bluuebunny/crossref_metadata_2025 huggingface dataset:
Análisis preliminar de la amplificación de microsatélites en abejorros para estudios de biodiversidad y conservación
Authors: Cejas Acuña D. , Ornosa Serrano C. , Muñoz Gabaldón I. , De la Rúa Tarín P.
Published: August 2019

La península Ibérica alberga una gran diversidad de abejorros, pero falta mucha información sobre su biodiversidad en esta zona. Para evitar esto y facilitar estudios de conservación, presentamos dos novedosos ensayos para la amplificación múltiple de seis y cinco loci de microsatélites respectivamente. Ambos ensayos funcionaron con éxito para la mayoría de las especies estudiadas en las poblaciones ibéricas. Se detectaron las obreras hermanas y se infirieron parámetros genético-poblacionales en la especie manejada B. terrestris y en las especies silvestres B. monticola y B. mesomelas, demostrando la capacidad de estos ensayos para estudios de biodiversidad de especies de abejorros tanto manejadas como silvestres.
Vibiro vulnificus hemolysin binds to gangliosides.
Authors: KASHIMOTO Takashige , Sugiyama Hiroyuki , Kawamidori Keigo , Yamazaki Kohei , Kado Takehiro , Matsuda Kaho , Mukai Takao , Ueno Shunji
Published: August 2019

Abstract
Background: Vibrio vulnificus hemolysin (VVH) is a pore-forming toxin secreted by Vibrio vulnificus. Cellular cholesterol was believed to be the receptor for VVH, because cholesterol could bind to VVH and preincubation with cholesterol inhibited cytotoxicity. It has been reported that specific glycans such as N-acetyl-D-galactosamine and N-acetyl-D-lactosamine bind to VVH, however, it has not been known whether these glycans could inhibit the cytotoxicity of VVH without oligomer formation. Thus, to date, binding mechanisms of VVH to cellular membrane, including specific receptors have not been elucidated.
Results: We show here that gangliosides are a good candidate cellular receptor for VVH. Binding of VVH was not affected by depletion of cholesterol on ghost membrane. In contrast, ganglioside GM1a, Fucosyl-GM1, GD1a, GT1c, and GD1b bind to VVH directly, and the GD1a inhibited the cytotoxicity of VVH without the formation of oligomers.
Conclusion: This is the first report of a molecule able to inhibit the binding of VVH to target cells without oligomerization of VVH.
A mutant allele of zeta-carotene isomerase (Z-ISO) is associated with the yellow pigmentation of the ‘Pinalate’ sweet orange mutant and reveals insights into its role in fruit carotenogenesis
Authors: Rodrigo Maria Jesus , Lado Joanna , Alos Enriqueta , Alquezar Berta , Dery Orly , Hirschberg Joseph , Zacarias Lorenzo
Published: August 2019

Fruit coloration is one of the main quality parameters of Citrus fruit primarily determined by genetic factors. The fruit of ordinary sweet orange (Citrus sinensis) displays a pleasant orange tint due to the accumulation carotenoids, representing b,b-xanthophylls more than 80% of the total content. Pinalate is a spontaneous bud mutant derived from sweet orange Navelate, characterized by yellow fruits due to elevated proportions of upstream carotenes and reduced b,b-xanthophylls. To identify the molecular basis of Pinalate yellow fruit, a complete characterization of carotenoids profile together with transcriptional changes in carotenoid biosynthetic genes were performed in mutant and parental fruits during development and ripening. Pinalate fruit tissues showed a distinctive carotenoid profile at all ripening stages, accumulating phytoene, phytofluene and unusual proportions of 9,15,9´-tri-cis- and 9,9´-di-cis-z-carotene, while content of downstream carotenoids was significantly decreased. Transcript levels for most of the carotenoid biosynthetic genes showed no alterations in Pinalate; however, the steady-state level mRNA of z-carotene isomerase (Z-ISO), which catalyses the conversion of 9,15,9´-tri-cis- to 9,9´-di-cis-z-carotene, was significantly reduced in Pinalate fruit and leaf tissues. The isolation of the Pinalate Z-ISO genomic sequence identified a new allele with a single nucleotide insertion at the second exon, which generates an alternative splicing site that alters Z-ISO transcripts encoding non-functional enzyme. Moreover, functional assays of citrus Z-ISO in E.coli showed that light is able to enhance a non-enzymatic isomerization of tri-cis to di-cis-z-carotene which is in agreement with the partial rescue of mutant phenotype when Pinalate fruits are highly exposed to light during ripening. The defect in Pinalate Z-ISO gene causes a bottleneck in the carotenoid pathway with an unbalanced content of carotenes upstream to b,b-xanthophylls in fruit tissues. Taken together, our results indicate that a spontaneous single nucleotide insertion in Z-ISO is the molecular basis of the altered pigmentation in Pinalate sweet orange mutant and points this isomerase as an essential activity for carotenogenesis in citrus fruits.
The predicted Meloidogyne javanica effectome is governed by the 9-hydroxide oxylipin of linolenic acid
Authors: Fitoussi Nathalia , Borrego Eli , Kolomiets Michael V , Xue Qing , Bucki Patricia , Sela Noa , Belausov Eduard , Miara Sigal Braun
Published: August 2019

