bluuebunny/crossref_metadata_2025 huggingface dataset:
Iatrogenic jugulo-subclavian fistula
Authors: Tatar Abdel , Mallios Alexandros
Published: May 2020

Iatrogenic arteriovenous fistula of major neck vessels is a rare complication but can occur after central venous catheterization. Symptoms can range from nothing to severe heart failure and management can be particularly complex. We report a case that we treated recently in our department.
YARNING AS PROTECTED SPACE: principles and protocols
Authors: Barlo Stuart , Boyd William (Bill) Edgar , Pelizzon Alessandro , Wilson Shawn
Published: May 2020

Traditional methods of imparting knowledge are known as yarning to Australian Aboriginal Elders and talking circles to North American First Nations peoples. Yarning is a relational methodology for transferring Indigenous knowledge. This article describes an emerging research methodology with yarning at its core, which provides respect and honour in a culturally safe environment. Yarning is highly structured, with protocols and principles providing participants control over the process and their stories. The methodology is embedded in a yarning space, which is framed by six protocols and seven principles. The protocols are gift, control, freedom, space, inclusiveness and gender specificity, and the principles are reciprocity, responsibility, relationship, dignity, equality, integrity and self-determination—to protect participants, stories and data. This is ensured through respectful and honouring relationships, responsibility and accountability between participants. The key camps in which the yarning journey is segmented are the Ancestors, protocols, principles, connections, data, analysis, processing and reporting, and the wider community.
A possible case of serum sickness after ocrelizumab infusion
Authors: Moreira Ferreira Vanessa F , Kimbrough Dorlan J , Stankiewicz James M
Published: May 2020

A 41-year-old female diagnosed with multiple sclerosis began ocrelizumab treatment. She received her first treatment course without significant complication. After receiving the first maintenance dose 6 months later, she developed weakness, myalgias, gastrointestinal symptoms, headache, and intermittent fever persisting for 4 weeks. A working diagnosis of serum sickness was determined after excluding other probable entities. She received 3 days of 1 g methylprednisolone intravenously and five plasma exchanges, experiencing gradual improvement. Serum sickness has occurred with monoclonal antibodies including rituximab. This case of possible ocrelizumab-associated serum sickness suggests that clinicians should remain vigilant about this possibility with this medication.
Discrepancy between two-dimensional and three-dimensional digital subtraction angiography for the planning of endovascular coiling of small cerebral aneurysms <5 mm
Authors: Wu Te-Chang , Tsui Yu-Kun , Chen Tai-Yuan , Ko Ching-Chung , Lin Chien-Jen , Chen Jeon-Hor , Lin Ching-Po
Published: May 2020

Background

To investigate the discrepancy between two-dimensional digital subtraction angiography and three-dimensional rotational angiography for small (<5 mm) cerebral aneurysms and the impact on decision making among neuro-interventional experts as evaluated by online questionnaire.

Materials and methods

Eight small (<5 mm) ruptured aneurysms were visually identified in 16 image sets in either two-dimensional or three-dimensional format for placement in a questionnaire for 11 invited neuro-interventionalists. For each set, two questions were posed: Question 1: “Which of the following is the preferred treatment choice: simple coiling, balloon remodeling or stent assisted coiling?”; Question 2: “Is it achievable to secure the aneurysm with pure simple coiling?” The discrepancies of angio-architecture parameters and treatment choices between two-dimensional-digital subtraction angiography and three-dimensional rotational angiography were evaluated.

Results

In all eight cases, the neck images via three-dimensional rotational angiography were larger than two-dimensional-digital subtraction angiography with a mean difference of 0.95 mm. All eight cases analyzed with three-dimensional rotational angiography, but only one case with two-dimensional-digital subtraction angiography were classified as wide-neck aneurysms with dome-to-neck ratio < 1.5. The treatment choices based on the two-dimensional or three-dimensional information were different in 56 of 88 (63.6%) paired answers. Simple coiling was the preferred choice in 66 (75%) and 26 (29.6%) answers based on two-dimensional and three-dimensional information, respectively. Three types of angio-architecture with a narrow gap between the aneurysm sidewall and parent artery were proposed as an explanation for neck overestimation with three-dimensional rotational angiography.

Conclusions

Aneurysm neck overestimation with three-dimensional rotational angiography predisposed neuro-interventionalists to more complex treatment techniques. Additional two-dimensional information is crucial for endovascular treatment planning for small cerebral aneurysms.
Chemical Composition of Volatile Oils of Fresh and Air-Dried Buds of Cannabis chemovars, Their Insecticidal and Repellent Activities
Authors: Wanas Amira S. , Radwan Mohamed M. , Chandra Suman , Lata Hemant , Mehmedic Zlatko , Ali Abbas , Baser KHC , Demirci Betul , ElSohly Mahmoud A.
Published: May 2020

