bluuebunny/crossref_metadata_2025 huggingface dataset:
External validation of the Simplified PADUA REnal (SPARE) nephrometry system in predicting surgical outcomes after partial nephrectomy
Authors: Huang Chi-Ping , Chang Chao-Hsiang , Wu Hsi-Chin , Yang Che-Rei , Hsieh Po-Fan , Chen Guang-Heng , Hsiao Po-Jen , Chang Yi-Huei , Wang Yu-Ping , Wang Yu-De
Published: August 2020

Background

Pentafecta is a major goal in the era of partial nephrectomy (PN). Simplified PADUA REnal (SPARE) nephrometry system was developed to evaluate the complexity of tumor. However, the predictive ability in pentafecta of SPARE system is yet to be determined. The aim of this study was to externally validate the applicability of SPARE nephrometry system in predicting pentafecta achievement after partial nephrectomy, and to examine inter-observer concordance.

Methods

We retrospectively reviewed data of 207 consecutive patients who underwent PN between January 2012 and August 2018 at a tertiary referral center. We obtained SPARE, R.E.N.A.L., and PADUA scores and evaluated correlations among the nephrometries and surgical outcomes including pentafecta by Spearman test. Logistic regression analysis was used to identify independent predictors of pentafecta outcomes. We compared the nephrometries to determine the predictive ability of achieving pentafecta using receiver operating characteristic curve analysis. Fleiss’ generalized kappa was used to assessed interobserver variation in the SPARE system.

Results

Based on the SPARE system, 120, 74, and 13 patients were stratified into low-risk, intermediate-risk, and high-risk groups, respectively. Regarding the individual components of pentafecta, there were significant differences in the complication rate (p=0.03), ischemia time (p<0.001), and percent change of eGFR (p<0.001) among the three risk groups. In addition, higher tumor complexity was significantly associated with a lower achievement rate of pentafecta (p=0.01). In Spearman correlation tests, SPARE nephrometry was correlated with ischemia time (ρ:0.37, p<0.001), operative time (ρ:0.28, p<0.001), complication rate (ρ:0.34, p<0.001), percent change of eGFR (ρ:0.34, p<0.001), and progression of chronic kidney disease stage (ρ:0.17, p=0.02). Multivariate analysis revealed that SPARE significantly affected pentafecta (OR: 0.67, p<0.001). In ROC curve analysis, SPARE showed fair predictive ability in the achievement pentafecta (AUC: 0.71). The predictive ability of pentafecta was similar between nephrometries (SPARE vs. R.E.N.A.L., p=0.78; SPARE vs. PADUA, p=0.66). The interobserver concordance of SPARE was excellent (Kappa: 0.82, p=0.03).

Conclusions

SPARE system was a predictive factor of surgical outcomes after PN. This refined nephrometry had similar predictive abilities for pentafecta achievement compared with R.E.N.A.L. and PADUA.
Prevalence and factors associated with intestinal parasites among food handlers in Medebay Zana District, North West Tigray, Northern Ethiopia.
Authors: Regassa Kebrom , Tedla Kiros , Bugssa Gessessew , Gebrekirstos Gebretsadkan , Gebreyesus Hailay , Shfare Mebrahtu Teweldemedhin
Published: August 2020

Introduction: Several epidemiological studies suggest that the prevalence of intestinal parasites is high, especially in developing countries, and are amongst the major public healthchallenges facing Sub-Saharan Africa.The aim of the study was to determine the prevalence of intestinal parasites and its associated factors among food handlers in Medebay Zana District, Tigray, Ethiopia.Methods: A cross-sectional study was conducted among 401 food handler individuals selected by systematic random sampling.Binary and multivariable logistic regression was used to determine the possible association between the independent variable and outcome variables. Statistical significance was declared at p-value <0.05 with a 95% confidence interval. Result: The prevalence of intestinal parasites was 33.2% within this sample. The dominant parasite was Entamoeba coli 50(37.4%), followed by Entamoebahistolytica/dispar 24(18%), Entamoeba hartmanni 18(13.5), Giardia lamblia 17(12.8%), Schistosoma mansoni 8(6%), Hymenolepis nana 7(5.3%), Entervious vermicularies 6(4.5%) and Taenia species 3(2.5%).Conclusion: This study revealed a high prevalence of intestinal parasites among food handlers for a range of intestinal parasites. The significant predictors werethe source of water, washing hands before food preparation, washing hands with soap and water after visiting the toilet, shower installation at workplace, washing the body regularly, and eating raw vegetables and raw meat. Hence, local health planners should implement appropriate interventional measures for the novel risk factors to mitigate the problem.
Withdrawal of Treatment in a Pediatric Intensive Care Unit at a Children’s Hospital in China: A 10-year Retrospective Study
Authors: Liu Huaqing , Su Dongni , Guo Xubei , Dai Yunhong , Dong Xingqiang , Zhu Qiujiao , Bai Zhengjiang , Li Ying , Wu Shuiyan
Published: August 2020