Background: The sedentary root-knot nematode Meloidogyne spp. secretes effectors in a spatial and temporal manner to interfere with and mimic multiple physiological and morphological mechanisms, supporting construction and maintenance of nematodes' feeding sites. For successful parasitism, many effectors act as immunomodulators, aimed to manipulate and suppress immune defense signaling triggered upon nematode invasion.
Results: Comprehensive oxylipin profiling of tomato roots, performed using LC–MS/MS, indicated a sharp fluctuation in oxylipin profile following Root Knot Nematode infection. To identify genes that might respond to the lipidomic defense pathway mediated through oxylipins, RNA-Seq was performed by exposing Meloidogyne javanica second-stage juveniles to tomato protoplasts and the oxylipin 9-HOT, early induced in tomato roots upon nematode infection. A total of 4810 differentially expressed genes were identified. To target putative effectors, we explored differentially expressed genes carrying a predicted secretion signal peptide. Among these, several were homologous with known effectors in other nematode species; other unknown, potentially secreted proteins may have a role as root-knot nematode effectors that are induced by plant lipid signals. These include effectors functioning in the manipulation of plant defense signaling and root lipidomics, cell-wall weakening, detoxifying the stressful environment at the plant-nematode interface, allowing feeding site construction and development.
Conclusions:
Being an integral part of the plant's defense response, oxylipins may play an important signaling role in the regulation of nematode effectors. Herein we uncover activation of specific oxylipins signaling pathways upon nematode infection, which in turn

result in reprogramming the nematode effector repertoires responsible for promotion of feeding site construction and nematode parasitism.
Adequacy and complication rates of percutaneous renal biopsy on native kidneys in Chinese with 18- vs. 16-gauge needles
Authors: Xie Weiji , Xu Jing , Xie Yi , Lin Zhijun , Xu Xiaochang , Zhang Yimin
Published: August 2019

Aim: The study aims to compare the adequacy, complication and pathological classification rates of using 18G vs. 16G needles to perform renal biopsy with ultrasound-guided on native kidneys in Chinese. Methods: We retrospectively analyzed the number of glomeruli, adequate sample rates, complication rates and pathological classification in 270 patients who were used by 18G or 16G needles separately from January, 2011 to May, 2017，and verified whether the needle gauge affect the diagnosis of the disease. Results: A total of 270 kidney biopsies were performed. Among them :72 were with 18G needles, and 198 were with16G needles. There was no difference in the number of glomeruli count under light microscope using 18G relative to 16G needles（24±11vs25±11，p=0.265）, whereas more glomeruli count were found for the 16G group using immunofluorescence microscopy(3±2 vs 5±3， p＜0.05).There was no significant difference in the adequate sample rates between 18G group and 16G group (90.28%vs93.94%, p=0.298). Minor complications including the incidence of lumbar or abdominal pain (4.17% vs 7.07%, p = 0.57), gross hematuria (4.17% vs 3.54%, p = 0.729), and perinephric hematoma without symptoms (4.17% vs1.52%, p = 0.195) were not significantly different for 18G vs 16G group. In 16G group, there was 2 cases of serious complications occurred, including severe gross hematuria requiring blood transfusion, and retroperitoneal hematoma requiring surgery. No serious complications were observed in the 18G group, even although there was no significant difference in serious complications rates between the 18G and 16G group (0% vs 1.02%，p = 1). Conclusion: There was no significant difference in the number of glomeruli, adequate sample rates, and complication rates of using the 18G and 16G needles to perform renal biopsy, and the 18G needle with smaller diameter did not affect the pathological diagnosis and classification of IgA nephropathy and lupus nephritis.
Magnitude of iodine deficiency disorder and associated factors in Dawro zone, southwest Ethiopia: the hidden hunger
Authors: Asfaw Agize , Belachew Tefera
Published: August 2019

Background: Iodine deficiency disorder (IDD) is continued to be a major public health problem in Ethiopia. The problem is worse but the data is scarce in some pocket areas of the country. This study was aimed to assess the magnitude of IDD and associated factors in southwest Ethiopia by using different biochemical and clinical indicators.
Methods: Both community and school based cross- sectional study was conducted on school age children (6-12 years) from March 1 to 24, 2017. Simple random and systematic sampling techniques were applied to select districts and eligible children respectively. Household data was collected from children’s primary care takers by using structured questionnaire. A trained emergency surgeon examined children for goiter. Urine sample was collected from 20% of children (n=130).
Results: A total of 652 school children were participated in the study. Total goiter rate and median urinary iodine concentration (UIC) was 54.8 % and 96.12μg/l respectively. In multivariate logistic regression analyses student’s age was significantly (P<0 05) associated with both goiter and median UIC. However; sex of students and family income were significantly (P<0.001) associated with goiter and cassava consumption was significantly (P<0.001) associated with UIC.
Conclusion: As indicated by the median UIC, there was mild iodine deficiency in this study community. However; chronic iodine deficiency was still a severe public health problem (high goiter prevalence). In addition, there was low concentration of iodine in the salt and increased cassava cultivation and consumption in the area. Therefore, it is necessary to intensify IDD elimination activities along with teaching communities on techniques of cassava processing for household consumption.
Trial registration: PACTR201809544276357. Retrospectively registered on 14 Sept 2018.
Fluoxetine treatment for more than 2 days decreases the cellular neuroplasticity and microtubule plasticity in differentiated PC12 cells
Authors: Wu Zuotian , Wang Gaohua , Wang Huiling , Xiao Ling , Wei Yanyan , Yang Can
Published: August 2019