The volatile oils of fresh and air-dried buds of 3 different varieties of Cannabis, namely, high cannabidiol (CBD) chemotype, intermediate CBD/tetrahydrocannabinol (THC) chemotype, and high THC chemotype were prepared by hydrodistillation. Gas chromatography analysis of the volatile oils resulted in the identification of 71 compounds, of which 33 were monoterpenes and 38 were sesquiterpenes. The volatile oil obtained from the THC chemotype showed an increase in the ratio of the sesquiterpenes to monoterpenes content. The content of terpinolene was dramatically decreased upon drying of THC chemotype. Moderate increase in β-caryophyllene and caryophyllene oxide was observed. However, there was no detectable change in the percentage of monoterpenes and sesquiterpenes content in both the intermediate type and CBD chemotype upon drying. The insecticidal activity of the volatile oils was evaluated. The oil obtained from the fresh and dried high CBD cannabis showed good biting deterrent activity at 10 ug/cm2 compared with N, N-diethyl-meta-toluamide at 4.78 µg/cm2, and good larvicidal activity.
Pinus maritima Extract Induces Apoptosis in Human Malignant Melanoma Cells via ROS/Caspase-3 Signaling
Authors: Thaichinda Sunisa , Tancharoen Salunya , Kanekura Takuro , Higashi Yuko , Dararat Pornpen , Kikuchi Kiyoshi , Nararatwanchai Thamthiwat
Published: May 2020

Melanoma is the most aggressive type of skin cancer due to its rapid metastasis with a high recurrence rate following conventional therapy. Pine bark extract (PBE) from Pinus maritima contains numerous phenolic compounds and functions as a potent antioxidant. The present study aimed to analyze the potential anticancer properties of PBE on human malignant melanoma A375 cells. The chemical composition of PBE was determined by high-performance liquid chromatography/photodiode array detector. The effects of PBE on cell death, migration, and invasion were determined using xCELLigence Technology real-time cell analysis. Annexin/propidium iodide flow cytometry and Hoechst 33342 staining were conducted to detect cell apoptosis. PBE induced apoptosis and inhibited cell migration and invasion. Cleaved caspase-3 expression and activity were significantly increased ( P < 0.01) in cells treated with PBE compared with control cells. PBE ameliorated hydrogen peroxide (H2O2)-induced reactive oxygen species (ROS) formation. Treatment of the cells with PBE in the presence of H2O2 led to significant ( P < 0.001) reduction of matrix metallopeptidase-9, which is a mediator responsible for advanced melanoma. PBE induces A375 programmed cell death and suppresses cellular invasion by attenuating the ROS-dependent pathway associated with MMP-9 reduction.
Educating for ‘glocal’ perspectives at Sultan Qaboos University: Studying students’ perceptions after studying a global citizenship education course
Authors: AlMaamari Saif Nasser
Published: May 2020

Today, globalisation expands the affiliation of the individual from a national level to an international level. Global citizenship has been regarded as an important outcome for students in major universities around the world, yet there is little literature about how it is integrated at universities in the Arab world, although some of them emphasise it in their policies. This article reports on how one Omani University, namely Sultan Qaboos University, interpreted and implemented global citizenship education in their undergraduate programmes. Particularly, this study seeks to identify the perceptions of students who studied a course entitled Global Citizenship Education in the academic year 2018–2019. The data were collected using two tools: a questionnaire which was administered to a sample consisting of 49 students and semi-structured interviews with 10 students. The data analysis was conducted by calculating the medium for the questionnaire and by employing an inductive process where the data were coded and then the themes that emerged from the data were highlighted. The results indicated that Omani University students had different perceptions of global citizenship and their perspectives tended to be more cosmopolitan and humanistic . In addition, they highlighted the impact of the course on developing three dimensions of global citizenship education: the cognitive, socioemotional and behavioural dimensions.
Influence of Parenting Costs on Second-Child Fertility Anxiety Among Adults of Childbearing Age in China: The Moderating Role of Gender
Authors: Zhang Jingyue
Published: May 2020

The present study investigated the moderating role of gender in the relationship between parenting costs and second-child fertility anxiety. This secondary data analysis relied on information from 1,834 respondents of childbearing age (20–45) from Jilin province in China who were selected through multilevel cluster sampling in 2016. The final sample size of this study was 542 adults who had only one child and were uncertain about whether to have a second child. The proposed hypothesis was examined by hierarchical multiple regression. The results showed that gender had no moderating effect in the relationship of direct parenting costs and second-child fertility anxiety; the association between direct parenting costs and second-child fertility anxiety was significant in both male and female groups. However, gender had a moderating role in the relationship between indirect parenting costs and second-child fertility anxiety. Indirect parenting costs related to occupation had a significant effect on second-child fertility anxiety among men, whereas indirect parenting costs involving entertainment time and space had a significant effect on second-child fertility anxiety among women.
It’s Never Too Late: Neurological Outcome of Delayed Decompression in Tuberculosis of Spine
Authors: Rathod Tushar Narayan , Sathe Ashwin Hemant , Marathe Nandan Amrit
Published: May 2020

Study Design:

Retrospective observational study.

Objective:

To study the neurological recovery in patients with progressive neurological deficit undergoing delayed decompression and fixation in tuberculosis of spine.

Methods:

Retrospective analysis of 50 cases with thoracolumbar tuberculosis of spine, undergoing posterior decompression and instrumentation was done. Parameters like time interval between appearance of neurological deficit to decompression surgery, maximal spinal cord compression, neurology on admission, presence of drug resistance, and number of vertebrae involved were evaluated. The subjects were divided into 2 groups depending on neurological improvement measured with LEMS (Lower Extremity Motor Score) at the end of 1-year follow-up.