Background: Published data and practice recommendations on end-of-life care generally reflect Western practice frameworks; there are limited data on withdrawal of treatment for children in China. Methods: Withdrawal of treatment for children in the pediatric intensive care unit (PICU) of a regional children’s hospital in eastern China from 2006 to 2017 was studied retrospectively. Withdrawal of treatment was categorized as medical withdrawal or premature withdrawal. The guardian’s self-reported reasons for abandoning the child’s treatment were recorded from 2011. Results: The incidence of withdrawal of treatment for children in the PICU decreased significantly; for premature withdrawal the 3-year average of 15.1% in 2006–2008 decreased to 1.9% in 2015–2017 (87.4% reduction). The overall incidence of withdrawal of care reduced over the time period, and withdrawal of therapy by guardians was the main contributor to the overall reduction. The median age of children for whom treatment was withdrawn increased from 14.5 months (interquartile range: 4.0–72.0) in 2006 to 40.5 months (interquartile range: 8.0–99.0) in 2017. Among the reasons given by guardians of children whose treatment was withdrawn in 2011–2017, “illness is too severe” ranked first, accounting for 66.3%, followed by “condition has been improved” (20.9%). Only a few guardians ascribed treatment withdrawal to economic reasons. Conclusions: The frequency of withdrawal of medical therapy has changed over time in this children’s hospital PICU, and parental decision-making has been a large part of the change.
Osteopontin promoter polymorphisms and risk of urolithiasis: a candidate gene association and meta-analysis study
Authors: Amar Ali , Afzal Ayesha , Hameed Athar , Ahmad Mumtaz , Khan Abdul Rafay , Najma Humaira , Abid Aiysha , Khaliq Shagufta
Published: August 2020

Background: Urolithiasis is a worldwide urological problem with significant contribution of genetic factors. Pakistan, which resides within the Afro-Asian stone belt, has a high reported prevalence (12%) of urolithiasis. Osteopontin (SPP1) is a urinary macromolecule with a suggested critical role in modulating renal stone formation, genetic polymorphisms of which may determine individual risk of developing urolithiasis. However, results of previous studies regarding SPP1 polymorphisms and susceptibility to urolithiasis have apparent inconsistencies with no data available for local population. Methods: A total of 235 urolithiasis patients and 243 healthy controls, all of Pakistani ancestry, underwent genotyping for six SPP1 genetic polymorphisms in an effort to investigate potential association with urolithiasis using indigenous candidate gene association study design. Further, a comprehensive meta-analysis following a systematic literature search was also done to ascertain an evidence based account of any existent association regarding SPP1 promoter polymorphisms and risk of developing urolithiasis.Results: Three SPP1 promoter polymorphisms, rs2853744:G>T, rs11730582:T>C and rs11439060:delG>G, were found to be significantly associated with risk of urolithiasis in indigenous genetic association study (OR = 3.14; p = 0.006, OR = 1.78; p = 0.006 and OR = 1.60; p = 0.012, respectively). We also observed a 1.68-fold positive association of a tri-allelic haplotype of these SPP1 promoter polymorphisms (G-C-dG) with risk of urolithiasis (OR = 1.68; p = 0.0079). However, no association was evident when data were stratified according to gender, age at first presentation, stone recurrence, stone multiplicity, parental consanguinity and family history of urolithiasis. The overall results from meta-analysis, which included 4 studies, suggested a significant association of SPP1 rs2853744:G>T polymorphism with susceptibility of urolithiasis (OR = 1.37; p = 0.004), but not for other SPP1 polymorphic variants analyzed. Conclusions: In conclusion, we report significant association of 3 SPP1 polymorphisms with urolithiasis for the first time from South Asia, however, this association persisted only for SPP1 rs2853744:G>T polymorphism after meta-analysis of pooled studies. Further studies with a larger sample size will be required to validate this association and assess any potential usefulness in diagnosis and prognosis of renal stone disease.
Clinical significance of skeletal muscle density and sarcopenia in patients with pancreatic cancer undergoing first-line chemotherapy : a retrospective observational study.
Authors: Kim In-Ho , Choi Moon Hyung , Lee In Seok , Hong Tae Ho , Lee Myung Ah
Published: August 2020

Background: To investigate the clinical impact of sarcopenia and skeletal muscle density among patients with metastatic pancreatic adenocarcinoma who underwent palliative first line gemcitabine-based chemotherapy.Methods: A total of 330 patients with metastatic pancreatic adenocarcinoma who were treated with palliative first line gemcitabine-based chemotherapy between January 2010 and March 2017 were included in this study. Sarcopenia and skeletal muscle density status were identified by L3 vertebra level skeletal muscle index in cm2/m2 and muscle attenuation in Hounsfield units using computed tomography.Results: A skeletal muscle index to skeletal muscle density comparison revealed a positive correlation (R2 = 0.058, P<0.001). Kaplan–Meier analysis showed that the low skeletal muscle density was related to poor overall survival. Multivariate analysis using Cox regression showed that low skeletal muscle index and low skeletal muscle density were poor prognostic factors for overall survival, respectively. Co-presence of low skeletal muscle index and low skeletal muscle density had more powerful prognostic implication for overall survival. Grade 3 or higher toxicity of chemotherapy was more frequently observed in patients who have a low skeletal muscle index and low skeletal muscle density. Overall survival was not related to skeletal muscle density status among patients who were chemotherapy responders (complete or partial responses). However, among non-responders (stable or progressive disease), low skeletal muscle density groups had significantly poorer overall survival in comparison with high skeletal muscle density groups.Conclusions: Sarcopenia and skeletal muscle density status can be considered a prognostic factor in patients with metastatic pancreatic adenocarcinoma who received palliative first line gemcitabine-based chemotherapy. Severe chemotherapy toxicity occurred in the sarcopenia and low skeletal muscle density groups. Our data suggest that a comprehensive assessment of skeletal muscle parameters may be more useful prognostic factors.
Efficacy of Smartphone-Based Mobile Learning Versus Lecture-Based Learning for Instruction of Cephalometric Landmark Identification 
Authors: Golshah Amin , Dehdar Fatemeh , Imani Mohammad Moslem , Nikkerdar Nafiseh
Published: August 2020