Background: Recent studies indicate that antidepressants treatment restores neuroplasticity. But some researchers claimed that antidepressants, including fluoxetine (FLU), may exacerbate neuroplasticity, which is contradictory and rarely studied. Since almost all of those studies treated with drugs for 1 to 2 days as treatment models of antidepressants, it is possible that FLU treatments for longer periods would have opposite effects on neuroplasticity.
Results: In the present study, we examined the effects of FLU treatment up to 3 days on the cellular neuroplasticity and microtubule plasticity in PC12 cells. The cell viability of cells happened a small decease at 2 days (93.5±3.5%), followed by highly significant decreases at 3 days (71.4±4.4%). As report previously, cellular neuroplasticity was significantly upregulated with FLU treatment at 1 day, but that was inhibited FLU treatment at 3 days. Similarly, the expression of tubulin, which is microtubulin plasticity marker, was also upregulated with FLU treatment at 1 day. But it decreased significantly in cells treated with FLU at 3 days. Furthermore, we found tubulin interacted with CRMP2, which accelerated to cellular neuroplasticity, and the regulation of CRMP2 activity influenced microtubule plasticity.
Conclusions: The results demonstrate that cellular neuroplasticity and microtubule plasticity were increased with FLU treatment at 1 day, but treatment with FLU for more than 2 days has opposite effect on them. The reduction in cellular neuroplasticity andmicrotubule plasticity with FLU treatment for more than 2 days might be involved in some aspects of the drugs’ therapeutic effects on depression.
Altered somatosensory evoked potentials associated with improved reaction time in a simple sensorimotor response task following repetitive practice
Authors: Akaiwa Mayu , Iwata Koki , Saito Hidekazu , Sasaki Takeshi , Sugawara Kazuhiro
Published: August 2019

Background Repetitive practice of sensorimotor tasks is widely used for neurorehabilitation; however, it is unknown how practice alters sensory processing (e.g., recognition, discrimination, and attentional allocation) and associated cognitive processing, such as decision-making. The purpose of this study was to investigate whether somatosensory evoked potentials (SEPs) reflecting sensory processing, attention, and decision-making are altered by sensorimotor learning. 15 participants preformed a simple sensorimotor response task (thumb opposition in response to surface electrical stimulation), with experimental recording sessions before and after three days of practice. We then compared multiple SEP waveforms and reaction times (RTs) between pre- and postpractice trials. Results As expected, the RT was reduced after practice of three days, and this was associated with shorter N140 and N250 latencies and larger P300 amplitude. Conclusions The present study suggests that motor learning improves somatosensory processing and attentional allocation via neuroplasticity and that these alterations are reflected by specific SEP changes.
Changes in the level of nursing students’ empathy during four years education
Authors: Kesbakhi Maryam Sedaghati , Rohani Camelia
Published: August 2019

Background: A review of previous studies on nursing students’ empathy showed contradictory results with reducing or increasing empathy in nursing students and other students in the healthcare field during academic years of education at the university. Methods: The descriptive study with comparative design was conducted to determine the level of empathy and its changes in 122 undergraduate nursing students from the first to the fourth year of study. The data were collected using Jefferson Scale ofPhysician Empathy Nursing Student Version-R (JSE- NS version R) . Data were analyzed with descriptive and analytical tests by SPSS version 20. Results: Results showed that the mean score of empathy in all nursing students was 91.8 ± 28.7 (range: 20-140). Changes of empathy across the academic education years indicated that it was significantly declined in the fourth year of education, compared to the first year (p<0.001). The mean score of empathy in more than 76% of nursing students in the fourth academic education year was set at less than 50 th percentile. Conclusions: Based on this significant reduction, it is recommended that the reasons are explored by qualitative studies. Also, empathy is introduced to the nursing students, as one of the standards of clinical competency using strategies, such as education for empathic communication with the patient in training programs, and in the core courses of the nursing profession.
Urban-based Longitudinal Integrated Clerkship: A scoping review
Authors: Roh HyeRin , Yun Jiyoung , Park SongYi
Published: August 2019