Results:

The mean LEMS score on admission was 27.72 (SD 12.88), which improved to 40.80 (SD 10.46) at the end of 1 year ( P < .001). A total of 26 (52%) subjects were categorized into “Satisfactory” outcome (LEMS >10) group and remaining 24 subjects formed the “nonsatisfactory” outcome group. The median time interval between the appearance of neurological deficit and decompression surgery was 23.50 days in the satisfactory group and 29.50 days ( P = .110) in the nonsatisfactory group. Maximal spinal cord compression was 0.370 in satisfactory group and 0.357 in nonsatisfactory group ( P = .754). The mean preoperative LEMS score was 34.62 in the satisfactory outcome group while that in the nonsatisfactory outcome group was 20.25 ( P < .001).

Conclusion:

There is significant scope for neurological improvement even after delayed decompression and fixation in cases of tuberculosis of spine with progressive neurological deficits. Preoperative neurological status was found to be the most significant determinant of postoperative neurological outcome.
Courtroom Language and Article 19(1)(a)
Authors: Bhardwaj Shrutanjaya
Published: May 2020

Many would agree that the State should try to ensure that the language used in its courtrooms is one that its subjects understand. The question is whether the subjects can claim this as a matter of right—specifically, as part of the right to free speech. Using the philosophical justifications of the freedom of speech, I argue that Article 19(1)(a) of the Indian Constitution assures a right to the litigant to communicate with the court in her own language. Even though the right may be restricted under Article 19(2), or even otherwise if it comes into conflict with another fundamental right, its threshold recognition under Article 19(1)(a) is significant to ensure a disciplined inquiry into the constitutional validity of official courtroom languages.
Study of the Older Adults’ Motivators and Barriers Engaging in a Nutrition and Resistance Exercise Intervention for Sarcopenia: An Embedded Qualitative Project in the MIlkMAN Pilot Study
Authors: Dismore Lorelle , Hurst Christopher , Sayer Avan A. , Stevenson Emma , Aspray Terry , Granic Antoneta
Published: May 2020

Objectives: The present study aimed to investigate motivators and barriers to older adults engaging in a nutrition and resistance exercise (RE) intervention for sarcopenia. Methods: We conducted a content analysis of structured interviews with 29 community-dwelling older adults (aged 65–80 years) completing the MIlk Intervention Muscle AgeiNg (MIlkMAN) study. Results: Content analysis revealed that self-perceived improved health, knowledge acquisition in nutrition and exercise, social well-being, professional support in a fun environment, and positive reported outcomes were motivators for engagement in the intervention. Peer encouragement, social bonds, and their retention were motivators to continuing engagement after study completion, especially in widowed women. Barriers to maintenance included affordability, environmental factors, and concerns over negative health outcomes. Discussion: Nutrition and RE interventions for sarcopenia should focus on knowledge acquisition about their health benefits, being enjoyable, and offering social opportunities that have the potential to last beyond the study duration to promote and maintain positive health behaviors.
The Dimensions of Tokenism in Patient and Family Engagement: A Concept Analysis of the Literature
Authors: Majid Umair
Published: May 2020

Patient engagement (PE) has become embedded in discussions about health service planning and quality improvement, and the goal has been to find ways to observe the potential beneficial outcomes associated with PE. Patients and health care professionals use various terms to depict PE, for example, partnership and collaboration. Similarly, tokenism is consistently used to describe PE that has gone wrong. There is a lack of clarity, however, on the meanings and implications of tokenism on PE activities. The objective of this concept analysis was to examine the peer-reviewed and gray literature that has discussed tokenism to identify how we currently understand and use the concept. This review discusses 4 dimensions of tokenism: unequal power, limited impact, ulterior motives, and opposite of meaningful PE. These dimensions explicate the different components, meanings, and implications of tokenism in PE practice. The findings of this review emphasize how tokenism is primarily perceived as negative by supporters of PE, but this attribution depends on patients’ preferences for engagement. In addition, this review compares the dimensions of tokenism with the levels of engagement in the International Association of the Public Participation spectrum. This review suggests that there are 2 gradations of tokenism; while tokenism represents unequal power relationships in favor of health care professionals, this may lead to either limited or no meaningful change or change that is primarily aligned with the personal and professional goals of clinicians, managers, and decision-makers.
Integrative Review of the Interventions for Improving Patients’ Experiences Revealed in Quality Improvement Projects
Authors: Jun Jin , Stern Kailyn , Djukic Maja
Published: May 2020

Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) is the first national, standardized, publicly reported survey of patients’ perspectives of hospital care closely linked to hospitals’ reimbursement and reputation. Thus, it is critical to learn about what interventions work for improving HCAHPS. Eight peer-reviewed studies examining nursing-led interventions at improving patient satisfaction in hospitals, measured by the HCAHPS, were identified. Using the Critical Appraisal Skills Program for cohort studies, each study was evaluated for a level of evidence. Interventions that increased HCAHPS were (1) nursing rounds, (2) the use of discharge nurses, (3) follow-up phone calls by nurses, and (4) continuing education for nurses. However, the quality of evidence is low and based on single-site, pre–postdesign studies. Hospital leaders should focus their efforts on a combination of nurse rounding, comprehensive discharge planning to improve patients’ overall experience with hospital care, and their likelihood to recommend the hospital.
Health Care Experience Among Women Who Completed Group Prenatal Care (CenteringPregnancy) Compared to Individual Prenatal Care Within Military Treatment Facilities
Authors: Fowler Tara Trudnak , Aiyelawo Kimberley Marshall , Frazier Chantell , Holden Craig , Dorris Joseph
Published: May 2020