Background: Considering the increasing popularity of electronic learning, particularly smartphone-based mobile learning, and its reportedly optimal efficacy for instruction of complicated topics, this study aimed to compare the efficacy of smartphone-based mobile learning versus lecture-based learning for instruction of cephalometric landmark identification. Methods: This quasi-experimental interventional study evaluated 53 dental students (4th year) in two groups of intervention (n=27; smartphone instruction using an application) and control (n=26, traditional lecture-based instruction). Two weeks after the instructions, dental students were asked to identify four landmarks namely the posterior nasal spine (PNS), orbitale (Or), articulare (Ar) and gonion (Go) on lateral cephalograms. The mean coordinates of each landmark identified by orthodontists served as the reference point, and the mean distance from each identified point to the reference point was reported as the mean consistency while the standard deviation of this mean was reported as the precision of measurement. Data were analyzed using SPSS version 18 via independent sample t-test.Results: No significant difference was noted between the two groups in identification of PNS, Ar or Go (P>0.05). However, the mean error rate in identification of Or was significantly lower in smartphone group compared with the traditional learning group (P=0.020).Conclusions: Smartphone-based mobile learning had a comparable, and even slightly superior, efficacy to lecture-based learning for instruction of cephalometric landmark identification, and may be considered, at least as an adjunct, to enhance the instruction of complicated topics.
Impact of long-term industrial contamination on the bacterial communities in urban river sediments
Authors: Zhang Lei , Tu Demei , Li Xingchen , Lu Wenxuan , Li Jing
Published: August 2020

Background: The contamination of the aquatic environment of urban rivers with industrial wastewater has affected the abiotic conditions and biological activities of the trophic levels of the ecosystem, particularly sediments. However, most current research about microorganism in urban aquatic environments has focused on indicator bacteria related to feces and organic pollution. Meanwhile, they ignored the interactions among microorganisms. To deeply understand the impact of industrial contamination on microbial community, we study the bacterial community structure and diversity in river sediments under the influence of different types of industrial pollution by Illumina MiSeq high-throughput sequencing technology and conduct a more detailed analysis of microbial community structure through co-occurrence networks.Results: The overall community composition and abundance of individual bacterial groups differed between samples. In addition, redundancy analysis indicated that the structure of the bacterial community in river sediments was influenced by a variety of environmental factors. TN, TP, TOC and metals (Cu, Zn and Cd) were the most important driving factors that determined the bacterial community in urban river sediments (P <0.01). According to PICRUSt analysis, the bacterial communities in different locations had similar overall functional profiles. It is worth noting that the 15 functional genes related to xenobiotics biodegradation and metabolism were the most abundant in the same location. The non-random assembly patterns of bacterial composition in different types of industrially polluted sediments were determined by a co-occurrence network. Environmental conditions resulting from different industrial pollutants may play an important role in determining their co-occurrence patterns of these bacterial taxa. Among them, the bacterial taxa involved in carbon and nitrogen cycles in module I were relatively abundant, and the bacterial taxa in module II were involved in the repair of metal pollution.Conclusions: Our data indicate that long-term potential interactions between different types of industrial pollution and taxa collectively affect the structure of the bacterial community in urban river sediments.
Sickness absence trajectories following labour market participation patterns: a cohort study in Catalonia (Spain), 2012-2014
Authors: Hernando-Rodriguez JC , Serra L , Benavides FG , Ubalde-Lopez M
Published: August 2020

Background Previous studies have focused on the relationship between employment pathways and health-related outcomes based on cross-sectional or longitudinal approaches. However, little is known about the cumulative effects of employment status mobility on sickness absence (SA) over time. The aim of the present study was to examine the association between prior labour market participation (LMP) patterns and SA trajectories from a life-course perspective.Methods This cohort study was based on a sample of 11,968 salaried workers living in Catalonia and affiliated with the Spanish Social Security system, who accumulated more than 15 days on SA in at least one quarter during 2012–2014. Individuals were grouped into three different working life stages: early (18–25 years), middle (26–35 years), and late (36–45 years). To identify LMP patterns, we applied sequence analysis and cluster analysis (2002–2011), and we used latent class growth modelling to identify SA trajectories (2012–2014). Finally, we applied multinomial logistic regression models to assess the relationship between LMP patterns and SA trajectories.Results The analyses yielded six LMP patterns: stable employment (value range: 63%–81%), increasing employment (5%–22%), without long-term coverage (7%–8%), decreasing employment (4%–10%), fluctuant employment (13%–14%), and steeply decreasing employment (7%–9%). We also identified four SA trajectories: low stable (83%–88%), decreasing (5%–9%), increasing (5%–11%), and high stable (7%–16%). However, the only significant association we identified for LMP patterns and SA trajectories was among young men, for whom an increasing employment pattern was significantly associated with a lower risk for increased days on SA (adjusted odds ratio: 0.21; 95% confidence interval: 0.05–0.96).Conclusions SA trajectories are generally not related to prior 10-year LMP patterns at any stage of working life. To disentangle this relationship, future research might benefit from considering working life transitions with a quality-of-work approach framed with contextual factors closer to the SA course.
The characterization of extracellular vesicles-derived microRNAs in Thai malaria patients
Authors: Ketprasit Nutpakal , Cheng Iris Simone , Deutsch Fiona , Tran Nham , Imwong Mallika , Combes Valery , Palasuwan Duangdao
Published: August 2020