Background Reports about longitudinal integrated clerkship (LIC) mostly deal with rural-based LICs. Clinical clerkships usually take place in urban academic medical center (AMC). We need to explore how to implement LIC in urban AMC. Authors reviewed the existing literature focused on urban-based LIC (uLIC) to explore the features and challenges uLIC. 'Method Authors adopted the scoping review framework. Research questions were: (1) What are the characteristics of uLIC studies? (2) How did medical schools implement uLICs? (3) What were the challenges when implementing uLICs? and (4) What gaps exist in uLIC research? Authors reviewed 495 studies from an initial electric database search and selected 27 articles for inclusion, and extracted relevant data and organized the demographic information and details of the uLICs for each of medical school. Authors conducted a thematic analysis on the challenges of uLIC. Results Twenty-five papers were published in the United States. Urban-based LICs were evaluated by participants’ responses (n=13) and students’ learning outcome (n=10). One paper discussed obstacles of uLIC implementation. Fourteen papers were reported by two medical schools (Harvard Medical School, University of California San Francisco College of Medicine). The two medical schools reported student selection methods and six medical schools reported student assessment methods. Challenges related to LICs included preceptors' burden about LIC education, students’ concern about academic achievement, students’ inability to adapt to LICs, shortage of educational resources of AMC, and lack of understanding about LICs. Conclusion Research is needed to understand the long-term outcomes of uLICs and strategies to overcome challenges. Medical schools should prepare student support systems and faculty development programs to facilitate successful implementation of uLICs. Medical schools’ and hospitals’ resources and funding should be taken into careful consideration prior to implementing uLICs.
Treatment effects of Chinese Medicine (Yi-Qi-Qing-Jie Herbal Compound) combined With immunosuppression therapies in patients of IgA Nephropathy with high-risk of ESRD (TCM-WINE): study protocol for a randomized controlled trial
Authors: Li Shen , Li Jin-pu
Published: August 2019

Background: IgA nephropathy (IgAN) is the most common glomerular disease worldwide. It has a high incidence in Asians and is more likely to progress to end-stage renal disease (ESRD). However, for high-risk IgAN clinically characterized by massive proteinuria and renal dysfunction, there has been no international consensus on treatment options. Compared with other developed countries, Chinese IgAN patients are often found to have severe kidney function loss at the initial diagnosis. Yi-Qi-Qing-Jie Formula Granule (a compound recipe of Chinese medicinal herbs, YQF) has shown potential renal protection in our previous clinical studies. To further confirm the efficacy and safety of YQF in the treatment of high-risk IgAN, we design a prospective double-blind randomized placebo-controlled trial.
Methods/Design: The TCM-WINE study is a single-center, prospective, double-blind placebo-randomized controlled trial. We plan to randomize 60 participants with biopsy-proven IgAN to YQF combined group (YQF compound, combined with prednisolone, and cyclophosphamide if necessary) and immunosuppression group (placebo-YQF, combined with prednisolone, and cyclophosphamide if necessary). The two groups will enter 48-week in-trial treatment phase and receive post-trial follow-up till study completion (3-year). All patients will receive optimal supportive care. The primary composite outcome is defined as the first occurrence of a 40% decrease in estimated glomerular filtration rate (eGFR) from the baseline lasting for 3 months, initiating continuous renal replacement treatment or death due to chronic kidney disease (CKD), during the 3-year study phase. Secondary endpoint events are defined as the mean annual eGFR decline rate (eGFR-Slope, ml/min per 1.73 m 2 per year) which is calculated by the eGFR regression curve for each eligible patient, and proteinuria remission (prescribed as proteinuria<0.5g/day) at week 24, 36, 48 during the in-trial phase. Safety monitoring and assessment will be undertaken during the study .
Discussion: TCM-WINE study will evaluate effects and safety of YQF combined therapy compared with immunosuppression monotherapy on basis of optimal supportive treatment in high-risk IgAN. The evidence from this study will provide a novel, effective and safe Chinese characteristics therapy for high-risk IgAN patients.
Trial registration: Clinicaltrials.gov, identifier: NCT03418779. Registered on 18 June 2018.
https://clinicaltrials.gov/show/NCT03418779
Geostatistical analysis and mapping: Social and environmental determinants of under-five child mortality, evidence from the 2014 Ghana Demographic and Health Survey.
Authors: Aheto Justice Moses K. , Yankson Robert , Chipeta Michael Give
Published: August 2019

Background Under-five mortality (U5M) rates are among the health indicators of utmost importance globally. It is the goal 3 target 2.1 of the Sustainable Development Goals that is expected to be reduced to at least 25 per 1000 livebirths by 2030. Despite a considerable reduction in U5M was observed globally, several countries especially those in sub-Saharan Africa (SSA) like Ghana are struggling to meet this target. Evidence-based targeting and utilization of the available limited public health resources are critical for effective design of intervention strategies that will enhance under-five child survival. We aimed to estimate and map U5M risk, with the ultimate goal of identifying communities at high risk where interventions can be targeted.Methods The 2014 Ghana Demographic and Health Survey data was used in this study. Geostatistical analyses were conducted on 5,801 children residing in 423 geographical clusters. The outcome variable is child survival status (alive or dead). We employed a geostatistical generalised linear mixed model to investigate both measured and unmeasured child specific and spatial risk factors for child survival. We then visualise child mortality by mapping the predictive probability of survival.Results Of the total sampled under 5 children, 280 (4.83%) experienced the outcome of interest. Children born as multiple births were at increased risk of mortality with AOR (9.28, 95% CI: 6.35 – 13.58) compared to singletons. Maternal education AOR (0.80, 95% CI: 0.68 – 0.93) and number of children under 5 within each household AOR (0.34, 95% CI: 0.28 – 0.41) were shown to have a protective effect. The predicted U5M risk in 2014 was at 8.3%. High altitude areas were highly associated with high U5M.Conclusion The analysis found that multiple births and high elevation are highly associated with U5M in Ghana. The high-resolution maps show areas and communities where interventions for U5M can be prioritised to have health impact.
Virtual Reality Video Promotes Advance Care Planning Effectiveness
Authors: Hsieh Wan-Ting
Published: August 2019