This study compared TRICARE, the health care program of the United States Department of Defense Military Health System, beneficiaries in CenteringPregnancy, an enhanced prenatal care model, to women in individual prenatal care within the same military treatment facility. Maternity patient experience ratings from May 2014 to February 2016 were compiled from the TRICARE Outpatient Satisfaction Survey. Centering patients had 1.91 higher odds of being satisfied with access to care ( p < .01, 95% CI = 1.2-3.1) than women in individual care. Specifically, the saw provider within 15 minutes of appointment measure found Centering patients to have 2.00 higher odds of being satisfied than women in individual care ( p < .01, 95% CI = 1.2-3.3). There were no other statistically significant differences between cohorts. Qualitative responses indicate most Centering patients surveyed had good experiences, appreciated the structure and communication with others, and would recommend the program. Providers identified command/leadership support, dedicated space, and buy-in from all staff as important factors for successful implementation. Enhanced prenatal care models may improve access to and experiences with care. Program evaluation will be important as the military health system continues to implement such programs.
Community-based Organizations (CBOs) and Their Role in the Development of Women: A Case from Andhra Pradesh
Authors: Eswarappa Kasi
Published: May 2020

In a development forum, there is a great need to look at the ground realities of organizations, especially in the context of the post-globalization scenario. Thereby comes the notion of ‘community’ from the donor’s point of view. The donors’ participation in the daily activities of the people, especially women, to make them earn their means of livelihoods poses questions which are of prime importance to have an academic engagement theoretically, empirically and otherwise. My study discusses the role of community-based organizations (CBOs) in implementing developmental programmes in rural areas across the country. It is noteworthy in the case of sericulture enterprise a large number of women are active at various levels, which further proved to be one of the important crop enterprise prevailing in the locality. This paper attempts to interrogate how women empowered themselves as a part of the CBOs. This could eventually lead to policymakers, government and other agencies to advise development programmes. The paper draws its analysis and inferences from a fieldwork carried out with the sericulturists of a village in Chittoor district of Andhra Pradesh in India.
The risk of multidrug- or rifampicin-resistance in malesversusfemales with tuberculosis
Authors: McQuaid C. Finn , Horton Katherine C. , Dean Anna S. , Knight Gwenan M. , White Richard G.
Published: May 2020

Males are at an increased risk of tuberculosis (TB) disease compared to females. Additionally, several risk factors for multidrug-resistant (MDR) or rifampicin-resistant (RR) TB disease are more common in males, hence male TB patients may have a higher relative risk of MDR/RR-TB than female TB patients.

We used sex-disaggregated data of TB patients reported to the World Health Organization for 106 countries to calculate male-to-female (M:F) risk ratios of having MDR/RR-TB.

There was no evidence of either sex being more at risk of MDR/RR-TB in 81% (86 out of 106) of countries, with an overall random-effects weighted M:F risk ratio of 1.04 (95% CI 0.97–1.11). In 12% (13 out of 106) of countries there was evidence that males were more at risk, while in 7% (seven out of 106), females were more at risk. The risk of having TB that was MDR/RR increased for males compared to females as MDR/RR-TB incidence increased, and was higher for males than females in the former Soviet Union, where the risk ratio was 1.16 (1.06–1.28). Conversely, the risk increased for females compared to males as gross domestic product purchase power parity increased, and was higher for females than males in countries where the majority of TB burden was found in the foreign-born population, where the risk ratio was 0.84 (0.75–0.94).

In general, the risk of MDR/RR-TB, among those with TB, is the same for males as for females. However, males in higher MDR/RR-TB burden countries, particularly the former Soviet Union, face an increased risk that their infection is MDR/RR-TB, highlighting the need for a sex-differentiated approach to TB case-finding and care.
Serology characteristics of SARS-CoV-2 infection after exposure and post-symptom onset
Authors: Lou Bin , Li Ting-Dong , Zheng Shu-Fa , Su Ying-Ying , Li Zhi-Yong , Liu Wei , Yu Fei , Ge Sheng-Xiang , Zou Qian-Da , Yuan Quan , Lin Sha , Hong Cong-Ming , Yao Xiang-Yang , Zhang Xue-Jie , Wu Ding-Hui , Zhou Guo-Liang , Hou Wang-Heng , Li Ting-Ting , Zhang Ya-Li , Zhang Shi-Yin , Fan Jian , Zhang Jun , Xia Ning-Shao , Chen Yu
Published: May 2020

Background

Timely diagnosis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is a prerequisite for treatment and prevention. The serology characteristics and complement diagnosis value of the antibody test to RNA test need to be demonstrated.