Background Extracellular vesicles (EVs) have been broadly studied in malaria for nearly a decade. These vesicles carry various functional biomolecules including RNA families such as microRNAs (miRNA). These EVs-derived microRNAs have numerous roles in host-parasite interactions and are considered promising biomarkers for disease severity. However, this field lacks clinical studies of malaria-infected samples. In this study, EV specific miRNAs were isolated from the plasma of patients from Thailand infected with Plasmodium vivax and Plasmodium falciparum. In addition, it is postulated that these miRNAs were differentially expressed in these groups of patients and had a role in disease onset through the regulation of specific target genes.Methods EVs were purified from the plasma of Thai P. vivax-infected patients (n=19), P. falciparum-infected patients (n=18) and uninfected individuals (n=20). EV-derived miRNAs were then prepared and abundance of hsa-miR-15b-5p, hsa-miR-16-5p, hsa-let-7a-5p and hsa-miR-150-5p was assessed in these samples. Quantitative polymerase chain reaction was performed, and relative expression of each miRNA was calculated using hsa-miR-451a as endogenous control. Then, the targets of up-regulated miRNAs and relevant pathways were predicted by using bioinformatics. Receiver Operating Characteristic with Area Under the Curve (AUC) was then calculated to assess their diagnostic potential.Results The relative expression of hsa-miR-150-5p and hsa-miR-15b-5p was higher in P. vivax-infected patients compared to uninfected individuals, but hsa-let-7a-5p was up-regulated in both P. vivax-infected patients and P. falciparum-infected patients. Bioinformatic analysis revealed that these miRNAs might regulate genes involved in the malaria pathway including the adherens junction and the transforming growth factor-β pathways. All up-regulated miRNAs could potentially be used as disease biomarkers as determined by AUC; however, the sensitivity and specificity require further investigation.Conclusion An upregulation of hsa-miR-150-5p and hsa-miR-15b-5p was observed in P. vivax-infected patients while hsa-let-7a-5p was up-regulated in both P. vivax-infected and P. falciparum-infected patients. These findings will require further validation in larger cohort groups of malaria patients to fully understand the contribution of these EVs miRNAs to malaria detection and biology.
Diagnosis of left ventricular hypertrophy using convolutional neural network
Authors: Jian Zini , Wang Xianpei , Zhang Jingzhe , Wang Xinyu , Deng Youbin
Published: August 2020

Background: Clinically, doctors obtain the left ventricular posterior wall thickness (LVPWT) mainly by observing ultrasonic echocardiographic video stream to capture a single frame of images with diagnostic significance, and then mark two key points on both sides of the posterior wall of the left ventricle with their own experience for computer measurement. In the actual measurement, the doctor's selection point is subjective, and difficult to accurately locate the edge, which will bring errors to the measurement results.Material/Methods: In this paper, a convolutional neural network model of left ventricular posterior wall positioning was built under the TensorFlow framework, and the target region images were obtained after the positioning results were processed by non-local mean filtering and opening operation. Then the edge detection algorithm based on threshold segmentation is used. After the contour was extracted by adjusting the segmentation threshold through prior analysis and the OTSU algorithm, the design algorithm completed the computer selection point measurement of the thickness of the posterior wall of the left ventricle. Results: The proposed method can effectively extract the left ventricular posterior wall contour and measure its thickness. The experimental results show that the relative error between the measurement result and the hospital measurement value is less than 15%, which is less than 20% of the acceptable repeatability error in clinical practice. Conclusions: Therefore, the method proposed in this paper not only has the advantage of less manual intervention, but also can reduce the workload of doctors.
Protocol registration issues of systematic review and meta-analysis studies: a survey of global researchers
Authors: Tawfik Gehad Mohamed , Giang Hoang Thi Nam , Ghozy Sherief , Altibi Ahmed M. , Kandil Hend , Le Huu-Hoai , Eid Peter Samuel , Radwan Ibrahim , Makram Omar Mohamed , Hien Tong Thi Thu , Sherif Mahmoud , Hossain As-Saba , Thang Tai Luu Lam , Puljak Livia , Salem Hosni , Numair Tarek , Moji Kazuhiko , Huy Nguyen Tien
Published: August 2020

Background: Although protocol registration of systematic reviews/meta-analysis (SR/MA) is still not mandatory, authors are strongly suggested to publish their SR/MA protocols prior to submitting their manuscripts for publication as recommended by the Cochrane guidelines for conducting SR/MAs. We aimed to assess awareness, obstacles, and opinions of SR/MA authors about the protocol registration process.