Introduction: In 2019, the Patient Autonomy Act has gone into effect, allowing Taiwanese citizens to establish an advance decision(AD) with legal effect. In an effort to secure more realistic and accurate perception of patients as the basis for them to explore their values, a VR video was developed to supplement the traditional way of decision making before advance care planning(ACP).
Methods: Participants were asked to complete pre-test questionnaires and were then asked to read a handout with information about life-sustaining treatment and the legal process of making an effective AD. Participants then viewed a six-minute 360-degree VR video on a portable VR headset with a smartphone inside to play it and then completed the post-test questionnaire followed by feedback on the help of the VR.
Results: Of the 120 participants, 71.1% had heard about of AD. The increased percentage of the certainty of their preferences for the five kinds of life-sustaining treatments before and after participants read the handout and viewed the VR video was noted.
Conclusion and Discussion: The decrease in the number of participants who couldn’t make decision indicates indicate that VR video may be helpful for users to make decision and clarify users’ preference. According to feedback of VR video, highly agreement also lied in its help of equipping users with better understanding of medical scenarios and it is a good decision aid tool for preparing our users before ACP.
Risk factors of nosocomial infection after cardiac surgery in children with congenital heart disease
Authors: Yu Xindi , Chen Maolin , Liu Xu , Chen Yiwei , Hao Zedong , Zhang Haibo , Wang Wei
Published: August 2019

Background: The aim of our study was to analyze the risk factors of nosocomial infection after cardiac surgery in children with congenital heart disease (CHD). Methods: We performed a retrospective cohort study, and children with CHD who underwent open-heart surgeries at Shanghai Children’s Medical Center from January 1, 2012 to December 31, 2018 were included. The baseline characteristics of these patients of different ages, including neonates (0-1 months old), infants (1-12 months old) and children (1-10 years old), were analyzed, and the association of risk factors with postoperative nosocomial infection were assessed. Results: A total of 11937 subjects were included in the study. The overall nosocomial infection rate was 11.10%. Nosocomial infection rates in neonates, infants, and children with congenital heart disease were 25.41%, 15.78%, and 5.31%, respectively. Multivariate logistic regression analysis found age (OR 0.804, 95%CI: 0.776-0.834; P<0.001), STS risk grade (OR 1.308, 95%CI: 1.203-1.423; P<0.001), body mass index (BMI)
Single nucleotide polymorphisms associated with postoperative inadequate analgesia after single-port VATS in Chinese population
Authors: Xing Xiufang , Bai Yongyu , Sun Kai , Yan Min
Published: August 2019

Background Postoperative inadequate analgesia following video-assisted thoracoscopic surgery (VATS) is a common and significant clinical problem. While genetic polymorphisms may play role in the variability of postoperative analgesia effect, few studies have evaluated the associations between genetic mutations and inadequate analgesia after single-port VATS.Methods Twenty-eight single nucleotide polymorphisms (SNPs) among 17 selected genes involved in pain perception and modulation were genotyped in 198 Chinese patients undergoing single-port VATS. The primary outcome was the occurrence of inadequate analgesia in the first night and morning after surgery which was defined by a comprehensive postoperative evaluation. Multivariable logistic regression analyses were used to identify the association between genetic variations and postoperative inadequate analgesia.Results The prevalence of postoperative inadequate analgesia was 45.5% in the present study. After controlling for age and education level, association with inadequate analgesia was observed in four SNPS among three genes encoding voltage-gated sodium channels. Patients with the minor allele of rs33985936 ( SCN11A ), rs6795970 ( SCN10A ), and 3312G>T ( SCN9A ) have an increased risk of suffering from inadequate analgesia. While the patients carrying the minor allele of rs11709492 ( SCN11A ) have lower risk experiencing inadequate analgesia.Conclusions We identified that SNPs in SCN9A , SCN10A , and SCN11A play a role in the postoperative inadequate analgesia after single-port VATS. Although future larger and long-term follow up studies are warranted to confirm our findings, the results of the current study may be utilized as predictors for forecasting postoperative analgesic effect for patients receiving this type of surgery.
Incidence and risk factors of a severe Clostridium difficile infection: results of a retrospective cohort study at a tertiary care hospital
Authors: Baier Claas , Valentin Simone , Schwab Frank , Steffens Sandra , Vonberg Ralf-Peter , Chaberny Iris Freya , Ebadi Ella
Published: August 2019

Background Clostridium difficile infection (CDI) is a relevant healthcare burden worldwide and one of the leading causes for nosocomial diarrhea. Besides mild courses, the development of a severe infection can occur and has a relevant impact on healthcare costs and patient outcome.Methods We conducted a retrospective cohort study over a 4 year-long period to analyze the incidence of CDI and the contributing risk factors for a severe course at a tertiary care clinic. Independent risk factors were determined by a multivariable logistic regression analysis.Results A total of 761 CDI cases were identified in the study period, thereof 612 (80.4%) cases were nosocomially acquired. The mean incidence for a CDI was 0.42 cases per 1000 patient-days. A severe CDI occurred in 131 cases (17.2%). Independent risk factors for a severe course were pulmonary disease, a Charlson comorbidity index >3, and a preceding antibiotic therapy within three months with glycopeptides (vancomycin/teicoplanin) and/or aminoglycosides.Conclusions This study highlights the relevant burden of CDI in hospitals. Moreover, it underscores that specific knowledge of risk factors contributing to severe CDI is crucial to optimize treatment, infection prevention measures and to guide clinical monitoring and therapy strategy.
Six Basic Clinical Principles of Primary Care Practice
Authors: Lee John Yang , Liu Yingying
Published: August 2019