Method

Serial sera of 80 patients with PCR-confirmed coronavirus disease 2019 (COVID-19) were collected at the First Affiliated Hospital of Zhejiang University, Hangzhou, China. Total antibody (Ab), IgM and IgG antibodies against SARS-CoV-2 were detected, and the antibody dynamics during the infection were described.

Results

The seroconversion rates for Ab, IgM and IgG were 98.8%, 93.8% and 93.8%, respectively. The first detectible serology marker was Ab, followed by IgM and IgG, with a median seroconversion time of 15, 18 and 20 days post exposure (d.p.e.) or 9, 10 and 12 days post onset (d.p.o.), respectively. The antibody levels increased rapidly beginning at 6 d.p.o. and were accompanied by a decline in viral load. For patients in the early stage of illness (0–7 d.p.o), Ab showed the highest sensitivity (64.1%) compared with IgM and IgG (33.3% for both; p<0.001). The sensitivities of Ab, IgM and IgG increased to 100%, 96.7% and 93.3%, respectively, 2 weeks later. When the same antibody type was detected, no significant difference was observed between enzyme-linked immunosorbent assays and other forms of immunoassays.

Conclusions

A typical acute antibody response is induced during SARS-CoV-2 infection. Serology testing provides an important complement to RNA testing in the later stages of illness for pathogenic-specific diagnosis and helpful information to evaluate the adapted immunity status of patients.
Host–microbe cross-talk in the lung microenvironment: implications for understanding and treating chronic lung disease
Authors: Gosens Reinoud , Hiemstra Pieter S. , Adcock Ian M. , Bracke Ken R. , Dickson Robert P. , Hansbro Philip M. , Krauss-Etschmann Susanne , Smits Hermelijn H. , Stassen Frank R.M. , Bartel Sabine
Published: May 2020

Chronic respiratory diseases are highly prevalent worldwide and will continue to rise in the foreseeable future. Despite intensive efforts over recent decades, the development of novel and effective therapeutic approaches has been slow. However, there is new and increasing evidence that communities of micro-organisms in our body, the human microbiome, are crucially involved in the development and progression of chronic respiratory diseases. Understanding the detailed mechanisms underlying this cross-talk between host and microbiota is critical for development of microbiome- or host-targeted therapeutics and prevention strategies. Here we review and discuss the most recent knowledge on the continuous reciprocal interaction between the host and microbes in health and respiratory disease. Furthermore, we highlight promising developments in microbiome-based therapies and discuss the need to employ more holistic approaches of restoring both the pulmonary niche and the microbial community.
Co-delivery of Dacarbazine and All-Trans Retinoic Acid (ATRA) Using Lipid Nanoformulations for Synergistic Antitumor Efficacy Against Malignant Melanoma
Authors: Li Chenyang , Han Xiuping
Published: May 2020

Malignant melanoma is a highly aggressive skin cancer responsible for 80% of mortality, and the overall median survival in patients with metastatic melanoma is only 6–9 months. Combination treatment through the simultaneous administration of dual drugs in a single nanocarrier has been demonstrated to be elegant and effective in combatting cancer. Herein, we employ a combination therapy based on dacarbazine (DBZ), FDA approved drug for melanoma and all-trans retinoic acid (ATRA), promising anticancer agents loaded on lipid nanoformulations (RD-LNF) as a new treatment strategy for malignant melanoma. We have successfully encapsulated both the drugs in lipid nanoformulations and showed a controlled release of payload over time. We demonstrated that the simultaneous delivery of DBZ and ATRA could effectively reduce cell proliferation in a concentration-dependent manner. The combinational nanoparticles significantly reduced the colony formation ability of B16F10 melanoma cells. Flow cytometer analysis showed that RD-LNF induced a greater proportion of apoptosis cells with significant inhibition of cell cycle progression and cell migration. These results suggest the promising potential of RD-LNF in the treatment of malignant melanoma with high efficacy.
Keeping up with the information explosion: a surge in consumption of data on pediatric SARS-CoV-2 infection by pediatric emergency physicians
Authors: Feldman Oren , Boukai Amit , Shavit Itai
Published: May 2020

PEM-Database.org is an unaffiliated, not-for-profit website, dedicated to the field’s advancement of pediatric emergency medicine. PEM-Database published the first early access pediatric-related SARS-CoV-2 articles on March 13th, two days following the World Health Organization’s declaration of a global pandemic. Over the following 2 weeks, the number of PEM-Database entries increased dramatically. This surge expresses interest by pediatric emergency medicine physicians in data on pediatric SARS-CoV-2 infection.
Fast-track breeding system to introduce CTV resistance of trifoliate orange into citrus germplasm, by integrating early flowering transgenic plants with marker-assisted selection
Authors: Endo Tomoko , Fujii Hiroshi , Omura Mitsuo , Shimada Takehiko
Published: May 2020

Background

Global warming will expand the range of new and invasive pathogens in orchards, and subsequently increase the risk of disease epidemics and economic losses. The development of new resistant plant varieties can help to reduce the impact of pathogens, however, the breeding speed can be extremely slow, due to the growth rates of the plants, and the availability of resistance genes. Citrus trees are suffering immense damage from serious diseases such as citrus canker (XCC), huanglongbing (HLB), and citrus tristeza virus (CTV). A fast-track breeding system, that aimed at shortening the duration for disease resistance breeding by incorporating the resistance genes from related species to commercial varieties, has been developed using the integration of precocious transgenic trifoliate orange with the overexpression ofCiFTand MAS. It was applied here to incorporate CTV resistance of trifoliate orange into citrus germplasm.