Methods: A cross-sectional survey study included all authors who published SR/MAs during the period from 2010 to 2016 were contacted for participation in our survey study. They were identified through the literature search of SR/MAs in Scopus database. Upon receiving their approval to join our study, an online questionnaire was sent via e-mail to each participant. We received 275 responses from 6650 successfully sent emails.
Results: A total of 270 authors' responses were complete and were included in the final analysis. Our results showed that PROSPERO was the most commonly used database for protocol registration (71.3%). The registration-to-acceptance interval in PROSPERO was less than one month (99.1%). Almost half of the authors (44.2%) did not register their protocols prior to publishing their SR/MAs and their opinion that lack of knowledge of its importance and mandance to be registered was the most commonly reported reason (44.9%). A significant proportion of respondents (37.4%) believed that people would steal their ideas from protocol databases, while only 5.3% reported that their SR/MA had been stolen. However, the majority (72.9%) of participants agreed that protocol registries have a role in preventing unnecessary duplication of reviews. Finally, 37.4% of participants agreed that SR/MA protocol registration should be mandatory.

Conclusion: About half of the participants seemed that the primary reason for not registering such protocols, that was not knowing that protocols must or should be mandatory. Therefore, tools should be available to mandate protocol registration of any SRs beforehand and increasing awareness about the benefits of protocol registration among researchers.
​Effectiveness of a Psychoeducation Intervention by Midwives on Childbirth Fear and Childbirth Self-efficacy in Fearful First Time Pregnant Women: A Randomized Controlled Trial
Authors: Firouzan Laya , Kharaghani Roghieh , Zenoozian Saeedeh , Moloodi Reza , Jafari Elham
Published: August 2020

​Background: Studies showed that childbirth fear is a prevalent problem among Iranian women and therefore most Iranian women prefer caesarean section as method of birth. However, there is no published study that explore effectiveness of psychoeducational interventions on childbirth fear among Iranian women. Thus, present study investigated the effectiveness of a Psychoeducation Intervention by Midwives (Birth Emotions- Looking to Improve Expectant Fear (BELIEF)) in decreasing childbirth fear and childbirth self-efficacy among fearful first pregnant women in Iran. Methods: One-hundred-seventy-one pregnant women who referred to six governmental antenatal clinics of healthcare centers of Zanjan city screened to participate in the study. Among them, 80 women who got score ≥ 66 on the Wijma Delivery Expectancy/Experience Questionnaire were recruited. They were randomly assigned into two groups: intervention (n = 40) and control group (n = 40). The intervention group received two face-to-face counseling sessions based on the BELEF protocol in the 24th week and 34th week of pregnancy. Between this two counseling sessions, intervention group had 8 weekly telephone counseling sessions. The control group only received the prenatal routine care. The outcome measures were childbirth fear, childbirth self-efficacy, and childbirth preference. Results: At the post-test, the intervention group showed significantly higher reduction in childbirth fear and higher increase in childbirth self-efficacy compared to the control group. Also, at post-test more women in the intervention group reported that they preferred to give birth via normal vaginal birth than women in the control group. Conclusions: The BELIEF protocol could be effective approach to improve childbirth fear and childbirth self-efficacy in fearful first pregnant women. Trial registration number: IRCT20101219005417N3, Date of Registration: 19-12-2018.
Tensile Mechanical Properties of Fly Ash Concrete at Early Age for Thermal Stress Analysis
Authors: Mimura Yoichi , Vimonsatit Vanissorn , Horiguchi Itaru , Yoshitake Isamu
Published: August 2020

The present study investigates tensile properties of concrete with and without fly ash at early age, such as tensile Young’s modulus, strength and creep. Some Young’s modulus of fly ash concrete for thermal crack analysis was compared with the tensile Young’s modulus, secant modulus, initial tangent modulus and linear modulus obtained from the direct tension test and compression test. The tensile creep test was also performed to obtain the specific creep behavior considering decrease in elastic strain due to stiffness development at early age during creep test. The results show that the Young's modulus for crack evaluation can be obtained from the compression test based on the stress range less than the splitting tensile strength, while the compressive secant modulus was smaller than the tensile Young's modulus. The decrease of the elastic strain at early age contributes more to the evaluation of the tensile creep than the use of the fly ash mixing.
Maternal Sciatic Nerve Administered Bupivacaine Induces Hippocampal Cell Apoptosis in Offspring
Authors: Mirkheshti Alireza , Shakeri Alireza , Memary Elham , Baniasadi Mansoureh , Zaringhalam Jalal , Tajbakhsh Ardeshir , Mirzaei Marzieh , Lak Elena
Published: August 2020

Background: Bupivacaine, an amid-type local anesthetic, is widely used for clinical patients especially in pregnant women. In addition to neurotoxicity effect of bupivacaine, it can cross the placenta, accumulates in this tissue and retained in fetal tissues. Nevertheless, whether bupivacaine can cause neurotoxicity in fetus remains unclear. Hence, this study was design to investigate the effects of maternal bupivacaine use on fetus hippocampal cell apoptosis and the possible related mechanism. Methods: On day 15 of pregnancy, sciatic nerve of pregnant rats were exposed by lateral incision of the right thigh and 0.2 ml of bupivacaine was injected. After their delivery, we randomly selected one male offspring of every mother. On day 30 after of their birth, the rat’s hippocampi were isolated for molecular studies. Western blotting was used to examine the expression of cleaved caspase-3, caspase-8 and p-Akt in fetal hippocampus. Results: Our results showed that maternal bupivacaine use caused a significant increment of cleaved caspase-3 and caspase-8 expression in fetal hippocampus compared with the control group. In addition, maternally administered bupivacaine could significantly decrease hippocampal P.Akt/T.Akt ratio which was concurrent with an increment of cleaved caspase-3 and caspase-8 expression. Conclusion: Our data suggest that maternal bupivacaine use caused fetal hippocampal cell apoptosis, at least in part, via inhibiting the Akt activation.
Risk factors for malaria infection prevalence and household vector density between mass distribution campaigns of long-lasting insecticidal nets in North-western Tanzania
Authors: Mosha Jacklin Franklin , Lukole Eliud , Charlwood J Derek , Wright Alexandra , Rowland Mark , Bullock Olivia , Manjurano Alphaxard , Kisinza William , Mosha Franklin W , Kleinschmidt Immo , Protopopoff Natacha
Published: August 2020