BACKGROUND: The features of primary care are well described on the dimension of public health. Primary care clinicians consist of a large portion of health-care workforce. To guide clinical thinking in primary care practice, its basic clinical principles should be synthesized. METHODS: We searched literature in PubMed, MEDLINE, China National Knowledge Infrastructure, and Wanfang Med Online, using the key words of “primary care practice”, “primary care”, “primary health care”, “general practice” in combination with “principle”, “ideal”, “description”, “characteristic” and “feature” to synthesize basic clinical principles of primary care practice. RESULTS: Six basic clinical principles of primary care practice are synthesized. 1. Holistic: includes holism, whole person care, bio-psycho-social model, lateral clinical thinking, and overcoming fragmented specialization. 2. Integrative: consists of combination of orthodox and complementary medicine, coordinated care, and practicing holistic integrated medicine(HIM). 3. Continuous: deals with continuous clinician-patient relationship, seamless services, life-cycle medical services, and full medical care at any time and place. 4. Preventive: contains undifferentiated disease care, health habit counseling, screening for asymptomatic diseases, and immunization. 5. Patient-centered: comprises responsive to individual patient needs and values, people-oriented care, and practicing Patient Centered Medical Home (PCMH). 6. Standardized: involves use of evidence-based medicine (EBM), following the clinical guideline, and applying clinical pathway. CONCLUSION: The six basic clinical principles of primary care practice are holistic, integrative, continuous, preventive, patient-centered and standardized care. They might be the backbone of primary care practice and be recommended to be used to construct the disciplinary knowledge of clinical primary care practice. KEY WORDS: Primary care practice, primary care, primary health care, general practice.
Prevalence, Antimicrobial Resistance, and Relatedness of Salmonella Isolated from Chicken, Pork and the Environment at Abattoirs and Supermarkets in Chongqing, China
Authors: Chen Tingting , Jiang Jiali , Ye Chao , Xie Jianhua , Chen Xia , Xu Dongyi , Zeng Zheng , Peng Yuanyi , Hu Dong-Liang , Fang Rendong
Published: August 2019

Background: Salmonella is one of the most important foodborne pathogens, causing outbreaks of human salmonellosis worldwide. Owing to large scales of consumption markets, pork and poultry that contaminated by Salmonella could pose a tremendous threat to public health. The aim of this study was to investigate the contamination of Salmonella from chicken, pork and the environment in slaughtering and retailing segments in Chongqing, China.
Results: A total of 115 Salmonella isolates were recovered from 1122 samples, with 10.76% (47/437) in slaughterhouses and 10.07% (68/675) in supermarkets. 30 different serotypes were identified, in which S. Derby, S. London and S. Rissen were mostly detected. Antimicrobial susceptibility testing and resistance genes verification were carried out to investigate the relationship between phenotypes and genotypes. Altogether, 75.65% isolates showed resistance to tetracycline, followed by 60.87% to doxycycline and 69.5% to ampicillin. More than half (50.43%) of the isolates were multidrug resistant, which were mostly from supermarkets (P<0.05). According to antibiotic resistance genes detection results, a high correlation between antibiotic phenotypes and genotypes was presented by lactam-, tetracycline-, and sulfonamide-resistant isolates. Multilocus sequence typing results showed 24 out of 115 isolates were ST40, which was the most prevalent. Furthermore, isolates from supermarkets (n=15) had more sequence types than that in slaughterhouses (n=3).
Conclusion: Our study highlighted the fact that Salmonella contamination were more severe in pork production chain than that of chicken. Isolation rates were similar in slaughterhouses and supermarkets for both pork and chicken, but isolates from supermarkets had more MDR profiles and represented a wide range of serotypes and sequence types, indicating that more diverse sources of contamination in retailing.
Prevalence and antibiotic susceptibility of urinary tract infections in febrile children below ten years attending mulago hospital, Uganda
Authors: Ssemambo Ronald , Odongo Isaac , Kungu Joseph
Published: August 2019