Results

One generation of backcrossed breeding, that would normally take at least 5 years, was achieved in a single year by fast-track breeding system. Linkage analysis using the corresponding DNA markers revealed that CTV resistance and T-DNA integrated regions were found in different linkage groups, and they were independently segregated in the BC progenies. The CTV resistant null segregants, in which the T-DNA integrated region was removed from their genome, were feasibly obtained by MAS in each generation of the BC progenies, and their CTV resistance was confirmed by immunological analysis. Several BC3null segregants, whose genetic backgrounds had been substituted into citrus germplasm, except for the haplotype block of CTV resistance, were successfully obtained. CGH and NGS analyses revealed that the T-DNA integrated region was safely segregated out in null segregants.

Conclusion

Fast-track breeding systems are expected to shorten the required breeding time by more than one-fifth in comparison with conventional cross breeding techniques. Using this system, we obtained BC3–8, whose genetic background was successfully substituted except for the CTV resistance locus, and could be a novel mandarin breeding material. The fast-track breeding system will be useful to introduce important traits from related species to citrus germplasm while also drastically reducing the time required for breeding.
Clinical characteristics of patients with 2019 coronavirus disease in a non-Wuhan area of Hubei Province, China: a retrospective study
Authors: Zhao Xin-Ying , Xu Xuan-Xuan , Yin Hai-Sen , Hu Qin-Ming , Xiong Tao , Tang Yuan-Yan , Yang Ai-Ying , Yu Bao-Ping , Huang Zhi-Ping
Published: May 2020

Background

Since December 2019, the 2019 coronavirus disease (COVID-19) has expanded to cause a worldwide outbreak that more than 600,000 people infected and tens of thousands died. To date, the clinical characteristics of COVID-19 patients in the non-Wuhan areas of Hubei Province in China have not been described.

Methods

We retrospectively analyzed the clinical characteristics and treatment progress of 91 patients diagnosed with COVID-19 in Jingzhou Central Hospital.

Results

Of the 91 patients diagnosed with COVID-19, 30 cases (33.0%) were severe and two patients (2.2%) died. The severe disease group tended to be older (50.5 vs. 42.0 years; p = 0.049) and have more chronic disease (40% vs. 14.8%; p = 0.009) relative to mild disease group. Only 73.6% of the patients were quantitative polymerase chain reaction (qPCR)-positive on their first tests, while typical chest computed tomography images were obtained for each patient. The most common complaints were cough (n = 75; 82.4%), fever (n = 59; 64.8%), fatigue (n = 35; 38.5%), and diarrhea (n = 14; 15.4%). Non-respiratory injury was identified by elevated levels of aspartate aminotransferase (n = 18; 19.8%), creatinine (n = 5; 5.5%), and creatine kinase (n = 14; 15.4%) in laboratory tests. Twenty-eight cases (30.8%) suffered non-respiratory injury, including 50% of the critically ill patients and 21.3% of the mild patients.

Conclusions

Overall, the mortality rate of patients in Jingzhou was lower than that of Wuhan. Importantly, we found liver, kidney, digestive tract, and heart injuries in COVID-19 cases besides respiratory problems. Combining chest computed tomography images with the qPCR analysis of throat swab samples can improve the accuracy of COVID-19 diagnosis.
Performance of malaria microscopy external quality assessment and networking among health facilities in west Amhara region, Ethiopia
Authors: Tegegne Banchamlak , Ejigu Kefale , Alemu Getaneh , Fetene Yeshimebet , Endaylalu Kindye , Melese Mulatu
Published: May 2020

Background

Microscopic examination of peripheral blood smear produces reliable results both about the malaria infection status and level of parasitemia. However, test results are affected by skill of the laboratory personnel, workload, condition of microscopes and quality of laboratory supplies. Therefore, continuous monitoring of the performance of laboratories is of pivotal importance in order to make timely correction.

Methods

A facility based cross-sectional study was conducted from July 2017 to July 2019 to assess malaria microscopy performance among thirty malaria diagnostic laboratories in west Amhara region. Thirty slides were collected from participating laboratories every quarter. Collected slides were taken to Amhara Public Health Institute reference laboratory and re-checked by malaria microscopists who were blind to the results from health facilities. Percentage of test agreement, rates of false positive, false negative and species misdiagnosis were calculated using Excel 2010.

Results

Among a total of 6689 slides re-checked, results of 6146 slides were the same with that of participating laboratories. The test agreement was 97.31 and 94.6% for parasite detection and species identification, respectively. Variations in the overall performance of individual laboratories were seen within a range of 81.55 to 97.27% test agreement. Results of 543 (8.12%) slides were discordant, of which 363 (5.4%), 93 (1.4%) and 87 (1.3%) slides were due to species misdiagnosis, false positive and false negative results, respectively.