Background Long-lasting insecticidal nets (LLINs) are the most widely deployed vector control intervention in sub-Saharan Africa to prevent malaria. Recent reports indicate selection of pyrethroid insecticide resistance is widespread in mosquito vectors. This paper explores risk factors associated with malaria infection prevalence and vector density between mass distribution campaigns, changes in net coverage, and loss of protection in an area of high pyrethroid resistance in Northwest Tanzania. Methods A cross sectional malaria survey of 3,456 children was undertaken in 2014 in Muleba district, Kagera region west of Lake Victoria. Vector density was assessed using indoor light traps and outdoor tent traps. Anophelines were identified to species using PCR and tested for Plasmodium falciparum circumsporozoite protein. Logistic regression was used to identify household and environmental factors associated with malaria infection and regression binomial negative for vector density. Results LLIN use was 27.7%. Only 16.9% of households had sufficient nets to cover all sleeping places. Malaria infection was independently associated with access to LLINs (OR: 0.57; 95%CI 0.34 – 0.98). LLINs less than 2 years old were slightly more protective than older LLINs (53% vs 65% prevalence of infection); however, there was no evidence that LLINs in good condition (hole index <65) were more protective than LLINs which were more holed. Other risk factors for malaria infection were age, group, altitude and house construction quality. Independent risk factors for vector density were consistent with malaria outcomes and included altitude, wind, livestock, house quality, open eaves and LLIN usage. Indoor collections comprised 4.6% Anopheles funestus and 95.4% Anopheles gambiae of which 4.5% were Anopheles arabiensis and 93.5% were Anopheles gambiae sensu stricto. Conclusion Three years after the mass distribution campaign and despite top-ups, LLIN usage had declined considerably. While children living in households with access to LLINs were at lower risk of malaria, infection prevalence remained high even among users of LLINs in good condition. While effort should be made to maintain high coverage between campaigns, distribution of standard pyrethroid-only LLINs appears insufficient to prevent malaria transmission in this area of intense pyrethroid resistance.
Prevalence of multimorbid degenerative lumbar spinal stenosis with knee and/or hip osteoarthritis: protocol for a systematic review and meta-analysis
Authors: Young James J. , Hartvigsen Jan , Jensen Rikke K. , Roos Ewa M. , Ammendolia Carlo , Juhl Carsten Bogh
Published: August 2020

Background: Lumbar spinal stenosis (LSS) and knee and hip osteoarthritis (OA) are prevalent conditions in the aging population and published literature suggests they share many symptoms and often are present at the same time in patients. However, no prevalence estimates of multimorbid LSS and knee and/or hip OA are currently available. The primary objective of this systematic review is therefore to estimate the prevalence of multimorbid LSS with knee and/or hip OA using radiological, clinical, and combined case definitions. Methods: This systematic review protocol has been designed according to the guidelines from the Cochrane Collaboration and are reported according the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols. A comprehensive search will be performed in the following databases: MEDLINE, EMBASE, CENTRAL, and CINAHL. Forward citation tracking will be performed in Web of Science. No restriction for publication data and language will be applied in the literature search, but only articles in English will be included. The search strategy will include the following domains: LSS, knee OA, and hip OA. Retrieved citations will be screened by two authors independently. Disagreements will be discussed until consensus, and a third reviewer will be consulted if consensus cannot be reached. Data extraction and assessment of methodological quality will be done by two authors independently, using a standardized data extraction form and a modified Risk of Bias Tool for Prevalence studies. Meta-analysis estimating prevalence with 95% CI will be performed using a random effects model. Meta-regression analyses will be performed to investigate the impact of the following covariates: LSS clinical presentations, sample population, healthcare setting, risk of bias, and other patient characteristics on prevalence estimates for multimorbid LSS and knee and/or hip OA.Discussion: The results of this review will provide the first estimates of the prevalence of multimorbid LSS and hip and knee OA based on various case definitions. The impact of covariates such as LSS clinical presentations, sample population, healthcare setting, risk of bias, and patient characteristics on prevalence estimates will also be presented. Systematic review registration: Submitted to PROSPERO, awaiting registration
Relative age effects in male Japanese professional athletes: A 25-year historical analysis
Authors: Sasano Nao , Katsumata Yoichi , Nakata Hiroki
Published: August 2020

