OS for patients with hepatoblastoma who underwent liver resection was satisfactory. Neoadjuvant chemotherapy and TACE seemed to have a similar effect on OS. However, the abandonment of treatment by patients with hepatoblastoma was common, and may have biased our results.