Conclusion

There was good test agreement between participated laboratories and Amhara Public Health Institute. More accurate performance is expected as the country is tracking to malaria elimination. Hence, further strengthening the external quality assurance program is recommended.
Preoperative SCC-Ag as a predictive marker for the use of adjuvant chemotherapy in cervical squamous cell carcinoma with intermediate-risk factors
Authors: Guo Hong-tao , Bi Xue-han , Lei Ting , Lv Xiao , Yao Guang , Chen Yao , Liu Chang
Published: May 2020

Background

For cervical cancer patients whose tumors display a combination of intermediate risk factors, postoperative radiation with or without adjuvant chemotherapy is suggested for them. However, who should be administered with adjuvant chemotherapy is unknown. The current study was designed to explore the clinical value of squamous cell carcinoma antigen (SCC-Ag) in guiding the use of adjuvant chemotherapy in cervical cancer patients.

Methods

A total of 301 cervical cancer patients were included in the present study from March 2006 to March 2016. There were 156 patents who received adjuvant chemotherapy, while the rest of 145 patents did not receive it. The survival analysis including Overall survival (OS) and disease-free survival (DFS) was assessed by using the Kaplan-Meier method. Cox proportional hazards regression was done to detect factors in predicting the tumor prognosis.

Results

In patients with high pre-treatment SCC-Ag level, those who received adjuvant chemotherapy acquired better prognosis than patients who did not receive it. Particularly, a lower rate of distant metastasis was found in the group of adjuvant chemo-radiotherapy than that in the group of adjuvant radiotherapy. As for patients with low pre-treatment SCC-Ag level, we observed no differences in both the OS and DFS between patients who were given and not given with adjuvant chemotherapy. In the multivariable analysis, adjuvant chemotherapy was significantly correlated with DFS and distant metastasis-free survival (DMFS) in patients with high SCC-Ag level.

Conclusion

Preoperative SCC-Ag can be a predictive marker for the use of adjuvant chemotherapy in cervical squamous cell carcinoma with intermediate-risk factors.
Measuring upper limb function and patient reported outcomes after major breast cancer surgery: a pilot study in an Asian cohort
Authors: Chan Kai Siang , Zeng Ding , Leung Joelle Hoi Ting , Ooi Belinda Si Yin , Kong Kit Teng , Yeo Yi Heng , Goo Jerry Tiong Thye , Chia Clement Luck Khng
Published: May 2020

Background

Breast cancer is the most common cancer in women worldwide. Major breast cancer surgery especially with axillary lymph node dissection (ALND), is associated with upper limb functional decline. Majority of studies are conducted in Western population and may not be applicable to Asians. This pilot study aims to evaluate whether major breast surgery results in upper limb functional impairment in a cohort of Asian women with breast cancer.

Methods

This is a prospective cohort study of 41 patients who underwent 44 major breast surgeries from April 2018 to August 2019. Main inclusion criteria were patients over 21 years of age undergoing major breast surgery for breast cancer. Major breast surgery was defined as wide local excision (WLE) or mastectomy. Main exclusion criteria were patients with pre-existing neurological or rheumatological co-morbidities affecting upper limb function or previous trauma with resulting deformities to the upper limbs. Patients underwent early rehabilitation from post-operative day 1. Shoulder flexion and abduction active range of motion (AROM) and QuickDASH disability score were assessed 1 week before surgery, post-operative week 2 and week 6. Baseline demographics and peri-operative data were also collected.

Results

Median age was 62.5 years. There were 16 (36.4%) wide local excisions and 28 (63.6%) simple mastectomies. Two (4.5%) cases had neoadjuvant chemotherapy. Fifteen (34.1%) cases had ALND. At post-operative week 6, shoulder flexion was comparable to baseline (p = 0.775), while abduction improved from baseline (p = 0.016). However, QuickDASH disability score was significantly worse at post-operative week 6 compared to baseline (median score 2.5 vs 0, p = 0.027). Subgroup analysis of patients with ALND demonstrated significantly worse QuickDASH disability score at post-operative week 6 (p = 0.010) but not for patients with only sentinel lymph node biopsy (p = 0.396).

Conclusion

This pilot study in an Asian cohort found that patients were able to regain AROM of shoulder after major breast surgery at post-operative week 6 but had a worse QuickDASH disability score, especially in the subgroup with ALND. Aggressive and early rehabilitation should be encouraged. However, a longer follow-up is required to evaluate long term functional outcomes.
Predictors of dopamine agonist resistance in prolactinoma patients
Authors: Vermeulen Elle , D’Haens Jean , Stadnik Tadeusz , Unuane David , Barbe Kurt , Van Velthoven Vera , Gläsker Sven
Published: May 2020

Background

Surgical resection of prolactinomas resistant to dopamine agonists is frequently incomplete due to fibrotic changes of the tumour under pharmacological therapy. In order to identify a subgroup of patients who may benefit from early surgery, we thought to investigate possible predictive factors of pharmacological resistance of prolactinomas to dopamine agonists.

Methods

We retrospectively analyzed a database of a Belgian tertiary reference center for patients with pituitary tumours from 2014 to 2016. The groups of interest were patients with dopamine agonist responsive and resistant prolactinomas. The possible predictive factors, including MRI findings, endocrinological parameters, response of tumour and patient factors for dopamine agonist resistance were investigated.