Background: The mechanisms underlying the relative age effect (RAE), a biased distribution of birth dates, in sport events have been investigated for more than two decades. The present study comprised an historical analysis involving the most recent quarter-century (1993-2018) on RAEs among Japanese male professional athletes (soccer, baseball, basketball, and volleyball) to clarify how the RAEs changed over time.Methods: Birth data were obtained from 7,805 Japanese male professional athletes registered in 1993, 2001, 2010, and 2018. The athletes were divided into four groups based on their month of birth: quartiles Q1 (April–June), Q2 (July–September), Q3 (October–December), and Q4 (January–March of the following year). In addition, based on the data in 1993 for soccer and baseball and in 2010 for basketball and volleyball, the expected numbers of players were calculated in 2001, 2010, and 2018 for soccer and baseball, and 2018 for basketball and volleyball.Results: Significant RAEs were observed among soccer and baseball players in 1993, 2001, 2010, and 2018, and strong tendencies of RAEs were found among basketball and volleyball players in 2010 and 2018. The magnitudes of the RAEs in soccer, baseball, and volleyball decreased over time, but not in basketball.Conclusion: The exact reasons for the decreasing or unchanging RAEs among these professional players remains unclear, but socio-culture factors, such as low birthrates and the popularity of sports in Japan, might be related to the changing RAEs.
Oral Clonazepam versus Lorazepam in the Treatment of Methamphetamine-Poisoned Children: A Pilot Clinical Trial
Authors: Farnaghi Fariba , Rahmani Razieh , Hassanian-Moghaddam Hossein , Zamani Nasim , McDonald Rebecca , Gholami Narges , Gachkar Latif
Published: August 2020

Background: To evaluate the efficacy of oral clonazepam versus oral lorazepam following initial parenteral benzodiazepine administration to control methamphetamine-induced agitation in children. Methods: In a single-center clinical trial, intravenous diazepam (0.2 mg/Kg) was initially administered to all methamphetamine-poisoned pediatric patients to control their agitation, followed by a single dose of oral clonazepam (0.05 mg/Kg; n=15) or oral lorazepam (0.05 mg/Kg; n=15) to prevent relapse of toxicity. Results: The median age [IQR] (range) was 15 [10, 36] (6-144) months. The source of poisoning was methamphetamine exposure from oral ingestion in 23 (76.7%) and passive inhalation in 7 (23.3%) patients. The most common symptoms/signs were agitation (29; 96.7%), mydriatic pupils (26; 86.7%), and tachycardia (20; 66.6%). Two in each group (13.3%) needed re-administration of intravenous diazepam due to persistent agitation. There was no report of benzodiazepine complications in either group.Conclusions: Although both benzodiazepines were effective, considering the similar administered doses of oral clonazepam and lorazepam as well as the higher potency of clonazepam, it seems that lorazepam is a better suited oral benzodiazepine for the maintenance treatment of methamphetamine-induced agitation in children and can be used with minimal complications.Trial registration: IRCT20180610040036N2, April 18th, 2020. Retrospectively registered
Perceptions on preeclampsia and eclampsia among older women in rural southwestern Uganda
Authors: Nabulo Harriet , Ruzaaza Gad , Mugabi Francis , Bajunirwe Francis
Published: August 2020

Background: Eclampsia is among the leading causes of maternal mortality. It is a serious hypertensive (HT) complication of pregnancy and increases the risk of cardiovascular disease (CVD) in later life. Pregnancy-related HT complications predispose to chronic hypertension and premature heart attacks. A significant proportion of women with preeclampsia/eclampsia does not reach the formal healthcare system or arrive too late because of certain traditional or cultural beliefs about the condition. The older senior women in the community are knowledgeable and play a significant role in decision making regarding where mothers should seek maternal health care. Therefore, the purpose of this study was to explore the perceptions of older women regarding the manifestation of, risk factors and possible causes of preeclampsia/eclampsia. Methods: We conducted a qualitative study in a rural area in southwestern Uganda. The key informants were older women including community elders, village health team members and traditional birth attendants who were believed to hold local knowledge and influence on birth and delivery. We purposively selected key informants (KI) and data were collected till we reached saturation point. We analyzed data using a combined inductive and deductive approach to identify themes. Analysis was completed using N-Vivo version 12. Results: We interviewed 20 key informants. Four themes emerged namely: local name, causes and risk factors, remedies, and effects of preeclampsia/eclampsia. There was no identifiable local name from the interviews. Women carried several myths regarding the cause and these included little blood, witchcraft, stress from relations including marital tension and ghost attacks. The remedies identified included corrective nutrition, herbal treatment and prayers. Women were generally aware of the outcomes of eclampsia; mainly that it kills. Conclusion: Eclampsia is associated with significant myths and misconceptions in this rural community. We recommend interventions to increase awareness and dispel the myths and misconceptions regarding eclampsia, increase access to antenatal preeclampsia surveillance, and facilitate timely referral for basic maternity care as means for early detection and management of preeclampsia.
Parents' Multi-layered Expectations when Requesting an Autism Spectrum Disorder Assessment of their Young Child: an In-Depth Interview Study
Authors: Jacobs Delphine , Steyaert Jean , Dierickx Kris , Hens Kristien
Published: August 2020