Background: Urinary tract infections (UTIs) are one of the most common infections in the pediatrics population. This study was performed to determine the prevalence of urinary tract infections amongst febrile children below 10 years attending Mulago National Referral Hospital, and the susceptibility patterns of the isolated uropathogens to common antibiotics.
Methods: A cross-sectional study of febrile pediatric patients below 10 years from various ward of Mulago National Referral Hospital was conducted between January and May 2019. Biodata and midstream urine samples were collected from 160 children .The urine samples were cultured onto Blood Agar and Cystine Lactose Electrolyte Deficient (CLED) simultaneously. Growth was considered significant when a pure isolate had ≥ 10 5 CFU/mL. Susceptibility to 8 antibiotics was set using the modified Kirby-Bauer disc diffusion technique.
Results: Out of the 160 urine samples analyzed, 29(18.1%) had significant bacterial growth. The frequency of UTIs was significantly higher in girls 20(69.0%) than boys 9(31.0%). Escherichia coli was the most predominant microorganism (41.4%), followed by Klebsiella pneumoniae (20.7%) and Staphylococcus aureus at (13.8%). Overall susceptibility tests exhibited a very high Antibiotic resistance of uropathogens to ampicillin (96.6%), cotrimoxazole (82.8%) and nalidixic-acid. Nitrofurantoin and imipenem showed the lowest resistances of 34.5% and 31.0% respectively. A total of 24(82.8%) isolates were multidrug resistant.
Conclusion: Bacteriuria is a highly prevalent condition amongst febrile children attending Mulago hospital, with Enterobacteriaceae being the most predominant uropathogens. Uropathogens were highly sensitive to nitrofurantoin and imipenem but with significant resistance to ampicillin and cotrimoxazole. This information can be useful in decision making during management of UTIs among children.
Diagnostic Value of Pituitary Volume in Girls with Precocious Puberty
Authors: Wu Su , Yang Yan , Wang Yujiao , Liu Qianqi , Zhu Zi-yang , Gu Wei
Published: August 2019

Background: To investigate the diagnostic significance of pituitary magnetic resonance imaging (MRI) in girls with precocious puberty (PP).
Methods: A total of 288 young female patients who presented to the Clinic of Pediatric Endocrinology for evaluation of PP from January 2015 to December 2017 were enrolled. All the subjects contained 90 girls diagnosed with premature thelarche (PT), 133 girls determined as idiopathic central precocious puberty (ICPP), 35 early pubertal girls, and 30 normal girls. All patients received pituitary MRI.
Results: The largest pituitary volume (PV) and pituitary height were shown in the ICPP and pubertal groups, followed by the PT group. The receiver operating characteristic (ROC) curve analysis showed that PV might be a predictive marker for ICPP, with a sensitivity of 54.10% and a specificity of 72.20% at the cutoff value of 196.01 mm3. By univariate analysis, PV was significantly and positively associated with peak LH, LH/FSH, age, bone age, and BMI (all P < 0.05). However, bone age and peak LH were the only significant predictors of PV by the stepwise multivariate regression analysis (Model: PV = 9.431 * bone age + 1.230 * peak LH + 92.625 [P = 0.000, R2 = 0.159)).
Conclusions: The PV in the ICPP group was significantly higher than that in the PT and control groups, but there was no reliable cutoff value to distinguish ICPP from PT. Pituitary MRI should be combined with clinical and laboratory tests to maximize the diagnostic value of PV for PP.
Comparison of Visual Outcomes for Myopia after Refractive Surgery using Femtosecond Laser-assisted and Epipolis LASIK
Authors: Piao Junjie , Whang Woong-Joo , Joo Choun-Ki
Published: August 2019

Background This prospective cohort study clinically evaluated the visual outcomes after refractive surgery for myopia using femtosecond laser-assisted in situ keratomileusis (femto-LASIK) and epipolis LASIK (flap-off epi-LASIK).Methods Forty eyes of 27 patients were divided into 2 groups in this prospective cohort study. Femto-LASIK flaps were created using a femtosecond laser; epi-LASIK flaps (flap-off) were made using and Epi-K TM epikeratome. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), manifest refraction (MR), corneal asphericity (Q-value), and corneal higher-order aberrations (HOAs) were assessed pre- and postoperatively.Results The improvement in LogMAR UDVA after refractive surgery was statistically significant for both groups ( P < 0.001 for all groups); it was significantly improved for femto-LASIK at 1 day and 1 week postoperatively ( P < 0.001, P = 0.019, respectively). In analysis of the front and total corneal HOAs, there were significant differences in spherical aberrations (Z 4,0 ) between the femto-LASIK and flap-off epi-LASIK groups ( P = 0.016 and P = 0.017, respectively). In analysis of the back corneal HOAs, there were significant differences in vertical coma (Z 3,-1 ) aberration 0.027 ± 0.027 (femto-LASIK) and 0.001 ± 0.034 (flap-off epi-LASIK); horizontal secondary astigmatism (Z 4,2 ) aberration -0.008 ± 0.012 (femto-LASIK) and 0.007 ± 0.018 (flap-off epi-LASIK); oblique tetrafoil (Z 4,-4 ) aberration -0.008 ± 0.029 (femto-LASIK) and 0.015 ± 0.026 (flap-off epi-LASIK), respectively ( P = 0.018, P = 0.007, and P = 0.022, respectively). However, the back corneal HOA changes did not have a significant effect on the total corneal HOA changes.Conclusion Femto-LASIK yielded better early visual outcomes than that by flap-off epi-LASIK, but there was no significant difference between the outcomes of the 2 procedures 1 week postoperatively.
iTRAQ-based comparative proteomics analysis reveals specific urinary biomarkers for various kidney diseases
Authors: Jin Juan , Gong Jianguang , Zhao Li , Li Yiwen , He Qiang
Published: August 2019