Results

We included 69 patients of whom 52 were women (75,4%) and 17 were men (24,6%). Rate of dopamine agonist resistance was 15.9%. We identified four significant predictors of dopamine agonist resistance: male gender, a large tumour volume, prolonged time to prolactin normalization and presence of a cystic, hemorrhagic and/or necrotic component. In addition, symptoms due to mass effect, high baseline prolactin level and a high contrast capture on MRI are factors that can be taken into consideration.

Conclusion

We identified predictive factors for pharmacological resistance and developed a scoring system for patient specific prediction of resistance to dopamine agonists. This scoring system may have impact on the timing and decision of surgery in prolactinoma patients after further prospective evaluation.
Confidence, attitudes, beliefs and determinants of implementation behaviours among physiotherapists towards clinical management of low back pain before and after implementation of the BetterBack model of care
Authors: Schröder Karin , Öberg Birgitta , Enthoven Paul , Kongsted Alice , Abbott Allan
Published: May 2020

Background

Implementing clinical guidelines is challenging. To facilitate uptake, we developed a model of care (BetterBack Model of Care) and an implementation strategy to support management of low back pain in primary care. The aim of this study was to evaluate physiotherapists´ confidence, attitudes and beliefs in managing patients with low back pain before and after a multifaceted implementation of the BetterBack Model of Care. A further aim was to evaluate determinants of implementation behaviours among physiotherapists.

Methods

This clinical trial was an experimental before and after study within a hybrid type 2 effectiveness-implementation trial. The primary outcome was Practitioner Self-Confidence Scale (PCS), secondary outcomes were the Pain Attitude and Beliefs Scale for Physiotherapists (PABS-PT) and Determinants of Implementation Behaviour Questionnaire (DIBQ). Data was analysed using repeated measures ANOVA and pairwise comparisons.

Results

One hundred sixteen physiotherapists answered a questionnaire before, directly after, as well as 3 and 12 months after implementation of the Model of Care. PCS improved over time with a large effect size post implementation (ηp2 = 0.197, p < 0.001). Changes in PABS-PT were only significant after 12 months with higher biopsychosocial orientation, (ηp2 = 0.071, p < 0.01) and lower biomedical orientation, (ηp2 = 0.136, p < 0.001). Directly after the workshop, after 3 and 12 months, physiotherapists had high ratings on all DIBQ domains, (scores > 50) implying that all were potential facilitators of the implementation. However, after 3 months, all domains had significantly decreased except for organisation, social influence and patient expectation domains. However, after 12 months, organisation and social influence domains had significantly decreased while domains such as knowledge, skills and beliefs about capabilities returned to initial levels.

Conclusions

Physiotherapists´ confidence and biopsychosocial orientation increased after implementation and may have the potential to improve management of low back pain in primary care. The implementation behaviour showed mostly facilitating patterns but changed over time, pinpointing a need to repeatedly monitor these changes. This can inform the need for changes of implementation efforts in different phases and support sustainability strategies.

Trail registration

ClinicalTrials.gov NCT03147300 3 May 2017, prospectivly registered.
Health care seeking behavior among presumptive tuberculosis patients in Ethiopia: a systematic review and meta-analysis
Authors: Gamtesa Dinka Fikadu , Tola Habteyes Hailu , Mehamed Zemedu , Tesfaye Ephrem , Alemu Ayinalem
Published: May 2020

Background

Health seeking behavior is one of the challenges affecting tuberculosis (TB) control program because of its high risk to prolonged diseases transmission and poor treatment outcome. Although there are few primary studies that reported diversified magnitudes of health seeking behavior among presumptive TB patients in Ethiopia, there is no review study that attempted to summarize the available evidence. Thus, this review was aimed to estimate the proportion of health care seeking behavior from health facility and to summarize the reasons why individuals with presumptive TB are not seeking health care in Ethiopia.

Method

A systematic review and meta-analysis study was conducted on primary studies that reported proportion of health seeking behavior among presumptive TB patients. Electronic databases: PubMed, Google Scholar and Science Direct were searched to retrieve studies published in English language from Ethiopia without restricting publication year. In addition, bibliographies of included studies were also screened to retrieve potential studies. The keywords “health seeking”, “health seeking behavior”, “TB suspects” and “presumptive TB” were used both in Medical Subject Heading (MeSH) and free text. Random effects meta-analysis model was used to estimate the pooled proportions of health care seeking and not seeking behaviors. Stata version 14 was used for data analysis.

Result

Five studies which involved 3230 patients with presumptive TB were included into this review. The pooled estimated proportion of health care seeking behavior among presumptive TB patients from health facilities was 65% (95% CI, 54–76%), while the pooled proportion of not seeking health care from any sources was 17% (95% CI;6–27%). In addition, 18% (95% CI; 5–30%) of presumptive TB patients were seeking health care from inappropriate sources. Being female, younger age, low income status, absence of previous TB treatment history, low education status were the risk factors that associated with low health care seeking behavior.

Conclusion

Considerable proportion of patients with presumptive TB were not seeking health care from health facilities or seeks care from inappropriate sources in Ethiopia. Implementing efforts that could improve health care seeking behavior is vital to prevent prolonged disease transmission through immediate treatment commencement.