BackgroundParents are valued stakeholders in research, clinical practice and policy development concerning autism spectrum disorder (ASD). However, little is known about what drives and moves parents besides their obvious worries and help request when they ask for a diagnostic ASD assessment of their child.MethodsSeventeen Flemish parents of 11 young children participated in a longitudinal study consisting of three in-depth interviews before and after their child’s diagnostic ASD assessment. Data were analysed in Nvivo 11 according to the procedures of Interpretative Phenomenological Analysis.ResultsIn this paper we report the results of the first series of interviews which were conducted after parents had asked for an ASD assessment of their young child, and before this assessment started. The pre-assessment experiences of the parents were dominated by the anticipation of various implications of an ASD diagnosis, comprising both positive and negative expectations. The theme of positive expectations consisted of two equally prominent subthemes: treatment-related implications but also expectations pertaining to their psychological and relational experiences.ConclusionsThis study suggests important issues for clinicians to bear in mind during a consultation with parents who request an ASD assessment of their young child. We argue that attending to and communicating about parents’ expectations prior to their child’s ASD assessment may help clinicians to better understand parents’ requests for help, and to address their needs more effectively.
Treatment of Severe COVID-19 with Human Umbilical Cord Mesenchymal Stem Cells
Authors: Shu Lei , Niu Changming , Li Ruyou , Huang Tingrong , Wang Yan , Huang Mao , Ji Ningfei , Zheng You , Chen Xiaolin , Shi Lei , Wu Mingjing , Deng Kaili , Wei Jing , Wang Xueli , Cao Yang , Yan Jiaxin , feng ganzhu
Published: August 2020

Background: COVID-19 is a highly infectious respiratory disease. No therapeutics have yet been proven effective for treating severe COVID-19. Objectives: To determine whether human umbilical cord mesenchymal stem cell infusion may be effective and safe for the treatment of severe COVID-19. Methods: Patients with severe COVID-19 were randomly divided into 2 groups: the standard treatment group and the standard treatment plus hUC-MSC infusion group. The incidence of progression from severe to critical illness, 28-day mortality, clinical symptom improvement, time to clinical symptom improvement, hematologic indicators including C-reactive protein, lymphocyte number, and interleukin 6, and imaging changes were observed and compared between the two groups. Measurements and Main Results: The incidence of progression from severe to critical illness and the 28-day mortality rate were 0 in the hUC-MSC treatment group, while 4 patients in the control group deteriorated to critical condition and received invasive ventilation; 3 of them died, and the 28-day mortality rate was 10.34% . In the hUC-MSC treatment group, the time to clinical improvement was shorter than that in the control group. Clinical symptoms of weakness and fatigue, shortness of breath, and low oxygen saturation obviously improved beginning on the third day of stem cell infusion and reached a significant difference on day 7. CRP and IL-6 levels were significantly lower from day 3 of infusion, the time for the lymphocyte count to return to the normal range was significantly faster, and lung inflammation absorption was significantly shorter on CT imaging in the hUC-MSC group than in the control group. Conclusions: Intravenous transplantation of hUC-MSCs is a safe and effective method that can be considered a salvage and priority treatment option for severe COVID-19.
Primary and secondary three-month outcomes of a cluster-randomized trial of home-based postpartum contraceptive delivery in Southwest Trifinio, Guatemala
Authors: Harrison Margo , Bunge-Montes Saskia , Rivera Claudia , Jimenez-Zambrano Andrea , Heinrichs Gretchen , Bolanos Antonio , Asturias Edwin , Berman Stephen , Sheeder Jeanelle
Published: August 2020

Design: This a cluster-randomized parallel arm pragmatic trial to observe the association of home-based postpartum contraceptive provision, including the contraceptive implant, with implant utilization rates at 3 months post-enrollment.Methods: In a region of rural Guatemala referred to as the Southwest Trifinio, twelve communities are served by a community-based antenatal and postnatal care program. The communities were combined into eight clusters based on 2017 birth rates and randomized to receive the home-based contraceptive delivery (condoms, pills, injection, implant) during the routine 40-day postpartum visit. All participants receive comprehensive contraceptive counseling beginning at the first antenatal visit, so control clusters received this as part of routine care; this education preceded the study intervention. Results: Once the 12 communities were combined into 8 clusters by expected birth volume and nurse team, which we expected to translate to eventual postpartum visits, the allocation sequence was generated in SAS. Of 208 women enrolled in the study, 108 were in four intervention and 100 in four control clusters. We used descriptive statistics to produce counts and percentages of characteristics of the study population overall and by intervention arm followed by univariate modeling using a mixed effects regression adjusted for cluster. Three-month contraceptive initiation rates were 56.0% in the control clusters compared to 76.8% in the intervention clusters, p < 0.001. Women in control clusters overwhelmingly opted for the injectable contraceptive (94.6%) while women in intervention clusters chose both the injection (61.5%) and the implant (33.7%), p < 0.001. Implant use by 3 months, the primary outcome of the study, was significantly higher in the intervention arm (25.9%) compared to the control arm (3.6%), p < 0.001, RR 1.3 CI [1.2, 1.4]. Conclusion: Our study was designed to respond to previously identified barriers to contraceptive uptake, and it was successful. Not only did it increase overall use of contraception by 3 months, but it shifted that contraceptive use away from short-acting methods in favor of longer-acting methods, with high continuation and satisfaction rates and no adverse outcomes reported.Registration: clinicaltrials.gov, NCT04005391; Retrospectively Registered 7/2/2019, https://clinicaltrials.gov/ct2/show/NCT04005391Protocol: https://doi.org/10.1186/s13063-019-3735-3