Background Urinary proteomics has been extensively applied to investigate renal diseases including acute kidney injury (AKI), chronic kidney disease (CKD), IgA nephropathy (IgAN) and diabetic CKD. However, differential urinary proteome studies have not been reported for multiple diseases. The present study was aimed to explore early clinical diagnosis biomarkers for patients with AKI, AKI+CKD, diabetic CKD, non-diabetic CKD with IgAN and non-diabetic CKD without IgAN. Methods Differentially expressed proteins (DEPs) were screened by iTRAQ labeling and 2-D LC-MS/MS. Bioinformatics analysis was performed by subsequent GO enrichment and KEGG pathway analysis. DEPs were authenticated by ELISA assay. Results 156, 156, 286, 187 and 184 differentially abundant proteins were identified in patients with AKI, AKI+CKD, diabetic CKD, and non-diabetic CKD with or without IgAN. Comparative analysis indicated that 34, 35 and 17 unique DEPs were found in AKI, AKI+CKD and CKD samples, respectively. 91 and 14 specific DEPs were screened out in diabetic CKD and non-diabetic CKD. In comparison with Non-diabetic CKD with IgAN (38 DEPs), 47 unique urinary proteins were found in Non-diabetic CKD without IgAN. Among these DEPs, urinary SAA1 and HGFAC were only unregulated in AKI and Non-diabetic CKD without IgAN implying that they might be employed as the potential indicators of the two diseases. C5, APOC1 and Reg3A upregulation was not exclusively expressed in each disease which suggested that they could not be used for biomarker to distinguish one disease from the other. Conclusion Collectively, this research contributes to the urinary biomarker discovery from multiple renal diseases.
Accuracy of Self-report for Cervical and Breast Cancer Screening: A Systematic Review and Meta-analysis
Authors: Anderson Johanna , Bourne Donald S. , Peterson Kim A. , Mackey Katherine M.
Published: August 2019

Background: Guideline-based breast and cervical cancer screenings are fundamental components of high-quality preventive women’s health care services. Accurate measurement of screening rates is vital to ensure all women are adequately screened. Our systematic review and meta-analysis aims to provide an updated synthesis of the evidence on the accuracy of self-reported measures of cervical and breast cancer screening compared to medical records.

Methods: To identify studies, we searched MEDLINE®, Cochrane Database of Systematic Reviews, and other sources up to July 2019. Two reviewers sequentially selected studies, abstracted data, and assessed internal validity and strength of the evidence. Adjusted summary numbers for sensitivity and specificity were calculated using a bivariate random-effects meta-analysis.

Results: Unscreened women tended to over-report screening among 39 included studies examining the accuracy of self-report for cervical and/or breast cancer screening. The specificity of self-report was 48% (95% CI 41 to 56) for cervical cancer screening and 61% (95% CI 53 to 69) for breast cancer screening while the sensitivity of self-report was much higher at 96% (95% CI 94 to 97) for cervical cancer screening and 96% (95% CI 95 to 98). We have moderate confidence in these findings, as they come from a large number of studies directly assessing the accuracy of self-report compared to medical records and are consistent with findings from a previous meta-analysis.

Conclusions: Unscreened women tend to over-report cervical and breast cancer screening, while screened women more accurately report their screening. Future research should focus on assessing the impact of over-reporting on clinical and system-level outcomes.
Ups and downs of drug rehab among women: a qualitative study
Authors: Boroumandfar Zahra , Kianpour Masoud , Afshari Maryam
Published: August 2019

Background: due to the increasing importance of addicted women and the need to pay particular attention to this vulnerable group, and more awareness of women-specific addiction prevention and rehab programs among authorities. Objectives: In this content analysis of qualitative study we explored experiences of the women’s experience of the ups and downs of drug rehab Methods: 30 participants (addicted women) were selected through purposive and theoretical sampling until data saturation. Data collection was conducted through semi structured interviews. Conventional content analysis was utilized to analyze the transcribed interviews. Results: Based on analysis of the obtained results, the experience of women from the ups and downs of leaving the drug abuse yielded two themes and nine sub-themes. The themes were “the need for emancipation” and “Sinking factors”. Conclusions: It is concluded that addiction rehab strategies can only lead the addicted women to a brighter life when, along with open-hearted assistance by the families, women-specific rehab centers are established to help them meet their specific needs.
The significance of resilience in mental health promotion of marriage immigrant women: A qualitative study of factors and processes
Authors: Jo Yeonjae
Published: August 2019

Background: This study explores a series of processes in which marriage immigrant women achieve positive mental health status after experiencing various marriage- and migrant-related difficulties through the framework of resilience theory. As marriage immigrant women face greater barriers to public health services than non-immigrant women, it is necessary to understand the related factors, process, and context to address these barriers and strengthen available assets. Methods: Using data from semi-structured interviews, the author applied theme analysis to identify factors that affect resilience and its development process. Results: Findings indicated that the process of resilience follows enduring difficulties, collapse of stability, access to professional help, satisfaction of desire, and experience of growth. A combination of the level of spousal support, children as a driving force for change, the need for economic activity, and satisfaction of desire were identified as factors affecting the difference in growth in marriage immigrant women’s resilience. Conclusions: Spouses, children, and economic activity play key roles in resilience in positive and negative ways. The existing information barrier should be addressed at a structural level to improve the mental health of marriage immigrant women, and the optimum time for intervention is suggested within two years post-migration. Efforts to build supportive relationships with Korean spouses and meet the needs of women’s desires may also help promote these women’s resilience.